Table of Content

20 September 2021, Volume 36 Issue 9

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Effect of levothyroxine for pregnancy outcomes due to subclinical hypothyroidism during pregnancy: A meta-analysis

Cai Kexin, Guo Hongju, Yu Shuxia, Chang Lirong

2021, 36(9):  773-777.  doi:10.3969/j.issn.1004-583X.2021.09.001

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Objective To evaluate the effect of levothyroxine(LT₄) for pregnancy outcomes in subclinical hypothyroidism(SCH) by meta-analysis. Methods Randomized controlled trials(RCT) of levothyroxine for pregnancy outcomes in SCH were searched from the computer databases according to the related inclusion and exclusion criteria. Following retrieval and quality evaluation, Rev Man 5.3 software was used for statistical analysis. Results A total of 14 literature including 3,596 patients were enrolled. LT₄ reduced the incidence of gestational hypertension, gestational diabetes mellitus, pre-eclampsia, postpartum hemorrhage, premature rupture of membranes, anemia, premature delivery, abortion, neonatal distress, low birth weight infants. Compared with no LT₄ use, the above items in LT₄ group were lower significantly. Conclusion For pregnancy outcomes due to SCH, LT₄ can decrease complications and incidence of adverse neonatal outcomes.

Effects of ticagrelor and clopidogrel on vascular endothelial function of patients with coronary heart disease

Guo Jiamin, Zhang Guangming, Yang Jing, Gu Guoqiang, Lu Rui, Xing Hanghang, Cui Wei

2021, 36(9):  778-781.  doi:10.3969/j.issn.1004-583X.2021.09.002

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Objective Some basic studies and clinical trials have shown that P2Y12 receptor antagonists have protective effects on vascular endothelial function. This study was designed to compare the protective effects of ticagrelor and clopidogrel on vascular endothelium. Methods Eighty cases of acute coronary syndrome(ACS) inpatients who underwent percutaneous coronary intervention(PCI) were enrolled. All patients were randomly divided into two groups in a 1∶1 ratio, 40 cases in ticagrelor group with ticagrelor 90 mg twice daily, 40 cases in clopidogrel group with clopidogrel 75 mg once daily. All patients were given aspirin and statins to regulate blood lipids. Serum nitric oxide(NO) and endothelin-1(ET-1) were measured at the admission and after 1-month of the treatment. Results The serum NO of all patients was significantly higher after treatment compared with before administration(P<0.01), but serum ET-1 level was significantly lower (P<0.01). After 1-month treatment, serum NO was significantly higher in ticagrelor group than in clopidogrel group (P<0.01). But the serum ET-1 level was significantly lower in ticagrelor group than in clopidogrel group(P=0.016). Conclusion For patients with ACS undergoing PCI, P2Y12 receptor antagonist has the effect of protecting vascular endothelial function, while ticagrelor can effectively improve the vascular endothelial function, and promote early recovery of vascular function, which is superior to clopidogrel in this respect.

Clinical effect of sacubitril-valsartan combined with activin on acute left heart failure

Luo Fanglin, Guan Suying, Wu Guoxiang

2021, 36(9):  782-785.  doi:10.3969/j.issn.1004-583X.2021.09.003

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Objective To investigate the clinical effect of sacubitril-valsartan combined with recombinant human brain natriuretic peptide for acute left heart failure(ALHF). Methods A total of 112 ALHF patients admitted to our hospital from June 2018 to October 2020 were by random number table method divided into experimental group (56 cases received sacubitril-valsartan combined with activin) and control group (56 cases received sacubitril-valsartan). After treatment, the total effective rate, heart rate, N-terminal pro-brain natriuretic peptide(NT-proBNP) and left ventricular ejection fraction(LVEF) were analyzed. Malondialdehyde(MDA), superoxide dismutase(SOD) and glutathione peroxidase(GSH-Px) were compared in two groups. Results The total effective rate in experimental group was higher than that of control group (92.86% vs 76.79%, P<0.05). After treatment, the heart rate, NT-proBNP and MDA were lower in experimental group than in control group (P<0.05), while LVEF, SOD and GSH-Px were higher than in control group (P<0.05). Conclusion Sacubitril-valsartan combined with activin can improve cardiac function for ALHF patients, reduce oxidative stress, and stably enhance clinical efficacy.

