Table of Content

20 July 2021, Volume 36 Issue 7

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Effects of insulin aspart combined with vitamin D in treatment of blood glucose levels and perinatal complications of patients with gestational diabetes mellitus: A meta-analysis

Wang Mengmeng, Wang Ying, Chen Zhaojing, Xu Xianrong, Yang Jun, Li Hongjuan

2021, 36(7):  581-586.  doi:10.3969/j.issn.1004-583X.2021.07.001

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Objective To evaluate the clinical efficacy of insulin aspart combined with vitamin D (VD) supplementation for patients with gestational diabetes mellitus(GDM).Methods The randomized controlled trials (RCTs) of insulin aspart and VD in treating GDM were collected by searching electronic databases including CNKI, Wanfang, PubMed, etc, and the retrieval time extended from the creation of database to July 1, 2020. Two researchers independently screened trials that met the inclusion criteria and extracted the data of randomized controlled trials meeting inclusion criteria; the quality of literatures was evaluated by referring to the criterion for Cochrane quality evaluation, and RevMan 5.3 software was used to conduct the meta analysis.Results Twelve literature and 1130 cases (563 cases in the experimental group and 567 cases in the control group) were finally included. Meta analysis results showed that insulin aspart combined with VD supplementation could significantly reduce the fasting plasma glucose, 2 h postprandial glucose, fasting insulin, insulin resistance index. Meta analysis results also suggested that insulin aspart combined with VD supplementation significantly reduced the incidence of neonatal hypoglycemia, cesarean section, premature delivery and giant children.Conclusion Insulin aspart combined with VD supplementation can improve blood glucose metabolism, decrease insulin resistance and reduce the occurrence of adverse perinatal outcomes in patients with GDM. However, more high-quality RCTs remain to be verified.

Diagnostic value of serum IgG4 for IgG4-related diseases: A meta-analysis

Ding Hang, Liu Yuan, Zhang Lianfeng, Zhou Lin

2021, 36(7):  587-594.  doi:10.3969/j.issn.1004-583X.2021.07.002

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Objective To systematically evaluate the diagnostic value of serum IgG4 for IgG4-related diseases (IgG4-RD).Methods All related English studies to explore diagnostic value of serum IgG4 in IgG4-related diseases published in PubMed, EMBASE, Wangfang, Weipu and CNKI from January 1st, 2011 to January 1st, 2020 were searched by computer. Strict inclusion and exclusion criteria for literature screening and data extraction were established, the quality assessment was made by the quality evaluation tool (QUADAS-2), and meta-disc 1.4 software and the “Midas” command in STATA15.0 software were used for heterogeneity analysis and comprehensive quantitative synthesis. The pooled sensitivity, specificity, diagnostic advantage ratio, positive likelihood ratio and negative likelihood ratio were calculated respectively, and the relevant forest map was drawn, and the summary receiver operating curve (SROC) was fitted. The included literature were subgroup analyzed by region, disease type and sample size. Results A total of 17 articles and 17 095 patients were included in this meta-analysis. The cut-off value of IgG4 ranged from 1.3 to 1.44 g/L, the pooled sensitivity was 0.88(95%CI:0.81-0.93), the pooled specificity was 0.89(95%CI: 0.83-0.93), the pooled positive likelihood ratio was 8.3(95%CI: 5.1-13.7), the pooled negative likelihood ratio was 0.13(95%CI: 0.08-0.22) and the diagnostic advantage ratio was 62 (95%CI:25-153),respectively. The diagnostic value of serum IgG4>2×ULN (2.7-2.8 g/L) was reported in 11 studies, and the pooled sensitivity was 0.59(95%CI: 0.47-0.7), the pooled specificity was 0.96(95%CI: 0.94-0.97), the pooled positive likelihood ratio was 14.3(95%CI:9.1-22.7), the pooled negative likelihood ratio was 0.42(95%CI: 0.32-0.57), and the pooled diagnostic advantage ratio was 34(95%CI:17-69). Subgroup analysis showed that geography, whether only AIP patients were included, and sample size of IgG4-RD patients were all possible sources of heterogeneity. Deeks funnel plot showed no publication bias, and the sensitivity analysis revealed that the analysis result were stable and reliable. Conclusion Serum IgG4 has a high reference value in the diagnosis of IgG4-RD, and there is no significant diagnostic advantage in increasing the cut-off value to 2×ULN. This result still needs to be verified by more prospective and high-quality diagnostic tests.

