Table of Content

20 June 2024, Volume 39 Issue 6

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Safety and efficacy of rivaroxaban in the treatment of discharged COVID-19 patients: A meta-analysis

Yu Jingyi, Si Yuanguo, Lan Cuixia, Xing Jiaxuan

2024, 39(6):  485-493.  doi:10.3969/j.issn.1004-583X.2024.06.001

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Objective To evaluate the safety and efficacy of anticoagulation with rivaroxaban in discharged COVID-19 patients. Methods We searched related literatures on Embase, PubMed, Scopus, Cochrane library, Web of Science, Med Rxiv and Clinical Trials. Two independent researchers conducted literature selection and data extraction according to pre-determined inclusion and exclusion criteria. Results We included 6 studies with a total of 4605 patients with COVID-19, including 4 randomized controlled trials (RCTs) and 2 cohort studies. The results showed that no significant difference in mortality between patients with rivaroxaban and those without rivaroxaban (0.50% vs 1.50%; OR: 0.40; 95%CI: 0.11-1.44; P=0.16). When only RCTs were selected for meta-analysis, there was still no significant difference in mortality between subgroups, which negative result was confirmed after being adjusted by trial sequential analysis (TSA-adjusted CI: 0.09-6.23). There was also no difference in the incidence of major bleeding events between two groups, even adjusted by TSA (0.12% vs 0%; OR: 2.73; 95%CI: 0.43-17.4; P=0.29; TSA-adjusted CI: 0.08-114.92). The incidence of thrombotic events in the rivaroxaban group was significantly lower than that in the control group (0.42% vs 1.53%; OR: 0.28; 95%CI: 0.11-0.74; P=0.01; TSA-adjusted CI: 0.08-1.08). In addition, subgroup analysis results showed that mortality and thrombotic events were reduced in discharged patients treated with rivaroxaban. Conclusion Rivaroxaban can benefit COVID-19 patients, and reduce the occurrence of thrombotic events without increasing major bleeding, especially in discharged COVID-19 patients.

Systematic evaluation of the incidence and the influencing factors of sleep disorders in breast cancer patients

Liu Jiazhu, Liu Rong, Meng Limin, Guo Yinshu, Zhang Xiaobo, Ai Yiqin

2024, 39(6):  494-500.  doi:10.3969/j.issn.1004-583X.2024.06.002

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Objective To determine the incidence and the influencing factors of sleep disorders in breast cancer (BC) patients through a systematic evaluation. Methods Articles reporting the influencing factors of sleep disorders in BC patients published before December 2023 were searched in comprehensive databases, such as China National Knowledge Infrastructure (CNKI), Wanfang, VIP, sinomed, PubMed, Web of Science, Cochrane Library, Embase, EBSCO. The eligible data were evaluated using the Agency for Healthcare Research and Quality (AHRQ) and Newcastle-Ottawa scale (NOS). Results Twenty papers representing a total of 4409 cases sample size and 29 influencing factors were included. The results of the systematic evaluation showed that the detection rate of sleep disorders in BC patients was 67%, the main influencing factors were chemotherapy, age, surgery, tumour classification, depression, anxiety, pain, fatigue, and exercise frequency, the secondary influencing factors were radiotherapy, genetics, income, family status, hormone levels, hot flushes, coping styles, environmental changes, and quality of life, and the other influencing factors included ethnicity, number of hospitalisations, physiological function, place of residence, constitutional type, hyperlipidaemia, religious beliefs, previous respiratory disease, self-image, social support and form of medical insurance payment. Conclusion The prevalence of sleep disorders in BC patients is high, and healthcare professionals can identify high-risk factors and intervene early for reducing the risk of sleep disorders in BC patients.

