Table of Content

20 February 2023, Volume 38 Issue 2

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Therapy on left ventricular thrombus:Systematic review and meta-analysis

Zhou Huixian, Zhou Yaqing, Guo Ganlin, Cui Wei

2023, 38(2):  101-110.  doi:10.3969/j.issn.1004-583X.2023.02.001

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Objective Left ventricular thrombus (LVT) is a complication of many cardiac diseases, thrombus detachment can lead to severe systemic embolism. Hence, early treatment of LVT is extremely vital. Methods The document retrieval was made from four aspects involving the anticoagulation therapy, thrombolytic therapy, antiplatelet therapy, and surgical therapy. The key words including “left ventricular thrombus”, “novel oral anticoagulants”, “factor Xa inhibitors”, “NOAC”, “DOAC”, “dabigatran”, “rivaroxaban”, “edoxaban”, “apixaban”, “vitamin K antagonist”, and “warfarin” were performed to search in the web of science, Ovid, EMBASE, Pubmed and Cochrane databases. A total of 25 articles were available for meta analysis to compare the efficacy and adverse events of novel oral anticoagulants (DOACs) versus vitamin K antagonists (VKA). Currently searchable articles on the use of heparin, antiplatelet drugs, thrombolytic therapy and surgery for LVT were systematically reviewed. Results The incidences of bleeding, stroke events and all-cause mortality of DOAC patients was lower than those of VKA patients. Differences in the incidence rate of left ventricular thrombus disappearance, severe bleeding events, systemic embolic events weren’t statistically significant between DOAC patients and VKA patients. Thrombolytic therapy is effective on LVT. The anti-platelet therapy remained controversial. Surgery was considered to be the most effective and direct method for LVT, and the incidence of systemic embolic events was minimum. Conclusion Anticoagulation is considered to be the most effective treatment for LVT, and thrombolysis or surgery is optionally used in some specific patients, the effectiveness of antiplatelet therapy remains controversial.

Meta-analysis of disability risk factors in stroke patients

Ma Hongli, Lu Hao, Wang Dan, Jiao Haixing, Li Yike, Li Siyu, Lu Jing

2023, 38(2):  111-116.  doi:10.3969/j.issn.1004-583X.2023.02.002

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Objective To investigate the disability risk factors in stroke patients via meta-analysis. Methods We searched databases of CNKI, Wanfang, VIP, CBM, PubMed, EmBase, Cochrane Library, and Web of Science from the establishment of the database to August 8, 2022. A meta-analysis was performed using RevMan 5.3. Results A total of 13 articles representing 47 related factors and 6 risk factors were included. Meta-analysis results showed that diabetes (OR=1.41, 95% CI=[1.32-1.52]), National Institutes of Health Stroke Scale (NIHSS) score (OR=1.46, 95% CI=[1.17-1.82]), age (OR=1.12, 95% CI=[1.02-1.23]), gender (OR=1.93, 95% CI=[1.45-2.57]), onset frequency (OR=1.70,95% CI=[1.41-2.04]) and marriage (OR=1.81, 95% CI=[1.08-3.02] were disability risk factors in stroke patients. Conclusion Diabetes mellitus, NIHSS score, age, gender, hypertension, onset frequency, and marriage are disability risk factors in stroke patients.

Analysis of one-year follow-up results of ≥75-year-old atrial fibrillation inpatients with high CHA2DS2-VASc score

