Table of Content

20 September 2024, Volume 39 Issue 9

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Risk prediction model for readmission of chronic obstructive pulmonary disease: A systematic review

Zhu Jieyun, Gao Min, Huang Chunli, Pan Dongzan, Wang Qiaoyan, Lu Zhao

2024, 39(9):  773-779.  doi:10.3969/j.issn.1004-583X.2024.09.001

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Objective To systematically evaluate the risk for readmission in patients with chronic obstructive pulmonary disease (COPD) and provide references for the construction and optimization of prediction model.Methods The literatures on the risk prediction model for COPD readmission were independently screened in China National Knowledge Infrastructure (CNKI), VIP, WanFang Data, Cochrane Library, PubMed, Embase databases from database inception to November 22, 2023 by two researchers. After extracting data, the bias risk and applicability of the models were evaluated using the PROBAST tool. Results Twelve cohort studies representing 21 models were finally included. Eleven studies reported the area under a receiver operator characteristic (ROC) curve (AUC) and one study for the C-index. The AUC ranged from 0.603 to 0.917, with AUC>0.7 for 16 models. Six studies conducted model calibration and eight studies for internal or external validation. The overall applicability of the 12 studies was good, but with a high risk of bias, mainly in the analysis domain. The included studies had significant differences in the predictive factors, with the most common predictive factors of lung function indicators, Charlson comorbidity index, times of hospitalization due to a history of acute exacerbation during the previous year, eosinophil levels, and inhaled drug therapy. Conclusion The performance of the included models varied greatly, with good applicability but high risk of bias. Due to the incomplete screening method, and there were significant differences in predictive factors of the included studies. Future prediction models should focus on lung function, Charlson comorbidity index, times of hospitalization due to a history of acute exacerbation during the previous year, eosinophil levels, and inhaled drug therapy.

Evidence summary of the application of the diary method in adult ICU patients

Wang Yu, Peng Lili, Shi Yao, Du Yunhong, Duan Yuliang, Wang Li

2024, 39(9):  780-786.  doi:10.3969/j.issn.1004-583X.2024.09.002

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Objective To systematically screen, evaluate, summarize and extract the optimal evidence for the application of the diary method in adult patients in the intensive care unit (ICU), so as to provide evidence-based basis for the implementation of the diary method in ICU. Methods All the evidence on the application of the diary to adult ICU patients were searched in relevant professional websites and databases at home and abroad, including the guidelines, evidence summary, expert consensus, systematic reviews, clinical decisions, etc. The retrieval time was from the establishment of the database to January 25, 2024. Two researchers independently conducted literature screening, quality evaluation, data extraction, classification and evidence summary according to the topic. Results A total of 13 articles were included, with 1 expert consensus, 2 guidelines and 10 systematic reviews. The optimal evidence for the application of diary method in ICU adult patients was formed, including 8 dimensions (application cognition, application effect, target population, writers, diary content, writing notes, application guidance and diary management) and 32 pieces of evidence. Conclusion Medical staff should carefully select appropriate evidence according to the corresponding clinical situation, and a multidisciplinary team cooperation should be carried out to yield the optimal individualized evidence practice of the diary method in ICU.

Application of musculoskeletal ultrasound in ankylosing spondylitis with peripheral osteophytes

Xie Jianli, Wang Junxiang, Chen Haiying

2024, 39(9):  787-791.  doi:10.3969/j.issn.1004-583X.2024.09.003

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Objective To investigate the application of musculoskeletal ultrasound in ankylosing spondylitis (AS) patients with peripheral osteophytes. Methods Peripheral joint ultrasound examination was performed in 80 patients with AS. According to the detection of osteophytes, the patients were divided into the observation group (42 cases with osteophytes) and the control group (38 cases without osteophytes). The clinical characteristics, laboratory indexes, dual-energy bone mineral density (BMD) and the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) score were compared. The t-test and Sperman's rank correlation were used for statistical analyses. Results The highest incidence of osteophytes of finger joints (33.3%) was detected in the observation group. The C-reactive protein (CRP), BASDAI score and course of disease in the observation group were significantly higher than those of the control group, and the BMD was significantly lower (P<0.05). In the observation group, the erythrocyte sedimentation rate (ESR), CRP and course of disease in the smoking subgroup were significantly higher than those of the non-smoking subgroup (P<0.05). CRP was positively correlated with ESR, BASDAI score and smoking index. Conclusion Inflammatory response in patients with AS is related to osteophyte formation. Musculoskeletal ultrasound is used to detect osteophytes, which is helpful to disease assessment.