Effect of optimized treatment approach on acute STEMI patients under the situation of prevention and control of COVID-19

Deng Kaibin, Han Liang, Niu Shaoqian, Wang Haiyan, Wang Yanbo, Fu Yang, Wang Qing, Zhan Yang, Fu Xianghua

2021, 36(7):  595-599.  doi:10.3969/j.issn.1004-583X.2021.07.003

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Objective To analyze the effectiveness and safety of optimized treatment approach for acute ST-segment elevation myocardial infarction(STEMI) patients under the situation of prevention and control of COVID-19.Methods Consecutive 34 acute STEMI patients admitted to the Department of Cardiology of the Second Hospital of Hebei Medical University under COVID-19 prevention and control were included in study group, and 62 acute STEMI patients admitted during COVID-19 prevention and control period were included in control group. The general clinical data, reperfusion treatment status (time from system onset to first medical contact,onset-to-FMC), time from first medical contact to wire(FMC-to-W), thrombolysis in myocardial infarction(TIMI) blood flow classification, total ischemic time (time from symptom onset to guide wire passing through the lesion), the time from the first medical contact to the start of thrombolysis (FMC to needle of thrombolysis, FMC-to-N), thrombolysis recanalization rate, the rate of reperfusion therapy within 24 hours, stent implantation rate, hospitalization time, etc), major adverse cardiac events(MACEs) were recorded.Results Compared with the control group, Onset-to-FMC time and total ischemic time in the study group were significantly prolonged (P<0.05), and the proportion of receiving intravenous thrombolytic therapy was significantly increased, while the proportion of undergoing direct percutaneous coronary intervention(PCI) was significantly decreased(P<0.05), and the proportion of stent implantation and the hospitalization time were significantly decreased (P<0.05). The cardiac function indexes, the serum BNP at admission in the study group were significantly increased (P=0.042).Conclusion Under the situation of prevention and control of COVID-19, Onset-to-FMC time and total ischemic time of STEMI patients were significantly prolonged, the proportion of receiving intravenous thrombolytic therapy increased, while the proportion of receiving direct PCI decreased, but bleeding risk and MACEs have no increase. The study suggested that the optimized treatment approach ensures the effective reperfusion for STEMI patients, without adversely affecting the effectiveness and safety for the treatment of STEMI patients.

Application of BNP, Hcy, AVP, CPT in disease development and efficacy evaluation of patients with chronic pulmonary heart disease

Wei Qingyuan, Yin Xufang, Li Jiaojiao

2021, 36(7):  600-603.  doi:10.3969/j.issn.1004-583X.2021.07.004

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Objective To investigate the value of brain natriuretic peptide(BNP), homocysteine(Hcy), arginine vasopressin(AVP), and copeptin(CPT) in disesae development and efficacy evaluation of patients with chronic pulmonary heart disease(CPHD).Methods Totally 80 CPHD patients, including 42 in remission stage and 38 in exacerbation phase were enrolled from January 2020 to January 2021, 60 patients without CPHD, who came to our hospital for a physical examination at the same time, were served as control group. BNP, Hcy, AVP, CPT of all patients were obtained. Low flow oxygen, clear airway, and heart failure control as well as other therapies were performed in CPHD patients, and BNP, Hcy, AVP, CPT of those 80 CPHD patients were recorded before and after treatment.Results BNP, Hcy, AVP, CPT of CPHD patients were significantly higher than those of without CPHD patients. Before treatment for CPHD patients, BNP, Hcy, AVP, CPT in exacerbation phase were higher than those in remission stage (P<0.05), but they were significant decrease in all CPHD patients after treatment, while the items were still higher in exacerbation phase than in remission stage (P<0.05).Conclusion Compared with those without CPHD, BNP, Hcy, AVP, CPT of CPHD patients were significantly higher with disease development, strengthened inspection will be beneficial to CPHD patients.