Correlation between serum angiopoietin-like protein 2 and diabetic retinopathy in type 2 diabetes mellitus

Wang Xiang, Lin Fang, Li Li, Sun Jiehui

2024, 39(6):  501-505.  doi:10.3969/j.issn.1004-583X.2024.06.003

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Objective To explore the correlation between serum angiopoietin-like protein 2 (ANGPTL2) and diabetic retinopathy (DR) in type 2 diabetes mellitus (T2DM). Methods A total of 168 T2DM patients aged 18-80 years who attended the Department of Endocrinology of the First Affiliated Hospital of Ningbo University from January 2019 to December 2019 were selected, including 84 patients with DR (DR group) and 84 patients without non-DR (NDR group). The baseline information and serological indicators were collected and compared between the two groups. The risk factors of DR were explored by binary logistic regression analysis, and the predictive value of serum ANGPTL2 and glycosylated hemoglobin (HbA₁c) for DR was assessed by plotting receiver operating characteristic (ROC) curves. Results In the comparison of baseline information, DR group had significantly longer disease duration and smaller hip circumference relative to the NDR group (all P<0.05). In the comparison of serological indicators, DR group had significantly higher serum ANGPTL2, fasting blood glucose (FBG) and HbA₁c, and lower 2-hour postprandial C-peptide compared to the NDR group (all P<0.05). Binary logistic regression analysis suggested that high serum ANGPTL2 (OR=1.766, 95%CI: 1.115-2.797) and HbA₁c (OR=2.423, 95%CI: 1.258-4.669) levels were risk factors for DR (all P<0.05). The area under the ROC curve (AUC) for serum ANGPTL2 predicting DR was 0.728(95%CI: 0.653-0.803), with a moderate predictive efficacy. The AUC for HbA₁c predicting DR was 0.682(95%CI: 0.580-0.784), with a low predictive efficacy. Conclusion High serum levels of ANGPTL2 and HbA₁c levels are risk factors for DR, and serum ANGPTL2 levels are informative in predicting the disease.

Predictive value of C-reactive protein combined with triglyceride glucose index for coronary heart disease risk in patients with rheumatoid arthritis

Song Yijing, Li Jian, Song Qin, Shao Li

2024, 39(6):  506-511.  doi:10.3969/j.issn.1004-583X.2024.06.004

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Objective To explore the predictive value of C-reactive protein (CRP) and triglyceride glucose (TyG) index for coronary heart disease (CHD) risk in patients with rheumatoid arthritis. Methods Totally 300 eligible patients diagnosed with RA admitted to the Department of Rheumatology and Immunology of the Affiliated Hospital of Jining Medical University from January 2019 to December 2022 were included and screened. The subjects were divided into CHD group (102 cases) and non-CHD group (198 cases) based on the performance of CHD or not. The baseline information and laboratory data were collected. After analyzing their differences, statistically significant indicators were included in logistic regression analysis, a regression model was built to observe the correlation between CRP and TyG index with the risk of CHD in RA patients, and receiver operating characteristic (ROC) curves of CRP, TyG index and CRP combined with TyG index were plotted. Area under the curve (AUC) was reported to evaluate the predictive value of CRP and TyG index for CHD in RA patients. Results Correlation analysis showed that CRP, fasting blood glucose (FBG), TyG index, age, history of hypertension and history of diabetes were significantly different between the two groups. Logistic regression analysis showed that CRP, TyG index, history of hypertension and age were independent risk factors for CHD in RA patients. The AUC of CRP, TyG index and their combined coefficient was 0.608, 0.602 and 0.656, respectively. Conclusion The combination of CRP and TyG index has good predictive value for the risk of CHD in RA patients.

Correlation between systemic immune inflammation index and multivessel coronary disease in patients with acute coronary syndrome

Wang Zhongqi, Li Jinzhao, Wu Nan

2024, 39(6):  512-517.  doi:10.3969/j.issn.1004-583X.2024.06.005

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Objective To investigate the correlation between systemic immune inflammation (SII) index and severity of coronary artery disease in patients with acute coronary syndrome (ACS). Methods A total of 206 ACS patients with typical symptoms of chest pain and chest tightness underwent coronary angiography in the Department of Cardiology of Anshan Central Hospital from September 2021 to March 2023 were enrolled. The clinical data and the immune inflammation indexes were assessed. According to the coronary angiography results or the modified Gensini score, the patients were divided into single-vessel disease group (n=51) and multi-vessel disease group (n=155), or mild lesion group (n=89) and advanced lesion group (n=117). The inter-group differences in clinical data were compared, and the independent risk factors for severity of coronary artery disease were screened for evaluating their predictive value. Results The area under the curve of SII in predicting severity of coronary artery disease in ACS patients was 0.93. When SII was 631.31, the predictive ability for severity of coronary artery disease in ACS patients was the highest, with 81.9% of the sensitivity and 96.1% of specificity. Conclusion SII is an independent risk factor for severity of coronary artery disease in ACS patients, and it has a high predictive value.

