Table of Content

20 August 2021, Volume 36 Issue 8

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Effects of goal-directed fluid therapy on intraoperative balance between oxygen delivery and consumption and postoperative outcomes in thoracic surgery patients: a meta-analysis

Li Guanzhu, Lai Yuan, Zheng Xiaozhuo, Jiang Ran, Wei Ke

2021, 36(8):  677-684.  doi:10.3969/j.issn.1004-583X.2021.08.001

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Objective To systematically evaluate the effects of goal-directed fluid therapy (GDFT) on intraoperative balance between oxygen delivery and consumption and postoperative outcomes in patients undergoing thoracic surgery. Methods We searched PubMed, Cochrane Library, VIP, CNKI and WanFang Database from inception to October 2019, literature selection, quality evaluation and data extraction were performed according to inclusion and exclusion criteria, and meta-analysis was completed by RevMan 5.3. Results A total of 11 eligible randomized controlled trials (RCTs) were enrolled, including 810 patients. The results of meta-analysis showed that intraoperative oxygenation index (OI) was significantly increased by the use of GDFT for thoracic surgery patients (at the end of one-lung ventilation [OLV]: MD=57.04, 95%CI [24.04, 90.05], P=0.001; at the end of surgery: MD=97.33, 95%CI[27.21, 167.45], P=0.007), significantly decreased for postoperative blood lactic acid (Lac) (MD=-0.51, 95%CI[-0.84, -0.18], P=0.002), significantly increased for intraoperative cardiac index (CI) (at the end of OLV: MD=0.42, 95%CI [0.23, 0.61], P<0.01; at the end of surgery: MD=0.40, 95%CI[0.26, 0.54], P<0.01); meanwhile, incidence of postoperative complications were significantly decreased with use of GDFT, including the incidence of postoperative pulmonary infection (RR=0.35, 95%CI[0.16, 0.76], P=0.008), incidence of acute lung injury (ALI) (RR=0.15, 95%CI[0.04, 0.67], P=0.010), incidence of postoperative nausea and vomiting (PONV) (RR=0.39, 95%CI [0.22, 0.68], P=0.001), as well as reduced hospitalization time in GDFT group (MD=-0.66, 95%CI [-1.20, -0.12], P=0.020).Conclusion For thoracic surgery patients, using GDFT can effectively improve tissue perfusion and balance of oxygen delivery and consumption, reduce incidence of PONV and complications of pulmonary, decrease medical expenses, and improve the prognosis of patients.

Relationship between long non-coding RNA overexpression and poor prognostic of small cell lung cancer: a meta-analysis

Xu Ying, Han Caijuan, Fan Hong, Meng Zerong, Wang Xiaojun, Liu Hua

2021, 36(8):  685-690.  doi:10.3969/j.issn.1004-583X.2021.08.002

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Objective This meta-analysis aims to come to a judgement the clinical value of long non-coding RNA(LncRNA) as a prognostic marker and potential clinicopathological value in small cell lung cancer(SCLC).Methods A comprehensive search of available literature resources included PubMed, Embase, Cochrane Library, China National Knowledge Infrastructure, Wanfang Database, CQVIP Journal Database, and Chinese Biology Medicine database to study the association between LncRNA overexpression and prognosis for SCLC up to May 2020. Related information was screened and extracted from the qualified studies by two independent reviewers. After the quality evaluation, the statistical software STATA12.0 was used to perform Meta quantitative comprehensive analysis. Results A total of thirteen case-control studies including 1302 SCLC patients were involved. The results revealed that: LncRNA overexpression patients had poor disease stage (Odds ratio, [OR]=6.10, 95% confidence interval[CI] (4.69, 7.93), P<0.01), poorer chemosensitivity (OR=5.17, 95%CI[3.44, 7.77], P<0.01), poorer survival status (OR=5.96, 95%CI[4.22, 8.40], P<0.01), overall survival (OS) (hazard ratio, [HR]=3.33, 95%CI[2.65, 4.19], P<0.01) and progression-free survival (PFS) (HR=4.88, 95%CI[3.00, 7.94), P<0.01).Conclusion LncRNA overexpression can predict poor survival and poor clinicopathological features in SCLC patients, may be a potential prognostic marker. However, the above conclusion still needs to be supported by more high-quality studies.