Zhang Fang, Zhang Yichao, Jia Xinwei, Li Jianlong, Chen Chunhong

2023, 38(2):  117-120.  doi:10.3969/j.issn.1004-583X.2023.02.003

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Objective Atrial fibrillation (AF) is a common arrhythmia that increases the risk of ischemic stroke with age. It is a prospective study to analyze the prognosis of ≥75-year-old AF patients with high CHA2DS2-VASc scores, and to explore the risk factors. Methods A total of 196 elderly patients older than 75 years with high CHA2DS2-VASc scores who were hospitalized in the Department of Cardiology, Affilated Hospital of Hebei University, from December 2015 to November 2017 were recruited, including 90 in the AF group and 106 in the non-AF group. A 1-year follow-up was performed, the primary endpoint events of all-cause death, heart failure (HF), and ischemic stroke were recorded. Data processing was performed using the SPSS19.0 statistical software package. Results ①There were 31 deaths (15.8%) at 1-year follow-up. The incidence of all-cause death, stroke and HF in AF group was significantly higher than that in non-AF group (P <0.05). ②Age and history of heart failure were independent risk factors for death and HF in elderly patients older than 75 years with high CHA2DS2-VASc scores. ③Female gender and hypertension were independent risk factors for stroke at 1-year follow-up in elderly patients older than 75 years with high CHA2DS2-VASc scores. Conclusion Elderly patients (≥75 years old) with high CHA2DS2-VASc scores have a poor prognosis, and those combined with AF have a worse prognosis. Sex and age are the independent risk factors for assessing the prognosis. As an independent risk factor, HF has a significant power, and active control can significantly improve the prognosis. Our prospective and observational study provides some theoretical basis for the current clinical treatment of such patients.

Predictive values of serum homocysteine, cystatin C and high sensitive C-reactive protein levels on heart failure after percutaneous coronary intervention in patients with acute ST-elevation myocardial infarction

Li Nana, Jiang Shan

2023, 38(2):  121-125.  doi:10.3969/j.issn.1004-583X.2023.02.004

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Objective To investigate the value of serum homocysteine, Cystatin C and high-sensitivity C-reactive protein in predicting heart failure (HF) after percutaneous coronary intervention (PCI) in patients with acute ST-elevation myocardial infarction (STEMI). Methods A total of 168 patients with STEMI who underwent PCI from July 2020 to December 2020 were retrospectively selected as the research objects. They were followed up for 1 year. They were assgined to HF group (n=92) and non-HF group (n=76) according to the presence or absence of HF after PCI. The clinical data of the patients were collected and compared between the two groups were compared. Multivariate logistic regression was used to analyze the risk factors, and ROC curve was drawn to analyze the predictive value of serum homocysteine, Cystatin C and high-sensitivity C-reactive protein for HF after PCI in STEMI patients. Results The age, homocysteine, Cystatin C and high sensitive C-reactive protein levels in HF group were significantly higher than those in non-HF group, while the left ventricular ejection fraction (LVEF)level was significantly lower (P<0.05). There were no significant differences in gender, smoking history, drinking history,diabetes history, hypertension history, single vessel disease, heart rate, body mass index (BMI), troponin T, creatine kinase MB (CK-MB), triglyceride, high density lipoprotein cholesterol, low density lipoprotein cholesterol, uric acid and creatinine between the two groups (P >0.05). Multivariate logistic regression analysis showed that age, homocysteine, Cystatin C, and high-sensitivity C-reactive protein were independent risk factors for HF after PCI in STEMI patients. ROC curve analysis showed that the area under the curve (AUC) of serum homocysteine, Cystatin C and hypersensitive C-reactive protein in predicting HF after PCI in STEMI patients was 0.706, 0.698 and 0.762 respectively, with the specificity of 0.609, 0.641 and 0.601 respectively, and the sensitivity of 0.724, 0.697 and 0.812 respectively. AUC of the combined prediction of serum homocysteine, Cystatin C and hypersensitive C-reactive protein was 0.817, with the specificity and sensitivity of 0.690 and 0.868, respectively. Conclusion Serum homocysteine, Cystatin C and high sensitive C-reactive protein are the risk factors of HF after PCI in STEMI patients, and their combination detection has a high clinical value in predicting HF after PCI in STEMI patients.

