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Clinical Focus    2022, 37 (7): 653-657.   DOI: 10.3969/j.issn.1004-583X.2022.07.014 Abstract （1504）   HTML （5）    PDF（pc） （886KB）（1329）       Knowledge map    Save Reference | Related Articles | Metrics | Comments（0）

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Comparative analysis on pathological results of preoperative & postoperative colorectal intraepithelial neoplasia and early colorectal cancer endoscopic therapies Shi Yujuan, Wang Jing, Xu Ping Clinical Focus    2023, 38 (1): 55-59.   DOI: 10.3969/j.issn.1004-583X.2023.01.007 Abstract （708）   HTML （0）    PDF（pc） （850KB）（130）       Knowledge map    Save Objective To provide reference for the improved pathological diagnosis of lesions of the tissues by exploring pathological differences of preoperative and postoperative endoscopic polypectomy for colorectal intraepithelial neoplasia and early colorectal cancer. Methods One hundred and twenty nine patients receiving both biopsies and surgeries based on the inclusion and exclusion criteria were selected as study samples, the specimen data and preoperative pathology biopsy data of 129 patients diagnosed with high-grade colorectal intraepithelial neoplasia or early colorectal cancer patients under endoscopic mucosal resection (EMR)/ endoscopic submucosal dissection (ESD) were retrospectively analyzed, differences in preoperative and postoperative pathological results were compared, and the risk factors associated with pathological differences in preoperative and postoperative endoscopic therapies were analyzed. Differences in the accuracy of pathological biopsies and EMR/ESD samples of patients with different parts (ascending colon, transverse colon, descending colon, sigmoid colon, rectum), lesion morphology (pedicled, sessile and lateral developmental morphology), maximum diameter of lesions, gender and age were observed. Results The diagnostic accordance rate of the postoperative pathological diagnosis of preoperative colonoscopy biopsies and endoscopic EMR/ESD therapies was 17.1% (22/129), the number of postoperative pathological ascending and descending lesions of endoscopic therapies amounted to 103 cases (79.8%) and 4 cases (3.1%), respectively, the mild-severity judgment rate of sites was 82.4%, 80.0%, 85.7%, 80.9% and 76.7%, respectively, and differences weren’t statistically significant (P>0.05). The results of single-factor Logistic regression analysis showed that the phenomenon of mild-severity judgments on preoperative biopsies was more obvious in patients with pedunculated polyps, and difference was statistically significant (P<0.05), while difference in mild-severity judgment rate for preoperative biopsies was not statistically significant for the lesion site, maximum diameter, sex, and age (P>0.05). Conclusion Both the preoperative pathological biopsy diagnosis and postoperative EMR/ESD pathological diagnosis with low compliance rate provide certain basis for selection on endoscopic follow-up and surgical treatment. Patients with pedunculated polyps are vulnerable to mild severity judgment for preoperative biopsies. Therefore, patients with pedunculated polyps are subject to intraepithelial neoplasia diagnose via biopsies, EMR/ESD surgery is supported to be selected based on the conditions in combination with narrow band imaging and magnifying endoscopy technique, and necessities for follow-up treatment and endoscopic follow-up time are supported to be determined by combining the pathological diagnosis on postoperative specimens. Table and Figures | Reference | Related Articles | Metrics | Comments（0）

