Table of Content

15 July 2023, Volume 26 Issue 20

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Guideline·Consensus

Quality Assessment and Recommendations of Clinical Guidelines and Consensuses on Non-alcoholic Fatty Liver Disease: a Comparative Study

ZHANG Zhuoran, YU Changhe, AN Yi, HE Xin, GUO Yi, DENG Jinyan, LI Yue, HAN Deng, PI Shanshan, HE Junzhi, CHEN Yue, YE Yong'an, DU Hongbo

2023, 26(20):  2439-2446.  DOI: 10.12114/j.issn.1007-9572.2022.0835

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Background

Non-alcoholic fatty liver disease (NAFLD) is a common disease of the digestive system. With the improvements of living standards and breakthroughs in viral hepatitis research, NAFLD has replaced viral hepatitis as the most common chronic liver disease. Guidance documents can provide clinical staff with standard and reliable diagnosis and treatment approaches. The screening and development of high-quality guidance documents is of great importance to standardise the clinical practice of NAFLD.

Objective

To analyze the methodological quality and reporting quality of guidance documents for NAFLD, summarize and compare the recommendations, so as to provide a reference for the development and report of future guidelines for NAFLD.

Methods

PubMed, CNKI, CBM, Wanfang Data Knowledge Service Platform, VIP Database were searched for clinical guidelines and consensuses on NAFLD supplemented by WHO, GIN, NICE, SIGN and Medlive from 2012-01-01 to 2022-01-01. Two researchers in the field of liver disease screened the literature, extracted the data and independently evaluated the methodological quality and reporting quality of the included guideline documents using AGREE Ⅱ and RIGHT, respectively. The recommendations of the higher quality guideline documents were collated and compared by the two researchers.

Results

A total of 19 publications were enrolled, including 12 guidelines and 7 consensuses; 6 in Chinese and 13 in English; 10 of which were developed using an evidence-based approach. The average scores for each domain of AGREE Ⅱ were 42.84% for scope and purpose, 31.43% for participants, 31.25% for rigour, 60.67% for clarity, 32.68% for application and 37.50% for independence. The average scores of RIGHT in each area were 59.65% for basic information, 66.12% for background, 42.11% for evidence, 39.85% for recommendations, 17.11% for review and quality assurance, 18.42% for funding and conflict of interest statement and management, 47.37% for other aspects. The average scores in AGREEⅡ and reporting qualities in RIGHT of evidence-based guidance documents were both higher than non-evidence-based guidance documents. The average scores in AGREEⅡ and reporting qualities in RIGHT of foreign guidance documents were higher than domestic guidance documents. The main recommendations relate to screening and diagnosis, assessment, management (non-pharmacologic and pharmacologic treatment) and surgical treatment.

Conclusion

The methodological quality and reporting quality of the published guidance documents for NAFLD still need to be improved, and there are still gaps between domestic guidance documents and international guidance documents. The development of TCM guidance documents should follow an evidence-based approach. Further reference should be made to international standards such as AGREE Ⅱ and RIGHT in the development and reporting of guidelines. Clinical screening awareness for high-risk population of NAFLD and a comprehensive system for early non-invasive diagnosis and assessment should be established. Multidimensional treatment plans for lifestyle, liver function and metabolic disorders should be provided for patients with NAFLD.

Approaches to Improving General Practice

How to Synergize the Development of General Practice and Sleep Medicine

HAN Tingting, CUI Xiaochuan, HAN Fang

2023, 26(20):  2447-2451.  DOI: 10.12114/j.issn.1007-9572.2022.0482

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General medicine and sleep medicine are two emerging clinical disciplines in China. They have many common things with complementarity in their own developments, and some crossovers in academic development of disciplines and talent training. The China National Accreditation Service for Conformity Assessment has opened up a way for general practitioners to engage in sleep medicine, which may be a basis and a necessity for sound cooperative development of general medicine and sleep medicine. We analyzed the basis and necessity of the cooperative development of general medicine and sleep medicine, introduced relevant experiences of Nanjing Medical University Affiliated Wuxi People's Hospital in the co-construction of general medicine and sleep medicine, and invited relevant experts to discuss the current issues.

Skills Training of Infectious Diseases in the Community: a Survey Research of Questions

ZHANG Dahao, YAN Weihui, CHENG Dandan, LIN Chengbiao, WU Jiang, XIANG Yuling, HUANG Zhiwei

2023, 26(20):  2452-2458.  DOI: 10.12114/j.issn.1007-9572.2022.0771

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Background

As the most basic unit of infectious disease prevention and control, community health service institutions are the frontline and important gateway for the prevention and control of infectious disease. Primary care physicians are responsible for epidemic surveillance, vaccination, health promotion and assistance to centers for disease control in investigating and disposing outbreaks and public health emergencies in their districts, and play an active role in disease prevention and control by groups, susceptible population protection, infectious source control and health education, as well as the effective prevention and control of infectious diseases.

Objective

To understand the ability of primary care physicians to diagnose and treat infectious diseases in the community, analyse their existing problems and shortcomings, design and conduct a series of intensive training related to infectious diseases for improving the capacity of infectious disease prevention and control at the primary level; To evaluate the effectiveness of online continuing medical education, so as to provide a reference for better continuing medical education on infectious diseases in the community.

Methods

All participants of the National Community Infectious Diseases Continuing Education Conference held by the Department of Family Medicine of the University of Hong Kong-Shenzhen Hospital in November 2021 were selected as research subjects from November 2021 to March 2022. The questionnaires were distributed to all registered attendees before and after the conference through the QR code of the questionnaire star, and the content of pre-conference questionnaire included demographic characteristics of the participants, participation in infectious disease training in the community since started working, diagnosis and treatment of infectious diseases in the community, subjective attitudes towards the prevention and control of infectious diseases in the community (willingness to manage infectious diseases in the community, satisfaction with their own infectious disease management skills), expertise in infectious disease prevention and control and knowledge related to conference content, attitude towards hepatitis B. The content of the post-conference questionnaire mainly included knowledge about the content of conference, attitude towards hepatitis B and satisfaction survey of this online conference. A total of 301 primary care physicians completed the questionnaire before and after the conference, and a total of 194 completed the questionnaire before and after the conference.