Clinical significance of blood lactic acid assisted APACHEⅡ in judging prognosis of elderly SI patients in ICU

Zhang Yuan, Huang Tao, Wang Baoping

2021, 36(7):  604-607.  doi:10.3969/j.issn.1004-583X.2021.07.005

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Objective To study the clinical significance of blood lactate acid(LAC) assisted Acute Physiology and Chronic Health Evaluation Ⅱ(APACHE Ⅱ) in judging the prognosis of elderly severe infections (SI) patients in intensive care unit(ICU).Methods The clinical data of 100 elderly SI patients admitted to the ICU ward of our hospital from July 2017 to July 2018 were retrospectively analyzed, and the patients were divided into good prognosis (survival, n=82) and poor prognosis group (death, n=18) according to their prognosis. The general information at admission including gender, age, site of infection, history of alcohol consumption, smoking history, APACHE-Ⅱ score and LAC level were collected in two groups. Multivariate logistic regression analysis was used to predict the risk factors affecting prognosis of elderly SI patients in ICU.Results The age, APACHEⅡ score and LAC level were significantly higher in poor prognosis group than in good prognosis group (P<0.05). ROC analysis confirmed that age, APACHEⅡ score and LAC level could all be used to predict the prognosis of elderly SI patients in ICU. The areas below the curve were 0.878, 0.886 and 0.884, respectively (all P<0.05). Multivariate logistic regression analysis showed that risk factors affecting prognosis of elderly SI patients in ICU were age ≥73 years, APACHEⅡ score ≥13 points, and LAC≥9.145 mmol/L (all P<0.05).Conclusion The prognosis of elderly SI patients in ICU is affected by age, APACHEⅡ score, and LAC. Clinicians should pay close attention to them, which is of great significance to the prognosis evaluation of patients.

Effects of different doses of clopidogrel bisulfate on hemodynamic indexes and serum miR-191 and miR-18a levels in patients with cerebral infarction

Chen Lilong, Liu Wuchao, Si Qiuyan, Zhang Jianping, Cheng Rong, Wu Quan

2021, 36(7):  608-611.  doi:10.3969/j.issn.1004-583X.2021.07.006

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Objective To investigate the effects of different doses of clopidogrel bisulfate (CB) on hemodynamics, expression of microRNAs(miRs), and nerve function in cerebral infarction (CI).Methods A total of 60 CI patients admitted from Jan 2018 to Jan 2020 were randomly divided into the control group and observation group with 30 patients in each group. Both groups were given different doses of CB on the basis of conventional treatment, the control group was given low dose (50 mg each time, once a day), and the observation group was given regular dose (75 mg each time, once a day). Hemodynamics, miR-191, miR-18a, National Institutes of Health Stroke Scale (NIHSS) score and adverse reactions were compared before and after treatment in two groups.Results After 28 days of treatment, peak systolic velocity, end diastolic velocity and mean velocity in both groups increased significantly, and they were higher in observation group than in control group. Pulsatility index and resistance index in both groups decreased, and they were lower in observation group than in control group (all P<0.05). miR-191 in both groups decreased, and the index was lower in observation group than in control group. But, miR-18a in both groups increased, and the index was higher in observation group than in control group (all P<0.05). Compared with before treatment, NIHSS score in both groups showed decrease after treatment (P<0.05).NIHSS score had significant difference between groups and different time points. Different doses of CB could affect NIHSS score trend over time ( P<0.05). There were no significant difference in the incidence of adverse reactions between two groups (P>0.05).Conclusion Regular dose CB can improve cerebral blood flow for CI patients, which may affect the expression of functional miRs, improve neurological function, therefore, reduce adverse reactions.

Relationship between H-type hypertension and severity of neurological deficit in early acute cerebral infarction of LAA

