Table of Content

20 July 2022, Volume 37 Issue 7

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Meta analysis on correlation between sporadic duodenal neoplasm and colorectal neoplasm

Wang Chengyao, Zhang Zheng, Wu Jing

2022, 37(7):  581-590.  doi:10.3969/j.issn.1004-583X.2022.07.001

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Objective Meta-analysis was applied to comprehensively review published studies on sporadic duodenal neoplasm (SDN) and colorectal neoplasm (CRN, mainly including colorectal adenoma and colorectal cancer). Methods Fifteen documents (14 case-control studies +1 cross-sectional study) satisfying the inclusion criteria were subject to meta analysis with Review Manager 5.3 software, OR value and 95% C I were selected as meta-analysis indicators, and inverted funnel plot was developed to test the heterogeneity of results and calculate combined effect values. Results A total sample size of 205 959 including 1 286 cases in the case group and 204 673 cases in the control group were included. Moderate heterogeneity (I^2=44%, P=0.03) was considered in the results of case-control studies through meta-analysis, and subgroup analysis showed that the site of SDN occurrence may be a potential source of heterogeneity in studies. The results of grouping according to different outcomes showed that SDN increased the onset risk of CRN at all stages (colorectal adenoma O R=2.29, 95% C I=1.74-3.02; colorectal cancer O R=2.87, 95% C I=1.96-4.02; advanced adenoma O R=2.83, 95% C I=2.27-3.53; advanced neoplasm O R=3.60, 95% C I=2.14-6.07).The grouping was made according to the different sites and number of CRN, the results showed that multiple tumors in left colon was certainly related to SDN (O R=1.37, 95% C I=1.16-1.62; O R=9.30, 95% C I=1.41-61.44). Conclusion The risks of various CRN in SDN patients will increase, especially, it is more significantly correlated with advanced and multiple CRN lesions located in the left colon.

Meta analysis on effects of glucocorticoid on the immunotherapy of advanced cancer

Ye Qian, Ling Zhai, Liu Shenxiang, Lu Guotao, Yin Xudong

2022, 37(7):  591-598.  doi:10.3969/j.issn.1004-583X.2022.07.002

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Objective To evaluate the application of glucocorticoid on the overall survival (OS) and progression-free survival (PFS) of the cancer patients receiving immune checkpoint inhibitors (ICIs). Methods PubMed, Wiley, Web of Science and Cochrane Library databases were applied to search the papers for effects of GC on cancer patients during the therapy period of receiving ICIs published prior to October 2020. Review Manager 5.3 software and Stata 14.0 software were used for statistical analysis. Results A total of 23 studies were included in the meta analysis, Meta-analysis showed that for patients with advanced cancer during the period of ICIs, the application of GC was a risk factor for death (H R=1.54, 95% C I=1.29-1.83) and disease progression (H R=1.82, 95% C I=1.36-2.43). Moreover, the subgroup analysis showed that GC applied to relief tumor-related complications including the cerebraledema and cancer pain increased the risk of death (H R=2.14, 95% C I=1.62-2.81) and disease progression (H R=2.26, 95% C I=1.72-2.96). While GC was used to treat non-tumor-related complications including immune-related adverse events (irAEs), and the difference between the use of GC and no-use or low dose of GC (<10 mg/d) wasn’t statistically significant (P>0.05). Conclusion The application of GC has negative effects on the prognosis of cancer patients receiving immunotherapy when it is used to treat tumor-related complications.

Impacts of Tai Chi exercise cycle on blood pressure and cardiovascular risk factors in essential hypertension: a systematic review and meta-analysis

