Table of Content

20 March 2024, Volume 39 Issue 3

Previous Issue    Next Issue

Tonsillectomy as a therapy for patients with IgA nephropathy: A meta-analysis

Sun Shuaigang, Zhai Yaling, Zhang Wenhui, Tian Huijuan

2024, 39(3):  197-207.  doi:10.3969/j.issn.1004-583X.2024.03.001

Asbtract ( 105 )   PDF (1879KB) ( 16 )   HTML ( 10)  

Figures and Tables | References | Related Articles | Metrics

Objective The efficacy of tonsillectomy in immunoglobulin A nephropathy (IgAN) still remains controversial. This meta-analysis aims to evaluate the efficacy of tonsillectomy as an auxiliary or independent therapy and provide more evidence-based evidence for its clinical application. Methods We retrieved the literatures about the efficacy of tonsillectomy in IgAN published in Pubmed, Embase, ScienceDirect, Cochrane library, Web of science, Chinese National Knowledge Infrastructure (CNKI), VIP, China Biomedical Literature Database (CBM) and Wanfang databases from the time of establishment to November 1, 2022. The rate of proteinuria remission, hematuria remission, complete remission (CR) and end-stage renal disease (ESRD) were taken as observation points and meta-analyse were conducted by using Stata 12.0 software. Results A total of 36 studies representing 5797 patients with primary IgAN were ultimately enrolled. Meta-analysis showed that compared with drug therapy alone, tonsillectomy, as auxiliary or independent therapy, significantly improved proteinuria remission rate (OR=4.44, 95%CI: 3.14-6.27), hematuria remission rate (OR=5.11, 95%CI: 2.92-8.93) and CR rate (OR=3.32, 95%CI: 2.79-3.96), and significantly reduced incidence of ESRD (OR=0.24,95%CI: 0.17-0.33). Conclusion As auxiliary or independent treatment, tonsillectomy may induce clinical remission and inhibit the progression of ESRD in patients with IgAN and more attention should be paid to its application value in clinic.

Effects of pituitrin combined with epinephrine in cardiopulmonary resuscitation: A meta-analysis

Li Guanzhu, Yang Yating, Deng Jinhe, Shao Lan, Zeng Chaokun

2024, 39(3):  208-215.  doi:10.3969/j.issn.1004-583X.2024.03.002

Asbtract ( 60 )   PDF (2147KB) ( 16 )   HTML ( 5)  

Figures and Tables | References | Related Articles | Metrics

Objective To systematically evaluate the effects of pituitrin combined with epinephrine in treating cardiopulmonary resuscitation (CPR). Methods We retrieved the literatures about pituitrin combined with epinephrine in treating CPR published in PubMed, The Cochrane Library, VIP, China National Knowledge Infrastructure (CNKI) and WanFang Date from inception to October 2022. Literature selection, quality evaluation and data extraction were performed according to inclusion and exclusion criteria, and a meta-analysis was completed by RevMan 5.3. Results Seventeen eligible literatures representing 1059 patients were included. The results of meta-analysis showed that pituitrin combined with epinephrine significantly increased the rate of return of spontaneous circulation (ROSC) (RR=2.02, 95%CI[1.74, 2.34], P<0.01), shorten the time to ROSC (MD=-8.91, 95%CI[-11.13, -6.69], P<0.01), and significantly increased the 24 h survival rate (RR=2.43, 95%CI[1.86, 3.18], P<0.01) and discharge survival rate (RR=2.41, 95%CI[1.83, 3.18], P<0.01), significantly reduced termination-of-resuscitation rate (RR=0.39, 95%CI[0.22, 0.68], P=0.001), significantly increased urine volume at 6 hours after resuscitation (MD=130, 95%CI[113.68, 146.32], P<0.01). However, after resuscitation, there was no significant difference in mean arterial pressure and ST-segment depression on electrocardiography between groups. Conclusion Pituitrin combined with epinephrine on CPR can significantly improve the success rate of resuscitation, shorten the time to resuscitation, improve 24 h and discharge survival rate, increase urine volume at 6 hours after resuscitation, and improve organ perfusion.

