Table of Content

20 May 2023, Volume 38 Issue 5

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Meta-analysis of the application value of metagenomic next-generation sequencing technology in the diagnosis of pulmonary tuberculosis

Wolazihan Madeniyati, Dilixiati Tuerdimaimaiti, Li Mengchen, Baihetinisha Tuerdi

2023, 38(5):  389-398.  doi:10.3969/j.issn.1004-583X.2023.05.001

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Objective To evaluate the diagnostic value of metagenomic next-generation sequencing (mNGS) technology in different clinical specimens for pulmonary tuberculosis (PTB). Methods Relevant researches on the diagnosis of PTB by using mNGS included in PubMed, Embase, The Cochrane Library, CNKI, Wanfang and Vip and other databases for published from the establishment to November 2022were searched. After strict screening and quality evaluation, the literatures were screened by two researchers independently, followed by data extraction and risk assessment of inclusion study bias. StataSE16 software and Revman5.3 software were used for meta-analysis. Results A total of 11 eligible literature and 1995 patients were included in the meta-analysis. The results showed that the sensitivity and specificity of mNGS for PTB diagnosis in lung specimens was 70% (95% CI: 58%-79%) and 99% (95% CI: 98%-100%), positive likelihood ratio (PLR) was 106.9 (95% CI: 31.1-366.6), negative likelihood ratio(NLR) was 0.31 (95% CI: 0.21-0.43), diagnostic odds ratio(DOR) was 350 (95% CI: 81-1512) and the area under curve(AUC) was 0.97. The sensitivity, specificity, PLR, NLR, DOR, and AUC of mNGS for PTB diagnosis in bronchoalveolar lavage fluid (BALF) were 71% (95% CI: 55%-83%), 99% (95% CI: 97%-100%), 76.4 (95% CI: 26.6-218.9), 0.30 (95% CI: 0.18-0.48), 258 (95% CI: 75-895), and 0.99, respectively. The sensitivity and specificity of mNGS for PTB diagnosis in lung tissues were 81% (95% CI: 69%-89%) and 97% (95% CI: 88%-99%), PLR was 26.0 (95% CI: 6.6-102.4), NLR was 0.19 (95% CI: 0.11-0.33), DOR was 135 (95%CI: 29-639), and AUC was 0.97. Conclusion Application of mNGS technology exerts high diagnostic value for PTB, especially for sputum-negative PTB, which can be used as an auxiliary tool for rapid diagnosis of PTB.

The efficacy of Endo combined with cisplatin in the treatment of lung cancer complicated with malignant pleural effusion:A meta-analysis

Zhao Zhe, Mu Peijuan, Zhang Dong

2023, 38(5):  399-404.  doi:10.3969/j.issn.1004-583X.2023.05.002

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Objective To systematically evaluate the efficacy and safety of Endo combined with cisplatin in the treatment of lung cancer with malignant pleural effusion. Methods We conducted a Computer search in CNKI databases, WanFang Data, the Chongqing VIP Chinese Science and Technology Periodical Database (VIP), Chinese Biomedical Literature Database (CBM), Pubmed, Cochrane Library, Web of Science, Proquest, and Embase to screen the randomized controlled trial regarding endostar plus intrapleural cisplatin for lung cancer with malignant pleural effusion. We performed a meta-analysis using Revman 5.3 software to calculate the relative risk (RR) and 95% confidence interval (CI), and performed the Egger test using Stata 15.0 software. Results A total of 2 randomized controlled studies were included representing 728 patients who consisted cisplatin single drug group(control group, n=363) and endu combined with cisplatin group(experimental group, n=365). Meta analysis showed that the total effective rate( RR=1.62,95% CI[1.45-1.81];Z=8.48, P<0.05) and the improvement rate of quality of life(RR =1.68,95%CI[1.44-1.96]; Z =6.60,P<0.05) in the experimental group were higher when compared with the control group, but there was no significant difference in the main adverse reactions such as leucopenia, thrombocytopenia and malignant vomiting (P>0.05) between groups. Conclusion The combination endostar with intrapleural cisplatin is better than cisplatin single drug in the treatment of lung cancer with malignant pleural effusion, which can improve the total effective rate, improve the quality of life of patients, and did not increase the incidence of adverse reactions as a whole.

