Table of Content

20 May 2024, Volume 39 Issue 5

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Diagnostic value of contrast-enhanced ultrasound in differentiating focal testicular lesions: A meta-analysis

Gao Ming, Liu Hao, Yu Hang, Lin Lin, Zhang Zijie, Xiong Ying

2024, 39(5):  389-395.  doi:10.3969/j.issn.1004-583X.2024.05.001

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Objective To evaluate the diagnostic value of contrast-enhanced ultrasound (CEUS) in focal testicular lesions. Methods Relevant studies regarding CEUS in differentiating focal testicular lesions which reported from the establishment of the databases to August 10, 2023 were retrieved from databases including PubMed, EMBASE, Cochrane Library, Web of Science, China BioMedical Literature Database (CBM), China National Knowledge Infrastructure (CNKI), Wanfang Data and VIP Data. Eligible documents were conducted for data extraction, quality evaluation. RevMan 5.4, Meta disc1.4 and Stata15.0 were employed to analyze the diagnostic performance of CEUS for differentiating testicular lesions in tumor-like lesions and differentiation of benign and malignant. Results Thirteen original studies representing 712 lesions were included. Meta analysis showed that the pooled sensitivity, specificity, positive likelihood radio and negative likelihood ratio of CEUS for differentiating testicular neoplastic tumors in tumor-like lesions were 0.95(95%CI: 0.87-0.98), 0.84(95%CI: 0.73-0.91), 5.8(95%CI: 3.3-10.2), 0.06(95%CI: 0.02-0.17), respectively, and the area under the curve (AUC) for the summary receiver operating characteristic (SROC) was 0.94 (95%CI: 0.92-0.96). The pooled sensitivity, specificity, positive likelihood radio and negative likelihood ratio of CEUS for differentiating testicular lesions in differentiation of benign and malignant were 0.95(95%CI: 0.85-0.99), 0.81(95%CI: 0.65-0.90), 4.9 (95%CI: 2.5-9.6), 0.06(95%CI: 0.02-0.20), respectively, and the AUC for SROC was 0.96(95%CI: 0.94-0.97). Conclusion CEUS has a high diagnostic value for focal testicular lesions and can provide a reference for clinical diagnosis and treatment.

Summary of evidence for exercise interventions in patients with knee osteoarthritis

Hu Zelin, Wu Meixuan, Mei Jia, Meng Shujing, Zhang Qiang, Qin Dianju

2024, 39(5):  396-400.  doi:10.3969/j.issn.1004-583X.2024.05.002

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Objective To summarize and evaluate optimal evidence of exercise intervention in patients with knee osteoarthritis (KOA). Methods We systematically searched professional websites or databases at home and abroad for clinical decisions, guidelines, expert consensus, recommendations, evidence summaries, and systematic reviews of exercise intervention in patients with KOA from inception to July 2022. Results A total of 12 articles were included in this study, including 3 guidelines, 1 clinical decision, 1 recommendation, 3 expert consensus, and 4 systematic reviews. Twenty-two pieces of optimal evidence were summarized from five aspects: pre-exercise evaluation, exercise mode, amount and intensity of exercise, and principles and precautions for the formulation of exercise programs. Conclusion This study summarizes optimal evidence of exercise intervention in patients with KOA, which can provide a basis of evidence-based for healthcare personnel to manage exercise in patients with KOA, thus promoting safe and effective exercise in patients.

