Table of Content

20 May 2020, Volume 35 Issue 5

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Metaanalysis of docetaxel,  cisplatin and 5fluorouracil in treatment of advanced esophageal cancer

2020, 35(5):  389-395.  doi:10.3969/j.issn.1004-583X.2020.05.001

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Objective   To systematically review efficacy and safety of docetaxel,  cisplatin and 5fluorouracil in treatment of advanced esophageal cancer.Methods   PubMed,  Cochrane Library,  Web of Science,  Excerpta Medica Database (EMbase),  ChemicalBiological Munitions (CBM),  WanFang Data and Chinese National Knowledge Infrastructure (CNKI) were searched for the multicenter randomized controlled trials (mcRCTs) about docetaxel,  cisplatin and 5fluorouracil in treatment of advanced esophageal cancer from inception to December 2019. Results  A total of 4 mcRCTs involving 764 patients were included. The studies were of low bias according to the bias assessment tools. There were significant differences in ORR and OS between DCF group (in which esophageal cancer patients treated with docetaxel combine with cisplatin and 5fluorouracil) and control group(P=0.93,  I2=0<50%,  RR=1.58,  95%CI［1.281.94］,  P<0.01; P=0.86. I2=0<50%,  HR=1.16,  95%CI 1.051.29,  P=0.003). But, there were no significant differences in DCR (OR=1.23,  95%CI 0.742.05,  P=0.42). In terms of adverse events,  the incidence rates of thrombocytopenia (Level:14,  OR=2.15,  95%CI［1.044.46］, P=0.04; Level:34,  OR=9.64,  95%CI［9.1978.08］,  P=0.03),  diarrhea (Level:14,  OR=2.06,  95%CI［1.273.33］,  P=0.003; Level: 34,  OR=3.01,  95%CI［1.874.83］,  P<0.01),  mucositis (Level:14,  OR=4.21,  95%CI［2.566.92］, P<0.01; Level: 34,  OR=3.65,  95%CI［1.2210.90］,  P=0.02) in DCF group were higher than those in control group. There were no significant differences in leukocytopenia,  anaemia,  nausea and vomit between those two groups
(P>0.05).Conclusion  Docetaxel combine with cisplatin and 5fluorouracil showed no significant effects on the treatment of advanced esophageal cancer. And some adverse events such as thrombocytopenia,  diarrhea,  and mucositis were caused. The combined treatment must be applied with to patients with advanced esophageal cancer.

Systematic review of tirofiban in the treatment of acute ischemic stroke

Li Yaopeng, Zhao Xing, Zhu Xiaolin

2020, 35(5):  404-407.  doi:10.3969/j.issn.1004-583X.2020.05.002

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Objective  To systematically review about RCTs clinical studies related to tirofiban in treatment of acute ischemic stroke(AIS), and to evaluate its efficacy and safety for AIS. Methods  Databases, such as Cochrane Library, EmBase, PubMed, SCI, WF, CNKI, VIP, and CBM were searched to collect all RCTs relevant to the tirofiban in the treatment of AIS. Then, the related data were extracted from the trials. Results  A total of 15 RCT clinical studies involving 1 266  patients were selected. The meta analysis showed that NIHSS of the AIS patients treated with tirofiban was lower than that of control group which was not treated with tirofiban (MD=1.31,  95%CI=1.011.62, I2=0%, P<0.01). The subgroup analysis revealed that NIHSS was lower than that of control group after 7 days of treatment(MD=1.39,  95%CI=0.732.04, P<0.01) and the result did not change after 14 days (MD=1.31,  95%CI=0.961.66, P<0.01). The BI score was higher than that of control group (MD=5.74, 95%CI=3.587.90, I2=0%, P<0.01). The MRS score was lower than that of control group (RR=2.09, 95%CI=1.522.87, I2=36%,  P<0.01). And the ADL score was higher than that of control group (MD=4.26, 95%CI=2.186.34, I2=18%, P=0.0001). Conclusion  Tirofiban was beneficial to the improvement of neurological deficit in the treatment of AIS patients.