Effect of ginkgolide meglumine in NSE, hs-CRP and quality-of-life of patients with acute cerebral infarction

Huang Xubing, Lin Yang, Cai Wenjing

2021, 36(9):  786-789.  doi:10.3969/j.issn.1004-583X.2021.09.004

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Objective To study the effect of ginkgolide meglumine combined with batroxobin on serum NSE, high-sensitivity C-reactive protein(hs-CRP) and quality-of-life in patients with acute cerebral infarction(ACI). Methods Totally 108 ACI inpatients were randomly divided into two groups. On the basis of routine treatment, 54 cases in control group were injected with batroxobin, and 54 cases in observation group with ginkgolide meglumine combined with batroxobin. After 14 days of treatment. The clinical efficacy, 1-week, 1-month, and 3-month Barthel index, serum of neuron-specific enolase(NSE) and hs-CRP in two groups were observed. The evaluations were performed in modified Rankin Scale(mRS) scores on the 7th, 15th, 30th and 60th day of treatment, and the incidence of adverse reactions during this period. Results The total effective rate was significantly higher in observation group than in control group (92.15% vs 74.07%, P<0.05). After treatment, Barthel score in observation group was significantly higher than that before treatment, and the score was higher than in control group(P<0.05). The NSE and hs-CRP were significantly lower in observation group than before treatment(P<0.05). mRS score was significantly lower in observation group as compared with control group(P<0.05). There was no significant difference in the incidence of adverse reactions between groups (P>0.05). Conclusion For ACI patients, Ginkgolide meglumine combined with batroxobin has good curative effect, which can significantly improve their activity function, dysfunction, quality-of-life, prognosis, and has high safety.

TG/HDL-C, TyG and non-HDL-C in predition of metabolic syndrome incidence in middle-aged and elderly women

Zhao Wei, Luo Lan, Li Shen, Dong Yingying, Li Xinyu, Gao Zhengnan

2021, 36(9):  790-794.  doi:10.3969/j.issn.1004-583X.2021.09.005

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Objective To investigate the predictive values of TG/HDL-C,TyG index and non-HDL-C for incidence risk of metabolic syndrome(MS) in middle-aged and elderly women. Methods A cohort study was performed from 2011 to 2014 in communities in Dalian by recruiting 2,098 female residents aged ≥40 years. Binary logistic regression model was used to analyze the relationship between TG/HDL-C, TyG index, non-HDL-C and MS of new diagnosis. ROC curve was built in three indicators for their predictive values in MS. Results Totally 363 MS cases(17.30%) were diagnosed from follow-up participants(n=2,098). Binary logistic regression analysis showed that elevated TG/HDL-C, TyG index and non-HDL-C were independent risk factors in MS (OR=2.297, 95%CI 1.822-2.897, OR=3.370, 95%CI 2.515-4.516, OR=1.555, 95%CI 1.367-1.770, P<0.01). AUC of three indicators was 0.721, 0.708 and 0.614 respectively in predicting MS(P<0.05), and optimal cut-off value was 0.70, 8.49 and 4.06. AUC was larger in both TG/HDL-C and TyG index than in non-HDL-C (Z=6.113, Z=5.819, all P<0.01). Conclusion Higher TG/HDL-C, TyG index and non-HDL-C for three years were independent risks of MS in middle-aged and elderly women. TG/HDL-C and TyG index showed good predictions for MS.

Risk factors and pregnancy outcomes of gestational diabetes mellitus in Nanchong area