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Diagnostic value of galactomannan on the comorbidity of bronchiectasis and pulmonary aspergillosis Zhou Jingkun, Yang Caihong, Feng Tao, Cui Huaying Clinical Focus    2022, 37 (9): 799-803.   DOI: 10.3969/j.issn.1004-583X.2022.09.006 Abstract （708）   HTML （0）    PDF（pc） （447KB）（41）       Knowledge map    Save Objective To compare the efficacy of galactomannan (GM) in serum and bronchoalveolar lavage fluid (BALF) in the diagnose of the comorbidity of bronchiectasis and pulmonary aspergillosis (PA). Methods Totally 128 bronchiectasis patient from the Department of Respiratory and Critical Care Medicine, Shengli Oilfield Central Hospital (March 2018- March 2021) were enrolled into observation group (n=41, including 12 diagnosed cases and 29 clinically diagnosed cases) and control group (n=82) as the diagnostic result. The serum GM and BALF-GM were respectively conducted to detect in two groups before instituting anti-Aspergillus therapy, the receiver operating characteristic (ROC) curves were drawn to compare the diagnostic value of the two detection on the comorbidity of bronchiectasis with PA and assess the cut-off values of serum GM and BALF-GM. Results The Optimal cut-off values of were 0.65 μg/L for serum GM (area under the ROC curve [AUROC] of 0.856; sensitivity of 65.4%; specificity of 88.5%) and 0.93 μg/L for BALF-GM (AUROC of 0.929; sensitivity of 80.4%; specificity of 95.0%). At a cut-off value of 1.5μg/L, the specificity and sensitivity in serum-GM were 11.5% and 100%, respectively; but at a cut-off value of 2.0 μg/L, those in BALF-GM were 19.2% and 100%, respectively. Conclusion BALF-GM is superior to serum GM for the sensitivity and specificity in the diagnose of the the comorbidity of bronchiectasis and PA, preferring to assist the diagnosis as a tool. Table and Figures | Reference | Related Articles | Metrics | Comments（0）

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Effects of dual coping intervention on coping ability and marital adjustment of young adult patients with breast cancer and their spouses Gu Jiahua, Wu Qi Clinical Focus    2022, 37 (9): 822-826.   DOI: 10.3969/j.issn.1004-583X.2022.09.011 Abstract （682）   HTML （1）    PDF（pc） （855KB）（613）       Knowledge map    Save Objective To explore the effect of dual coping intervention on coping ability and marital adjustment of young adult patients with breast cancer and their spouses. Methods The young ault postoperative patients with breast cancer and their spouses (n=80 pairs), who visited the Department of Breast, the International Peace Maternity & Child Health Hospital of China welfare institute (June 2021 to September 2021) were randomized to recevie conventional care (control group, n=40 pairs) or dual coping intervention + conventional care (observation group, n=40 pairs) for 4 months, aiming to compare intergroup coping ability and marital adjustment.Results Before intervention, the two groups had insignificant differences in the total scores and dimension scores of the dyadic coping inventory (DCI) scale and Locke-Wollance marital adjustment scale (LWMAS) (all P>0.05); after intervention, the observation group had significantly higher total scores and dimension scores of DCI scale and LWMAS than the control group (all P<0.05).Conclusion Dual coping intervention can improve the coping ability and marital adjustment of young adult patients with breast cancer and their spouses, which contributes to the improvements in marital quality and happiness. Table and Figures | Reference | Related Articles | Metrics | Comments（0）

