Clinical Focus

Risk assessment of pancreatic cancer in patients with type 2 diabetes mellitus treated with sitagliptin: A meta-analysis of randomized controlled trials

Zhu Chenglou, Wu Qiong, Da Mingxu

2023, 38(12): 1061-1066. doi:10.3969/j.issn.1004-583X.2023.12.001

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Objective To evaluate the risk of pancreatic cancer (PC) in patients with type 2 diabetes mellitus (T2DM) who are treated with sitagliptin. Methods Articles reporting the risk of PC in T2DM patients treated with sitagliptin published before July 10, 2022 were searched in the online databases, including EMBASE, MEDLINE, the Cochrane Library, PubMed. STATA 12.0 software was used for meta-analysis. Two investigators were independently responsible for article screen, data collection and quality assessment. Results A total of 11 randomized controlled trials involving 33, 360 T2DM patients were identified. Meta-analysis using a fixed-effect model showed that sitagliptin treatment did not significantly increase the risk of PC in T2DM patients ( $R R$ =0.74, 95% $C I$ : 0.45-1.21, $P$ =0.225). Subgroup analyses showed that the monotherapy ( $R R$ =0.82, 95% $C I$ : 0.39-1.71, $P$ =0.600) and combination regimen of sitagliptin ( $R R$ =0.68, 95% $C I$ : 0.35-1.31, $P$ =0.244) did not significantly increase the risk of PC in T2DM patients. Conclusion Sitagliptin treatment is not associated with the increase in the risk of PC.

Meta-analysis of expression and clinical significance of HER-2 in hepatocellular carcinoma

Tao Jianan, Li Wenqian, Ma Xiuwen, An Qi, Wang Xuehong

2023, 38(12): 1067-1072. doi:10.3969/j.issn.1004-583X.2023.12.002

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Objective To systematically evaluate the relationship between the expression of human epidermal growth factor receptor-2 (HER-2) and clinicopathologic featurests in hepatocellular carcinoma (HCC). Methods Case-control studies regarding the expression of HER-2 in HCC were searched from PubMed, CNKI, Wanfang database and VIP database from establishment of the database to May 2023. Literature screening, data extraction and risk-of-bias assessment were independently performed by two researchers. Meta-analysis was performed using Revman5.3 software. Results Thirty one case-control studies representing 2558 patients were included. Meta-analysis showed that the positive rate of HER-2 in HCC cases was significantly higher than that in control cases (54.3% vs 50.5%, $O R$ =1.87, 95% $C I$ : 1.13-3.10, $P$ =0.01). The expression of HER-2 in HCC cases in age ( $O R$ =0.48, 95% $C I$ : 0.25-0.94, $P$ =0.03), differentiation degree( $O R$ =2.61, 95% $C I$ : 1.84-3.69, $P$ <0.01), tumor diameter ( $O R$ =1.93, 95% $C I$ : 1.25-2.98, $P$ =0.003), blood metastases ( $O R$ =5.42, 95% $C I$ : 3.15-9.31, $P$ <0.01), clinical stage ( $O R$ =2.02, 95% $C I$ : 1.39-2.94, $P$ =0.0003), portal vein invasion ( $O R$ =1.73, 95% $C I$ : 1.11-2.72, $P$ =0.02) and serum HBsAg ( $O R$ =2.22, 95% $C I$ :1.55-3.18, $P$ <0.01) were statistically significant. Conclusion HER-2 is differentially expressed in HCC, and its expression level is related to clinicopathological features of HCC, suggesting a important role in the pathogenesis of HCC, and which can provide a higher level of evidence for the diagnosis and molecular targeted therapy of HCC in the future. However, the evidence for its quantity and quality remains limited, the results need to be verified by more high-quality studies.