Exploration of central mechanisms for post-stroke fatigue based on resting-state functional magnetic resonance imaging

Liu Xiuying, Cui Kaige, Liu Liying, Wu Yankai, Yu Jiaqi, Yang Jiping

2024, 39(5):  401-407.  doi:10.3969/j.issn.1004-583X.2024.05.003

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Objective To explore the central mechanism for post-stroke fatigue (PSF) by using resting-state functional magnetic resonance imaging. Methods Patients with acute cerebral infarction who were admitted to the Second Hospital of Hebei Medical University from April 2019 to September 2021 were randomly enrolled. Fatigue severity scale assessment and functional magnetic resonance imaging examination were performed on the subjects in the acute phase of cerebral infarction (within 14 days of onset) and chronic phase (3 months after onset). The subjects were grouped according to the fatigue degree, and the data were processed by MATLAB R2013b software. The differences in eigenvalues γ, λ, σ, Cp, Lp of small-world attribute and whole-brain static functional network connectivity (sFNC) between groups were analyzed, and the correlation between the different brain regions and clinical data was analyzed. Results There was no significant difference in gender and age between the PSF group and the non-fatigue (NPSF) group in the acute and chronic stages of cerebral infarction (P>0.05). The brain networks of the subjects in the both groups had small-world properties (σ>1, γ>1, λ≈1), the area under the curve of λ and Cp in the PSF group in the chronic phase was significantly reduced than that of the NPSF group (P<0.05), and there was no significant difference in area under the curve of other characteristic parameters(P>0.05). Compared with the NPSF group, sFNC of the left fronto-parietal network, visual network (VN) and other networks were significantly decreased in the PSF group at the acute stage of infarction (P<0.05). Left and right fronto-parietal network showed significantly increased sFNC (P<0.05) in the default mode network and sensory-motor network, respectively. Compared with the NPSF group, the sFNC of right fronto-parietal network-VN was significantly decreased in the chronic PSF group (P<0.05), and the sFNC in default mode network and other networks was increased (P<0.05). Conclusion The occurrence of PSF in acute stage of cerebral infarction may be related to cognitive dysfunction. The increase of sFNC between some brain networks in PSF patients with chronic cerebral infarction may lead to cognitive dysfunction. The decrease of sFNC in RFPN-VN is speculated to be an inhibitory compensatory effect caused by excessive advanced executive network function.

Clinical application of GEMOX combined with target-immunity therapy in patients with advanced biliary tract cancer

Wu Xiaomin, Fang Yipeng, Zhang Zhen, Zhang Ye, Jin Cheng

2024, 39(5):  408-412.  doi:10.3969/j.issn.1004-583X.2024.05.004

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Objective To evaluate the clinical efficacy and safety of gemcitabine and oxaliplatin (GEMOX) combined with target-immunity therapy (lenvatinib and programmed cell death 1 [PD-1] monoclonal antibody) in patients with advanced biliary tract cancer (BTC). Methods Twenty-four patients with advanced BTC received GEMOX combined with target-immunity therapy visited Integrative Oncology Department or Hepatobiliary Surgery Department of our hospital from January 2015 to January 2024 were recruited. The primary end points were set as overall survival (OS) and progression-free survival (PFS), and the secondary end points were objective response rate (ORR), disease control rate (DCR) and safety. The safety and overall clinical efficacy of GEMOX combined with target-immunity therapy regimen on advanced BTC were comprehensively evaluated via tumor marker indexes (carcinoembryonic antigen [CEA], carbohydrate antigen 125 [CA125], CA199), adverse reactions rates, quality of life scores, imaging indicators, and other data. Results None of the 24 patients had complete remission (CR). ORR was 33.3% (8/24, 8 patients had PR), DCR was 66.7% (16/24; 8 patients had SD and 8 patients had PD, respectively), median OS was 13 months and median PFS was 8 months. After treatment, the levels of CA199 were significantly lower than those before treatment (P<0.05). The incidence of adverse events in 24 patients were rash (14/24, 58.3%), leucopenia (22/24, 91.6%), anemia (20/24, 83.3%). One patient had serious adverse events and withdrew from treatment, one patient died of biliary obstruction with infection during treatment. Conclusion GEMOX combined with target-immunity therapy regimen is safe and effective in the treatment of advanced BTC, it may be used clinically.