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Clinicopathological analysis of colorectal mixed adeno-neuroendocrine carcinoma: 8 cases report Zhang Yiming, Li Mingzhao, Gu Xin Clinical Focus    2022, 37 (10): 921-926.   DOI: 10.3969/j.issn.1004-583X.2022.10.007 Abstract （614）   HTML （0）    PDF（pc） （2523KB）（73）       Knowledge map    Save Objective To explore the clinicopathological features of colorectal mixed adeno-neuroendocrine carcinoma (MANEC). Methods A retrospective analysis were porformed in 8 patients underwent MANEC eradication in Tianjin Hospital of ITCWM (Nankai Hospital) from August 2016 to December 2020. Results There were 3 female and 5 male, age averaged 63 years among these patients. Their clinical manifestations obviously had no-specificity, with the imaging showing space occupying and lymph node metastasis.The tumor marker detection verified 2 cases of significantly elevated ferritin, 2 cases of significantly elevated carcinoembryonic antigen (CEA), and all cases of insignificantly elevated alpha-fetoprotein and carbohydrate antigen 199 (CA199). The preoperative biopsy were conducted in 6 cases, 5 cases of adenocarcinoma and 1 case of adenocarcinoma or MANEC, with main space occupying in colon. There were 5 cases for ulcer type, 3 cases for protuberant type, with the maximum diameter of tumor for 3-9 cm. Under light microscope, the tumor cells of adenocarcinoma were arranged like glandular tubes, and 2 cases were accompanied with mucinous adenocarcinoma; neuroendocrine tumor cells showed diffuse, nest like or organ like distribution, including 1 case of small cell type and 7 cases of large cell type. Lymph node metastasis was found in 7 cases and liver metastasis in 1 case. Immunohistochemistry indicated that cytokeratin8/18 (CK8/18), cytokeratin19 (CK19) and CEA were positive to varying degrees in adenocarcinoma, chromogranin A (CgA), synaptophysin (Syn) and cluster of differentiation 56 (CD56) were positive to varying degrees in neuroendocrine tumors, and 40%-80% of Ki-67 hot spots were positive. Five patients survived, the median survival time was 17 months, and two patients died, the average survival time was 8 months. Conclusion Colorectal MANEC is a highly malignant tumor characterized by lower morbidity, no-specificity, and incident lymph node metastasis, its diagnosis mainly depends on pathology with immunohistochemistry. Table and Figures | Reference | Related Articles | Metrics | Comments（0）

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Guidelines for Diagnosis and Treatment of Chronic Gastritis in China (2022, Shanghai): An interpretation Wu Haotian, Fan Yuwen, Zhang Xiaolan Clinical Focus    2023, 38 (10): 926-930.   DOI: 10.3969/j.issn.1004-583X.2023.10.012 Abstract （607）   HTML （31）    PDF（pc） （843KB）（2127）       Knowledge map    Save In 2022, the Chinese Society of Gastroenterology has referred the research and guidelines associated with chronic gastritis at home and abroad in recent years, formulated a total of 53 recommendations on the epidemiology, clinical manifestations, endoscopic and laboratory diagnosis, treatment principles, outcomes and prognosis, and unsolved problems at home and abroad, and published the Guidelines for Diagnosis and Treatment of Chronic Gastritis in China (2022, Shanghai). This article interprets the updates and highlights of this guideline. Table and Figures | Reference | Related Articles | Metrics | Comments（0）

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A meta-analysis of the renal protective effects of vitamin D and its analogues in non dialysis patients with chronic kidney disease Wang Lingling, Wu Jinlan, Wu Wei, Shen Shipeng, Chi Yanqing, Liu Maodong Clinical Focus    2022, 37 (12): 1081-1088.   DOI: 10.3969/j.issn.1004-583X.2022.12.003 Abstract （574）   HTML （0）    PDF（pc） （1889KB）（93）       Knowledge map    Save Objective To investigate the renal protective effect of vitamin D and its analogs in non-dialysis patients with chronic kidney disease (CKD). Methods PubMed, Embase, China National Knowledge Infrastructure (CNKI), China Biomedical Literature Database (CBM), etc. were searched according to the literature search strategy, and randomized controlled studies regarding the effects of vitamin D and its analogs on proteinuria and disease progression in CKD patients were included. Controlled studies were conducted, and the literature was screened according to the inclusion and exclusion criteria, the data of the included literature was meta-analyzed by Revman 5.4 software. Results A total of 7 articles with 616 patients were included.Compared with the control group, the vitamin D and its analogs reduced the ratio of urine protein/creatinine in CKD patients (SMD=-0.30, P=0.001; 95%CI:-0.48 to -0.12), decreased 24-hour urine protein (SMD=-0.67, P=0.01; 95%CI: -1.19 to -0.14), meantime, reduce serum parathyroid hormone (PTH) (SMD=-33.53, P=0.008; 95%CI: -58.48 to -8.58), increase serum calcium (SMD=0.11, P=0.04; 95%CI: 0.01 to 0.21), decreased blood phosphorus (SMD=-0.01, P=0.04; 95%CI: 0.01 to 0.21). However, the positive effect of vitamin D on serum creatinine (SMD=-9.41, P=0.38; 95%CI: -30.27 to 11.46) and estimated glomerular filtration rate ( eGFR ) (SMD=0.94, P=0.67; 95%CI: -3.35 to 5.22) was not observed. Conclusion Vitamin D and its analogs can reduce 24-hour proteinuria and urine protein/creatinine ratio in non-dialysis patients with CKD, also increase blood calcium level, reduce PTH, and inhibit the occurrence and development of secondary hyperparathyroidism. However, there is no evidence-based medical evidence to support the roles in reducing serum creatinine and improving renal function in CKD patients. Table and Figures | Reference | Related Articles | Metrics | Comments（0）

