Table of Content

20 June 2023, Volume 38 Issue 6

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Effect of enteral nutrition on postoperative clinical outcome of esophageal neoplasms: A meta-analysis

You Yi, Gao Shuqing, Xu Hao

2023, 38(6):  485-492.  doi:10.3969/j.issn.1004-583X.2023.06.001

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Objective To evaluate the effect of enteral nutrition on postoperative clinical outcomes and the quality of life of patients with esophageal neoplasms by a meta-analysis. Methods Randomized controlled trials on enteral nutrition support for postoperative patients with esophageal neoplasms were searched in the databases of Medline, Embase, Cochrane Central Register of Controlled Trials, Web of Science, BIOSIS Previews, Clinical trials.gov, CNKI, SinoMed, and WanFang Data database from January 2000 to December 2021. Two researchers were responsible for screening eligible literatures and extracting the data. The main outcomes, including the complication rate, the first time of postoperative anal exhaustion, length of stay, and hospitalization expenses, and the overall quality of life were extracted. Endnote X9 was used for literature screening and RevMan 5.3 was used for meta-analysis. Resultss A total of 759 studies were retrieved and ultimately 18 eligible studies with 1732 subjects were included. Meta-analysis results showed that after enteral nutrition support, patients in the intervention group had significantly lower rate of complications ( RR =0.50, 95% CI : 0.39, 0.64, P <0.01), shorter time of postoperative anal exhaustion ( MD =-33.32, 95% CI : -54.27, -12.36, P <0.01), and shorter length of stay than those of control group ( MD =-1.40, 95% CI : -2.25, -0.56, P <0.01). However, there were no significant differences in the overall quality of life ( MD =2.39, 95% CI : -2.02, 6.80, P =0.29) and hospitalization expenses ( MD =-0.16, 95% CI : -1.37, 1.06, P =0.80) between groups. Conclusion Current evidence shows that enteral nutrition support can help to improve the postoperative clinical outcome of patients with esophageal neoplasms, reduce the incidence of complications, promote the recovery of intestinal function, and shorten the length of stay.

Values of IL-6 and CRP in predicting the severity of coronavirus disease 2019: A meta-analysis

Ni Yiyun, Liu Bin, Liang Qi, Li Xiaofeng

2023, 38(6):  493-499.  doi:10.3969/j.issn.1004-583X.2023.06.002

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Objective To investigate the clinical values of interleukin-6 (IL-6) and C-reactive protein (CRP) in predicting the severity of coronavirus disease 2019 (COVID-19). Methods Relevant studies about COVID-19 published between December 1, 2019 and January 16, 2021 were searched in online databases of Web of Science, Scopus, Embase, CNKI, Wanfang Data, VIP and CBM. Two investigators were independently responsible for literature screening and data extraction. RevMan5.4 software was used for meta-analysis. Resultss A total of 18 literatures involving 4286 COVID-19 patients were collected, including 1624 in severe group and 2662 in mild group. IL-6 ( SMD =0.92, 95% CI : 0.65-1.18, P <0.01) and CRP levels ( SMD =1.47, 95% CI : 1.03-1.91; P <0.01) in COVID-19 patients of severe group were significantly higher than those of mild group.Conclusion The increases in IL-6 and CRP levels are positively correlated with the severity of COVID-19, serving as inflammation markers for risk stratification of COVID-19, and providing meaningful references for clinical treatment.

Analysis of demographic, clinical and imaging in patients with acute cerebral infarction caused by patent foramen ovale