Gong Tao, Hu Yueyuan, Gao Yun, Guo Chang, Shen Huinan, Wang Dongyu

2021, 36(7):  612-615.  doi:10.3969/j.issn.1004-583X.2021.07.007

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Objective To explore the relationship between H-type hypertension and the severity of neurological deficits in the early acute cerebral infarction of large atherosclerosis (LAA).Methods The general information of 270 patients with acute cerebral infarction of LAA were recorded, the fasting serum homocysteine (Hcy) within 24 hours were performed in all patients. According to with or without of hypertension and serum Hcy levels, the patients were divided into H-type hypertension group (hypertension and Hcy≥10 μmol/L), simple hypertension group (only hypertension), and simple high Hcy group (only Hcy≥10 μmol/L), control group (without hypertension and elevated Hcy). National Institutes of Health Stroke Scale (NIHSS) was used to assess the severity degree of neurological deficits at admission (mild NIHSS ≤5 points, moderate to severe NIHSS> 5 points). The analysis was made for the correlation between H-type hypertension and the severity of neurological deficits in the early acute cerebral infarction of LAA.Results The incidence of H-type hypertension in patients with moderate to severe acute cerebral infarction was higher than that in patients with mild acute cerebral infarction (P<0.01); the interaction index (S)>1 of hypertension and high Hcy on the severity of neurological deficits had a positive interaction.Conclusion H-type hypertension may be a risk factor for the deterioration of neurological function in the early acute cerebral infarction of LAA, and hypertension and high Hcy have a synergistic effect on the deterioration of neurological function.

Clinical efficacy of dapagliflozin combined with liraglutide in the treatment of type 2 diabetes mellitus with metabolic syndrome

Gao Li, Chu Xuan

2021, 36(7):  616-619.  doi:10.3969/j.issn.1004-583X.2021.07.008

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Objective To investigate the clinical efficacy of dapagliflozin combined with liraglutide in the treatment of type 2 diabetes mellitus(T2DM) with metabolic syndrome.Methods Fifty-two T2DM patients concurrent with metabolic syndrome were selected and randomly divided into the control group (n=26) and the observation group (n=26), according to 1∶1.The control group was treated with liraglutide, and the observation group was additionally treated with dapagliflozin on the basis of the control group.The course of treatment was 12 weeks. The changes of related indicators were compared before and after treatment in two groups.Results After treatment, the blood glucose metabolism index, islet function index, body mass index, waist circumference, blood pressure, blood lipids in both groups were improved(P<0.05). The levels of fasting blood glucose, 2 h postprandial blood glucose, glycosylated hemoglobin, insulin resistance index,body mass index, waist circumference, systolic blood pressure, diastolic blood pressure, total cholesterol, triglycerides in the observation group were significantly decreased compared with the control group after treatment(P<0.05), and high-density lipoprotein cholesterol, fasting insulin and pancreatic β cell function index were significantly increased(P<0.05), while low-density lipoprotein cholesterol had no difference(P>0.05). There was no statistical difference in the incidence of adverse reactions between the two groups during treatment(P>0.05).Conclusion The combination of dapagliflozin and liraglutide for T2DM concurrent with metabolic syndrome can effectively control blood sugar, reduce weight, improve obesity, regulate blood pressure and lipid metabolism, reduce insulin resistance and improve islet function, and have good safety.

Differential expression of IGF1R antisense noncoding RNA in hepatocellular carcinoma

Xie Zhihai, Zhou Zhicong, Gui Yuan, Sun Jingfeng

2021, 36(7):  620-622.  doi:10.3969/j.issn.1004-583X.2021.07.009

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Objective To detect the difference of insulin-like growth factor 1 receptor(IGF1R) antisense noncoding RNA(IGF1RAIN RNA) content between hepatocellular carcinoma and normal hepatic tissues, and to verify its possibility as a characteristic marker of hepatocellular carcinoma.Methods Reverse transcriptase polymerase chain reaction(RT-PCR) was used to detect the expression of IGF1RAIN RNA in 30 cases of hepatocellular carcinoma tissues, adjacent tissues and 16 cases of normal hepatic tissues(adjacent to the resection margin of hepatic hemangioma and hepatic cyst). Combined with the clinical and pathological data, the relationship between the content and hepatocellular cancer was analyzed.Results The content of IGF1RAIN RNA was significantly lower in hepatocellular cancer than that in normal hepatic tissues and adjacent tissues (P<0.05); IGF1RAIN RNA was different in tumor size, tumor differentiation and pathological stage(P<0.05).Conclusion The content of IGF1RAIN RNA was significantly decreased in hepatocellular cancer. It may be a marker for early diagnosis of hepatocellular cancer.