Correlation between serum secreted frizzled-related protein 5 and early renal damage in patients with essential hypertension

Liu Yi, Cui Kun, Liu Chang, Zhao Haotian, Li Li, Xue Hongyuan

2023, 38(12): 1073-1077. doi:10.3969/j.issn.1004-583X.2023.12.003

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Objective To investigate the correlation between serum secreted frizzled-related protein 5 (SFRP5) and early renal damage in patients with essential hypertension. Methods During January 2017 to December 2017, a total of 88 patients who were initially diagnosed as essential hypertension in the Second Hospital of Hebei Medical University were recruited, and they were divided into group B (UACR<30 mg/g, $n$ =41) and group C (30 mg/g≤UACR≤300 mg/g, $n$ =47) based on the urine albumin creatine ratio (UACR). During the same period, 32 healthy volunteers receiving physical examinations were included in group A. Serum SFRP5, cystatin C (Cys-C), blood urea nitrogen and serum creatinine were compared. Results Serum SFRP5 was significantly lower in group C than that of group A and group B ( $P$ <0.01), which was significantly lower in group B than that of group A ( $P$ <0.05). Cys-C was significantly higher in group C than that of group A and group B ( $P$ <0.01). SFRP5 was negatively correlated with UACR ( $r$ =-0.839, $P$ <0.01) and Cys-C ( $r$ =-0.378, $P$ <0.05). Cys-C was positively correlated with UACR ( $r$ =0.625, $P$ <0.01). SFRP5 was an independent protective factor for hypertensive renal damage (β=-0.036, $P$ <0.01), and Cys-C was an independent risk factor for it (β=0.288, $P$ <0.01). Conclusion SFRP5 may be a protective factor for renal damage in hypertension, serving as a potential predictive and therapeutic target for it. Our findings provide a new direction for clinical medication and evaluation of drug efficacy.

Effect of serum s100A4 levels on polycystic ovary syndrome in patients with polycystic ovary syndrome

Ren Yumei, Zhang Qiu, Hu Honglin

2023, 38(12): 1078-1085. doi:10.3969/j.issn.1004-583X.2023.12.004

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Objective To detect serum S100A4 levels in patients with polycystic ovary syndrome (PCOS) and explore the effects of S100A4 on the development. Methods One hundred twenty-nine women of childbearing age with PCOS were enrolled into PCOS group from December 2021 to June 2023 at the Department of Endocrinology of the First Affiliated Hospital of Anhui Medical University, and 47 healthy women of childbearing age with regular menstrual cycles and no hyperandrogenemia, who underwent routine medical examinations at the hospital in the same period, were as the normal control group (NC group). According to the levels of body mass index (BMI) and glucose metabolism, the PCOS group was assigned into PCOS-over BIM group, PCOS-normal BIM group, PCOS-normal glucose metabolism group and PCOS-abnormal glucose metabolism group, respectively. The general data, S100A4 levels, and other biochemical indicators were collected, and the differences of clinical data between groups were compared. Results The serum S100A4 level of PCOS group was significantly higher than that of the NC group ( $P$ <0.01). There was a significant difference in serum S100A4 levels amongNC group, PCOS-normal BIM group and PCOS-over BIM group ( $P$ <0.01), which was significantly higher in the latter two groups than that of NC group ( $P$ <0.05). There was a significant difference in serum S100A4 levels among NC group, PCOS-normal glucose metabolism group and PCOS-abnormal glucose metabolism group( $P$ <0.01), which was significantly higher in the latter two groups than that of NC group ( $P$ <0.05). Spearman related analysis results showed that serum S100A4 levels were negative correlation with homeostasis model assessment- β (HOMA-β) and positively correlated with low-density lipoprotein cholesterol (LDL-C) ( $P$ <0.05). Multi-factor logistic regression analysis showed that S100A4 was the influencing factor for the occurrence of PCOS in women of childbearing age ( $O R$ =1.046, 95% $C I$ : 1.015-1.078, $P$ <0.05). The area under receiver operating characteristic (ROC) curve for serum S100A4 levels predicting PCOS was 0.681, and its optimal cutoff value was 0.176 ng/ml ( $P$ <0.01). Conclusion The increase in serum S100A4 in PCOS patients was related to obesity, insulin resistance, and abnormal lipid metabolism, and involving the development of PCOS.

