Table of Content

20 January 2025, Volume 40 Issue 1

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The risk prediction models for pneumonia in patients with intracerebral hemorrhage: A systematic review

Liu Jinteng, Liu Xingyu, Huang Lumei, Pan Hailong

2025, 40(1):  5-13.  doi:10.3969/j.issn.1004-583X.2025.01.001

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Objective To systematically analyze and evaluate the risk prediction model for pneumonia in patients with intracerebral hemorrhage (ICH). Methods Articles reporting risk prediction model for pneumonia in ICH patients published prior to February 2023 were searched in the online databases of Pubmed, Web of Science, Embase, The Cochrane Library, Scopus, Ovid Medline, CNKI (China National Knowledge Infrastructure), WanFang Data, VIP and CBM (Chinese Biomedical Literature Database). Two researchers were independently responsible for screening literature and extracting data. The quality of the literature included in this study was rigorously evaluated, and both the risk of bias and adaptability were assessed in accordance with the Transparent Reporting of a Multivariable Prediction Model for Individal Prognosis or Diagnosis(TRIPOD), and the Prediction Model Risk of Bias Assessment Tool(PROBAST). Results A total of 12 relevant studies were included, involving 7 registered studies, 1 ovarian case-control study, 3 single-center case-control studies, and 1 retrospective cohort study. Logistic regression and machine learning were used for modeling. Eight studies were validated internally, 2 studies were only validated externally, and 2 studies were validated both. The area under the receiver operating characteristic curve of the model was 0.740-0.920. The range of predictors in the 12 studies ranged from 4 to 11, and the common predictors were the age, the National Institutes of Health Stroke Scale score, the Glasgow Coma Scale score, dysphagia, smoking, chronic obstructive pulmonary disease, and nasogastric tube feeding. Model calibration was performed in 9 studies and not in 3 studies. The model was mainly presented in the form of risk score, risk calculation formula and nomogram. The included studies exhibited moderate quality and a high risk of bias. Conclusion The current model for predicting the risk of pneumonia in ICH patients demonstrates good predictive ability, and the predictive factors are relatively easy to obtain. However, there are also significant defects and high bias. In future research, it is recommended that researchers adhere to the TRIPOD guideline and PROBAST statement when conducting prediction model studies. It is important to summarize the advantages and disadvantages of existing models and to conduct external verification, thus developing a risk prediction model for pneumonia in ICH patients with excellent predictive performance and ease of use.

Epidemiological characteristics of hospital-acquired infections in pediatric patients supported by extracorporeal membrane oxygenation: A meta-analysis

Wang Ying, Zhong Bohua, Wang Lifang, Lang Qiuyan, Luo Haibin, Wang Shulin, Li Chunpeng, Liao Min

2025, 40(1):  14-20.  doi:10.3969/j.issn.1004-583X.2025.01.002

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Objective To systematically evaluate the epidemiological characteristics of nosocomial infections in pediatric patients supported by extracorporeal membrane oxygenation (ECMO). Methods A comprehensive search of observational studies related to nosocomial infections in pediatric ECMO patients published from database inception to December 2023 was conducted using a combination of subject terms and free words across multiple databases, including CNKI, Wanfang Medical Database, China Biomedical Literature Database, Weipu Database, Pubmed, Embase, and Web of Science. Two researchers independently screened the literatures, extracted data, and assessed the risk of bias in the included studies. Meta-analysis was performed using Stata 18.0 software. Results A total of 16 studies were included, encompassing 3,353 pediatric patients supported by ECMO, with 712 patients experiencing nosocomial infections. The random effects model in meta-analysis revealed that the overall incidence of nosocomial infections was 28.55% (95% CI [22.26%, 35.28%]). The distribution of pathogens showed that Gram-negative bacteria were predominant (approximately 68.68%), with the top of Acinetobacter baumannii (26.93%), Klebsiella pneumoniae (11.90%), and Pseudomonas aeruginosa (9.39%). Conclusion Current evidence indicates a high rate of nosocomial infections in pediatric patients supported by ECMO, potentially influenced by geographical factors. Due to the impact of study quality, these conclusions require verification through higher-quality research.

