Table of Content

15 May 2022, Volume 25 Issue 14

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Focus·Sleep Disorders & Problems

Clinical Subtypes and Significanceof Adult Insomnia Disorders

Fangyi DENG, Rui TANG, Liqing ZHANG, Yixian CAI, Rong PAN, Jiyang PAN

2022, 25(14):  1667-1673,1693.  DOI: 10.12114/j.issn.1007-9572.2022.0004

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Insomnia disorder is the most prevalent sleep disorder with high heterogeneityand can be divided into multiple subtypes. Significant differences may be found in symptoms, pathophysiology and therapeutic responsesacross its subtypes. Current classification methods for subtypes of insomnia disorder are mainly based on clinical characteristics of insomnia, subjective and objective sleep duration, and non-insomnia-related clinical characteristics.We systematically and comprehensively discussed the advantages, limitations and clinical significance of the above-mentioned three classification methods, and the differences in pathophysiological mechanism, treatment responses and clinical outcomes according to subtypes classified by each of the three, which will contribute to making an appropriatediagnosis, formulating an individualized treatment measure and developing more practical and operable classification methodsregardinginsomnia disorder, and may be seen as directions for deepening and meticulously exploring the pathophysiological mechanism of different subtypes of insomnia disorder.

Hotspots and Trends Related to Sleep Disturbance and Hypertension

Haiqi SONG, Lifei WANG, Miaomiao WU, Yi YAO, Youmao XIANG, Rong YANG, Bo YUAN, Xiaoyang LIAO

2022, 25(14):  1674-1680.  DOI: 10.12114/j.issn.1007-9572.2022.01.002

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Background

Many factors are associated with hypertension, the most prevalent chronic disease, among which, the association of sleep disturbance and hypertension has received wide attention as sleep medicine advances rapidly in recent years. However, relevant studies on sleep disturbance and hypertension have some limitations, and there is no bibliometric analysis of hotspots about sleep disturbance and hypertension.

Objective

To review and summarize the research hotspots and trends of literature related to sleep disturbances and hypertension.

Methods

Studies about sleep disturbance and hypertension were searched in Web of Science Core Collection from inception to June 30, 2021 using "hypertension" and "sleep disturbance" "insomnia" "sleep deprivation" "sleep fragmentation" and "short-term sleep" as subject headings. CiteSpace 5.7.R5W was used for visual analysis.

Results

In total, 4 589 studies were included for analysis. The number of studies generally showed an increasing trend, with a peak in 2018, and a rapider growth rate between 2011 and 2021. The top 10 most frequently used keywords in the studies published between 2011 and 2021 were hypertension, blood pressure, prevalence, obstructive sleep apnea, risk factor, sleep, cardiovascular disease, positive airway pressure, obesity and insomnia. The tag clusters were sleep time, sleep quality, sleep-disordered breathing, obstructive sleep apnea, sleep apnea, insomnia, stress, sleep, epidemiology, heart failure and symptoms. Keyword clustering analysis revealed that major directions in the studies published between 2011 and 2021 were: (1) the association of sleep-disordered breathing, especially obstructive sleep apnea, and hypertension; (2) the association of sleep time and blood pressure; (3) the association of sleep quality and blood pressure. The most frequently cited studies were mainly about sleep apnea, obstructive sleep apnea and short-term sleep. REDLINE was the most prolific author, and the largest group of authors was formed with her as the core. The US was the most prolific country, and the most prolific institution was the University of Pittsburgh.

Conclusion

The research on sleep disturbance and hypertension had become increasingly popular. The research hotspots of this field had changed greatly in 2011 and 2018. The effects of obstructive sleep apnea and sleep duration on hypertension were the mostly focused hotspots.

Association between Sleep Duration and Hyperuricemia in Community Residents

Zhenyu LIU, Jiangmin WANG, Yunpeng WEI, Huaqing YING

2022, 25(14):  1681-1686.  DOI: 10.12114/j.issn.1007-9572.2022.0026

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Background

Sleep problems are increasingly common in residents with the acceleration of pace of life. Studies have shown that sleep duration is associated with chronic diseases such as hypertension and diabetes, but there is a lack of research on its association with hyperuricemia.

Objective

To assess the association and its dose-response level between sleep duration and hyperuricemia.

Methods

Data stemmed from the 2019 surveillance of epidemiology and risk factors of chronic diseases in adult residents in Haidian District, Beijing, involving individuals aged 18-79 years old, with an experience of living in Haidian District at least six months. The information was obtained via a face-to-face questionnaire survey, including the following aspects: demographics (sex, age, education level, marital status, occupation) , lifestyle factors (smoking and drinking, physical activity level, sleep duration) , history of chronic diseases (hypertension and diabetes) , height, weight, blood pressure, laboratory indices (fasting blood glucose, serum uric acid, and serum creatinine) . A multivariable Logistic regression model was used to assess the association between sleep duration and the risk of hyperuricemia, whose dose-response relationship was analysed using restricted cubic spline regression.