Bioinformatic analysis of differentially expressed genes of primary Sjögren's syndrome

Wang Yun, Wang Dandan

2024, 39(9):  792-797.  doi:10.3969/j.issn.1004-583X.2024.09.004

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Objective To screen for differentially expressed genes (DEGs) associated with primary Sjögren's syndrome(pSS) by bioinformatics and to explore its underlying pathogenesis. Methods Gene expression profiles were downloaded from the GEO database, and DEGs were obtained by integrating the datasets. Furthermore, we explored DEGs’ potential function by GO and KEGG enrichment analysis. Finally, we screened the hub genes of pSS by PPI network analysis. Results A total of 29 DEGs(27 up-regulated and 2 down-regulated) were identified, and the GO enrichment results showed that these genes are involved in lymphocyte and monocyte differentiation and proliferation, T cell activation, positive regulation of cell-cell adhesion, and chemokine-related molecular functions. KEGG analysis mainly involves chemokine signaling pathways, hematopoietic cell regulatory signaling pathways, B cell receptor signaling, viral protein-cytokine and receptor interaction pathways. Five hub genes, including MX1, SELL, IFIT1, IFI44L and SAMD9L were screened from the PPI network.Conclusion The MX1, SELL, IFIT1, IFI44L, and SAMD9L genes were identified and may be involved in pSS pathogenesis.

Blood potassium fluctuations before and after dialysis in maintenance hemodialysis patients

Yang Haiyan, Chen Ling, Dai Bo, Liu Xia, Sun Shangping

2024, 39(9):  798-802.  doi:10.3969/j.issn.1004-583X.2024.09.005

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Objective To observe the fluctuations of serum potassium in maintenance hemodialysis (MHD) patients before and after hemodialysis.Methods A total of 42 MHD patients admitted in the Nephrology and Rheumatology Department of Zunyi Hospital of Traditional Chinese Medicine from February 2021 to February 2023 were selected. According to the median grouping method, patients were divided into Δserum potassium (difference of serum potassium before and after dialysis) ≥1.44 mmol/L group (n=21) and Δserum potassium <1.44 mmol/L group (n=21). Clinical data between the two groups were compared. Results There were no significant differences in the age, gender, urea reduction ratio (URR), single-pool urea Kt/V (sp Kt/V) and hemodialysis (HD) mode between the two groups (P>0.05). Compared with the Δserum potassium <1.44 mmol/L group, the proportion of non-diabetic nephropathy (P =0.019) and serum potassium before dialysis were significantly higher in the Δserum potassium ≥1.44 mmol/L group (P <0.001). Partial correlation analysis showed that after adjusting for age, Δserum potassium was positively correlated with serum potassium before and after dialysis, and the positive correlation between Δserum potassium and serum potassium before dialysis was more significant (P <0.05).Conclusion Non-diabetic nephropathy as the comorbidity and the high-level serum potassium before MHD is related to the large fluctuation of serum potassium before and after MHD, which should be paid attention to in clinical practice.

Effect of a multidisciplinary intervention on the quality of life in maintenance hemodialysis patients

Guo Xiaocui, Yu Xiaojuan, Shen Xia, Ye Shuiying, Zhou Dongchi, Lai Bihong

2024, 39(9):  803-807.  doi:10.3969/j.issn.1004-583X.2024.09.006

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Objective To investigate the effect of a multidisciplinary intervention on the quality of life in patients with maintenance hemodialysis (MHD). Methods A total of 100 MHD patients admitted to the Department of Hemodialysis, Shanghai Pudong Hospital from January 2020 to December 2022 were included. They were randomly assigned 1∶1 into the intervention group (n=50) and control group (n=50). A multidisciplinary team which comprised nephrologists, nutritionists, and nurses was responsible for managing MHD patients the intervention group, while those in the control group received a standard daily care from the nursing team. After 12 months of intervention, 1 case in each group withdrew, and finally, 49 eligible cases were included in each group. The self-management ability, quality of life, and nutritional status were compared between two groups. Results There were no significant differences in general information, quality of life, self-management ability, and nutritional status between the two groups before intervention (P>0.05). After intervention, the self-management score and quality of life score of the intervention group were significantly higher than those of the control group (P<0.05). Body mass index, serum albumin, serum ferritin, and total cholesterol were significantly better than those in the control group (P<0.05). Conclusion A multidisciplinary intervention effectively improves the nutritional status, self-management ability and quality of life of MHD patients.