Yin Yikun, Yin Xunwei, Wang Jialin, Sun Junzhi

2022, 37(7):  599-606.  doi:10.3969/j.issn.1004-583X.2022.07.003

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Objective To provide a reasonable exercise intervention program for patients with essential hypertension(EH) by systematically reviewing, the aiming is to assess if the continuous cycle of Tai Chi Chuan exercise impacts the therapeutic effects on EH patients by the meta-analysis. Methods The randomized controlled trials(RCT) of Tai Chi Chuan treating EH were retrieved from electronic databases involving CNKI,WANFANG Database,PubMed,Cochrane Library,Science Direct and Web Of Science,and the meta-analysis was conducted by RevMan5.3 software. Results Twenty-one papers with 2 129 participants were finally selected. Meta-analysis results showed that Tai Chi Chuan exercise lasting over 12 weeks was more conductive to the decreased level of systolic blood pressure [M D=-10.20,95% C I(-14.57,-5.83)] and diastolic blood pressure [M D=5.12,95% C I(-7.63,-2.60)] compared with the control group. Tai Chi Chuan was found to increase the NO content of EH patients [M D=6.87,95% C I(4.83,8.90)], improve blood lipid metabolism level including total cholesterol (TC) [M D=0.51, 95% C I(-0.69,-0.33)], triglyceride (TG)[M D=0.72,95% C I(-1.09,-0.36)],low-density lipoprotein cholesterol (LDL-C) [M D=0.59,95% C I(-0.87,-0.32)] excluding high-density lipoprotein cholesterol (HDL-C). The results of subgroup analysis showed that exercise frequency ≥5 times/week and exercise duration< 60 min/d had better antihypertensive effect. Conclusion Meta-analysis indicate that Tai Chi Chuan exercise with the continuous cycle>12 weeks, the frequency ≥5 times/week and exercise duration< 60min/d demonstrates obvious effect in reducing blood pressure level and improving NO content and lipid metabolism, being worthy of promotion in clinic practices.

Correlations between sleep disorder and cognitive function in elderly patients with mild cognitive impairment

Li Zhongmei, Ran Li, Jiang Yi, Guo Zhiwei, Mu Qiwen

2022, 37(7):  607-611.  doi:10.3969/j.issn.1004-583X.2022.07.004

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Objective To explore the sleep disorders (SD) in elderly patients with mild cognitive impairment (MCI) and corresponding correlations with cognitive function. Methods A total of 171 eligible patients with MCI in a community located in Nanchong, Sichuan from November 2018 to January 2019 were included. The overall sleep conditions of patients was assessed by the Pittsburgh sleep quality index (PSQI). The enrolled patients were divided into MCI with SD group (MCI-SD group) and MCI without SD group (MCI-NSD group) according to scoring results. Montreal cognitive assessment-basic (MoCA-B), mini-mental status examination (MMSE), auditory verbal learning test (AVLT), Boston naming test (BNT), animal verbal fluency test (AFT), trail making test (TMT) were applied to evaluate the overall cognition, memory, language and executive function of MCI patients, and the differences in overall cognitive function and cognitive domain between two groups were comparatively analyzed. Results SD was found in 70 (40.9%) out of 171 MCI patients, and the differences in the gender, age and education level between two groups were not statistically significant (all P>0.05), while the differences in the sleep quality, time of sleep onset, sleep duration, sleep efficiency, night sleep disorders, hypnotic drug and daytime function were statistically significant (all P<0.05). Compared to the MCI-NSD group, MoCA-B, MMSE, and BNT scores of MCI-SD group were significantly lowered, and the total time spent on TMT-A was significantly increased (all P<0.05). The time to fall asleep in the MCI-SD group was negatively correlated with the total score of MMSE and positively correlated with the total time spent in TMT-A; the sleep efficiency was negatively correlated with total scores of MMSE; total scores of PSQI were negatively correlated with total scores of MoCA-B and MMSE and were positively correlated with the total time spent in TMT-A. The total time spent on BNT and TMT-A was considered to be an independent risk factor for MCI patients complicated with SD (all P<0.05). Conclusion MCI patients are found to have higher incidence of SD, and long-term sleep disorder may lead to or aggravate the decline of cognitive dysfunction, especially the impacts on language naming and executive function may be more significant.

Effects of diagnosis age on clinical manifestations of polymyalgia rheumatica: A single center retrospective cohort study on 68 patients

