Table of Content

20 July 2023, Volume 38 Issue 7

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Probiotic supplementation on improving glucose metabolism in patients with type 2 diabetes mellitus: A meta-analysis

Jin Jiahui, Yang Yang, Qin Tong, He Yuxin, Su Meihua

2023, 38(7):  581-587.  doi:10.3969/j.issn.1004-583X.2023.07.001

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Objective To evaluate the effect of probiotics on glucose metabolism in patients with type 2 diabetes mellitus (T2DM), and to elaborate its mechanism of action, so as to provide ideas and approaches for clinical diagnosis and treatment of T2DM. Methods Randomized controlled trials (RCTs) reporting the effect of probiotics on glucose metabolism in T2DM patients published before 31^st November 2022 were searched in the online databases of PubMed, Embase, Web of science, CNKI, Wanfang Data Knowledge Service Platform and CQVIP database were searched. Two investigators were independently responsible for literature screening. The included literatures were assessed and data were extracted and analyzed using RevMan 5.4 software. Results A total of 11 studies were included in the study, involving 709 T2DM patients. There were 371 T2DM patients in the experimental group and 338 in the control group. Meta-analysis showed that probiotic supplementation significantly reduced fasting plasma glucose (FPG), hemoglobin A1C (HbA₁C), homeostatic model assessment for insulin resistance (HOMA-IR), and fasting insulin levels in the experimental group than those in the control group. Conclusion Probiotic supplementation can improve glucose metabolism in T2DM patients, and probiotics can be used as one of the adjuvant treatments for T2DM patients.

Efficacy and safety of repetitive transcranial magnetic stimulation treatment on central neurogenic dysphagia: A meta-analysis

Xiao Wangjing, Li Xinmeng, Lu Songling, Sun Xuehua

2023, 38(7):  588-599.  doi:10.3969/j.issn.1004-583X.2023.07.002

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Objective To systematically analyze the clinical efficacy and safety of repetitive transcranial magnetic stimulation in the treatment of central neurogenic dysphagia. Methods Randomized controlled trials on the treatment of dysphagia by repetitive transcranial magnetic stimulation in domestic and foreign databases were thoroughly searched. The retrieval time ranged from database inception to January 15, 2022. According to the inclusion and exclusion criteria, data were extracted from eligible literatures and analyzed. Literature quality was assessed. Finally, 17 articles (11 English language-published articles and 6 Chinese language-published articles) were included with a total of 857 patients. The Cochrane Collaboration tool and the Physiotherapy Evidence Database were used to evaluate the risk of bias. RevMan software and R language programming were used for statistical analysis. This systematic review was registered on International Prospective Register of Systematic Reviews (PROSPERO; CRD42022304209). Results The results of meta-analysis showed that repetitive transcranial magnetic stimulation significantly reduced the severity of dysphagia (SMD=-0.83, 95%CI: -1.03, -0.63, Z=8.14, P<0.01), improved the Standardized Swallowing Assessment (SSA) score (MD=-3.14, 95%CI: -3.70, -2.57, Z=10.84, P<0.01), the Water Swallow Test (WST) score (MD=0.95, 95%CI: 0.82, 1.07, Z=15.05, P<0.01), the Penetration-Aspiration Scale (PAS) score (MD=-0.41, 95%CI: -0.63, -0.19, Z=3.68, P<0.01), surface electromyography (sEMG) parameters (SMD=-0.47, 95%CI: -0.77, -0.16, Z=2.99, P<0.01) and the Barthel Index (BI) (MD=22.50, 95%CI: 13.67, 31.32, Z=4.99, P<0.01). There were no significant differences in the pharyngeal transit time (PTT) (MD=-0.07, 95%CI: -0.16, 0.02, Z=1.45, P=0.15) and the incidence of adverse events (RR=2.63, 95%CI: 0.85, 8.14, Z=1.68, P=0.09). Conclusion Repetitive transcranial magnetic stimulation has a certain clinical effect in the treatment of central neurogenic dysphagia, which can reduce the severity of dysphagia, improve swallowing safety, efficiency, and daily living ability, without obvious adverse events. However, it does not significantly improve the PTT. More high-quality studies are still needed to verify the above conclusions.

