Table of Content

20 December 2023, Volume 26 Issue 36

Previous Issue    Next Issue

Guidelines·Consensus

Chinese Expert Consensus on the Diagnosis and Treatment of Bulimia Nervosa

Eating Disorders Coordination Group of the Psychosomatic Medicine Society of the Chinese Medical Association, Eating Disorders Research Collaboration Group of the Psychiatric Medicine Society of the Chinese Medical Association, CHEN Yan, CHEN Han, LIU Lanying, KONG Qingmei, QIAO Huifen, ZHANG Lan, LI Xueni, KUANG Guifang, ZHANG Darong, LI Keqing, WANG Zhen, CHEN Jue

2023, 26(36):  4487-4497.  DOI: 10.12114/j.issn.1007-9572.2023.0443

Asbtract ( )   HTML ( )   PDF (1175KB) ( )  

Figures and Tables | References | Related Articles | Metrics

Bulimia nervosa is a type of eating disorders characterized by recurrent binge eating and compensatory behaviors to prevent weight gain, as well as excessive concern about body shape and mass. The patients with bulimia nervosa present with disturbed eating behavior, resulting in electrolyte abnormalities, gastrointestinal disorders, metabolic and endocrine disorders and other physical problems; secondly, the bulimia nervosa patients are often co-morbid with a variety of mental disorders such as bipolar disorder, depression, substance use disorders, which need to be taken seriously. However, bulimia nervosa and even eating disorders cannot be recognized and diagnosed at an early stage in China, which leads to a prolonged course of the disease. Therefore, under the organization of the Eating Disorders Coordination Group of the Psychosomatic Medicine Society of the Chinese Medical Association, in conjunction with the Eating Disorders Research Collaboration Group of the Psychiatric Medicine Society of the Chinese Medical Association, this expert consensus was formulated by 12 experts in the field of psychiatry and evidence-based medicine based on evidence-based medicine, domestic and foreign guidelines and expert consensus and expert experience, in order to improve the recognition, diagnosis and treatment of bulimia nervosa by psychiatric professionals and general practitioners in China.

Article

Opportunities and Challenges of Surveillance for Liver Cancer in Primary Care Institutions in China

WANG Shiyue, DONG Chen, CHANG Chudi, NAN Yuemin

2023, 26(36):  4498-4504.  DOI: 10.12114/j.issn.1007-9572.2023.0337

Asbtract ( )   HTML ( )   PDF (898KB) ( )  

References | Related Articles | Metrics

Primary liver cancer (PLC) is one of the common malignant tumors and the main causes of tumor death in China. Although the diagnosis and treatment technology of PLC in China has made great progress in recent years, its morbidity and mortality have been decreasing year by year, but the low early diagnosis rate and 5-year survival rate of PLC are major public health problems that need to be solved urgently in the field of chronic disease prevention and control. Effective implementation of early screening, detection, diagnosis and treatment of PLC is an important measure to improve the rates of radical treatment and survival. The combination of serum alpha-fetoprotein (AFP) and liver ultrasound is a routine method for screening hepatocellular carcinoma (HCC) in patients with chronic liver disease; the combination of AFP and AFP-L3 and/or abnormal prothrombin can improve the early diagnosis rate of early-stage HCC; the early diagnosis rate of small hepatocellular carcinoma can be improved by Gd-EOB-DTPA-enhanced magnetic resonance imaging or its combination with computerized tomography. With the continuous promotion of hierarchical medical system and improvement of primary medical resources allocation and health service capacity in China, primary care institutions have become an important force for early screening of many cancers. Based on this context, this paper mainly discusses the development opportunities, risk challenges and future thinking of surveillance for liver cancer in primary care institutions in China, in order to provide new ideas and direction guidance for it in the future.

Advances in Liver Cancer Screening and Health Surveillance Management in Primary Care Institutions

LU Lixia, WANG Rongqi

2023, 26(36):  4505-4509.  DOI: 10.12114/j.issn.1007-9572.2023.0240

Asbtract ( )   HTML ( )   PDF (876KB) ( )  

References | Related Articles | Metrics

At present, the incidence and mortality of primary liver cancer (hereafter referred to as liver cancer) in China are high with heavy economic and disease burden. Standardized screening and health surveillance management for population as risk of liver cancer are important measures to effectively reduce the related burden of liver cancer. Currently, patients with liver cancer in primary care institutions in China lack the awareness of the necessity of liver cancer screening and surveillance with poor compliance, and the existing screening tools are less sensitive and cost-effective. This paper discusses the strategies of liver cancer screening and health surveillance management in primary care institutuons in terms of stratification of liver cancer risk assessment and screening in primary care institutions of chronic liver disease population in China, the current status of enhanced screening and long-term surveillance for population at high risk of liver cancer, to provide a reference for the standardization of screening, early diagnosis and treatment of liver cancer in China, with the aim of improving the screening coverage and control effects of liver cancer in primary care in China.

Current Status of Lymphadenectomy during Radical Resection of Intrahepatic Cholangiocarcinoma: a Single-center Retrospective Study

HU Chao, CHENG Xi, JIN Wangxun, YAO Hongqing, WANG Xinbao

2023, 26(36):  4510-4513.  DOI: 10.12114/j.issn.1007-9572.2023.0094

Asbtract ( )   HTML ( )   PDF (867KB) ( )  

Figures and Tables | References | Related Articles | Metrics

Background

Lymph node metastasis is an important factor affecting the prognosis of patients with intrahepatic cholangiocarcinoma, but lymphadenectomy extent remains controversial both domestically and internationally.

Objective

To explore the current status of lymphadenectomy during radical resection of intrahepatic cholangiocarcinoma.

Methods

A retrospective analysis of the clinical data of 152 patients with intrahepatic cholangiocarcinoma who underwent radical resection at Zhejiang Cancer Hospital from 2017 to 2022 was conducted to determine the current status of lymphadenectomy during radical resection of intrahepatic cholangiocarcinoma, including the decision to perform lymphadenectomy, the extent of lymphadenectomy and the distribution of positive lymph nodes. The patients were divided into the left hemi-liver group and right hemi-liver group according to the location of the tumour in the liver.

