Table of Content

20 August 2023, Volume 38 Issue 8

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Meta-analysis of clinical significance of serum total bilirubin level in inflammatory bowel disease

Chen Xiaotian, Huo Lijuan

2023, 38(8):  677-685.  doi:10.3969/j.issn.1004-583X.2023.08.001

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Objective To systematically evaluate the clinical significance of serum total bilirubin (STB) in patients with inflammatory bowel disease (IBD). Methods Case-control studies on the correlation between STB and IBD published from their inception to November 2022 were searched in online databases, including the PubMed, Embase, Web of Science, Cochrane Library, CNKI, VIP, Wanfang, and Chinese Biomedical Databases (CBM). The quality of recruited articles was assessed using the Newcastle-Ottawa Scale (NOS). RevMan 5.4.1 and Stata13.1 were used for data analysis. Results A total of 14 articles, involving 6067 participants in 18 case-control studies (2972 in IBD group and 3905 in control group) were enrolled in this meta-analysis. STB was significantly lower in IBD patients than that of controls (SMD=-0.80, 95%CI:-0.99, -0.61, P<0.01). STB level in the active stage of IBD was significantly lower than that in remission stage (SMD=-0.76, 95%CI:-1.33, -0.19, P=0.009). STB decreased with the increase of IBD severity (mild vs moderate: SMD=-0.35, 95%CI:-0.52,-0.18, P<0.01; moderate vs severe: SMD=-0.59, 95%CI:-0.78, -0.39, P<0.01; mild vs severe: SMD=-0.88, 95%CI:-1.10, -0.66, P<0.01). STB level was negatively correlated with erythrocyte sedimentation rate (ESR) (r=-0.41, 95%CI:-0.45, -0.35, P<0.01), C-reactive protein (CRP) (r=-0.37, 95%CI:-0.48, -0.26, P<0.01) and clinical score (r=-0.54, 95%CI:-0.70, -0.39; P<0.01), and positively correlated with hemoglobin (Hb)(r=0.45, 95%CI:0.40, 0.50; P<0.01). The risk of IBD in patients with low-level STB within the normal range was 3.15 times higher than that of patients with high-level STB (OR=3.15, 95%CI:2.24, 4.44, P<0.01). Conclusion Low-level STB within the normal range is correlated with the increased risk, disease activity and severity of IBD, which may have reference values for clinical evaluation of IBD.

Effect of goal-directed fluid therapy on brain tumor resection: A systematic review and meta-analysis

Hou Youling, Li Yi, Guan Hongyu, Luo Hongxia

2023, 38(8):  686-693.  doi:10.3969/j.issn.1004-583X.2023.08.002

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Objective To systematically evaluate the effect of goal-directed fluid therapy (GDFT) on brain tumor resection. Methods Relevant articles reporting the application of GDFT to brain tumor resection published from the inception to April 2022 were searched in online databases, including the PubMed, Embase, Cochrane Library, Web of Science, VIP database, CNKI, WanFang database, and Chinese Biomedical Database (CBM). Eligible studies were screened according to the inclusion and exclusion criteria. After quality evaluation and extraction of relevant data, RevMan5.3 software and Stata SE16.0 software were used for meta-analysis. Results A total of 17 eligible randomized controlled trials (RCTs) involving 962 patients were included. Meta-analysis results showed that at the end of surgery, patients in GDFT group had increased cardiac index (CI) (MD=0.45; 95%CI: 0.36, 0.55; P<0.01), mean arterial pressure (MAP) (MD=6.14; 95%CI: 4.85, 7.44; P<0.01), and jugular bulb mixed oxygen saturation (SjvO₂) (1 hour after incision of the dura: MD=4.77; 95%CI: 2.58, 6.96; P<0.01; at the end of surgery: MD=4.42; 95%CI: 1.21, 7.62; P=0.007), but significantly lower blood lactate (Lac) (MD=-0.57; 95%CI: -0.77, -0.37; P<0.01) than those of regular fluid group. The postoperative National Institute of Health stroke (NIHSS) score decreased [24 h after surgery: MD=-2.95; 95%CI: -3.85, -2.05; P<0.01), and the postoperative Mini-mental State Examination (MMSE) score increased (1 day after surgery: MD= 1.12; 95%CI: 0.26, 1.99; P=0.01; 3 days after surgery: MD=1.40; 95%CI: 0.75, 2.05; P<0.01) in patients of GDFT group than those of regular fluid group. Conclusion GDFT can maintain hemodynamic stability, improve tissue perfusion, sustain oxygen supply-demand balance, and facilitate postoperative recovery in patients undergoing brain tumor resection.