Results

A total of 5 380 people were enrolled, with an average age of (46.9±16.0) years and an average sleep duration of (7.24±1.16) hours. Univariate Logistic regression analysis showed that, compared with those with 7-9 hours of sleep duration, the risk of hyperuricemia increased in those with less than 7 hours of sleep duration and in those with greater than 9 hours of sleep duration 〔OR (95%CI) =1.30 (1.12, 1.51) ; OR (95%CI) =1.48 (1.15, 1.89) 〕. After adjusting for age, gender, education level, marital status, occupation, smoking, drinking, physical activity level, BMI, hypertension, diabetes, and serum creatinine, the risk of hyperuricemia still increased in those with less than 7 hours of sleep duration and in those with greater than 9 hours of sleep duration 〔OR (95%CI) =1.37 (1.17, 1.62) ; OR (95%CI) =1.39 (1.07, 1.81) 〕. Restricted cubic spline regression analysis showed that sleep duration had a U-shaped association with hyperuricemia (non-linear test, χ²=27.530, P<0.001) .

Conclusion

Too longer or shorter sleep duration was a factor responsible for increased risk of hyperuricemia among adults in Haidian District of Beijing.

Sleep Research Projects Supported by the National Natural Science Foundation of China during 1988—2019: Analysis and Prospects

Rui DENG, Xin JIN, Jinzhong JIA, Fang HAN

2022, 25(14):  1687-1693.  DOI: 10.12114/j.issn.1007-9572.2022.0191

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Background

Sleep research has a major part to play in facilitating the development of sleep medicine. In China, the development of sleep medicine started later compared with other medical disciplines, and related advances have been seldom reported.

Objective

To review the development of sleep research in China by analyzing sleep research projects supported by the National Natural Science Foundation of China (NSFC) , providing data for future development of sleep research.

Methods

Data were collected from the NSFC, including the supported projects regarding sleep-disordered breathing (code H0113) and sleep and sleep disorders (code H0916) as well as those with corresponding codes involving sleep or sleep disorder of Department of Health Sciences, and supported projects involving sleep or sleep disorder in Departments of Life Sciences. The number and composition of supported projects and funding amount, geographical, regional and institutional distribution of supported projects in terms of number and funding amount were statistically analyzed.

Results

From 1988 to 2019, the sleep research projects supported by the NSFC numbered 399 in total. The number of these projects and the founding amount for them showed an increasing trend, particularly after 2010. The types of projects were gradually enriched, among which four were key projects, while no key talent projects had been supported. The geographical and institutional distribution of supported projects was uneven, presenting a tendency of aggregation in some specific regions and institutions, and a pattern of Matthew effect. Colleges and universities were the main body of sleep research. At present, sleep research is mainly based on basic experiments and clinical applications.

Conclusion

In general, the level and composition distribution of sleep research projects supported by the NSFC during the period demonstrated a trend of gradual enhancement, but still need improvements. To promote the development of sleep medicine, it is recommended to strengthen the reserve force via improving the top-level design and macro layout concerning NSFC supported projects, and to achieve early prevention, appropriate diagnosis and treatment of sleep disorders via taking advantage of interdisciplinary cooperation and integration.

Article

Sex-specific Analysis of the Management and Outcome of Elderly Patients with Acute Myocardial Infarction

Siqi YANG, Hanxiong LIU, Xiuqiong YU, Lin TONG, Jin LI, Lianchao CHENG, Xu CHEN, Lingyao QI, Yan LUO, Lin CAI

2022, 25(14):  1694-1699,1706.  DOI: 10.12114/j.issn.1007-9572.2022.0021

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Background

There may be sex-specific differences in the treatment and outcome of elderly people with acute myocardial infarction (AMI) . However, few studies have reported sex-specific differences in management and prognosis of older Chinese people with AMI.

Objective

To assess the sex-specific differences in management strategies, in-hospital mortality and cardiovascular mortality within one year after discharge in older Chinese people with AMI.

Methods

We consecutively enrolled 1 579 elderly (>60 years of age) patients with AMI admitted to 11 tertiary general hospitals in Chengdu between January 2017 and June 2019, including 1 056 men and 523 women. Sex-specific analysis of clinical characteristics, management strategies and 1-year outcome were performed. Kaplan-Meier estimator was used to describe the incidences of cardiovascular death within one year after discharge between men and women and the associated factors were explored using multivariate Cox proportions hazards regression analysis.

Results

Female patients had lower prevalence of smoking, and alcohol consumption, history of percutaneous coronary intervention and chronic obstructive pulmonary disease, typical symptoms including chest pain and chest tightness, and use of dual antiplatelet agents and statins, and lower mean creatinine levels than male patients (P<0.05) . Moreover, female patients had older mean age, diabetes, and higher mean heart rate, greater prevalence of Killip class≥Ⅱ, and higher mean level of total cholesterol, longer mean symptom-onset-to-balloon time and first medical contact to balloon dilation time, and higher in-hospital mortality rate (P<0.05) . Furthermore, the cardiovascular mortality rate within one year after discharge was higher in women (P<0.05) . Multivariate Cox proportions hazards regression analysis showed sex〔HR=1.830, 95%CI (1.029, 3.255) , P=0.040〕, age〔HR=1.063, 95%CI (1.031, 1.095) , P<0.001〕, ST-segment elevation myocardial infarction〔HR=2.382, 95%CI (1.380, 4.113) , P=0.002〕, cardiogenic shock〔HR=2.474, 95%CI (1.259, 4.859) , P=0.009〕, creatinine〔HR=1.004, 95%CI (1.001, 1.006) , P=0.003〕 and PCI〔HR=0.228, 95%CI (0.135, 0.386) , P<0.001〕 were associated with cardiovascular death within one year after discharge.

