Table of Content

15 June 2023, Volume 26 Issue 17

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Guide·Consensus

Clinical Practice Guideline for Non-pharmacological Interventions for Malnourished Elderly

China Gerontological Nursing Alliance, Xiang Ya Nursing School Central South University (Xiangya Oceanwide Health Management Research Institute of Central South University), Xiangya Hospital Central South University (National Clinical Research Center for Geriatric Disorders), Beijing Hospital (National Center for Gerontology, National Clinical Research Center for Geriatric Disorders), LI Mengqi, WU Lina, NING Hongting, FENG Hui

2023, 26(17):  2055-2069.  DOI: 10.12114/j.issn.1007-9572.2023.0074

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The older adults are high risk population for malnutrition. Malnutrition is closely associated with numerous adverse clinical outcomes, which may seriously affect the physical health and life quality of the older adults, causing heavy burdens on families and society. Therefore, it is of great importance to take effective measures to improve malnutritionin the older adults, and non-pharmacological interventions have been proved to be important measures to improve nutritional status. However, there is no domestic clinical practice guideline for non-pharmacological interventions specifically for malnourished older adults. Therefore, nutrition experts from China Gerontological Nursing Alliance, National Center for Gerontology and National Clinical Research Center for Geriatric Disorders developed the guideline based on the Grading of Recommendation Assessment, Development and Evaluation (GRADE) including 9 recommendations of non-pharmacological intervention formal nourished older adults through a comprehensive search and analysis of the latest domestic and international literature on malnutrition in the elderly, in order to improve malnutrition and quality of life in the older adults. This guideline focuses on malnourished older adults who can be fed orally and enteral nutrition, parenteral nutrition is not covered by the scope of this guideline.

Original Research

Precise Thrombolytic Treatment for Stroke Using AI-based Algorithms: a Real-world Study

SHEN Huiwen, LIN Yongzhong, CHEN Shuliang, ZHANG Lihong, MA Chunye, MA Deyuan, ZHANG Ce

2023, 26(17):  2070-2077.  DOI: 10.12114/j.issn.1007-9572.2023.0048

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Background The thrombolytic effect for ischemic stroke (IS) is affected by complex factors, such as acute onset of stroke, short therapeutic time window, various individual patient factors, treatment model, types and doses of medicines as well as mode of administration. To identify the influencing factors of thrombolytic effect, most existing studies adopt statistical methods, while rare studies use artificial intelligence (AI) -based algorithms.Objective To establish models using AI-based algorithms for IS patients based on the real-world data including general patient characteristics, medication model and recovery effects, to achieve precise individualized thrombolytic treatment and provide data support for clinical prescription decisions.Methods A retrospective design was used. The clinical information of IS patients (n=55 621) was extracted from the Yidu Cloud scientific research big data server system of the Second Affiliated Hospital of Dalian Medical University from January 1, 2001 to December 31, 2021, among whom 1 855 with complete information were enrolled according to the inclusion criteria. Thrombolysis effect was evaluated by comparing the National Institutes of Health Stroke Scale (NIHSS) score measured at admission and discharge, and those with an improvement in the NIHSS score by ≥4 points and <4 points were assigned to neurological improvement group (n=1 236) , and control group (n=619) , respectively. Factors possibly associated with post-IS thrombolytic effect (including general patient characteristics, medication indicators, examination indicators, test indicators, and treatment methods) were obtained by summarizing the factors suggested separately by three neurology experts with a senior title, and reviewing relevant guidelines and literature, then were screened using univariate analysis, and the identified ones were treated by dimensionality reduction using principal component analysis (PCA) . Models of Logistic, support vector machine (SVM) , C5.0 decision tree arithmetic, classification and regression tree (CART) , deep neural network (DNN) , and Wide&Deep, were built and compared to find the one with the best performance in predicting thrombolytic effect, then to determine its parameters. Then by use of two randomly generated two numbers, 7 and 11, the 1 855 patients were randomly assigned to three datasets, training (n=1 113, for building and practicing models to discover rules) , validation (n=371, for adjusting model parameters) , and test (n=371, for evaluating the generalization ability of the final model) . Feature engineering was used to construct a simplified model and evaluate its accuracy. The clinical information of IS patients (n=3 925) was extracted from the Yidu Cloud scientific research big data server system of Dalian Central Hospital for external verification of the model.

Results

Twenty-six patients characteristics associated with thrombolytic effect were included for establishing models. The dimensionalities were reduced to two principal components by PCA, explaining 93.1% of the total variance. Comparison analysis revealed that the Wide&Deep model had the best predictive performance with an accuracy of 0.815, and an F-index of 0.871. Furthermore, the values of the area under the receiver operating characteristic (AUC) curve of the Wide&Deep model in predicting the thrombolytic effect in patients in the training set and test set were 0.753 and 0.793, respectively. The number of hidden layers and neurons in each layer of the model was 7 and 15, respectively. Using sigmoid as the activation function showed that the model parameters were optimal. The feature-engineering analysis of factors influencing the improvement of neurological function showed that the importance of medication type, administration mode and dosage ranked high, and the importance ranking in a descending order was: cerebrovascular disease history, type of medication, mode of administration, single dose, atherosclerosis, therapeutic time window of thrombolytic therapy, prevalence of use of anticoagulant drugs and drugs for promoting blood circulation and removing blood stasis. After simplifying the independent variables of the model, the accuracy of the Wide&Deep model was 0.819, and its accuracy was 0.801 suggested by the external verification after model simplification, indicating good predictive performance and generalizability.Conclusion The Wide&Deep model has proven to have excellent evaluation indicators. The importance of influencing factors of thrombolytic effect in a descending order is: cerebrovascular disease history, type of medication, administration mode, single dose, atherosclerosis, therapeutic time window of thrombolytic therapy, prevalence of use of anticoagulants and blood-activating and stasis-removing drugs. It provides clinicians with timely and effective thrombolysis treatment support involving thrombolysis related factors and individualized administration using AI-based algorithms.