Predictive effect of parathyroid hormone combined with carotid intima-media thickness on coronary artery calcification

Ma Guofei, KuangShiquan

2023, 38(8):  694-701.  doi:10.3969/j.issn.1004-583X.2023.08.003

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Objective To explore the predictive value of parathyroid hormone (PTH) and carotid intima-media thickness (IMT) on the degree of coronary artery calcification (CAC). Methods The clinical data of 164 patients with suspected coronary heart disease hospitalized in the First Affiliated Hospital of Dali University from December 2018 to March 2020 were retrospectively analyzed. According to the coronary artery calcification score (CACS), the patients were allocated to non-calcification group (CACS=0, n=63) and the calcification group (CACS>0, n=101). CAC-associated factors were identified. Clinical data between different groups were compared, including PTH and IMT. Independent risk or protective factors for CAC were identified by univariable logistic regression analysis. The predictive efficacy of PTH, IMT and their combination on CAC was analyzed by plotting the receiver operating characteristic (ROC) curves. The cut-off value was determined based on the Youden index, and the corresponding specificity and sensitivity were calculated. The area under the curve (AUC) was calculated to assess the diagnostic potential.Results There were significant differences in age, blood glucose, PTH and IMT between the groups (P<0.05). Compared with the non-calcification group, the levels of the above indicators in the calcification group were significantly higher(P<0.05). The PTH level in the severe calcification group was significantly higher than that in the moderate, mild and lesscalcification groups, and the PTH level in the moderate calcification group was significantly higher than that in the mild and lesscalcification groups (P<0.01). There was no significant difference in IMT among groups (P>0.05).The ROC curves were plotted with PTH and IMT as test variables and CAC as state variable. The combination detection of PTH and IMT presented the best diagnostic potential in CAC, followed by the single detection of PTH, and IMT. When PTH was greater than 77 pg/ml, the possibility of CAC was greater. When IMT was greater than 0.98 mm, the possibility of CAC was also greater. After calculating AUC, PTH, IMT and their combination were all able to predict CAC. The pairwise comparison showed that the diagnostic potential of the combination detection of PTH and IMT was superior to their single detection. ROC curves of PTH, IMT and their combination were drawn. AUC>0.7 suggested a certain predictive effect, and AUC>0.9 suggested an acceptable predictive value. Conclusion The predictive effect of PTH on CAC is significantly higher than that of IMT.The predictive effect of PTH combined with IMT is higher than that of PTH or IMT alone. It can be used for clinical reference.

Analysis of screening data of urinalysis in 1973 students in Yangzhou

Wu Weijun, Chen Xiao, Wang Shaodan, Bu Laijun, Wu Xinchao, Yan Chenyang, Dong Gaiqin, Jiang Lijun, Wei Wenping