The potential of geriatric nutritional risk index in predicting the short-term outcome of intravenous thrombolysis in elderly individuals with acute cerebral infarction

Liu Jinhua, Wang Chunmei, Wang Ying, Chen Kai

2025, 40(1):  21-28.  doi:10.3969/j.issn.1004-583X.2025.01.003

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Objective To evaluate the value of Geriatric Nutritional Risk Index (GNRI) in predicting the short-term outcome of elderly patients with acute ischemic stroke (AIS) after intravenous thrombolysis with alteplase. Methods A retrospective study was performed in 773 elderly AIS patients treated with alteplase intravenous thrombolytic therapy from July 2021 to January 2024 at Beichen Hospital in Tianjin, China. GNRI was calculated based on clinical data, and the nutritional status was assessed. Patients were evaluated with a modified Rankin score (mRS), and 575 patients were included in the poor outcome group (mRS score>2) and 198 in the good outcome group (mRS score≤2). They were further classified into the low GNRI (GNRI<92.107, n=388) and high GNRI (GNRI≥92.107, n=385) groups based on the optimal cut-off. The correlation of GNRI with short-term outcome of AIS after alteplase intravenous thrombolytic therapy was analyzed by logistic regression. Results Significantly lower GNRI was detected in the poor outcome group than the good outcome group (90.106[84.622-98.141] vs 90.722[82.239-100.055], P<0.01). Multivariate logistic regression revealed that age, the National Institutes of Health Stroke Scale (NIHSS) score on admission, the Trial Org 10172 in Acute Stroke Treatment (TOAST) classification system of cardioembolism, outcome of bleeding, body mass index (BMI), and low GNRI were independent risk factors for the short-term poor outcome of AIS after alteplase intravenous thrombolytic therapy (P<0.01). The receiver operating characteristic (ROC) curve showed that an area under the curve (AUC) of GNRI predicting the prognosis of intravenous thrombolysis in elderly AIS patients is 0.876(95%CI: 0.845-0.907). Conclusion GNRI, as an independent risk factor for malnutrition and inadequate regression after intravenous thrombolysis in elderly AIS patients, is a promising indicator for assessing immune and nutritional status in this population.

Clinical application of multispectral irradiation combined with conventional therapy on acute exacerbation of chronic obstructive pulmonary disease

Zhou Zhiming, Ru Yi, Li Ping, Ping Fen

2025, 40(1):  27-32.  doi:10.3969/j.issn.1004-583X.2025.01.004

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Objective To investigate the efficacy of multispectral irradiation combined with conventional therapy on the acute exacerbation of chronic obstructive pulmonary disease (AECOPD). Methods A total of 86 patients with AECOPD who were treated in Hebei General Hospital from January 2022 to November 2023 were selected and divided into observation group (n=42) and control group (n=44) according to a random number table. Patients in the control group were treated with conventional therapy, and those in the observation group were treated with multispectral irradiation plus conventional therapy. The clinical data within 24 hours before and after treatment were compared between the two groups. Results There were significant differences in the modified medical research council score, alkaline phosphatase, serum amyloid A, white blood cell, absolute neutrophil count, 6-meter walking test, vitamin D, Ca²⁺, and oxygenation index between groups after treatment (P<0.05), while there were no significant differences in the Global Initiative for Chronic Obstructive Lung Disease grading, C-reactive protein, forced expiratory volume in one second/forced vital capacity, forced expiratory volume in 1 second percentage of predicted, P⁵⁺, and eosinophil(P>0.05). Conclusion The application of multispectral irradiation combined with conventional therapy on AECOPD patients can better increase their oxygen content, subjective perception of breathing difficulties, vitamin D levels, exercise endurance, and inflammatory response.

Analysis of influencing factors of sleep quality and metabolically associated fatty liver disease in the physical examination population

Gou Caixia, Zhang Jie, Baoyixiamu·Ababaikeli , Wang Yiming, Yao Lei, Zheng Rongjiong, Pan Jinliang, Lu Xiaobo