Effects of Spironolactone on chemerin in patients with acute myocardial infarction

Wang Yaling, Liu Tao, Zhang Yang, Guo Anjun, Li Liang, Liu Yulong

2020, 35(5):  404-407.  doi:10.3969/j.issn.1004-583X.2020.05.003

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Objective  To investigate the effect of Spironolactone on the level of serum chemerin and cardiac function in patients with acute myocardial infarction（AMI）. Methods   A total of 96 patients with AMI were selected and divided into two groups according to different treatment methods. The control group was treated with conventional treatment and the study group was given Spironolactone. The differences and changes in serum chemerin levels before and after treatment were observed and compared between two groups. The relevant indexes of cardiac function before and after 6 months of treatment were compared between two groups: left ventricular end diastolic diameter (LVEDD),  left ventricular ejection fraction (LVEF) and left ventricular end systolic diameter (LVESD) levels. The adverse reactions of two groups were observed. Results  The serum chemerin levels at 3 months and 6 months after treatment were significantly lower than those before treatment (P<0.05). The serum chemerin level in study group at 3 and 6 months after treatment was significantly lower than that in control group(P<0.05). At 6 months after treatment,  the levels of LVEF,  LVEDD and LVESD were significantly improved compared to before treatment(P<0.05). At 6 months after treatment,  the LVFE level in study group was significantly higher than that in control group (P<0.05). The LVEDD level and the LVESD level at 6 months after treatment were significantly lower than those in control group(P<0.05). Conclusion  Spironolactone treatment in patients with AMI can significantly reduce the serum chemerin level and improve the level of relevant indicators of cardiac function in patients with high safety.

Correlation between coronary artery stenosis and sleep apnea

Yang Jingjing1, Ma Liqun2a, Gou Lisha2b, Wang Haitao2b, Gan Jihong2b

2020, 35(5):  408-412.  doi:10.3969/j.issn.1004-583X.2020.05.004

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Objective  Obstructive sleep apnea(OSA)  has been considered as a risk factor for coronary heart disease(CHD). This study was designed to investigate the relationship between OSA and coronary artery stenosis. Methods  A total of 420 patients with suspected CHD were selected. All subjects underwent coronary angiography, and Gensini score was calculated to determine the severity of coronary artery stenosis. Then polysomnography was used to determine apnea hypopnea index (AHI). Finally, the correlation between the severity of coronary artery stenosis and OSA was analyzed. Results  Patients with Gensini score ≥80 had higher age, AHI, and prevalence of hypertension, diabetes and OSA than patients with Gensini score <80 (P<0.01). Gensini scores of patients with moderate and severe OSA were significantly higher than those of patients without OSA or with mild OSA (P=0.007, 0.037). Logistic regression analysis found that age, male, AHI, hypertension and diabetes were risk factors for Gensini score ≥80 in the overall population. In the age ≥55 group,  after adjusting for gender and age,  AHI elevation increased the risk of Gensini score ≥80 (OR=1.03,  95%CI:1.001.05, P<0.05). In patients <55 years of age,  the risk of Gensini score ≥80 was 1.77  times higher in patients with diabetes than those without diabetes(OR=2.77,  95%CI: 1.295.94, P<0.05). Conclusion  The severity of coronary stenosis was correlated with AHI. Gensini score was higher in patients with moderate and severe OSA, and it was independently correlated with AHI in patients aged ≥55 years. 

Efficacy and safety of rivaroxaban in elderly patients with nonvalvular atrial  fibrillation complicated with cardiac insufficiency

Ma Jincai, Ma Rongzhi, Ma Zhenzhen

2020, 35(5):  413-416.  doi:10.3969/j.issn.1004-583X.2020.05.005

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Objective  To analyze the clinical efficacy and safety of rivaroxabanin elderly patients with nonvalvular atrial fibrillation (NVAF) complicated with cardiac insufficiency. Methods  A total of 182 elderly NVAF patients complicated with cardiac insufficiency who were admitted to the hospital from January 2016 to January 2020 were enrolled. The patients were randomly divided into two groups,  91 cases were selected for rivaroxaban  anticoagulation as observation group,  and other 91 cases were treated with warfarin anticoagulation as control group. The adverse events including thrombotic events,  hemorrhage,  and coagulation, as well as the coagulation function and cardiac function were recorded during the followup in two groups. Results  The total bleeding events in observation group were  significantly lower than those in control group. NTproBNP  of observation group significantly decreased compared with that of control group after  treatment. COX risk model found  that the age and warfarin were risk factors for adverse events. Conclusion  Rivaroxaban is not inferior to warfarin in treating the elderly NVAF  patients complicated with cardiac insufficiency,  but  its  safety is significantly higher than that of warfarin.