Correlation between serum β-CTx and TRACP-5b and the severity and prognosis of multiple myeloma bone disease

Zhang Lihong, Ma Bing

2021, 36(7):  623-627.  doi:10.3969/j.issn.1004-583X.2021.07.010

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Objective To explore the relationship between serum type Ⅰ collagen carboxy-terminal peptide β-specific sequence(β-CTx), anti-tartrate acid phosphatase 5b isoenzyme(TRACP-5b) and the severity and prognosis of multiple myeloma bone disease(MMBD).Methods The clinical data of 142 patients with MMBD from Jan. 2016 to Jan. 2020 were retrospectively analyzed. When treatment guidelines and imaging examination were performed, the patients were divide into level Ⅰ group, level Ⅱ group, level Ⅲ group and level Ⅳ group according to disease severity. Enzyme-linked immunosorbent assay (ELISA) were used to detect serum levels of β-CTx and TRACP-5b of the patients. Spearman was used to analyze the correlation between serum β-CTx, TRACP-5b and severity of MMBD. All patients were divided into survival group and death group according to whether survived. Cox regression was used to analyze the related factors affecting prognosis.Results The serum β-CTx and TRACP-5b increased with severity grade in four groups(P<0.05). Spearman analysis showed that β-CTx and TRACP-5b levels were positively correlated with the severity of MMBD (r=0.753, 0.627, P<0.05). At the follow-up time, 98 cases were survival and 44 cases were death in 142 patients. The proportion of International Staging System(ISS) level Ⅲ, MMBD severity level Ⅳ, bone disease of pathological fracture, β2-MG, β-CTx and TRACP-5b levels were higher in death patients than in survival patients (P<0.05). The difference in survival curves of β-CTx/TRACP-5b of patients was statistically significant (P<0.05). Cox regression analysis showed that the risk factors for affecting prognosis in MMBD patients were β-CTx, TRACP-5b, β2-MG levels, ISS level Ⅲ, MMBD severity level Ⅳ, and bone disease of pathological fracture (P<0.05).Conclusion Serum β-CTx and TRACP-5b increase with the severity of MMBD, and both are the risk factors affecting prognosis of MMBD.

Interpretation on Chinese Expert Consensus of Irritable Bowel Syndrome in 2020

Song Yiran, Liang Xiaonan, Li Chenyang, Zhang Xiaolan

2021, 36(7):  628-631.  doi:10.3969/j.issn.1004-583X.2021.07.011

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Irritable bowel syndrome(IBS), as a common chronic disease in clinic, has obtained deep understanding constantly updated in recent years. In the second half of 2020, the Study Group of Gastrointestinal Functional Disorders of Chinese Society of Gastroenterology called on many domestic experts to formulate Chinese Expert Consensus of Irritable Bowel Syndrome in 2020. Based on 2015 consensus, this consensus improved and updated the definitions on etiology, epidemiology, pathogenesis, diagnoses and treatments of IBS. This paper interpreted the consensus in order to better guide the basic research and clinical diagnosis and treatment of IBS.

Application of the principle of inter-subjectivity in doctor-patient communication from doctor's perspective

Liu Yunzhang, Ding Zhiguang, Cui Zhangguo, Yang Jintao

2021, 36(7):  632-636.  doi:10.3969/j.issn.1004-583X.2021.07.012

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The essence of doctor-patient communication is the process of forming intersubjectivity on the basis of the development of subjectivity, replenishing intersubjectivity, enriching and developing subjectivity, and it maintains the existence and development of doctor-patient relationship. Based on the doctor's perspective, the intersubjectivity in the process of doctor-patient communication is mainly reflected in three levels, namely, the intersubjectivity between the patient's disease perception and the doctor's test results in the aspect of disease cognition, the intersubjectivity between the patient's life perspective and the doctor's knowledge perspective in the aspect of medical decision-making, and the intersubjectivity between the patient's evaluation and the doctor's evaluation in the aspect of satisfaction evaluation. Doctors and patients should follow the common value goal, adhere to the principle of intersubjectivity, achieve intersubjectivity through effective communication, and build doctor-patient fate community.

Hypertrophic cranial pachymeningitis: Two cases report and literature review

Wang Lu, Zeng Zhaohao, Luo Hong, Cen Haimei, Zhang Yu

2021, 36(7):  637-640.  doi:10.3969/j.issn.1004-583X.2021.07.013

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Hypertrophic cranial pachymeningitis(HCP) is a clinical disease involving local or diffuse thickening of the dura mater, with or without related inflammation. Due to lower incidence for HCP and diversified clinical manifestations, the difficulty of clinical diagnosis significantly increased. In this article, recurrent headache in two HCP cases were regarded as clinical feature, one of them showed optic nerve damage, the headache improved significantly after hormone treatment. The disease was discussed in conjunction with literature review.