Conclusion

The rates of reperfusion treatment in older women and men with AMI were similar, but there were differences in treatment efficiency and outcome. Older women with AMI had lower in-hospital treatment efficacy, longer total myocardial ischemia time, lower prevalence of pharmacological treatment, and higher in-hospital all-cause mortality and cardiovascular mortality within one year after discharge.

A Comparative Study of Levels of Serum Biomarkers in Patients with Different Stages of Asthma

Jiang YANG, Xinmin TU, Huanhuan ZHAO, Xiaohong LIN, Yang XIE, Suyun LI, Minghang WANG

2022, 25(14):  1700-1706.  DOI: 10.12114/j.issn.1007-9572.2022.0031

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Background

Asthma is a complex heterogeneous disease, whose frequent acute attacks seriously affect the quality of life of patients, and cause a heavy economic burden. The recent development of serum biomarkers provides a new idea for accurate treatment of asthma and diagnosis and treatment of refractory asthma.

Objective

To analyze the difference of serum biomarkers between different stages of asthma patients and healthy people, and to explore the predictive potential of different serum biomarkers for acute asthma attack.

Methods

A cross-sectional design was used. Participants were recruited from the First Affiliated Hospital of Henan University of Chinese Medicine during November 2018 to December 2020, including 293 asthma patients (155 in the acute attack stage, and 138 in non-acute attack stage) , and 39 healthy volunteers from physical examinee center of this hospital. ELISA was used to detect the contents of serum biomarkers〔interleukin 4 (IL-4) , interleukin 6 (IL-6) , interleukin 8 (IL-8) , interleukin17 (IL-17) , interferon-γ (IFN-γ) , transforming growth factor-β₂ (TGF-β₂) , tumor necrosis factor-α (TNF-α) , total immunoglobulin E (TIgE) , specific immunoglobulin E (SIgE) , eosinophil-selective chemokine (Eotaxin) , eosinophil cationic protein (ECP) , periostin, leukotriene D4 (LTD4) , high mobility group protein B1 (HMGB1) , chitinase 3-like protein 1 (YKL-40) 〕.

Results

Compared with healthy volunteers, both acute and non-acute attack asthma patients had higher levels of serum IL-4, IL-6, IL-8, IL-17, TGF-β₂, TNF-α, HMGB1, TIgE and SIgE, and lower level of serum IFN-γ (P<0.05) . The levels of serum Eotaxin and YKL-40 in acute attack asthma patients were higher than those in non-acute attack asthma patients and healthy volunteers (P<0.05) . The levels of Eotaxin and YKL-40 in non-acute attack asthma patients were higher than those in healthy volunteers (P<0.05) . In addition, the level of periostin in non-acute attack asthma patients was lower than that in healthy volunteers (P<0.05) .

Conclusion

Serum IL-4, IL-6, IL-8, IL-17, IFN-γ, TGF-β₂, TNF-α, SIgE, TIgE, HMGB1 may be related to asthma, but their expression levels may not be related to disease stage. Eotaxin and YKL-40 may be potential predictors of the acute attack of asthma.

Association between Free Triiodothyronine and Depression in Patients with Coronary Heart Disease

Anbang LIU, Cheng JIANG, Han YIN, Huan MA, Qingshan GENG

2022, 25(14):  1707-1712.  DOI: 10.12114/j.issn.1007-9572.2022.0016

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Background

Cardiovascular disease and psychological disease are the two major public health problems threatening the health of Chinese residents. At present, there are about 11 million patients with coronary heart disease (CHD) in China. The comorbidity rate of coronary heart disease hospitalized patients with depression can reach 51%, and the combined major depression is 3.1% to 11.2%. At present, there are few studies on the association between thyroid function and depression status in CHD patients.

Objective

To explore the association between thyroid function and depression status in patients with CHD.

Methods

From October 2017 to February 2018, 561 patients diagnosed CHD from the Department of Cardiology of Guangdong Provincial People's Hospital were selected, and divided into coronary heart disease without depression group and CHD combined depression group according to whether depression was combined, which was evaluated by the patient health Questionnaire-9 (PHQ-9) . The gender, age, body mass index (BMI) , comorbid diseases (hypertension, diabetes, dyslipidemia, acute myocardial infarction) , the levels of high-sensitivity C-reactive protein (hs-CRP) , high-sensitivity troponin T (hs-cTnT) , N-terminal-B-type natriuretic peptide precursor (NT-proBNP) , serum free triiodothyronine, free thyroxine, thyroid-stimulating hormone, free triiodothyronine (FT₃) , free thyroxine (FT₄) and thyroid stimulating hormone (TSH) of patients wre recorded. Univariate and multivariate Logistic regression was used to analyze the effect of FT₃ on the risk of depression in patients with CHD.