Risk factors of proteinuria in hypertensive people living at high altitude for generations

Jiang Ji, Zhu Xiaogang, Jiang Shan, Dawa Zhaba, Cen Qiang

2023, 38(12): 1086-1090. doi:10.3969/j.issn.1004-583X.2023.12.005

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Objective To investigate the incidence and related risk factors of proteinuria in hypertensive patients living at high altitude for generations. Methods The clinical data of hypertension patients over 18 years old admitted in the internal medicine ward of Nangqian People's Hospital in Yushu Tibetan Autonomous Prefecture of Qinghai Province from January 2017 to March 2023 were retrospectively analyzed. The patients were assigned into albuminuria group and non-albuminuria group according to the level of proteinuria. The differences of baseline demographic characteristics, blood pressure, and 24-hour laboratory examination indexes after admission between groups were compared, and multivariate logistic regression analysis was performed to explore the risk factors of proteinuria in patients with hypertension at high altitude. Results A total of 695 patients with hypertension representing 148 in albuminuria group and 547 in non-albuminuria group were enrolled in this study. Patients of albuminuria group had significantly higher proportion of men and diabetes mellitus (DM), increased levels of systolic/diastolic blood pressure (SBP/DBP), total cholesterol (TC), triglyceride (TG), low density lipoprotein cholesterol (LDL-C), white blood cell (WBC), red blood cell (RBC), hemoglobin (Hb), uric acid (UA), urea nitrogen (BUN) and serum creatinine (SCr), and had significantly decreased levels of mean age and platelets (PLT) than those of non-albuminuria group ( $P$ <0.05). Both albuminuria group and non-albuminuria group were comparable in the levels of body mass index (BMI) and high density lipoprotein cholesterol (HDL-C) ( $P$ >0.05). The total incidence of high-altitude polycythemia (HAPC) was 7.3%(51/695). The incidence of HAPC and hyperuricemia in the albuminuria group was significantly higher than that in the non-albuminuria group (16.2% vs 4.9%, 42.6% vs 30.2%, both $P$ <0.01, respectively). Multivariate Logistic regression analysis showed that DM ( $O R$ : 3.924, 95% confidence interval [ $C I$ ]: 2.208-6.973, $P$ <0.01), HAPC ( $O R$ : 2.956, 95% $C I$ : 1.486-5.880, $P$ =0.002), and elevated SCr levels ( $O R$ : 1.021, 95% $C I$ : 1.010-1.031, $P$ <0.01) were the independent associations of proteinuria. Conclusion Diabetes mellitus, HAPC and elevated SCr are significant independent associations of proteinuria in hypertensive people living at high altitude for generations.

Analysis of factors affecting clinical efficacy of Tirofiban in treating branch atheromatous disease

Liang Bingsong, Li Yuying, Zhang Qiping, Chen Yingdao, Li jian

2023, 38(12): 1091-1094. doi:10.3969/j.issn.1004-583X.2023.12.006

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Objective To analyze the factors affecting the clinical efficacy of Tirofiban in the treatment of branch atheromatous disease (BAD). Methods The clinical data of 186 BAD patients treated with Tirofiban were retrospectively analyzed. According to the 90-day modified Rankin Scale (mRS) score, they were assigned into the good outcome group ( $n$ =122, mRS Score 0-2) and the poor outcome group ( $n$ =64, mRS Score 3-5). The general clinical data and clinical indicators of patients between groups were compared, and the risk factors affecting the clinical efficacy were analyzed by logistic regression model. Results There were significant differences in age of onset(AOO), low-density lipoprotein cholesterol (LDL-C), homocysteine, baseline the national institute of health stroke scale (NIHSS) score at admission, thrombolytic therapy (TT), and time to application of tirofiban between the two groups ( $P$ <0.05). Multivariate logistic analysis showed that younger AOO, lower LDL-C, lower baseline NIHSS score on admission, and earlier application of Tirofiban were factors affecting the clinical efficacy ( $P$ <0.05). Conclusion For BAD patients, their clinical prognosis might be better when the younger AOO, the lower LDL-C, the lower the baseline NIHSS score at admission, and the earlier the application of tirofiban.

