Clinical Focus

The overview of diagnosis and treatment of fibromyalgia syndrome

Jiao Juan

2019, 34(4): 293-298. doi:10.3969/j.issn.1004-583X.2019.04.001

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Fibromyalgia syndrome, also known as fibromyalgia, is a very common rheumatic disease, which mainly occurs in women over 40 years. As the main characteristic, the diffuse pain across the whole body often accompanied by fatigue, sleep disorders, mood disorders and cognitie impairment, and other nonspecific clinical symptoms, seriously affecting the patients' physical and mental health. In China, fibromyalgia syndrome is a “little known” disease and is generally not well understood by the medical community and the general public. In order to improve the level of diagnosis and management of fibromyalgia syndrome in China, this article introduces the American College of Rheumatology Research Criteria of fibromyalgia syndrome and the latest management methods.

Progress in standardized diagnosis and treatment of spondyloarthritis

Lei Lingyan, Guo Huifang

2019, 34(4): 299-305. doi:10.3969/j.issn.1004-583X.2019.04.002

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Spondyloarthritis (SpA) is a common rheumatic disease, which is the main cause of low back pain, young and middleaged men have high incidence. When the clinical symptoms and signs are not typical, it is easy to misdiagnose. In recent years, the guidelines for the diagnosis and treatment of SpA have been updated many times. Based on the “treat to target” treatment strategy, imaging examination plays an increasingly prominent role in the diagnosis, treatment and followup of patients with SpA. NonSteroidal Antiinflammatory drugs (NSAIDs) still belong to the basic treatment in SpA. The application opportunity and its scope and transformation principle of biological agents in SpA are clear and definite, while adopting systemic glucocorticoid therapy for active SpA in Assessment of Spondylo Arthritis International Society(ASAS)the European League Against Rheumatism(EULAR) have been opposed. Above all, the application principles of biological agents, NSAIDs and glucocorticoids are very clear.

Diagnosis and treatment of osteoporosis

Wang Junxiang1, Lv Xiuqin2

2019, 34(4): 306-311. doi:10.3969/j.issn.1004-583X.2019.04.003

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Osteoporosis is the most common bone disorder characterized by the decrease of bone mineral density，deterioration in bone microarchitecture and increased risk of bone fracture.With the coming of aging society, osteoporosis has become a serious social problem threatening human health. Despite the adverse outcomes, osteoporosis is largely underdiagnosed, and the management of osteoporosis is less than optimal.It is important to detect, prevent and treat osteoporosis in the early stages. The purpose of this article is to review the diagnosis and treatment of osteoporosis and provide therapeutic strategies for medical workers.

Inflammatory arthropathy and osteoporosis

Li Hongchao, Song Hui

2019, 34(4): 312-315. doi:10.3969/j.issn.1004-583X.2019.04.004

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Inflammatory arthropathy is a group of diseases characterized by arthritis, mainly including rheumatoid arthritis, spondyloarthritis and osteoarthritis.Osteoporosis is divided into primary and secondary types. Inflammatory arthropathy is a common cause of secondary osteoporosis.The incidence of osteoporosis and the risk of falls increase in inflammatory arthropathy. Therefore, once osteoporosis appears, the risk of fracture will increase significantly.Bone mineral density should be screened as soon as possible in patients with inflammatory arthropathy.Once osteoporosis is diagnosed, treatment should be initiated to reduce the risk of fracture and improve the prognosis. The epidemiology and pathogenesis of inflammatory arthropathy and osteoporosis and their diagnosis as well as treatment were reviewed in this paper.

Differential diagnosis and treatment of chest pain and abdominal pain caused by rheumatic disease

Han Yuxiang, Tian Yu, Qi Xuan, Gao Lixia, Guo Huifang

2019, 34(4): 316-320. doi:10.3969/j.issn.1004-583X.2019.04.005

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Rheumatic disease can cause chest pain and abdominal pain. Rheumatic disease in some patients can be very severe and even fatal, and many patients have difficulties in diagnosis. So when patients have chest pain or abdominal pain, doctors should think about the possibility of rheumatic disease. The paper aims at summarizinge the clinical features of chest pain and abdominal caused by rheumatic disease, and differential diagnosis is vital to improve the prognosis of patients.