Zhang Xueqian, Li Yang, Xu Guodong, Lyu Peiyuan

2023, 38(6):  500-503.  doi:10.3969/j.issn.1004-583X.2023.06.003

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Objective To analyze the demographic, clinical and imaging characteristics of patients with acute cerebral infarction(ACI) caused by patent foramen ovale(PFO). Methods From June 29, 2020 to June 15, 2022, the clinical data including their demographic characteristics (age, sex), the National Institutes of Health Stroke Scale (NIHSS) scores, serum laboratory indicators, imaging lesions (location, number and volume of lesions) were collected form 120 ACI patients with cerebral infarction caused by PFO and 120 ACI patients without PFO.The above data of the two were assessed. Resultss The ACI patients with PFO has significantly younger age ([66.00±13.75] vs [(71.50±10.75)], P <0.05), lower the NIHSS score([5.08±3.78]vs [6.89±4.29], P <0.05) and higher the serum homocysteine (Hcy) value([11.98±5.74] μmolL vs [10.04±4.40 ] μmolL, P <0.05) than those without PFO. In brain imaging, the proportion of lesions in the posterior circulation territory and the numbers of small lesions (infarct≤10mm) in ACI patients with PFO were significantly higher than those without PFO( P <0.05).Conclusion Compared with those without PFO, ACI patients with PFO mostly occurs lesions in the posterior circulation territory, and they has mainly small infarcts, relatively mild symptoms and relatively younger onset age.

Value of neutrophil-lymphocyte ratio and platelet-lymphocyte ratio in predicting cognitive impairment in patients with acute mild ischemic stroke

Xin Yanhong, Lang Guiyan, Chen Ziwei, Wang Dongyu

2023, 38(6):  504-509.  doi:10.3969/j.issn.1004-583X.2023.06.004

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Objective To investigate the value of neutrophil-lymphocyte ratio (NLR) and platelet-lymphocyte ratio (PLR) in predicting cognitive impairment at 3 months of acute mild ischemic stroke. Methods A total of 254 hospitalized patients with an initial ischemic stroke from December 2020 to May 2022 in Central Hospital of Jinzhou were selected as the study objects.NLR and PLR were measured at admission. Cognitive function was evaluated at 3 months of stroke by the Montreal Cognitive Assessment (MoCA). According to the MoCA score, patients were classified into post-stroke cognitive impairment group (PSCI group, n=101)and non-cognitive impairment group(NCI group, n =153). Logistic regression was used to screen the risk factors of PSCI. The predictive values of NLR and PLR in PSCI were analyzed by drawing the receiver operating characteristic (ROC) curves.Resultss There were significant differences in the median NLR (3.74[3.41, 5.15] vs 3.15[2.80, 3.82]) and PLR (131.78 [122.63, 149.56] vs 114.70[91.44, 134.52]) between PSCI group and NCI group (both P <0.05). Logistic regression showed that both NLR ( OR =1.437, 95% CI : 1.045-1.978, P =0.026) and PLR ( OR =1.011, 95% CI : 1.001-1.021, P =0.030) were risk factors for PSCI. The area under the curve (AUC) of NLR in predicting cognitive impairment at 3 months of stroke was 0.695(95% CI : 0.627, 0.763), with the cut-off value, sensitivity and specificity of 4.19, 43.6% and 82.4%, respectively. The AUC of PLR in predicting cognitive impairment at 3 months of stroke was 0.677(95% CI : 0.610, 0.745), with the cut-off value, sensitivity and specificity of 119.58, 79.2% and 59.5%, respectively.Conclusion NLR and PLR in the acute phase of ischemic stroke are independently correlated with cognitive impairment at 3 months of stroke, which can predict cognitive impairment at 3 months of stroke.

Analysis of clinical features and prognostic factors of IgA nephropathy complicated with depression