Construction of a nomogram to predict the risk of lung metastasis in extremity osteosarcomas based on the SEER database and its validation

Wang Zhuangzhuang, Ren Huan, Liu Yanting, Tian Chunlei, Ai Wenbing

2024, 39(5):  413-419.  doi:10.3969/j.issn.1004-583X.2024.05.005

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Objective To construct a nomogram to predict the risk of lung metastasis in patients with extremity osteosarcomas. Methods Clinical data of 1 610 extremity osteosarcoma patients were acquired from the National Cancer Institute’s Surveillance, Epidemiology, and End Results database from 2010 to 2020. The data were assigned into the training dataset and validation dataset at a ratio of 7:3. Univariate and multivariate logistic regression analyses were used to identify independent risk factors for the occurrence of lung metastasis in patients with extremity osteosarcomas. A nomogram to predict risk factors for lung metastasis in patients with extremity osteosarcomas was then constructed based on the results of multivariate logistic regression analysis. Its performance was assessed by the receiver operating characteristic curve, calibration curve, and decision curve analysis (DCA). Results Logistic regression analysis showed that advanced T staging, lymph node metastasis, refusal of surgery and treatment of radiotherapy and chemotherapy were independent risk factors for lung metastases in patients with extremity osteosarcomas (P<0.05). The area under the curve of the nomogram in predicting lung metastasis of extremity osteosarcomas was 0.801 and 0.640 in the training dataset and validation dataset, respectively. The calibration curve and DCA showed the good accuracy and a high net benefit over a wide range of probability thresholds, respectively. Conclusion We created a nomogram to predict lung metastasis in patients with extremity osteosarcomas, showing high accuracy and feasibility. It assists orthopedists to make a faster and more reliable prediction and provide an individualized treatment.

Single-center analysis of David I versus Bentall's procedure for acute aortic dissection

Liu Yang, Ma Ning, Zhang Weihua

2024, 39(5):  420-425.  doi:10.3969/j.issn.1004-583X.2024.05.006

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Objective A single-center analysis of the efficacy of David I versus Bentall procedure for acute aortic dissection was conducted. Methods A total of 28 patients with acute aortic dissection hospitalized in the Department of Cardiovascular Surgery, the First Affiliated Hospital of Zhengzhou University from January 2020 to December 2022 were enrolled. According to the surgical methods, they were divided into David I group (n=13, received David I procedure ) and Bentall group (n=15, received Bentall’s procedure). After 1 year of follow-up, the inter-group perioperative indexes, cardiac indexes and complications were assessed. Results The operation time, transfer time and aortic occlusion time were significantly longer in David I group versus Bentall group (P<0.05). There were no significant differences in intraoperative blood loss, 24 h postoperative drainage volume, ventilator-assisted time, intensive care unit stay time, and hospitalization time in David I group versus Bentall group (P>0.05). There was no significant inter-group difference in left ventricular ejection fraction (LVEF), maximum diameter of ascending aorta and left ventricular end-diastolic diameter (LVDD) before operation and on year 1 of operation (P>0.05). LVEF in David I group was significantly decreased on year 1 of operation than that before operation (P<0.05), and maximum diameter of ascending aorta and LVDD were significantly decreased on year 1 of operation in the both groups than those before operation (P<0.05). There was no inter-group significant difference in the incidence of complications (46.1% vs 46.7%, P>0.05). Conclusion There was no significant difference in postoperative survival rate and valvular complications between Bentall and David Ⅰ procedure in the treatment of acute aortic dissection. The Bentall procedure has a shorter operating time, transit time, and aortic occlusion time.

Correlation analysis between sub-health and QUS bone mineral density based on human energy assessment: A case study of adult residents in Karamay, Xinjiang