Shi Yao, Wang Hu, Chen Min, Li Yuling

2021, 36(9):  795-798.  doi:10.3969/j.issn.1004-583X.2021.09.006

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Objective To discuss the risk factors and pregnancy outcomes of gestational diabetes mellitus(GDM) for GDM prevention and treatment in Nanchong area. Methods This study enrolled 1,800 pregnant women who performed prenatal check-up and delivery in Affiliated Hospital of North Sichuan Medical College from July 1, 2018 to September 30, 2019. Among the subjects, 537 cases were diagnosed GDM (GDM group), 1,263 cases with normal blood glucose (NGT group).The key observation involved the incidence, risk factors and pregnancy outcomes of GDM. Results In Nanchong area, the incidence of GDM was 29.83%. Age, residence, prenatal body mass index(BMI), polycystic ovary syndrome(PCOS), hepatitis B surface antigen(HBsAg), hypertensive disorder of pregnancy(HDP), thyroid function during pregnancy, scar uterus, in vitro fertilization(IVF), abortion history and delivery history were related to the onset of GDM. GDM was related to cesarean section, HDP, intrahepatic cholestasis of pregnancy(ICP), postpartum hemorrhage, preterm delivery, and macrosomia(all P<0.05). The risk factors of GDM were age, residence, prenatal BMI, PCOS, HBsAg, HDP, thyroid function during pregnancy, IVF and abortion history. GDM was a risk factor for cesarean section, HDP, ICP, postpartum hemorrhage and macrosomia (all P<0.05). Conclusion In Nanchong area, the incidence of GDM may be closely related to age, residence site, prenatal BMI, PCOS, HBsAg, HDP, thyroid function during pregnancy, IVF and abortion history. The risks of cesarean section, HDP, ICP, postpartum hemorrhage and macrosomia were higher in pregnant women with GDM.

Clinical analysis in 84 children with the sepsis of non-elevated peripheral blood leukocytes

Hou Wei, Zhang Lijun, Zhang Man, Wang Yakun, Jia Meixuan, Tian Liyuan

2021, 36(9):  799-802.  doi:10.3969/j.issn.1004-583X.2021.09.007

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Objective To understand the clinical characteristics and pathogenic composition of non-elevated peripheral blood leukocytes in children with sepsis. Methods A retrospective analysis was performed in 84 children with sepsis who had non-elevated peripheral blood leukocytes hospitalized in Hebei Children's Hospital from 2013 to 2020. Children with only gram-positive bacteria were divided into gram-positive bacteria infection group(n=27) and children only with gram-negative bacteria were divided into gram-negative bacteria infection group(n=26). Furthermore, the clinical data in groups were compared. Results In 84 children, the age of onset was mainly from 0 to <1 year (47 cases, 55.9%). There were 81 cases (96.4%) with fever and 80 cases (95.2%) with abnormal mental state. The median of peripheral blood C-reactive protein and procalcitonin were 157.7 g/L and 12.66 μg/L, respectively.Respiratory system was the most common site of first infection (43 cases, 51.2%). Fifty-five cases (65.5%) were only detected with bacteria and 6 cases (7.1%) were only detected with viruses. Two cases (2.4%) were only detected with Mycoplasma pneumoniae, and a total of 21 cases (25.0%) were detected with multiple pathogens. Among them, the majority of the detected bacteria were multi-drug resistant bacteria. Thirty-seven cases (44.0%) were diagnosed with severe sepsis and septic shock; 58 cases were cured(69.0%). Compared with the gram-negative bacteria infection group, the gram-positive bacteria infection group had statistical differences in the terms of first infection, peripheral blood white blood cell count, neutrophil count, and neutrophil percentage (P<0.05). Conclusion Multi-drug resistant bacteria are the main infections for non-elevated peripheral blood leukocytes of sepsis. The age of onset was relatively small and the mortality rate was relatively high. First-onset infection site, peripheral blood leukocytes and neutrophil counts are used to preliminarily determine bacteria identification, and carry out early empirical treatment.

Effect of limited and open fluid resuscitation on respiratory mechanics and oxygen metabolism in septic shock patients