Constructing a Risk Prediction Model of Breast Cancer-related Lymphedema Based on a Meta-analysis of Prospective Cohort Studies

SHEN Aomei, LU Qian, FU Xin, WEI Xiaoxia, BIAN Jingru, ZHANG Liyuan, QIANG Wanmin, PANG Dong

2023, 26(17):  2078-2088.  DOI: 10.12114/j.issn.1007-9572.2022.0827

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Background Lymphedema is a common chronic complication bothering breast cancer patients. Early assessment and prediction of the risk for developing breast cancer-related lymphedema (BCRL) is particularly important. However, there is still a lack of an authoritatively recognized and suitably promoted risk prediction model.Objective To construct and validate a risk prediction model for BCRL based on the results of a meta-analysis.Methods Electronic databases including PubMed, Embase, CINAHL, Scopus, Web of Science, Cochrane Library, CNKI, CBM, and Wanfang Data, were searched for prospective cohort studies on risk factors of BCRL from inception to November 2021. Two systematically trained researchers independently screened the literature, extracted data, and assessed the study quality using the Newcastle-Ottawa Scale. Stata 17.0 was used for meta-analysis. The risk factors with significant pooled effect size and their combined risk value were extracted to construct the Logistic risk prediction model. The Logistic and additive risk scoring models were constructed based on regression coefficients and pooled risk values, respectively. The data of 486 breast cancer patients recruited in the breast cancer research center of Peking University People's Hospital, from April 2017 to December 2018, were selected as the validation set. The area under the ROC curve (AUC) and the Hosmer-Lemeshow test were used to evaluate the prediction performance of the risk scoring model. Decision curve analysis was used to evaluate the clinical practicability.Results A total of 49 prospective cohort studies involving 32 543 breast cancer patients were included. Meta-analysis showed that the incidence of BCRL was 20.6%〔95%CI (17.9%, 23.3%) 〕. Among 49 studies, five risk factors with significant pooled effect sizes were reported more than five times, including body mass index (BMI) 〔RR=1.777, 95%CI (1.515, 2.085) 〕, type of breast surgery〔RR=1.320, 95%CI (1.125, 1.549) 〕, type of axillary surgery〔RR=3.058, 95%CI (2.325, 4.020) 〕, radiotherapy〔RR=1.620, 95%CI (1.214, 2.160) 〕, and postoperative complications〔RR=2.373, 95%CI (1.278, 4.405) 〕. The total score for the Logistic risk scoring model ranged from 0 to 34, and that for the additive risk scoring model ranged from 5 to11. The AUCs of Logistic and additive risk scoring models were 0.748〔95%CI (0.701, 0.794) 〕and 0.737〔95%CI (0.691, 0.784) 〕, respectively. The values of Hosmer-Lemeshow test were 0.185 and 0.763, respectively. The optimal cut-off value of the Logistic risk scoring model was 18, with a sensitivity of 81.7%, and a specificity of 43.1%. The optimal cut-off value of the additive risk scoring model was 8.5, the sensitivity was 80.9%, and the specificity was 42.8%. When the probability threshold ranged from 20% to 30%, the model achieved higher net clinical benefit. Conclusion The BCRL risk prediction model based on this meta-analysis has good predictive performance. It can be used as a risk assessment tool for BCRL to guide the hierarchical monitoring and management of BCRL. However, prediction performance and clinical practicability of the model still needs to be validated and optimized in future research.

Potential Effect of Walking on Emotional Health among Breast Cancer Survivors: the Mediating Effects of Different Dimensions of Posttraumatic Growth

FU Shi, CHEN Chen, YU Mengzhu, JIN Changqin, HE Gan, CHU Qiao, HE Yaping

2023, 26(17):  2089-2094.  DOI: 10.12114/j.issn.1007-9572.2022.0797

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Background

Breast cancer has become the most prevalent cancer worldwide, which leads to both physical symptom burden and psychological distress among patients. Although available literature has demonstrated the effect of physical activity in improving psychological health among breast cancer survivors, the underlying psychosocial mechanism is relatively understudied.

Objective

To investigate the association of walking with positive and negative affect among breast cancer patients, and examine the potential mediating effects of different dimensions of posttraumatic growth between them.

Methods

From April to July, 2019, 256 breast cancer patients receiving community-based management were recruited using convenience sampling from Shanghai Pengpuxincun Community Health Center to attend a household survey. Two hundred and thirty-five of them who completed the survey were included as final participants (achieving a response rate of 91.8%) . Levels of walking were measured using International Physical Activity Questionnaire-Long Form (IPAQ-long) , posttraumatic growth was assessed using Posttraumatic Growth Inventory-Short Form (PTGI-SF) , emotional health was assessed using the 20-item Positive and Negative Affect Scale (PANAS) . Structural equation modeling was conducted to test the parallel mediating effects of different dimensions of posttraumatic growth between walking and positive and negative affect.

Results

The result of intermediary effect analysis show that, walking was associated with greater positive affect through facilitating the personal strength dimension of posttraumatic growth among breast cancer patients, with an indirect effect of 0.07〔95%CI (0.02, 0.13) 〕. Moreover, walking was associated with lower level of negative affect through facilitating the appreciation for life dimension of posttraumatic growth, with an effect size of -0.13〔95%CI (-0.21, -0.05) 〕. The result of the intermediary model show that, the level of walking activity promoted positive emotions (β=0.34, P<0.01) by promoting the personal strength dimension of post-traumatic growth (β=0.21, P<0.01) . In addition, walking activity decreased negative mood (β=-0.37, P<0.01) by promoting the life appreciation dimension of post-traumatic growth (β=0.35, P<0.01) .

Conclusion

Posttraumatic growth plays an important role as a mediator between walking and emotional health in breast cancer patients. In view of this, physicians from community health centers, the institutions responsible for long-term health management of cancer patients, should value walking as a potential intervention for improving psychological health of breast cancer patients in the future community health management. In addition, it is recommended to use both physical activity and psychological interventions to improve posttraumatic growth, in order to further enhance the intervention efficacy.