Gao Qinyu, Bao Beiyan, Jin Yan, Zhao Yu

2023, 38(6):  510-515.  doi:10.3969/j.issn.1004-583X.2023.06.005

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Objective To analyze the clinical features and prognostic factors of IgA nephropathy complicated with depression. Methods A total of 100 patients with IgA nephropathy treated in the Ningbo Yinzhou No.2 Hospital from January 2019 to December 2019 were selected as the study objects. According to the absence or presence of depression, they were divided into control group (50 cases without depression) and observation group (50 cases with depression). The general data, laboratory indexes and pathological classification were analyzed and compared between groups. Kaplan-Meier method was used to evaluate the overall survival (OS), and Logistics regression was used to analyze the prognostic factors. Resultss There were statistically significant differences in the course of disease, working status, monthly household income per capita, glomerular filtration rate (eGFR), hemoglobin, serum albumin, blood uric acid (SUA) and C3 levels, as well as the degree of inflammatory cell infiltration and vascular injury between the two groups ( P <0.01). Compared with the control group, patients in the observation group had a longer course of disease, a higher proportion of non-employees and lower family per capita monthly income ( P <0.05). Compared with the control group, patients in the observation group had significantly lower estimated glomerular filtration rate (eGFR), hemoglobin and serum albumin, significantly higher serum uric acid (SUA) and C3, and significantly higher degree of inflammatory cell infiltration and vascular injury ( P <0.05). Logistic regression analysis showed that the course of disease, family per capita monthly income, eGFR, hemoglobin, serum albumin, degree of inflammatory cell infiltration and degree of vascular injury were independent risk factors for IgA nephropathy patients complicated with depression ( P <0.05). At the end of the 3-year follow-up, endpoint events were recorded in 12 patients (doubling the serum creatinine level and/or progressing to the end-stage renal disease [ESRD] and/or receiving renal replacement therapy and/or death was considered as a composite endpoint event), including 9 in the observation group and 3 in the control group. The 1-year and 3-year OS in the observation group was 94.00% and 82.00%, respectively, and that in the control group was 98.00% and 94.00%, respectively. There was a significant difference in the 3-year OS between groups ( P =0.034).Conclusion The independent risk factors for IgA nephropathy complicated with depression include the course of disease, family per capita monthly income, eGFR, hemoglobin, serum albumin, the degree of inflammatory cell infiltration and vascular injury, and the survival time of IgA nephropathy patients complicated with depression significantly decreases.

High-risk identification of depressive symptoms in middle-elderly patients with diabetes

Wu Yanan, Yan Tianmei, Liang Peng, Wei Limin

2023, 38(6):  516-520.  doi:10.3969/j.issn.1004-583X.2023.06.006

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Objective To detect the depressive symptoms in middle-elderly patients with diabetic, and to provide evidence for identifying high-risk groups of pooled diabetic and depression. Methods According to the 2018 China Health and Retirement Longitudinal Study (CHARLS) data, a total of 1815 eligible middle- elderly diabetic patients aged 45 years and over were recruited, including these patients who was being treated with a certain method. Depression score was adopted by the 10-item Center for Epidemiological Studies Depression Scale (CESD-10) questionnaire, and the presence of depressive symptoms was defined as ≥10 points. Univariate and multivariate Logistic regression analysis were performed to analyze the detection of depressive symptoms in middle-elderly patients with diabetic.Resultss There were 790 (43.5%) patients pooled diabetic and depressive symptoms among 1815 patients. In the results of Logistic regression analysis, pulmonary disease, stroke, kidney disease, memory-related disease, arthritis chronic disease, education level of junior high school and below, female, and rural residence were the risk factors for depressive symptoms in middle-elderly patients with diabetic. Conclusion The detection rate of depressive symptoms in middle-elderly diabetic patients is at a high level in China, especially women, living in rural areas, low educational background, patients with lung disease, stroke, kidney disease. The memory related diseases, arthritis and chronic diseases should be paid more attention.

Changes in immune function and prognostic risk factors for severe pneumonia in children

Sun Xingxing, Lin Hai

2023, 38(6):  521-525.  doi:10.3969/j.issn.1004-583X.2023.06.007

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Objective To investigate the prognostic factors of severe pneumonia in children. Methods It was a retrospective analysis involving 152 children with severe pneumonia in the pediatric intensive care unit (PICU), Quanzhou First Hospital affiliated to Fujian Medical University from December 2019 to December 2021. According to the outcome after treatment, the patients were allocated to complete remission group and incomplete remission group (partial remission or death). Clinical data like gender, age, onset season, pediatric critical illness score (PCIS) with in 24 hours after admission, laboratory examination, length of stay, blood routine, C-reactive protein (CRP), treatment and outcome were compared between groups. Immune levels in children with different prognosis were analyzed, and influencing factors for the prognosis were identified by Logistic regression analysis.Resultss There were significant differences in age, onset season, length of stay, white blood cell count, CRP, and PCIS scores between the both groups ( P <0.05). The proportion of children with low levels of CD3⁺, CD4⁺, CD8⁺T lymphocytes, B lymphocytes, IgG, IgM and IgA in the incomplete remission group was significantly higher than that in the complete remission group ( P <0.05). Logistic regression analysis showed that age, onset season, PCIS score, CD4⁺ and IgG levels were important factors affecting the prognosis of severe pneumonia in children ( P <0.05). Conclusion Children with severe pneumonia who are young, with the onset season of autumn and winter, low PCIS score, and accompanied by low levels of CD4⁺ and IgG have a poor prognosis.