Results

A total of 152 patients were selected, including 83 patients in the left hemi-liver group and 69 in the right hemi-liver group. Eighty-six of them underwently mphadenectomy, accounting for higher proportion in the left hemi-liver group〔61 cases (73.5%) 〕 than the right hemi-liver group〔25 cases (36.2%) 〕 (P<0.05) . The average number of dissected lymph nodes was (7.6±6.1) , with no significant difference between the left〔7.0 (4.0, 10.5) 〕 and right hemi-liver groups 〔5.0 (1.5, 9.5) 〕 (P>0.05) . Of the 86 patients underwent lymphadenectomy, 39 (45.3%) cases showed lymph node metastasis (positive lymph nodes) on pathological examination, accounting for higher proportion in the left hemi-liver group〔34 cases (55.7%) 〕 than the right hemi-liver group〔5 cases (20.0%) 〕 (P<0.05) . Regardless of which lobe the tumour was located, lymph node stations 8, 12, and 13 accounted for a higher proportion of metastasis in routine dissection areas, among which the proportion of lymph nodes station 12 was the highest, with 79.4% (27/34) in the left hemi-liver group and 80.0% (4/5) in the right hemi-liver group.

Conclusion

Regardless of the location of tumour, lymph node stations 8, 12 and 13 have a higher incidence of lymph node metastasis and should be considered for routine dissection during radical resection.

The Value of Nomogram Established by Serological Indicators and Tumor Diameter to Predict the Risk of Microvascular Invasion in Hepatocellular Carcinoma

TANG Can, LI Xiangyang, LI Jing, QIN Haoran, ZHU Hong

2023, 26(36):  4514-4520.  DOI: 10.12114/j.issn.1007-9572.2023.0095

Asbtract ( )   HTML ( )   PDF (990KB) ( )  

Figures and Tables | References | Related Articles | Metrics

Background

Microvascular invasion (MVI) is an aggressive behavior of hepatocellular carcinoma (HCC) that being an independent predictor of tumor recurrence after hepatectomy or liver transplantation. Preoperative prediction of MVI has important clinical significance.

Objective

To use non-invasive imaging and serological indicators to construct a nomogram for predicting MVI in order to provide a clinical reference.

Methods

The relevant clinical data of 284 patients who underwent radical resection of HCC in the Second Affiliated Hospital of Kunming Medical University from 2016 to 2021 were retrospectively analyzed, and HCC patients admitted from 2016 to 2020 were categorized as the model group (n=208) according to the admission time, and HCC patients admitted in 2021 were categorized as the validation group (n=76) . LASSO regression and multivariate Logistic regression analysis were performed to determine the independent risk factors for MVI in HCC, and R software was used to establish a nomogram model for predicting the risk of MVI in HCC before operation. The internal validation of the model was performed by Bootstrap method, external validation of the model was performed by using the validation group. The consistency index, calibration curve and decision curve analysis (DCA) were used to evaluate the discrimination, calibration ability and clinical application value of the nomogram.

Results

Multivariate Logistic regression analysis showed that WBC>7.1×10⁹/L〔OR=3.144, 95%CI (1.301, 7.598) , P=0.011〕, tumor diameter>7.05 cm〔OR=3.836, 95%CI (1.758, 8.372) , P=0.001〕, S-Index>0.097〔OR=3.165, 95%CI (1.024, 9.779) , P=0.040〕, AAR>0.879〔OR=2.146, 95%CI (1.062, 4.337) , P=0.030〕, ANRI>24.074〔OR=2.769, 95%CI (1.175, 6.526) , P=0.020〕 were independent predictors of MVI in HCC. The consistency index of the nomogram model established using the five variables combined with AFP was 0.800〔95%CI (0.739, 0.861) 〕 and 0.755〔95%CI (0.641, 0.868) 〕 in the model group and validation group, respectively. The model fitted well with the calibration prediction curve. The optimal critical value of the nomogram calculated by Youden index was 174 points. The sensitivity, specificity, positive predictive value and negative predictive value at the critical value were 90%, 61%, 71%, and 85% in the model group, and 78%, 71%, 76% and 74% in the validation set, respectively.

Conclusion

The nomogram constructed with AFP>45 ng/mL, WBC>7.1×10⁹/L, tumor diameter>7.05 cm, S-Index>0.097, AAR>0.879, ANRI>24.074 can better predict the risk of preoperative MVI in HCC, the use of this nomogram can conveniently guide the clinical treatment of HCC patients by routine examination test indicators.

Correlation between Atrial Fibrillation and the Risk of New-onset Chronic Kidney Disease in Northern Chinese Population

ZHANG Aili, HOU Qiqi, HAN Quanle, ZHANG Boheng, ZHANG Jiawei, CAO Hongxia, ZHANG Chao, CHEN Shuohua, WU Shouling, LI Kangbo

2023, 26(36):  4521-4526.  DOI: 10.12114/j.issn.1007-9572.2023.0006

Asbtract ( )   HTML ( )   PDF (931KB) ( )  

Figures and Tables | References | Related Articles | Metrics

Background

The global population disease burden report shows that atrial fibrillation (AF) and chronic kidney disease (CKD) have emerged as the fast-growing causes of death in the last 20 years. The concept of cardiorenal syndrome suggests that AF may increase the risk of new-onset CKD, however, there are few studies related to the increased risk of new-onset CKD with AF at home and abroad, and the interaction with age remains unclear atpresent.

Objective

To investigate whether AF increases the risk of new-onset CKD in northern Chinese population.

Methods

The population who attended a comprehensive health check-up for the employees of Kailuan Group in Hebei Province from 2006 to 2010 were selected as study subjects. The general information and laboratory test results of the study subjects were collected, and the study subjects were followed up with the final follow-up date of 2020-12-31 and the end point of new-onset CKD. The included patients were divided into AF group (n=368) and non-AF group (n=110 487) according to the presence or absence of AF. The cumulative incidence of new-onset CKD in patients was calculated using the lifetable method. The Kaplan-Meier method was used to plot the survival curves of the cumulative incidence of new-onset CKD in the AF group and the non-AF group. The Log-rank test was used to compare the differences in the cumulative incidence of CKD between the two groups. The multivariate Cox proportional hazard regression model was used to explore the effect of AF on the risk of new-onset CKD.