2025, 40(1):  33-38.  doi:10.3969/j.issn.1004-583X.2025.01.005

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Objective To study the association between sleep quality and metabolically associated fatty liver disease (MAFLD) in the physical examination population, and to explore the influencing factors of MAFLD. Methods From March 2024 to April 2024, 142 people who received the assessment of the Pittsburgh Sleep Quality Index (PSQI) and physical examination in the physical examination center of a tertiary hospital in Urumqi, Xinjiang were selected. According to the exclusion criteria, 2 cases that did not meet the requirements were excluded, and a total of 140 cases were finally selected. According to whether they had MAFLD, they were divided into MAFLD group (n=60) and non-MAFLD group (n=80). Clinical data between the two groups were compared to explore the influencing factors of MAFLD. Results Compared with the non-MAFLD group, patients in the MAFLD group had a significantly higher male proportion, hemoglobin, total bilirubin (T-BIL), urine albumin, total cholesterol, triglyceride, alanine aminotransferase and aspartate aminotransferase, and lower high density lipoprotein cholesterol (HDL-C)(P<0.05). There were significant differences in daytime nap time, total PSQI, the score of sleep quality factor, the score of sleep disorder factor and the score of hypnotic drug factor between the two groups (P<0.05). Further multivariate logistic regression analysis showed that T-BIL, HDL-C, daytime nap time, sleep quality score and sleep disorder score were the influencing factors of MAFLD (P<0.05). Pearson correlation analysis and scatter plots showed that PSQI score was not correlated with T-BIL, HDL-C and daytime nap time (P>0.05), but significantly correlated with sleep quality factor score and sleep disorder factor score in MAFLD patients (P<0.05). Conclusion In the physical examination population, higher T-BIL, lower HDL-C, longer daytime nap time, worse sleep quality, and more serious the sleep disorder indicate a higher risk of MAFLD.

Study on influencing factors and prevention for the complications of the “pull technique” technique for peritoneal catheter extubationremoval and the prevention

Lin Zexing, Guo Hancheng, Yao Chunmeng, Xiao Liangxiang, Dai Yunxin, Wu Sai, Wang Fuzhen, Xie Zugang, Yao Cuiwei

2025, 40(1):  39-43.  doi:10.3969/j.issn.1004-583X.2025.01.006

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Objective To investigate the postoperative complications of the “pull” technique for peritoneal tube extubation in peritoneal dialysis (PD) patients and its influencing factors, and to further optimize the “pull” technique to reduce the incidence of complications. Methods From September 1, 2018 to October 31, 2023, 98 PD patients in peritoneal dialysis centers of four hospitals, including Zhongshan Hospital Xiamen University, and 339 PD patients extubated using the “pull” technique reported at home and abroad were analyzed. Literatures with a small sample size or unclear descriptions were excluded. The clinical data were compared. Results Complications occurred in 13 of the 98 patients in the dialysis center. Multivariate logistic regression analysis showed that body mass index (BMI) was an independent risk factor for the complications after the “pull” technique for peritoneal cathether extubation (P<0.05). Compared with the cases reported in literatures, the proportion of PD catheter rupture and abdominal wall bleeding in our study group was significantly larger (P<0.05). There were 7 cases of PD catheter rupture out of 98 patients, which may be related to the number of traction, traction angle and traction intensity. Among the 98 patients, there were 8 cases reporting the distance between the outer cuff and the skin outlet less than 2 cm or the infection of the outlet and the outer cuff before extubation, and no complications were observed after the modified “pull” technique for peritoneal cathether extubation. Due to repeated infection and prolapse of shallow cuff in 7 cases, Seldinger puncture catheterization combined with the “pull” technique for peritoneal cathether extubation was used to replace the PD catheter. Conclusion The “pull” technique for peritoneal catheter extubation is a safe and reliable technique with few and treatable complications.

Risk factors for constipation in patients with chronic kidney disease in Gansu province: a single-center study

Pu Qian, Cheng Gang, Dao Jiecao, Qi Zizhao, Dou Lele, Zhao Junfang, Zhang Wenjun, Guo Caixia, Wang Yingying