Correlation between pruritus and the prognosis of intrahepatic cholestasis of pregnancy and prediction of its risks

Zhang Yuan, Zhou Juan, Li Wenxiang, Liu Jinxiang, Tang Xiaomei, Luo Huijuan

2023, 38(5):  405-411.  doi:10.3969/j.issn.1004-583X.2023.05.003

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Objective To compare the clinical characteristics of intrahepatic cholestasis of pregnancy (ICP) with or without pruritus and to evaluate the significance of pruritus in ICP. Methods A total of 359 ICP patients were divided into different groups according to the presence or absence of pruritus, the onset of gestational age and the total bile acid (TBA) levels. Pregnant women with normal birth examination during the same period were randomly selected as the control group. The correlation of pruritus and TBA levels with perinatal morbidity was evaluated. Results The incidence of ICP was about 1.1%, and most of them were asymptomatic (71.03%). Liver function, gestational diabetes mellitus (GDM), low birth weight, preterm birth and cesarean section rate were significantly higher in ICP patients with or without pruritus than those in the control group (P <0.05). The cord blood flow before delivery was within the normal range in all three recruited pregnant women. In ICP group, especially in symptomatic ICP group, the cord blood flow values were within the upper limit of the normal range (P <0.05). Pregnant women with mild and asymptomatic ICP had the lowest rates of cesarean section and preterm birth (P<0.05). Pruritus and TBA level were positively correlated with perinatal morbidity, especially when TBA≥40 μmol/L. Conclusion Pruritus should not be a prerequisite for the diagnosis of ICP. Regardless of the presence or absence of pruritus, ICP increases perinatal morbidity, but pruritus and TBA≥40 μmol/L are risk factors for perinatal morbidity. Cases of asymptomatic ICP are mostly mild, but intrauterine fetal death can occur without warning. Therefore, TBA and liver function should be regularly monitored during pregnancy to prevent missed diagnosis in asymptomatic ICP patients.

Predictive value of a combiniton detection of serum resistin, malondialdehyde and IL-6 tests in predicting the severity of acute pancreatitis

Yu Xuehua, Zhang Ning, Wu Jing, Sun Hui, Zhao Yunhong, Liu Gaifang

2023, 38(5):  412-416.  doi:10.3969/j.issn.1004-583X.2023.05.004

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Objective To investigate the predictive value of a combination detection of serum resistin, malondialdehyde (MDA) and interleukine-6 (IL-6) in predicting the severity of acute pancreatitis (AP). Methods A total of 120 AP patients hospitalized in the Department of Gastroenterology, Hebei General Hospital, from January 2022 to November 2022 were selected and divided into three groups: mild acute pancreatitis group (MAP), moderately severe acute pancreatitis (MSAP) and severe acute pancreatitis group (SAP). Baseline characteristics of them were collected, and 4 ml of venous blood was drawn within 48-72 hours of onset of illness to measure serum levels of resistin, MDA and IL-6 by enzyme-linked immunosorbent assay (ELISA). Results There were significant differences in serum resistin, MDA and IL-6 levels among the MAP, MSAP and SAP group (P<0.05). There was a significant linear correlation among serum resistin, MDA and IL-6 levels (P<0.01). The area under the receiver operating characteristic (ROC) curves (AUC) of detecting serum resistin, MDA and IL-6 in predicting SAP (including both MSAP and SAP) was 0.850, 0.774 and 0.817, respectively, with the sensitivity of 77.80%, 90.70% and 72.20%, respectively, and the specificity of 78.80%, 62.10% and 83.30%, respectively. The AUC of a combination detection of them in predicting SAP (MSAP+SAP) was 0.890, with the sensitivity and specificity of 74.10% and 90.90%, respectively. Conclusion Serum resistin, MDA and IL-6 levels are significantly elevated in SAP patients, and their combination detection has a high efficacy in predicting the severity of AP, which may be used as a novel predictive method.

Clinical characteristics and risk factors of gastric cancer-related stroke

Wang Yingnan, Zhao Qi, Bai Haiwei, Wu Danna, Wei Jinmei, Li Shengjiang, Li Ruiling, Zhang Ruixing