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Clinical Focus    2022, 37 (8): 748-752.   DOI: 10.3969/j.issn.1004-583X.2022.08.014 Abstract （501）   HTML （10）    PDF（pc） （884KB）（574）       Knowledge map    Save Table and Figures | Reference | Related Articles | Metrics | Comments（0）

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Clinical Focus    2022, 37 (11): 1048-1052.   DOI: 10.3969/j.issn.1004-583X.2022.11.016 Abstract （501）   HTML （1）    PDF（pc） （823KB）（67）       Knowledge map    Save Reference | Related Articles | Metrics | Comments（0）

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Correlation of Chinese visceral adipose index and visceral fat area with diabetic nephropathy and their warning values He Feng, Nin Lu, Luo Gao, Yang Ruifei, Li Fanfan, Cheng Xiaoqiong, An Binbin, Li Jingjuan, Liu Yuanyuan, Guo Qian, Wang Jinyang Clinical Focus    2022, 37 (12): 1089-1093.   DOI: 10.3969/j.issn.1004-583X.2022.12.004 Abstract （496）   HTML （1）    PDF（pc） （943KB）（60）       Knowledge map    Save Objective To explore the correlation between Chinese visceral adipose index (CVAI) and visceral fat area (VFA) with diabetes nephropathy (DN) in Chinese population, and their values of early warning. Methods Clinical data of 240 patients with type 2 diabetes (T2DM) hospitalized in the Department of Endocrinology of Gansu Provincial People's Hospital from October 2020 to October 2021 were retrospectively analyzed, including the baseline characteristics, physical examination findings, and biochemical indicators. They were divided into DN group (n=114) and non-DN group (n=126) according to the presence or absence of DN. The correlation between CVAI and VFA with urinary albumin excretion rate (UAER), urinary albumin-to-creatinine ratio (UACR), and estimated glomerular filtration rate (eGFR) was assessed by the Spearman’s correlation test. Independent risk factors of DN in T2DM patients were screened by multivariatestepwise logistic regression analysis, and a multivariate logistic regression model was created. The predictive value of the model and each risk factor was evaluated by plotting the receiver operating characteristic (ROC) curve. Results Compared with those of the non-DN group, patients in DN group presented significantly longer duration of diabetes, larger weight, body mass index, waist circumference, hip circumference, waist height ratio, waist hip ratio, and neck circumference, and higher fasting plasma glucose (FPG), urinary albumin excretion rate (UAER), urine albumin-creatinine ratio (UACR), glycosylated hemoglobin(HbA1c), lipid accumulation production, CVAI, VFA and subcutaneous fat area, and lower estimated glomerular filtration rate (eGFR) (all P<0.05). Spearman’s correlation test showed that UAER and UACR were positively correlated with CVAI and VFA (all P<0.05). Logistic regression analysis showed that CVAI, VFA, FPG and the course of diabetes were independent risk factors for DN in T2DM patients (all P<0.05). ROC curve analysis showed that the area under the curve (AUC), sensitivity and specificity of CVAI were 0.6730, 0.3947, and 0.881, respectively, which of VFA were 0.6453, 0.7456, and 0.4921, respectively. Besides, AUC, sensitivity and specificity of the created logistic regression model were 0.7493, 0.7368, and 0.6825, respectively. The predictive potential of the logistic regression model was better than that of a single independent risk factor. Conclusion CVAI, VFA, FPG and the course of diabetes are independent risk factors for DN in T2DM patients. CVAI and VFA can be used as early warning indicators for DN in T2DM patients, providing an important basis for the management of visceral obesity patients. Table and Figures | Reference | Related Articles | Metrics | Comments（0）

