Table of Content

20 August 2022, Volume 37 Issue 8

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Original article

Long-term effect of hypoglossal nerve stimulation in the treatment of obstructive sleep apnea hypopnea syndrome: A meta analysis

Sun Ying, Yu Qin

2022, 37(8):  677-684.  doi:10.3969/j.issn.1004-583X.2022.08.001

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Objective To explore the long-term effect of hypoglossal nerve stimulation (HGNS) in the treatment of obstructive sleep apnea hypopnea syndrome (OSAHS). Methods Through the systematic search of China knowledge Network database, Wanfang database, VIP database, Chinese biomedical literature database, Pubmed, Embase, Cochrane Library, the article published by domestic and foreign scholars regarding HGNS, untill to March 2022, were collected. The literatures were screened and extracted by two evaluators independently and the quality of the literatures was evaluated by NOS scale, Meta analysis was carried out by stata12.0 software. Results A total of 12 cohort studies with 776 patients were included. The posttreatment 6-month sleep apnea hypopnea index, (AHI, mean difference [SMD]=-1.47, 95% CI 95% confidence interval [95%CI]-1.68-1.25, P=0.000), oxygen desaturation index (ODI, SMD=-0.77,CI: -0.95--0.58, P=0.000), epworth scale score (ESS, SMD=-1.00, CI: -1.16--0.84, P=0.000), functional qutcomes of sleep questionnaire (FQSQ, SMD=1.10, CI: 0.92~1.28, P=0.000), AHI in 12 months after operation (SMD=-1.250, CI:-1.39--1.10, P=0.000), ODI (SMD=-0.874, CI:-1.114--0.634, P=0.001) and FQSQ (SMD=1.10, CI: 0.96-1.22, P=0.000) were significantly improved than those before treatment. Conclusion Hypoglossal nerve stimulation is effective in the treatment of OSAHS.

Rebamipide in the treatment of nonsteroidal anti-inflammatory drug-associated intestinal disease: A meta-analysis

Wang Tengyan, He Yajun, Shu Jianchang

2022, 37(8):  685-690.  doi:10.3969/j.issn.1004-583X.2022.08.002

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Objective To evaluate the clinical efficacy of Rebamipide in the treatment of nonsteroidal anti-inflammatory drugs (NSAIDs)-associated intestinal disease. Methods PubMed, MedLine, Embase, The Cochrane Library, China Biomedical Literature Database (CBM), CNKI and Wanfang Data were searched for randomized controlled trials(RCTs)in the treatment of NSAIDs-associated bowel diseases. Set a time limit for each database to be built until January 2021. According to the evaluation criteria recommended by the Cochrane system evaluation guide manual, the quality of the included study was evaluated, and Review Manager 5.3 software was used for Meta analysis after entering the main outcome indicators of the literatures. Results Finally, eligible 6 RCTs were included, with a total of 255 subjects; 3 articles mainly observed the number of cases of intestinal injury after treatment with Rebamipide, and all of them could extract effective data; the effective data could be extracted from 4 articles focused the number of intestinal mucosal erosion after treatment, 3 articles observed the number of intestinal mucosal ulcers after treatment with extracted effective data. The results of Meta analysis showed that the number of intestinal injuries (OR=0.34, 95%CI: 0.15-0.75, P<0.05), intestinal mucosal erosion(MD=-4.71, 95%CI:-6.40 to -3.02, P<0.05) and intestinal mucosal ulcers (MD =-0.45, 95% CI: -0.89 to -0.01, P<0.05) decreased significantly in the Rebamipide group as compared to the routine regimen group. Conclusion Rebamipide has advantages in the prevention and treatment of NSAIDs-associated intestinal disease and can reduce intestinal injury in patients who take NSAIDs drugs for a long time.

Unilateral biportal endoscopy versus microendoscopic discectomy for degenerative lumbar spinal stenosis: A meta-analysis