Results

AF group was higher than non-AF group in age, male proportion, systolic blood pressure level, diastolic blood pressure level, body mass index, the proportions of education level, participation in physical exercise, hypertension, diabetes, taking hypotensive drugs and hypoglycemic drugs, and high-sensitivity C-reactive protein level (P<0.05) . AF group was lower than non-AF group in the proportion of alcohol consumption, total cholesterol, triacylglycerol and low density lipoprotein cholesterinlevels (P<0.05) . There were statistically significant differences in the incidence and cumulative incidence of new-onset CKD between atrial fibrillation group and non-atrial fibrillation group (P<0.05) . Stratifying the study population by age, there were statistically significant differences in the incidence and cumulative incidence of new-onset CKD in the study subjects aged≤65 years (P<0.05) and statistically significant difference in the incidence of new-onset CKD in the study subjects aged>65 years (P<0.05) . The results of the adjusted multivariate Cox proportional hazard regression analysis showed that AF was a risk factor for new-onset CKD in people aged≤65 years〔HR=1.350, 95%CI (1.038, 1.755) , P=0.025〕.

Conclusion

AF is an independent risk factor for new-onset CKD in northern Chinese population, especially for young and middle-aged populationaged≤65 years.

Dynamic Monitoring of Gene Changes and Its Prognostic Value in Lung Cancer Patients

XUE Chongxiang, LU Xingyu, LIU Zhening, DONG Huijing, ZHENG Yumin, CUI Huijuan

2023, 26(36):  4527-4534.  DOI: 10.12114/j.issn.1007-9572.2022.0833

Asbtract ( )   HTML ( )   PDF (1139KB) ( )  

Figures and Tables | References | Related Articles | Metrics

Background

Targeted therapy, represented by epidermal growth factor receptor-targeting tyrosine kinase inhibitors (EGFR-TKIs) , has significantly prolonged the survival time of patients with EGFR mutations with relatively mild adverse reactions, and become a prior choice for advanced non-small cell lung cancer (NSCLC) patients with driver genes. Dynamic monitoring of treatment progress and gene mutations in NSCLC patients by means of gene detection will help to provide a more effective, long-term and stable individualized targeted therapy for such patients.

Objective

To compare the gene mutations before and after the progression of NSCLC, and to analyze the regularities of gene mutations dynamically monitored and related prognostic value in NSCLC patients.

Methods

NSCLC outpatients and inpatients undergoing genetic tests were selected from Department of Integrated Medicine and Lung Cancer Center of China-Japan Friendship Hospital from 2007 to 2021. Their data were collected and used to establish a lung cancer genes testing database. Tissue samples or peripheral blood circulating tumor DNA (ctDNA) before and after progression were obtained for full-coding area detection of lung cancer genes, and the number of gene mutations and testing results were recorded. We divided enrolled patients into gene clearance group and non-gene clearance group, and compared baseline characteristics and survival status between the groups.

Results

A total of 217 cases were enrolled and followed until their clinical endpoint. The total changes in gene mutations in tissue samples before and after the disease progression were as follows: the number of patients with wild type increased from 70 (32.3%) to 95 (43.8%) , the number of patients with mutant type decreased from 147 (67.7%) to 122 (56.2%) , the number of patients with 19DEL mutation increased from 64 (29.5%) to 67 (19.8%) , the number of patients with 21 L858R mutations decreased from 74 (34.1%) to 64 (24.0%) , the number of patients with T790M mutations increased from 2 (0.9%) to 45 (20.7%) , and the number of those with rare mutations or concomitant rare mutations such as TP53 increased from 20 (9.2%) to 84 (38.7%) . Gene clearance group (n=67) and non-gene clearance group (n=150) had significant differences in clinical features except the history of lung disease (P=0.032) and the history of targeted therapy (P=0.001) . The median progression-free survival (PFS) of patients in the two groups was 9.8 months and 11.8 months, respectively, with no significant difference〔HR=0.89, 95%CI (0.66, 1.20) , P=0.310〕. The median PFS of 134 patients with advanced NSCLC in two groups was 8.1 months and 9.8 months, respectively, with no significant difference〔HR=0.83, 95%CI (0.58, 1.19) , P=0.359〕. The median overall survival (OS) of patients in two groups was 50.5 months and 28.5 months, respectively, with statistically significant difference〔HR=0.56, 95%CI (0.41, 0.78) , P<0.000 1〕. The median OS of 134 patients with advanced NSCLC in two groups were 45.5 months and 24.9 months, respectively, showing statistically significant difference〔HR=0.55, 95%CI (0.37, 0.81) , P=0.000 2〕.

Conclusion

The gene mutation status before and after disease progression for patients with NSCLC changed dynamically. After the progression, the proportion of wild type increased significantly compared with mutant type. The proportion of classical mutation decreased, but the proportion of concomitant mutations increased. Patients with 19DEL mutations developed a higher rate of T790M after disease progression. Monitoring gene clearance could not help to predict a PFS, but the gene clearance type predicted better OS benefits. Dynamic monitoring of changes in gene status could help guide treatment promptly for optimal clinical benefits.

Effect of Ocular Acupuncture and Exercise Combination Therapy on Postoperative Heart Rate Variability and Prognosis of Patients Treated with Percutaneous Coronary Intervention

ZHANG Di, LI Hongpeng, MA Jiang, NIE Qian, SUN Jianfeng, WU Zhipeng, ZHANG Hongcai, ZHAO Jue

2023, 26(36):  4535-4544.  DOI: 10.12114/j.issn.1007-9572.2022.0881

Asbtract ( )   HTML ( )   PDF (994KB) ( )  

Figures and Tables | References | Related Articles | Metrics

Background

Heart rate variability (HRV) is commonly used to evaluate the short-term prognosis of coronary artery diseaseas a well-known non-invasive indicator of cardiac autonomic function. Percutaneous coronary intervention (PCI) is a commonly usedsuigical treatment of coronary artery disease, however, major adverse cardiac event (MACE) such as malignant arrhythmias and recurrent myocardial infarction are common after suigical treatment. Although dual antiplatelet therapy (DAPT) can reduce the occurrence of MACE to a certain extent, it is prone to be complicated with gastrointestinal bleeding, and unable to consistently improve the prognosis of PCI. Ocular acupuncture can effectively reduce the duration and frequency of chest pain, and exercise therapy can enhance the function of heart and blood vessels. The application of ocular acupuncture and exercise combination therapy (OAECT) after PCI remains to be explored.

Objective

To investigate the effect of OAECT on postoperative heart rate variability and prognosis of patients treated with PCI.