Correlation analysis of serum cystatin C and NIHSS, poststroke depression  in patients with firstever acute cerebral infarction

Xing Limiana, Li Yansongb, Su Dongfengb

2020, 35(5):  417-420.  doi:10.3969/j.issn.1004-583X.2020.05.006

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Objective   To explore the relationship among National Institutes of Health Stroke Scale(NIHSS), serum cystatin C(Cys C) and post stroke depression(PSD) one month after the onset of acute cerebral infarction. Methods   The baseline data, NIHSS and Cys C concentration of 101 patients with first ever acute cerebral infarction were collected. Followedup for 1 month,  patients were divided into PSD group and nonPSD group according to the diagnostic criteria agreed by Chinese experts on clinical practice of PSD.   PSD group was further divided into mild PSD group and moderatesevere PSD group according to the result of Hamilton Depression Rating Scale (HAMD17). Results  The Cys C concentration in  nonPSD group,  mild PSD group and moderatesevere PSD group were significantly different (P<0.05); The NIHSS showed difference among nonPSD group,  mild PSD group and moderatesevere PSD group (P<0.05); NIHSS score, Cys C were positively correlated with HAMD17 score (r=0.766,  r=0.511, P<0.05),  and they were independent risk factors for PSD(OR=1.153,  95%CI 1.0091.317; OR=21.234,  95%CI  15.85628.436). Conclusion  High NIHSS and high Cys C concentration are independent risk factors for PSD.

Diagnostic value of modified Wells score in lung cancer  complicated with venous thromboembolism

Li Shuangping, Mao Yimin, He Xuegai

2020, 35(5):  421-424.  doi:10.3969/j.issn.1004-583X.2020.05.007

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Objective  To evaluate the diagnostic value of modified Wells score in lung cancer complicated with venous thromboembolism(VTE).Methods  A total of 145 patients with lung cancer admitted to the hospital were selected.  The diagnostic value of Wells score and plasma D dimer level in lung cancer with VTE were calculated.Results   The optimal cutoff value of plasma Ddimer for the diagnosis of lung cancer with VTE was 2.51 mg/L. The AUC of Wells score for the diagnosis of lung cancer with VTE was 0.703（95%CI［0.621, 0.776］）, Youden index was 0.407, and the optimal cutoff value was 2 points, with the sensitivity of  66.7% and the specificity of 74%. The AUC of the modified Wells score for the diagnosis of lung cancer with VTE was 0.855（95%CI［0.787，0.908］）, Youden index was 0.543 and the optimal cutoff value was 2 points, with the sensitivity of 93.3%  and the specificity of  61%. The difference of AUC between the modified Wells score and the Wells score in the diagnosis of lung cancer with VTE was statistically significant  （Z=4.712，95%CI［0.088，0.215］，P<0.05）.Conclusion  The modified Wells score is of high diagnostic value for lung cancer with VTE.

Analysis of highrisk factors of pressure injury in severely ill children

Wang Huanhuan, Jiao Huifang, Wang Fei

2020, 35(5):  425-428.  doi:10.3969/j.issn.1004-583X.2020.05.008

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Objective  To explore the  highrisk factors of pressure injury(PI) in severely ill children. Methods  151 children were divided into PI group and non PI group  according to the presence or absence of PI. The occurrence of PI in severely ill children was analyzed, and  the  risk factors of PI in severely ill children  were analyzed. Results  A total of  25 cases occurred in  151 children, and the incidence rate  of PI was 16.57%. PI staging included: 20 cases  in stage  Ⅰ, 4 cases  in stage Ⅱ, and 1 case  in stage Ⅲ. There were 29 PI sites in 25 patients  and 18 in the head and face(62.07%). Respiratory mode, PICS score, medical device use and Braden Q score were the independent risk factors of  the occurrence of PI in severely ill children(P<0.05). Conclusion  Children with  severe  diseases are at high  risk of PI, and most of the injuries  are in the head and face,mainly in phase I. PCIS score, respiratory mode, medical device use and Braden Q score are highrisk factors of PI in severely ill children.