Correlation between serum uric acid with TOAST classification and prognosis in patients with first-onset acute ischemic stroke

Song Mengjiao, Wang Ruiqi, Cao Can, Cheng Guangsen, Liu Yu, Li Zhongliang, Yang Jianhao

2024, 39(3):  216-221.  doi:10.3969/j.issn.1004-583X.2024.03.003

Asbtract ( 63 )   PDF (850KB) ( 15 )   HTML ( 5)  

Figures and Tables | References | Related Articles | Metrics

Objective To explore the correlation between serum uric acid (SUA) levels with the Trial of Org 10172 in Acute Stroke Treatment (TOAST) classification and long-term prognosis in patients with first-onset acute ischemic stroke (AIS). Methods A total of 199 patients with first-onset AIS who were hospitalized at Zhuhai People's Hospital from October 2020 to October 2021 were enrolled. They were divided into 4 groups based on SUA levels, which consisted of ≤280 μmol/L group (n=50), 280.1-331 μmol/L group (n=50), 331.1-398 μmol/L group (n=50) and >398 μmol/L group (n=49), and the correlation between SUA levels and TOAST classification was analyzed. The modified Rankin scale was used to evaluate the prognosis of patients after 3 months of onset, and the patients were assigned into good prognosis group (modified Rankin scale: 0-2 points, n=157) and poor prognosis group (modified Rankin scale: 3-6 points, n=42). The correlation between SUA levels and the prognosis of the two groups was compared. Results There was no statistically significant difference in TOAST classification among different SUA groups (P>0.05), but there were overall statistically significant differences in gender, proportion of dyslipidemia, and blood homocysteine levels (P<0.05). The ordinal multinomial logistic regression analysis indicated both male (OR=2.984, 95%CI: 1.603-5.553, P=0.001) and dyslipidemia (OR=2.600, 95%CI: 1.442-4.686, P=0.001) were associated with high SUA levels. There was no statistically significant difference in SUA levels between good prognosis group and poor prognosis group (P>0.05), but there was a statistically significant difference in baseline scores of National Institute of Health Stroke Scale (NIHSS) and Barthel Index (BI)(P<0.01). Binary logistic regression analysis showed a lower baseline score of BI was a risk factor for poor prognosis in the patients (OR=0.905, 95%CI: 0.867-0.944, P=0.000). Conclusion There was no correlation between SUA levels with TOAST classification and prognosis in patients with first-onset AIS, but both male and dyslipidemia were associated with high SUA levels, and a lower baseline score of BI indicated poor prognosis.

Clinical characteristics and risk factors of Parkinson's disease with white matter lesions

Li Qian, Zhong Ping

2024, 39(3):  222-226.  doi:10.3969/j.issn.1004-583X.2024.03.004

Asbtract ( 93 )   PDF (841KB) ( 13 )   HTML ( 3)  

Figures and Tables | References | Related Articles | Metrics

Objective To explore the clinical characteristics and related risk factors of Parkinson's disease (PD) patients with white matter lesions (WML). Methods A total of 127 PD patients admitted to the Neurology Department of Suzhou Hospital Affiliated to Anhui Medical University from February 2022 to September 2023 were selected, and their clinical data were collected. According to the modified Fazekas scale, participants were divided into normal group (n=15), mild abnormal group (n=43), moderate abnormal group (n=45), and severe abnormal group (n=24). The clinical data differences among the four groups were compared. Spearman correlation analysis and multivariate logistic regression analysis were used to study the risk factors for the severity of WML in PD patients. Results There were no significant differences in the gender, hypertension, diabetes, coronary heart disease, Self-Rating Anxiety/ Depression Scale score, Parkinson's Disease Sleep Scale score, uric acid, triglycerides, total cholesterol and low-density lipoprotein cholesterol among the four groups (P>0.05). There were significant differences in the age, Unified Parkinson Disease Rating Scale-part Ⅲ (UPDRS Ⅲ), Hoehn and Yahr (HY) staging, Mini-Mental State Examination (MMSE), Montreal Cognitive Assessment (MoCA) score, homocysteine (HCY), and high-density lipoprotein cholesterol (HDL-C) levels (P<0.05). Age, UPDRS Ⅲ scores, HY staging, and HCY level were positively correlated with the severity of WML in PD patients (r=0.759, 0.319, 0.378, and 0.545, respectively; P<0.01). The MMSE score, MoCA score, and HDL-C level were negatively correlated with the severity of WML in PD patients (r=-0.510, -0.524, and -0.319, respectively; P<0.01). Age and HCY level were risk factors for the severity of WML in PD patients (P<0.05), while HDL-C level was a protective factor (P<0.05). Conclusion WML exacerbates motor symptoms and cognitive impairment in PD patients. The age and HCY are risk factors for the severity of WML in PD patients, while HDL-C is a protective factor.