Methods

A total of 32 CHD patients after PCI with moderate and low risk attending Hospital of Chengdu University of Traditional Chinese Medicine were selected and randomly divided into the OAECT group and drug treatment group in a 1∶1 allocation ratio. Patients in the OAECT group received OAECT in addition to DAPT, patients in the drug treatment group received DAPT alone, patients in both 2 groups completed the 2-week intervention. The data of patients was collectedas follows: (1) Baseline indicators: gender, age, height, weight, blood pressure, respiratory rate, interval between onset and intervention, education level, occupation, severity of coronary artery disease, and number of underlying diseases. (2) Main indicators: HRV within 24 h after PCI and on the day of the end of 2-week intervention, including the standard deviation of all normal to normal RR intervals (SDNN) , standard deviation of all 5-minute RR intervals (SDANN) , mean of the standard deviation of all NN intervals for all 5-min segment of 24 hours (SDNN index) , root mean square of difference between adjacent NN intervals (rMSSD) , percent of NN50 in the total number of NN intervals (PNN50) , high frequency (HF) , low frequency (LF) low frequency/high frequency (LF/HF) values. Prognosis at 2, 4, and 8 weeks after the intervention assessed by MACE, including cardiac or all-cause deaths, malignant arrhythmias such as ventricular tachycardia and ventricular fibrillation, severe heart failure, recurrent myocardial infarction, repeat PCI and chest pain recorded by telephone and outpatient consultations. (3) Secondary indicators: C-reactive protein (CRP) , N-terminal pro B type natriuretic peptide (NT-proBNP) , creatine kinase isoenzyme (CK-MB) , high-sensitivity troponin I (hs-TnI) . (4) Safety indicators: the occurrence of complications after PCI such as subcutaneous hematoma, skin lesions, muscle soreness, respiratory abnormalities and stroke, all the outcome indicators were measured within 24 hours after PCI and on the day of the end of 2-week intervention.

Results

There was no significant difference in LF/HF, SDNN, SDANN, SDNN index, LF, HF, RMSSD and PNN50 between the 2 groups (P>0.05) . There were significant differences in LF/HF, SDNN and SDANN (P<0.05) .CRP was higher in the drug treatment group than OAECT group after 2 weeks (P<0.05) ; there was no significant difference in NT-proBNP, CK-MB and hs-TnI between the 2 groups (P>0.05) . The incidence rates of MACE and adverse reactions in the OAECT group were lower than DAPT group (P<0.05) .

Conclusion

OAECT is more effective than drug treatment in improving HRV with a lower incidence rate of MACE and better prognosis for patients after PCI.

Predictive Value of Serum Uric Acid in Perioperative Acute Ischemic Stroke in Patients with Non-small Cell Lung Cancer

BAI Haiwei, MI Xiaokun, LIU Qingrui, ZHU Lin, WANG Yingnan, LIU Junyan, HAN Ying

2023, 26(36):  4545-4551.  DOI: 10.12114/j.issn.1007-9572.2023.0193

Asbtract ( )   HTML ( )   PDF (1529KB) ( )  

Figures and Tables | References | Related Articles | Metrics

Background

Perioperative acute ischemic stroke (POAIS) is a severe complication of surgery, which can increase surgical mortality and reduce patients' quality of life. The pathogeneses are complex and rarely explored, especially in patients with non-small cell lung cancer (NSCLC) .

Objective

To investigate the influencing factors of POAIS in NSCLC patients and the predictive value of serum uric acid (SUA) on the occurrence of POAIS in NSCLC patients.

Methods

A total of 25 NSCLC patients admitted to the Fourth Hospital of Hebei Medical University from July 2014 to April 2022, who suffered from POAIS following lung resection were selected as the case group, while 126 patients without POAIS were randomly selected as the control group after matching by age and gender. The preoperative baseline data, intraoperative data and postoperative pathology-related data of all patients were collected. Multivariate Logistic regression analysis was performed to explore the influencing factors of POAIS in the NSCLC patients, and the receiver operating characteristic (ROC) curve was plotted to evaluate the predictive value of preoperative SUA on the development of POAIS in NSCLC patients.

Results

The average age of the 151 patients was (64±7) years, 57.62% (87/151) of whom were male. The multivariate Logistic regression analysis showed that SUA was an influencing factor of POAIS in NSCLC patients〔OR=0.990, 95%CI (0.982, 0.998) , P=0.019〕. The ROC curve indicated that the area under the curve (AUC) of SUA to predict POAIS in NSCLC patients was 0.64, with an optimal threshold value of 307.40 μmol/L, sensitivity and specificity of 58.7% and 76.0%, respectively.

Conclusion

Preoperative SUA level can serve as an independent predictor of POAIS incidence in NSCLC patients. Higher SUA levels at baseline may predict a lower risk of POAIS.

Ultrasound and ^99mTc-MIBI Scintigraphy in Differentiating between Parathyroid Hyperplasia and Parathyroid Adenoma

MA Jinmei, LIU Wen, CAO Chunli, KANG Yanfei, ZHANG Xiaomei, LI Jun

2023, 26(36):  4552-4557.  DOI: 10.12114/j.issn.1007-9572.2022.0276-1

Asbtract ( )   HTML ( )   PDF (1208KB) ( )  

Figures and Tables | References | Related Articles | Metrics

Background

Different pathological types of parathyroid lesions determine the choice of treatment and prognosis. Ultrasound and ^99mTc-MIBI scintigraphy techniques have been widely used in the diagnosis of parathyroid lesions. Studies have shown that ultrasound and radionuclide manifestations of parathyroid lesions differ by the pathological type, but how to extract the characteristic indices of various types of parathyroid lesions from many ultrasound features and ^99mTc-MIBI scintigraphy is a difficulty of current research.

Objective

To compare the value of ultrasound versus ^99mTc-MIBI scintigraphy in differentiating between parathyroid hyperplasia (PH) and parathyroid adenoma (PA) by analyzing the features of PH and PA measured by them.

Methods

One hundred and fifty patients with 199 thyroid lesions in total who underwent parathyroidectomy in First Affiliated Hospital, School of Medicine, Shihezi University from February 2016 to March 2022 were selected. Parathyroid ultrasound and ^99mTc-MIBI scintigraphy were performed before operation, and the detected results by them were comparatively assessed with postoperative pathological findings as the gold standard for reference. The receiver operating characteristic (ROC) analysis was used to estimate the value of the two modalities in differentiating between PH and PA.