2025, 40(1):  44-53.  doi:10.3969/j.issn.1004-583X.2025.01.007

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Objective To investigate the prevalence of constipation among patients with chronic kidney disease (CKD) in Gansu province, and to analyze potential risk factors. Methods CKD patients in the Department of Nephrology and Dialysis Center & Clinical Medical School of the Second Hospital, Lanzhou University were surveyed by a constipation questionnaire developed according to the Rome III criteria during the two periods of July 2022 to August 2022, and January 2023 to February 2023 via the WJX platform. At the same time, demographics, hemodialysis-related data, laboratory parameters, and use of drugs such as iron and phosphorus binders were collected. Results Totally 279 adult CKD patients older than 18 years were enrolled, including 191 hemodialysis patients and 88 non-dialysis patients. The prevalence of constipation in CKD stage 1-2, 3-4, and 5 patients was 36.2%, 45.8%, and 29.8%, respectively. Univariate Logistic regression analysis showed that primary diabetic nephropathy (OR=4.694, 95% CI 1.436-15.350, P=0.011) was a significant risk factor for constipation in non-dialysis patients. High serum triglyceride (TG) (OR=1.493, 95% CI 1.082-2.060, P=0.015) was a risk factor for constipation in CKD patients receiving hemodialysis. The risk factors for constipation in CKD patients included the use of phosphorus binding agents (OR=1.669, 95% CI 1.001-2.784, P=0.049) and use of iron agents (OR=1.745, 95% CI 1.047-2.909, P=0.033), high serum glucose (Glu)(OR=1.070, 95% CI 1.008-1.135, P=0.026) and TG (OR=1.254, 95% CI 1.017-1.546, P=0.034). Multivariate Logistic regression showed that female (OR=3.258, 95% CI 1.022-10.386, P=0.046) and diabetic nephropathy (OR=13.863, 95% CI 1.815-105.901, P=0.011) were independent risk factors for constipation in non-dialysis patients. In addition, diabetic nephropathy (OR=2.137, 95% CI 1.015-4.499, P=0.046) was a risk factor for constipation in CKD patients. Conclusion Diabetic nephropathy is an independent risk factor for constipation in CKD patients. The female gender represents an independent risk factor for constipation in non-dialysis patients.

Application value of right heart ultrasound combined with renal vascular doppler score in patients with end-stage renal disease during dialysis

Liu Yi, Zhao Haotian, Wang Xiaona, Liu Yuanlin, Li Li, Wang Zekai

2025, 40(1):  54-59.  doi:10.3969/j.issn.1004-583X.2025.01.008

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Objective To explore the value of right heart ultrasound index combined with renal vascular doppler score (RVDS) in evaluating the need for re-dialysis in patients with end-stage renal disease (ESRD). Methods According to the need for re-dialysis, 46 patients diagnosed as ESRD during dialysis were divided into the dialysis and control groups. Right heart ultrasound index was recorded by bedside ultrasonography, and the RVDS of bilateral kidneys was recorded. Receiver operating characteristic (ROC) curves were plotted to evaluate the diagnostic efficacy of each parameter. The correlation of RVDS with glomerular filtration rate and creatinine was analyzed. Results Compared with the control group, ESRD patients in the dialysis group had significantly higher right ventricular diameter (RVD), maximum tricuspid regurgitation velocity, pulmonary arterial systolic pressure, interventricular septal eccentricity index, and lower tricuspid annular plane systolic excursion (TAPSE), maximum velocity of tricuspid annulus contraction (S’), right-side RVDS (R-RVDS) and left-side RVDS (L-RVDS)(P<0.05). The area under the curve (AUC) of RVD, interventricular septal eccentricity index, TAPSE, S’, maximum tricuspid regurgitation velocity, pulmonary arterial systolic pressure and R-RVDS was 0.765, 0.750, 0.770, 0.780, 0.707, 0.723 and 0.682, respectively. TAPSE combined with R-RVDS had a sensitivity of 92.0%, specificity of 76.2% and AUC value of 0.850. Correlation analysis showed that R-RVDS and L-RVDS were positively correlated with glomerular filtration rate (r=0.514 and 0.544, respectively), but negatively correlated with creatinine (r=-0.337 and -0.484, respectively). Conclusion Right heart ultrasound index combined with renal vascular doppler score has higher evaluation and predictive value for patients who need re-dialysis with end-stage renal disease.

Analysis of risk factors for bronchopulmonary dysplasia in extremely premature/very low birth weight infants

