Table of Content

20 November 2019, Volume 34 Issue 11

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Is beta blockers suitable for all patients with coronary heart disease?

Wang Qian, Cui Wei

2019, 34(11):  965-969.  doi:10.3969/j.issn.1004-583X.2019.11.001

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It was believed that the symptoms and prognosis of patients with coronary heart disease(CHD) could be improved by beta receptor blockers (BBs). However, more and more evidencebased medical study suggests that the impact of BBs is declining in the treatment of patients with CHD. Clinical studies in recent years have shown that patients with CHD without myocardial infarction or heart failure (or cardiac dysfunction) do not benefit from BBs treatment. In addition to heart failure, there was no evidence to support the lifelong application of BBs in patients with CHD. And increasing the dose of BBs did not bring additional benefits to patients with CHD. Revascularization (PCI) treatment reduces the need for BBs in patients with CHD. In this paper, the status change of BBs in the treatment of CHD in recent years is reviewed.

Correlation between inflammatory cytokine polymorphisms and cancerrelated fatigue

Li Zhaoxia1, Yu Xinlin1, Xiao Xiaohui2, Wang Juncheng1, Hu Wei1, Mi Denghai1

2019, 34(11):  970-975.  doi:10.3969/j.issn.1004-583X.2019.11.002

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Objective  To explore  the correlation between the inflammatory cytokine polymorphisms and cancerrelated fatigue(CRF),  and provide  research basis for the investigation of genetic variation in the development and progression of CRF. Methods  Totally 242 lung cancer patients were divided into CRF group (162) and nonCRF group (80). Genotyping  was carried out according to the polymerase chain reaction restriction fragment length polymorphism(PCR RFLP), then  the distribution of allele frequency and genotypes were analyzed, as well as the correlation between inflammatory cytokine polymorphisms and CRF.Results  There was statistically significant  difference between the distribution of   TNFα308 G/A  and   IL1β511 C/T genotypes(all P<0.05).  After adjusting the confounding factors such as age and gender, multivariate logistic regression showed that patients with GA/AA genotype had a lower risk for CRF by 74%  as compared with  patients with  TNF α308GG genotype(15%92%);  patients with GC/CC genotype had a  lower risk by 78% in comparison with  patients with IL6174GG genotype(0%95%); in the genetic locus of IL1β511C/T,  the patients with CC genotype were 3.96 times more likely to develop CRF than those with TT genotype (95%CI 1.0215.45). Conclusion  Patients with TNFα308GG,  IL6174GG and  IL1β511CC genotypes have a significantly increased risk of CRF.

Efficacy of Da Vinci robot and traditional videoassisted thoracic surgeryin  the treatment of pulmonary diseases

Yang Qi1, Ma Ya1, Wang Bing1,2, Ming Haixia1, Gou Yunjiu2

2019, 34(11):  976-981.  doi:10.3969/j.issn.1004-583X.2019.11.003

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Objective  To evaluate the efficacy of Da Vinci robotassisted thoracic surgery (RATS) and videoassisted thoracic surgery (VATS) in the treatment of pulmonary diseases.Methods  The clinical data of 218 patients with pulmonary diseases and treated with Da Vinci RATS and and traditional VATS were retrospectively analyzed. Patients chose the surgical method on their own, including 98 cases in RATS group and 120 cases in VATS group.Results  The operation time of RATS group was longer than that of VATS group (P<0.01), and the surgical cost  (P<0.05) and total hospitalization costs (P<0.01)   of RATS were also higher than those of VATS group.  However  RATS group had less intraoperative blood loss (P<0.01)  and shorter postoperative hospital stay (P<0.05).There were no statistically significant differences between two groups in the conversion to thoracotomy, total drainage volume and  postoperative drainage time (P>0.05). Patients with lung cancer in RATS group had shorter postoperative hospital stay (P<0.01) and higher total hospital costs(P<0.01). Nonlung cancer patients in  RATS group had longer surgery time (P<0.01) and higher overall hospital costs (P<0.01). Patients in RATS group had less intraoperative blood loss(P<0.05)  and shorter postoperative hospital stay (P<0.05).Conclusion  Da  Vinci RATS  is safe and effective,and it has obvious advantages in intraoperative blood loss and postoperative hospital stay, while other indicators have no obvious advantages in   robot assisted surgery.