Clinical characteristics of patients infected with Omicron and Delta variants in novel coronavirus

Huang Huayan, Lin Chunguang, Wu Changru, Chen Yongdong, Huang Huanmou

2023, 38(7):  600-605.  doi:10.3969/j.issn.1004-583X.2023.07.003

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Objective To explore the clinical and laboratory characteristics of patients infected with Omicron and Delta variants in novel coronavirus. Methods A retrospective study was conducted, and the clinical data were collected from patients infected with Omicron variant (51 cases) and Delta variant (45 cases) admitted in our hospital from December 2021 to March 2022. The clinical baseline data and chest CT imaging characteristics were compared between the two groups. Results Both groups had the onset of the disease in all age groups, with more children and women in the Omicron variant group than in the Delta variant group (P<0.01). The Omicron variant group was mainly light and the Delta variant group was mainly ordinary, with significant differences between the two groups (P<0.01). However, there was no significant difference in vaccination status between the two groups. Fever and sore throat were the main symptoms in both groups, with the rate of fever significantly higher in the Omicron variant group than the Delta variant group (86.3% vs 51.5%, P<0.01). The number of patients with C-reactive protein (CRP) abnormalities in the Omicron variant group was less than that in the Delta variant group (P<0.01), and there were fewer changes in the first imaging feature of chest CT (2.0% vs 73.3%, P<0.05). After treatment, the nasopharyngeal swab test in the Omicron variant group showed a significantly shorter nucleic acid conversion time compared to the Delta variant group (29.96±8.17 days vs 25.82±10.73 days, P=0.013). In addition, compared with nasopharyngeal swab test, the anal swab test had a significantly shorter nucleic acid conversion time in the Omicron variant group (P<0.01). The serum IgG level was (6.504±1.33) S/CO at admission, which increased to (218.6±14.51) S/CO after one week (P<0.01). Meanwhile, the serum IgM level was (0.05±0.01) S/CO at admission, and it showed an increasing trend after one week, with an average of (1.205±0.22) S/CO (P<0.01). Conclusion Compared with Delta variant, the Omicron variant group was mainly mild, with fever and sore throat as the main manifestations. The pulmonary CT showed less and slight changes in the imaging characteristics of COVID-19. The nasopharyngeal swab test of the Omicron variant group showed a longer nucleic acid conversion time compared to the Delta variant group. In addition, serum levels of IgM and IgG antibodies in patients with Omicron variant were negative or low at admission, which increased significantly 1 week after onset.

Correlation of anti-phospholipase A2 receptor antibody with idiopathic membranous nephropathy

Wang Tao, Gao Yuwei, Wang Xinghua, Hu Xiuhong, Cui Hongrui, Xu Baozhen, Yang Hongjuan

2023, 38(7):  606-612.  doi:10.3969/j.issn.1004-583X.2023.07.004

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Objective To explore the correlation of anti-phospholipase A2 receptor (PLA2R) antibody with idiopathic membranous nephropathy (IMN). Methods Clinical data of 110 IMN patients in Department of Nephrology, the First Hospital of Hebei Medical University were retrospectively analyzed. They were divided into antibody-negative group and antibody-positive group based on the anti-PLA2R antibody (anti-PLA2R-Ab) testing before treatment. Differences between the two groups were compared. The correlation of anti-PLA2R antibody titers with clinical efficacy on IMN was analyzed, and relevant factors affecting clinical remission of IMN were identified. Results A total of 89 IMN patients were followed up for 12 months. Compared with the antibody-negative group, IMN patients in the antibody-positive group had significantly increased proteinuria, decreased serum albumin (ALB) and thicker basement membrane (P<0.05). After 12 months of treatment, the IMN remission rate in the antibody-positive group and the antibody-negative group was 69.35% and 88.89%, respectively, and the cumulative remission rate in the antibody- negative group was significantly higher than that in the antibody-positive group (P<0.05). At 3, 6, and 12 months after treatment, the 24-hour urine protein in both groups was significantly lower than that before treatment, and the ALB level was significantly higher than before treatment (P<0.05). ALB level in the antibody-negative group significantly increased at 3 months, and that in the antibody-positive group significantly increased at 6 months (P<0.05). Before and after treatment, there was no significant difference in serum creatinine between groups. With the decrease of anti-PLA2R-Ab titer, the 24 h urine protein of the antibody-positive group gradually decreased, and ALB level increased. Correlation analysis showed that the anti-PLA2R-Ab titer was positively correlated with 24 h urine protein, and the decrease in the anti-PLA2R-Ab titer was prior to the decrease in 24 h urine protein. Serum anti-PLA2R antibody titer, baseline ALB level, urine protein level, age, gender, and blood pressure were introduced in the multivariate Logistic regression model. It is found that the baseline anti-PLA2R antibody titer was an independent risk factor for non-remission of IMN at 12 months of treatment (OR=2.571, 95%CI: 0.983-3.354, P=0.024). Spearman correlation analysis showed that patients with lower anti-PLA2R antibody titers were more likely to be in remission, and the area under the curve (AUC) of baseline anti-PLA2R-Ab titer in predicting 12-month clinical remission of IMN was 0.7781(95%CI: 0.648-0.816, P<0.01), with the sensitivity and specificity of 68.27% and 77.38%, respectively. Conclusion There is a positive correlation between the anti-PLA2R antibody titer and 24-hour urine protein. The baseline anti-PLA2R antibody titer is an independent risk factor for non-remission of IMN. The change from the assessment of proteinuria to that of serum anti-PLA2R antibody titer is helpful to improve the accuracy of diagnosis and prognosis of IMN and reduce the adverse events of immunosuppressive drugs.