Zhao Yipin, Cui Qingyang

2025, 40(1):  60-64.  doi:10.3969/j.issn.1004-583X.2025.01.009

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Objective To explore the risk factors of bronchopulmonary dysplasia (BPD) in extremely preterm/low birth weight infants and to construct a logistic regression prediction model. Methods Medical records 140 ultra-premature infants/ultra-low birth weight infants hospitalized in Zhoukou Maternal and Child Health Hospital and the neonatal intensive care unit of Zhoukou Hospital of TCM from January 1, 2017 to December 31, 2023 were recruited. A total of 102 cases were finally included according to the inclusion and exclusion criteria. They were divided into BPD group and non-BPD group based on whether BPD occurred. The general data of the two groups were compared, and the pathological causes of ultra-premature infants/ultra-low birth weight infants were analyzed using logistic regression. Results A total of 102 ultra-premature/ultra-low birth weight infants were included in this study, and 59 of them developed BPD, with an incidence of 57.8%. Fetal conditions were as follows. Infants in the BPD group had significantly lower birth weight and gestational age, but higher proportions of 1-min Apgar≤7 points, neonatal pneumonia and neonatal sepsis, and longer mechanical ventilation time than those of the non-BPD group (P<0.05). Maternal conditions were as follows. The proportions of premature amniotic rupture>18 hours, and chorioamnionitis in the BPD group were significantly higher than those of the non-BPD group (P<0.05). Multivariate logistic regression analysis showed that gestational age and birth weight were independent protective factors for BPD in ultra-premature infants/ultra-low birth weight infants, and mechanical ventilation time and chorioamnionitis were independent risk factors for BPD in ultra-premature infants/ultra-low birth weight infants (P<0.05). Based on the results of multiple factors, a logistic regression risk prediction model was constructed. Logit (P) ranged from 0 to 1. The test results showed that the area under the curve (AUC) of the model in predicting extremely preterm/low birth weight infants with concurrent BPD was 0.891 (95%CI: 0.846-0.939), with the chi-square value (χ²) in the Hosmer-Lemeshow test of 6.543(P=0.072). Conclusion Birth weight, gestational age, duration of mechanical ventilation, and chorioamnionitis are all risk factors for the development of BPD in extremely preterm infants/very low birth weight infants. A logistic regression model based on these factors has high predictive value and can be used as an effective clinical model in predicting the occurrence of BPD. It also has certain guiding significance for subsequent clinical decisions.

Small cell lung carcinoma with multiple cutaneous metastases as the initial presentation: A rare case report

Chen Zheyu, He Qianqian, Guo Xiaodong, Wang Huanhuan, Yang Yanli, A Saiguli

2025, 40(1):  65-69.  doi:10.3969/j.issn.1004-583X.2025.01.010

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Objective To investigate the clinical significance and pathological manifestations of small cell lung carcinoma with multiple skin metastases as the first manifestation. Methods The clinical data of a case of small cell lung carcinoma with multiple skin metastases as the initial manifestation were analyzed retrospectively, and the related literatures were reviewed. Results A 65-year-old male patient without smoking history was admitted due to “growth and enlargement of skin masses on chest, back and waist for 3 months”. With a maximum diameter of 6-12 cm, spherical masses on the surface of the skin were bluish and erosive, tough, and presenting a clear boundary with the surrounding tissue. In addition, the patient had poor appetite since the onset, with a 40-year history of tracheitis. Biopsy of the subcutaneous mass in the right scapular region was performed. Histopathology determined the metastatic nature of the mass consistent with cutaneous metastasis of small cell lung carcinoma. Chest X-ray and magnetic resonance plain scan revealed a large irregular mass in the right hilum of the lung, multiple skin metastases in the bilateral perirenal space, the abdominal cavity and the right scapula, waist and buttocks. Conclusion This rare case shows skin metastases as the first manifestation of primary visceral tumors, which may be the first sign of internal malignancy. Metastasis to the skin is usually a late event that predicts a poor prognosis.

A case report of adult MOGAD and literature review

Zhong Yuan, Meng Fenglei

2025, 40(1):  70-75.  doi:10.3969/j.issn.1004-583X.2025.01.011

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Objective To discuss the clinical manifestations, magnetic resonance imaging (MRI) features, MOG-IgG testing, diagnostic criteria, treatment and prognosis of myelin oligodendrocyte glycoprotein (MOG)-associated disease (MOGAD). Methods We reported a case of adult MOGAD, and reviewed relevant literatures. Results A 38-year-old female presented with headache and blurred vision in both eyes for three days. She had a history of prodromal fever. The head MRI showed lesions and enhancement in the thalamus, basal ganglia, cerebral peduncle, and brainstem. Serum and cerebrospinal fluid antibody testing showed a weak positive MOG IgG at a 1:10 ratio in both serum and cerebrospinal fluid. She was diagnosed with MOGAD, mainly manifested as optic neuritis and brainstem encephalitis. The combination therapy of corticosteroid and rituximab was given, and the patient's symptoms were completely disappeared at the 4-month follow-up. Conclusion MOGAD is a rare, antibody-mediated infl ammatory demyelinating disorder of the central nervous system (CNS) with cardinal features of optic neuritis, myelitis, brainstem encephalitis, cerebral cortical encephalitis (often with seizures) and acute disseminated encephalomyelitis. New diagnostic criteria for MOGAD have recently been proposed by an international panel of experts in 2023. MOG-IgG detection is the key to diagnosing MOGAD. There is no clear guideline for MOGAD treatment. About 50% of patients will experience a recurrence.