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    20 April 2024, Volume 39 Issue 4
    Clinical features of adenovirus pneumonia in immunocompetent adults: A meta-analysis
    Yun Xiaoxiao, Li Shufen, Sun Fang
    2024, 39(4):  293-303.  doi:10.3969/j.issn.1004-583X.2024.04.001
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    Objective To analyze the clinical features of adenovirus pneumonia in immunocompetent adults. Methods The literature about adult patients with adenovirus pneumonia were screened in China National Knowledge Infrastructure (CNKI), Wanfang, VIP, Great Medical Medicine, PubMed, Cochrane Library, Springer Link, Wiley, JSTOR and other databases from the establishment of the database to July 15, 2022. State 16 software was used to conduct a meta-analysis of the clinical features. Results Forty-three literatures representing 2381 adults were included. Among adult patients with adenovirus pneumonia, 96.8% of the patients were male, Human adenovirus type 55 (HAdV-55) and Human adenovirus type 7 (HAdv-7) were the most common types, with lower mortality (0.3%, 95%CI: 0.0-1.5). The common clinical symptoms of adult patients with adenovirus pneumonia were fever (99.1%, 95%CI: 97.5-100.0), following by cough, fatigue, phlegm, and sore throat. The common signs included pharyngeal congestion (74.7%, 95%CI: 57.9-88.7), following by increased heart rate, tonsil enlargement, pharyngeal lymphoid follicle hyperplasia, abnormal respiratory sounds, and increased respiratory rate. The most common complications were pharyngitis (66.6%, 95%CI: 47.9-85.3), following by hypoxemia, acute respiratory distress syndrome (ARDS), respiratory failure, shock, abnormal liver function, hypoproteinemia and electrolyte disturbance. The laboratory test results verified that most patients had normal white blood cell count (68.4%, 95%CI: 60.4-75.9), reduced lymphocyte count (65.5%,95%CI: 44.8-86.1), normal platelet count (79.1%, 95%CI: 74.8-83.3), increased C-reactive protein (82.1%, 95%CI: 67.9-93.2), oxygenation index less than 300 (60.5%, 95%CI: 28.4-88.6), increased erythrocyte sedimentation rate (ESR) (44.3%, 95%CI: 33.2-55.3), and the part patients had increased procalcitonin (PCT) (37.3%, 95%CI: 12.8-65.3). Conclusion Adenovirus pneumonia can also affect immunocompetent adults, and it is more common in middle-aged and young men in the military, mainly with HAdV-55 and HAdV-7 infection. The common clinical manifestations are fever, cough, fatigue, sputum, and pharyngeal pain. The common signs include pharyngeal congestion, rapid heart rate, tonsil enlargement, pharyngeal lymphatic follicular hyperplasia, abnormal respiratory sound, and often complicated with pharyngitis. Most patients had normal white blood cell count, decreased lymphocyte count, normal platelets, elevated C-reactive protein, oxygenation index less than 300, with relatively low mortality.

    Review: efficacy and pharmacogenomics of leflunomide plus methotrexate versus iguratimod plus methotrexate in the treatment of rheumatoid arthritis
    Zhu Suhua, Xu Shengqiu
    2024, 39(4):  304-313.  doi:10.3969/j.issn.1004-583X.2024.04.002
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    Objective To investigate the efficacy and pharmacoeconomics of leflunomide plus methotrexate versus iguratimod plus methotrexate in the treatment of rheumatoid arthritis (RA), and to provide reference for the rational selection of clinical drugs. Methods The randomized controlled trials about leflunomide plus methotrexate versus iguratimod plus methotrexate for RA were retrieved from Pubmed, Medline, China National Knowledge Infrastructure (CNKI), Wanfang, and VIP from the establishment of the databases to July 2023. Meta-analysis was performed on the included literature by RevMan5.4 software. Ultimately, TreeAge Pro 2019 software was used to construct a decision tree model for cost-effectiveness analysis of leflunomide plus methotrexate versus iguratimod plus methotrexate for RA, and the sensitivity evaluation was assessed. Results The Meta-analysis showed the efficacy of leflunomide plus methotrexate or iguratimod plus methotrexate for RA was significantly higher than that of methotrexate alone (OR =2.95, 95%CI [1.91-4.56], P<0.01; OR =3.35, 95%CI [1.88-5.97], P<0.01; respectively). The incremental cost-effectiveness ratio(ICER) indicated that for each unit of increase in effectiveness of iguratimod plus methotrexate versus leflunomide plus methotrexate for RA, would lead to an increase the cost by 196, 312.5 RMB. The most influential factor on ICER was the treatment efficiency of iguratimod plus methotrexate or leflunomide plus methotrexate. Conclusion The efficacy of leflunomide plus methotrexate or iguratimod plus methotrexate is higher than that of methotrexate alone. Leflunomide plus methotrexate in the treatment of RA has economic advantages.