Results

Among all participants, 166 (55.1%) had attended infectious disease training in the community, of whom 49 (29.5%) were satisfied with their infectious disease diagnosis and treatment ability; 135 (44.8%) had not attended the training, of whom 22 (16.3%) were satisfied with their infectious disease diagnosis and treatment ability. 143 (86.1 %) of 166 participants who had attended infectious disease training in the community indicated their willingness to manage community infectious diseases, 99 (73.3%) of 135 participants who had not attended infectious disease training in the community indicated their willingness to manage community infectious diseases. 66 (27.3%) of participants who were satisfied with their infectious disease diagnosis and treatment ability indicated their willingness to manage community infectious diseases. The top three infectious disease tests conducted by the institutions were hepatitis B, AIDS, and hepatitis C; the top three infectious diseases treated in the past six months were hepatitis B, influenza, hand, foot and mouth disease. Different self-evaluation and willingness to train may affect the willingness to manage community infectious diseases (P<0.05). Among the participants who completed the questionnaire both before and after the conference, the highest correct answer rate for compulsory management of statutory infectious diseases before the conference was 89.7%, the lowest accuracy rate for the type of disinfection of the COVID-19 infection was only 17.0%, the correct rates of other questions ranged from 34.0% to 40.7%. The correct rates of the questions after the conference were higher than those before the conference, and the correct rates ranged from 48.9% to 52.6%. The score of attitude towards hepatitis B after the conference was higher than that before the conference (P<0.05). In terms of feedback after conference, 254 (98.1%) expressed satisfaction in the total of 259 questionnaires. In terms of suggestions for online conference, 179 (69.1%) and 174 (67.2%) participants believed that online fluency and online interaction need to be improved.

Conclusion

The primary care physicians receive relatively less infectious diseases training in the community, inadequate infectious diseases training in the community can improve the confidence of self-competence, attitude of active management of infectious diseases and diagnosis and treatment ability in the primary care physicians. The future direction of continuing medical education should focus on the training of emerging infectious diseases and novel medical concepts, relevant experts should be invited to comment on the necessity and effectiveness of training in the community.

Original Research

Association of Obstructive Sleep Apnea-hypopnea Syndrome with Blood Pressure Variability and Heart Rate Variability in Patients with Hypertension

FEI Min, LEI Si, XU Yan, YE Yun, ZHUO Hui, ZHANG Hui, LUO Yingquan

2023, 26(20):  2459-2468.  DOI: 10.12114/j.issn.1007-9572.2023.0068

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Background

Obstructive sleep apnea-hypopnea syndrome (OSAHS) is highly prevalent but is underdiagnosed in hypertensive patients. There are few studies on the internal association of OSAHS with two predictors of cardiovascular events, namely heart rate variability (HRV) and blood pressure variability (BPV), in hypertensive patients.

Objective

To explore the influence of OSAHS on HRV and BPV in hypertension patients, and to develop and validate a nomogram for predicting the risk of OSAHS in these patients using HRV and BRV related indicators.

Methods

Two hundred and twenty-eight hypertensive patients〔including 114 without OSAHS (simple hypertension subgroup) and 114 with OSAHS (hypertension with OSAHS subgroup) assessed by the diagnostic criteria of OSAHS〕were selected as internal validation group from the Second Xiangya Hospital of Central South University from January 2018 to December 2020, and other 34 hypertensive patients with or without OSAHS who hospitalized in the same hospital during January to February 2021 were selected as an independent external verification group. General information (age, gender, BMI, etc.〕, average blood pressure level〔nighttime systolic blood pressure (nSBP), etc.〕, BPV related indices〔nighttime systolic blood pressure standard deviation (nSSD), nighttime diastolic blood pressure standard deviation (nDSD), 24-hour diastolic blood pressure standard deviations (24 hDSD), etc〕, blood pressure circadian rhythm, HRV related parameters〔standard deviation of the mean RR intervals (SDANN), low frequency (LF), etc.〕, polysomnography parameters〔oxygen desaturation index (ODI), apnea hypopnea index (AHI), minimum oxygen saturation (MinSpO₂), etc.〕. Multiple linear regression analysis were used to explore the influencing factors of HRV and BPV. Restricted cubic splines were used to test the correlation of the average blood pressure level, BPV and HRV related indicators with the risk of OSAHS. Multivariate Logistic regression model was used to analyze the influencing factors of OSAHS, and the screened factors were used to construct a nomogram for predicting OSAHS risk. The Bootstrap method was used to validate the performance of the internal and external groups in the nomogram model. And its predictive value for OSAHS risk in the two groups was assessed using the receiver operating characteristic (ROC) curve with the area under the curve (AUC) and other indicators calculated.

Results

Multiple linear regression analysis showed that BMI, ODI and MinSpO₂ were independently associated with nSSD, nDSD or HRV related indices in hypertensive patients with OSAHS (P<0.05). Restricted cubic splines revealed that BPV related indices had a nonlinear relationship with OSAHS, and so did HRV related indices (P<0.05). Multivariate Logistic regression analysis showed that nSBP, nSSD, 24 hDSD, SDANN, LF, age and BMI were associated with OSAHS in hypertensive patients (P<0.05). The Bootstrap method showed that, the absolute error of the nomogram constructed using age, BMI, nSBP, nSSD, 24 hDSD, SDANN and LF was 0.013 in internal verification group, and was 0.021 in external verification group, indicating that the model had good calibration. The values of the AUC of the nomogram in predicting the risk of OSAHS in hypertension in internal and external validation groups were 0.861〔95%CI (0.818, 0.919), P<0.001〕 and 0.744〔95%CI (0.691, 0.839), P<0.001〕, respectively.

Conclusion

OSAHS can increase the nSSD and nDSD and decrease HRV in hypertensive patients. Both HRV and BPV are closely related to the severity of OSAHS. Nocturnal hypoxia may be more likely to cause changes in blood pressure and heart rate. Our nomogram could be used to facilitate individualized prediction of OSAHS risk in hypertensive patients. HRV and BPV parameters might be powerful tools to screen for OSAHS.

Correlation of Shearing Force and Estradiol with Hypertension

YU Tong, YANG Yi, DU Shihong, DING Zihao, HONG Xiuqin

2023, 26(20):  2469-2475.  DOI: 10.12114/j.issn.1007-9572.2023.0008

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Background

Low shearing force can induce vascular inflammatory response, which leads to the occurrence and development of hypertension. Estrogen can regulate the immune system and inflammatory response through estrogen receptor mediated pathway, with a protective effect on hypertension. Cardiovascular diseases have become the leading cause of death in China.