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Clinical Focus    2022, 37 (11): 1044-1047.   DOI: 10.3969/j.issn.1004-583X.2022.11.015 Abstract （491）   HTML （7）    PDF（pc） （796KB）（138）       Knowledge map    Save Reference | Related Articles | Metrics | Comments（0）

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Effect of semaglutide on total myocardial ischemic burden and serum inflammatory factors in patients with type 2 diabetes mellitus complicated with coronary heart disease Wang Wenqi, Zhang Tao Clinical Focus    2022, 37 (11): 996-1000.   DOI: 10.3969/j.issn.1004-583X.2022.11.006 Abstract （468）   HTML （1）    PDF（pc） （817KB）（141）       Knowledge map    Save Objective To investigate the effects of semaglutide, a once-weekly glucagon-like peptide-1 receptor agonist (GLP-1RA), on total myocardial ischemic burden and inflammatory factors in patients with type 2 diabetes mellitus (T2DM) complicated with coronary heart disease (CHD). Methods From June 2021 to June 2022, totally 96 patients with T2DM and CHD admitted to the First Affiliated Hospital of Jinzhou Medical University were retrospectively recruited. They were randomized 1∶1 to the conventional treatment group and the semaglutide treatment group. Patients in the conventional treatment group were treated with standard hypoglycemic, hypotensive, lipid-regulating, and antiplatelet medications. According to blood glucose target, insulin glargine was applied and adjusted. Semaglutide injection 1.0 mg subcutaneously, once a week, was additionally given to those in the semaglutide treatment group. The clinical manifestations, body mass index (BMI), blood pressure, fasting blood glucose (FPG), blood lipids, glycosylated hemoglobin A1c (HbA1c) and other indicators were observed in the two groups before and 3 months after treatment, and the total myocardial ischemia burden and serum inflammation indicators were detected. Results One case was lost to follow-up in both groups. At the end of the trial, clinical symptoms, FPG, blood lipid and HbA1c were significantly improved in the both groups. BMI and low-density lipoprotein cholesterol (LDL-C) in the semaglutide treatment group were significantly decreased than those in the conventional treatment group. The dosage of insulin glargine and incidence of hypoglycemia were significantly lower in the semaglutide treatment group than in the conventional treatment group. The total load of myocardial ischemia was significantly reduced in the both groups and the effect of semaglutide treatment group was better than that of the coventional treatment group. The serum levels of high sensitive C-reactive protein (hs-CRP) and interleukin-6 (IL-6) in the semaglutide treatment group were significantly decreased than those in the conventional treatment group. Conclusion Semaglutide provides clinical benefits to T2DM patients by lowering glucose, regulating lipid and reducing body weight. It delays the progression of coronary atherosclerosis in patients with T2DM and CHD, and improves myocardial ischemia and prognosis by inhibiting inflammatory response and reducing total myocardial ischemic load. Table and Figures | Reference | Related Articles | Metrics | Comments（0）