Effect of  kinesio taping on hand function in patients with stroke in early  stage

Chen Lihua1, Qu Yanping2, Yuan Haixin1, Kan Shifeng2

2019, 34(11):  982-985.  doi:10.3969/j.issn.1004-583X.2019.11.004

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Objective  To observe the clinical effect of Kinesio taping on hand function in patients with stroke  in early  stage. Methods   Totally 60 patients with early stroke who met the inclusion criteria were randomly divided into three groups: Kinesio taping group (Kinesio taping + rehabilitation, n=20, 2 cases dropped off), white patch group (white patch + rehabilitation, n=20, 1 case dropped off) and blank group (rehabilitation, n=20, 1 case dropped off). Before the treatment, 3 weeks after treatment and 6 weeks after treatment, the modified Ashworth Scale (MAS), the degree of hand swelling (hand volume), Fugl Meyer motor function score (FMA) and simple upper extremity function examination (STEF) were used for evaluation. Results  After 3 weeks and 6 weeks of treatment, there was no statistically  significant difference in MAS score among three groups (P>0.05).  FMA score, STEF and hand volume in Kinesio taping group were better than those in other two groups (P<0.05).  MAS score in Kinesio taping group was significantly increased compared with that before treatment (P<0.05). Conclusion  Kinesio taping can be applied to improve hand spasms and swelling in patients with early stroke so as to improve the hand function.

Prognostic value of pulse wave velocity and anklebrachial index

Li Yi, Yao Mahui, Liu Demin, Wang Qian, Geng Xue, Cui Wei

2019, 34(11):  986-990.  doi:10.3969/j.issn.1004-583X.2019.11.005

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Objective  To investigate whether pulse wave velocity and anklebrachial index  are related to the prognosis of patients with cardiovascular disease,  and whether the traditional monitoring indexes are still meaningful after the introduction of the new prognostic index. Methods  A total of 353 patients were included. The clinical data of patients were analyzed retrospectively and they were followed up after hospital discharge. Multivariate logistic regression analysis and propensity score matching  were used to determine whether the vascular function indicators were independent influencing factors for poor prognosis of patients with cardiovascular disease. Results  During the followup, totally 53 patients had cardiovascular events, and 11 cases died. Compared with patients in nonevent group,  patients in event group had higher risk of  heart failure and were more likely to have angiotensinconverting enzyme inhibitors/angiotensin receptor antagonists(ACEI/ARB),  and the anklebrachial index was smaller. Compared with patients in the survival group, the anklebrachial index was smaller in the allcause death group. Heart failure and ACEI/ARB were independent risk factors for the prognosis of patients with cardiovascular disease,  and anklebrachial index was an independent factor for death. Heart failure and anklebrachial index were independent risk factors influencing prognosis of patients with cardiovascular disease after propensity score matching. In the coronary heart disease subgroup analysis, gender,  heart failure,  stroke,  and ACEI/ARB drugs were independent risk factors for prognosis, while the anklebrachial index  was an independent factor for the death of  patients with cardiovascular disease.Conclusion  The anklebrachial index  was an independent factor for the prognosis of patients with cardiovascular diseases. After the introducing of vascular function monitoring indicators,  only anklebrachial index  and heart failure had predictive value for the prognosis of cardiovascular patients, while traditional cardiovascular risk factors had no predictive value.

Clinical study on the relationship between trimethylamine NOxide and mild cognitive impairment in young and middleaged patients with maintenance hemodialysis

Zhu Zhaozhang, Zhou Fanli, Lu Lan

2019, 34(11):  991-994.  doi:10.3969/j.issn.1004-583X.2019.11.006

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Objective  To investigate the relationship between trimethylamine N-Oxide(TMAO) and mild cognitive impairment (MCI)in young and middleaged patients with maintenance hemodialysis(MHD). Methods  Totally 108 cases of young and middleaged MHD patientsadmitted to the hospital from June 2016 to June 2018 were selected as subjects. Simple intelligence state examination scale and Montreal cognitive assessment(MoCA) scale were used to evaluate patients' cognitive function, and investigate the clinical data and laboratory indicators of selected patients, TMAO levels were measured by highefficiency liquid chromatography series mass spectrometry, and the correlation between TMAO and MCI was also analyzed.Results  Among 108 young and middleaged MHD patients, totally 50 cases suffered from  MCI,which was accounted for 46.3%.  Compared with the nonMCI group, the proportion of male, dialysis age, combined diabetes, TG, LDL, UA, CRP and TMAO were higher, the proportion of middle school patients above the education was lower(P<0.05). MoCA integrals were negatively correlated with dialysis age, diabetes, and TMAO, and they were positively correlated with educational attainment (r=-0.402, -0.216, -0.416, 0.389, P＜0.05).   The elderly, long dialysis age and  increase of TMAO were independent risk factors for the occurrence of MCI in young and middleaged MHD patients, while the high education level was a protective factor.Conclusion  The incidence of MCI was higher in young and middleaged MHD patients, and the increase of  TMAO was an independent risk factor for MCI.