Guo Yujiang, Zhao Zan, Xiao Xin, Jiang Xianyang, Huang Chunmei, Li Shuai

2024, 39(5):  426-432.  doi:10.3969/j.issn.1004-583X.2024.05.007

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Objective To understand the sub-health and bone mineral density (BMD) status of different adult groups in Karamay urban area, and explore the correlation between the two parts, thus, providing reference for the health care of urban residents in Xinjiang and the prevention of osteoporosis. Methods A total of 4, 377 adult residents in Karamay, Xinjiang were randomly selected. The sub-health and BMD status of the subjects were detected by instruments and statistically analyzed. Results The detection rate of sub-health was 71.85%, and which in female was slightly higher than that of male. There were significant differences in bone mass between sub-health group (including female group, Han people group, 20-39 years old group, obesity group, social service group and public institution residents) and healthy group (P<0.05). There were significant differences in BMD between the sub-health group (including female group, different nation group, 20-39 years old group, normal weight group, social service group) and the healthy group (P<0.05). There were differences in BMD among residents according to gender, weight and occupation (P<0.01). Logistic regression analysis showed that female, public institutions, high BMI, sub-health were protective factors for abnormal bone mass (OR=0.402, 95%CI: 0.308-0.524; OR=0.622, 95%CI: 0.480-0.806; OR=0.679, 95%CI: 0.466-0.990; OR=0.642, 95%CI: 0.501-0.822). Ethnic minorities, other people and the elderly were risk factors for bone abnormalities (OR=1.529, 95%CI: 1.118-2.091; OR=1.616, 95%CI: 1.027-2.542; OR=3.489, 95%CI: 2.151-5.660). Conclusion The middle-aged and elderly residents of Karamay ethnic minorities in Xinjiang should pay attention to their health status and the dynamic changes in bone mass, prevent and treat osteoporosis prematurely, so as to realize the goal of early detection and establish a healthy bones awareness. Meantime, the government should strengthen residents ' awareness of osteoporosis prevention, cultivate a healthy lifestyle, scientifically guide physical exercise, build a healthy and effective national fitness service system, and promote the healthy development of the whole people.

Bioequivalence of aspirin enteric-coated tablet in healthy volunteers

Liu Junyu, Zhang Tiancai, Zhang Baie, Li Yizhou, Li Yafei, Liu Hongbin, Duan Liping, Zhang Quanying, Wang Yijun, Meng Fanhua, Sun Min

2024, 39(5):  433-439.  doi:10.3969/j.issn.1004-583X.2024.05.008

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Objective To evaluate the bioequivalence and safety of aspirin enteric-coated tablets in healthy Chinese adult. Methods A single-center, randomized, open, two-preparation, two-sequence, four-cycle, fully replicated design was used. The subjects took orally one tablet of test (T) or reference (R) preparation on fasting or fed condition every cycle. The plasma concentration of acetylsalicylic acid (ASA) was determined by liquid chromatography with tandem mass spectrometry (LC-MS/MS) method at different time points, and the bioequivalence and safety of the two formulations were evaluated. Results In the main results for pharmacokinetic parameters of T and R under fed condition, C_max were (690.97±196.91) and (669.28±337.40) ng·ml^-1, AUC_0-t were (867.37±228.64) and (821.16±349.85) ng·h·ml^-1, AUC_0-∞ were (883.48±233.72) and (923.59±287.95) ng·h·ml^-1, T_max were (8.98±2.47) and (10.69±3.75) h. In the main result for pharmacokinetic parameters of T and R under fasting condition, C_max were (466.83±222.89) and (441.42±211.99) ng·ml^-1, AUC_0-t were (753.24±269.49) and (678.50±278.85) ng·h·ml^-1, AUC_0-∞ were (809.11±309.27) and (726.51±267.00) ng·h·ml^-1, T_max were (5.81±2.53) and (6.41±2.47) h. The geometric mean ratios of the main pharmacokinetic parameters C_max, AUC_0-t and AUC_0-∞ in the fed group were within the range of 80.00% to 125.00%, therefore the two formulations were bioequivalent. However,the fasting group did not meet the relevant criteria, and the two preparations were not equivalent. During the study period, 0 case and 2 cases of adverse events occurred under the fasting and the fed condition. No serious adverse events occurred. Conclusion The two kinds of aspirin enteric-coated tablets were bioequivalent in human under the fed condition, but not in the human under fasting conditions, and the formulations were safe and well tolerated.