Clinical study of the efficacy of intracoronary injections of low-dose prourokinase through the tail of the balloon on acute ST-segment elevation myocardial infarction patients undergoing percuteneous coronary intervention

Li Yanan, Zhang Hongyu

2024, 39(6):  518-523.  doi:10.3969/j.issn.1004-583X.2024.06.006

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Objective To explore the clinical effect of the intracoronary injections of low-dose prourokinase through the tail of the ballon on acute ST-segment elevation myocardial infarction (STEMI) after percutaneous coronary intervention (PCI). Methods A total of 122 acute STEMI patients with onset within 12 h, and emergency coronary thrombosis in infarct-related artery (IRA) with thrombus score≥4 who visited the Chest Pain Center of Tianjin Baodi Hospital from June 2022 to July 2023 were recruited. They were randomly assigned into the observation group (n=61, intracoronary injections of low-dose prourokinase and tirofiban through the tail of the ballon) and control group (n=61, intracoronary injections of tirofiban through the tail of the ballon). Clinical data of the two groups were compared. Results There were no significant differences in the age, sex, smoking history, hypertension history, diabetes history, family history of coronary heart disease, history of previous myocardial infarction, hyperlipidemia history, cardiac function classification, preoperative thrombolysis in myocardial infarction (TIMI) flow grade, TIMI myocardial perfusion grade (TMPG), preoperative laboratory testing (including creatine kinase MB [CK-MB], high-sensitive cardiac troponin T [hs-cTnT], C -reactive protein [CRP], D-dimer, B-type natriuretic peptide [BNP], creatinine, hemoglobin), IRA, number of diseased vessels, symptom to reperfusion time, and thrombus load between the two groups (P>0.05). No significant differences were found between the groups in TIMI flow grade, TMPG, and incidences of major adverse cardiovascular events (MACEs) and bleeding after PCI (P>0.05). The rate of reduced ST-segment elevation (STR%) of less than 50% (≤50%) at 2 h, peak values of hs-cTnT and CK-MB, and BNP at 24 h postoperatively were significantly lower in the observation group than those of control group, while the left ventricular ejection fraction at 1 week postoperatively was significantly higher (P<0.05).Conclusion Intracoronary injections of low-dose prourokinase through the tail of the ballon reduces myocardial damage and improves cardiac function in acute STEMI patients with severe thrombus load, without increasing the risk of bleeding during hospitalization.

Predictive value of milk fat globule-epidermal growth factor 8 in cognitive impairment after ischemic stroke

Xu Yuping, Shen Tao

2024, 39(6):  524-530.  doi:10.3969/j.issn.1004-583X.2024.06.007

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Objective To explore the predictive value of milk fat globule-epidermal growth factor 8 (MFG-E8) in cognitive impairment after ischemic stroke (IS). Methods A prospective nested case-control study was conducted, involving 135 IS patients admitted to Shanghai Baoshan District Wusong Central Hospital, from January 2021 to January 2023 as the case group. During the same period, 135 healthy individuals who underwent physical examinations in our hospital were included in the control group. All patients in the case group were treated conservatively and evaluated for their cognitive function 6 months after discharge using the Montreal cognitive assessment basic scale(MoCA). They were assigned into the normal cognition group(n=78) and impaired cognition group(n=52) based on the MoCA scores. Furthermore, patients in the impaired cognition group were sub-divided into mild group, moderate to severe group. Clinical data of patients in the case group were collected. Serum MFG-E8 levels of the patients were measured before clinical treatment, 7 days after admission and at discharge. The efficacy of serum MFG-E8 levels on predicting cognitive dysfunction after IS was analyzed. Results After excluding 5 patients in the case group, finally a total of 130 eligible patients in the case group were included for the analysis. Serum MFG-E8 levels in the case group before treatment were significantly lower than those in the control group (P<0.01). Cognition impairment was detected in 52 (40.0%) patients in the case group, including 34 cases of mild cognitive impairment, 16 cases of moderate cognitive impairment, and 2 cases of severe cognitive impairment. Serum MFG-E8 levels, changes in serum MFG-E8 from before clinical treatment to 7 days of admission (△₁MFG-E8), and changes in serum MFG-E8 from before clinical treatment to discharge (△₂MFG-E8) in the impaired cognition group at all time points were significantly lower than those of the normal cognition group (P<0.05). Serum MFG-E8 levels in the moderate and severe groups were significantly lower than those of the mild group before treatment, 7 days after admission, and at discharge (P<0.05). The results of logistic regression analysis showed that serum MFG-E8 levels, Δ1MFG-E8, Δ2MFG-E8, infarction in the frontal lobe and moderate infarction size before treatment, 7 days of admission and at discharge were significantly correlated with cognitive dysfunction after IS (P<0.05). The receiver operating characteristic (ROC) curve showed that the △₂MFG-E8 value had a better predictive effect on cognitive impairment after IS, with an area under the curve of 0.895(95%CI: 0.843-0.947), sensitivity of 74.4% and specificity of 88.5%. Conclusion Serum MFG-E8 levels have a high predictive value in cognitive dysfunction in IS patients, and the changes in serum MFG-E8 at discharge are effective in predicting cognitive dysfunction after IS.