Effect of Qishenyiqi dropping pill on heart failure with preserved  ejection fraction

Zhang Kaixuan1, Geng Wei2, Jiang Yiming1, Wang Xueshuo1, Hou Xuena1

2019, 34(11):  995-998.  doi:10.3969/j.issn.1004-583X.2019.11.007

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Objective  To observe the clinical efficacy of Qishenyiqi dropping pill on heart failure with preservedejection fraction. Methods   A total of 180 patients who suffer from heart failure with preserved ejection fraction were randomly divided into the conventional therapy group (90  cases,  with routine treatment) and the treatment group (90 cases, with routine treatment accompanied by Qishenyiqi dropping pill).  NTproBNP,  6MWT,  MLHFQ and E/A were recorded before treatment and after the treatment of 6  months.Results  Totally 169 patients were included, including 88 cases in treatment group and 81 cases in conventional therapy group. After 6 months of followup，the NTproBNP   and  MLHFQ of  treatment group were lower than those of  conventional therapy group(P<0.05). The E/A and 6MWT of  treatment group were higher than those of conventional therapy group(P<0.05). No serious adverse reactions  were observed.Conclusion  Qishenyiqi dropping pill can obviously improve cardiac diastolic function, exercise tolerance and life quality  in heart failure patients with preserved ejection fraction.

Expression analysis of serum miR2213p in patients of severe depression

Lu Ruia, Cao Yecaib, Wang Xiaoqic

2019, 34(11):  999-1003.  doi:10.3969/j.issn.1004-583X.2019.11.008

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Objective  To detect the expression of RNA2213p (miR2213p) in patients with severe depression, analyze its clinical significance, and explore the relationship between miR2213p and brainderived neurotrophic factor(BDNF), human neurotrophic factor4(NT4), S100B protein(S100B) and superoxide dismutase(SOD), respectively. And to explore the expression consistency of miR2213p in cerebrospinal fluid and serum. Methods  A total of 59 patients with severe depression were selected as observation group and normal serum samples were taken. Totally 59 serum samples of normal adults were taken as control group. MiR2213p was detected by realtime fluorescence quantitative PCR(qPCR) in two groups. The expressions of BDNF and S100B were detected by ELISA method in observation group, SOD was detected by xanthine oxidase method in serum, and NT4 was detected by Western Blot method in the serum. MiR2213p was detected in cerebrospinal fluid which was extracted from 39 patients with severe depression. Results  There was statistically significance in the difference of MiR2213p of  two groups (P<0.05).  miR2213p in the groups divided by family history of mental disorders also showed  significant difference(P<0.05). Negative correlation was found between miR2213p and BDNF(r=-0.51, P=0.036), miR2213p and SOD (r=-0.57, P=0.013), miR2213p and NT4(r=-0.62, P=0.009). miR2213p and S100B had positive correlation(r=0.59, P=0.014). Positive correlation of miR2213p  existed between serum and cerebrospinal fluid(r=0.72, P=0.001). Conclusion  Abnormal expression of serum miR2213p affects the formation and progression of severe depression. MiR2213p may play a role in regulating neurotrophic factors, injury factors and stress indicators. There is expression consistency of miR2213p in the serum and cerebrospinal fluid.

Metaanalysis of percutaneous cutting balloon angioplasty for the treatment of hemodialysis stenosis

He Jinsen1, Lu Linqi1, Yao Ying2

2019, 34(11):  1004-1009.  doi:10.3969/j.issn.1004-583X.2019.11.009

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Objective  To evaluate the safety and efficacy of percutaneous cutting balloon angioplasty (PCB) in the treatment of hemodialysis stenosis,  and to provide reference and help for clinical treatment and related research. Methods  Databases such as Pubmed,  Embase,  Cochrane,  China Knowledge Network,  Wanfang,  and Weipu were searched up to August 2018 for relevant literature on hemodialysis stenosis and percutaneous balloon angioplasty (PTA). The document inclusion and exclusion criteria and evaluation criteria for effect indicators were given out. Two investigators independently screened the literature and evaluated the quality of the included literature with Cochrane Risk Bias Evaluation Tool. Results  A total of 58 relevant Chinese and foreign literatures were retrieved,  including four randomized clinical trials (RCT). The PCB and PTA results were compared headtohead: a total of 1 073 participants,  including 544 PCB and 529 PTA people. The 6month stenotic patency rate of PCB was significantly higher than that of PTA (65.93% vs 55.11%; RD=0.11; 95%CI: 0.050.16; P=0.0002).  There was no statistically significant difference in the success rate of PCB versus PTA (87.68% vs 84.31%; RD=0.03; 95%CI:-0.010.08; P=0.10).There was no statistically significant difference in complications rates of PCB and PTA (0.026% vs 0.004%; RD=0.03; 95%CI:-0.010.07; P=0.19). Conclusion  PCB treatment of hemodialysis pathway stenosis has good efficacy and safety; it is an ideal choice in the treatment of hemodialysis stenosis.