Effect of frailty on rehospitalization for acute exacerbations of COPD

Wang Lua, Tian Ronga, Zhou Weia, Niu Jianruia, Gao Maolongb

2019, 34(4): 321-325. doi:10.3969/j.issn.1004-583X.2019.04.006

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Objective To analyze of the clinical data of inpatients with COPD from Respiratory Department of Geriatric Hospital, and hospitalization survey on AECOPD and frailty, and to study the relationship between frailty and rehospitalized for AECOPD in elderly patients.Methods A total of 117 inpatients with AECOPD from September 1,2015 to October 31,2018 were prospectively recruited in this study. Diagnosis of frailty was evaluated with CFS within 24 hours of discharge, and then they were assigned into the frailty group and nonfrailty group. General clinical data, disease history, number of comorbidities and drug use were collected. All patients were followed up for 3 months for AECOPD rehospitalization.Results According to CFS evaluation results, 117 patients were divided into two groups, frailty group (n=53, 45.3%) and nonfrailty group (n=64, 54.7%).The proportion of patients age, cardiac insufficiency and cerebral infarction in frail group was higher than that in nonfrail group(P＜0.05) , besides, the frailty group had larger numbers of comorbidities (≥4), of medications (＞5) and of COPD level.There were 6 cases of AECOPD hospitalization in nonfrail group within 3 months, compared with 45 cases in frailty group (P<0.05).Through binary logistic regression analysis, frailty was the greatest impact on rehospitalization of AECOPD (OR=35.247, 95%CI=10.57117.527,P<0.05).Conclusion The fragile elderly people have higher risk of rehospitalization for AECOPD within three months.

Prediction of acute kidney injury in patients with heart failure

Hao Xiaoping, Wu Bibo, Zhang Liming, Yu Hua, Tang Qi

2019, 34(4): 326-329. doi:10.3969/j.issn.1004-583X.2019.04.007

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Objective To explore the value of urinary liver fatty acid binding protein (uLFABP) in early prediction of acute kidney injury (AKI) in patients with acute decompensated heart failure (ADHF).Methods A total of 57 patients with ADHF were enrolled. According to AKI diagnostic criteria, all patients were divided into two groups: AKI group and nonAKI group. Serum creatinine (Cr) and uLFABP levels were measured at admission and 12, 24 and 48 hours after admission. According to the ROC curve, the diagnostic boundary, sensitivity, specificity, and area under the ROC curve (AUC) were diagnosed by uLFABP at 12 h, 24 h, and 48 h. Results The uLFABP level of AKI patients was significantly higher than that of nonAKI patients（P<0.01）. The ROC curve analysis showed that uLFABP reached an area of 0.785 at the cutoff point of 63.28 μg/g·Cr at the time 12 h after admission, and the sensitivity and specificity reached 83% and 84%, respectively. And it gradually increased with time. The ROC curve analysis showed that uLFABP reached an area of 0.876 at the cutoff point of 86.12 μg/g·Cr at the time 24 h after admission, the sensitivity reached 85%, and the specificity reached 88%. The ROC curve analysis showed that uLFABP reached an area of 0.911 at the cutoff point of 105.30 μg/g·Cr at the time 48 h after admission, the sensitivity reached 94%, and the specificity reached 89%.Conclusion Urinary uLFABP can be used as an effective marker for early prediction of AKI in ADHF patients. Urinary uLFABP can predict AKI earlier than traditional indicators of SCr.

Efficacy of plasma diafiltration in treatment of hepatic failure complicated with sepsis

Feng Junshuai, Fu Caihong, Ma Ru, Zhou Qianqian, Zhou Huiru, Zhang Jinzhou, Gao Junlong, Wang Xiandong

2019, 34(4): 330-333. doi:10.3969/j.issn.1004-583X.2019.04.008

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Objective To explore the clinical efficacy of plasma diafiltration（PDF） in treatment of hepatic failure with sepsis. Methods Clinical data of 31 patients with hepatic failure and sepsis were retrospectively analyzed. The recruited patients accepted comprehensive medical treatments such as PDF, antiinfection and others.Changes in clinical symptoms and physical signs were observed before and after treatment. The levels of coagulation function (prothrombin activity and fibrinogen), biochemical indicators (transaminase, total bilirubin, blood creatinine and ions) and endstage liver disease model score were investigated before and after treatment, and the changes of primogen, interleukin6, Creactive protein, blood routine, lactic acid, and sequential organ failure scores were compared were evaluated before and after PDF.Results The clinical effective rate was 61.29%, and the adverse reaction was 8.21%. There were significant differences in PTA, fibrinogen, TBIL, AST, Na+, K+, PCT, IL6, CRP, WBC, lactic acid, SOFA and MELD scores before and after PDF treatment (P<0.05). Conclusion PDF can significantly improve the coagulation function and liver function of patients with hepatic failure and sepsis, and can eliminate inflammatory factors and effectively relieve the disease with combined treatment.