Results

CHD without depression group included 350 cases (62.4%) , CHD complicated with depression group included 211 cases (37.6%) , with 148 mild depression cases (26.4%) , 46 moderate depression cases (8.2%) , 17 severe depression cases (3.0%) . The level of FT₃ in the CHD complicated with depression group was lower than that in the CHD without depression group (P<0.05) , but there was no significant difference in FT₄ and TSH levels between the CHD complicated with depression group and the CHD without depression group (P>0.05) . PHQ-9 score was negatively correlated with FT₃ level (r_s=-0.114, P<0.05) and positively correlated with age (r_s=0.093) and hs-CRP (r_s=0.090) (P<0.05) in the CHD combined with depression group. The results of the univariate and multivariate Logistic regression to analyze the effect of FT₃ on the risk of depression in patients with CHD showed that for each standard deviation of FT₃, the risk of depression in patients with CHD decreased by 20%〔OR=0.8, 95%CI (0.67, 0.96) 〕. Similar results were observed in the FT₃ quintile stratified analysis, in which the lowest risk of incident depression was observed in CHD patients in the FT₃ quartile (4.98-5.34 pmol / L) , andunivariate analysis (unadjusted) showed a significant trend in OR values among the quintiles of FT₃ (P<0.05) .

Conclusion

The level of serum FT₃ in patients with CHD complicated with depression was lower than that in patients without depression, and the level of FT₃ in severe depression group was more significant. FT₃ may be a potential biochemical marker of depression in patients with CHD, and it is recommended that patients with CHD and depression should be evaluated for thyroid function.

Clinical Value of Inflammatory Bowel Disease Symptom Inventory in Evaluating the Activity of Inflammatory Bowel Disease

Zhanpeng LIU, Xiaozhong YANG, Mengxue CHEN, Menghui ZHANG, Honggang WANG

2022, 25(14):  1713-1718.  DOI: 10.12114/j.issn.1007-9572.2022.0063

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Background

Foreign studies have shown that the Inflammatory Bowel Disease Symptom Inventory (IBDSI) can be used for self-assessment of disease activity in patients with inflammatory bowel disease (IBD) , but the scale has not yet been validated in China.

Objective

To study the value of IBDSI in assessing the activity of patients with either ulcerative colitis (UC) or Crohn's disease (CD) .

Methods

A total of 102 patients with IBD who were hospitalized in the Affiliated Huaian No. 1 People's Hospital of Nanjing Medical University from April 2020 to August 2021 were selected, including 59 patients with UC and 43 patients with CD. The activity of UC was assessed using Modified Mayo score and the activity of CD was assessed using CDAI score, respectively. Chinese version of the IBDSI translated by the gastroenterologist of our hospital was filled by patients in the next morning after admission. Spearman rank correlation analysis was used to analyze the correlation between IBDSI and each subscale score and Modified Mayo score, CDAI score and laboratory test indexes. The receiver operating characteristic curve (ROC curve) of IBDSI and its sub-items (including intestinal symptoms, abdominal discomfort, fatigue, intestinal complications, systemic complications) was drawn to evaluate the disease activity of UC and CD.

Results

The Modified Mayo score of 59 UC patients: 1 case was clinically relieved, 8 cases were mild, 46 cases were moderate, and 4 cases were severe; IBDSI score was (26.27±15.16) . The CDAI scores of 43 CD patients: 11 cases were in remission, 8 cases were mild, 22 cases were moderate, and 2 cases were severe; IBDSI score was (26.95±16.19) . Spearman rank correlation analysis showed that total IBDSI score, intestinal symptom score, abdominal discomfort score and fatigue score were positively correlated with Modified Mayo score in UC patients (P<0.05) . In CD patients, total IBDSI score, intestinal symptom score, abdominal discomfort score, fatigue score and systemic complication score were significantly positively associated with CDAI score (P<0.05) . The area under the ROC curve (AUC) of total IBDSI score, intestinal symptom score, abdominal discomfort score, and fatigue score to assess disease activity of UC were 0.829, 0.836, 0.710 and 0.786, respectively (P<0.05) .In patients with CD, the AUC of total IBDSI score, intestinal symptom score, abdominal discomfort score, fatigue and systemic complication score were 0.911, 0.806, 0.785, 0.867 and 0.734, respectively (P<0.05) .

Conclusion

IBDSI and its sub-scores have a certain correlation with the disease activity of inflammatory bowel disease (including UC and CD) .

Pulmonary Function and Imaging Characteristics of Tuberculosis Associated Obstructive Pulmonary Disease Using Propensity Score-matched Analysis

Yide WANG, Zongxiang TIAN, Zheng LI, Fengsen LI

2022, 25(14):  1718-1723.  DOI: 10.12114/j.issn.1007-9572.2022.02.012

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Background

Studies on tuberculosis associated obstructive pulmonary disease (TOPD) are still scarce in China, a country with a high burden of tuberculosis and chronic obstructive pulmonary disease (COPD) .

Objective

To compare clinical features and pulmonary functions between TOPD and COPD, and to explore the relationship between imaging features and pulmonary function in TOPD, aiming at providing information for improving clinicians' understanding of TOPD.

Methods

A retrospective design was adopted. TOPD (n=387) and COPD (n=364) patients were recruited from the Fourth Clinical Medical College of Xinjiang Medical University from January 2018 to November 2020. The TOPD patients were matched with COPD patients at a ratio of 1∶2 using propensity score matching based on age, gender, ethnic group and other baseline data. Clinical data and lung function indices (FEV₁/FVC, FEV₁%pre, and FVC%pre) were compared between the groups before and after matching. Imaging manifestations of TOPD patients were further described. Spearman rank correlation analysis was used to analyze the correlation of imaging features with lung function.