Occurrence and Treatment of Endocrinologic Adverse Reactions Associated with Immune Checkpoint Inhibitors: a Single-center Real-world Study

CHANG Junpei, CHEN Lu, WU Tong, ZHAO Xiaoli, DUAN Fangfang, LIU Danna, KONG Tiandong

2023, 26(17):  2095-2101.  DOI: 10.12114/j.issn.1007-9572.2022.0855

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Background

Immunotherapy-related endocrine adverse reactions are relatively common, which often lead to serious outcomes if not treated in time. However, the incidence of immunotherapy-related endocrine adverse reactions varies widely in previous literature reports without standard processing.

Objective

To investigate the occurrence and treatment process of endocrinologic adverse reactions caused by immune checkpoint inhibitors (ICIs) in the real world.

Methods

The clinical data of 204 patients with solid tumors treated with ICIs at the Third People's Hospital of Zhengzhou from January 2019 to March 2022 was retrospectively analyzed, the endocrinologic adverse reactions occured their treatment were observed and standardized management was conducted according to the adverse reactions grading.

Results

A total of 204 patients with solid tumors were included, involving 139 male patients and 65 female patients, with a median age of 65.4 (8.0, 88.4) years. The types of solid tumor were predominantly non-small cell lung cancer (43.1%) , the treatment drugs were mainly sindilizumab (47.1%) , and the treatment patterns were predominantly immunotherapy combined with targeted agents (57.4%) . 12 patients developed ICIs-related endocrinologic adverse reactions, including 9 cases (4.4%) of hypothyroidism (1 case of gradeⅠ, 7 cases of grade Ⅱ, 1 case of grade Ⅲ) with the median onset time of 7 (6, 10) weeks after the treatment of immunological drugs, 1 case (0.5%) of hyperthyroidism (gradeⅠ) occurred 9 weeks after the immunotherapy, 1 case (0.5%) of type 1 diabetes (gradeⅣ) occurred 6 weeks after auto-immunotherapy, 1 case (0.5%) of adrenal dysfunction (gradeⅢ) occurred 7 weeks after immunotherapy. All the 12 patients with endocrinologic adverse reactions were treated in time according to the hierarchical management process, and all their symptoms were improved or returned to normal, and continued to be treated with ICIs.

Conclusion

The risk of endocrinologic adverse reactions in the endocrine system is relatively high during the use of ICIs, especially abnormal thyroid function, which requires regular detection of endocrine indicators during treatment, timely intervention will not affect the subsequent treatment of ICIs.

Influencing Factors of Insulin Resistance in Polycystic Ovary Syndrome Patients with Normal Body Mass Index

LUO Rong, WANG Yu, MIAO Afeng, WU Xiaoke

2023, 26(17):  2102-2107.  DOI: 10.12114/j.issn.1007-9572.2022.0825

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Background

The incidence of insulin resistance (IR) is higher in patients with polycystic ovary syndrome (PCOS) regardless of whether they are obese, which seriously affects their reproductive and metabolic health. At present, there are few studies on the influencing factors of IR in PCOS patients with normal body mass index (BMI) .

Objective

To explore the influencing factors of IR in PCOS patients with normal BMI.

Methods

This study was a secondary analysis based on the clinical trial of the Effect of Acupuncture and Clomiphene Citrate on Live Birth in Infertile Women with PCOS (PCOSAct) , which was a multicenter, large-sample randomized controlled trial conducted in Chinese from 2011 to 2015, involving 1 000 PCOS infertile participants with fertility demand from 27 hospitals in the sub-centers, among whom 453 with normal BMI (18.5 kg/m²<BMI<24.0 kg/m²) were included in this study. The demographic characteristics, sex hormones, glucose and lipid metabolism, liver and kidney functions, and electrolytes were compared between patients with IR〔IR (+) group, 114 cases〕 and those without〔IR (-) group, 339 cases〕 grouped by the level of homeostasis model assessment of insulin resistance (HOMA-IR) . And the correlation between each index and HOMA-IR was analyzed. Multivariate Logistic regression analysis was used to explore the influencing factors of IR in PCOS patients with normal BMI.

Results

Compared with IR (-) group, IR (+) group had higher average levels of BMI, waist circumference (WC) , waist-to-hip ratio (WHR) , systolic blood pressure (SBP) , free androgen index (FAI) , fasting plasma glucose (FPG) , fasting insulin (FINS) , total cholesterol (TC) , triacylglycerol (TG) , low-density lipoprotein cholesterol (LDL-C) and apolipoprotein B (ApoB) , and lower average levels of serum AMH, sex hormone-binding globulin (SHBG) , total bilirubin (TBiL) , direct bilirubin (DBiL) , creatinine, β2 microglobulin, calcium, phosphorus, magnesium, sodium, and chloride (P<0.05) . Correlation analysis showed that TG, WC, BMI, ApoB, TC, FAI, WHR, SBP, and LDL-C had positive correlation with HOMA-IR (P<0.05) . Serum DBiL, TBiL, SHBG, phosphorus, chloride, sodium, creatinine, AMH, magnesium, FT, calcium, and β2 microglobulin was negatively correlated with HOMA-IR (P<0.05) . Multivariate Logistic regression analysis showed that BMI〔OR=1.291, 95%CI (1.067, 1.561) 〕, WC〔OR=1.042, 95%CI (1.004, 1.081) 〕, FAI〔OR=1.092, 95%CI (1.022, 1.167) 〕, TG〔OR=1.902, 95%CI (1.401, 2.583) 〕, AMH〔OR=0.956, 95%CI (0.918, 0.997) 〕, TBiL〔OR=0.871, 95%CI (0.789, 0.962) 〕, phosphorus〔OR=0.209, 95%CI (0.067, 0.651) 〕were influencing factors for IR in PCOS patients with normal BMI (P<0.05) .

Conclusion

The incidence of IR in PCOS patients with normal BMI was 25.16% (114/453) , whose risk increased with the elevation in BMI, WC, FAI and TG, and the reduction in serum AMH, TBiL, and phosphorus.

Study on the Influencing Factors of Minimal Clinically Important Difference of the FACT-G Scale Based on Patients with Cervical Precancerous Lesions

YANG Yuli, JING Mingxia, HU Xin, YANG Ping, YAN Xiaolong

2023, 26(17):  2108-2113.  DOI: 10.12114/j.issn.1007-9572.2022.0696

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Background

The minimum clinical importance difference (MCID) of the quality of life scale is an important parameter to explain and define the score changes of the scale, which can promote the clinical application of the quality of life scale as a tool to evaluate the effectiveness of treatment and intervention. MCID may be influenced by a variety of factors and there are few current studies on MCID of the Functional Assessment of Cancer Therapy-Generic Scale (FACT-G) .