Risk factors for Carbapenemresistant and mortality in inpatients with pneumonia due to gramnegative bacteria

Liu Qimeng, Ye Huan

2019, 34(4): 334-338. doi:10.3969/j.issn.1004-583X.2019.04.009

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Objective To explore the risk factors and its related prognostic factors of the pneumonia caused by Carbapenemresistant gramnegative bacteria(CRGNB).Methods We retrospectively analyzed the clinical materials of patients diagnosed by gramnegative bacteria pneumonia in 2016. According to the sputum or bronchoalveolar lavage fluid(BALF) culture results, patients were divided into CRGNB group (n=114) and nCRGNB group (n=112). We further divided CRGNB group into survived (n=88) and died (n=26) in terms of patients' 30 day prognosis.We conducted the statistical analysis using univariate analysis and multivariate analysis to identify independent risk factors for CRGNB and associated mortability in pneumonia patients. Results Univariate analysis revealed that eleven factors were associated with the pneumoniae caused by CRGNB, including ICU stay, recent history of surgery, bedridden, fever, conscious disturbance, carbapenem antibiotics application in past 90 days, respiratory failure, shock, invasive manipulation, ABA and SMA infection, hospital acquired. ICU stay, coronary heart disease, diabetes mellitus, renal failure, respiratory failure, shock, retention catheterization, deep vein catheterization and mechanical ventilation were associated with the mortality of CRGNB pneumonia. Multivariate analysis showed that Carbapenem antibiotics application in past 90 days, mechanical ventilation, ABA infection and hospital acquired is independent risk factor of CRGNB. Furthermore, shock, deep vein catheterization, diabetes mellitus and coronary heart diseases were independently associated with mortality of CRGNB pneumonia. Conclusion Carbapenem antibiotics application in past 90 days, mechanical ventilation, ABA infection and hospital acquired is independent risk factor of CRGNB. Furthermore, shock, deep vein catheterization, diabetes mellitus and coronary heart diseases were independently associated with mortality of CRGNB pneumonia.

Clinical effect of Shenmai injection on radiationinduced oral mucositis in head and neck neoplasms

Zhang Shenglina, Li Wenxina, Liu Chunlib, Xu Fana, Zhang Guannana, Liu Chengyia, Li Qingshana

2019, 34(4): 339-342. doi:10.3969/j.issn.1004-583X.2019.04.010

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Objective To investigate the therapeutic effect of Shenmai injection on radiation induced oral mucositis in head and neck neoplasms. Methods 120 cases were diagnosed as head and neck neoplasms, all of which received radiation therapy. The patients were randomly divided into two groups, 60 cases in each group. The control group received routine symptomatic treatment; the observation group was given Shenmai injection more. Both groups were given intensitymodulated radiation therapy: 1.82 to 2.18 Gy once daily, 5 days per week, and the total dose of radiotherapy was 6071.96 Gy. ResultsCompared with control group, the radioactive oral mucositis appeared later and the recovery time was shorter in observation group, with significant difference (P<0.05).The incidence of moderate and severe radioactive oral mucositis in the two groups was 20% in observation group and 80% in control group, respectively (P<0.01). The average radiotherapy time in observation group was significantly shorter than that in control group, with significant difference(P<0.05).Conclusion Shenmai injection can significantly alleviate the symptoms of radioactive oral mucositis in patients, ensure that radiotherapy is completed on time, improve the quality of life, and has good clinical promotion value.

The value of ultrasonography in the diagnosis of papillary thyroid Microcarcinoma

Du Juan

2019, 34(4): 343-346. doi:10.3969/j.issn.1004-583X.2019.04.011

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Objective To analyze the ultrasonographic features of papillary thyroid Microcarcinoma (PTMC) and to evaluate its clinical diagnostic value for PTMC. Methods A retrospective study of 203 patients with thyroid nodules ≤1 cm confirmed by ultrasonography and surgical pathology was established in our hospital from January 2015 to September 2018, including 103 cases of PTMC and 100 cases of benign thyroid nodules. The sonographic differences of benign and malignant thyroid nodules were analyzed. According to the pathological results, the receivers' operating characteristic curve (ROC) and the area under curve (AUC) were used to evaluate the diagnostic efficacy of ultrasound on PTMC. Results Nodular echo, cystic solidity, microcalcification, aspect ratio, border, margin, and acoustic halos were significantly different between PTMC and benign thyroid nodules (P<0.05). Ultrasonography showed good diagnostic value for PTMC with an AUC of 0.88（95%CI: 0.840.93）. When TI RADS4 was used as the cutting point, the sensitivity, specificity, accuracy, positive predictive value and negative predictive value of ultrasound for PTMC diagnosis were 85.4%, 75.0%, 80.2%, 77.8% and 83.3%, respectively. Conclusion PTMC has characteristic features on sonograms. Ultrasonography has a good clinical diagnostic value for PTMC.