Objective

To investigate the current prevalence and influencing factors of hypertension in women, explore the correlation of shearing force and estradiol with hypertension as well as the effect of estradiol on hypertension under various shearing force, so as to further explore the effect of the interaction between estradiol and shearing force on hypertension.

Methods

Female patients admitted to the Department of Cardiology of Hunan People's Hospital from January to August 2021 were selected as the study subjects, 288 of whom with essential hypertension were included as the case group, and 296 female non-hypertensive medical examiners in the physical examination department of Hunan People's Hospital were randomly selected as the control group. The self-designed questionnaire was used to investigate the general information of the study subjects, and the fasting venous blood samples of the subjects were taken in the early morning for the examination of laboratory indicators. The color doppler ultrasound was used for ultrasonography on vessels to calculate the shearing force. Multivariate Logistic regression was used to construct the hypertension prediction model and draw the nomogram. Receiver operating characteristic curve (ROC curve) was plotted to evaluate the hypertension prediction model. Stratification analysis was conducted on estradiol in four groups to explore the effect of each estradiol group on the occurrence of hypertension under different shearing force dichotomous groups. The multiplicative interaction model was used to evaluate the interaction between estradiol and shearing force.

Results

There were significant differences in age, education level, body mass index (BMI), menopause, family history of hypertension, triglyceride (TG), total cholesterol (TC), low density lipoprotein cholesterol (LDL-C), high density lipoprotein cholesterol (HDL-C), estradiol, uric acid (UA), creatinine (Scr), urea nitrogen (BUN), shear force, and blood viscosity between the case group and control group (P<0.05). Multivariate Logistic regression results showed age>60 years old〔OR=2.172, 95%CI (1.361, 3.468) 〕, menopause〔OR=14.940, 95%CI (1.938, 115.176) 〕, family history of hypertension〔OR=1.614, 95%CI (1.014, 2.570) 〕, BMI of 24-28 kg/m²〔OR=3.454, 95%CI (2.072, 5.758) 〕, BMI>28 kg/m²〔OR=6.750, 95%CI (2.380, 19.146) 〕, TG of 1.30-1.83 mmol/L〔OR=1.980, 95%CI (1.114, 3.520) 〕, TG>1.83 mmol/L〔OR=2.311, 95%CI (1.308, 4.082) 〕, TC of 4.29-5.12 mmol/L〔OR=2.222, 95%CI (1.250, 3.950) 〕, TC>5.12 mmol/L〔OR=1.884, 95%CI (1.062, 3.341) 〕, LDL-C>2.81 mmol/L〔OR=1.546, 95%CI (1.150, 2.078) 〕, HDL-C>1.17 mmol/L〔OR=0.140, 95%CI (0.065, 0.301) 〕, BUN>5.47 mmol/L〔OR=3.249, 95%CI (2.380, 4.434) 〕, Scr>69 μmol/L〔OR=1.166, 95%CI (1.126, 1.207) 〕, UA>324 μmol/L〔OR=1.040, 95%CI (1.029, 1.050) 〕, WBV<3.39 mPa·s or >4.41 mPa·s〔OR=3.456, 95%CI (2.557, 4.671) 〕, estradiol of 10.60-<15.39 ng/L〔OR=0.053, 95%CI (0.015, 0.183) 〕, estradiol of 15.39-<23.99 ng/L〔OR=0.022, 95%CI (0.006, 0.077) 〕, estradiol >23.99 ng/L〔OR=0.005, 95%CI (0.001, 0.020) 〕, shearing force >8.21 dyne/cm²〔OR=0.033, 95%CI (0.017, 0.062) 〕were influncing factors for hypertension (P<0.05). ROC curve of clinical prediction model of hypertension was plotted, the results showed that the area under ROC curve of the prediction model was 0.907〔95%CI (0.882, 0.923), P<0.01〕, with sensitivity of 79.60% and specificity of 87.90%. The risk of hypertension tended to decrease in the shearing force≤8.21 dyne/cm² group (P_trend =0.001). In the shearing force ≤8.21 dyne/cm² group, estradiol≥15.39 ng/L was more significantly associated with reduced risk of hypertension〔OR=0.037, 95%CI (0.017, 0.079), P<0.05〕. In the shearing force >8.21 dyne/cm² group, estradiol≥15.39 ng/L was significantly associated with reduced risk of hypertension〔OR=0.012, 95%CI (0.005, 0.019), P<0.05〕.

Conclusion

Estradiol≥10.60 ng/L as a protective factor for hypertension, with higher protective effect of estrogen on hypertension at low shearing force, and there is a multiplicative interaction between shearing force and estradiol on hypertension.

Effect of Azovudine on Hepatic and Renal Function in Patients with COVID-19: a Case Series Study

HE Mei, LI Hui, MU Lifeng, YANG Ming

2023, 26(20):  2476-2481.  DOI: 10.12114/j.issn.1007-9572.2023.0117

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Background

Azovudine is a widely used antiviral drug for COVID-19 in China, but published trials on its effect on hepaticand renal function are extremely scarce.

Objective

To explore the changes of in hepatic and renal function in patients with COVID-19 infection after using Azovudine, so as to provide a reference for thesafe use of Azovudine in patients with renal insufficiency.

Methods

Inpatients ina tertiary general hospitalwho used Azovudine for COVID-19 from December 26, 2022 to December 31, 2022 were consecutively included in the retrospective study and divided into the normal group, mild injury group, moderate injury group, severe injury group, and end-stage groupaccording to estimated glomerularrate (eGFR) levels. The changes of biochemical parametersof liver and kidney including alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (ALP), albumin (ALB), total bilirubin (TB), serum creatinine (Scr), eGFR were observed in each group; the formula D_FR=D_NL×[1-F_k (1-K_f) ] was used to correct the maintenance dose of Azivudine in patients with eGFR<60 mL·min^-1· (1.73 m²) ^-1. The patients were divided into the corrected group and uncorrected group according to whether they were administered according to this formula, the biochemical parameters of liver and kidney were compared between the two groups.