    Correlation between the lung ultrasound phenotype of gravity-dependent deaeration and poor prognosis in sepsis patients requiring mechanical ventilation
    Wang Qian, Yin Wanhong, Zou Tongjuan, Tie Xin, Zhu Junchen, Chen Lyulin, Zeng Xueying
    2024, 39(4):  314-319.  doi:10.3969/j.issn.1004-583X.2024.04.003
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    Objective To analyze the clinical characteristics of sepsis patients requiring mechanical ventilation who presented varying lung ultrasound phenotypes, and to explore the correlation between the lung ultrasound phenotype of gravity-dependent deaeration and poor prognosis in this population. Methods This retrospective study involving 155 sepsis patients requiring mechanical ventilation who were admitted to the Department of Critical Care Medicine, West China Hospital, Sichuan University from April 2019 to October 2020. According to the 28-day prognosis, they were assigned into survival group (n=124) and death group (n =31). The influence of the lung ultrasound phenotype of gravity-dependent deaeration on the 28-day prognosis was analyzed by univariate and multivariate Cox analysis. Kaplan-Meier curves were plotted to analyze the correlation of gravity-dependent and non-gravity-dependent deaeration with 28-day prognosis of sepsis patients requiring mechanical ventilation. Results Univariate Cox regression analysis showed that interleukin-6 (IL-6), Sequential Organ Failure Assessment (SOFA) score, mechanical ventilation time (h), interstitial deaeration, consolidation deaeration, atelectasis deaeration, and gravity-dependent deaeration changes were significantly correlated with 28-day prognosis (P<0.05). Multivariate Cox analysis with adjustment further identified the correlation of interstitial deaeration, mechanical ventilation time and gravity-dependent deaeration changes were significantly correlated with the poor prognosis of sepsis (P <0.05). The risk of death was 2.003 times greater for gravity-dependent lung deaeration than for non-gravity-dependent lung deaeration (HR=2.003, P =0.028, 95%CI=1.112-6.387). Conclusion The lung ultrasound phenotype of gravity-dependent deaeration can be used as an independent risk factor for the prognosis of sepsis patients with mechanical ventilation.

    Effect of cognitive behavioral therapy on cognitive function in patients with first-episode depressive disorder
    Lu Xiangxiu, Wang Haiming, Zhang Yijie, Qiu Erxian
    2024, 39(4):  320-324.  doi:10.3969/j.issn.1004-583X.2024.04.004
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    Objective To explore the effect of cognitive behavior therapy (CBT) on cognitive function in patients with first-episode depressive disorder. Methods Sixty-four eligible patients with first-episode depressive disorder hospitalized in Mental Hospital of Yunnan Province from January 2020 to December 2021 were included as study objects. According to the inclusion order, the first 32 cases were as the combined group (CBT plus escitalopram), and the last 32 cases were as the control group (escitalopram alone). Patients' cognitive function was assessed by the Wsiconsin card sorting test (WCST) and the Struse color word test (Stroop). SPSS was used to analyze the differences between the two groups before and after treatment. Results There were no differences in WCST and Stroop scores between groups before treatment (P >0.05). At the end of the 8th week of treatment, the scores of total response (RA), correct response (RC), persistent correct (RP), and persistent error (RPE) in the two groups were significantly improved (P <0.05), and the scores of RC, RP and RPE in the combination group were significantly better than those of the control group (P <0.05). The scores of conflict response, neutral response and interference response were significantly decreased in the two groups, the decreases were more significant in the combined group relative to the control group (P <0.05). Conclusion Cognitive behavioral therapy can improve cognitive function in patients with first-episode depressive disorder.