Clinical significance of reform  vesselplussurface classification  in  diagnosis of early gastric cancer

Jia Mengmeng, Zhou Yingfa

2020, 35(5):  429-433.  doi:10.3969/j.issn.1004-583X.2020.05.009

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Objective  To explore the clinical significance of reform vessel plus surface classification(RVS) in the diagnosis of early gastric cancer(EGC). Methods  Totally 60 cases of EGC and precancerous lesions were retrospectively analyzed, with 46 males (76.67%) and 14 females (22.33%).  The average age of patients was (61.03±9.87) years old, and their total lesions were 63. The relationship among patients' age, gender, lesion location, and endoscopic morphological classification of lesions were observed and analyzed. Results  The most common endoscopic appearance was type Ⅱ form. And the most common sites of the lesions were cardia and antrum of the stomach. Both vessel plus surface classification(VS) and RVS had high diagnostic value for EGC diagnosis. Conclusion  Magnifying endoscopy with narrowband imaging(MENBI) and RVS classification can help identify gastric neoplasms and nonneoplastic lesions, and they also have high diagnostic value for EGC.

Clinical observation of health education combined with auxiliary measures  to improve clarity of gastrointestinal mucosa

Wu Jie, Lai Yuexing, Wu Mei, Yu Haibin, Yang Jing, Yuan Haipeng

2020, 35(5):  434-437.  doi:10.3969/j.issn.1004-583X.2020.05.010

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Objective  To study the effect of preventing swallowing of saliva on the visibility of upper gastrointestinal mucosa through education and other measures before gastroscopy.Methods  A prospective, randomized, singleblind, controlled clinical study was conducted on 400 patients who underwent gastroscopy to compare the upper gastrointestinal mucosa visibility score between research group and control group. Results  The total score of mucosal visibility in research group was significantly higher than that in control group (P<0.01). The mucosal visibility scores of all parts of upper gastrointestinal in research group were significantly higher than those in control group（P<0.05）. The proportion of patients with a mucosal visibility score≥3 in research group was significantly higher than that in control group（P<0.05）. Conclusion  Health education and other measures before gastroscopy can prevent patients from swallowing saliva and improve the visibility of the upper gastrointestinal mucosa.

Expression of apoptosisregulating proteins XIAP and Omi/HtrA2  in diffuse large Bcell lymphoma and relationship with prognosis

Bian Le, Ai Limei

2020, 35(5):  438-444.  doi:10.3969/j.issn.1004-583X.2020.05.011

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Objective  To investigate expression and prognosis of XIAP and Omi/HtrA2 in diffuse large B cell lymphoma (DLBCL) and the relationship with prognosis.Methods  Paraffin sections were collected from 59 patients with DLBCL and 30 patients with lymph node hyperplasia (RHL).The XIAP and Omi/HtrA2 proteins in both groups were stained by immunoh is to  chemical method, the relationship of their expressions with clinical parameters and prognosis of DLBCL were analyzed.Results  XIAP and Omi/HtrA2 were highly expressed in DLBCL, but lower expressed or even not expressed in RHL.  The average positive rate of XIAP in DLBCL was 61.02%, and that of RHL was 36.67%(P＜0.05). The average positive rate of Omi/HtrA2 in DLBCL was 52.54%, and that of RHL was 30.00%(P＜0.05). The positive expressions of XIAP and Omi/HtrA2  were associated with clinical stage, pathological type, LDH level, and IPI score of DLBCL(P＜0.05), but were not associated with gender, age, extranodal involvement, and symptom grouping(P＞0.05).The expressions of XIAP and Omi/HtrA2 were negatively correlated(P<0.05). Kaplanmeier survival analysis showed that the expression of XIAP was correlated with the prognosis of patients with DLBCL(P＜0.05),but the expression of Omi/HtrA2 was not correlated with the prognosis of DLBCL patients(P＞0.05).Conclusion  XIAP and Omi/HtrA2 are both highly expressed in DLBCL, and there are negatively correlated.  The upregulation of Omi/HtrA2 and the suppression of  XIAP expression can provide a basis for DLBCL targeted therapy. XIAP, a prognostic factor related to  DLBCL,  will expect to be an indicator of DLBCL prognosis.