Lin Changyi, Song Minghui, Wu Peicheng

2022, 37(7):  612-615.  doi:10.3969/j.issn.1004-583X.2022.07.005

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Objective To compare the clinical manifestations of polymyalgia rheumatica (PMR) patients with different ages at diagnosis (>60 years and ≤60 years). Methods Sixty eight patients with PMR who were diagnosed and treated in our hospital from January 2013 to December 2019 were retrospective analyzed. The patients were divided into the PMR≤60 years old group (24 cases) and PMR>60 years old group (44 cases) based on different diagnosis age. The clinical data (general data, clinical features, laboratory indicators, treatment response) of two groups were compared. Results The differences in the course of disease and smoking between two groups weren’t statistically significant (P>0.05), and the proportion of women in the PMR>60 years old group was higher compared with that in the PMR≤60 years old group (P<0.05). The differences in the weight reduction, fever, shoulder girdle myalgia, pelvic girdle myalgia, neck pain, low back pain and morning stiffness weren’t statistically significant between groups (P>0.05); the difference in the level of lactate dehydrogenase (LDH) between groups wasn’t statistically significant (P>0.05). The level of the PMR>60 years old group had higher level of erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) and lower hemoglobin (Hb) level when compared with such indicators in the PMR≤60 years old group (P<0.05 at all points). All patients received the first-line glucocorticoid therapy, the differences in the proportion of glucocorticoids administered exclusively and cumulative doses of patients between two groups weren’t statistically significant (P>0.05). The proportion of recurrence in the PMR≤60 years old group was less when compared with that in the PMR≤60 years old group, (P<0.05). Conclusion Patients with the age at diagnosis ≤60 years old have a lower risk of recurrence compared with PMR patients with the age at diagnosis >60 years, and more aggressive glucocorticoid therapy is unreasonable.

Effect of pSOFA score combined with C-reactive protein and procalcitonin in prognosis assessment of sepsis children

Zhou Bin, Zeng Cizheng, Huang Yuge, Zhong Mianling, Wu Jiayuan

2022, 37(7):  616-622.  doi:10.3969/j.issn.1004-583X.2022.07.006

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Objective To evaluat pediatric sequential organ failureassessment (pSOFA) score combined with C-reactive protein (CRP), procalcitonin (PCT), and other infection-related biomarkers of the prognostic assessment in sepsis children. Methods A retrospective observational study was applied to collect the clinical data of 289 sepsis children (2018.8-2019.8) admitted to Pediatric Intensive Care Unit (PICU) of the Hospital. The children were divided into the survival group and death group according to 28-day survival outcomes. The differences in intergroup physiological and laboratory data in pediatric intensive care unit (PICU) within 24 hours of admission were compared, binary logistic regression was applied to analyze high-risk factors impacting the prognosis of sepsis children, the receiver operating characteristic (ROC) curve and the area under ROC curve (AUC) were drawn to assess the effects of the pSOFA scores combined with CRP and PCT in the early diagnosis and prognosis of children with sepsis. Results A total of 289 children including 254 (87.9%) in the survival group and 35 (12.1%) in the death group were included in the study. The comparative differences of children in terms of availability of constantly pumped vasoactive drugs, duration of mechanical ventilation, Glasgow coma scores, gastrointestinal functions, and serum PCT concentration were statistically significant (all P<0.05). Binary logistic regression showed that pSOFA scores and availability of continuously pumped vasoactive drugs were high-risk factors for poor prognosis in children with sepsis (P<0.05); AUCs for CRP and PCT to predict death in children with sepsis was 0.547(95%CI: 0.488-0.606) and 0.667(95%CI: 0.609-0.721), respectively. The AUC of pSOFA+CRP, pSOFA+PCT and pSOFA scores for predicting death of children with sepsis was 0.947 without exception (95%CI: 0.914-0.970), and the differences weren't statistically significant (P>0.05). Conclusion pSOFA scores deliver important value for prognostic evaluation of sepsis children, while pSOFA score combined with CRP and PCT fail to improve the prognostic evaluation of children with sepsis.

Changes of vitamin A in children with community-acquired pneumonia and corresponding immune function