Analysis of norovirus genotypes of patients with acute gastroenteritis in Mentougou District of Beijing from 2018 to 2020

Liu Haitao, Cao Dianqi, Zhang Bowen, Lyu Qiuyan, Su Jian

2021, 36(8):  691-695.  doi:10.3969/j.issn.1004-583X.2021.08.003

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Objective To investigate the norovirus genotypes of patients with acute gastroenteritis in Mentougou District of Beijing. Methods Ribonucleic Acid(RNA) of norovirus was detected in fecal samples of acute gastroenteritis patients by real time fluorescent quantitative PCR, and region of polyzyme and capsid protein of type samples of norovirus GⅡ was amplified by general RT-PCR, in order to determine sequence of amplified. Results Positive rate of norovirus was 10.75%, 95.89% for GⅡ gene group and 4.11% for G Igene group were detected. GⅡ gene of norovirus include GⅡ.6 [P7], GⅡ.4 [P16], GⅡ.3 [P12], GⅡ.2 [P16] and GⅡ.17 [P17], variation of each genotype virus was not obvious, and nucleotide homology was 86%-100%. Conclusion There are many genotypes and different recombinant subtypes of norovirus in Mentougou District of Beijing, continuous monitoring of dynamic epidemic characteristics of norovirus recombinant genotypes is helpful to improve ability of early warning for disease prevention and control.

Relationship between indoleamine 2, 3-dioxygenase and peripheral blood CD4 + in patients with ulcerative colitis

Zhang Xiumin, Zhao Changdong, Li Xue, Lu Xuefeng, Liu Weizhong, Wang Shufang

2021, 36(8):  696-698.  doi:10.3969/j.issn.1004-583X.2021.08.004

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Objective To explore the relationship between indoleamine 2, 3-dioxygenase (IDO) and CD4 +in peripheral blood in patients with ulcerative colitis(UC).Methods Seventy-two patients with UC from August 2014 to January 2019 were retrospectively analyzed, and they were used as the observation group and 72 controls in the physical examination center during the same period were recruited. Aim to compare IDO and CD4+ between groups at different times and analyze the correlation between the two in the observation group.Results Compared with control group, IDO of patients in observation group was higher, while CD4+ was lower (all P<0.05). In observation group, the expression of IDO at active period was better than that at remission period, while CD4+ in peripheral blood of patients was lower than that at remission period (all P<0.05); CD4+ in peripheral blood of moderate-to-severe patients was lower than that of mild patients, which of severe patients was lower than that of moderate patients (all P<0.05); IDO of moderate-to-severe patients was higher than that of mild patients, which of severe patients was higher than that of mild patients (all P<0.05). Pearson correlation analysis showed that IDO was negatively correlated with CD4+ in peripheral blood in UC patients (r=-0.801, P=0.000).Conclusion The serum IDO level of UC patients increased, and the peripheral blood CD4+ expression level decreased, and they were negatively correlated.

Correlation study of epicardial adipose tissue volume and essential hypertension with coronary heart disease

Wang Yazhu, Guo Yunfei, Si Yueqiao, Liu Chao, Zhang Ying

2021, 36(8):  699-703.  doi:10.3969/j.issn.1004-583X.2021.08.005

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Objective To explore the relationship between epicardial adipose tissue(EAT) volume and essential hypertension(EH) with coronary heart disease(CHD) for its pathogenic risk and predictive value. Methods The study involved 408 patients with EH who underwent coronary computed tomographic angiography(CCTA) from December 2014 to June 2017 in our hospital. The patients were divided into study group (n=319) and control group (n=89) by CCTA diagnosis of CHD and non-CHD. The differences in terms of clinical baseline characteristics and EAT volume between two groups were compared. Receiver operating characteristic (ROC) curve were used to assess the diagnostic value of EAT volume for EH with CHD and to determine the optimal cut-off value. Logistic regression analysis to assess risk factors for combined CHD in EH. EAT volume with Gensini score and coronary artery calcification score (CACS) were evaluated with Spearman correlation analysis. Results The EAT volume was higher in CHD group than in non-CHD group (P<0.05). ROC curve analysis showed that the AUC of EAT volume in diagnosing EH combined CHD was 0.698(P<0.05). When the truncation value of EAT volume was 172.5 cm³, the diagnostic EH concurrent CHD was most effective, with the sensitivity and specificity of 42.7% and 94.3%. Multi-factor logistic regression analysis showed that EAT volume≥172.5 cm³ was independent risk factors for EH combined with CHD(P<0.05), the relative hazard level was 10.050(3.459-29.204).Spearman correlation analysis showed that EAT volume was positively correlated with Gensini scores and CACS (r=0.207, 0.235, P<0.05). Conclusion Measurement of EAT volume by CCTA may be a new clinical non-invasive diagnostic tool for EH with CHD. EAT volume was positively correlated with Gensini score and CACS in patients with EH. High EAT volume was an independent risk factor for EH with CHD.