2023, 38(5):  417-422.  doi:10.3969/j.issn.1004-583X.2023.05.005

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Objective To investigate the clinical characteristics and risk factors of patients with gastric cancer-related stroke (GCS). Methods A total of 42 patients with gastric cancer who were diagnosed in the Fourth Hospital of Hebei Medical University from January 2014 to December 2019 and had new cerebral infarction in the course of diagnosis and treatment were included in GCS group. During the same period, eighty-four gastric cancer patients without new cerebral infarction occurred in the course of diagnosis and treatment were included in the control group. Clinical data and characteristics between groups were compared, and those with significant differences were introduced into the multivariate logistic regression analysis to analyze independent risk factors for new cerebral infarction in gastric cancer patients. Results A total of 42 GCS patients with the mean age of 67.14±8.15 (47-86) years were collected in this study, including 34 males and 8 female. They were pathologically diagnosed as gastric adenocarcinomas. Cerebral infarction occurred 0-985 days after the diagnosis of gastric cancer, with the median onset time of 38 days. Magnetic resonance imaging (MRI) showed that 22 cases (52.4%) had multiple lesions and multiple sites involved in the brain, and 25 cases (59.5%) did not receive targeted treatment for gastric cancer because of cerebral infarction. The proportion of hypertension history, diabetes history, hyperlipidemia history and previous cerebral infarction history in GCS group was significantly higher than that in the control group (P<0.05). The prothrombin time, D-dimer and carbohydrate antigen 199 levels in GCS group were significantly higher than those in the control group, while the hemoglobin level was significantly lower than that in the control group (P<0.05). The proportion of patients with surgical history and chemotherapy history in the GCS group was significantly lower than that in the control group (P<0.05). Multivariate logistic regression analysis showed that a previous history of cerebral infarction was an independent risk factor for cerebral infarction in GCS patients. Conclusion Cerebral infarction is highly prevalent within 1-6 months after the diagnosis of gastric cancer. Conventional risk factors for stroke are also independent risk factors for stroke in gastric cancer patients, so as the history of cerebral infarction. Our findings have a important guiding significance for preventing and reducing the occurrence of GCS.

Effect of prone position ventilation combined with fiberoptic bronchoscopy in the treatment of coma patients with atelectasis

Feng Yang, Wang Xiangmeng

2023, 38(5):  423-427.  doi:10.3969/j.issn.1004-583X.2023.05.006

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Objective To investigate the therapeutic effect of prone position ventilation combined with fiberoptic bronchoscopy on coma patients with atelectasis. Methods A total of 36 patients hospitalized in the surgical intensive care unit (ICU) of our hospital from June 2021 to May 2022 due to severe brain injury, spontaneous cerebral hemorrhage, intracranial aneurysm rupture and hemorrhage who were unable to withdraw the ventilator due to pulmonary infection and atelectasis were retrospectively analyzed. Their primary diseases tended to be stable. They were randomly divided into observation group and control group, with 18 in each group. Patients in observation group were managed by conventional treatment combined with prone position ventilation and fiberoptic bronchoscopy, and those in control group were managed by conventional treatment combined with fiberoptic bronchoscopy. Imaging data (chest computed tomography [CT]/digital radiography [DR]), arterial blood gas test data, ventilator parameters, mechanical ventilation time, use of antibiotics, ICU hospitalization time, and complications before and after treatment in both groups were collected. Results After treatment, the atelectasis of all patients in observation group was improved, with the significantly increased oxygenation index. Among them, six cases had pressure sores of varying degrees, and eventually cured. Other serious complications in observation group were not reported. In the control group, twelve patients had improved atelectasis and increased oxygenation index. The improvement rate of atelectasis in the observation group was significantly higher than that in the control group (100% vs 67%), suggesting that the treatment of prone position ventilation combined with fiberoptic bronchoscopy was more beneficial to atelectasis than conventional treatment. Conclusion Prone position ventilation combined with fiberoptic bronchoscopy is an effective treatment to coma patients with atelectasis.

Prevalence and risk factors of hyperuricemia in health examination population in Yangzhou, 2020

Liu Jing, Luo Na, Feng Shangyong, Wang Yan, Zhang Zhenwen, She Dunmin

2023, 38(5):  428-432.  doi:10.3969/j.issn.1004-583X.2023.05.007

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Objective To analyze the prevalence and risk factors of hyperuricemia (HUA) in health examination population in Yangzhou, Jiangsu Province in 2020. Methods A retrospective analysis was conducted on 12188 healthy adults over 20 years who had received health examinations in Yangzhou, Jiangsu Province. The prevalence of HUA in different age and gender groups was measured, and the correlation between biochemical parameters and the occurrence of HUA was analyzed. Results The prevalence of HUA among the health examination population in Yangzhou, Jiangsu Province in 2020 was 18.7%, which was 5.6% for females and 24.8% for males, respectively. Among males, the prevalence of HUA was the highest among young men aged 20-29 years and 30-39 years, reaching 31.9% and 29.9% respectively. Spearmen correlation analysis and logistic regression analysis indicated that body mass index (BMI) was positively correlated with HUA. The receiver-operating characteristic curve (ROC) analysis showed BMI>23.84 kg/m² could be used to predict the occurrence of HUA. Conclusion In 2020, the prevalence of HUA is 18.7% in health examination population in Yangzhou. Young men aged 20-39 years have the highest prevalence among males, indicating that the high prevalence of HUA among young males can not be ignored. BMI is positively correlated with HUA occurrence, which may be a potential risk factor for HUA.