Clinical value of multimodal ultrasound in screening middle cerebral artery stenosis in hypertensive patients

Li Zhiyong, Li Xing

2023, 38(7):  613-617.  doi:10.3969/j.issn.1004-583X.2023.07.005

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Objective To explore the clinical value of multimodal ultrasound involving both carotid ultrasound and Transcranial color-coded duplex sonography (TCCD) in screening middle cerebral artery stenosis in hypertensive patients. Methods Sixty hypertensive patients admitted to our hospital who underwent carotid ultrasound, TCCD, and digital subtraction angiography (DSA) were selected as the study subjects. According to the presence of the middle cerebral artery stenosis detected by DSA or not, patients were divided into experimental group (middle cerebral artery stenosis, n=30) and control group (non-stenosis, n=30). The morphological and hemodynamic changes of carotid ultrasound were compared between groups. The consistency of the middle cerebral artery stenosis diagnosed by TCCD with that by DSA was analyzed. Results There were no significant differences in thickness of the carotid artery intima media and the incidence of plaques between experimental group and control group (P>0.05). The number of involved plaques, and the incidence of stenosis in the common carotid artery and internal carotid artery were significantly higher in the experimental group than those in the control group (P<0.05). There was no significant difference in the peak systolic flow velocity of the affected internal carotid artery between the two groups (P>0.05). The end diastolic flow velocity of the internal carotid artery in the experimental group was significantly lower than that in the control group, while the resistance index was significantly higher (P<0.05). Pearson correlation analysis showed that the end diastolic flow velocity of the affected internal carotid artery was negatively correlated with the middle cerebral artery stenosis (r=-0.39), and the resistance index was positively correlated with middle cerebral artery stenosis (r=0.28). The Kappa value of TCCD and DSA in diagnosing the middle cerebral artery stenosis was 0.895 (95%CI: 0.756-1.034), with a diagnostic accuracy of 93.3%. Conclusion There is a certain correlation of the morphology and hemodynamics of carotid ultrasound structure with the middle cerebral artery stenosis, which has a certain warning value. The combination of carotid ultrasound with TCCD is able to identify the degree of disease, showing a consistency with that diagnosed by DSA. It is preferred to the screening of the middle cerebral artery stenosis in hypertensive patients.