Jia Yajie, Yao Ming

2021, 36(9):  803-806.  doi:10.3969/j.issn.1004-583X.2021.09.008

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Objective To compare the effects between resuscitation regimens of two fluids on respiratory mechanics and oxygen metabolism function in patients with septic shock(SS). Methods Totally 98 patients with SS admitted to our hospital were selected and divided into two groups, limited fluid resuscitation in observation group(n=45), and open fluid resuscitation in control group(n=53). 72 h index of respiratory mechanics, oxygen metabolism, hemodynamics and drug use were counted. Results After treatment, the indexes of the static lung compliance (Cst), oxygen delivery (DO₂), oxygenation index (PaO₂/FiO₂) were higher in observation group than in control group, while blood lactic acid (Lac) was lower (P<0.01). The dose of 24 h resuscitation fluid was lower, but that of vasoactive drugs was higher, and the use time was longer in observation group than in control group (all P<0.05). The correlation analysis showed that the dose of 24 h resuscitation fluid was negatively correlated with Cst,DO₂ and PaO₂/FiO₂ (all P<0.01). The duration of mechanical ventilation and hospitalization were shorter in observation group than in control group(both P<0.01). There was no significant difference in 28-day mortality between two groups (P=0.350). Conclusion In the treatment of SS, limited fluid resuscitation regimen can improve lung compliance and oxygen metabolism without adverse hemodynamic risk.

CT-guided percutaneous radiofrequency ablation for hepatic carcinoma

Guo Xiaojun, Kong Yanliang, Liu Tao, Cheng Zhengxiang, Zhang Rui, Fan Lei

2021, 36(9):  807-810.  doi:10.3969/j.issn.1004-583X.2021.09.009

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Objective To investigate the efficacy of CT-guided percutaneous radiofrequency ablation(RFA) for hepatic malignancies(HM). Methods Totally 76 HM inpatients from March 2016 to October 2018 were randomly divided into observation group and control group, 38 patients in observation group treated with CT-guided percutaneous RFA and 38 patients in control group with transcatheter arterial chemoembolization(TACE). Follow-up lasted for more 24 months. The key observation was the objective remission rate (ORR) of posttreatment, 6-,12-, 24-month survival rate, 3-month tumor markers, and complications. Results The difference was statistic significance in ORR between observation group and control group after treatment(81.6% vs 57.9%, χ ²=5.814,P<0.05). Clinical effect was significantly better in observation group than in control group(Z=6.457, P<0.05). 12-, 24-month survival rate were significantly higher in observation group than in control group(P<0.05). Conclusion For HM patients, CT-guided percutaneous RFA has good short-term and long-term effect, with little pain.

Analysis of bioinformatics in pediatric influenza based on chip with high-throughput

Jin Hong, Li Xiaolan

2021, 36(9):  811-819.  doi:10.3969/j.issn.1004-583X.2021.09.010

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Objective To screen the related differential genes(DEGs) of pediatric influenza by bioinformatics tools, aiming to explore core genes and elucidate pathogenesis. Methods The transcriptome data of pediatric influenza that met the requirements were downloaded from gene expression omnibus(GEO) database, and DEGs were screened by gene analysis tool GEO2R. Gene ontology(GO) and Kyoto encyclopedia of genes and genomes(KEGG) were analyzed for the function and enrichment pathway of DEGs. The protein-protein interaction(PPI) network was constructed by using the STRING database, and the core differential genes were selected by using Cytoscape software. Results A total of four databases (GSE42026, GSE29366, GSE34205 and GSE38900) and 30 DEGs were included in the study with 29 down regulated and 1 up regulated. GO analysis showed that DEGs were mainly involved in type I IFN signaling pathway, cell response to type I IFN, 2'-5'-oligoadenylate synthase activation and double stranded RNA binding. KEGG analysis showed that DEGs were mainly enriched in influenza A virus, measles, hepatitis C and herpes simplex virus infection signaling pathways. PPI analysis showed that the potential 10 core genes were IFIT3, MX1, OAS3, OAS2, OAS1, IFI27, IFI44, RSAD2, IFI44L and LY6E. Conclusion Interferon centered gene enrichment pathway may be the main pathogenesis for pediatric influenza. The core genes screened out may participate in the infection process of children with influenza, and become a new target for clinical treatment.

Genetic diagnosis strategy in children with intellectual disability/global developmental delay

Zhou Youfeng, Huang Yan, Liu Guanghua

2021, 36(9):  820-823.  doi:10.3969/j.issn.1004-583X.2021.09.011

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Objective To explore the diagnostic strategy of genetics in children with unexplained intellectual disability/global developmental delay(ID/GDD). Methods The peripheral blood samples of 65 children with ID/GDD were collected and sequenced with CNV-seq. The negative samples were detected with trio-WES. The characteristics of clinical phenotype between CNVs positive group and SNV positive group were compared. The samples were divided into single detection group (CNV-seq) and combined detection group (CNV-seq combined with trio-WES), and the statistical significance of positive rate between two groups was compared. Results There was significant difference in positive rate between combined test group and single test group, 44.6%(29/65) vs 33.8%(22/65), respectively. Conclusion The combined detection of CNV-seq and trio-WES may increase the positive rate.