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The relationship between CEA, CA125 and NSE and the pathological characteristics of patients with NSCLC and the value of combined detection Jia Chengbang, Shen Lijuan, Sun Zhigang Clinical Focus    2022, 37 (11): 992-995.   DOI: 10.3969/j.issn.1004-583X.2022.11.005 Abstract （456）   HTML （1）    PDF（pc） （860KB）（72）       Knowledge map    Save Objective To analyze the relationship between carcinoembryonic antigen (CEA), carbohydrate antigen 125 (CA125), neuron-specific enolase (NSE) and the pathological characteristics of patients with non-small cell lung cancer (NSCLC) and the value of combined detection. Methods Totally 175 NSCLC patients (NSCLC group) who were treated in Shanghai Jinshan District Hospital of Integrated Traditional Chinese and Western Medicine (January 2018-January 2022), and 180 patients with benign pulmonary diseases during the same period (no-NSCLC group) were retrospectively enrolled. The clinical data, the level of CEA, CA125, and NSE of patients at different stages were included as comparators. Spearman correlation analysis was conducted to assess the association between serum indexes and staging system. the diagnostic value of CEA, CA125 and NSE of NSCLC patients, alone and in combination, were analyzed by the receiver operating characteristic (ROC) curve.Results The serum levels of CEA, CA125 and NSE in NSCLC group were markedly higher than those in no-NSCLC group ( P<0.05). The significant increasing trend for serum levels of CEA, CA125 and NSE were found in patients with classification grades Ⅰ-Ⅲ( P<0.05). The results of Spearman correlation analysis showed that CEA, CA125, NSE were positively correlated with the clinical stage of patients with NSCLC ( r=0.579, 0.437, 0.686, P<0.05). The ROC curve was drawn with NSCLC as positive and benign lung disease as negative, the area under the curve (AUC) of CEA, CA125, and NSE for predicting NSCLC, alone and in combination, were 0.809, 0.842, 0.867, and 0.910, respectively ( P<0.05). Conclusion The increased expressions of CEA, CA125 and NSE are detected in NSCLC patients, and increasing trend with the disease progression, the detection of serum levels of CEA, CA125 and NSE alone and in combination had certain diagnostic value for NSCLC. Table and Figures | Reference | Related Articles | Metrics | Comments（0）

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Correlation analysis between dietary nutrient intake with blood glucose and insulin resistance in healthy population Han Tuo, Wang Lixia, Wang Yiwen, Li Ying, Gong Hong, Zhang Chunyan, Zhang Yan, Li Yongqin, Wang Congxia Clinical Focus    2023, 38 (2): 126-131.   DOI: 10.3969/j.issn.1004-583X.2023.02.005 Abstract （455）   HTML （0）    PDF（pc） （1884KB）（53）       Knowledge map    Save Objective To explore the correlation between the intake of different dietary nutrients with fasting blood glucose (FBG) and insulin resistance (IR). Methods Based on the data of the China Health and Nutrition Survey(CHNS), the data of 1 376 samples were included by matching the basic demographic data and serological test results with ID. The differences in fasting blood glucose of people with different nutrient intake groups, and their correlation with IR indexes were analyzed. Results Serum total cholesterol, triglyceride, LDL-C and serum uric acid in prediabetes group and diabetic group significantly increased, especially in the latter group (P<0.05). FBG was significantly higher in the highest quartile of fat intake group than that in the lowest quartile of fat intake group (5.38±1.34 vs 5.06±1.10 mmol/L, P=0.017). It was positively correlated with fat intake (r=0.1122, P<0.01), but not correlated with carbohydrate and protein intake (both P>0.05). In addition, fat intake was correlated with Homeostatic model assessment of insulin resistance(HOMA-IR) (r=0.0525, P =0.051), and negatively correlated with the Homeostatic model assessment of insulin sensitivity (HOMA-IS) (r=-0.0520, P=0.053) and Homeostasis model assessment for beta-cell function (HOMA-β) (r=-0.0681, P=0.011). Conclusion Fat intake is closely correlated with the increased FBG and IR in healthy population, although the specific mechanism needs to be further explored. Table and Figures | Reference | Related Articles | Metrics | Comments（0）