Analysis of the clinical value for anti-Ro52 and anti-Ro60 antibodies in connective tissue disease

Gong Sijing, Yang Yushu, Guo Huifang, Ding Meng, Wang Wei, Gao Lixia

2024, 39(3):  227-233.  doi:10.3969/j.issn.1004-583X.2024.03.005

Asbtract ( 68 )   PDF (915KB) ( 10 )   HTML ( 3)  

Figures and Tables | References | Related Articles | Metrics

Objective To investigate the clinical significance of anti-Ro52 and anti-Ro60 antibodies in connective tissue disease (CTD), and to analyze their potential in risk prediction of CTD-associated interstitial lung disease (CTD-ILD). Methods A total of 785 patients diagnosed as CTD and hospitalized in the Department of Rheumatology and Immunology, the Second Hospital of Hebei Medical University from October 2019 to January 2021 were enrolled in this study. Their clinical and laboratory data were collected. According to the testing result for anti-Ro52 and anti-Ro60 antibodies, patients were assigned into anti-Ro52⁺anti-Ro60^- group (n=94), anti-Ro52^-anti-Ro60⁺ group (n=80), anti-Ro52⁺anti-Ro60⁺ group (n=251) and anti-Ro52^-anti-Ro60^- group (n=360). According to the presence or absence of ILD, patients were assigned into CTD with ILD group (n=243) and CTD without ILD group (n=542). Clinical data were compared between groups. Multivariable logistic step-wise regression was performed to assess the potential of anti-Ro52 and anti-Ro60 antibodies in predicting the risk of CTD, especially CTD-ILD. Results Titers of anti-Ro52 and anti-Ro60 antibodies varied among enrolled patients. Significant differences were detected in the general information, clinicalsymptoms, cytokines, immunoglobulins, complements and autoantibodies between groups (P<0.05). Compared with females, the incidence of ILD increased by 56.7% in males. The risk of ILD increased by 3.8% for each additional year of age. Patients in the anti-Ro52⁺anti-Ro60^- group had a higher risk of ILD than those in other groups. Conclusion Positivity for anti-Ro52 antibody, male and old age are independent risk factors for ILD in CTD patients. Anti-Ro52 and anti-Ro60 antibodies have a complicated role in CTD, both of which should be used to replace the detection of traditional anti-SSA antibodies as independent variables to be examined.

Value of lung ultrasound in the assessment of community-acquired pneumonia in infants aged 1-3 months

Zhang Xia, Tang Yan, Liu Wenli, Liu Juan

2024, 39(3):  234-238.  doi:10.3969/j.issn.1004-583X.2024.03.006

Asbtract ( 61 )   PDF (1010KB) ( 7 )   HTML ( 3)  

Figures and Tables | References | Related Articles | Metrics

Objective To evaluate the clinical value of lung ultrasound score (LUSS) in infants aged 1-3 months who suffered from community-acquired pneumonia (CAP). Methods Clinical data of infants with CAP at the age of 1-3 months and examined by lung ultrasound (LUS) within 48 hours after admission were collected. The severity of pneumonia was quantified and classified, and the correlation of disease severity with LUSS was analyzed. Receiver operating characteristic (ROC) curves were plotted to assess the potential of the LUSS in predicting severe pneumonia. Results The LUSS was significantly higher in infants of severe pneumonia group than those of the mild pneumonia group (12.0[6.0, 21.5] points vs 3.0[1.0, 8.0] points, P<0.05). Disease severity was positively correlated with LUSS (r=0.487, P<0.01). The optimal cut-off value of LUSS in predicting severe pneumonia was 5.5 points, with the sensitivity and specificity of 81.8% and 69.6%, respectively. Conclusion LUSS reflects the severity of CAP in infants aged 1-3 months, and it is a practical tool for clinical evaluation and follow-up monitoring.