Results

Compared with ^99mTc-MIBI scintigraphy, ultrasound had higher sensitivity (82.14% vs 50.00%) , specificity (89.51% vs 64.34%) , accuracy (87.43% vs 60.30%) and larger area under the ROC curve (0.885 vs 0.775) (P<0.05) in differentiating between PH and PA.

Conclusion

Both ultrasound and ^99mTc-MIBI scintigraphy could differentiate between PA and PH, but the performance of ultrasound was better

Clinical Characteristics and Traditional Chinese Medicine of Hyperlipidemia in Estrogen Receptor Positive Breast Cancer Patients during Endocrine Therapy: a Real World Study

LIU Bingwei, WANG Jing, QIAO Xue, MU Silin, SHI Guangxi, LI Jingwei

2023, 26(36):  4558-4564.  DOI: 10.12114/j.issn.1007-9572.2023.0136

Asbtract ( )   HTML ( )   PDF (917KB) ( )  

Figures and Tables | References | Related Articles | Metrics

Background

Breast cancer is the most prevalent malignancy in the world. Endocrine therapy reduces the level of estrogen in vivo, thus affecting the blood lipid level, which reduces the quality of life and the treatment compliance of patients.

Objective

To analyze the clinical characteristics and traditional Chinese medicine (TCM) prescription of hyperlipidemia in estrogen receptor (ER) positive breast cancer patients during endocrine therapy in real world.

Methods

Based on method of retrospective study, a total of 238 patients with ER positive breast cancer who received endocrine therapy in Affiliated Hospital of Shandong University of Traditional Chinese Medicine from January 2012 to March 2022 were selected as the study subjects. The data including age, triglyceride, total cholesterol, low density lipoprotein, endocrine therapy drugs, TCM prescriptions of the patients were exported through the search platform of scientific research big data to establish a clinical data table of the patients. ER positive breast cancer patients with normal baseline blood lipid levels were divided into the normal group and dyslipidemia group according to the blood lipid levels during endocrine therapy, and hyperlipidemia was classified into hypercholesterolemia, hypertriglyceridemia and mixed hyperlipidemia. The exported prescriptions were analyzed for frequency, four properties, five flavors, channel tropism and medication regularity by using the "prescription analysis", an auxiliary platform for TCM inheritance, to obtain new prescriptions.

Results

Among 238 ER positive breast cancer patients, 97 patients (40.8%) had normal baseline blood lipid levels, of whom 42 patients (205 person-time return visit) developed dyslipidemia during standardized endocrine therapy. Among the patients with dyslipidemia, 37.6% (77/205) occurred in the age group of 51 to 60 years as the highest number; 86 person-time with dyslipidemia received exemestane treatment, accounting for the highest proportion of 42.0%. Among the 42 patients with dyslipidemia (205 person-time return visit) , hyperlipidemia occurred in 99 person-time, and hypercholesterolemia occurred in 49.5% (49/99) . There was no statistically significance difference in the age of patients with three types of hyperlipidemia (P>0.05) . There were statistically significance differences in the proportion of endocrine therapy types among patients with three types of hyperlipidemia (P<0.05) . There were 189 kinds of TCM prescriptions for hyperlipidemia in ER positive breast cancer patients during endocrine treatment, licorice was the most frequently used medicine (408 times) , the highest frequency of use was tonifying qi drug (22.6%) . The channels of TCM collected by the big data platform were mainly distributed in the spleen, lung and liver channels. The properties of TCM were mainly cold, flat and warm, and the flavors were mainly sweet, bitter and pungent. The combination of "Astragalus and Licorice" had the highest frequency. Six core drug combinations and three new prescriptions were obtained through complex system entropy clustering analysis.

Conclusion

The highest incidence of hyperlipidemia in ER positive breast cancer patients during endocrine therapy is 51-60 years old, and hypercholesterolemia is the most common. The position of hyperlipidemia in ER positive breast cancer patients during endocrine therapy is in the spleen. The medication are maily used for invigorating spleen to remove dampness, tonifying qi and regulating stomach.

Effect and Mechanism of Pivot Meridian Massage on TLR8/ERK Signaling Pathway and LncRNA-GAS5 in Rats with Neuropathic Pain

WEI Zongbo, LONG Bingcai, WANG Xiongjiang, LIANG Yingye, TANG Hongliang, XIA Tian, LU Dongming

2023, 26(36):  4565-4574.  DOI: 10.12114/j.issn.1007-9572.2023.0145

Asbtract ( )   HTML ( )   PDF (1354KB) ( )  

Figures and Tables | References | Related Articles | Metrics

Background

Pivotal meridian massage for neuropathic pain obtained favorable results in recent years, however, its specific mechanism of action has not been fully elucidated.

Objective

To observe the analgesic effect of pivotal meridian massage on rats according to the research indexes taking rat model of neuropathic pain induced by L₅ spinal nerve ligation as the object of observation, to further investigate whether the analgesic effect is achieved by affecting LncRNA-GAS5 and then regulating the apoptosis of neurons in the dorsal horn of the spinal cord.

Methods

The experiment was conducted from January to June 2021 at the Experimental Center for Animal Medicine of Guangxi University of Chinese Medicine and Guangxi University. A total of 120 healthy female SD rats were randomly divided into the normal group, model group, sham-operated group, sham-manipulation group, and meridian manipulation group, with 24 rats in each group. Rat model of neuropathic pain was prepared by ligating the L₅ spinal nerve in the model, sham-operated, sham-manipulation and meridian manipulation groups. After modeling for 24 hours, the L₅ spinal nerve was exposed for a few minutes without ligation, and the wound was closed layer by layer in the sham-operated group; hind limbs of the rats in the sham-manipulation group were gently stroked for 18 minutes; a self-made massager was used to sequentially stimulate the three acupoints on the bilateral Foot Shaoyang Gallbladder Meridian of Huan Tiao, Yang Ling Quan, and Xuan Zhong, with a stimulation force of 5 N, frequency of 2 Hz, intervention of 1 minute for each acupoint and technique, totaling 18 minutes in the meridian manipulation group. The normal group and model group were fed and observed normally without any intervention. Behavioral tests (mechanical withdrawal threshold and thermal withdrawal latency) were performed before modeling and on days 1, 3, 7, and 14 after modeling. On days 7 and 14 of the intervention, 12 rats were randomly selected for tissue sampling to detect the expression of TLR8/ERK signaling pathway-related proteins (Bcl-2, Caspase-3, ERK, TLR8 protein levels) and the expression levels of LncRNA-GAS5 and miR-21 genes in the spinal cord tissue.