Objective

To develop the MCID of FACT-G scale of patients with cervical precancerous lesions by a variety of methods and analyze the influence of patients' social demographic characteristics on the MCID of the FACT-G scale, so as to provide quantitative basis for clinicians to judge the clinical effectiveness of interventions.

Methods

A total of 66 patients with cervical precancerous lesions who received operation related to cervical precancerous lesions from October 2020 to November 2021 were included as study subjects in the First Affiliated Hospital of Shihezi University. The social demographic characteristics and disease-related information of the patients were collected, and the FACT-G scale was used to evaluate the quality of life of the patients before and 1 month after operation. The anchoring methods and distribution method were used to develop MCID for FACT-G scales. Multiple linear regression was used to analyze the influencing factors of MCID of the FACT-G scale.

Results

The four anchors including Global Rating of Change Questionnaire (GRCQ) , entry 10 of Global Rating of Change Questionnaire (SF-36 scale) , utility values (UI) of the Five-level EuroQol Five-dimensional Questionnaire (EQ-5D-5L scale) and EQ Visual Analogue Scale (EQ-VAS) were selected. The MCID of the total score of the FACT-G scale developed by the anchoring method ranged from 7.048 to 12.932, the MCID of the total scores of the FACT-G scale developed by the distribution method ranged from 3.696 to 10.243. The MCID developed by the anchoring method and distribution method were inconsistent. The MCID developed by the anchor-based GRCQ was considered as an example, there were 34 patients with slight improvement after operation were screened. The results of multiple linear regression analysis showed that that single (β=15.264, P<0.001) , obesity (β=-4.830, P=0.038) , and baseline scale total scores>89.5 (β=-7.600, P=0.001) were the influencing factors of MCID of the FACT-G total score in patients with cervical precancer lesions.

Conclusions

The MCIDs of FACT-G scale developed by different calculation methods are inconsistent. For patients with different characteristics of cervical precancerous lesions, MCIDs of the FACT-G scale should be selected to determine the effectiveness of clinical decisions and the clinical relevance of changes in quality of life after treatment.

Effects of Reducing Indoor Air Particles on Cardiovascular and Respiratory Physiological Indexes in the Elderly: a Randomized Crossover Controlled Trial

ZHOU Min, ZHENG Ziguang, YOU Hongyu, GUO Miao, YU Wei, YANG Xu

2023, 26(17):  2114-2119.  DOI: 10.12114/j.issn.1007-9572.2022.0799

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Background

Exposure to indoor air particles pollution increases the incidence and mortality of respiratory and cardiovascular diseases, especially in the elderly population.

Objective

To explore the effect of indoor air particles on cardiopulmonary-related physiological indexes of the elderly and short-term use of air purifiers on the improvement of cardiopulmonary health of the elderly.

Methods

A randomized, double-blind, crossover trial was conducted in January 2020 on 24 healthy older adults selected from a senior apartment in Jiangbei District of Chongqing. These included older adults equally divided into two groups alternately using real and sham air purifiers for 48 h with a 12-days washout interval by complete randomization. 14 health indexes including biomarkers of circulatory system inflammation, coagulation, oxidative stress and pulmonary function, blood pressure, heart rate, exhaled fractional nitric oxide (FeNO) were measured. Linear mixed-effect model was used to evaluate the effect of the air purifiers on health indexes.

Results

The results of the linear mixed-effect model showed that compared with the sham purifiers, fibrinogen, MCP-1 and MPO in the blood inflammatory indicators were changed by -15.1%〔95%CI (-23.1%, -6.3%) , P<0.05〕, -17.7%〔95%CI (-22.9%, -12.3%) , P<0.05〕 and -17.2%〔95%CI (-23.9%, -9.8%) , P<0.05〕, PAI-1 and t-PA in the coagulation factors changed by -14.9%〔95%CI (-21.1%, -8.2%) , P<0.05〕 and -13.5%〔95%CI (-18.7%, -8.0%) , P<0.05〕, heart rate changed by -5.8%〔95%CI (-10.6%, -0.8%) , P<0.05〕in the real purifiers, respectively. For every 1 μg/m³ increase in PM_2.5 concentration, fibrinogen, MCP-1, MPO, PAI-1, t-PA, D-dimer and heart rate in the elderly increased by 0.51%, 0.48%, 0.56%, 0.49%, 0.43%, 0.31% and 0.20%, respectively (P<0.05) .

Conclusion

Indoor air purifiers are associated with decreased concentrations of systemic and local inflammation and coagulation biomarkers. Reducing air particles may be a public health measure to improve circulatory and cardiopulmonary health in the elderly.

Risk Factors of Thrombocytopenia Caused by Pyogenic Liver Abscess

MA Yong, GAO Weibo, ZHU Jihong

2023, 26(17):  2120-2124.  DOI: 10.12114/j.issn.1007-9572.2022.0742

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Background

Pyogenic liver abscess (PLA) is a common visceral infectious disease, its associated thrombocytopenia has been rarely studied clinically.

Objective

To discuss the epidemiological and clinical characteristics as well as risk factors of thrombocytopenia secondary to PLA.

Methods

All 161 patients hospitalized for PLA in Peking University People's Hospital from January 2011 to December 2020 were recruited. Patient data were collected, including general demographics〔age, gender, body mass index (BMI) , symptoms (fever, abdominal pain, nausea, vomiting) , and past medical history information (hypertension, diabetes, coronary heart disease, hepatobiliary disease, and cancer) , auxiliary examination results, including white blood cell count, absolute neutrophil count, absolute lymphocyte count (ALC) , absolute monocyte count, hemoglobin, C-reactive protein (CRP) , procalcitonin (PCT) , alanine aminotransferase (ALT) , aspartate aminotransferase (AST) , total bilirubin (TBiL) , blood urea nitrogen (BUN) , serum creatinine (Scr) , albumin (ALB) , prothrombin time (PT) , activated partial thromboplastin time, fibrinogen, D-Dimer, platelet count (PLT) 〕, imaging examination results (abdominal CT or ultrasonographic findings of liver abscesses) , pathogenic examination results (blood culture, prevalence of cultured Klebsiella pneumoniae) and complications and prognosis. The above-mentioned data were compared between group with decreased PLT (n=21) and group without decreased PLT (n=140) divided by the prevalence of PLT less than 100×10⁹/L. The risk factors of thrombocytopenia were analyzed by multivariate Logistic regression analysis.