Ultrasound evaluation of speckle tracking imaging on right ventricular function and right ventricular pulmonary artery coupling in severe pneumonia underwent mechanical ventilation versus common pneumonia

Yan Yaru, Zhao Haotian, Zhang Jiesi, Wang Xiaona, Zhao Heling

2024, 39(6):  531-536.  doi:10.3969/j.issn.1004-583X.2024.06.008

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Objective To analyze ultrasound evaluation of two-dimensional speckle tracking imaging (2D-STI) on right ventricular (RV) function and RV- pulmonary artery coupling in severe pneumonia underwent mechanical ventilation versus common pneumonia. Methods Sixty-six patients of pneumonia were divided into severe pneumonia group (group S, 25 cases) and general pneumonia group (group G, 41 cases), and 20 healthy people were enrolled as control group. Ultrasonic parameters were obtained in apical four-chamber images, including RV diameter (RVD), tricuspid annular plane systolic excursion (TAPSE), tricuspid lateral annular peak systolic velocity (S'), tricuspid regurgitation velocity (TRV). Inferior vena cava diameter (IVCD) and inferior vena cava variability (IVCV), and the RV pressure (RVP) were estimated, and pulmonary artery systolic pressure (PASP) was calculated. The RV-pulmonary artery coupling index was represented by TAPSE/PASP. The 2D-STE was performed to observe strain parameters, including right ventricular longitudinal strain in the free wall (RVLSfw), right ventricular longitudinal strain in the basal segment (RVLSbas), right ventricular longitudinal strain in the middle segment (RVLSmid), and right ventricular longitudinal strain in the apical segment (RVLSapi). The new index RVLSfw/PASP was obtained by incorporating RVLSfw into the RV-pulmonary artery coupling. The between groups differences and the correlation were assessed. Results RVD, IVCD, TRV and PASP in group S were significantly higher than those in group G and control group, while IVCV and TAPSE were significantly lower (P<0.05). S’ in group S was significantly lower than that in group G (P<0.05). RVD and IVCD in group G were significantly higher than those in control group (P<0.05). 2D-STI indexes including RVLSfw, RVLSbas and RVLSapi in group S were significantly lower than those in group G and control group (P<0.05). There was no statistically significant difference in 2D-STI indexes between group G and control group (P>0.05). RV-pulmonary artery coupling indexes including TAPSE/PASP, S'/PASP and RVLSfw/PASP in group S were significantly lower than those in group G and control group, and there was no statistical significance in RV-pulmonary artery coupling indexes between group G and control group (P>0.05). RVLSfw/PASP was strongly correlated with TAPSE/PASP (r=0.927, P<0.05). Conclusion Both 2D-STI index and RV-pulmonary artery coupling have certain value in evaluating the RV function of patients with severe pneumonia underwent mechanical ventilation. RVLSfw/PASP can be used as a reliable index to evaluate RV-pulmonary artery coupling.