Correlation analysis between dietary nutrient intake with blood glucose and insulin resistance in healthy population

Han Tuo, Wang Lixia, Wang Yiwen, Li Ying, Gong Hong, Zhang Chunyan, Zhang Yan, Li Yongqin, Wang Congxia

2023, 38(2):  126-131.  doi:10.3969/j.issn.1004-583X.2023.02.005

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Objective To explore the correlation between the intake of different dietary nutrients with fasting blood glucose (FBG) and insulin resistance (IR). Methods Based on the data of the China Health and Nutrition Survey(CHNS), the data of 1 376 samples were included by matching the basic demographic data and serological test results with ID. The differences in fasting blood glucose of people with different nutrient intake groups, and their correlation with IR indexes were analyzed. Results Serum total cholesterol, triglyceride, LDL-C and serum uric acid in prediabetes group and diabetic group significantly increased, especially in the latter group (P<0.05). FBG was significantly higher in the highest quartile of fat intake group than that in the lowest quartile of fat intake group (5.38±1.34 vs 5.06±1.10 mmol/L, P=0.017). It was positively correlated with fat intake (r=0.1122, P<0.01), but not correlated with carbohydrate and protein intake (both P>0.05). In addition, fat intake was correlated with Homeostatic model assessment of insulin resistance(HOMA-IR) (r=0.0525, P =0.051), and negatively correlated with the Homeostatic model assessment of insulin sensitivity (HOMA-IS) (r=-0.0520, P=0.053) and Homeostasis model assessment for beta-cell function (HOMA-β) (r=-0.0681, P=0.011). Conclusion Fat intake is closely correlated with the increased FBG and IR in healthy population, although the specific mechanism needs to be further explored.

Comparison of short-term efficacy of insulin degludec/insulin versus continuous subcutaneous infusion of insulin asparton diabetic patients admitted in non-endocrinology departments

Rao Xiaojuan, Shi Shuangwei, Sang Yanhong

2023, 38(2):  132-136.  doi:10.3969/j.issn.1004-583X.2023.02.006

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Objective To observe the efficacy and safety of insulin degludec/insulin aspart (IDegAsp) and continuous subcutaneous infusion (CSI) of insulin aspartate for diabetic inpatients in non-endocrinology departments. Methods From December 2021 to June 2022, 82 diabetic inpatients admitted to the in non-endocrinology departments, the Fifth Affiliated Hospital of Zhengzhou University, who had uncontrolled blood glucose after injections of insulin aspart-30 were retrospectively analyzed. They were randomly allocated into IDegAsp group (n=50) and CSI group(n=32), and patients in the two groups were intervened by IDegAsp infusion and CSI of insulin aspartate, respectively. Clinical data were compared between groups, including fasting blood glucose (FBG) and insulin dosage before and after treatment, time to achieve a standard FBG, time to achieve targeted FBG, FBG fluctuation indexes like mean amplitude of glycemic excursion (MAGE), standard deviation of blood glucose (SDBG), maximum blood glucose fluctuation and absolute means of daily difference (MODD), and insulin dosage at the standard FBG, incidence of hypoglycemia, and patient’s and doctor’s satisfaction. Results On day 10, FBG and insulin dosage in both groups were significantly reduced (P<0.05). There were no significant differences in FBG and blood glucose changes before and after treatment, insulin dosage changes and doctor’s satisfaction, changes in blood glucose and insulin dosage and satisfaction of doctors between the two groups (P>0.05). The incidence of hypoglycemia was significantly lower in the IDegAsp group than that in CSI group, while the patient’s satisfaction was significantly higher (P<0.01). SDBG, MAGE, MODD and time to achieve standard FBG in Deguaspart group were obviously inferior to those in CSI group (P<0.05). Conclusion For diabetic patients in non-endocrinology departments, both IDegAsp and CSI of insulin aspartate can effectively control blood glucose and lowerinsulin dosage, and the former is featured by a low risk of hypoglycemia, high patient’s satisfaction, long time to achieve target FBG and large blood glucose fluctuations.