Analysis of correlations between serum severe mycoplasma pneumoniae pneumonia level with immunoglobulin E and C-reactive protein in children

Cheng Tingting, Qi Caiying, Zhang Xuelian, Xiao Meng, Sui Weihang, Li Xiaoyan, Liu Jianying

2023, 38(5):  433-437.  doi:10.3969/j.issn.1004-583X.2023.05.008

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Objective To investigate the correlations between serum severe mycoplasma pneumoniae pneumonia (SMPP)levels with immunoglobulin E (IgE) and C-reactive protein (CRP) in children. Methods A total of 153 children with MPP hospitalized in the Department of Pediatrics of NO.2 Clinical Teaching Hospital, Chengde Medical University from July 2021 to May 2022 were enrolled in this retrospective study, including 84 SMPP and 69 non-SMPP. Clinical characteristics, laboratory examination results and pulmonary imaging features were compared between SMPP children and non-SMPP children. Meanwhile, the correlation between serum levels of IgE and CRP with the severity of SMPP in patients was determined. Results SMPP children had longer duration of fever and hospitalization duration than non-SMPP children, and the differences were statistically significant (P<0.05). The proportion of pulmonary complications in SMPP children was significantly higher than that in non-SMPP children (P<0.05). The percentage of neutrophil, the ratio of neutrophil/lymphocyte, and serum levels of IgE and CRP in SMPP children were significantly higher than those in non-SMPP children (P<0.05). However, the percentage of lymphocytes in SMPP children was remarkably lower (P<0.05). The proportion of SMPP children with large consolidation shadows on pulmonary imaging was obviously higher than that in non-SMPP children (P<0.05). IgE and CRP levels were positively correlated with SMPP, and elevated levels of IgE and CRP were independent risk factors for SMPP occurrence (P<0.05). Conclusion Serum IgE and CRP are independent risk factors for SMPP, which are of great significance for early identification of SMPP.

Epidemiological characteristics of 58 elderly fracture patients with in-hospital acute cerebral infarction before operation

Zhou Qi, Zhu Yanbin, Li Weining, Li Shuhan, Zhang Xiuguo

2023, 38(5):  438-443.  doi:10.3969/j.issn.1004-583X.2023.05.009

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Objective To investigate the epidemiological characteristics of in-hospital acute cerebral infarction in elderly patients with fractures before operation. Methods A total of 18,435 elderly patients undergoing fracture surgery in our hospital from January 1, 2016 to October 31, 2021 were retrospectively investigated, among whom 58 patients had acute cerebral infarction before surgery. Their medical records included general information, first detected laboratory indicators on admission, time from injury to admission, time from admission to operation, time of cerebral infarction, etc. The epidemiological status of preoperative acute cerebral infarction in patients was analyzed, and the mechanism and risk factors of preoperative acute cerebral infarction in elderly patients with fractures were described and analyzed. Results The incidence of in-hospital acute cerebral infarction in elderly patients with fractures was 0.314%. Among 58 recruited patients, there were 19 males (32.8%) and 39 females (67.2%), with a male to female ratio of 1∶2.05. The mean age of them was (74.0±1.3) years, and 40 patients (69.0%) were over 75 years.There were 47 cases of hip fractures (81.0%), 3 cases of distal femoral fractures (5.2%), 3 cases of humeral fractures (5.2%), 2 cases of femoral shaft fractures (3.4%), 2 cases of olecranon fractures (3.4%) and 1 case of proximal tibia fracture (1.7%). The onset time of cerebral infarction ranged 1-7 days, and 35 cases (60.3%) occurred within 72 hours. Most of the abnormal laboratory indicators detected for the first time on admission were hemoglobin, serum C-reactive protein, serum homocysteine and serum albumin. Anemia was the most-common complication during hospitalization (70.7%), followed by lower extremity deep vein thrombosis (56.9%), electrolyte disturbance (43.1%), hypoproteinemia (41.7%) and pulmonary infection (37.9%). Conclusion Acute cerebral infarction mostly occurs within 72 hours in elderly patients with fractures, and hip fracture is the more common type in female patients ≥75 years old. Laboratory indicators detected for the first time on admission should be thoroughly evaluated, and targeted measures should be taken to prevent complications and reduce the incidence of acute cerebral infarction before operation.