Results

The two matched groups had no significant differences in sex ratio, mean age, and ethnic group distribution (P>0.05) . Compared to COPD patients, TOPD patients had mean younger age of onset, longer mean length of hospital stay, and lower mean levels of FEV₁/FVC, and FEV₁%pre (P<0.05) . Imaging examination showed that the sites of tuberculosis scar in TOPD patients were mostly in upper and lower lobes of the right lung, and some patients had signs of emphysema and bronchiectasis to a certain extent. Spearman correlation analysis showed that the number of lung lobes affected by tuberculosis was negatively correlated with FEV₁/FVC, FEV₁%pre, and FVC%pre (r_s=-0.202, P=0.011; r_s=-0.456, P<0.001; r_s=-0.442, P<0.001) .

Conclusion

Compared with COPD patients, TOPD patients were characterized by younger age, longer hospital stay, and severer obstructive ventilatory disorder. In addition, lung function decreased with the increase in the number of lobes affected by tuberculosis.

Value of 3D Ultrasonography with Malignancy Risk Model for Screening for Endometrial Cancer with Postmenopausal Bleeding

Panping LU, Yumei LIAO, Zhelin ZHANG

2022, 25(14):  1724-1729,1740.  DOI: 10.12114/j.issn.1007-9572.2022.02.018

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Background

With the increasing incidence and mortality of endometrial cancer (EC) , early and effective screening for EC has become a hot research topic.

Objective

To investigate the value of three-dimensional (3D) ultrasonography with a malignancy risk model for screening for EC with postmenopausal bleeding (PMB) .

Methods

A total of 168 patients who visited the Second Affiliated Hospital of Zhengzhou University for PMB between January 2019 and December 2020 were selected, and 136 of them were found with benign endometrial lesion, other 32 with EC by histopathological examination. All of them underwent 3D transperineal ultrasonography, and parameters such as endometrial volume, vascularization index (VI) , flow index (FI) , and vascularization-flow index (VFI) were calculated using VOCAL software. Clinical data were retrospectively collected, in which endometrial thickness, recurrent vaginal bleeding, age, body mass index (BMI) , and history of diabetes mellitus were included in a malignancy risk model and scored for predicting EC with PMB. The ROC curve was plotted and the area under which (AUC) was calculated to measure the performance of 3D transperineal ultrasonography, malignancy risk model, and the combination of them in predicting EC with PMB.

Results

Compared with those with benign endometrial lesion, EC patients had greater average BMI, and higher rate of vaginal bleeding (P<0.05) . Moreover, they also had thicker average endometrial thickness, greater average endometrial volume as well as higher average VI, FI, and VFI (P<0.05) . In predicting EC with PMB, 3D transperineal ultrasonography (the combination of EV, VI, FI and VFI parameters) combined with the malignancy risk model had a greater AUC than did 3D transperineal ultrasonography { 0.949 〔95%CI (0.908, 0.989) 〕vs 0.883〔95%CI (0.817, 0.949) 〕} (Z=4.762, P=0.032) , and the malignancy risk model { 0.949〔95%CI (0.908, 0.989) 〕 vs 0.723〔95%CI (0.629, 0.817) 〕} ( Z=2.613, P=0.018) . The sensitivity, specificity, and Youden index of the combined use of 3D transperineal ultrasonography and malignancy risk model for predicting EC with PMB were 84.4%, 96.3%, and 0.807, respectively.

Conclusion

The combined use of 3D transperineal ultrasonography and malignancy risk model for predicting EC with PMB has high accuracy, which could be used to initially triage patients.

Comparison of Clinical Characteristics and Response to Glucocorticoid Therapy in Patients with Different Inflammatory Phenotypes of AECOPD and ACO

Zelin CHEN, Rui JIAO, Siyu WU, Zheng WANG, Guangwei ZHOU, Jing LI, Xinxiu LIU, Aihong MENG

2022, 25(14):  1730-1735.  DOI: 10.12114/j.issn.1007-9572.2022.0022

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Background

Acute exacerbation is an important cause for the significant decline of lung function in patients with chronic airway disease, which seriously affects the health and quality of life of patients, and significantly increases the medical and economic burden of the disease. Early identification of different inflammatory phenotypes in acute exacerbations of chronic obstructive pulmonary disease (AECOPD) and asthma-COPD overlap (ACO) and timely and precise treatment are important in reducing the occurrence of exacerbations, controlling disease progression, and improving quality of life.

Objective

To compare the clinical characteristics of AECOPD with different inflammatory phenotypes and ACO patients and their response to glucocorticoid therapy, and to provide a reference for further guiding the application of glucocorticoids.

Methods

The basic clinical data of AECOPD and ACO patients hospitalized in respiratory and critical care Medicine Department of the Second Hospital of Hebei Medical University from January 2018 to December 2020 were collected. The basic clinical data were collected, and the peripheral blood eosinophils (EOS) percentage (2%) was used as the critical value, EOS%≥2% was defined as EOS group, EOS%<2% was defined as non-EOS group, and ACO patients were defined as ACO group. The clinical characteristics and response to glucocorticoids of the three groups were analyzed.