Results

The mean BMI in PLT reduction group was statistically significant higher than that in non-PLT reduction group (P<0.05) . PLT reduction group had much lower mean levels of ALC and ALB, PT, and much higher mean levels of CRP, PCT, ALT, AST, TBiL, BUN, Scr and D-Dimer than non-PLT reduction group (P<0.05) . Furthermore, PLT reduction group had significantly higher prevalence of concomitant pneumonia, brain abscess and ICU admission (P<0.05) . ALB〔OR=0.255, 95%CI (0.074, 0.877) 〕and PT〔OR=0.282, 95%CI (0.085, 0.941) 〕were influencing factors for thrombocytopenia in PLA (P<0.05) .

Conclusion

ALB and PT are the influencing factors of thrombocytopenia in PLA patients. PLT levels should be closely monitored in PLA patients, especially those with reduced ALB and decreased PT.

Clinical Characteristics and Risk Factors for Unfavourble Prognosis of Mycoplasma Pneumoniae Encephalitis in Children

XUE Jingru, SUN Suzhen

2023, 26(17):  2125-2131.  DOI: 10.12114/j.issn.1007-9572.2022.0832

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Background The incidence of Mycoplasma pneumoniae encephalitis (MPIE) in children has increased in recent years, but it is under-recognized by clinicians due to its heterogenous clinical presentations and limited diagnostic tools. Objective To analyze the clinical characteristics of children with MPIE and to explore the independent risk factors for unfavourble prognosis, so as to provide a theoretical basis for reducing the incidence of neurological sequelae and mortality of MPIE in children. Methods The clinical data of 101 children with MPIE who were hospitalized in Department of Neurology, Children's Hospital of Hebei Province from January 2020 to June 2022 were retrospectively analyzed. The Glasgow Outcome Scale (GOS) was used to assess the children's condition at discharge, by which they were divided into favourble prognosis group and unfavourble prognosis group. Clinical characteristics including demographics (age, gender, etc.) , clinical symptoms and signs, as well as auxiliary examination results〔laboratory tests related to Mycoplasma pneumoniae (MP) , cerebrospinal fluid (CSF) , electroencephalogram (EEG) and imaging, and immunological indicators〕and treatment were analyzed, and then compared between the two groups. Multivariate Logistic regression analysis was used to explore the independent risk factors for unfavourble prognosis of MPIE. Results The prevalence of favourble and unfavourble prognosis was 72.3% (73/101) and 27.7% (28/101) , respectively. Most of the children were of school age, and MPIE in them was mainly manifested by occurring sporadically throughout the year but with a relatively high incidence in winter and spring, acute onset, with fever as the most common symptom, lalopathy and dyskinesia and other focal lesions as the common neurological manifestations. Epilepsy was found in some cases, which may even develop into refractory status epilepticus. The prevalence of MP in CSF detected by PCR was 26.7% (27/101) . The EEG mainly showed slowing of background alpha rhythm. Brain MRI mainly showed long T1 and T2 signals in the involved region, and the abnormal rates of both were 68.3% (69/101) and 44.6% (45/101) , respectively. By tests for cellular immunity and humoral immunity, or the blood or CSF test in some children, anti-NMDAR, myelin oligodendrocyte glycoprotein and other immune encephalitis and demyelinating related antibodies could be detected. There were significant differences between favourble and unfavourble prognosis groups in the prevalence of psychobehavioral abnormality, disturbance of consciousness, epileptic seizures, status epilepticus, focal neurological dysfunction, EEG abnormalities, brain MRI abnormalities, hormone therapy and intravenous immunoglobulin therapy, as well as average level of white blood cell count in CSF (P<0.05) . Multivariate Logistic regression analysis showed that focal neurological dysfunction〔OR=6.292, 95%CI (1.188, 33.327) , P=0.035〕, status epilepticus〔OR=18.031, 95%CI (1.231, 264.082) , P=0.031〕, abnormal EEG〔OR=7.379, 95%CI (1.077, 50.548) , P=0.042〕, abnormal brain MRI〔OR=5.757, 95%CI (1.105, 30.003) , P=0.038〕, and requiring hormone therapy〔OR=12.441, 95%CI (1.082, 143.114) , P=0.043〕were independent risk factors for unfavourble prognosis in children with MPIE. Conclusion Focal neurological dysfunction, status epilepticus, abnormal EEG and brain MRI changes and the need for glucocorticoid therapy may be independent risk factors for unfavourble prognosis in children with MPIE, and clinicians should pay high attention to these factors to early identify them, so that the incidence of neurological sequelae and mortality of MPIE could be reduced.

Analysis of Risk Factors and Exploration of Predictors of Serious Cases of COVID-19 in Xi'an during the Period of 2021-2022

WANG Hai, WANG Zhuoli, PEI Honghong, PAN Longfei

2023, 26(17):  2132-2137.  DOI: 10.12114/j.issn.1007-9572.2022.0826

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Background

The outbreak of COVID-19 in Xi'an between 2021 and 2022 was a large-scale local epidemic in a large city with a huge number of cases. It is necessary to analyze and summarize the contents of this outbreak.

Objective

To analyze the disease characteristics of patients with COVID-19, and to explore the risk factors as well as predictors of serious cases.