Shen Tianyu, Bai Gang, Chen Rui, Xiang Zhicheng, Zhu Hao, Shang Hui

2022, 37(8):  691-698.  doi:10.3969/j.issn.1004-583X.2022.08.003

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Objective To provide instructions to clinical decision-making by comparing the efficacy of unilateral biportal endoscopic(UBE) and microendoscopic discectomy (MED) in treating degenerative lumbar spinal stenosis(LSS). Methods Chinese and English study papers on UBE and MED for degenerative LSS were respectively searched in PubMed, Web of Science,Cochrane Library,Embase,Wanfang Database,CNKI,VIP,China Biologicl Medicine (CBM) and other databases, and controlled clinical studies on UBE and MED therapies with the search duration starting from the setup of databases to March 2020 were collected. The study documents were subject to the screening, quality evaluation and data extraction based on the inclusion and exclusion criteria. RevMan 5.4 and Stata15.1 software were applied for meta-analysis on the extracted data. The operation duration, blood loss, visual analogue scake (VAS) score of back and leg pain in the last follow-up, disability index (ODI), complication rates, postoperative dural distension, and intraoperative blood loss were included as comparator. Results Finally, 10 study papers (3 randomized controlled trials (RCTs) and 7 non-randomized controlled trials (N-RCTs)) involving a total of 880 patients were included, and 407 UBE cases and 473 MED cases were noted. The meta-analysis results showed that differences in the degree of dura extension, operation duration, intra-operative blood loss and ODI between groups weren't statistically significant. Compared with MED group, the lower VAS scores of the back pain in the last follow-up [MD=-0.18,95%CI(-0.31,-0.05),P=0.006] and leg pain [MD=-0.15,95%CI(-0.27,-0.04),P=0.008] as well as higher incidence rate of complications[OR=0.54,95%CI(0.31,0.94),P=0.03] were noted in UBE group. Conclusion Both UBE and MED are both effective treatments of degenerative LSS, MED is found to be superior to UBE in reducing the complications, while UBE is advantageous in improving VAS scores of the post-operative back pain, and overall consideration should be taken in the selection on surgery program.

Aripiprazole and olanzapine on senile dementia of the alzheimer type: A control study

Li Ping, Xu Manhua, He Lanying, Wang Lifeng, Zhang Pei, Song Lihua

2022, 37(8):  699-703.  doi:10.3969/j.issn.1004-583X.2022.08.004

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Objective To assess the effectiveness and safety of aripiprazole and olanzapine on senile dementia of the alzheimer type (SDAT). Methods A total of 86 SDAT patients visited in the Eighth Hospital of Shijiazhuang from November 2020 to November 2021 were enrolled and randomly assigned into the observation group and the control group. The patients were managed by supportive treatment based on etiology of delirium, the observation group was treated with oral or sublingual administration of aripiprazole at dose range 2.50-10.00 mg/d, and the control group with olanzapine at dose range 1.25-10.00 mg/d. The aiming was to compare the clinical efficacy and safety. Results The treatment efficiency of patients with hypoactive SDAT in the observation group was better than that in the control group (P<0.05). The difference was not statistically significant in the treatment efficiency of hyperactive SDAT and mixed SDAT between groups (all P>0.05). There was no interruption of treatment due to serious adverse reactions in both groups during the observation period. Conclusion For SDAT patients, aripiprazole and olanzapine are safe to use. The low-dose aripiprazole is superior to olanzapine for hypoactive SDAT patients. Moreover, both low-dose, short-course of aripiprazole and olanzapine were well tolerated for these patients.

Clinical correlation between fatigue and multi-dimensional indexes in patients with stable moderate chronic obstructive pulmonary disease

Wang Xuefeng

2022, 37(8):  704-707.  doi:10.3969/j.issn.1004-583X.2022.08.005

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Objective To study the relationship between fatigue and the indexes of nutritional, quality-of-life, inflammatory, and mental & emotional in patients with stable moderate chronic obstructive pulmonary disease (COPD). Methods In this prospective study, 30 patients(fatigue group) and 26 patients (non-fatigue group), who were in stable moderate COPD, were randomly enrolled according to the definition of general fatigue. The aiming was to compare the baseline data, the indexes of nutritional, quality-of-life, inflammatory, and mental & emotional. Results There was no significant difference in age, gender, smoking index between the two groups (all P>0.05). The indexes of albumin, hemoglobin, body mass, percent predicte forced expiratory volume in one second (FEV1)%, and 6-minute walk distance (6MWD) in the fatigue group were significantly lower than those in the non-fatigue group (all P<0.05). COPD Assessment Test (CAT) score, C-reactive protein (CRP), procalcitonin (PCT), white blood cell (WBC), Beck Anxiety Inventory (BAI), and Physical and mental tension relaxation test (PSTRT) were found to be higher in the fatigue group (all P<0.05). Conclusion Fatigue closely associated with the indexes of nutritional, quality-of-life, inflammatory, and mental & emotional in patients with stable moderate COPD, which is an important part of establishing multi-dimensional fatigue measurement for COPD patients.