Prediction of thyroid hormone level on risk of type 2 diabetes nephropathy

Li Huifang, Miao Xia

2023, 38(2):  137-142.  doi:10.3969/j.issn.1004-583X.2023.02.007

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Objective Studies have shown that thyroid function is closely related to chronic kidney disease (CKD), and there are few studies on the relationship between thyroid function and diabetes kidney disease (DKD). This study aims to assess the relationship between thyroid function and DKD in patients with type 2 diabetes mellitus (T2DM). Methods Totally 553 inpatients in the Department of Endocrinology of Hebei Yiling Hospital from January 2021 to December 2021 were included, involving 304 non-DKD patients and 249 DKD patients. Clinical demographic characteristics (age, diabetes duration, systolic pressure, diastolic pressure, diabetes retinopathy, etc.), thyroid function (thyroid-stimulating hormone [TSH], total triiodothyronine [TT3], total thyroxine [TT4], free triiodothyronine [FT3], free thyroid hormone [FT4], FT3/FT4), renal function (blood urea nitrogen [BUN], serum creatinine [SCr], uric acid [UA], β₂ microglobulin [β₂-MG], urinary albumin-to-creatinine ratio [UACR]), estimated glomerular filtration rate (eGFR). Comprehensively analyze was performed to evaluate the effect of demographic characteristics and thyroid function of patients on DKD. Results There were proportion of 249/553(45.03%) DKD patients among the T2DM patients. In DKD group, patients with diabetes had a long diabetes duration and older. FT3 and FT3/FT4 were significantly reduced in DKD group, FT3 was positively correlated with eGFR (r=0.219, P<0.01) and negative correlation in UACR, β₂-MG and BUN. FT3 levels were related to the risk of DKD (OR: 0.712, 95% CI: 0.564-0.901). Further stratified analysis showed that FT3 level less than 3.45 pmol/L was a risk factor for DKD. However, the difference in correlation strength between TSH, FT4 and DKD was not statistically significant. Conclusion TSH and FT3 are closely related to DKD, and FT3 can be used as sensitive indicators for clinical monitoring of DKD.

Value of different clock drawing tests in identifying acute post-stroke cognitive impairment no dementia

Jia Yangjuan, Han Ning, Guo Hui, Li Cancan, Li Jianguo

2023, 38(2):  143-148.  doi:10.3969/j.issn.1004-583X.2023.02.008

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Objective To explore the value of three clock drawing tests (CDT) scoring systems and error types in identifying acute post-stroke cognitive impairment no dementia (PSCIND). Methods From October 2019 to April 2021, 114 patients with acute PSCIND treated in the Department of Neurology, Hebei General Hospital were as the PSCIND group, meantime, 95 healthy examination people in the Department of Physical Examination of our hospital were as the control group. The cognitive functions of these patients were assessed, including CDT scoring systems (Cahn, Babins, and three-point) and Mini Mental State Examination (MMSE),and an analysis of CDT error type was performed between the two groups. The receiver operating characteristic (ROC) curve was conducted to identify the diagnostic value of CDT, MMSE, and the two combination for PSCIND. Results Babins, Cohen of CDT scoring systems and MMSE score were independent risk factors for PSCIND. The sensitivity and the specificity of Babins, Cohen and MMSE in the diagnosis of PSCIND was (87.5% vs 58.7% vs 76.9%) and (55.8% vs 81.1% vs 61.1%), respectively. The sensitivity and specificity of Babins and Cohen combined with MMSE were 57.5% and 70.2%, and 85.3% and 75.8% respectively. The analysis of error types found that the two groups of common error types were mainly concept loss (type Ⅳ error), space plan error (type Ⅴ error) and drawing difficulty (type Ⅱ error). Compared with the control group, PSCIND group accounted for more type Ⅱ errors, stimulus-limiting response (type Ⅲ errors), type Ⅳ errors and repetition (type Ⅵ errors) (all P<0.05). Conclusion The CDT score applied alone fails to identify PSCIND well, while Cohen method of CDT score is eligible to identify PSCIND well with high sensitivity and specificity after being combined with MMSE score. CDT error types are eligible to well distinguish PSCIND and control persons and be used as a preliminary screening tool for PSCIND.