Anomalous left coronary artery from the pulmonary artery: A case report and literature review

Liu Duo, Li Yanling, Guo Zhaoxia, Li Jianfeng, Zhang Huijuan, Xie Ping

2023, 38(7):  618-622.  doi:10.3969/j.issn.1004-583X.2023.07.006

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Objective To explore the diagnosis and treatment of the anomalous left coronary artery from the pulmonary artery (also known as Bland-White-Garland [BWG] syndrome) in the elderly. Methods A retrospective analysis was performed on an elderly patient with BWG syndrome, and the relevant literature was reviewed. Results A 66-year-old male patient presented repeated intermittent chest tightness and shortness of breath within the past 2 years, which was aggravated after exertion and not relieved after rest. Color Doppler ultrasound of the heart and computed tomography angiography (CTA) of the coronary artery confirmed the diagnosis of BWG syndrome. After a comprehensive assessment, the patient was managed by a conservative treatment of medications, and he was recovered well and discharged. During the 1-year follow-up, no adverse cardiovascular events were reported. Conclusion BWG in the elderly is rare, which is easily to be misdiagnosed or missed diagnosed. The diagnosis of BWG depends on multiple imaging examinations. For asymptomatic or mildly symptomatic elderly patients, the risks of surgery may outweigh the potential benefits, and conservative treatment with vasodilators and antiarrhythmic drugs may be used to prevent death.

Primary pulmonary mucosa-associated lymphoid tissue lymphoma with dry cough as the only symptom: A case and literature review

Yang Wei, He Chendong

2023, 38(7):  623-627.  doi:10.3969/j.issn.1004-583X.2023.07.007

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Objective To review the clinical, imaging, and pathological features of primary pulmonary mucosa-associated lymphoid tissue lymphoma (MALT lymphoma) and analyze the causes of misdiagnosis. Methods A case of primary pulmonary MALT lymphoma confirmed by pathology was analyzed retrospectively. Results The patient had a recurrent dry cough, which was relieved after anti-inflammatory treatment at a local hospital. But then the symptoms recurred, so the patient came to Jiangsu Provincial Hospital of Traditional Chinese Medicine. After chest CT and magnetic resonance imaging (MRI), the patient was diagnosed with multicentric adenocarcinoma or inflammatory granuloma. CT-guided percutaneous lung biopsy was performed, and finally, primary pulmonary MALT lymphoma was diagnosed by pathology. Conclusion Primary pulmonary MALT lymphoma usually has no specific clinical manifestations and is difficult to be diagnosed by imaging examination. The biopsy is recommended when anti-inflammatory therapy is ineffective, which is helpful to avoid misdiagnosis and mistreatment.

Androgen insensitivity syndrome combined with choriocarcinoma and human chorionic gonadotropin-induced hyperthyroidism: A case and literature review

Xie Xinrong, Gan Jinghua, Qin Rui, Zhong Muxian

2023, 38(7):  628-632.  doi:10.3969/j.issn.1004-583X.2023.07.008

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Objective To analyze the diagnostic and therapeutic characteristics of androgen insensitivity syndrome (AIS). Methods Clinical data of a patient treated in the Minzu Hospital of Guangxi Zhuang Autonomous Region in 2020, who was diagnosed as AIS combined with choriocarcinoma and human chorionic gonadotropin (HCG)-induced hyperthyroidism were retrospectively analyzed. The diagnostic and therapeutic process were summarized. Results The patient was characterized by a female phenotype and 46, XY karyotype, who had higher testosterone levels than normal men. The patient was combined with choriocarcinoma and HCG-induced hyperthyroidism, and managed by the surgical resection of the gonad and primary tumor. Conclusion Chromosomal analysis should be provided to female gender patients with primary amenorrhea and high testosterone levels. Genetic testing is necessary once disease-associated genes are detectable, thus providing early diagnosis and early treatment, and preventing gonad tumours.

Multiple immune related adverse events with special clinical manifestations: A case report

Li Yang, Mo Feng, Xin Zhifei, Wang Qian, Deng Xinna

2023, 38(7):  633-637.  doi:10.3969/j.issn.1004-583X.2023.07.009

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Objective To report a case of special clinical manifestations of multi system immune related adverse events, discuss the mechanism and risk factors of immune related adverse reactions in this case, and improve the understanding of the disease. Methods The clinical data, diagnosis and treatment process of this patient were analyzed, and the related literature was reviewed for discussion. Results In this patient with special clinical manifestations of multiple immune related adverse events, immune related pneumonia was G3, immune related hepatitis was G2, and immune related endocrine toxicity was G2. He still died after the symptoms improved. Conclusion The special clinical manifestations of multi system immune related adverse events are rare, and the pathogenesis and risk factors of treatment are still controversial. Although the incidence is low, the prognosis is poor, which is worth further study.