Methods

General data and laboratory parameters were retrospectively collected from patients diagnosed with a new coronavirus pneumonia who were admitted to the Fourth People's Hospital of Xi'an between December 2021 and January 2022. Based on the the ratios of total IgG to lymphocyte percentage (IgG∶L%) , total IgM to lymphocyte percentage (IgM∶L%) , total IgG to lymphocyte count ratio (IgG∶L#) , and total IgM to lymphocyte count ratio (IgM∶L#) , patients were divided into three groups: mild and common, severe and critical. Multivariate Logistic regression analysis was used to explore the risk factors of developing severe and critically new coronavirus; then the ROC curve was drawn to analyze the predictive indexes and predictive value of severe and critical COVID-19, the area under the ROC curve (AUC) was calculated, and the AUC of each index was compared using the Delong test.

Results

A total of 699 patients with identified COVID-19 were finally included, and divided into two groups: the mild and common (n=678) and the severe and critical (n=21) forms, with the mild and common forms having younger age, and less underlying disease, D-dimer, IgM∶L%, IgM∶L#, and higher lymphocyte percentage and lymphocyte count than the severe and critical forms (P<0.05) . Multivariate Logistic regression analysis showed that age〔OR=1.068, 95%CI (1.031, 1.105) , P<0.001〕, D-dimer 〔OR=1.612, 95%CI (1.026, 2.533) , P=0.038〕as well as IgM∶ L#〔OR=1.034, 95%CI (1.006, 1.063) , P=0.018〕 were risk factors for the development of severe and dangerous new coronavirus, and lymphocyte percentage 〔OR=0.918, 95%CI (0.844, 0.997) , P=0.043〕was a protective factor for the development of severe and critical new coronavirus. To establish a joint prediction model for severe and critical novel coronavirus infection, P=-5.031+0.065×age-0.086× lymphocyte percentage +0.738× lymphocyte count +0.477× D-dimer +0.034×IgM∶L#, and the cutoff value for combined detection to predict severe and critical COVID-19 was 0.04, with a sensitivity of 90.00%, a specificity of 83.18%, and its AUC of 0.912〔95%CI (0.858, 0.965) 〕, which was greater than that for age (Z=5.314, P<0.001) , lymphocyte percentage (Z=-1.987, P=0.047) , D-dimer (Z=2.273, P=0.023) , and IgM∶L# (Z=0.161, P<0.001) , with statistically significant differences.

Conclusion

In the acute phase of COVID-19, there is an imbalance between inflammatory response and cellular immune function, and this imbalance, along with age and D-dimer, are all risk factors for severe COVID-19. Combined indicators including age, D-dimer, lymphocyte percentage and IgM∶L# can effectively predict severe and critical COVID-19 .

Evidence-based Medicine

Fear of Cancer Recurrence Assessment Tools Based on COSMIN: a Systematic Review

ZHANG Lulu, CHEN Huan, LUO Huan, CHEN Tingting, CHEN Xinyu, GAO Jing

2023, 26(17):  2138-2146.  DOI: 10.12114/j.issn.1007-9572.2022.0810

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Background There is a wide variety of scales that can be used to assess fear of cancer recurrence both domestically and internationally. Currently, the fear of cancer recurrence can be assessed by multiple domestic and foreign scales, most of which are self-report scales. However, it remains difficult to select assessment tools due to the lack of the systematic reviews of the measurement characteristics of such scales.Objective To systematically review the measurement characteristics and methodological quality of fear of cancer recurrence assessment tools in cancer patients, so as to provide reference for healthcare staff to select more appropriate assessment tools.Methods The search was performed in PubMed, Embase, Web of Science, CINAHL, CNKI, VIP, Wanfang Data, and China Biomedical Literature Database from the inception to September 10, 2022 for the measurement characteristic of fear of cancer recurrence assessment tools. Data were extracted independently by two researchers and the included assessment tools was evaluated by the Consensus-based Standards for the Selection of Health Measurement Instruments (COSMIN) system, to derive the final recommendations.Results A total of 24 studies were included, involving 6 fear of cancer recurrence assessment tools, including the Fear of Cancer Recurrence Inventory (FCRI) , Fear of Progression Questionnaire (FOPQ) , 7-item Fear of Cancer Recurrence Scale (FCR-7) , 1-item Fear of Cancer Recurrence (FCR-1) , Cancer Worry Scale (CWS) , and Assessment of Survivor Concerns (ASC) . In terms of the quality of measurement characteristics, the content validity of the scales were "uncertain" except for FCR-1 ("inadequate") , FCR-7 ("inadequate") and CWS ("not reported") , the construct validity of the scales were "uncertain" except for FCR-1 ("not reported") , the internal consistency of the scales were "adequate" except for FCR-1 ("uncertain") and ASC ("inadequate") , the stability of the scales were "uncertain" except for FCR-1 ("uncertain") and ASC ("not reported") . the criterion validity were "inadequate" except for ASC ("not reported") , the cross-cultural validity of the scales were "not reported" except for FCRI ("uncertain") and ASC ("uncertain") . In the end, FCRI, FOPQ, FCR-7, FCR-1, and CWS were considered as level B recommendation, and ASC was considered as level C recommendation.Conclusion Each measurement characteristic of FCRI has been evaluated more comprehensively with good reliability and validity, which can be temporarily recommended. However, other measurement characteristics still need to be verified.

Risk Factors for Positive Surgical Margins after Radical Prostatectomy in Chinese Men: a Meta-analysis

JIN Tongtong, WU Wangjian, FU Hao, HE Wanbin, ZHOU Fenghai

2023, 26(17):  2147-2154.  DOI: 10.12114/j.issn.1007-9572.2022.0568

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Background

Prostate cancer is one of the most prevalent cancers that endangers the live and health of elderly Chinese men. Currently, radical prostatectomy (RP) is the predominant treatment for localized prostate cancer, but postoperative positive surgical margins (PSMs) have been detected pathologically in some cases. Studies have shown that PSMs indicate high probability of biochemical recurrence and poor prognosis after RP. There is no consensus of risk factors for PSMs after RP in Chinese men.

Objective

To perform a meta-analysis of risk factors for PSMs after RP in Chinese men, providing evidence for the containment of PSMs.

Methods

Databases of PubMed, Embase, The Cochrane Library, Web of Science, CNKI, Wanfang Data, CBM and VIP were searched to collect literature on risk factors for PSMs after RP in Chinese men from the time of database creation to March 1, 2022. The Newcastle-Ottawa scale was adopted to assess the quality of included cohort studies. Stata 16.0 was used to perform meta-analysis.