Mesenchymal stem cells in treatment of perianal Crohn's disease--a meta analysis

Liu Jianwei1, Liu Jianping2, Wu Yuhuai2

2019, 34(4): 347-351. doi:10.3969/j.issn.1004-583X.2019.04.012

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Objective To systematically evaluated the efficacy and safety of mesenchyme stem cells for treatment of perianal Crohn's disease. MethodsThe Pubmed, Cochrane Library, CNKI, CBM and Wan fang databases were searched to find studies reporting efficacy and/or safety of mesenchyme stem cells for the treatment of perianal Crohn's disease. Results According to the inclusion criteria, 5 studies met the inclusion criteria,including 436 patients. Meta analysis results showed that the therapeutic effect of mesenchymal stem cells was higher than that of control group (RR=1.348, 95%CI=1.0571.719, P=0.016), and number needed to treat(NNT)=8.78 (95%CI=4.8348.21). The highdose group showed a tendency to reduce the efficacy of mesenchymal stem cells (RR=0.500, 95%CI=0.1281.953, P=0.319). The safety of mesenchymal stem cells was higher than that of control group（RR=0.796，95%CI=0.4171.519, P=0.489). No publication bias were found and the outcome was stable by the sensitivity analysis. Conclusion Mesenchymal stem cells for the treatment of perianal Crohn's disease can improve healing and do not increase the adverse events.

Monoclonal immunoglobulin disease complicated with neurological dysfunction: a case report and literature review

Luo Tiancheng，Lu Jing，Qiang Wanting，Fu Weijun，Du Juan

2019, 34(4): 352-355. doi:10.3969/j.issn.1004-583X.2019.04.013

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Monoclonal immunoglobulin disease is comprised of a group of heterogeneous diseases，which is characterized by the presence of monoclonal immunoglobulin in blood or urine. The clinical manifestations of the disease are versatile，and neurological dysfunction is one of the clinical manifestations. In our hospital, a patient with monoclonal immunoglobulinemia complicated with neurological dysfunction was diagnosed as BingNeel syndrome, given RFC regimen chemotherapy（rituximab 600 mg d1+flumurabin 40 mg d24+cyclophosphamide 0.3 g d24）, combined with intrathecal injection, the patient's clinical symptoms improved significantly.

JGES guidelines for endoscopic papillary large balloon dilation--an interpretation

Liu Xuechen, Feng Zhijie

2019, 34(4): 356-362. doi:10.3969/j.issn.1004-583X.2019.04.014

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Japan Gastroenterological Endoscopy Society has developed the ‘EPLBD Clinical Practice Guidelines’ as fundamental guidelines based on new scientific techniques. EPLBD is a treatment method that has recently become widely used for choledocolithiasis. The evidence level in this field is usually low, and in many instances, the recommendation grading has to be determined on the basis of expert consensus. At this point, the guidelines are divided into the following six sections according to the ‘EST Clinical Practice Guidelines’: ① Indications.EPLBD is indicated for large and multiple stones with bile duct dilatation that are difficult to treat by EST and EPBD alone. ② Procedures. EPLBD following EST improves the stone removal rate in the first session, and it might reduce the frequency of mechanical lithotripsy usage. The distal bile duct diameter and the short diameter of the stone are taken into consideration when selecting the balloon diameter. ③Special cases. In patients with periampullary diverticulum, EPLBD can be performed. EPLBD also can be performed in patients with surgically altered anatomy. ④ Procedurerelated adverse events. The incidence of early adverse events caused by EPLBD is in the range of 0%22.5%, including bleeding, perforation, pancreatitis, and cholangitis. ⑤Treatment outcomes. The rate of stone removal in EPLBD for gallstones of the common bile duct is from 80.9% to 89% for the initial treatment and ultimately from 95.2% to 100% for the complete stone removal.The recurrent rate of bile duct stone after EPLBD is 4.4% to 14.5%. ⑥Postoperative follow up observation.Delayed adverse events other than recurrent stones of the common bile duct have an incidence of 0% to 10% and include cholecystitis and cholangitis.

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