Value of platelet volume and platelet distribution width in children Kawasaki disease

Liu Ruixi, Yi Qijian

2021, 36(9):  824-827.  doi:10.3969/j.issn.1004-583X.2021.09.012

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Objective Mean platelet volume(MPV) and platelet distribution width(PDW) are related with platelet function, which may be more sensitive indicators of abnormal platelet function compared with the number of platelets(PLT). the article aims to study the changes and clinical significance of platelet parameters in Kawasaki disease(KD). Methods MPV, PDW, PLT, white blood cell(WBC), C-reactive protein(CRP) and erythrocyte sedimentation rate(ESR) were counted and analyzed from 439 KD patients and 261 healthy children, retrospectively. KD patients were divided into two groups depending on the complex degree of coronary arterial lesions (CAL): coronary artery injury group (CALs group), no coronary artery injury group (no-CALs group). On the other hand, and the difference of complete Kawasaki disease(cKD) and incomplete Kawasaki disease(iKD) were compared. Results Compared with healthy controls, WBC, PLT, CRP and ESR in KD children significantly increased (P<0.01), while MPV and PDW significantly decreased (P<0.01, P<0.05). Compared with cKD patients, MPV and PDW in iKD patients were significantly lower (P=0.003, 0.014). Conclusion This study suggested that MPV and PDW were reduced in acute-phase, especially in iKD. Therefore, low-levels of MPV and PDW may be helpful for the diagnosis of iKD.

The Guidelines for Colorectal Cancer Screening by the American College of Gastroenterology in 2021--an interpretation

Song Jie, Wang Jing, Zhang Xiaolan

2021, 36(9):  828-831.  doi:10.3969/j.issn.1004-583X.2021.09.013

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In March 2021, Am J Gastroenterol published online the Guidelines for Colorectal Cancer Screening by the American College of Gastroenterology (ACG) in 2021. The screening goal was to remove adenomas and sessile serrated polyps, and detect early colorectal cancer. Based on 2009 guidelines, 2021 guidelines put forward unresolved issues, and conducted a comprehensive literature search and discussion, and provided more comprehensive and specific recommendations for colorectal cancer screening. Based on 2021 ACG clinical guidelines, the paper mainly interpreted from the aspects of screening age, screening methods, and colorectal cancer chemoprevention. The purpose is to optimize colorectal cancer screening and effectively and continuously reduce the incidence and mortality of colorectal cancer.

Lymphocytic hypophysitis in adolescents: A report of four cases and literature review

Chen Xuefeng, Li Yijun, Yang Guoqing, Dou Jingtao, Lyu Zhaohui, Mu Yiming

2021, 36(9):  832-838.  doi:10.3969/j.issn.1004-583X.2021.09.014

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To analyze the clinical data of 4 cases diagnosed as lymphocytic hypophysitis(LYH) in adolescents at PLA General Hospital between January 2008 to December 2019.There were 3 females and 1 male. The age of females were 11, 7, 12 years respectively, and the male was 17 years. The course of LYH ranged from 3 to 36 months. (1) Clinical features: 1 patient had headache, 3 patients had central diabetes insipidus(CDI), 3 patients had hypopituitarism, and growth disorder was seen in 1 patient.(2)Imaging features: All patients had space-occupying lesions on magnetic resonance imaging(MRI),which were symmetrically enlarged and homogenously enhanced with pituitary stalk thickening, without extending into suprasellar area and compressing optic chiasm and cavernous sinus. (3)Treatments and outcomes: 1 patient was treated with high dose methylprednisolone pulse therapy(HDMPT), 3 patients with hormone replacement. The follow-up ranged from 6 to 144 months, 2 patients were spontaneous remission, 2 patients with hormone replacement permanently. One patient had empty sella, but the condition is necessary to realize the possibility of lymphocytic hypophysitis in adolescents and mostly expects good prognosis.