Three cases review and literature review of elderly heart failure patients with delirium as the initial symptom

Wang Ting, Chai Chunyan, Li Min

2024, 39(5):  440-444.  doi:10.3969/j.issn.1004-583X.2024.05.009

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Objective To analyze the clinical characteristics, misdiagnosis reason and treatment methods in elderly heart failure (HF) patients with delirium as the initial symptom. Methods Three elderly HF patients with delirium as the initial symptom were retrospectively analyzed. Results None of the three patients had typical symptoms of heart failure such as shortness of breath and asthma, and all of them took delusion as the initial symptom. Two cases were diagnosed with senile dementia and one case with brain organic mental disorder. Among the three patients, two cases had been treated in the department of neurology, but the treatment effect was not satisfactory. HF was diagnosed by results of echocardiography and N-terminal pro-brain natriuretic peptide in our department, and delirium was improved after improving cardiac function. Conclusion When elderly patients experience mental and behavioral abnormalities, the possibility of delirium should be considered. Thinking should be broadened and comprehensive assessment should be carried out. Especially if there is a previous heart disease, abnormal cardiac function should be checked.

A case of sudden death from mitochondrial cardiomyopathy

Qiao Yan, Cai Jia, Zeng Jing, Li Ruizhen, Zhang Huijuan, Zhang Xiaoming

2024, 39(5):  445-449.  doi:10.3969/j.issn.1004-583X.2024.05.010

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Objective This article reports a rare case of mitochondrial cardiomyopathy (MCM) to enhance the awareness of clinical physicians in the diagnosis and treatment of MCM, thus avoiding missed diagnosis and misdiagnosis. Methods The clinical data and diagnosis and treatment process of this patient were analyzed, and relevant literatures were reviewed for discussion. Results This young female patient was diagnosed with consciousness disorders, and the result for electromyography (EMG), electroencephalography (EEG), and brain magnetic resonance imaging (MRI) were all negative. Due to left ventricular hypertrophy (LVH) and elevated markers of myocardial damage, cardiac MRI revealed myocardial damage. The patient was transferred to the cardiology department for treatment with “viral myocarditis”. However, the myocardial markers did not return to normal and the extent of myocardial damage increased. The diagnosis of MCM was confirmed after completing genetic testing and myocardial biopsy at the higher-level hospital. Due to sudden chest tightness and shortness of breath after intense activity, she died suddenly. Conclusion MCM is rare in clinical practice, and patients who are familiar with its atypical clinical manifestations and positive signs, as well as patients with multiple system damages, should consider the possibility of this disease based on clinical manifestations and auxiliary examinations. It is necessary to undergo walking gene testing and myocardial biopsy to avoid misdiagnosis and missed diagnosis, and actively follow up to avoid related causes to improve patient survival rate.

The occurrence of complete hydatidiform mole with co-existing fetus complicated by invasive mole: A case report

Liu Liting, Wang Jian, Xiao Yanlai, Zhang Yiwei

2024, 39(5):  450-454.  doi:10.3969/j.issn.1004-583X.2024.05.011

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Objective To explore the pathogenesis, clinical characteristics and treatment methods of complete hydatidiform mole with co-existing fetus (CHMCF). Methods A retrospective analysis was conducted on the diagnosis, treatment, and pregnancy outcome of a case involving CHMCF complicated by invasive mole, along with a review of related literature. Results The patient had a spontaneous pregnancy following ovulation induction treatment, with an ultrasound during pregnancy confirmed twin pregnancy complicated by hydatidiform mole. A full-term newborn was delivered by cesarean section. Combining clinical presentation, imaging examinations, histopathological characteristics and immunohistochemistry, the CHMCF diagnosis was confirmed. A 2-month follow-up after cesarean section revealed the diagnosis of an invasive mole (Ⅲ:2). Clinical remission was achieved after receiving 7 courses of single-agent methotrexate (MTX) chemotherapy. Conclusion Management of a twin pregnancy complicated by hydatidiform mole should be individualized, especially in cases involving CHMCF complicated by invasive mole.