    Bidirectional Mendelian randomization study of causality between body mass index and type 2 diabetes in a European population
    Sun Hui, Liu Haiying, Ren Junhao, Li Jinxia
    2024, 39(4):  325-331.  doi:10.3969/j.issn.1004-583X.2024.04.005
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    Objective The causal association between body mass index (BMI) and type 2 diabetes mellitus (T2DM) was evaluated by bidirectional Mendelian randomization (MR). Methods Statistical data were pooled using the publicly available Genome-wide association study (GWAS). A total of 461460 cases of BMI and 655666 cases of T2DM were obtained. Totally 373 Single Nucleotide Polymorphisms (SNPs) genetic variations closely related to T2DM were selected as forward instrumental variables, and 118 SNPs were selected as reverse instrumental variables. Inverse variance weighted (IVW), Weighted median (WME), MR-Egger, Simple mode, and weighted mode were used for two-way MR analysis, and odds ratio (OR) values were used to evaluate the causal relationship between BMI and T2DM. The heterogeneity test, pleiotropy test, and leave-one-out method were further used for sensitivity analysis to evaluate the robustness and reliability of the results. Results IVW showed a significant positive correlation between BMI and the incidence of T2DM, OR was 2.88, 95% confidence interval (CI) was 2.66-3.12, P value was 5.37e-87. Other methods showed similar cause-and-effect relationships. In addition, horizontal pleiotropy was not observed by the horizontal pleiotropy test (P=0.25). Reverse MR analysis did not observe reverse causality between BMI and T2DM. Conclusion There may be a positive causal relationship between BMI and T2DM.

    Effect of individualized hemodialysis on dialysis complications in elderly patients with diabetic nephropathy
    Wang Chunjie, Xie Jing, Han Xue, Wu Dan, Chen Jianhua
    2024, 39(4):  332-336.  doi:10.3969/j.issn.1004-583X.2024.04.006
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    Objective To explore the effect of individualized hemodialysis on dialysis complications in elderly patients with diabetic nephropathy (DN). Methods A total of 80 elderly hemodialysis patients with end-stage renal disease (ESRD) admitted in our hospital were selected, including 40 DN patients (DN group) and 40 non-DN (NDN group). They were further divided into DN1 subgroup and DN2 subgroup, as well as NDN1 subgroup and NDN2 subgroup, with 20 cases per group. Patients in DN1 and NDN1 group were given an individualized hemodialysis, and those in DN2 and NDN2 group were given a routine hemodialysis. After the observation for 1 year, the incidence of complications like hypotension, hypoglycemia, limb spasm and hypertension was compared. The decline rate of serum albumin (ALB), hemoglobin (Hg) and blood urea nitrogen (BUN) were recorded. Results After an individualized or routine dialysis, the frequency (number of times) of hypotension (11.0 vs 3.5, 19.5 vs 9.5), hypoglycemia (5.0 vs 0.0, 11.5 vs 3.5) and limb spasms (3.0 vs 0.0, 9.5 vs 1.0) was significantly higher in DN group than those of NDN group (P<0.01). Hypertension during dialysis was only found significantly more frequent in DN2 subgroup than that of NDN2 subgroup (18.0 vs 5.5, P<0.01). Compared with those of routine dialysis in DN group and NDN group, an individualized dialysis in both groups significantly reduced the frequency (number of times) of hypotension (11.0 vs 19.5, 3.5 vs 9.5), hypoglycemia (5.0 vs 11.5, 0.0 vs 3.5) and limb spasms (3.0 vs 9.5, 0.0 vs 1.0) (P<0.05). Hypertension during dialysis was only found significantly less frequent in DN1 subgroup than that of DN2 subgroup (10.0 vs 18.0, P<0.05). After an individualized or routine dialysis, there were no significant differences in ALB (40.80±2.84 g/L vs 42.75±4.56 g/L, 42.40±4.17 g/L vs 42.65±2.92 g/L), Hg (103.50±15.37 g/L vs 109.90±9.71 g/L, 108.60±13.80 g/L vs 112.90±7.81 g/L) and urea nitrogen reduction rate (URR%) (56.10%±8.01% vs 63.95%±6.05%, 59.70%±5.28% vs 63.15%±5.86%) between DN group and NDN group (P>0.05). Compared with those of routine dialysis in DN group and NDN group, there were no significant differences in ALB (40.80±2.84 g/L vs 43.40±4.17 g/L, 42.55±4.56 g/L vs 42.65±2.92 g/L), Hg (103.50±15.37 g/L vs 108.60±13.80 g/L, 109.90±9.71 g/L vs 112.90±7.81 g/L) and URR% (56.10%±8.01% vs 59.70%±5.28%, 63.95%±6.05% vs 63.15%±5.86%)(P>0.05). Conclusion The incidence of complications during dialysis is high in elderly patients with DN. An individualized dialysis is effective in reducing the above complications without affecting the dialysis effect.