2023, 38(8):  702-705.  doi:10.3969/j.issn.1004-583X.2023.08.004

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Objective To investigate the characteristics of screening data of urinalysis in school students in Yangzhou, thus providing basic data for abnormal urinalysis data in the local area and offering standardized management and follow-up. Methods In 2021, a total of 1973 school students aged 6-14 years old in Yangzhou were selected for urinalysis using a urine analyzer. Those with abnormal findings were re-examined for urinalysis and urinary sediment. Screening data of urinalysis and re-examined data were analyzed. Results Screening data showed that the positive rate of urinary occult blood was 9.22%, and the positive rate of re-examined hematuria was 0.61%. The positive rate of urinary protein in the initial examination and re-examination was 6.08%, and 0.76%, respectively. The positive rate of urinary leukocyte esterase was 5.58%, and that of leukocytosis in the re-examination was 1.93%. There were a few other abnormalities detected in the urinalysis. Conclusion The most common abnormal urinalysis findings in primary and middle school students in Yangzhou is occult blood, and a small amount of proteinuria. Urinary tract infection is mostly found in female children. Screening of urinalysis contributes to identify children with asymptomatic abnormalities in urinalysis, thus providing early interventions.

Effect of an optimized antibiotic management on the short-term clinical outcome of preterm infants born with gestational age of<32 weeks

Xue Ruirui, Li Xianghong, Li Liangliang, Yin Xiangyun, Xi Hongmin, Yang Ping, Ma Lili

2023, 38(8):  706-713.  doi:10.3969/j.issn.1004-583X.2023.08.005

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Objective To explore the effect of an optimized antibiotic management on the short-term clinical outcome of preterm infants born with gestational age of<32 weeks by retrospectively analyzing their clinical data. Methods Clinical data were retrospectively collected from preterm infants born with gestational age of <32 weeks who were admitted to the Neonatal Intensive Care Unit of the Affiliated Hospital of Qingdao University from January 1, 2017 to June 30, 2018 and from January 1, 2019 to December 31, 2020. The optimized antibiotic strategy was implemented since January 1, 2019. Included preterm infants were divided into two groups, including pre-optimization group (January 1, 2017 to June 30, 2018, n=158) and optimization group (January 1, 2019 to December 31, 2020, n=156). The clinical data of preterm infants were compared between groups.Results Compared with the pre-optimization group, the duration of antibiotic use in the early postnatal period (6 d vs 10 d), the total duration of antibiotic use during hospitalization (11 d vs 16 d), and the duration of parenteral nutrition (18 d vs 29.5 d) in the optimization group were significantly shortened (P<0.01). The incidence rate of retinopathy of prematurity (ROP) in the optimization group was significantly lower than that in the pre-optimization group (7.69% vs 15.82%, P<0.05). The multivariate logistic regression analysis revealed that optimized antibiotic management was not significantly correlated with short-term adverse outcomes (P>0.05). Prolonged antibiotic use, positive blood culture and mechanical ventilation were risk factors for short-term adverse clinical outcome.Conclusion Shortening unnecessary antibiotic exposure in preterm infants can reduce the duration of parenteral nutrition and the incidence of ROP without increasing short-term adverse clinical outcomes. Prolonged antibiotic use increases the risk of adverse clinical outcome.

Clinical study of ultrasound-guided trioxygen injection of posterior branch of cervical spinal nerve via the lateral approach on the treatment of chronic neck and shoulder pain caused by posterior branch of cervical spinal nerve

Wang Yue, Chen Hui, Cen Yi, Zhang Zhe, Zhang Xin, Li Zongxi, Chen Zhenzhen, Jia Tongtong, Zhang Meiling