Results

Among 322 patients who used Azovudine, 190 patients met the inclusion and exclusion criteria. After grouping by the level of eGFR, there were statistically significant differences in the distribution of age, COVID-19 severity, peak procalcitonin (PCT) values, antihypertensive drugs, loop diuretics and Azovudine maintenance dose in each group (P<0.05) ; there were 73 cases (38.4%) with elevated ALT level after Azovudine treatment, and 68 cases (93.2%) with elevated ALT level within one time of the upper normal limit; eGFR decreased in 58 cases (30.5%), of which 7 cases (12.1%) dropped to the next renal function grade; regardless of the grade of renal injury, there were no deterioration in eGFR, ALT, AST, TB, ALP and albumin after the use of conventional dose or corrected dose of Azivudine (P>0.05) ; because the patients with moderate and severe renal injury were dose-corrected with Azivudine, the safety of this population was not compared if the dose was not corrected.

Conclusion

The use of Azivudine is prone to cause the elevation of ALT level and the decrease of eGFR, but the injury with clinical significance is 2.6% and 3.7%, respectively; there was no aggravation of liver and kidney injury in patients with moderate and severe kidney injury after using the corrected dose of Azivudine, however, this conclusion needs to be confirmed in a multicenter randomized controlled study with a large sample.

Combined Predictive Value of Neutrophil-to-lymphocyte Ratio and Platelet-to-lymphocyte Ratio for In-hospital Mortality Risk in Patients with Acute Myocardial Infarction

CHEN Yan, CHEN Shengyue, HAN Yuanyuan, LYU Zhibo, XU Qing, ZHAO Xin

2023, 26(20):  2482-2487.  DOI: 10.12114/j.issn.1007-9572.2022.0877

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Background

Neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) have been shown to have significant predictive value for cardiovascular disease in previous studies, however, whether the combination of NLR and PLR can enhance the predictive value for in-hospital mortality risk in patients with acute myocardial infarction (AMI) has not been investigated.

Objective

To investigate the combined predictive value of NLR and PLR in the short-term prognosis of AMI patients.

Methods

The case data of 3 246 AMI patients hospitalized in the Department of Cardiology of the Second Hospital of Dalian Medical University from December 2015 to December 2021 were included, with the final outcome of all-cause death during hospitalization, who were divided into in-hospital death and non-death groupsand matched 1∶1 using propensity score matching (PSM). Receiver operating characteristic (ROC) curves were plotted for the predictive value of NLR+PLR, NLR, and PLR for the risk of in-hospital death in AMI patients. In order to better evaluate the predictive value of NLR+PLR for in-hospital mortality risk in patients with different types of AMI, patients were divided into NSTEMI and STEMI groups, and the predictive values of NLR+PLR, NLR, and PLR for in-hospital mortality risk in patients with NSTEMI and STEMI groups were analyzed.

Results

(1) Patients who died during hospitalization were matched based on PSM in a 1∶1 ratio, with 115 patients in each group. There was no significantly different in matching variables between the two groups after matching (P>0.05). (2) The area under the ROC curve of NLR + PLR for predicting the risk of in-hospital mortality in AMI patients (AUC=0.754) was greater than NLR (AUC=0.731) and PLR (AUC=0.577) (P<0.05). (3) NLR+PLR had a higher predictive ability for in-hospital mortality risk in STEMI patients (AUC=0.797) than in NSTEMI patients (AUC=0.739) .

Conclusion

Compared with NLR or PLR alone, the combination of NLR and PLR can better predict the risk of in-hospital mortality in AMI patients, especially with better efficacy in STEMI patients.

A Nephrotic Syndrome-specific Quality of Life Scale: Development Based on the Quality of Life Instruments for Chronic Diseases, and Verification Using the Classical Test Theory

ZHANG Xingshan, LIN Yue, WAN Chonghua, SONG Aifeng, PAN Haiyan

2023, 26(20):  2488-2495.  DOI: 10.12114/j.issn.1007-9572.2022.0728

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Background

The quality of life of patients with nephrotic syndrome requires a lot of focus, and improvements. A relevant scale can be used to measure it, but there is no nephrotic syndrome-specific quality of scale.

Objective

To develop a Quality of Life Instruments for Chronic Diseases-Nephrotic Syndrome〔QLICD-NS (V2.0) 〕 combined with QLICD-GM (V2.0), then verify it using the classical test theory.

Methods

From 2017 to 2021, an item pool was established according to literature review and the results of a semi-structured questionnaire, then the items were screened in accordance with a pre-test and importance score rated by physicians and patients, after that, the draft of the QLICD-NS (V2.0) was developed. The draft version was tested using onsite interview and questionnaire survey in nephrotic syndrome patients treated in Department of Nephrology, the Affiliated Hospital of Guangdong Medical University from March to November 2021. The first measurement was conducted on the day of admission, the second measurement was conducted with some of the patients, and the third measurement was conducted on the day of discharge. The coefficient of variation, correlation coefficient and Cronbach's α, factor analysis and classical test theory were used to evaluate QLICD-NS (V2.0) .

Results

The QLICD-NS (V2.0) contains 15 items, belonging to three domains of clinical symptoms, adverse drug reactions and psychological effects. The Cronbach's α measuring the split-half reliability was greater than 0.7 for the scale and each of the three domains. With the Chinese version of SF-36 as the calibration standard, the domains of the QLICD-NS (V2.0) were highly correlated with their counterpart domains of the Chinese version of SF-36. The standardized response mean was greater than 0.80 for all domains and items (except for the cognition and social support items), indicating that the responsiveness of the QLICD-NS (V2.0) was good. Scanning the QR code in the text can obtain the detailed evaluation of the scale.

Conclusion

The QLICD-NS (V2.0) compiled by us includes 15 items, and has proven with good reliability, validity and responsiveness.

16S rDNA Sequence Analysis of the Characteristics of Gut Flora in Patients with Esophageal Squamous Cell Carcinoma

ZHANG Yushuang, KONG Lingyang, GUAN Jiachang, LI Jianbo, WANG Yiran, WANG Yu, LI Jing

2023, 26(20):  2496-2502.  DOI: 10.12114/j.issn.1007-9572.2022.0832-1

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Background

In China, esophageal cancer is one of the most common cancers, and its incidence and mortality are more than twice the global average. However, most esophageal cancers in China are not detected until they are at moderate and advanced stages with poor prognosis, so early diagnosis and treatment are urgently needed. At present, the role of gut flora in the diagnosis and treatment of esophageal cancer has attracted much attention.