Predictive value of body composition and anthropometry for dyslipidemia in postmenopausal women

Zhang Shu, Bao Yun, Chen Fang, Shan Qing

2022, 37(8):  708-712.  doi:10.3969/j.issn.1004-583X.2022.08.006

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Objective To investigate the predictive value of body composition and anthropometry for dyslipidemia in postmenopausal women. Methods In the cross sectional study, postmenopausal women(n=201) who participated in the physical examination in our hospital during the same period were enrolled. Anthropometric measurements were performed by a professional clinical nutritionist, while the bioelectrical impedance was used to analyze human body composition.At the same time, medical history data and laboratory test results were collected; waist-hip ratio, waist-height ratio, skeletal muscle mass index(SMI), total cholesterol/high density lipoprotein ratio(TC/HDL-C) were obtained by data conversion, aiming to comprehensively analyze the influence of the above indexes on the blood lipid of postmenopausal women. Results The prevalence of dyslipidemia in postmenopausal women was 68.7%, of which, the rates of TG, TC, LDL-C increased and HDL-C decreased, for 48.8%, 34.8%, 22.4% and 19.4% respectively.Body mass index(BMI), body fat and fat percentage, visceral fat area, waist and hip circumference, waist-height ratio, waist-hip ratio were all positively correlated with TG and TC/HDL-C ratio (P<0.05). SMI was negatively correlated with TG, while body fat percentage, waist to height ratio and waist to hip ratio were positively correlated with LDL-C(P<0.05). Multivariate analysis found that the percentage of body fat of postmenopausal women was an independent risk factor for increased TG and LDL-C(P<0.01), waist-height ratio had significant effect on TC/HDL-C ratio(P<0.01). Waist-hip ratio was the predictor of dyslipidemia in postmenopausal women(OR=1.124,95%CI:1.062-1.190). Conclusion The prevalence of dyslipidemia in postmenopausal women is high, while in composition analysis, anthropometry measured body fat percentage, waist-height ratio and waist-hip ratio are all closely related to it. Among them, waist-hip ratio is an effective predictor for dyslipidemia in postmenopausal women, which has reference value for early warning of dyslipidemia and monitoring of lipid level.

Predictive value of progestational triglyceride glucose indexes and gestational weight gain on gestational diabetes mellitus petients with delivery of macrosomia

Wu Lulu, Wang Ruiya, Su Lin, Feng Jing

2022, 37(8):  713-716.  doi:10.3969/j.issn.1004-583X.2022.08.007

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Objective To analyze relationship between progestational triglyceride glucose (TyG) index, gestational weight gain and large for gestational age (LGA) in patients with gestational diabetes mellitus (GDM). Methods A total of 476 cases of pregnant women diagnosed with GDM during June 1, 2020 to January 31, 2022 in Obstetrics Department, Hebei General Hospital for institutional delivery were as the study subjects. All clinical data were collected from the two groups which comprised the macrosomia group (n=124) and non-macrosomia group (n=352), grouped based on the newborn weigh. The independent factors influencing macrosomia in GDM patients were analyzed, and receiver operating characteristic (ROC) curve was drawn to evaluate the predictive value of progestational TyG index and gestational weight gain for macrosomia in GDM patients. Results The age, gestational weight gain, and progestational TyG index in the macrosomia group were higher than those in the non-macrosomia group (P<0.05). The proportions of first pregnancy and first birth in the macrosomia group were lower than those in the non-macrosomia group (P<0.05). Multivariate logistic regression analysis showed that gestational weight gain and progestational TyG index were independent factors influencing LGA delivery of GDM patients (P<0.05). ROC curve results showed that gestational weight gain (AUC:0.613, 95%CI: 0.554-0.672, P<0.01) and progestational TyG index(AUC: 0.720, 95%CI: 0.672-0.768, P<0.01) had certain predictive abilities for macrocosm in GDM patients, and the combined predictor of two indices (AUC: 0.746, 95% CI: 0.699-0.794, P<0.01) had a higher ability, and it could predict LGA delivery of GDM patients in a better manner. Conclusion Gestational weight gain and progestational TyG index are independent risk factors for LGA delivery of GDM patients, and with better predictive value.