2023, 38(8):  714-718.  doi:10.3969/j.issn.1004-583X.2023.08.006

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Objective To investigate the clinical safety and efficacy of ultrasound-guided trioxygen injection of posterior branch of cervical spinal nerve via the lateral approach on the treatment of chronic neck and shoulder pain caused by posterior branch of cervical spinal nerve. Methods A total of 102 patients with chronic neck and shoulder pain caused by posterior branch of cervical spinal nerve admitted to the Department of Pain Medicine, Shanghai Fourth People's Hospital from October 2020 to October 2021 were selected. The patients were randomly divided into group A and B, with 51 cases per group. Using the out-of-plane ultrasound guidance technique, and C3, C4 and C5 posterior branch of spinal nerve as puncture sites, 5 ml of trioxygen (20 μg/ml) was administrated to separate C3, C4 and C5 posterior branch of spinal nerve in patients of group A, and anti-inflammatory and analgesic solutions (betamethasone 1 mg + lidocaine 40 mg, diluted to 12 ml with saline, 2 ml at each point) were injected. Patients in group B were administrated with Xiaoyan Zhentong Liquid into the posterior branch of C3, C4 and C5 spinal nerves alone (the drugs were the same as group A). The pain assessed by the Numerical Rating Scale (NRS), the Pittsburgh Sleep Quality Index (PSQI), head and neck range of motion score (ROM) and complications before treatment and at 1 week, 1 month, 3 months and 6 months after treatment were recorded. Treatment response rate and patient satisfaction with the treatment were recorded as well. Results Compared with those before treatment, there were significant differences in the NRS, PSQI, and ROM scores at 1 week, 1 month, 3 months, and 6 months after treatment between the two groups (P<0.05). There were no significant differences in the NRS, PSQI, and ROM scores at 1 week after treatment between the two groups (P>0.05). There were significant differences in NRS, PSQI, and ROM scores at 1 month, 3 months, and 6 months after treatment between the two groups (P<0.05). Six months after treatment, the patient satisfaction rate was significantly higher in group A than that in group B (75% vs 55%, P<0.05). Local hematoma, infection, regional numbness and other complications immediately after surgery and 3 days after surgery in both groups were not reported. Conclusion Ultrasound-guided trioxygen injection and release of the posterior branch of the cervical spinal nerve via the lateral approach can improve the symptoms of patients with chronic neck and shoulder pain caused by the posterior branch of the cervical spinal nerve for a long time. The puncture approach is safe and the therapeutic effect is exact. It is an effective treatment.

Extreme thrombocytosis caused by diabetic ketoacidosis: A case report and literature review

Zhang Xinxin, Liu Guoqing, Wang Beibei

2023, 38(8):  719-721.  doi:10.3969/j.issn.1004-583X.2023.08.007

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Objective To investigate the clinical characteristics and treatment of extreme thrombocytosis caused by diabetic ketoacidosis. Methods The clinical characteristics and treatment outcomes of a patient with extreme thrombocytosis caused by diabetic ketoacidosis who was treated in Shengli Oilfield Central Hospital were retrospectively analyzed. Results The present young female patient had a sudden onset of an extreme thrombocytosis, with multiple times of reporting critical values. She denied the history of thrombocytosis and other diseases of the blood system. After bone marrow biopsy and gene testing, hematological diseases were excluded, and secondary thrombocytosis caused by diabetic ketoacidosis was considered. Platelet count decreased during the treatment course. After adequate fluid rehydration and correction of ketoacidosis, platelet count returned to the normal range within 4 days, which remained normal during follow-up.Conclusion Through literature review, there is no case report of diabetic ketoacidosis with extreme thrombocytosis at home and abroad. This case report aims to provide reference to avoid misdiagnosis and excessive treatment of diabetic ketoacidosis patients with extreme thrombocytosis.