Objective

To explore the basic characteristics of gut flora in patients with esophageal squamous cell carcinoma.

Methods

From the Fourth Hospital of Hebei Medical University from April to August 2022, 35 patients with esophageal squamous cell carcinoma with no previous anti-cancer treatments were included as esophageal cancer group (EC group), and 35 healthy volunteers as control group. Stool samples of the two groups were collected to detect the gut flora using 16S rDNA sequence. Then an analysis was performed on the Alpha diversity, Beta diversity〔using the principal coordinate analysis (PCoA) 〕 and differential species of gut flora 〔using the linear discriminant analysis Effect Size (LEfSe) 〕 of two groups according to the species annotation of the test results.

Results

The Alpha diversity indices, such as Shannon index, Simpson index, Chao1 index, ACE index and Goods_coverage index demonstrated no significant differences between the two groups (P>0.05), while PCoA graph showed that the Beta diversity differed significantly between the two groups on the whole, and the community structures were different (t=10.837, P<0.001). T-test results showed that there were significant intergroup differences in the abundance of 16 genera at the genus level. Among the top eight genera with relatively high abundance, the abundance of Faecalibacterium, Roseburia and Citrobacter notably decreased, while that of Lactobacillus, Romboutsia, Ruminococcus_torques_group, Intestinibacter and Turicibacter notably increased in EC group (P<0.05). LEfSe analysis showed that two groups had differences in the abundance of 14 different species of gut flora. The abundance of Faecalibacterium and Faecalbacterium-prausnitzii declined significantly, and that of Romboutsia and Romboutsia-ilealis increased significantly in EC group at the genus and species levels (P<0.05) .

Conclusion

Esophageal squamous cell carcinoma patients have significantly differential gut flora, among which Faecalibacterium, Faecalibacterium -prausnitzii, Romboutsia and Romboutsia-ilealis may be specific altered species of esophageal cancer, which are closely related to the occurrence of esophageal cancer.

Executive Function of GO/NOGO Paradigm Experiment in Children with Bronchial Asthma and Its Relationship with Pulmonary Function

LI Jingbo, PANG Gaofeng, REN Yanling, SHA Xixue, NI Huiping

2023, 26(20):  2503-2507.  DOI: 10.12114/j.issn.1007-9572.2022.0843

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Background

Children with asthma may have deficits in executive functioning, affecting the quality of life and mental health of children. However, there are few studies on the relationship between executive function and pulmonary function.

Objective

To investigate whether executive dysfunction is comorbid and its specific manifestations and analyze the relationship between executive function and pulmonary function in children with bronchial asthma.

Methods

A total of 35 children diagnosed with bronchial asthma in the pediatric outpatient of the Third Affiliated Hospital of Soochow University (the First People's Hospital of Changzhou) from June 2020 to April 2022 were selected as the children with asthma group, and 35 healthy children were included in the pediatric outpatient of the Third Affiliated Hospital of Soochow University (the First People's Hospital of Changzhou) as the healthy control group. The GO/NOGO experiment was used to collect the executive function indexes and detect the pulmonary function. Pearson correlation analysis and Spearman rank correlation analysis were used to explore the relationship between executive function indexes and pulmonary function test indices.

Results

The number of hits in the children with asthma group was lower than that in the healthy control group, and the response time, response time variability and missed reporting errors were higher than those in healthy control group (P<0.05). The results of Pearson correlation analysis /Spearman rank correlation analysis showed that response time was negatively correlated with maximum vital capacity (VCmax) and forced vital capacity (FVC) in children with asthma, and response time variability was negatively correlated with VCmax, FVC and forced expiratory volume in one second (P<0.05). The number of missed reports was positively correlated with percent predicted forced vital capacity (P<0.05) .

Conclusion

Compared with healthy children, children with asthma perform sustained attentional deficits and reaction rate deficits, and the executive function indexes of children with asthma is correlated with pulmonary function test indices, mainly manifested in sustained attention, reaction speed decreased.

Effect of Aurora Kinase A Expression on Biochemical Cure in Patients after Medullary Thyroid Cancer Resection

ZHAO Zewei, KANG Ning, GUO Fengli, WANG Zhongyu, ZHENG Xiangqian

2023, 26(20):  2508-2512.  DOI: 10.12114/j.issn.1007-9572.2022.0883

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Background

The relationship between aurora kinase A (Aurora A) expression level in the medullary thyroid carcinoma (MTC) tissue and the clinicopathological characteristics and biochemical cure of patients remains unclear.

Objective

To analyze the relationship between Aurora A expression level in medullary thyroid tissue and the clinicopathological characteristics of patients, to further analyze the risk factors for biochemical cure and clarify the correlation between Aurora A expression and biochemical cure.

Methods

A total of 90 patients with MTC who were hospitalized with MTC resection in the Department of Head and Neck Oncology, Tianjin Medical University Cancer Institute and Hospital from February 2011 to July 2019 were enrolled, the clinical data of the patients were collected, and Aurora A expression level in the tissues was detected by immunohistochemical detection, and the influencing factors of biochemical cure of MTC patients were explored by multivariate Logistic regression model.

Results

62 patients with high Aurora A expression level and 28 patients with low Aurora A expression were included, 40 patients achieved biochemical cure and 18 patients experienced recurrence. There were significant differences in gender, maximum tumor length, T stage, N stage, AJCC8th clinical stage, biochemical cure, and recurrence between patients with high Aurora A expression level and low Aurora A expression level (P<0.05). There were significant differences in gender, number of lesions, T stage, N stage, AJCC8th clinical stage, and Aurora A expression level between biochemically cured patients and those who were not biochemically cured (P<0.05). Multiple lesions〔OR=3.18, 95%CI (1.01, 9.97), P=0.047〕, T staging as T₃/T₄〔OR=3.69, 95%CI (1.05, 12.93), P=0.042〕, and high Aurora A expression level〔OR=3.22, 95%CI (1.07, 9.74), P=0.038〕were the influencing factors of biochemical cure in patients with MTC.

Conclusion

High Aurora A expression level is associated with tumor invasion of MTC, and the expression level of Aurora A can influence the biochemical cure in patients with MTC.