Clinical characteristics of children with Mycoplasma pneumoniae infection complicated with asthmatic bronchopneumonia

Yang Xiaolin, Yang Yan

2024, 39(9):  808-811.  doi:10.3969/j.issn.1004-583X.2024.09.007

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Objective To investigate the clinical characteristics of children with Mycoplasma pneumoniae (MP) infection complicated with asthmatic bronchopneumonia. Methods Fifty children with MP infection and asthmatic bronchopneumonia admitted to Children's Hospital Affiliated to Zhengzhou University from September 2021 to February 2023 were selected as the observation group, and 50 children with MP infection but not asthmatic bronchopneumonia during the same period were selected as the control group. The levels of T cell lymphocyte subsets (CD₃⁺, CD₄⁺, CD₈⁺), immunoglobulins (IgG, IgM and IgE), and lung function (vital capacity [VC], forced expiratory volume in the first second [FEV₁], forced vital capacity [FVC], peak expiratory flow [PEF], maximum mid-expiratory flow [MMEF]), serum inflammatory factors (transforming growth factor-beta1 [TGF-β1], tumor necrosis factor alpha [TNF-α]), and complement C3 levels were compared. Results The levels of CD₃⁺, CD₄⁺, CD₈⁺ in the observation group were significantly higher than those of control group (p<0.05). IgG, IgM, and IgE levels in the observation group were significantly higher than the control group (P<0.05). The levels of VC, FEV₁, FVC, PEF and MMEF in the observation group were significantly lower than those of control group (P<0.05). The levels of TNF-α and complement C3 in the observation group were significantly higher than those of control group (P<0.05). There was no significant difference in TGF-β1 level between the two groups (P>0.05). Conclusion Children with MP infection and asthmatic bronchopneumonia have a significant immune response, reduced pulmonary function, and increased levels of TNF-α and complement C3.

Analysis of clinical characteristics and risk factors of lupus nephritis combined with neuropsychiatric systemic lupus erythematosus in children

Han Kaiyang, Feng Tongtong, Bao Ying

2024, 39(9):  812-815.  doi:10.3969/j.issn.1004-583X.2024.09.008

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Objective To explore the clinical characteristics of children with lupus nephritis (LN) complicated with neuropsychiatric systemic lupus erythematosus (NPSLE), and to analyze the risk factors of LN complicated with NPSLE.Methods A total of 119 children with LN who were admitted to the Department of Nephrology, Xi'an Children's Hospital from May 2017 to January 2024 were enrolled. They were divided into NPSLE group (n=26) and non-NPSLE group (n=93) according to the presence or absence of NPSLE. Clinical data were compared between the two groups, and the clinical characteristics and risk factors of LN children with NPSLE were analyzed.Results The incidence of NPSLE in children with LN was 21.8%, with male-to-female ratio of 1∶5.5, and an average age of 10 years and 6 months. The most common neurological manifestations were psychiatric abnormalities, erythema discoideum in general, and abnormalities of cranial MRI on imaging. There were significant differences in antinuclear antibody positivity, anti-ds-DNA antibody positivity, anti-Smith (anti-SM) antibody positivity, reduction of white blood cells, red blood cells and platelets, performance of only anemia, high erythrocyte sedimentation rate (>15 mm/h), hypoproteinemia, positive Coombs test, hematuria and massive proteinuria between the two groups (P<0.05). Binary logistic regression analysis showed that hematuria, massive proteinuria and positive anti-SM antibody were independent risk factors for NPSLE in children with LN. Conclusion A variety of factors can influence whether LN is comorbid with NPSLE, with children with LN who have haematuria, large amounts of proteinuria, and positive anti-SM antibodies being prone to comorbid neuropsychiatric changes.

Investigation of postoperative psychological behaviors in children with solid tumors and the influencing factors

Du Lihui, Lu Hangduo, Zhang Wenjun, Wang Wenhua, Wang Yuanyuan, Jia Yingping

2024, 39(9):  816-820.  doi:10.3969/j.issn.1004-583X.2024.09.009

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Objective To explore the differences in psychological behavior between children with solid tumors after surgery and non-tumor children, and to analyze the influencing factors. Methods Convenience sampling method was used to select 150 children with pathologically diagnosed solid tumors at Children's Hospital Affiliated of Zhengzhou University from May 2022 to April 2023 as the pediatric tumor group. During the same period, 100 healthy children were selected as the control group. The Conners Comprehensive Behavior Rating Scale (CBRS) and the Normal Development of Social Skills from Infame to Junior High School Children (S-M) were used to assess the psychological behavior and social life ability. Influencing factors for postoperative psychological and behavioral abnormalities in children with solid tumors were identified by logistic regression analysis. Results There were significant differences in the scores of learning problems, anxiety, and hyperactivity index in the psychological and behavioral dimensions of children at different age groups (P<0.05). The scores of various psychological and behavioral dimensions in the pediatric tumor group were significantly higher than those of the control group (P<0.05). The scores of sports, independent living, self-management, homework operations, and group activities in the pediatric group were significantly lower than those of the control group (P<0.05). There were significant differences in the age, time to return to school after surgery, completion of treatment, financial burden on the family, harmonious family relationship and social living ability comparison in children between abnormal and normal psychological behavior groups (P<0.05). CBRS score was negatively correlated with the S-M score (r=-0.667, P<0.01). Logistic regression analysis showed that older age, longer time to return to school after surgery, completion of treatment, harmonious family relationship, and good social living ability were protective factors for psychological and behavioral problems after surgery for children with solid tumors, while a heavy family financial burden was a risk factor (P<0.05). Conclusion The psychological and behavioral scores of children with solid tumors are at a moderate level. Paying attention to the postoperative psychological behavior of children with solid tumors and improving their social life abilities can help them integrate into the group and promote healthy growth.