Application value of cerebrospinal fluid and serum PCT and CRP in diagnosis of central nervous system infection

Li Dan, Hua Guohui

2021, 36(8):  704-707.  doi:10.3969/j.issn.1004-583X.2021.08.006

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Objective To investigate the application value of cerebrospinal fluid and serum procalcitonin(PCT), C-reactive protein(CRP) in diagnosis of infection of the central nervous system(ICNS). Methods Totally 72 ICNS patients admitted to our hospital from Jan 2016 to Dec 2020 were selected as observation group, they were divided into pyogenic infection subgroup (44 cases) and viral infection subgroup (28 cases) by infection type; in addition, 80 no-ICNS patients were regarded as control group. Cerebrospinal fluid and serum CRP, PCT level between groups were counted.Results Cerebrospinal fluid and serum PCT, CRP were higher in observation group than in control group (P<0.05); PCT, CRP in serum and cerebrospinal fluid were higher in pyogenic infection subgroup than in viral infection subgroup (P<0.05); ROC curve analysis showed that important factors for predicting ICNS were PCT (AUC=0.890), CRP (AUC=0.823) of cerebrospinal fluid, as well as serum PCT (AUC=0.793), CRP (AUC=0.729)(P<0.01). Conclusion Cerebrospinal fluid and serum PCT, CRP can be used as an indicator for diagnosis of ICNS, of which PCT of cerebrospinal fluid has a higher diagnostic efficiency.

Association between anxiety disorder and insulin resistance in middle-aged and elderly

Zhang Ruyang, Feng Qian

2021, 36(8):  708-712.  doi:10.3969/j.issn.1004-583X.2021.08.007

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Objective To explore the correlation between anxiety disorder and insulin resistance(IR) in middle-aged and elderly. Methods A total of 159 patients aged 50 to 80 years who were first diagnosed with anxiety disorder were randomly selected as the study group from January 2019 to December 2019. 150 healthy subjects were randomly selected as the control group at the same time. Demographic data of two groups were collected, and the Hamilton Anxiety Scale(HAMA) was used for grading.Fasting insulin(FINS) and fasting blood glucose(FPG) were measured and compared between groups. Homeostatic model assessment of insulin resistance was used to calculate insulin resistance index(HOMA-IR).Pearson correlation analysis was used to explore relationship between anxiety disorder and IR in middle-aged and elderly.Results FINS, HOMA-IR, HAMA score were significantly higher in study group than in control group (all P<0.05). Pearson correlation analysis showed that HOMA-IR had no significant correlation with HAMA score(r=-0.049, P=0.536).Conclusion The level of IR in middle-aged and elderly with anxiety disorder is higher than in healthy people of the same age, but there is no correlation between IR and the severity of anxiety.

Effect of empagliflozin on ventricular remodeling in patients with type 2 diabetes mellitus and coronary heart disease

Yin Xiaokang, Zhang Jiping, Zhu Yugang, Shen Hongxia, Wang Defeng

2021, 36(8):  713-718.  doi:10.3969/j.issn.1004-583X.2021.08.008

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Objective To investigate the effect of empagliflozin on ventricular remodeling in patients with type 2 diabetes mellitus(T2DM) complicated by coronary heart disease(CHD). Methods A total of 128 patients with T2DM complicated by CHD were randomly divided into two groups, 64 cases in each group. The control group was treated with conventional oral medicine, and the experimental group received empagliflozin on bases of conventional oral medicine, a course for 12 weeks. The experimental indicators were observed, including systolic blood pressure(SBP), diastolic blood pressure(DBP), fasting blood glucose(FBG), 2 h postprandial glucose (2 hPG), glycosylated hemoglobin A₁c(HbA₁c), total cholesterol(TC), triglycerides(TG), low-density lipoprotein cholesterol(LDL-C), brain natriuretic peptide(BNP), C-troponin I, creatine kinase-mb(CKMB), left ventricular end diastolic volume(LVEDV), left ventricular end systolic volume(LVESV), left ventricular ejection fraction(LVEF), left ventricular fractional shortening(LVFS), left ventricular end-diastolic diameter(LVEDD), left ventricular end-stage systole diameter(LVESD), interventricular septum(IVS), left ventricular posterior wall(LVPW), Fasting Insulin(FINS), C-peptide, Homeostasis model assessment- β(HOMA-β), Homeostasis Model Assessment of Insulin Resistance(HOMA-IR).Results Compared with before treatment, SBP, DBP, FBG, 2 hPG, HbA₁c, TC, TG, LDL-C, LVEDV, LVESV, LVEDD, LVESD, IVS, LVPW and HOMA-IR in both groups decreased. While LVFS, FINS, C-peptide and HOMA-β increased after treatment (P<0.05). After treatment, SBP, DBP, FBG, 2 hPG, HbA₁c, TC, TG, LDL-C, LVEDV, LVESV, LVEDD, LVESD, IVS, LVPW and HOMA-IR were lower in experimental group than in control group.LVFS, FINS, C-peptide, HOMA-β were higher in experimental group than in control group (P<0.05).Conclusion Empagliflozin can improve ventricular remodeling in patients with T2DM complicated by CHD, which have more advantages compared with conventional hypoglycemic drugs and cardiovascular drugs.