Expression and Significance of Regulatory B-lymphocytes in Peripheral Blood of Patients with Neuromyelitis Optica Spectrum Disorders

HE Dan, MA Jianhua, MA Juan, DU Lei, ZHANG Yan, HAO Chenguang

2023, 26(20):  2513-2517.  DOI: 10.12114/j.issn.1007-9572.2023.0031

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Background

Regulatory B-lymphocytes (Breg) are a group of cells with negative immunoregulatory effect, which have been detected of abnormal expression in the researches of various autoimmune diseases. Neuromyelitis optica spectrum disorders (NMOSD) belong to the category of autoimmune diseases, there are few studies on the expression and significance of Breg in the peripheral blood of patients with NMOSD.

Objective

To explore the expression and significance of Breg in peripheral blood of patients with NMOSD.

Methods

A total of 55 patients with NMOSD admitted to the Department of Neurology of the First Affiliated Hospital of Xinjiang Medical University from June 2019 to December 2021 were selected as the NMOSD group, and 50 healthy volunteers in the same period were selected as the control group. The expression of CD₁₉⁺CD₂₄^hiCD₃₈^hi Breg and CD₁₉⁺CD₂₄^hiCD₂₇⁺ Breg in peripheral blood of patients in the two groups was detected using flow cytometry, the levels of interleukin 10 (IL-10), interleukin 35 (IL-35) and transforming growth factor β1 (TGF-β1) in the serum of patients in the two groups were compared and measured by enzyme-linked immunosorbent assay (ELISA) .

Results

The proportions of CD₁₉⁺CD₂₄^hiCD₃₈^hi Breg and CD₁₉⁺CD₂₄^hiCD₂₇⁺ Breg cell phenotypes were lower in patients in the NMOSD group than in the control group (t=6.235, 12.131, P<0.05). The levels of IL-10, IL-35 and TGF-β1 were lower in patients in the NMOSD group than in the control group (t=4.249, 7.316, 2.057, P<0.05) .

Conclusion

The reduced expression of Breg and their cytokines in patients with NMOSD suggests a role for negative immune regulation in the development and progression of NMOSD disease.

Role of Prostasome-derived miRNA-146a in Regulating TLR-4/NF-κB Pathway and Mechanism of Action of Anemone Tomentosa in Treating Chronic Inflammation in a Rat Model of Experimental Autoimmune Prostatitis

LU Liangxi, SHI Hong, HUANG Zhimin, WANG Wenjie, ZOU Han, ZHANG Zhiying, WU Jinyu

2023, 26(20):  2518-2524.  DOI: 10.12114/j.issn.1007-9572.2022.0731

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Background

It is urgently necessary to find new drugs for chronic prostatitis (CP) as desired treatment effect is still yet to be achieved. Our previous clinical study has found that Anemone tomentosa (Maxim.) Péi has a good effect on CP, but the specific mechanism of action remains to be further studied.

Objective

To investigate the role of prostasome-derived miRNA-146a in regulating toll-like receptor 4/nuclear factor-κB (TLR-4/NF-κB) pathway and the mechanism of action of Anemone tomentosa in treating chronic inflammation in experimental autoimmune prostatitis (EAP) rats.

Methods

This study was conducted between December 2021 and June 2022. Forty-two Wistar rats were equally divided into seven groups using a random number table, including normal group, model group, low-, medium- and high-dose Anemone tomentosa groups, miRNA-146a mimics and inhibitor groups. After drug intervention, miRNA-146a-5p mRNA in prostasome was detected by real-time polymerase chain reaction, and TLR-4, inhibitor of NF-κB (IκB), phosphorylation of IκB (p-IκB) and tumor necrosis factor receptor-associated factor 6 (TRAF6) protein were detected by western blot, and inflammatory cytokines were detected by enzyme-linked immunosorbent assay.

Results

Compared with normal group, the expression level of miRNA-146a-5p mRNA in prostasome was down-regulated in each of the other six groups (P<0.01). Compared with model group, the expression level of miRNA-146a-5p mRNA in prostasome was up-regulated in medium- and high-dose Anemone tomentosa groups, and miRNA-146a mimics group (P<0.01), but was down-regulated in miRNA-146a inhibitor group (P<0.01). In Anemone tomentosa and miRNA-146a mimics groups, the expression levels of TLR-4, p-IκBα and TRAF6 proteins in prostate tissues were significantly down-regulated (P<0.01), the expression levels of IκBα proteins in prostate tissues were significantly up-regulated (P<0.01), and serum levels of TNF-α, interleukin (IL) -6, IL-8 and interferon-γ were significantly down-regulated (P<0.05), indicating that Anemone tomentosa and miRNA-146a mimics significantly reduced the inflammatory cell infiltration and improved the pathological injury in prostate tissue.

Conclusion

Prostasome-derived miRNA-146a can participate in local pathological changes of prostate via regulating the activation of TLR-4/NF-κB pathway in EAP rats. The mechanism of action of Anemone tomentosa inhibiting chronic inflammation in EAP rats may be related to its regulation of prostasome-derived miRNA-146a modulating the TLR-4/NF-κB pathway.

Effect of Pricking-bloodletting Therapy Combined with Zhuang-medicine-thread Moxibustion on TLRs/MyD88 Signal Pathway in a Rat Model of Acute Gouty Arthritis

ZHU Danmeng, HUANG Yuying, LUO Tong'an, HE Changyuan, CHEN Rilan

2023, 26(20):  2525-2531.  DOI: 10.12114/j.issn.1007-9572.2022.0775

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Background

With the change of people's environment and diet structure, acute gouty arthritis (AGA) has become a common clinical disease, which is prone to recurrence, causing harm to patients' health. Pricking-bloodletting therapy combined with Zhuang-medicine-thread moxibustion (moxibustion with a threat prepared with Zhuang herbal medicine) has proven to have a definite therapeutic effect on AGA clinically, but the mechanism of action is not very clear.

Objective

To assess the effect of pricking-bloodletting therapy combined with Zhuang-medicine-thread moxibustion on toll-like receptors /myeloid differentiation factor 88 (TLRs/MyD88) signal pathway in a rat model of AGA to explore the mechanism of action of this treatment in AGA.