Electrocardiographic findings of the spiked helmet sign: A case report and literature review

Zhang Canna, Xiang Lu, Luo Yaxiong

2023, 38(5):  444-447.  doi:10.3969/j.issn.1004-583X.2023.05.010

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Objective To identify the electrocardiographic (ECG) findings of the spiked helmet sign and to explore its clinical significance. Methods The clinical data of one patient with ECG findings of the spiked helmet sign who was admitted to the Department of Cardiology of Xiangxi Autonomous Prefecture People's Hospital were retrospectively analyzed. Relevant literatures reporting the spiked helmet sign were reviewed. Results A 48-year-old female patient presented with 9 days of abdominal distension and pain and aggravation with chest tightness and shortness of breath for 8 h. Laboratory tests were performed after admission. ECG showed acute anterior wall elevation myocardial infarction, and Spiked helmet sign. A pointed helmet sign on V3-V5 leads. The patient also had an elevated troponin and ST elevation, and therefore, the possibility of acute myocardial infarction could not be ruled out, which was finally ruled out by the coronary angiography examination. The patient was then diagnosed as intestinal obstruction with acute peritonitis, myocardial injury with cardiac dysfunction and Spiked helmet sign. Conclusion ECG findings of the spiked helmet sign should be timely recognized, and primary disease needs to be diagnosed to prevent delays in diagnosis and treatment.

Subarachnoid hemorrhage misdiagnosed as menigitis: A case report and literature review

Xin Zaie

2023, 38(5):  448-450.  doi:10.3969/j.issn.1004-583X.2023.05.011

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Objective To explore clinical features of subarachnoid hemorrhage (SAH) with negative imaging findings, aiming to decrease misdiagnosis rate and mortality. Methods A case of SAH with negative imaging findings was retrospectively analyzed and relevant literatures were reviewed. Results A 40-year-old female presented with 10 days of headache and 1 day of severe back pain. Lumbar puncture and the following examination showed uniform bloody cerebrospinal fluid, and SAH was clearly diagnosed. Brain computed tomography, spinal magnetic resonance, brain and spinal angiography findings were all negative. After three months, re-examined computed tomography angiography (CTA) of the brain and neck were negative, indicating that the patient was recovered well. Conclusion For patients with SAH and negative CTA findings of the brain, screening of cerebrospinal fluid and imaging examination are necessary to avoid the delayed diagnosis and treatment. A long-term imaging follow-up is needed to those with negative imaging findings, thus reducing the harm of SAH caused by intracranial aneurysm rupture, and the disability or mortality.

SLC32A1 gene mutation in hereditary epilepsy with febrile convulsion addition: A case report and literature review

Zhao Shuzhen, Wang Sanping, Zhao Xiaoyun

2023, 38(5):  451-454.  doi:10.3969/j.issn.1004-583X.2023.05.012

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Objective To investigate the influence of missense mutations in the SLC32A1 gene on hereditary epilepsy with febrile seizures plus (GEFS+). Methods Clinical data of a child with GEFS+ caused by the SLC32A1 gene mutation were retrospectively analyzed, and relevant literatures were reviewed. Results A boy with 1 and a half year old presented with recurrent febrile seizures for three times and febrile seizures twice. Two months ago, the child experienced two episodes of febrile seizures due to upper respiratory tract infection, with a temperature of 38.3 ℃. Tonic-clonic convulsions occurred and lasted 1-3 minutes, which were resolved spontaneously. He then experienced another episode of febrile seizure. One week ago, the child experienced two episodes of febrile seizures without an obvious cause, manifesting as tonic-clonic seizures. No abnormalities were found in electroencephalography and cranial magnetic resonance imaging. His father had one episode of febrile convulsion at the age of 1 year, and the remaining family members denied history of convulsions. The child was the first newborn of his mother and he did not experience hypoxia and asphyxia at delivery, with normal growth and development after birth. Full-exon sequencing showed one heterozygous variant with unknown significance in the SLC32A1 gene: c.1184C>T (p.Pro395Leu), indicating a missense variant. Conclusion SLC32A1 gene mutation is associated with GEFS+, and the phenotypic consistency of the tested subjects is relatively high. Literature review to determine its relevance to GEFS+ contributes to discover new gene profiles of GEFS+ and facilitates genetic counseling.