Status and influencing factors of fear of progression in patients with type 2 diabetes mellitus

Liao Kunfeng, Yao Yisong, Yang Jinpan, Yang Xining, Li Yaru, Zhou Hongyan, Liang Piao

2023, 38(12): 1095-1100. doi:10.3969/j.issn.1004-583X.2023.12.007

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Objective To investigate the status and influencing factors of fear of progression(FoP) in patients with type 2 diabetes mellitus (T2DM). Methods The convenience sampling method was performed to enroll 200 patients with T2DM who were hospitalized in a tertiary hospital in Nanning from July 2022 to December 2022 in the research. The general information questionnaire, Fear of Progression Questionnaire-Short Form (FoP-Q-SF), Self-Perceived Burden Scale (SPBS), Perceived Social Support Scale (PSSS) were conducted to investigate. Results The FoP-Q-SF score of patients was (30.4±6.44), and 68 patients (34.0%) had ≥ 34 score; the SPBS score was (23.0±7.91), and the PSSS score was (51.54±9.50). The specificity of decision tree model was significantly better than that of multiple linear regression model. A combination of multiple linear regression with decision tree showed that occupational status, monthly household income per capita, SPBS and PSSS were the influencing factors of FoG in T2DM patients. Conclusion The average status of FoG in T2DM patients is at an intermediate level. Medical staff should pay more attention to the psychological status of in-service T2DM patients, and take relevant measures to improve the social support level of patients and reduce their self-perceived burden level, aiming to reduce FoG level and promote the mental health of patients.

A case of neurological brucellosis misdiagnosed as amyotrophic lateral sclerosis and literature review

Chun Mei, Zhen Jin, Yan Yan, Liu Bin, Li Min, Sun Xia

2023, 38(12): 1101-1106. doi:10.3969/j.issn.1004-583X.2023.12.008

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Objective To explore the clinical features, diagnosis and treatment of neurobrucellosis (NB), and to analyze the causes of misdiagnosis of NB as amyotrophic lateral sclerosis (ALS). To compare the common points between NB and ALS and how to identify them in clinical work. Methods The clinical characteristics and treatment of a patient with NB misdiagnosed as ALS were reported and analyzed in combination with literature review. Results A 58-year-old male patient diagnosed with NB had significantly alleviated symptoms after 2 weeks of treatment, with right proximal limb muscle strength of grade Ⅴ^-, distal muscle strength of grade Ⅳ^-, left proximal muscle strength of grade Ⅴ^-, left distal muscle strength of grade Ⅴ^-, bilateral tendon reflexes (+++), and bilateral Babinski's sign (+). He was referred back to the local hospital for continuing anti-Brucella treatment. Conclusion Misdiagnosis of NB as ALS is mainly attributed to the atypical and diverse symptoms and signs of NB, and non-specific signs of intracranial infection, leading to misdiagnosis of other neurological diseases.

Wunderlich syndrome in a patient on haemodialysis with a review of the literature