Results

Twenty-one case-control studies were enrolled, including 6 782 patients, among whom 2 028 had PSMs. Meta-analysis indicated that high pre-RP prostate specific antigen (PSA) 〔OR=1.77, 95%CI (1.18, 2.65) 〕, perineural invasion at puncture time〔OR=5.83, 95%CI (2.05, 16.59) 〕, pre-RP clinical stage T3 or T4〔OR=2.17, 95%CI (1.06, 4.42) 〕, post-RP pathological stage T3 or T4 〔OR=4.30, 95%CI (2.43, 7.63) 〕, high percentage of positive puncture stitches〔OR=1.83, 95%CI (1.35, 2.47) 〕, high Gleason score at the time of puncture〔OR=2.14, 95%CI (1.67, 2.74) 〕, and high Gleason score after RP〔OR=2.33, 95%CI (1.80, 3.01) 〕were risk factors for PSMs after RP (P<0.05) . Subgroup analysis of different surgical approaches in RP showed that pre-RP clinical stage T3 or T4 〔OR=4.57, 95%CI (2.57, 8.12) 〕, post-RP pathological stage T3 or T4 〔OR=4.80, 95%CI (2.20, 10.48) 〕, and high Gleason score after RP〔OR=2.46, 95%CI (1.57, 3.86) 〕were risk factors for PSMs treated with laparoscopic RP (P<0.05) . But in robot-assisted RP, the risk factor was high pre-RP PSA 〔OR=2.17, 95%CI (1.60, 2.94) 〕 (P<0.05) . Sensitivity analysis demonstrated that there was high-level agreement on risks for PSMs in these studies, and the results of meta-analysis was robust. Asymmetric funnel plots showed potential publication bias for the meta-analysis of the impact of pre-RP PSA, post-RP pathological T stage and Gleason score on PSMs, while symmetric funnel plot showed no potential publication bias for the meta-analysis of the impact of pre-RP clinical T stage on PSMs.

Conclusion

PSA, perineural invasion at puncture time, pre-RP clinical stage T3 or T4, post-RP pathological stage T3 or T4, high percentage of positive puncture stitches, high Gleason score at the time of puncture, and high Gleason score after RP were risk factors for PSMs after RP, which should be early recognized and addressed to halt tumor growth and recurrence.

Traditional Chinese Medicine

Short-term Clinical Effect of Guasha Combined with Drug Therapy on Idiopathic Parkinson's Disease

WANG Qiuqin, ZHANG Yutong, XU Yuchen, BAI Yamei, CHEN Hua, JIANG Rongrong, YAN Shuxia, WANG Qing, XU Guihua, XIE Ying, QIAO Chun, YANG Juan

2023, 26(17):  2155-2161.  DOI: 10.12114/j.issn.1007-9572.2022.0904

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Background

Parkinson's disease (PD) , as one of the most common neurodegenerative diseases, has become a global medical problem due to the obvious adverse reaction of drug treatment and the reduced efficacy of long-term use. Guasha is one of the widely used non-drug therapies of traditional Chinese medicine (TCM) with unique advantages in the treatment of nervous system diseases. At present, there are few studies on the treatment of idiopathic PD with Guasha combined with drug therapy.

Objective

To explore the short-term clinical effect of Guasha combined with drug therapy for idiopathic PD.

Methods

Sixteen patients with idiopathic PD in the early and middle stages selected by the purposive sampling method from March 2021 to September 2021 in outpatients of Nanjing Hospital of Chinese Medicine and Jiangsu Province Hospital were selected as the observation group, and another 16 patients with idiopathic PD were selected as the control group according to the principle of matching gender, age, course of disease and Hoehn-Yahr stage. The observation group was treated with Guasha combined with western medicine orally for 4 weeks as a course of treatment; after 3 courses of treatment, Guasha was stopped and western medicine orally continued for 1 course of treatment as follow-up. The control group was treated with simple western medicine orally for 4 weeks as a course of treatment, and the last one of 4 courses of treatment was recorded as follow-up. After 3 months of treatment and 1 month of follow-up, the Movement Disorder Society-Unified Parkinson's Disease Rating ScaleⅢ (MDS-UPDRSⅢ) score, Non-motor Symptom Score (NMSS) and clinical efficacy were observed. The levels of serum interleukin-1β (IL-1β) and nuclear transcription factor κB (NF-κB) were observed after 3 months of treatment.

Results

After 3 months of treatment, the scores of MDS-UPDRS Ⅲ and NMSS, and the levels of serum IL-1β and NF-κB in two groups were lower than those before treatment (P<0.05) . After 1 month of follow-up, the scores of MDS-UPDRS Ⅲ and NMSS in two groups were lower than those before treatment (P<0.001) . The score of MDS-UPDRSⅢ of the control group at 1-month follow-up was lower than that at 3 months (P<0.001) . The score of NMSS of the observation group at 1-month follow-up was higher than that at 3 months (P=0.002) . The scores of MDS-UPDRSⅢ and NMSS in the observation group were lower than those in the control group after 3 months of treatment and 1 month of follow-up, and the differences were all statistically significant (P<0.05) . The levels of serum IL-1β and NF-κB in the observation group were lower than those in the control group after treatment (P<0.05) . After 3 months of treatment and 1 month of follow-up, the clinical efficacy of the observation group was better than that of the control group (Z=-3.651, -3.468, P<0.05) .

Conclusion

It is safe and feasible for Guasha combined with drug therapy in the treatment of idiopathic PD patients at the early and middle stage, which can improve some motor dysfunction and alleviate non-motor symptoms and significantly improve the clinical efficacy. However, its long-term efficacy needs to be further explored by large sample and multi-center studies.

Effect of Jin's Three Needles Therapy Combined with Mirror Therapy on Lower Limb Dysfunction with Cerebral Infarction Patients: Analysis Based on Surface Electromyography

XU Mingzhu, LIN Run, WEN Huaneng, WANG Yixiao, LIU Lu, WANG Bihan, CHEN Kexun, XUAN Chunyu, CUI Shaoyang

2023, 26(17):  2162-2168.  DOI: 10.12114/j.issn.1007-9572.2023.0064

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Background

Cerebral infarction often leads to lower limb motor dysfunction and reduces patients' quality of life. Previous studies have shown that acupuncture combined with mirror therapy can improve lower limb dysfunction in patients with cerebral infarction, but there are few studies and the evaluation methods need to be supplemented.