Results

High-sensitivity C-reactive protein (hs-CRP) , absolute value of peripheral blood neutrophils (NE) , neutrophil/lymphocyte ratio (NLR) , fibrinogen/serum albumin (FAR) , lung and the use rate of systemic hormones, total hormone application, hormone treatment course, and hospitalization time of AECOPD patients in the EOS group were lower than those in the non-EOS group (P<0.05) . ALB of AECOPD patients in EOS group was higher than that in non-EOS group (P<0.05) . Body mass index (BMI) , FEV₁%pred, severity of pulmonary function, absolute value of NE, NLR, utilization rate of pulmonary and systemic hormones, total hormone application, and hormone treatment course of AECOPD patients in the EOS group were lower than those in ACO group (P<0.05) . The age, hospitalization time, male prevalence rate, smoking rate, and EOS%≥2% of AECOPD patients in EOS group were higher than those in ACO group (P<0.05) .

Conclusion

EOS may be used as an important indicator to evaluate the severity of AECOPD and guide glucocorticoid therapy. The causes of acute exacerbations of COPD patients in the EOS group were mostly considered to be caused by non-infectious factors, and the treatment of antibiotics may be more prudent. AECOPD patients in EOS group have different clinical characteristics, and it is of positive significance to grasp their unique clinical characteristics for the early identification of chronic airway disease and accurate treatment decision.

Associations of P-selectin and Thromboxane B₂ Expression Levels with Efficacy and Prognosis in Patients with Ischemic Stroke Affecting Different Parts of the Brain

Cancan MENG, Yan CHENG, Liyan JIAO, Zhiwei ZHANG, Weigang LIU, Zhitang YANG

2022, 25(14):  1736-1740.  DOI: 10.12114/j.issn.1007-9572.2022.0020

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Background

Epidemiological investigations have demonstrated that the number of stroke cases is increasing recently, and stroke has become a leading cause of death. Patients affected by ischemic stroke, the most prevalent type of stroke, may have different therapeutic efficacies and prognosis if the affected parts are different, and platelet activation may play a vital role in the development of ischemic stroke.

Objective

To investigate the associations of P-selectin (CD62P) and thromboxane B₂ (TXB₂) expression levels with efficacy and prognosis in patients with ischemic stroke affecting different parts of the brain.

Methods

Participants were recruited from Department of Neurology, Affiliated Hospital of Hebei Engineering University from October 2019 to June 2021, including 44 neurology patients with ischemic stroke (23 with anterior circulation stroke and 21 with posterior circulation stroke) , and 28 healthy physical examinees. Demographics and routine blood test indicators of all participants were collected. The National Institutes of Health Stroke Scale (NIHSS) was used to assess the degree of neurological impairment, and ELISA was used to detect the levels of CD62P and TXB₂ of ischemic stroke patients at baseline, on the 7th and 30th days of treatment, respectively. The Modified Rankin Scale (mRS) was used to assess the prognosis of ischemic stroke patients on the 30th day of treatment.

Results

Before treatment, both anterior and posterior circulation stroke patients had higher mean levels of CD62P and TXB₂ than did the physical examinees (P<0.05) . On the 7th and 30th days of treatment, the mean NIHSS score, CD62P and TXB₂ levels in posterior circulation stroke patients were higher than those of anterior circulation stroke patients (P<0.05) . On the 30th day of treatment, the mean mRS score in anterior circulation stroke patients was lower than that of posterior circulation stroke patients (P=0.001) .

Conclusion

Posterior circulation stroke patients had higher mean levels of CD62P and TXB₂ and poorer efficacy and prognosis than did anterior circulation stroke patients, suggesting that the level of platelet activation may play a role in the treatment and prognosis of ischemic stroke patients.

Article·New Diagnostic and Therapeutic Techniques

Study of Fluorescence Immunochromatography Based on Quantum Dots for the Detection of SARS-CoV-2 anti-N Protein IgG Antibody

Renfeng YU, Xiaocang ZOU, Dayang ZOU, Linhao LI, Kehui WANG, Xiaoming HE, Yaqing XU, Rihui QIN, Dongdong MO, Jiahui Duan, Tao YU, Wei LIU, Jinpeng GUO

2022, 25(14):  1741-1749.  DOI: 10.12114/j.issn.1007-9572.2022.0166

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Background

Based on the current prevalence of Coronavirus Disease 2019 (COVID-19) , early diagnosis, isolation, and treatment are important methods to prevent and control infectious diseases. The establishment of convenient and efficient immunochromatographic detection techniques is essential for the prevention and control of COVID-19 epidemic.

Objective

To establish a method for the detection of SARS-CoV-2 anti-N protein IgG antibody by immun of luorescence chromatography method based on quantum dots labeling technology in August, 2020. In order to determine whether the detected persons had been infected with COVID-19 or been injected with SARS-CoV-2 inactivated vaccine.

Methods

The prepared rat anti-human secondary antibody and anti-N protein antibody were immobilized on a Nitrocellulose (NC) membrane as detection line (T) and quality control line (C) , respectively. Then the SARS-CoV-2 N protein labeled by quantum dots was evenly sprayed on glass fiber, which was assembled, cut and packaged into test strips after drying. The test strips were used to detect the clinical serum of 35 COVID-19 patients and 50 healthy individuals, the results of the initial screening of the ELISA kit were used as a control to calculate the detection specificity and sensitivity of quantum dots fluorescence immunochromatography. The sensitivity of the test strip was detected by using the N protein antibody standard.