Dynamic monitoring of blood 25 (OH) D level and its effect on pulmonary disease in very premature infants

Xi Hongmin, Yang Lijuan, Yin Xiangyun, Yang Ping, Ma Lili, Li Xianghong

2022, 37(8):  717-722.  doi:10.3969/j.issn.1004-583X.2022.08.008

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Objective To monitor the vitamin D level dynamically and to explore its effect on lung diseases of very preterm infants. Methods A total of 126 very premature infants <32 weeks were enrolled, who were admitted to the NICU of Affiliated Hospital of Qingdao University from June 2019 to December 2020 with informed consent of their parents. Serum 25-(OH)D levels were measured at postnatal 24h and postnatal month 1 and 2. All preterm infants were given vitamin AD (vitamin D 500 IU, vitamin A 1500 IU) daily and vitamin D3 400 IU after feeding tolerance. General clinical data were collected from the three groups which comprised Vitamin D deficiency group(n=71, 25-[OH] D <12 ng/ml), insufficient group(n=46, 25-[OH]D≥12~<20 ng/ml), and sufficient group(n=9, 25-OH]D≥20~≤100 ng/ml).The incidence of respiratory distress syndrome(RDS), duration of mechanical ventilation, hospital stay, early pulmonary hypertension(PH), patent ductus arteriosus(PDA), and bronchopulmonary dysplasia(BPD) were included as comparator, and statistical analysis was conducted. Results A total of 126 premature infants were included, ranging from 26 to 31⁺⁶ weeks with an average gestational age of (29.75±1.52) weeks, including 65 males (51.59%) and 61 females (48.41%). There were no significant differences in gestational age, birth weight, head circumference and body length among the three groups(P>0.05). The average level of vitamin D at birth was (10.57±4.79) ng/ml, and the rate of vitamin D deficiency reached 92.86%. Vitamin D900IU was taken orally daily. The mean level of vitamin D was (18.14±2.88) ng/ml and (21.13±7.48) ng/ml at month 1 and month 2 with deficiency rate 73.8% and 53.17%, no vitamin D overdose. The incidence of RDS or BPD was significantly higher in the vitamin D deficiency group at birth (P<0.05). However, there was no significant correlation between different vitamin D levels and the severity of BPD (P=0.984). There was no significant differences in postnatal Apgar score, duration of caffeine use, rate of mechanical ventilation, duration of non-invasive ventilation, duration of total oxygen use, patent ductus arteriosus (PDA), total length of hospital stay, and early pulmonary hypertension (P>0.05). Conclusion Vitamin D deficiency is common in very premature infants. After vitamin D900IU supplementation, the rate of vitamin D deficiency still accounted for 53.17% at aged 2 months. Therefore, it is recommended to provide individual vitamin D supplementation for premature infants.Vitamin D deficiency at birth in very premature infants increases the risk of RDS and BPD.

Comparison on the diagnostic value of 3.0T two-parameter MRI and multi- parameter imaging in benign & malignant prostate neoplasms

Zhong Ye, Xu Jun, Liu Chenping, Wu Gang

2022, 37(8):  723-727.  doi:10.3969/j.issn.1004-583X.2022.08.009

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Objective To explore the value of 3.0T bi-parametric magnetic resonance imaging (bp-MRI) of T2WI and DWI in the differential diagnosis of benign prostate disease and prostate neoplasms. Methods The patients receiving transrectal ultrasound-guided transperineal prostate biopsy hospitalized from 2018 to 2020 were retrospectively analyzed, and all cases received pre-operative multi-parameter prostate magnetic resonance imaging (mp-MRI). Two radiologists scored the prostate imaging-reporting and data system version 2 (PI-RADS v2) and measured apparent diffusion coefficient (ADC) value to confirm the presence of prostate cancer based on bp-MRI of T2WI and DWI, and the biopsy and surgical pathology were considered to be gold standards, the accuracy of corresponding diagnosis, consistency between two observers, as well as the accuracy of the ADC value in the diagnosis of benign and malignant prostate neoplasms were counted, and such indices were compared with the serum biomarker PSA. Results A total of 210 cases including 106 cases of prostate cancer and 104 cases of benign prostatic lesions were included in the study. The area under the curve (AUC) for discriminating benign and malignant nodules based on bp-MRI between Doctor 1 and Doctor 2 was 0.821 (P<0.05) and 0.805 (P<0.05) respectively high inter-observer consistency and KAPPA value in 0.812. The accuracy of AUC of mp-MRI in discriminating benign and malignant lesions was 0.806 (P<0.05), and the difference between bp-MRI and mp-MRI in discriminating benign and malignant prostate lesions wasn't statistically significant (P>0.05). The intraclass correlation efficient (ICC) of ADC value measured by two doctors was 0.795 (P<0.01), the mean value was considered to be the final ADC value due to high consistency, and the value of AUC for discriminating benign and malignant nodules based on ADC value was 0.89 (P<0.05), being higher than that of the total prostate specific antigen(TPSA), free prostate specific antigen (FPSA) and FPSA/TPSA(P<0.05). ADC was found to have the optimal cut-off value in 801.4 mm²/s, sensitivity of 87.5% and specificity of 81.6% in discriminating prostate cancer. Conclusion The difference between 3.0Tbp-MRI and mp-MRI in the diagnosis of benign and malignant prostate lesions wasn't statistically significant, the value of 801.4 mm²/s used as ADC threshold makes for discriminating between benign and malignant lesions.Conclusively, bp-MRI is considered to be a preferred choice in cases suffering from contrast agent allergy or renal insufficiency.