Study of mobile phone dependence and sleep disorder in patients with pulmonary tuberculosis

Li Baiyuan, Li Yuanjun, Li Lingxia

2021, 36(8):  719-723.  doi:10.3969/j.issn.1004-583X.2021.08.009

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Objective To explore the effects of mobile phone dependence and sleep disorder on nutritional status, inflammatory level and disease severity of patients with pulmonary tuberculosis. Methods A total of 154 young pulmonary tuberculosis patients admitted from January 2019 to December 2019 were selected. The patients were divided into four groups, group A (without mobile phone dependence or sleep disorder) (n=50), group B (only mobile phone dependence) (n=49), group C (only sleep disorder) (n=35) and group D (mobile phone dependence with sleep disorder) (n=20) according to with or without mobile phone dependence and sleep disorder.The differences of nutritional status, inflammatory level and disease severity among groups were analyzed. Results Compared with the group A, body mass index (BMI) and absolute lymphocyte value (LYM) in groups D were significantly lower; C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) were significantly higher; pathogenic positive, pulmonary cavity, bronchial tuberculosis were more likely to occurre (all P<0.05).Conclusion For pulmonary tuberculosis patients, mobile phone dependence combined with sleep disorder can affect their nutritional status, inflammatory level and disease severity. If these are intervened as soon as possible, the patient's condition may be improved.

Analysis of pathogenic bacteria resistance and prognosis of bloodstream infection

Peng Zhenli, Jiang Yao, Jia Lijuan, Wang Yanxin, Xue Weixiao, Shi Huiting

2021, 36(8):  724-729.  doi:10.3969/j.issn.1004-583X.2021.08.010

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Objective To study the pathogenic bacteria resistance in patients with bloodstream infections in intensive care unit(ICU), to analyze the prognostic factors for bloodstream infection, and to provide references for early antibacterial treatment. Methods Retrospective research method was used to count the clinical data of patients diagnosed with bloodstream infection in the Department of ICU of Chui Yang Liu Hospital Affiliated to Tsinghua University from January 2014 to December 2020, and the constitute and resistance of blood culture-positive pathogens were analyzed. The patients were divided into survival and non-survival groups according to the survival and death during the hospitalization period. The gender, age, hospital infection, underlying disease, time-to-positivity of blood culture, occurrence time of bloodstream infection, etc. were collected. Factors in which the differences were statistically significant in univariate analysis were included in Logistic regression analysis to further analyze the factors affecting patients' prognosis. Results There were 80 cases of bloodstream infection patients with complete case data, and a total of 84 strains of pathogens were isolated. Pathogens of bloodstream infections were coagulase-negative staphylococci, staphylococcus aureus, escherichia coli, acinetobacter, and klebsiella pneumoniae in turn. Pathogens with the percent of 67.86% are multi-drug resistant strains. No gram-positive strains resistant to vancomycin, linezolid and teicoplanin were found. ESBLs-producing Klebsiella pneumoniae and Escherichia coli had high resistance rates to cefotaxime, cefepime, aztreonam, ciprofloxacin, levofloxacin, moxifloxacin, tetracycline, and chloramphenicol. Univariate analysis showed that two pathogenic bacteria simultaneously growing in the blood culture were related to the prognosis of bloodstream infection(P<0.05), and no risk factor related to the prognosis of bloodstream infection was found in multivariate logistic regression analysis.Conclusion The distribution of bloodstream infection pathogens varies greatly in different regions and hospitals. Main pathogens of bloodstream infections in the Department of ICU in this hospital are dominated by Gram-positive bacteria, and its mainly composed methicillin-resistant Staphylococcus. The condition of severely ill patients with bloodstream infection is complex, there are many factors influencing the prognosis, great samples and multicenter studies are required.