Clinical analysis of 11 cases of coronavirus disease-19 associated with acute pancreatitis: Case report

Wei Fang, Zhang Yu, Wang Qingqing, Zheng Guoqi

2024, 39(3):  239-243.  doi:10.3969/j.issn.1004-583X.2024.03.007

Asbtract ( 45 )   PDF (1028KB) ( 10 )   HTML ( 2)  

Figures and Tables | References | Related Articles | Metrics

Objective To explore the clinical characteristics of coronavirus disease 2019 (COVID-19) associated with acute pancreatitis (AP), and analyze the correlation between the two. Methods A retrospective analysis was conducted on 11 patients with COVID-19 and AP treated at Cangzhou Central Hospital and Hejian Hospital of Traditional Chinese Medicine from December 15, 2022, to January 15, 2023, including analysis of age, gender, clinical manifestations, laboratory examinations, and imaging studies. Results Among the 11 patients, 8 were male and 3 were female, with ages ranging from 29 to 79 years. Ten cases were categorized as mild COVID-19, with one case being moderate. Eight cases presented with mild acute pancreatitis (MAP), two cases with moderate-severe acute pancreatitis (MSAP), and one case with severe acute pancreatitis (SAP). The manifestations in common digestive showed there were 11 cases of abdominal pain, 4 cases of nausea and vomiting, and 1 case of diarrhea. Laboratory findings showed blood amylase levels of 139 (38-851) U/L, blood triglyceride levels of 2.57 (0.69-4.2) mmol/L, and lipase levels of 74 (27-196) U/L in 8 patients. Among patients with a history of diabetes, fasting blood glucose levels increased by 2-4 mmol/L after onset in 3 cases. Five patients presented positive for hydrogen and methane breath test. Conclusion In patients with COVID-19 and AP, males were more commonly affected, with a predominance of mild COVID-19, and MAP was more prevalence in patients with APCOVID-19 and AP. COVID-19 may lead to gastrointestinal symptoms such as abdominal pain and diarrhea, affecting blood lipids, blood sugar, and intestinal microbiota in AP patients, potentially contributing to the pathogenesis of AP.

Clinical management for tuberculosis patients managed by different prevention and treatment systems in the Xicheng District in Beijing

Meng Weili

2024, 39(3):  244-248.  doi:10.3969/j.issn.1004-583X.2024.03.008

Asbtract ( 46 )   PDF (805KB) ( 5 )   HTML ( 1)  

Figures and Tables | References | Related Articles | Metrics

Objective To analyze the differences in clinical management for tuberculosis (TB) patients managed by different prevention and treatment systems in the Xicheng District in Beijing, thus providing references for the clinical management for TB. Methods Clinical data of TB patients who were managed by the Tuberculosis Prevention Institute of Xicheng District from January 1, 2016 to June 30, 2019 were downloaded from China Information System for Diseases Control and Prevention. Patients were divided into the integrated group of “prevention, treatment and control” and the trinity group according to the current diagnosis unit. The basic information and clinical characteristics of the two groups were analyzed retrospectively. Results A total of 1, 000 patients were included in this study, with 385 cases (38.50%) managed in the Tuberculosis Prevention Institute of Xicheng District as the integrated group of “prevention, treatment and control”, and 615 cases (61.50%) managed in the Beijing Municipal tuberculosis Prevention and Control Institute and Municipal Designated Hospital as the trinity group. The proportion of whole-process sputum examination in the integrated group was significantly higher than that of the trinity group (48.57% vs 23.90%, P<0.05). The proportion of standardized schemes in the integrated group was significantly higher than that of the trinity group (69.61% vs 51.06%, P<0.05). The rates of cure and treatment success in the integrated group were significantly higher than those of the trinity group (32.21% vs 16.75%,95.06% vs 83.41%; P<0.05). The proportion of patients with etiological results in the integrated group was significantly higher than that of the trinity group (89.61% vs 83.09%, P<0.05). The proportion of patients with molecular biology results in the 0 month sequence in the trinity group was significantly higher than that of the integrated group (28.46% vs 18.70%, P<0.05). Conclusion The proportion of patients with molecular biology results in the 0 month sequence in the trinity group is higher. The trinity mode has problems like non-standard management and adverse outcome. Measures need to be taken to improve the therapeutic effect of TB patients.