Cortical “ribbon sign” on DWI in adults: A case report and literature review

Zhang Yingqiu, Zhang Jin, Ge Shihao, Chen Junmin

2024, 39(9):  821-824.  doi:10.3969/j.issn.1004-583X.2024.09.010

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Objective To investigate the clinical characteristics of cortical “ribbon sign” on diffusion-weighted imaging (DWI). Methods The clinical data, relevant examination data, and imaging data of a case of cortical “ribbon sign” were analyzed, and relevant literatures were reviewed. Results The patient was admitted to the hospital due to involuntary grasping of objects with a walking instability for 10 days, and aggravated for 2 days. Brain imaging examination showed cortical “ribbon sign”, manifesting as a high signal intensity along the cerebral sulcus on T1-weighted imaging, DWI and fluid-attenuated inversion recovery sequence. The increase in signal intensity was pronounced on DWI sequence, reflecting the cytotoxic edema of the cerebral cortex. Symptomatic treatment was performed. The patient's symptoms gradually worsened and died about half a year later. Conclusion Cortical ribbon sign is a typical imaging change of laminar necrosis of the cerebral cortex, usually observed in vascular, infectious, metabolic, and toxic nerve system diseases. A deep mining of the pathogenesis and causes of cortical ribbon sign favors the clinical diagnosis and differentiation diagnosis.

Spinal dural arteriovenous fistula: A case report and literature review

San Dan, Zhen Jin

2024, 39(9):  825-827.  doi:10.3969/j.issn.1004-583X.2024.09.011

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Objective To study the clinical manifestations, pathogenesis and imaging pattern of spinal dural arteriovenous fistula (SDAVF). Methods The diagnosis and treatment of a SDAVF patient was analyzed retrospectively, and the related literature was reviewed. Results The 61-year-old male patient presented mobility limitation as initial symptom, followed by urination and defecation dysfunction, with strip long T2 signal in magnetic resonance imaging and spinal arteriovenous fistula at L1 segment in spinal angiography. Conclusion Although SDAVF is very rare and clinically atypical, spinal angiography is the gold standard for confirmed diagnosis, and surgery should be performed as soon as possible after diagnosis.

Rectal cap polyposis: A case report and literature review

Gu Dandan, Zhou Xiaoxian, Wang Jingxian, Wu Chunxiao

2024, 39(9):  828-832.  doi:10.3969/j.issn.1004-583X.2024.09.012

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Objective To explore the clinical characteristics of rectal cap polyposis, thus improving its understanding for clinical diagnosis and treatment. Methods Clinical data of a case of rectal cap polyposis treated in the Hebei Province Hospital of TCM were retrospectively analyzed, and relevant literatures published both domestically and internationally were reviewed. Results A young male patient presented for intermittent mucous bloody stool. Specialized physical examination revealed multiple hemispherical masses protruding towards the intestinal cavity near the lower segment of the dentate line, with erosion and necrosis observed on the surface, and covered with massive yellow white purulent secretions. Multiple pathological biopsies suggested inflammatory changes. After conservative anti-inflammatory and symptomatic treatment for 3 months, although the symptom of mucous bloody stool improved, microscopic lesions remained unchangeable. Surgical resection yielded a cure. Combined with postoperative pathological results, the patient was diagnosed as rectal cap polyposis. No recurrence was observed during a 1-year follow-up. Conclusion Rectal cap polyposis is a rare non-tumor disease and a special type of inflammatory polyp. A clinical diagnosis is usually made based on the characteristic “cap-like” changes under the microscope and pathological examination results. Conservative treatment may achieve the goal of relieving symptoms, but surgery for eradicating the lesion is preferred to those with a poor outcome of conservative treatment.

Protection and use of medical and health information with the construction of smart hospitals

Zhou Di, Wang Mao, Wang Jingwei

2024, 39(9):  833-836.  doi:10.3969/j.issn.1004-583X.2024.09.013

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With the construction of smart hospitals, the conflict between health data sharing and protection is increasingly obvious. Medical and health information has properties of privacy, sensitivity, and commonweal. In the present article, we recommended to establish and improve the classification and hierarchical protection system of medical and health data based on the dual-attribute characteristics. Through an optimal application of the informed consent of special notification plus individual agreement, and the exemption principle of informed consent via legitimate purpose+necessity+safety guarantee, the value of data sharing and the protection of patients' rights and interests can be balanced, and the medical and health information can be rationally utilized.