Effect of Buzhong Yiqi Decoction combined with FOLFIRI chemotherapy on immunity and inflammation in patients with colorectal cancer

Li Peipei, Cao Yang, Wang Haicun, Dui Weihua

2021, 36(8):  730-734.  doi:10.3969/j.issn.1004-583X.2021.08.011

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Objective To analyze the application effect of Buzhong Yiqi Decoction Combined with FOLFIRI chemotherapy in the treatment of colorectal cancer. Methods 80 patients with colorectal cancer in our hospital from January 2016 to January 2020 were selected and divided into two groups according to different treatment schemes. The control group was treated with FOLFIRI chemotherapy, while the observation group was treated with Buzhong Yiqi Decoction. Immune function index, inflammatory factor level, blood routine, liver and kidney function, clinical efficacy and quality of life score between groups before and after treatment were observed and analyzed.Results After treatment, total effective rate was significantly higher in observation group than in control group (P<0.05); significantly higher CD3⁺, CD4⁺, CD4⁺/CD8⁺ level were detected in groups and increase degree in observation group was even higher (P<0.05); significantly higher serum amyloid A(SAA) and C-reactive protein(CRP) in groups and the decline of which in observation group were lower than in control group (P<0.05); significantly lower platelet count and white blood cell count in groups were detected, which were more common to see in observation group (P<0.05); difference is no significant in liver function between groups before and after treatment (P>0.05). significantly decreased serum creatinine level in groups were detected and decreased degree in observation group was even lower (P<0.05); the quality of life and in groups were significantly improved and which in observation group were better (P<0.05); compared with control group, adverse reaction in observation group were lower (P<0.05). Conclusion FOLFIRI chemotherapy has a good therapeutic effect for patients with colorectal cancer; when combined with Buzhong Yiqi Decoction, it can further improve immunity and inflammatory reaction, improve quality of their life, reduce adverse reaction, which is a safe and effective and feasible for treatment.

Protection and effect of dexmedetomidine on liver and kidney function of incarcerated inguinal hernia caused intestinal ischemia and reperfusion injury in the elderly surgical patients

Zheng Zilei, Yang Yanjiang, Li Haiying

2021, 36(8):  735-738.  doi:10.3969/j.issn.1004-583X.2021.08.012

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Objective To investigate the clinical effect of dexmedetomidine on liver and kidney function and proinflammatory cytokines of incarcerated inguinal hernia in the elderly surgical patients. Methods Sixty elderly patients with incarcerated inguinal hernia, who met American Society of Anesthesiologists(ASA) Classification Ⅰ-Ⅱ, were randomly divided into experimental group and control group. All patients were preoperative fasting water and food and had a tension-free hernia repair under epidural anesthesia. Patients of experimental group received a pumping injection of dexmedetomidine at a rate of 0.3 μg/(kg·h). Patients of control group received a pumping injection of normal saline at the same rate. The venous blood sampled before operation and the first day after the operation were used to assay the liver and kidney function including alanine transaminase(ALT), aspartate aminotransferase(AST), blood urea nitrogen(BUN), creatinine(Cre) and serum C-reactive protein(CRP), interleukin-6(IL-6), IL-8 and tumor necrosis factor-α(TNF-α) levels. Results Hepatic and kidney function-related indicators and CRP, IL-6, IL-8, TNF-α after operation were significantly lower in experimental group than in control group (P<0.05 or 0.01). Conclusion Dexmedetomidine has protective effects on liver and renal function for elderly surgical patients with incarcerated inguinal hernia, and the mechanism may be related to the reduction of inflammatory response caused by intestinal ischemia and reperfusion injury.

Clinical value of tardus-parvus pattern spectrum of renal artery combined with echocardiography in adult aortic coarctation

Li Zhiyong, Li Xing, He Zhen

2021, 36(8):  739-743.  doi:10.3969/j.issn.1004-583X.2021.08.013

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Objective To investigate the clinical value of tardus-parvus pattern spectrum of renal artery combined with echocardiography in adult aortic coarctation.Methods The clinical data of 12 cases of adult aortic coarctation were retrospectively analyzed, and the clinical value of tardus-parvus pattern spectrum of renal artery combined with echocardiography was evaluated.Results There were significant differences in peak systolic velocity, acceleration time and resistance index between groups (P<0.05).Eleven cases of adult aortic coarctation were diagnozed by tardus-parvus pattern spectrum of renal artery combined with echocardiography, and one case was missed. The coincidence rate of ultrasonic diagnosis was 91.66%. There were 12 cases of adult aortic coarctation combined with aortic valve binarization in two cases, patent ductus arteriosus in one case, and the rest were isolated aortic coarctation.Conclusion The tardus-parvus pattern spectrum of renal artery can be used as an indirect sign to indicate the presence of aortic coarctation. Combined with echocardiography, the site of stenosis can be determined, and whether it is complicated with intracardiac malformation.The result has certain clinical value.