Clinical observation of serious adverse events in children with acute lymphoblastic leukemia during chemotherapy

Du Jiayi, Liu Lili, He Yongzhong, Tian Chuan, Lan Xiang, Ye Zhonglyu

2023, 38(2):  149-154.  doi:10.3969/j.issn.1004-583X.2023.02.009

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Objective To analyze the risk factors of severe adverse event(SAE)-related deaths in children with acute lymphoblastic leukemia (ALL) by summarizing the incidence of SAE during chemotherapy in patients receiving SCCLG-all-2016 regimen. Methods A retrospective analysis was performed on 82 ALL children admitted to the Department of Pediatrics of Affiliated Hospital of Guangdong Medical University, those children were treated with SCCLG-ALL-2016 regimen from December 2017 to January 2021, totally 21 children with SAE were assinged to death group (n=6) and survival group (n=15) to investigate the risk factors of SAE-related deaths during chemotherapy. Results Among the treatment stages, the largest number of SAEs was recorded in the stage of induction remission(30.9%). Hematology-related SAEs (60.3%) accounted for the majority of all SAEs. Among the non-hematology related SAEs, infection-related SAE accounted for the largest proportion (76.1%), and respiratory infection was the most frequent. Among the 6 children in the death group, 5 died of infection or co-infection factors, accounting for 83.3% of the causes of death. Conclusion For ALL children treated with SCCLG-ALL-2016 regimen, SAEs occurre mainly in the induced remission stage, mainly manifested as hematology-related SAE. Infection-related SAEs account for the highest proportion of non-hematology-related SAEs and are also important causes of death during chemotherapy. Positive chromosome results may be associated with death outcomes.

Status analysis of nurses' practice environment and job burnout in tertiary hospitals and community hospitals

Yu Xiaojuan, Zhou Huaxian, Ni Yanting, Tang Xiaowen, Tang Li, Qu Haihong

2023, 38(2):  155-161.  doi:10.3969/j.issn.1004-583X.2023.02.010

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Objective To explore the status of practice environment and job burnout of nurses among tertiary hospitals and community hospitals in Shanghai, and compare their differences. Methods Nurses in tertiary hospitals and community hospitals were investigated by general information questionnaire, Practice Environment Scale of the Nursing Work Index (PES-NWI) and Maslach Burnout Inventory based on the convenience sampling method. Results Totally 891 nurses participated in PES-NWI survey, among which, the overall evaluation scores of practice environment of 563 nurses from tertiary hospitals and 328 nurses from community hospitals were (63.66±27.34) points and (70.99±26.60) points, respectively. Totally 799 nurses participated in the job burnout survey, among which, the proportion of job burnout in 507 nurses from tertiary hospitals and 292 nurses from community hospitals was 85.8% and 78.4%, respectively, and with statistically significant difference (P<0.05). Conclusion Nurses in tertiary hospitals score lower on the practice environment than in community hospitals, and job burnout was worse than in community hospitals. Hospital managers should not only formulate relevant incentive measures from the aspect of external returns, but also formulate corresponding solutions from the aspects of internal returns such as personal development, career planning and humanistic care, so as to stabilize the nursing staff.