Analysis of 2 children with kala-azar misdiagnosed as hemophagocytic syndrome

Zhao Yanan, Wang Li, Li Xiaolei

2023, 38(8):  722-725.  doi:10.3969/j.issn.1004-583X.2023.08.008

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Objective To summarize the clinical characteristics and diagnostic key points of kala-azar, thus reducing misdiagnosis and mistreatment. Methods The clinical diagnosis and treatment processes of 2 children with kala-azar who were misdiagnosed as hemophagocytic syndrome in our hospital were reviewed. Results Two children with kala-azar who were misdiagnosed as hemophagocytic syndrome were admitted due to fever, liver and spleen enlargement, and hemophagocytic syndrome was considered after the improvement of relevant examinations. They were poorly responsive to hormone therapy. The bone marrow smear of 1 case showed a large amount of Leishmania. The other case was confirmed as leishmania infantile by high-throughput sequencing of pathogenic microorganism and dot immunogold chromatographic assay for positive recombinant antigen rk39. Antimony treatment was successful, presenting a normal body temperature, liver and spleen shrinkage, and normal blood routine testing and coagulation testing of four indexes.Conclusion For patients with fever, enlargement of liver and spleen and pancytopenia, detailed epidemiological information should be inquired and pathogen examination related to kala-azar should be conducted as soon as possible to reduce misdiagnosis and mistreatment.

Concerning the diagnosis and integrated Chinese and Western medicine treatment of acute biliary pancreatitis in children: A case report

Chen Congshui, Li Yuan, Chen Shufang

2023, 38(8):  726-730.  doi:10.3969/j.issn.1004-583X.2023.08.009

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Objective To investigate the early diagnosis, integrated Chinese and Western medicine treatment and prevention of acute biliary pancreatitis (ABP) in children, and to improve the success rate of diagnosis and treatment. Methods A typical pediatric case of ABP was analyzed, and the diagnosis, differential diagnosis, auxiliary examination characteristics, early integrated Chinese and Western medicine treatment, and the choice of surgical methods were summarized. Results Acute pancreatitis (AP) in children was more commonly caused by viral infection than that of biliary factors. Misdiagnosis, missed diagnosis and mistreatment were prone to occur in children with AP. In adults, ABP was mainly caused by biliary stones; while in children, it was usually caused by congenital biliary dysplasia like congenital choledochal cyst. When certain factors like strenuous exercise led bile to reflux into the pancreatic duct, AP occurred. ABP in children was featured by a sudden onset, manifesting as early neurological symptoms like vomiting and lethargy, which was easy to be misdiagnosed as a neurological disease. Color Doppler ultrasound and abdominal computed tomography (CT) contributed to visualize abnormal imaging findings of pancreatic and congenital biliary cysts, which were common and reliable diagnostic tools of ABP in children. Early treatment of ABP in children with integrated Chinese and Western medicine treatment could reduce the incidence of complications and mortality, and an appropriate time of operation should be individually determined. Conclusion ABP in children has its own characteristics. Clinicians should improve the understanding of ABP. It is recommended to carry out imaging screening in children's health examination, aiming to find out congenital biliary malformations, and to carry out corresponding treatment interventions as early as possible, which can effectively prevent the occurrence of ABP.

Bibliometric analysis of literatures reporting psychological intervention of patients with diabetes mellitus: Based on Web of Science

Yang Xin, Xu Huajiao

2023, 38(8):  731-736.  doi:10.3969/j.issn.1004-583X.2023.08.010

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Objective To analyze the research hotspots and frontiers of English-published literatures on psychological intervention patients with diabetes mellitus, thus providing reference for further research and practice of psychological intervention in China.Methods Relevant literatures on psychological intervention research of patients with diabetes mellitus included in the Web of Science from 2012 to 2022 were retrieved and screened. Bibliometric analysis of the included literatures was performed using the CiteSpace 6.1.R6 software. Results A total of 666 eligible literatures were included. The number of published literatures on psychological intervention of patients with diabetes mellitus has generally increased in recent years. The United States was the top one country with most published literatures on psychological intervention of patients with diabetes mellitus, and China ranked third. Research hotspots included depression, glycemic control, quality of life, mental health, distress and cognitive behavioral therapy. Stress reduction training, positive psychological intervention, and exercise therapy were the frontiers of research in this field within the past five years.Conclusion The psychological problem of patients with diabetes mellitus has been gradually concerned. In the future, China should strengthen international exchanges and cooperation to further improve the level of psychological intervention research, thus benefiting patients with diabetes mellitus.