Methods

The experiment lasted from May 2021 to March 2022, sixty SD rats were equally randomized into 6 groups: blank group, model group, pricking-bloodletting group, medicated thread group, colchicine group and pricking-bloodletting with medicated thread group. Except for the blank group, the other groups received sodium urate suspension injected into the right ankle cavity to prepare the AGA model. Twenty-four hours after the modelling, colchicine group received intragastric administration of colchicine suspension, pricking-bloodletting group received bloodletting after pricking the Ashi acupoint with a needle, medicated thread group received Zhuang-medicine-thread moxibustion at the site of lesion, and pricking-bloodletting with medicated thread group first received bloodletting after pricking the Ashi acupoint with a needle, then Zhuang-medicine-thread moxibustion at the site of lesion. The swelling degree of the right ankle joint was observed at 6, 12, 24 h and 72 h after modeling. Hematoxylin-eosin staining was used to observe the pathological changes of the synovium of the right ankle joint. The serum levels of interleukin (IL) -10, IL-8 and cyclooxygenase-2 (COX-2) were determined by ELISA. The expressions of MyD88 and IKK-β in the synovium of the right ankle were detected by western blotting.

Results

The transverse diameter of right lateral malleolus in model group, pricking-bloodletting group, medicated thread group or colchicine group was larger than that in blank group at 6, 12, 24, 48 h and 72 h after modeling (P<0.05). The transverse diameter of right lateral malleolus in pricking-bloodletting with medicated thread group was larger than that in blank group at 6, 12, 24 h and 48 h after modeling (P<0.05). The transverse diameter of the right lateral malleolus of the pricking-bloodletting group, medicated thread group, colchicine group or pricking-bloodletting with medicated thread group was smaller than that of the model group at 48 h and 72 h after modeling (P<0.05). Compared with model group, the inflammatory cell infiltration of right ankle in pricking-bloodletting group, medicated thread group, colchicine group and pricking-bloodletting with medicated thread group was improved. The blank group had lower levels of IL-8 and COX-2 and higher level of IL-10 than each of the other 5 groups (P<0.05). The model group had higher levels of IL-8 and COX-2 and lower level of IL-10 than colchicine group, pricking-bloodletting with medicated thread group, pricking-bloodletting group or medicated thread group (P<0.05). The colchicine group had lower levels of IL-8 and COX-2 and higher level of IL-10 than pricking-bloodletting group or medicated thread group (P<0.05). The pricking-bloodletting with medicated thread group had lower levels of IL-8 and COX-2 and higher level of IL-10 than pricking-bloodletting group or medicated thread group (P<0.05). The blank group had lower level of MyD88 than each of the other 5 groups (P<0.05). The blank group had lower level of IKK-β than model group, medicated thread group, pricking-bloodletting group or pricking-bloodletting with medicated thread group (P<0.05). The model group had higher IKK-β level than medicated thread group or colchicine group (P<0.05). The model group had higher MyD8 level than medicated thread group, colchicine group, pricking-bloodletting group or pricking-bloodletting with medicated thread group (P<0.05) .

Conclusion

Pricking-bloodletting with Zhuang-medicine-thread moxibustion is effective in improving the symptoms of AGA by regulating the TLRs/MyD88 signaling pathway, which may be a potential alternative therapy for AGA.

Evidence-based Medicine

Correlation between Mycoplasma Pneumoniae Infection and Coronary Artery Lesions in Mucocutaneous Lymph Node Syndrome: a Meta-analysis

WANG Shumin, LI Xuejun, ZHANG Yixing, JIANG Zhiyan, XIAO Zhen

2023, 26(20):  2532-2539.  DOI: 10.12114/j.issn.1007-9572.2022.0540

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Background

The incidence of mucocutaneous lymph node syndrome (MCLS), also known as Kawasaki disease (KD), has been increasing year by year. Coronary artery lesions (CAL) induced by KD has become the main cause of acquired heart disease in children. Many clinical studies show that mycoplasma pneumoniae (MP) is associated with CAL in KD, but the strength of association between them differs across original research on different individuals.

Objective

To systematically evaluate the correlation between MP infection and CAL in KD, providing evidence for early and timely delivery of effective clinical treatment to improve the quality of life and to prevent adverse outcomes in children with KD.

Methods

Observational studies on KD〔KD patients with MP infection (MP-IgM positive) (exposed group) compared with those with simple KD (control group), with CAL as the outcome measure〕 were retrieved from databases of CNKI, Wanfang Data, VIP, SinoMed, PubMed, Embase, Cochrane Library and Web of Science from inception to April 3, 2022. Two researchers independently performed literature screening and data exaction. The Newcastle-Ottawa Scale (NOS) was used to evaluate the quality of included studies. Stata 15.0 and RevMan 5.4 were used for data analysis.

Results

A total of 31 studies involving 6 131 subjects were included. The average quality score of the studies rated using the NOS was 7, indicating a high overall quality. Meta-analysis showed that the risk of CAL in the exposed group was higher than that in the control group〔RR=1.65, 95%CI (1.40, 1.94), P<0.000 01〕. Subgroup analysis based on baseline data revealed that, the risk of CAL in exposed group was higher in studies on exposed and control groups with matched baseline data〔RR=1.92, 95%CI (1.71, 2.16), P<0.000 01〕, but was similar in studies on two groups with unmatched baseline data〔RR=0.98, 95%CI (0.91, 1.06), P=0.65〕. Furthermore, the risk of CAL was found to be higher in the exposed group in subgroup analysis based on MP infection diagnosed serologically with IgM>1∶160, or by quantitative PCR, or undescribed method (P<0.05). And in subgroup analysis based on age, C-creactive protein/procalcitonin ratio, or undescribed method, the risk of CAL was still higher in the exposed group (P<0.05). Egger's and Begg's tests showed that all the studies had publication bias (P<0.05). However, the comparison of the pooled effect size using the random effects model〔RR=1.32, 95%CI (1.13, 1.54), P<0.000 01〕 showed that the results before and after trimming and filling were not reversed, indicating that the results of this study were relatively stable.

Conclusion

MP infection increased the risk of CAL in children with KD. Early detection of MP and timely delivery of effective intervention are very important.