Effect of local cold compress in the prevention of pegylated liposomal doxorubicin induced hand-foot syndrome

Shi Sufang, Jia Dongxiao, Han Jianjun, Zhao Hongxiang, Ren Yanfei, Li Junjiao

2024, 39(6):  537-541.  doi:10.3969/j.issn.1004-583X.2024.06.009

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Objective To observe the application effect of local cold compress in pegylated liposomal doxorubicin(PLD)induced hand-foot syndrome(HFS)from a clinical perspective. Methods During June 2021 to June 2023, a non-synchronous randomized controlled trial was conducted to recruit breast cancer(BC) patients who received chemotherapy with a PLD in the Department of Breast Surgery, Affiliated Hospital of Hebei Engineering University as the research objects, they were randomized to the routine care group (from June 2021 to May 2022, n=58) or local cold compress group (from June 2022 to June 2023, n=55). The incidence of HFS, treatment compliance, satisfaction and medical experience of the patients were included as comparisons between groups. Results The incidence of HFS in the local cold compress group was significantly lower than that of the routine care group (23.6% [13/55] vs 44.8% [26/58], χ²=5.609, P=0.018). The severity of HFS in the local cold compress group was significantly lighter than that of the routine care group (P<0.05). The incidence of HFS of grade II and above in the local cold compress group was significantly lower than that of the routine care group (10.9% vs 25.9%, P<0.05). The treatment compliance and satisfaction of patients in the local cold compress group were significantly higher than those of the routine care group (P<0.05).Conclusion Local cold compress can effectively prevent the incidence and reduce and severity of HFS in chemotherapy with a PLD,and it is capable of improving the treatment compliance and satisfaction of patients.

Cerebellar ataxia associated with antibodies against GAD65: A case report and literature review

Zhang Li, Fu Qingxi, Su Mingzhao, Su Quanping

2024, 39(6):  542-547.  doi:10.3969/j.issn.1004-583X.2024.06.010

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Objective To investigate the clinical characteristics, diagnosis, treatment and prognosis of cerebellar ataxia associated with antibodies against glutamic acid decarboxylase 65 (GAD65). Methods Clinical data of a case of cerebellar ataxia associated with antibodies against GAD65 were analyzed. Clinical characteristics, diagnosis, treatment and prognosis of cerebellar ataxia associated with antibodies against GAD65 were summarized by searching clinical cases at home and abroad reported before December 2023 in online databases of Pubmed, China National Knowledge Infrastructure (CNKI), Wanfang Data Knowledge Service platform and Chinese Science and Technology Periodical Database (VIP) using the key words of “GAD65 antibody” and “cerebellar ataxia”. Results A 67-year-old male presented with weakness in both lower limbs slowly and gradually worsened, and finally he was unable to independently walk. Physical examination showed unclear articulation, level 5 muscle strength of both lower limbs, decreased tendon reflexes in lower limbs, bilateral limb ataxia, unable to walk in a straight line, positive Romberg signs, and positive Babiniski signs. Brain magnetic resonance imaging (MRI) suggested brain atrophy. A panel of 14 diagnostic serum markers of autoimmune cerebellar ataxia showed a weak positivity for GAD65 antibody (IgG 1:30). After hormonal shock therapy and oral immunotherapy, the patient presented an improved symptom of limb weakness, increased red cell count and hemoglobin, and decreased thyroid hormone. Thyroid peroxidase antibody was not significantly changed. Through literature review, 15 case reports and 6 articles reported 186 patients with cerebellar ataxia associated with antibodies against GAD65. The disease develops slowly and progressively. Gait ataxia is the typical clinical manifestation. Cerebellar ataxia associated with antibodies against GAD65 involves the brain stem, and may accompany other autoimmune diseases, but occasionally combines with tumors. Immune therapy is able to alleviate symptoms, and an early treatment provides more clinical benefits. Conclusion Cerebellar ataxia associated with antibodies against GAD65 is a rare type of cerebellar ataxia. Positive detection of GAD65 antibodies in cerebrospinal fluid (CSF) or serum is important for the diagnosis. At present, clinical treatment of cerebellar ataxia associated with antibodies against GAD65 has not yet reached a unified understanding, and immunotherapy can improve clinical symptoms.