Zhang Dong, Wang Zhiyuan, Li Shujun

2022, 37(7):  623-626.  doi:10.3969/j.issn.1004-583X.2022.07.007

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Objective This study aimed to explore the correlation between serum vitamin A (VA) and immune function in children with community acquired pneumonia (CAP), and to provide information for the risk of pneumonia. Methods Totally 63 cases severe CAP (SCAP group) admitted to the pediatric intensive care unit (PICU) of the First Affiliated Hospital of Xinxiang Medical College, 30 cases in mild CAP (MCAP group), and 30 synchronous healthy children (control group) were enrolled. The serum levels of VA and immunoglobulin (Ig) IgG, IgA, and IgM, and T lymphocyte subsets (total T lymphocytes, CD4, CD8, CD4/CD8) in all patients were detected, The correlation between the VA level and immune-related indicators in SCAP group was assessed. Results Difference was not statistically significant in gender and age among the three groups. The average content of serum VA in the control group, MCAP group, and SCAP group were 0.36, 0.25, and 0.19 mg/L respectively. The content of VA in the two CAP group was significantly lower than the control group, and SCAP group was common (P<0.05). According to the VA diagnostic criteria recommended by the World Health Organization's (WHO), the rate of clinical/subclinical deficiency of VA in the control group, MCAP group, and SCAP group were 10.00%,36.67%, and 61.90%, respectively; and there was a significant difference among the three groups (P<0.05). The serum LG level in the two CAP group was significantly lower than that in the control group; and the SCAP group was significantly lower than the MCAP group (P<0.05);The serum levels of total T lymphocytes, CD4, CD8, and CD4/CD8 in SCAP group were 53.28%,30.26%, 20.24%, and 1.59, respectively.The analysis of the relationship between VA levels and immune-related indicators found that VA levels were positively correlated with Ig (IgG, IgA, IgM) levels, total T lymphocytes, and CD4, but were not correlated with CD8 levels. Conclusion The level of serum VA in children with CAP was associated with the risk of pneumonia and the immune function.

Epidemiological survey on pulmonary functions of people over 40 years old in Laiyuan County, Hebei Province

Qiao Qingzhe, Zhang Xin, He Xianghong, Xi Suya

2022, 37(7):  627-630.  doi:10.3969/j.issn.1004-583X.2022.07.008

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Objective To investigate the baseline characteristics, epidemiological characteristics and pulmonary function-related parameters of people aged ≥40 years in rural areas of Laiyuan County, Baoding. Methods Multi-stage stratified cluster random sampling method was applied to select rural residents aged ≥40 years old in public health center, and the combination of centralized survey and household survey was adopted to close the completion of questionnaires and lung function tests. Results A total of 700 respondents were selected for surveying, 655 cases with the pass rate of 93.6% were effectively surveyed. Wherein, 394 respondents were males, 261 respondents were females, and the age was ranged between (49.49±6.17) years old. The population with the total smoking rate of 43.4% (n=284) and smoking index ≥15 (cigarettes/day×years) accounted for 43.4% of the total population (n=284). The pulmonary function showed forced vital capacity (FVC) of (3.60±0.86) L, forced expiratory volume in the 1st second (FEV1) of (2.80±0.63) L, FEV1/FVC of (78.09±6.23)%, maximal mid-expiratory flow (MMEF) 75/25%pre of (60.69±22.59)%, forced expiratory flow (FEF) 50% pre of (74.98±23.70)%, FEF75% pre of (56.27±22.53)%. 123 cases (18.8%) were found to have small airway dysfunction, 56 cases (8.5%) were noted to have restrictive ventilation dysfunction, and 211 cases (32.2%) were confirmed to have obstructive ventilation dysfunction. Conclusion The morbidity rate of small airway dysfunction, restrictive ventilation and obstructive ventilation in people aged ≥40 years in rural areas (Laiyuan County) was 18.8%, 8.5% and 32.2%, respectively. The research on obstructive airway disease becomes necessary in the future to analyze corresponding independent factors, and further to prevent and treat related factors.

Investigation and analysis of knowledge, attitude and practice of medical workers in public hospitals on the prevention & protection from COVID-19

Hou Huiyu, Zhang Shaohua, Ma Xinxin, Zhang Jie, Wang Yazhen

2022, 37(7):  631-634.  doi:10.3969/j.issn.1004-583X.2022.07.009

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Objective To understand the current situation of knowledge, attitude and practice (KAP) of Healthcare workers (HCWs) in public hospitals on the prevention & protection from COVID-19, to explore the methods to improve comprehensive public health quality of HCWs on the basis of the existing staffing, and to improve the overall public health emergency response capacities of hospitals. Methods Totally 158 HCWs from three public hospitals in Shijiazhuang were selected as the research subjects. The KAP situation of HCWs on the prevention & protection from COVID-19 were investigated by questionnaires. The factors impacting KAP related to the prevention & protection from COVID-19 were analyzed by one-way ANOVA. Results In these HCWs, the means of KAP on practice for prevention & protection from COVID-19 were (28.64±7.91), (16.92±1.76) and (16.81±1.79), respectively. One-way ANOVA showed that the knowledge scores of nursing professionals were higher than those of clinical professionals, the scores of public health-related departments and clinical departments were higher than those of other departments, and the scores of public health professionals were higher than those of nursing and clinical professionals, practice scores of workers from clinical departments were significantly higher than those of workers in other departments, and the scores of other professional title series were significantly lower than those of doctors, nurses and technologists. Conclusion In HCWs, the level of KAP on prevention & protection from COVID-19 is imperative to be improved. It is an effective way to improve the overall level of the hospitals through strengthening relevant trainings and tightening supervision.