A case of scrub typhus without eschar located in a rare location

Feng Yu, Lang Xiaoqing, Wang Gang, Guo Shuping

2024, 39(3):  249-252.  doi:10.3969/j.issn.1004-583X.2024.03.009

Asbtract ( 54 )   PDF (946KB) ( 7 )   HTML ( 3)  

Figures and Tables | References | Related Articles | Metrics

Objective This case report aims to present a unique instance of atypical rash resulting from Orientia tsutsugamushi (Ot) infection. The primary objective is to augment the comprehension of the pathogenic microorganism and associated diseases among clinical practitioners, thus offering valuable insights for clinical diagnosis and treatment approaches. Methods A retrospective analysis was performed on a scrub typhus (ST) case admitted to First Hospital of Shanxi Medical University in June 2023, supplemented by a comprehensive review of pertinent literature. Results The patient, a 77-year-old male, presented with a persistent rash on the left forearm lasting one week, concomitant with a four-day febrile episode. Due to the initial diagnosis of soft tissue infection, the patient underwent empirical anti-infection therapy involving intravenous administration of ceftriaxone sodium and cefoperazone sodium sulbactam sodium. Despite treatment, the patient's fever persisted, and the rash failed to ameliorate. Notably, pathogen metagenomic next-generation sequencing (mNGS) testing confirmed Ot positivity. Subsequent management entailed oral administration of doxycycline hydrochloride enteric-coated capsules, resulting in prompt normalization of body temperature in five hours. Substantial clinical improvement was observed after three days, facilitating the patient's discharge. A follow-up examination one month post-discharge revealed an absence of complications. Conclusion Cases of ST are relatively infrequent, characterized by a spectrum of intricate and diverse clinical manifestations, particularly challenging in patients lacking typical rash presentations, thereby complicating diagnostic endeavors. While the overall mortality rate associated with ST is relatively low, delayed diagnosis and inadequate provision of targeted therapies may precipitate severe complications, potentially jeopardizing patient outcomes. Consequently, clinicians are urged to fortify their comprehension of the pathogenic microorganism and its infectious sequelae, emphasizing early detection and proactive intervention to avert grave complications.

Blastic plasmacytoid dendritic cell neoplasm: Two cases and literature review

Ren Lei, Liu Ye, Bao Shuyou, Li Kuifang

2024, 39(3):  253-258.  doi:10.3969/j.issn.1004-583X.2024.03.010

Asbtract ( 49 )   PDF (2410KB) ( 8 )   HTML ( 1)  

Figures and Tables | References | Related Articles | Metrics

Objective To explore the clinical and pathological characteristics, treatment, and prognosis of blastic plasmacytoid dendritic cell neoplasm (BPDCN). Methods Based on literature review, we retrospectively analyzed clinical manifestations, histological morphology, immune phenotype, treatment plan, and prognosis of two patients with BPDCN. Results The tissue morphology of both cases was consistent with the pathological changes in BPDCN. Immunohistochemical markers cluster of differentiation (CD)4, CD56, CD123, T-cell leukemia-1 (TCL1) were positively stained, and lymphoid, myeloid, and NK cell sources were ruled out. Epstein-Barr virus-encoded RNA (EBER) in situ hybridization results of both cases were negative. Case 1 involved bone marrow and lymph nodes, received symptomatic supportive treatment, and died 2 months later. Case 2 was managed by 8 cycles of chemotherapy with the cyclophosphamide, doxorubicin, vincristine, and prednisolone (CHOP) regimen. The condition of Case 2 progressed at 6 months with multiple rubella throughout the body. Later, gemcitabine, oxaliplatin, and pemetrexed chemotherapy were administered for 9 cycles. Currently, the condition of Case 2 was stable. Conclusion BPDCN often have skin symptoms as the first symptom and unique clinical and pathological characteristics. Diagnosis of BPDCN relies on histology and immunophenotype. There is currently no effective treatment plan, leading to a poor prognosis of BPDCN.