Results

The specificity and sensitivity of the strip were 100.00%, 94.29%, and the susceptibility was 8.53-17.06 ng/ml antibody concentration.

Conclusion

The detection of anti-N protein IgG antibody in serum by quantum dots labeling is simple, fast, with strong sensitivity and specificity.

Research on Virus Morphology Recognition Method Based on Enhanced Graph Convolutional Network

Yan HA, Weicheng YUAN, Xiangjie MENG, Junfeng TIAN

2022, 25(14):  1749-1756.  DOI: 10.12114/j.issn.1007-9572.2022.0123

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Background

Transmission electron microscope (TEM) is an important method to detect virus. TEM detection often relies on manual observation by experts, and the operation steps are cumbersome. Moreover, existing machine learning methods are easily affected by background and noise, resulting in poor virus detection methods, low efficiencyand time consuming.

Objective

In order to improve the efficiency of TEM virus detection, an Enhanced Graph Convolution Network (EGCN) is proposed to solve the problem of automatic identification of virus morphology in TEM images.

Methods

In this model, Convolutional Neural Network (CNN) was used to extract the local feature information between pixels, and GCN was used for graph feature learning combined with the nearest neighbor relationship between sample features. In the model optimization, the group super classification loss and classification cross entropy loss were introduced to improve the feature extraction ability of the model for virus category information, and further improve the robustness of TEM virus image features compared with convolution neural network.

Results

Experiments were carried out on 15 types of TEM virus image datasets through different methods, and EGCN achieved a top-1 error rate of 3.40%, a top-2 error rate of 1.88%, a precision of 96.65%, and a recall rate of 96.60%. A series of comparative experiments demonstrated that the EGCN can effectively solve the influence of background and noise in TEM virus recognition.

Conclusion

By using the enhanced graph convolutional neural network, the task of virus morphology recognition can be effectively solved, providing important reference value for virus diagnosis.

Evidence-based Medicine

A Meta-analysis of the Effect of Unprofessional Early Defibrillation on the Survival Rate of Patients with Out-of-hospital Cardiac Arrest

Lida YIN, Jiasen WANG, Yongchao HE, Aiqun LI

2022, 25(14):  1757-1764.  DOI: 10.12114/j.issn.1007-9572.2022.01.604

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Background

At this stage, cardiovascular disease is still the main cause of death among residents in China, about 10 000 people die from out-of-hospital cardiac arrest every year, and the survival rate of patients with out-of-hospital cardiac arrest is less than 5%. Early defibrillation has provided a new method and approach for improving the prognosis of patients with out-of-hospital cardiac arrest and reducing the mortality rate. However, the existing research conclusions are still controversial, and there is no relevant systematic review in China.

Objective

Meta-analysis was used to explore the effect of early defibrillation of on-site first responders on the survival rate of out-of-hospital cardiac arrest patients.

Methods

PubMed, The Cochrane Library, EMBase, CINAHL, CNKI, Wanfang Data and VIP database were retrieved by computer from database establishment to October 2021. A case-control study or cohort study of the impact of AED use on the patient's weekly survival and discharge rate in field first responders was collected, quality evaluation of included case-control studies using the Cochrane Systematic Evaluation Method and quality evaluation of included cohort studies using the New Castle-Ottawa Scale (NOS) . Meta-analysis was performed using Revman 5.4 software.

Results

12 articles were finally included, covering 29 605 patients. The overall quality of the articles was above the medium level. The results of the meta-analysis showed that, the weekly survival and discharge rate of out-of-hospital cardiac arrest patients with early defibrillation by first responders on site was higher than that of out-of-hospital cardiac arrest patients without early defibrillation by first responders on site〔OR=0.47, 95%CI (0.45, 0.50) , P<0.001〕, the weekly survival and discharge rate of out-of-hospital cardiac arrest patients with early defibrillation by professional first responders was higher than that of out-of-hospital cardiac arrest patients with early defibrillation by non-professional first responders〔OR=0.72, 95%CI (0.65, 0.81) , P<0.000 01〕.

Conclusion

Early defibrillation of first responders on site can effectively improve the weekly survival and discharge rate of out-of-hospital cardiac arrest patients, professional first responders who have received early defibrillation training can improve the weekly survival and discharge rate of out-of-hospital cardiac arrest patients compared with non-professional first responders. Due to limitations in the quality and quantity of included studies, the above conclusion needs to be verified by conducting more prospective cohort studies with large samples.

Effectiveness and Safety of Changyanning Granules in the Treatment of Dyspepsia in Children: a Systematic Review and Meta-analysis

Lei ZHANG, Jian LYU, Yanming XIE

2022, 25(14):  1765-1771.  DOI: 10.12114/j.issn.1007-9572.2022.01.003

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Background

Dyspepsia (namely, the functional dyspepsia) in children, is a common pediatric disease that has a high recurrence rate. Severe dyspepsia will affect the nutritional intake of children, and may further impair their physical development and even mental health.