Results

(1) In terms of behavioral observations, the mechanical withdrawal threshold of the model group, sham-manipulation group, and meridian manipulation group was lower than the normal group on days 1, 3, 7, and 14 after modeling (P<0.05) . The mechanical withdrawal threshold of the sham-operated group, sham-manipulation group and meridian manipulation group was higher than the model group on day 14 after modeling (P<0.05) . The mechanical withdrawal threshold of the sham-operated group, meridian manipulation group was higher than the sham-manipulation group on days 7 and 14 after modeling (P<0.05) . The thermal withdrawal latency in the sham-manipulation group and meridian manipulation group was shorter than the normal group on days 1, 3, and 7 after modeling (P<0.05) . The thermal withdrawal latency in the sham-operated group, sham-manipulation group and meridian manipulation group was longer than the model group on days 7 and 14 after modeling (P<0.05) . The sham-operated group, meridian manipulation group had longer thermal withdrawal latency than the sham-manipulation group on day 14 after modeling (P<0.05) . (2) In terms of protein and gene expression levels related to the signaling pathway, on day 7 after modeling, the Bcl-2 protein expression level in the normal group was lower than the other groups (P<0.05) . The Bcl-2 protein expression level in the meridian manipulation group was higher than the model group, while the Caspase-3, ERK, and TLR8 protein expression levels were lower than the model group (P<0.05) . The Bcl-2, Caspase-3, ERK, and TLR8 protein expression levels in the meridian manipulation group were lower than the sham-operated group, sham-manipulation group (P<0.05) . On day 14 after modeling, the Bcl-2 protein expression level in the meridian manipulation group remained higher than the model group, while the Caspase-3 and TLR8 protein expression levels remained lower than the model group, and the ERK protein expression level was higher than the model group (P<0.05) . After 7 days of modeling, the expression level of LncRNA-GAS5 gene in the sham-manipulation group and meridian manipulation group was higher than the model group, while the expression level of miR-21 gene was lower than the model group (P<0.05) . The expression level of LncRNA-GAS5 gene in the meridian manipulation group was higher than the sham-manipulation group, while the expression level of miR-21 gene was lower than the sham-manipulation group (P<0.05) . After 14 days of modeling, the expression level of LncRNA-GAS5 gene in the model group was lower than the normal group, while the expression level of LncRNA-GAS5 gene in the meridian manipulation group and sham-manipulation group was higher than the model group (P<0.05) . The expression level of miR-21 gene in the meridian manipulation group and sham-manipulation group was higher than the model group (P<0.05) .

Conclusion

The meridian manipulation technique has a certain analgesic effect on rats with neuropathic pain. It is initially hypothesized that the analgesic mechanism may be achieved by upregulating the expression level of LncRNA-GAS5 to inhibit neuronal apoptosis by adsorbing miR-21 to mediate TLR8/ERK pathway-related proteins. Although the specific mechanism has not been conclusively confirmed, LncRNA-GAS5 is expected to be a new target for future treatment of neuropathic pain in the future.

The Experience of Inhaled COVID-19 Vaccination among First-line Medical Staff in Epidemic Prevention Aged≥18 Years in Guiyang City: a Qualitative Study

YU Na, BAI Xiaoling, PANG Jin, NIU Yutian, HU Qing, WANG Yuanfang, YANG Rongze

2023, 26(36):  4575-4580.  DOI: 10.12114/j.issn.1007-9572.2023.0176

Asbtract ( )   HTML ( )   PDF (894KB) ( )  

Figures and Tables | References | Related Articles | Metrics

Background

Inhaled recombinant COVID-19 vaccine (type 5 adenoviral vector) (hereinafter referred to as the inhaled COVID-19 vaccine) is the first approved inhaled COVID-19 vaccine in China, with the advantages of good immunity, painlessness, and higher accessibility, which has been included in the WHO Emergency Use Listing and China's list of second-dose booster immunization vaccines. The real-world application of this vaccine deserves more attention due to the poor understanding of it by the public.

Objective

To understand the real experience in depth of first-line medical staff in epidemic prevention aged≥18 years in Guiyang city who received inhaled COVID-19 vaccine, so as to provide a reference for the promotion of this type of vaccine.

Methods

The recipients who completed the emergency vaccination with inhaled COVID-19 vaccine at a vaccination site of Guiyang city in October 2022 were selected as research subjects based on the the principle of booster immunization by using purposive sampling method. The sample size was determined by interviewing until no new case emerged which was data saturation. A total of 17 recipients were interviewed in this study. Semi-structured interviews were conducted with the research subjects, face-to-face interviews were conducted to understand the vaccination experience at that time firstly, and telephone interviews were conducted 5-7 days after vaccination. The Colaizzi seven-step analysis method was used for the data collection and analysis.

Results

A total of five themes were summarized including the convenience of vaccination, good vaccination experience, light psychological burden, low vaccine hesitancy and uncertain protective effect. The convenience of vaccination includes simple and time-saving vaccination process, fast vaccination speed, low cost, and no interruption of nucleic acid testing; the good vaccination experience includes comfortable feeling of vaccination, harmonious observation atmosphere, fewer adverse reactions, and no interference with daily life; light psychological burden includes reduction of tension and anxiety of vaccination, better mental health maintenance, non-invasive vaccination and elimination of vaccination fears; low vaccine hesitancy includes high vaccination accessibility, increase of vaccine acceptance, increase of public perception of epidemic outbreak risk; uncertain protective effect includes uncertain which vaccination method provides better protection between injection and inhalation, whether inhaled COVID-19 vaccine has a good protective effect against variant strains.

Conclusion

Inhaled COVID-19 vaccine is convenient to administer with fewer adverse reactions, which is highly accepted by first-line medical staff in epidemic prevention aged≥18 years in Guiyang city with good experience.

Disease Burden and Variation Tendency of Inflammatory Bowel Disease in China from 1990 to 2019

BAO Yunli, WANG Zhe, TANG Hairu, LI Na, ZHENG Ying, LI Bin, MA Jun, YU Xiaohui

2023, 26(36):  4581-4586.  DOI: 10.12114/j.issn.1007-9572.2023.0220

Asbtract ( )   HTML ( )   PDF (990KB) ( )  

Figures and Tables | References | Related Articles | Metrics

Background

Inflammatory bowel disease (IBD) has become highly prevalent in recent years characterized by a prolonged disease course and high disease burden. However, there is a lack of data to understand the burden of IBD in China, which may hinder health care planning and resource allocation for the disease.