Rheumatoid arthritis complicated with T-cell large granular lymphocytic leukemia: A case report and literature review

Zhang Yueyue, Xie Meifang, Sun Gen

2022, 37(8):  728-732.  doi:10.3969/j.issn.1004-583X.2022.08.010

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Objective To explore the clinical characteristics of rheumatoid arthritis (RA) complicated with T-cell large granular lymphocytic leukemia (T-LGLL). Methods The study was aiming to retrospectively analyze the clinical data, diagnosis and treatment process of a RA patient complicated with T-LGLL admitted to The Fourth Affiliated Hospital of Nanjing Medical University, and reviewing related literatures. Results The patient was a 64-year-old man with multiple joint swelling and pain for 10 years and fatigue for 2 years. The disease course was complicated with neutropenia and splenomegaly. In combination with the patient's medical history, physical examination and auxiliary examination, the following findings of admission diagnosis were made: RA, Felty's syndrome (FS).The admission diagnosis results (RA, and Ferty's syndrome [FS]) were made in combination with the case history, physical examination, and auxiliary examination.The patient was confirmed to have T-LGLL after supplementing relevant auxiliary examination and combining corresponding clinical manifestations.The patient's fatigue symptoms were improved without joint swelling and painafter the symptomatic treatment of immunosuppressant and glucocorticoid. Conclusion For patients with RA, RA and T-LGLL may have similar pathogenesis. It is necessary to be alert to the possibility of T-LGLL when developing FS.

Two cases of children's anti-MOG antibodies combined with anti-NMDAR antibody double positive autoimmune encephalitis and literature review

Hu Wencong, Liu Xiuzhen

2022, 37(8):  733-737.  doi:10.3969/j.issn.1004-583X.2022.08.011

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Objective To explore clinical features of double-positive autoimmune encephalitis of children's anti-myelin oligodendrocyte glycoprotein (MOG) antibodies complicated with anti-N-methyl-D-aspartate receptor (NMDAR) antibodies. Methods The case data of 2 children with anti-MOG antibodies combined with anti-NMDAR antibody double-positive autoimmune encephalitis admitted to Handan Central Hospital were retrospectively analyzed, and the relevant literature was reviewed. Results The number of leukocytes in cerebrospinal fluid increased in 2 cases, both supratentorial and infratentorial lesions were found in the head magnetic resonance imaging (MRI) of one case, one case was found to have supratentorial lesions only, and the video electroencephalogram outcome was similar to that of anti-NMDAR encephalitis. The symptoms of both two cases were improved after being treated with methylprednisolone and human immunoglobulin, and no recurrence was found with either case after 3 months of follow-up. Conclusion The disease is more common in adolescents, both encephalopathic manifestations of anti-MOG antibody-related diseases and anti-NMDAR encephalitis are noted, and the manifestations of anti-NMDAR encephalitis are also noted. Noninvasive examinations including cranial MRI and video electroencephalogram show certain indications, and neuroantibody examination becomes necessary for confirmation. The first-line therapies involve the hormone, immunoglobulin and plasma exchange. Most children respond well to the above therapies, while the pathogenesis remains further study.

Continuous veno-venous hemodiafiltration plus activated charcoal hemoperfusion in treatment of multiple organ dysfunction syndrome caused by fish bile poisoning: one case

Liu Peihua, Yang Qian, Liu Zhiqiang, Liang Lu

2022, 37(8):  738-742.  doi:10.3969/j.issn.1004-583X.2022.08.012

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Objective To observe the effect of continuous veno-venous hemodiafiltration (CVVHDF) plus activated charcoal hemoperfusion in treatment of multiple organ dysfunction syndrome (MODS) caused by bile poisoning. Methods The patient was treated with CVVHDF combined with HP (activated charcoal),and the trend of liver function, kidney function, cardiac function, coagulation function and other indicators as well as its efficacy after the treatment were observed. Results After 3 HP (activated charcoal) and 3 CVVHDF treatments, the liver function, kidney function, cardiac function, coagulation function and other indicators of this patient returned to normal when discharged. Conclusion On the basis of comprehensive treatment, CVVHDF plus activated charcoal hemoperfusion and other comprehensive treatment can improve the patients'perfusion of tissues and organs and blood biochemical indicators, as well as the patients' prognosis and disease outcome.