Clinical characteristics and laboratory examination of Epstein-Barr virus infection and infectious mononucleosis in Chengde

Xiao Meng, Cheng Tingting, Ma Qiange, Feng Xiaoying, Li Lihua, Li Tao

2023, 38(6):  526-531.  doi:10.3969/j.issn.1004-583X.2023.06.008

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Objective To explore the clinical characteristics of children with Epstein-Barr virus (EBV) infection and infectious mononucleosis (IM). Methods A total of 72 children with EBV infection and IM infection admitted to Chengde Central Hospital from January 2021 to July 2022 were retrospectively analyzed. They were divided into EBV infection group ( n =37) and IM group ( n =35), and the clinical data of the two groups were compared.Resultss (1) General data: there were no significant differences in gender, age and peak temperature between the two groups ( P >0.05). Compared with that in IM group, the fever time in EBV infection group was significantly shorter ( P <0.05). (2) Initial symptom: fever was the initial symptom in both groups, and there was no significant difference in the incidence of initial symptom between the two groups ( P >0.05). (3) Clinical manifestations: there was no significant difference in the incidence of lymph node enlargement, rash and angina between the two groups ( P >0.05). Compared with that in the IM group, the EBV infection group had a significantly lower incidence of sore throat, eyelid edema, hepatomegaly, splenomegaly, and fever ( P <0.05). (4) Laboratory tests: a total of 20 patients in the two groups received laboratory testing of herpes simplex virus, cytomegalovirus, rubella virus, Mycoplasma pneumoniae, and adenovirus. Rubella virus was detected in all children who received serum virology test, and 17/20 (85%) children were detected with cytomegalovirus infection. There were no significant differences in the percentage of lymphocytes, and monocytes, as well as alanine aminotransferase and aspartate aminotransferase levels between the two groups ( P >0.05). Compared with those in the IM group, the white blood cell count in the EBV infection group was significantly higher, the percentage of abnormal lymphocyte and lactate dehydrogenase were significantly lower ( P <0.05). A total of 19 children in the IM group received immunological tests, and 14/19 (73.7%) had elevated serum immunoglobulin E levels. Nine patients in the EBV group received immunological tests, and 8/9 (88.9%) had elevated serum immunoglobulin E levels. There was no significant difference in the incidence of a higher-than-normal range of immunoglobulin E between the two groups ( P =0.630). (5) Complications: compared with IM group, the incidence of respiratory tract infection in EBV infection group was significantly lower ( P <0.05). There was no significant difference in the incidence of complications of other systems (blood system, liver, kidney, myocardium, digestive tract) ( P >0.05).Conclusion The clinical features of EBV infection differ from those of IM in children. Clinical manifestations like sore throat, eyelid edema, hepatomegaly, splenomegaly, fever, and laboratory tests of white blood cell count, lactate dehydrogenase, and percentage of lymphocytes should be well concerned in children.

Study on brain functional connectivity in patients with liver cancer with depression

Li Ya, Du Taoming, Qiu Shixiang, Chen Chao, Zhong Liming

2023, 38(6):  532-536.  doi:10.3969/j.issn.1004-583X.2023.06.009

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Objective To explore the effect of resting-state functional magnetic resonance imaging (rs-fMRI) on functional connectivity(FC) in liver cancer(LC) patients with depression. Methods Twenty-one LC patients with depression (depression group) and 27 LC patients without depression (non depression group) were treated with 1.5T MR scanner, and rs-fMRI was obtained. The difference of FC was compared between groups, then, the correlation between functional imaging index and Hamilton Depression Scale (HAMD) score was analyzed.Resultss The patients with liver cancer and depression showed significantly weakened FC in the default mode network (the precuneus, the hippocampus and the parahippocampal gyrus, the inferior parietal lobule), the executive network (the cingulate gyrus, the medial frontal gyrus, the superior / middle / inferior frontal gyrus), the sensorimotor network (cerebellum), the salience network (the left insular lobe) and the thalamic node brain interval. The functional connection between the default mode network (inferior parietal lobule) and the sensorimotor network (the left cerebellum) was significantly enhanced in patients with liver cancer and depression.Conclusion LC patients with depression showed the functional connectivity abnormalities in multiple depression-related brain regions, which may be related to the neuropathological mechanism.