Association of the contactinassociated proteinlike 2 gene rs 2710102 polymorphism and autism spectrum disorder: a metaanalysis

Wang Yinga, Liu Yia, Xia Zhaoyib, Yu Hana, Gai Zhongtaoa

2019, 34(11):  1010-1014.  doi:10.3969/j.issn.1004-583X.2019.11.010

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Objective  To explore the association between CNTNAP2 rs 2710102 polymorphism and autism spectrum disorder(ASD)  by performing a metaanalysis. Methods  Databases,  such as China Biology Medicine disc(CBMdisc),  China National Knowledge Infrastructure,  WanFang data,  CQVIP,  PubMed,  Cochrane Library,  Ovid,  Wiley Online Library, Elsevier Science Direct and Spinger were  searched for the casecontrol studies on the association between the CNTNAP2 gene rs 2710102 polymorphism and ASD.  Stata 12.0 software was used to calculate the odds ratio (OR) and 95% confidence interval(CI),  as well as heterogeneity and publication bias analyses. Results  A total of 7 publications were included in this metaanalysis,  involving a total of 1689 ASD cases and 14227 controls. Pooled analyses showed no association between CNTNAP2 rs2710102 polymorphism and ASD risk using allelic model (C vs T,  OR=1,  95%CI: 0.84, 1.18),  heterozygote model (CT vs CC/TT,  OR=1.01,  95%CI: 0.88,1.17),  dominant model (TT vs CT/TT,  OR=1.09,  95%CI: 0.92,  1.304) and recessive model (CC vs TC/TT,  OR=0.98,  95%CI:0.77，1.07). No heterogeneity was observed in every model suggesting the results were stability,  and there was no evidence of publication bias. Conclusion  CNTNAP2 rs2710102 polymorphisms are not associated with ASD.

Endoscopic electrocoagulation hemostasis combined with purse string suture for treatment of gastric Dieulafoy lesiona report of one case

Yin Aihong, Wei Zhi, Liu Xiaofeng

2019, 34(11):  1015-1017.  doi:10.3969/j.issn.1004-583X.2019.11.011

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Dieulafoy lesion is an uncommon but potentially fatal reason of upper gastrointestinal bleeding. This article reports that a man admitted to one hospital who complained of haematemesis and melena for 4 days. The patient vomited blood twice, with a total amount of about  1 000  ml, accompanied by melena. The gastroscopy indicated a fundus ulcer of about 8 mm in diameter, accompanied by whitish fur and exposed red blood vessels in the center.  The diagnosis was Dieulafoy lesion. During the closure with titanium clamps,  exposed arterial bleeding in the center of ulcer   occurred. Hemostatic forcep was immediately used to coagulate the bleeding vessel,  and no active bleeding was observed for 10 minutes. Then, the operator carried out purse string suture with titanium clip and nylon rope. The patient recovered well and followed up for three months without haematemesis or melena. Endoscopic therapies such as sclerotherapy, band ligation, electrocoagulation, overthescopeclip were widely used to patients with Dieulafoy lesion at present. The patient with purse string suture recovered well. Literature review showed  that purse string suture can provide a good successful rate with less postoperative complications for mucosal wound closure.

Fibronectin glomerular disease combined with monoclonal gammopathy of renal significance--a case report

Zhu Minmin1, Ma Zhigang2

2019, 34(11):  1018-1021.  doi:10.3969/j.issn.1004-583X.2019.11.012

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Fibronect  in glomerular disease (FNG) is a rare autosomal dominant  in herited disease characterized by a large amount of fibronectin deposited in the glomerular subendothelial and mesangium.  The clinical manifestations are proteinuria, a different level of hematuria, hypertension, and slowly progressing renal dysfunction.And a small number of patients have renal tubular acidosis. The diagnosis is mainly based on the results of renal puncture, and the fibronectin staining is positive.There is no specific treatment, and more symptomatic treatment should be used. FNG is rare, and the complication, monoclonal immunoglobulinemia (MGRS) with renal significance, is rarely reported. This article reported a case of FNG accompanied by MGRS and literature were reviewed.