Acute myocardial infarction caused by spontaneous coronary artery dissection in a young woman: A case report and literature review

Wang Jiaqi, Wang Wenjing, Liu Litian, Zhang Feifei, Dang Yi, Qi Xiaoyong

2023, 38(2):  162-165.  doi:10.3969/j.issn.1004-583X.2023.02.011

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Objective To explore the clinical characteristics of spontaneous coronary artery dissection, aiming to improve the diagnosis and treatment of this disease. Methods The clinical data of a young female patient with acute myocardial infarction caused by spontaneous coronary artery dissection were retrospectively analyzed. In addition, relevant Chinese and English language literatures were searched in the CNKI, PubMed and Wanfang databases using the keywords of “spontaneous coronary artery dissection”, “acute myocardial infarction” and “young female” to perform literature review. Results A 35-year-old young woman presented in our hospital with an intermittent chest pain. Electrocardiography showed ST-segment elevation in leads I, aVL and V2-V5. Troponin T was elevated (>2 000 ng/L). Coronary angiography (CAG) showed that the left main stem (LM) was dissected from the opening, which was extended to the distal segment of the left anterior descending branch (LAD) and the middle part of the left circumflex branch (LCX). The lumen was under pressure throughout the whole process, and the proximal vessels were unable to be visualized. Percutaneous coronary intervention (PCI) was performed under the guidance of intravenous ultrasound (IVUS). At the 1-month follow-up visit, CAG showed a good therapeutic effect. Conclusion Spontaneous coronary dissection is a rare cause of acute coronary syndrome, and its disease characteristics and treatment methods are different from those of coronary atherosclerosis. The diagnosis is challenging and it is easy to be misdiagnosed and mistreated clinically. Therefore, the possibility of spontaneous coronary dissection should be considered in young patients with ACS.

Clinical analysis of three elderly patients with hypercalcemia and literature review

Chai Chunyan, Wang ting

2023, 38(2):  166-169.  doi:10.3969/j.issn.1004-583X.2023.02.012

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Objective To analyze clinical characteristics and causes of elderly patients with hypercalcemia. Methods The clinical manifestations and diagnosis and treatment process of three elderly patients with hypercalcemia admitted to Shaanxi Provincial People's Hospital were retrospectively analyzed, and the related literature were reviewed. Results Clinical manifestations of the three elderly patients with hypercalcemia varied, one patient suffered from drowsiness as the initial symptom, one patient showed systemic myasthenia, and the other patient showed speech disorder. All the three patients received multiple examinations, and hypercalcemia was confirmed by checking the serum calcium level curve. The serum calcium level was significantly decreased and the clinical symptoms were effectively improved after massive fluid rehydration, diuresis, intramuscular injection of salmon calcitonin, continuous renal replacement therapy and similar therapeutic measures. Conclusion The elderly should be alerted to the possibility of hypercalcemia and timely determine the serum calcium if they suffer from sudden changes in consciousness, general myasthenia gravis and speech disorder. Normally, the incidence of hypercalcemia in elderly patients is relatively hidden and the clinical symptoms are not specific, it is necessary to expand the idea for diagnosis and treatment when the acute attack of cardio-cerebrovascular disease is ruled out and the curative effect is not satisfactory, and take note of eliminating the possibility of hypercalcemia.

Delayed encephalitis after embolization of brain arteriovenous malformations: A case report and literature review

Dong Siyu, Sun Mei, Tian Yufei, Cheng Hong, He Chuan

2023, 38(2):  170-174.  doi:10.3969/j.issn.1004-583X.2023.02.013

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Objective To investigate the diagnosis and treatment of the rare embolic material-associated encephalitis. Methods Clinical data of a patient with delayed encephalitis after embolization of brain arteriovenous malformations (BAVM) were analyzed retrospectively, and the relevant literature was reviewed. Results The 52-year-old male patient with BAVM developed systemic rash and left-sided weakness within 1 mouth after embolization. The symptoms were gradually worsen after antiviral infection. After excluding other diseases, the patient was considered as delayed encephalitis associated with embolic materials, who was cured by a hormone therapy. Conclusion Endovascular embolization can induce severe delayed inflammatory response in the central nervous system. It is necessary to prolong the postoperative follow-up period of patients.