    Application of ultrasound-guided TAP block in acute pancreatitis and its effect on abdominal pain and PAP level
    Zhang Yuan, Ma Liang, Huang Tao, Wang Haili
    2024, 39(4):  337-341.  doi:10.3969/j.issn.1004-583X.2024.04.007
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    Objective To study application of ultrasound-guided transverse abdominal plane (TAP) block in acute pancreatitis and its effect on abdominal pain and pancreatitis associated protein (PAP) level. Methods Ninety-five patients with acute pancreatitis admitted to our hospital from July 2019 to August 2023 were enrolled in this study. They were randomly assigned into the control group (n=47, intravenous injection of sufentanil for analgesia) and the experimental group (n=48, ultrasound-guided TAP block for analgesia). The changes in vital signs, incidence of abdominal pain, positive rate of PAP, pain, sedation score, amylase, lipase, urine amylase, Acute Physiology and Chronic Health Evaluation Ⅱ (APACHEⅡ) and Modified Multiple Organ Dysfunction Score (modified Marshall score) were compared between the two groups after analgesia. Results There was no significant difference in body temperature between the two groups after analgesia (P>0.05). The heart rate and respiratory rate in the experimental group were significantly lower than those of control group, but the oxygenation index was significantly higher (P<0.05). After analgesia, the incidence of abdominal pain and positive rate of PAP in experimental group were significantly lower than those of control group (P<0.05). After analgesia, pain and sedation scores were significantly decreased in both groups, and the reductions in experimental group were more obvious relative to the control group (P<0.05). After analgesia, amylase, lipase and urine amylase were significantly decreased in both groups, and the decreases in experimental group were more common compared to the control group (P<0.05). After analgesia, the APACHEⅡ and Marshall scores of both groups were significantly decreased, and the decreases in the experimental group were more pronounced compared with the control group (P<0.05). Conclusion Ultrasound-guided TAP block has a certain effect in the analgesia of acute pancreatitis, which can effectively improve the abdominal pain and PAP level of patients.

    Ankylosing spondylitis combined with acute promyelocytic leukaemia and disseminated intravascular coagulation: A case report and literature review
    Zhang Xiaoyang, Zang Meirong, Suo Jing, Meng Jianbo, Song Xiaoning, Wang Jinkai
    2024, 39(4):  342-346.  doi:10.3969/j.issn.1004-583X.2024.04.008
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    Objective To explore the clinical characteristics, diagnosis and treatment of ankylosing spondylitis (AS) combined with acute promyelocytic leukaemia (APL) and disseminated intravascular coagulation (DIC), and to gain a deeper understanding of the potential relationship and mechanism among the three pathological conditions. Methods We reported a case of AS combined with APL and DIC. Clinical characteristics and treatment course of AS combined with APL and DIC were summarized through this case report and literature review. Results The condition of APL achieved a complete relieve, and consolidation therapy was continuously applied to this patient. The relationship among AS, APL and DIC involved human leukocyte antigen-B27, tumour necrosis factor-α and interleukin-23/17 axis and immune function. Conclusion AS is complicatedly linked with APL and DIC, with the underlying pathogenic mechanisms of gene expressions and immune function. Great efforts are needed in the future to unveil the pathogenesis of AS combined with APL and DIC.

    SARS-CoV-2 infection combined with Listeria meningitis: A case report and literature review
    Zhi Bingdi, Liu Ying, Liu Ying, Zhang Fubo, Li Junfeng
    2024, 39(4):  347-351.  doi:10.3969/j.issn.1004-583X.2024.04.009
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    Objective To improve the understanding of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and Listeria monocytogenes (LM) meningitis, thus strengthening the level of diagnosis and treatment of Listeria infections in clinicians. Methods A case of SARS-CoV-2 infection combined with LM meningitis was retrospectively analyzed, and the literatures were reviewed. Results A 77-year-old femal patient started with fever and headache, combined with SARS-CoV-2 infection, was diagnosed as LM meningitis through cerebrospinal fluid culture and blood culture. After sufficient penicillin combined with gentamicin, and meropenem subsequent for anti-infection treatment, the patient's clinical symptoms were significantly relieved, and the disease was effectively controlled. Conclusion For patients with infection of SARS-CoV-2 and immune disorders, curative care of basic diseases and improvement of immune status are the key. Once listeriosis is diagnosed, the application of sufficient and adequate treatment period of sensitive antibiotics is crucial to improve the prognosis.