Objective

To investigate the burden of IBD and its variation tendency in China from 1990 to 2019, and analyze the influence of age, gender and period on IBD.

Methods

The incidence, mortality and disability adjusted life year (DALY) rate of IBD in China from 1990 to 2019 were collected using the Global Burden of Disease Database 2019. Joinpoint software was used to analyze the variation tendency and characteristics of standardized incidence, standardized mortality and standardized DALY rate of IBD, and Excel 2019 software was used for data processing.

Results

From 1990 to 2019, the standardized incidence increased from 1.47/100 000 to 3.01/100 000 with avevage annual percent change (AAPC) of 2.50%〔95%CI (2.4%, 2.6%) 〕, the standardized mortality decreased from 0.86/100 000 to 0.35/100 000 with AAPC of -1.6%〔95%CI (-3.8%, -3.4%) 〕, the standardized DALY rate decreased from 24.47/100 000 to 16.31/100 000, with AAPC of -2.2%〔95%CI (-2.3%, -2.0%) 〕, the changes of trends were all statistically significant (P<0.05) . The standardized incidence and mortalityof of males were higher than females in each year, while the standardized DALY rate of females was higher than males before 1995, basically the same in males and females from 1995 to 2001, and higher in males than females after 2001. There was overall stable uptrend in the AAPC of the standardized incidence of IBD in all age groups by year (P<0.05) and overall downtrend in the AAPC of standardized mortality rate in all age groups, while the downtrend became slower with increasing age (P<0.05) .

Conclusion

From 1990 to 2019, the standardized mortality rate and DALY rate of IBD showed a downtrend, while the standardized incidence showed an uptrend. The standardized incidence and mortality of males were higher than females by year. The burden of IBD in elderly population deserves priority attention and will be a major public health challenge in China due to large population base and aging population.

Analysis of the Disease Burden Trends and Death Projections for Esophageal Cancer Attributable to Tobacco in China from 1990 to 2019

LIU Ailing, ZHOU Jingjing, LI Chengcheng, HE Kaiyue, LIANG Shanshan, ZHOU Shangcheng

2023, 26(36):  4587-4594.  DOI: 10.12114/j.issn.1007-9572.2023.0339

Asbtract ( )   HTML ( )   PDF (1213KB) ( )  

Figures and Tables | References | Related Articles | Metrics

Background

The disease burden of esophageal cancer is high in China, more and more studies have shown that tobacco has a greater adverse effect on the development of esophageal cancer.

Objective

To understand trends in esophageal cancer deaths and burden of disease attributable to tobacco in China from 1990 to 2019, and provide data to inform the development of public health policies and interventions.

Methods

Global burden of disease 2019 (GBD 2019) data were used to extract the age-specific and sex-specific data on esophageal cancer deaths attributable to tobacco in China from 1990 to 2019. Mortality, disability adjusted life years (DALYs) , years of life lost (YLLs) , and disability adjusted life years (YLDs) were used to assess the disease burden of esophageal cancer attributable to tobacco in China. Joinpoint regression software and age-period-cohort modeling methods were applied to analyze the trends of disease burden and mortality with age, period and cohort. the Bayesian-period-cohort analysis (BAPC) was applied to predict the mortality rate of esophageal cancer attributable to tobacco in China from 2020 to 2030.

Results

From 1990 to 2019, the number of deaths caused by esophageal cancer attributable to tobacco among Chinese residents rose from 76 400 to 123 900, with an increase of 62.17%, and the standardized mortality rate declined from 9.30/100 000 to 6.20/100 000, with a decrease of 33.33%; the DALYs rose from 1 972 500 person-years to 2 822 600 person-years, with an increase of 43.10%, and the DALYs rate decreased from 220.50/100 000 to 134.47/100 000, with a decrease of 39.02%. In terms of gender, the disease burden of esophageal cancer attributable to tobacco was mainly caused by males, with 117 700 deaths and a standardized mortality rate of 12.82/100 000 in 2019 due to tobacco-attributable esophageal cancer in males, compared to 0.62 million deaths number and a standardized mortality rate of 0.63/100 000 in females. In 2019, the number of esophageal cancer deaths attributable to tobacco among Chinese residents peaked in the age group of >69-74 years, while DALYs peaked in the age group of >64-69 years, at 23 000 and 510 300 cases, respectively. The mortality rate continued to increase with age, especially after 50 years of age. The results of Joinpoint regression analysis showed that the average annual percent change (AAPC) of esophageal cancer mortality attributable to tobacco was -1.4%〔95%CI (-1.6%, -1.2%) 〕 in China from 1990 to 2019, with -3.3%〔95%CI (-3.6%, -2.9%) 〕 for females, and -1.3%〔95%CI (-1.4%, -1.1%) 〕 for males; the AAPC for DALYs rate was -1.7%〔95%CI (-1.9%, -1.5%) 〕, with -3.7%〔95%CI (-4.0%, -3.4%) 〕 for females and -1.5%〔95%CI (-1.7%, -1.3%) 〕 for males. Analysis of the age-period-cohort model of mortality from esophageal cancer attributable to tobacco showed a negative net offset of -1.690%〔95%CI (-2.024%, -1.354%) 〕. It is expected that the number of deaths and mortality rate from tobacco-attributable esophageal cancer among Chinese residents will be relatively stable with a small decrease from 2020 to 2030, with mortality rates declining from 12.64/100 000 in 2020 to 12.63/100 000 in 2030 for males, and from 0.6/100 000 in 2020 to 0.46/100 000 for females.

Conclusion

Mortality rate and DALYs rate due to tobacco-attributable esophageal cancer among Chinese residents increased and then declined from 1990 to 2019. The burden of disease due to tobacco-attributable esophageal cancer is mainly caused by males in term of gender, by middle-aged and elderly people by age, which should be given sufficient attention. It is expected that the number of deaths and mortality rates from tobacco-attributable esophageal cancer will be stable and slightly decreasing from 2020 to 2030.