Klinefelter syndrome: A case report and literature review

Ma Furong, Bai Jinyu, Xu Xiangyu, Chen Hui

2023, 38(6):  537-540.  doi:10.3969/j.issn.1004-583X.2023.06.010

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Objective To investigate the clinical features of Klinefelter syndrome (KS). Methods A case of KS admitted to Lanzhou University Second Hospital was analyzed retrospectively, and the relevant literatures were reviewed. Resultss A young male presented with 3 years of bilateral breast enlargement and pain. After admission, the physical examination found that the male secondary sexual characteristics were hypoplasia, and the testes were small and hard. Follicle stimulating hormone and luteinizing hormone levels significantly increased, and the testosterone level significantly decreased. The patient was diagnosed as hypergonadotropic hypogonadism by relevant examinations, and furthermore, he was precisely diagnosed as KS by chromosome karyotype analysis. After testosterone replacement therapy and estrogen receptor antagonist treatment, breast development was significantly alleviated. Conclusion The early diagnosis rate of KS is low. Early diagnosis and timely testosterone replacement therapy have a positive impact on improving the quality of life of patients with KS. Clinicians should strengthen their understanding of KS.

A case report of mumps complicated with acute renal failure and literature review

Liu Qian, Ma Shiheng, Zhang Xu

2023, 38(6):  541-543.  doi:10.3969/j.issn.1004-583X.2023.06.011

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Objective To investigate the occurrence, possible causes and treatment of mumps complicated with acute renal failure. Methods Clinical data of a case of mumps complicated with acute renal failure hospitalized in the Affiliated Hospital of Hebei University from January 2018 to December 2018 were retrospectively analyzed. Relevant literatures were searched in the online databases, including the Chinese National Knowledge Infrastructure (CNKI), Wanfang Data Knowledge Service Platform (WanFang Data) and PubMed, using the following key words: mumps, renal damage, renal failure and complications.Through literature review, the causes and treatment of renal failure in the course of mumps were analyzed. Resultss Patients with mumps may suffer renal function damage during the course of disease that may be directly caused by the virus infection. Conclusion During the course of mumps, renal function damage can be manifested as hematuria, proteinuria, edema, elevated creatinine, hypertension, encephalopathy and other symptoms. After comprehensive treatment of anti-virus, active diuresis and protection of renal function, the prognosis is good. During the treatment of mumps, monitoring blood pressure, urine volume, renal function and urine routine are of significance. Once abnormalities are found, timely treatment can improve the prognosis to the greatest extent.

Childhood eosinophilic gastroenteritis with multiple serous cavity effusion: A case report and literature review

Song Jinfang, Song Hang, Song Shiyi, Tian Xin

2023, 38(6):  544-549.  doi:10.3969/j.issn.1004-583X.2023.06.012

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Objective To explore the clinical characteristics of eosinophilic gastroenteritis (EG) with multiple serous cavity effusion in children and improve understanding of the disease. Methods A retrospective analysis was conducted on the clinical data of a EG child accompanied by multiple serous cavity effusion admitted to the Department of Pediatrics, the Second Hospital of Jilin University, and relevant literature was reviewed. Resultss A 12-year-old girl was admitted with intermittent abdominal pain and multiple serous cavity effusion as the initial symptoms. The computed tomography scan of the chest and abdomen showed ascites, pleural effusion, and a small amount of pericardial effusion, as well as thickening of the jejunum, ileum, and colon. After completing relevant examinations, the patient was diagnosed with EG, which improved after receiving glucocorticoid and anti allergic treatment. Follow up for 1 year and 5 months, the patient's condition recurred, with abdominal pain and ascites. Oral corticosteroids were administered. Symptoms improve and ascites were absorbed. Conclusion EG mostly occurs in young adults, with low incidence rate and complex clinical manifestations. It should be diagnosed early to avoid delay in diagnosis and treatment.