Effects of different blood purification methods on microinflammatory state  and procalcitonin in maintenance hemodialysis patients

Chen Jianhua, LV Yanhui, Li Ying, Song Jingying, Wang Haifeng, Jia Yingjie, Wang Chunjie

2020, 35(5):  445-448.  doi:10.3969/j.issn.1004-583X.2020.05.012

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Objective  To explore the effects of different blood purification methods on microinflammatory status and procalcitonin (PCT) levels in maintenance hemodialysis (MHD) patients. Methods  A total of 120 MHD patients were randomly divided into hemodialysis(HD) group，hemodialysis combined with hemoperfusion (HD+HP) group，hemodialysis combined with hemodiafiltration (HD+HDF) group, hemodialysis combined with hemodiafiltration and hemoperfusion(HD+HDF+HP) group. All groups were observed for 12 months, the changes of interleukin 6(IL6), blood sedimentation (ESR), Creactive protein (CRP) and PCT level were compared before and after 12 months of treatment within each group and among groups in order to evaluate the effects of different blood purification methods on microinflammatory status and PCT in MHD patients. Results   The levels of IL6, ESR, CRP and PCT in HD+HP group, HD+HDF group and HD+HDF+HP group were significantly different from those before treatment (P<0.05). The levels of IL6, CRP and PCT in HD+HP group were better than those in HD+HDF group and HD+HDF+HP group after 12 months of treatment,  and the degree of decline of IL6 was significantly different from that in HD+HDF group and HD+HDF+HP group (P<0.05). Conclusion  Hemodialysis combined with hemoperfusion and (or) hemodiafiltration can improve the microinflammatory status of MHD patients and reduce the level of PCT. However, hemodialysis combined with hemoperfusion have more advantages in improving the microinflammatory state.

Correlation between MRI microcoil and antiCCP antibody  and RF level in rheumatoid arthritis

Sun Wenjing1, Dai Shipeng1, Gu Qing2, Tian Miaomiao1, Shang Haixia1

2020, 35(5):  449-452.  doi:10.3969/j.issn.1004-583X.2020.05.013

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Objective  To investigate the correlation between semiquantitative MRI microcoil and antiCCP antibody and rheumatoid factor(RF) level in rheumatoid arthritis（RA）.Methods  A total of 80 RA patients treated in our hospital from June 2018 to March 2019 were enrolled. MRI microcoil plain scan and enhanced scan were performed on all patients. Synovial score was graded by semiquantitative method. Serum RF and antiCCP antibody levels were collected to analyze the correlation between synovial score and serum factors. Results  Totally 15 cases were tested positive by Xray plain film,  with a positive rate of  18.75%,  while the positive rate of MRI microcoil image was 100%. The positive rate of MRI microcoil was significantly higher than that of Xray (χ2=109.474,  P=0.000);  80 patients with early RA showed different degrees of synovial thickening; the levels of serum RF and antiCCP antibody of RA patients in bone erosion group were significantly higher than those of RA patients in normal bone group(P<0.05); the total score of synovium was positively correlated with serum RF(r=0.561, P=0.000) and antiCCP antibody (r=0.631, P=0.000). Conclusion  MRI microcoil semiquantitative method can effectively evaluate the situation of early RA synovitis,  and the synovial score is positively correlated with serum RF and antiCCP antibody,  which has a certain value for early diagnosis of RA.

Resistance to thyroid hormone with atypical clinical presentation：one case report and literature  review

Yang Jing

2020, 35(5):  453-457.  doi:10.3969/j.issn.1004-583X.2020.05.014

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As a rare endocrine disease,  syndrome of thyroid hormone resistance (RTH) is characterized by significant heterogeneity in clinical manifestations and is very prone to improper treatment due to misdiagnosis.This paper systematically states  the diagnosis and treatment process of one RTH patient  who was misdiagnosed as Graves' disease in other hospitals,  then  analyzes the key points of identifying the disease and the importance of whole exon gene sequencing to the definite diagnosis.It also  points out the significance of avoidance of antihyperthyroidism drugs,  and emphasizes  the comprehensive management of glucose and lipid metabolism in RTH patients.

Leukocyte common antigen negative pediatric myeloid sarcoma misdiagnosed  as spinal tuberculosis: a case report and literature analysis

Lu Weihong, Wu Xiangtao, Xu Yali, Guo Xixia, Li Shujun, Li Jing

2020, 35(5):  458-461.  doi:10.3969/j.issn.1004-583X.2020.05.015

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To analyze the clinical characteristics,  imaging characteristics,  pathological characteristics of the misdiagnosed case and the limitations of MRI in the diagnosis of myeloid sarcoma (MS)  to gain deeper understanding of  MS. MS is a special type of acute myeloid leukemia, which is rarely seen in children. Due to its diverse onset and manifestations,  MS is easy to be misdiagnosed clinically. Histopathological diagnosis is the gold standard. Biopsy combined with imaging examination is the key to the diagnosis of MS. Early biopsy of the tumor can effectively reduce misdiagnosis and determine prognosis.