A case with extranodal NK/T cell lymphoma-related hemophagocyte syndrome

Mao Rong, Tao Qianshan, Shen Yuanyuan, Dong Yi

2022, 37(7):  635-639.  doi:10.3969/j.issn.1004-583X.2022.07.010

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Objective To explore the clinical characteristics and effective strategies of extranodal natural killer/T-cell lymphoma (ENKTL)-related hemophagocytic sydrome. Methods The clinical data and therapeutic strategies of a case of ENKTL-related hemophagocytic sydrome admitted to the Department of Hematology of the Second Affiliated Hospital of Anhui Medical University were retrospectively analyzed. Results A 17-year-old female patient with hemophagocytic sydrome onset was diagnosed with ENKTL by skin biopsy. The patient was also complicatedly infected with Epstein-Barr (EB) virus. The patient's body temperature, blood routine, fibrin, triglyceride, ferritin, bone marrow hemophagy and other hemophagocytic sydrome indicators were completely normal after 4 courses of treatment with programmed death 1(PD1) monoclonal antibody combined with pegaspargase, gemcitabine, and oxaliplatin (P-GEMOX) regimen, ENKTL had partial remission through efficacy evaluation, and EB virus(EBV) DNA quantitatively decreased significantly. The haploid allogeneic hematopoietic stem cell transplantation was performed subsequently, EBV was negative, and the disease continued to be in remission state. Conclusion Early diagnosis on ENKTL-related hemophagocytic sydrome with definite active EB viral infection and appropriate immunochemotherapy plus haploid allogeneic hematopoietic stem cell transplantation are critical for improved prognosis. The successful diagnosis and treatment of the patient provides certain reference for clinical practice.

Clinical and genetic analysis of a neonate with congenital central nervous system multiple malformation: An identification on mutations in VANGL1 genes

Peng Yu, Jiang Zhihong, Wang Zhihai

2022, 37(7):  640-643.  doi:10.3969/j.issn.1004-583X.2022.07.011

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Objective To explore the clinical and genetic characteristics of a neonate with central nervous system malformation. Methods The clinical data of the neonate were collected, and the next generation gene sequencing technology was applied to capture pathogenic mutations in the exome, and Sanger sequencing was applied for validation. Results Next generation sequancing detected V A N G L 1 gene missense mutation satisfied c.542G>A(p.R181Q), the neonate was followed up irregularly to 2 years old, and no abnormal growth and development for nerve, motor and nutrition were found. Conclusion The case makes for the pathogenicity of missense mutation of V A N G L 1 genes in China expanded, and provides some clinical and laboratory basis for gynecological examination, treatment and follow-up of the gynecological.

One case report of Wernicke-Korsakoff syndrome with corpora candicans atrophy resulting from acute pancreatitis

Guo Weina, Kang Ning, Li Xiaosha, Li Ling, Gao Junshu, Li Na, Wang Tianjun

2022, 37(7):  644-647.  doi:10.3969/j.issn.1004-583X.2022.07.012

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Objective To explore the etiology, clinical features, imaging characteristics and therapeutic regimen for Wernicke-Korsakoff syndrome(WKS). Methods One case of WKS associated with corpora candicans atrophy resulting from acute pancreatitis was retrospective analyzed, and related literature were reviewed. Results A 29-year-old female patient suffered from sudden acute pancreatitis during pregnancy, and was subject to cesarean section. Typical Wernicke's encephalopathy (WE) triad-sign manifestations were gradually found with the patient treated with long-term fasting & water deprivation, gastrointestinal decompressionand plasma exchange, the fabrication, delusion, anterograde forgetting and head nuclear magnetic were found with the patient later, symmetry abnormal signal of bilateral thalamus near ventricle and atrophic corpora candicans appeared gradual. The patient was comprehensively diagnosed as WKS and recovered well after vitamin B1 treatment. Conclusion WKS is a treatable and preventable disease. Clinicians should be alert to the occurrence of the disease for patients required to have fasting for a long time, and must supplement B1 to avoid adverse consequences.