Objective

To analyse the clinical efficacy of Jin's three needles therapy combined with mirror therapy in the treatment of lower limb dysfunction in patients with cerebral infarction based on surface electromyography (sEMG) .

Methods

Ninety lower limb dysfunction with cerebral infarction patients in the Department of Rehabilitation Medicine and the Department of Neurology of Shenzhen Hospital of Southern Medical University from July to December in 2022 were selected as the study subjects and divided into the Jin's three needles therapy group, mirror therapy group and Jin's three needles therapy combined with mirror therapy group. Patients in all three groups received basic treatment, Jin's three needles therapy was added to the Jin's three needles therapy group, knee mirror training was added to the mirror therapy group, and the Jin's three needles therapy and knee mirror training were both added to the Jin's three needles therapy combined with mirror therapy group. All three groups were treated once/d, 5 times/week, for a total of 4 weeks. sEMG was used to evaluate the function of the lower limb muscle and nervous system of the affected side before and after treatment, including time-domain index〔root mean square (RMS) 〕 and frequency-domain index〔median frequency (MF) 〕. Lower limb motor function was assessed using the Fugl-Meyer Assessment-Lower Extremity (FMA-LE) .

Results

There was no statistically significant difference in the scores of RMS and MF of biceps femoris, anterior tibial muscle, rectus femoris and gastrocnemius muscle in the affected side after 4 weeks of treatment between the mirror therapy group and the Jin's three-needle therapy group (P>0.05) . The scores of RMS and MF of biceps femoris, anterior tibial muscle, rectus femoris and gastrocnemius of the affected side after 4 weeks of treatment in the Jin's three-needle therapy combined with mirror therapy group were higher than those in the Jin's three needles therapy and mirror therapy group (P<0.05) . The FMA-LE scores of patients after 4 weeks of treatment in the Jin's three needles therapy combined with mirror therapy group were higher than those in the Jin's three-needle therapy and mirror therapy groups (P<0.05) .

Conclusion

Compared with the Jin's three-needle therapy or mirror therapy, Jin's three-needle therapy combined with mirror therapy can more effectively improve the lower limb muscle nervous system function and motor function of patients with cerebral infarction.

Review & Perspectives

Neutrophil-to-lymphocyte Ratio and Red Cell Distribution Width as Potential Biomarkers of Frailty: a Scoping Review

GOU Dengqun, ZHANG Lu, XU Yuanli, JIANG Mingjiao, WU Hemei, TAO Ming

2023, 26(17):  2169-2175.  DOI: 10.12114/j.issn.1007-9572.2022.0647

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Background

Frailty is associated with aging, which has recently become a health issue needs to be addressed urgently in the aging population. Neutrophil-to-lymphocyte ratio (NLR) and red cell distribution width (RDW) are novel inflammatory markers that are readily available clinically. Understanding the association of them with frailty is helpful to identify and monitor the development of frailty. There are few studies on the association of NLR and RDW with frailty, and they are not appropriate for traditional meta-analysis due to great heterogeneity between the study results.

Objective

To perform a scoping review of studies on NLR and RDW as potential biomarkers of frailty, so as to provide a reference for clarifying the pathogenesis of frailty and developing or improving frailty-related assessment tools.

Methods

Studies on the association of NLR and RDW with frailty were searched in eight databases (PubMed, Embase, Cochrane Library, Web of Science, CNKI, Wanfang Data, VIP and SinoMed) from inception to March 1, 2022. The studies on NLR and RDW as potential biomarkers of frailty was independently screened by two investigators, and the first author, publication time, country or region of publication, sample information, study methods, assessment tools, and assessment results were extracted. The quality of the literature was assessed using the Newcastle-Ottawa Scale and the AHRQ checklist for cross-sectional studies.

Results

A total of fourteen studies were enrolled, including five cross-sectional studies, four longitudinal studies, one cohort study and four case-control studies, which were all rated≥4 points in terms of methodological quality, indicating that they were high quality. Nine studies examined the association between NLR and frailty, and seven of them showed that elevated NLR was independently associated with increased risk of frailty, and could predict its progression. Seven studies analyzed the association between RDW and frailty, and five of them showed that elevated RDW was independently associated with increased risk of frailty, and could predict its progression.

Conclusion

Some studies have shown that the risk of frailty increased with the elevation of NLR or RDW in different populations, and its progression could be predicted by NLR or RDW. As potential biomarkers of frailty, NLR and RDW could provide evidence for the pathogenesis of frailty, and a new theoretical basis for the development or improvement of frailty assessment tools. However, the optimal cut-off value of both for predicting frailty in different age groups and sex groups needs to be studied further.

Advances of NLRP3 Inflammasome in Post-stroke Cognitive Impairment

LI Xiaoxiao, BAI Yanjie, WANG Yan, ZHANG Yongchuang, CHEN Shuying, CHEN Limin

2023, 26(17):  2176-2182.  DOI: 10.12114/j.issn.1007-9572.2022.0609

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A common complication of stroke patients is post-stroke cognitive impairment (PSCI) , which significantly reduces their quality of life. There are no effective targeted treatment measures currently available for PSCI in clinical practice. A large number of studies have already indicated that the activation of NLRP3 inflammasome plays a crucial role in PSCI, and many inhibitory treatments have been shown to improve cognitive impairment. The purpose of this study was to summarized the activation and modulating factors of NLRP3 inflammatory bodies and the relationship with PSCI. Some studies have been demonstrated that inhibiting NLRP3 or its associated inflammatory body components reduces the inflammatory response, promoting cognitive function recovery in cell and animal models of PSCI. Consequently, targeting NLRP3 inflammatory bodies may be a new trends of dealing with PSCI treatment. Despite the fact that numerous drugs and therapeutic measures have been proved to suppress the activation of NLRP3 inflammatory bodies, their clinical efficacy and safety have not yet been confirmed.