Objective

To systematically review the effectiveness and safety of Changyanning Granules in the treatment of dyspepsia in children.

Methods

We searched databases of CNKI, WanFang Data, CQVIP, and SinoMed for randomized controlled trials (RCTs) in Chinese and searched databases of PubMed, The Cochrane Libarary, EMBase, Web of Science for relevant RCTs in English from inception to May 2021. Regarding children with dyspepsia treated by Changyanning Granules or Changyanning Granules in combination with routine western treatment〔Live Combined Bifidobacterium and Lactobacillus Tablets (LCBLT) or Motilium Tablets (MT) 〕 (experimental group) compared with those treated with Xiaoer Xishi Pian (a Chinese patent medicine) or routine western treatment (LCBLT or MT) regardless of dosage, administration route and duration of treatment. We used response rate as the primary outcome indicator, and incidence of adverse reactions and clinical symptoms disappearing time as secondary outcome indicators. We used the Cochrane Handbook for Systematic Reviews of Interventions (Version 5.1) and RevMan 5.3 for conducting the meta-analysis.

Results

Six RCTs were included, involving 1 150 cases (575 in the experimental group and 575 in the control group) . Meta-analysis showed that Changyanning Granules were superior to Xiaoer Xishi Pian in terms of overall response rate〔RR=1.57, 95%CI (1.27, 1.94) , P<0.000 1〕 with lower incidence of adverse reactions〔RR=0.18, 95%CI (0.09, 0.37) , P<0.000 01〕. Compared with LCBLT or MT, Changyanning Granules with LCBLT or MT produced higher overall response rate〔RR=1.60, 95%CI (1.13, 2.26) , P=0.008〕, and shortened the clinical symptom disappearing time (P<0.05) , but showed no significant difference in the incidence of adverse reactions (P>0.05) .

Conclusion

For children with dyspepsia, available evidence has demonstrated that using Changyanning Granules alone, or in combination with LCBLT or MT, could improve the overall response rate, shorten the clinical symptoms disappearing time with relatively low incidence of adverse reactions. However, due to low quality of included RCTs, our conclusion needs to be further verified by RCTs meeting the international standards with a large sample size, and rigorous design.

Review

Progress of Anticancer Drug-induced Organizing Pneumonia

Ting PAN, Tieying SUN

2022, 25(14):  1772-1778.  DOI: 10.12114/j.issn.1007-9572.2021.01.035

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Drug-induced lung injury has received more and more attention. The most common pattern is interstitial lung disease. The diagnosis, treatment and prognosis of drug-induced interstitial lung disease (DIILD) have been explored in many researches. However, there are still many subtypes of DIILD, including usual interstitial pneumonia, non-specific interstitial pneumonia, organizing pneumonia, hypersensitivity pneumonia and diffuse alveolar damage depending on the pathology. Each subtype may be different in treatment and management and further clarification is needed. This paper focused on the common subcategory of organizing pneumonia, naming it as drug-induced organizing pneumonia (DIOP) , explored the most common anticancer drugs, understood the potential mechanism of anticancer drugs to cause OP, and explored the diagnosis, differential diagnosis, treatment and prognosis of DIOP, so as to make a better guide on the diagnosis and treatment of organizing pneumonia induced by anticancer drugs.

Recent Advances of the Wiskott-aldrich Syndrome Protein Family Members in Tumorigenesis and Progression

Xin XIE, Yan CHEN, Zhixu HE, Pei HUANG, Qinghua CHEN

2022, 25(14):  1779-1789.  DOI: 10.12114/j.issn.1007-9572.2021.01.029

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The development of cancer is an evolving process, with proliferation, invasion and metastasis as basic biological features. As a new class of actin regulatory proteins, Wiskott-aldrich syndrome protein (WASP) family is a key component in maintaining the basic morphology of actin cytoskeleton that is involved in many essential processes including maintaining basic structure of cells, and cell motility and signaling. It also mediates the proliferation, invasion and metastasis of cancer cells. We reviewed latest advances in the role of WASP family in cancer formation and progression, its expression levels in different cancers and related signaling pathways, suggesting that relevant research is highly promising, and reflecting the importance of WASP family in mechanisms of carcinogenesis, cancer treatment and prognosis prediction.

Recent Developments in Pituitary-directed Medical Treatment for Cushing's Disease

Ling LI, Huijuan ZHANG

2022, 25(14):  1789-1794.  DOI: 10.12114/j.issn.1007-9572.2021.01.039

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Cushing's disease is caused by excessive secretion of adrenocorticotropic hormone (ACTH) by hormone-secreting pituitary adenomas, the first-choice treatment for which is surgical resection of the pituitary adenoma. Medication therapy is the second-line treatment, and a necessary treatment for some patients with unsatisfactory surgical results or failing to use the surgery. With recent developments in pathogenesis studies of Cushing's disease, medications specifically targeting hormone-secreting pituitary adenomas have proven to be effective in controlling the tumor growth, and suppressing the tumor's secretion of ACTH, which may be a theoretical and practical basis for medical treatment of Cushing's disease. In this review, we discussed pituitary-directed medical therapies for Cushing's disease and their mechanisms of actions, aiming to increase medical workers' understanding of this disease, and to offer theoretical evidence for the development of appropriate treatment strategies.