The Efficacy and Safety of Home Enteral Nutrition in Patients with Esophageal Cancer: a Meta-analysis

XUE Shan, LI Laiyou, LIANG Junli, JIN Yinghui, WEI Shuyan

2023, 26(20):  2540-2547.  DOI: 10.12114/j.issn.1007-9572.2022.0853

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Background

Malnutrition is a common complication in patients with esophageal cancer, which has been validated by domestic and international studies to seriously impact the recovery of patients. While the number of patients receiving home enteral nutrition (HEN) is increasing, the effectiveness and safety of HEN for patients with esophageal cancer remains unclear.

Objective

To systematically evaluate the effectiveness and safety of HEN by meta-analysis.

Methods

RCTs on the HEN in patients with esophageal cancer were retrieved in PubMed, Cochrane Library, Embase, Web of Science, CINAHL, Scopus, Wanfang Data, CNKI, VIP and CBM from inception to December 2021. Patients in the experimental group received HEN support〔both enteral tube feeding (ETF) and oral nutritional supplement (ONS) were both acceptable〕, while patients in the control group received conventional oral diet only. Two researchers independently screened the literature and extracted data. The RoB 2.0 recommended by the Cochrane Collaboration was used to evaluate the quality of the included studies, and the RevMan 5.4.1 software was used to perform the meta-analysis.

Results

A total of 14 articles were included, involving 1 040 patients with esophageal cancer. Meta-analysis showed that the increase values of body mass, BMI, hemoglobin, serum total protein, serum prealbumin and serum transferrin in the experimental group were higher than those in the control group〔SMD=0.63, 95%CI (0.40, 0.85), P<0.000 01; SMD=0.60, 95%CI (0.44, 0.76), P<0.000 01; SMD=1.58, 95%CI (1.37, 1.79), P<0.000 01; SMD=1.19, 95%CI (0.79, 1.58), P<0.000 01; SMD=0.97, 95%CI (0.79, 1.14), P<0.000 01; SMD=1.12, 95%CI (0.45, 1.79), P=0.001〕. The increase value of serum albumin in the experimental group was higher than that in the control group in both ETF and ONS subgroups analysis〔SMD=1.25, 95%CI (0.82, 1.68), P<0.000 01; SMD=0.61, 95%CI (0.26, 0.97), P<0.000 01〕. The incidence of malnutrition was lower in the experimental group than in the control group〔OR=0.47, 95%CI (0.33, 0.67), P<0.000 1〕. There was no statistically significant differences in the incidence of gastrointestinal complications〔RR=1.33, 95%CI (1.00, 1.77), P=0.05〕and life quality score〔MD=4.97, 95%CI (0.06, 9.87), P=0.05〕 between the two groups. The physical function score of the experimental group was higher than that of the control group〔MD=6.67, 95%CI (2.86, 10.48), P=0.000 6〕, and the fatigue symptom score was lower than that of the control group〔MD=-7.31, 95%CI (-11.85, -2.77), P=0.002〕. Sensitivity analysis showed that the combined results were stable and reliable.

Conclusion

HEN can significantly improve the nutritional status and physical function, reduce fatigue symptoms of discharged patients after esophageal cancer surgery, and does not increase the incidence of gastrointestinal complications, however, it has not been found to improve the global overall quality of life.

Cutting Edge

Novel Developments in Lung and Gut Microbiota and Their Cross-talk with the Development of Chronic Obstructive Pulmonary Disease

SHEN Junxi, ZHU Xing, CHEN Yunzhi, LI Wen

2023, 26(20):  2548-2554.  DOI: 10.12114/j.issn.1007-9572.2022.0539

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Chronic obstructive pulmonary disease (COPD) is a common chronic respiratory disease that greatly threatens human health. Studies have found that compared with the healthy population, the mucosal barrier function and immune homeostasis in COPD patients are impaired due to significantly changed composition and structure of both lung and gut microbiota, which further aggravate the disease progression. Taking measures to actively improve the microbial balance in lung and gut microbiota is very important for the prevention and delaying of the development of COPD. However, the summary and understanding of the role of lung and gut microbiota and their cross-talk mechanism in COPD still have much room for development. We reviewed the latest developments in the composition characteristics of lung and gut microbiota and the possible cross-talk mechanism between them in healthy people and COPD patients, as well as the prevention and treatment of COPD based on lung and gut microbiota and their cross-talk, providing new ideas for pathogenesis exploration, early diagnosis, prevention and treatment of COPD.

A Review of Recent Advances in Screening for Obstructive Sleep Apnea during Pregnancy

WANG Jingyu, HONG Shenda, HAN Fang, LIU Guoli

2023, 26(20):  2555-2558.  DOI: 10.12114/j.issn.1007-9572.2022.0754

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Obstructive sleep apnea (OSA) is a common sleep-disordered breathing in pregnant population, which is associated with adverse perinatal outcomes, and may have long-term health consequences on both mothers and children. Currently, the vast majority of pregnant women are underdiagnosed due to the difficulties in extensively performing polysomnography, a gold standard in OSA diagnosis. So it is essential to seek other screening strategies and tools to accurately identify pregnant women with high risk of OSA to improve their perinatal outcomes. We reviewed the prevalence of OSA in pregnancy, screening status, screening timing, target population and recent advances in screening tools, to providing a theoretical basis for implementing the screening in this group.

Study of Typical Cases

Early Postnatal Management of an Extremely Low Birth Weight Periviable Infant

TANG Binzhi, YANG Qian, LING Qiying, LI Maojun, SHI Wei, WU Qing

2023, 26(20):  2559-2566.  DOI: 10.12114/j.issn.1007-9572.2022.0625

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Periviable neonates have been implicated in a higher incidence of multi-organ injuries and complications due to the extreme prematurity, which is usually associated with poor prognosis. To date, postnatal management of periviable neonates remains one of the most challenging issues, and has been reported by limited studies. By individualized treatment and intensive care, including effective resuscitation, respiratory and circulatory support, active nutritional support and feeding, prevention and treatment of infection, management of endocrine and metabolic problems, management of preterm-related complications, and individualized nursing such as developmentally supportive care and family integrated care, a periviable baby with gestational age of 230/7 weeks and birth weight of 450 g was successfully rescued by Sichuan Academy of Medical Sciences· Sichuan Provincial People's Hospital. We summarized early postnatal management of this periviable baby and reviewing relevant literature, aiming at providing evidence for improving the survival and prognosis of periviable babies with birth weight <500 g.