Dai Jing, Chen Huaqian

2023, 38(12): 1107-1111. doi:10.3969/j.issn.1004-583X.2023.12.009

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Objective To analyze the treatment course, etiology, pathogenesis, clinical manifestations and potential causes for the misdiagnosis of Wunderlich syndrome (spontaneous renal rupture). Methods Spontaneous renal rupture during dialysis in a male patient on maintenance hemodialysis and the associated diagnostic and therapeutic treatments were retros pectively analyzed, and relevant literatures were reviewed. Results A 35-year-old male patient admitted for 10 months of maintenance hemodialysisandelevated blood pressure for 2 weeks. He developed the left-sided lumbar pain 30 minutes before the end of the hemodialysis session, which was associated with changes in body position and accompanied by distension of the lower left abdomen and vomiting. Following a comprehensive abdominal CT scan, spontaneous rupture of the left kidney was suspected. The patient was treated with an emergencyl percutaneous superselective arteriography and left renal artery embolization. After receiving successive postoperative treatments including continuous renal replacement therapy, anticoagulant-free hemodialysis, anti-infection therapy, and antihypertensive measures, the patient’s condition was improved and discharged. Conclusion Typically, the occurrence of renal rupture is associated with clear causative factors such as abdominal trauma. However, this patient developed non-specific abdominal pain without obvious causes that should be concerned. At this time, rare causes such as spontaneous renal rupture (Wunderlich syndrome) need to be considered. Due to the atypical manifestations of Wunderlich syndrome, its diagnosis is complicated and prone to the misdiagnosis of renal colic, further leading to delayed treatment and poor prognosis.

Multisystem inflammatory syndrome in children after severe acute respiratory syndrome coronavirus 2(SARS-CoV-2) infection: Two cases report and literature review

Wang Siyuan, Wang Li, Wen Xinran, Li Xiaoqing

2023, 38(12): 1112-1116. doi:10.3969/j.issn.1004-583X.2023.12.010

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Objective To explore the clinical features and key points of diagnosis and treatment of multisystem inflammatory syndrome in children (MIS-C). Methods The clinical data of two children with MIS-C diagnosed and treated in the Department of Rheumatology and Immunology of XJTU Affiliated Children's Hospital were retrospectively analyzed and the relevant literature was reviewed. Results There were two patients (1 male and 1 female), the age of male was 2 years and 1 month, and the age of female was 3 years and 8 months. Both had a history of SARS-CoV-2 infection 4 weeks before their illness onset. At the beginning of the disease, Kawasaki Disease-like symptoms were the main clinical manifestations, with multi-system involvement in the course of the disease, including prominent gastrointestinal, cardiac, hematologic and respiratory, and one of them with neurologic symptoms. MIS-C was finally diagnosed according to the results of laboratory examination. All of them were treated with intravenous immunoglobulin and glucocorticoids. One of them was treated with continuous kidney replacement therapy and noninvasive mechanical ventilation due to progressive disease, and both patients had a good prognosis. Conclusion MIS-C should be considered in patients with recent SARS-CoV-2 infection followed by Kawasaki disease-like symptoms. The disease progresses rapidly and involves multiple systems, so early recognition and intervention are needed to improve the prognosis.

Quality analysis of the literatures associated with gastric cancer diagnosis from 1980-2021——A bibliometric analysis based on the Web of Science database

Wang Junhong, Gao Zhenhua, Zhang Ronglong, Ji Haomin, Zhao Xinke, Da Mingxu

2023, 38(12): 1117-1124. doi:10.3969/j.issn.1004-583X.2023.12.011

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Objective To explore the research status and development trend of gastric cancer diagnosis from 1980 to 2021. Methods Relevant literatures and data in the field of gastric cancer diagnosis were obtained from Web of Science core database, and the keyword co-occurrence analysis map and its cooperation network map like the country and region were plotted using the bibliometric visualization software VOSviewer and CiteSpace. Results From 1980 to 2021, the number of published papers in the field of gastric cancer diagnosis has increased year by year, with a total of 7, 746 articles included. China, Japan and the United States were the top 3 countries publishing articles about gastric cancer diagnosis, and the number of published papers in China in this field has increased rapidly since 2014. Shanghai Jiao Tong University was the most frequently cited institution, while Seoul National University and Yonsei University had the highest number of citations. The main journals published in this paper included the World Journal of Gastroenterology,Gastric Cancer & Oncology Letters. The Gastric Cancer (IF 7.37) had the highest influence factors, and the key words that maintained high research interest were “migration” and “circular RNA”. Conclusion This study focuses on the research status and development trend of gastric cancer diagnosis. Molecular diagnosis is a hot spot in the field of gastric cancer diagnosis.

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