Methodology·Clinical Tools

The Chinese Version of Inventory of Motivations for Hospice Palliative Care Volunteerism (IMHPCV) : Reliability and Validity Assessment

WANG Jiannan, SUN Jinming

2023, 26(36):  4595-4601.  DOI: 10.12114/j.issn.1007-9572.2022.0668

Asbtract ( )   HTML ( )   PDF (902KB) ( )  

Figures and Tables | References | Related Articles | Metrics

Background

Volunteers are essential human resources for hospice care. Exploring the service motivation of hospice care volunteers is of great significance to the early development of hospice care in China.

Objective

To translate and revise the Inventory of Motivations for Hospice Palliative Care Volunteerism (IMHPCV) and assess the the reliability and validity of the Chinese version of IMHPCV and its applicability in the Chinese cultural context, so as to provide a more accurate and valid tool and reference for future research on motivation to volunteer in hospice care.

Methods

The final version of Chinese version of IMHPCV was formed through literal translation, retroversion and adaptation by relevant experts. From June to July in 2019, the online questionnaire was sent to the directors of the pilot hospice careinstitutions by We Chat on cellphone and disseminated within their areas. The palliative care volunteers who completed the questionnaire were selected as the research subjects and investigated by the basic personal information questionnaire, the Chinese version of IMHPCV, new motivation questionnaire proposed by the hospice volunteers and considered by the researchers. The exploratory structural equation modeling (ESEM) and Cronbach's αwere used to assess the reliability and validity of IMHPCV. Pearson correlation analysis was used to analyze the correlation of all dimensions of the Chinese version of IMHPCV.

Results

A total of 220 valid questionnaires were returned. The result of the exploratory structural equation modeling showed general fitting of the Chinese version of IMHPCV (χ²=735.357, P<0.001) . The factor loadings of most items were >0.3, and new items were >0.5. There sult of the correlation analysis among dimensions showed that altruism was negatively related to civic responsibility and personal gain, and positively related to self-promotion and leisure; Civic responsibility was negatively related to self-promotion, and positively related to leisure and personal gain; Self-promotion was negatively correlated with leisure and personal gain; Leisure was positively correlated with personal gain (P<0.05) . In terms of internal consistency, the Cronbach's α was 0.829. The differences among the scores of each dimension were statistically significant (F=49.842, P<0.001) .

Conclusion

The Chinese version of IMHPCV have acceptable reliability and validity with certain applicability, while there is still much room for improvement. Although the new items cannot replace the content of the original scale, they also show that there may be motivation factors with local characteristics. The sample size of the previous interview should be increased in the future, and the interviewees with different characteristics should be selected as far as possible to extract possible alternative items to improve this measurement tool.

Analysis of the Measurement Characteristics of Inflammatory Bowel Disease Patient-reported Outcomes Measurement Scale

LUO Na, RUAN Yanqin, LEI Pingguang, WAN Chonghua, WAN Keyan, SONG Ying, CHEN Ying

2023, 26(36):  4602-4607.  DOI: 10.12114/j.issn.1007-9572.2023.0197

Asbtract ( )   HTML ( )   PDF (991KB) ( )  

Figures and Tables | References | Related Articles | Metrics

Background

The reported outcome level of patients with inflammatory bowel disease (IBD) has received attention. There are few mature outcome scales with Chinese cultural characteristics for patients with IBD, and the developed scales need strict evaluation.

Objective

To analyze and evaluate the measurement properties of the Inflammatory Bowel Disease Patient-Reported Outcome Measurement Scale〔PROISCD-IBD (V1.0) 〕, to provide basis for scientific evaluation of reported outcomes in patients with IBD.

Methods

From October 2020 to January 2022, PROISCD-IBD (V1.0) was used to detect 274 IBD patients who were treated in the Outpatient and Inpatient Departments of Gastroenterology in the First Affiliated Hospital of Kunming Medical University and the Affiliated Hospital of Guangdong Medical University. PROISCD IBD (V1.0) consisted of 1 commonality module and 1 IBD specific module (TIBD) . The commonality module had 30 items, which were divided into 4 domains of physical health (PHD) , mental health (MHD) , social health (SHD) , and spiritual/belief health (SBD) . TIBD covered four aspects of digestive system symptoms (DSS) , extraintestinal symptom (EXS) , special psychological symptoms (SPP) , and treatment side effects (TSE) . Cronbach's α coefficient and split-half coefficient were used to test the reliability. Correlation coefficient method, exploratory factor analysis and structural equation model were used to analyze the structural validity. Clinical validity of each domain was analyzed using t test.

Results

The Cronbach's α coefficients of PHD, MHD, SHD, SBD and TIBD of PROISCD-IBD (V1.0) were 0.732, 0.838, 0.781, 0.673 and 0.884, respectively. Cronbach's α coefficient of total scale was 0.932. The half-score coefficients of PHD, MHD, SHD, SBD and TIBD were 0.669, 0.859, 0.610, 0.494 and 0.795, respectively, and the half-score reliability of the total scale was 0.879. Correlation analysis showed that the phase coefficients of PHD, MHD, SHD and SBD scores and commonality module score were all >0.6 (P<0.05) . Three principal components were extracted from exploratory factor analysis, and the cumulative variance contribution rate was 58.05%. Structural equation model showed that χ²/df=2.568, root-mean-square error of approximation (RMSEA) =0.076, normed fit index (NFI) =0.677, non-normed fit index (NNFI) =0.774, comparative fit index (CFI) =0.772, incremental fit index (IFI) =0.774, SRMR=0.103 1. IBD patients were divided into active stage (n=90) and remission stage (n=184) according to clinical stages. The total scores of various domains, common modules, TIBD and scale in remission stage were higher than those in active stage (P<0.05) .

Conclusion

PROISCD-IBD (V1.0) has good reliability and validity for reporting outcome measures in patients with IBD.

Progress in the Diagnosis and Treatment of Urinary Retention during Pregnancy

NAN Ziqing, LIN li

2023, 26(36):  4608-4612.  DOI: 10.12114/j.issn.1007-9572.2022.0776

Asbtract ( )   HTML ( )   PDF (903KB) ( )  

Figures and Tables | References | Related Articles | Metrics

The incidence of urinary retention during pregnancy is low which is mainly manifested as dysuria, frequent urination, incomplete urination, lower abdominal distension and abdominal pain and may induce severe complications and adverse pregnancy outcomes, so the early identification and treatment of urinary retention during pregnancy are crucial in clinical practice. Only by timely symptomatic and etiological treatment can the adverse outcome be avoided. This article made a review of the research progress of etiology, diagnosis and treatment, to provide diagnostic and therapeutic approaches and reference for clinical physicians.