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Clinical Focus    2023, 38 (7): 647-653.   DOI: 10.3969/j.issn.1004-583X.2023.07.011 Abstract （448）   HTML （6）    PDF（pc） （1086KB）（97）       Knowledge map    Save Table and Figures | Reference | Related Articles | Metrics | Comments（0）

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Respiratory Whipple's disease: A case report and literature review Li Lifang, Wang Hongyan Clinical Focus    2022, 37 (12): 1127-1131.   DOI: 10.3969/j.issn.1004-583X.2022.12.012 Abstract （448）   HTML （0）    PDF（pc） （1377KB）（85）       Knowledge map    Save Objective To further improve the understanding of Whipple's disease(WD) as rare diseases, aiming to enhance clinicians' ability for the diagnosis of this intractable cases. Methods The clinical features and treatment process of one case respiratory WD were reported, and the literature was reviewed for discussion. Results WD can involve multiple systems, rarely involve the lungs, and the symptoms are atypical, which can be manifested as fever, dry cough, fatigue, chest pain, dyspnea, etc. Chest CT findings were mainly multiple nodules and interstitial lung disease, accompanied by mediastinal lymphadenopathy or pleural effusion. Tropheryma whippleii (TW) was detected by second-generation gene sequencing (NGS). Conclusion The course of WD is obscure, the clinical manifestation of respiratory system is atypical, and the general laboratory and imaging examinations are non-specific. The diagnosis of WD is helpful to NGS. After treatment with ceftriaxone sodium and doxycycline, the symptoms will be relieved with a good prognosis. Table and Figures | Reference | Related Articles | Metrics | Comments（0）

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Unilateral biportal endoscopy versus microendoscopic discectomy for degenerative lumbar spinal stenosis: A meta-analysis Shen Tianyu, Bai Gang, Chen Rui, Xiang Zhicheng, Zhu Hao, Shang Hui Clinical Focus    2022, 37 (8): 691-698.   DOI: 10.3969/j.issn.1004-583X.2022.08.003 Abstract （424）   HTML （0）    PDF（pc） （2175KB）（108）       Knowledge map    Save Objective To provide instructions to clinical decision-making by comparing the efficacy of unilateral biportal endoscopic(UBE) and microendoscopic discectomy (MED) in treating degenerative lumbar spinal stenosis(LSS). Methods Chinese and English study papers on UBE and MED for degenerative LSS were respectively searched in PubMed, Web of Science,Cochrane Library,Embase,Wanfang Database,CNKI,VIP,China Biologicl Medicine (CBM) and other databases, and controlled clinical studies on UBE and MED therapies with the search duration starting from the setup of databases to March 2020 were collected. The study documents were subject to the screening, quality evaluation and data extraction based on the inclusion and exclusion criteria. RevMan 5.4 and Stata15.1 software were applied for meta-analysis on the extracted data. The operation duration, blood loss, visual analogue scake (VAS) score of back and leg pain in the last follow-up, disability index (ODI), complication rates, postoperative dural distension, and intraoperative blood loss were included as comparator. Results Finally, 10 study papers (3 randomized controlled trials (RCTs) and 7 non-randomized controlled trials (N-RCTs)) involving a total of 880 patients were included, and 407 UBE cases and 473 MED cases were noted. The meta-analysis results showed that differences in the degree of dura extension, operation duration, intra-operative blood loss and ODI between groups weren't statistically significant. Compared with MED group, the lower VAS scores of the back pain in the last follow-up [MD=-0.18,95%CI(-0.31,-0.05),P=0.006] and leg pain [MD=-0.15,95%CI(-0.27,-0.04),P=0.008] as well as higher incidence rate of complications[OR=0.54,95%CI(0.31,0.94),P=0.03] were noted in UBE group. Conclusion Both UBE and MED are both effective treatments of degenerative LSS, MED is found to be superior to UBE in reducing the complications, while UBE is advantageous in improving VAS scores of the post-operative back pain, and overall consideration should be taken in the selection on surgery program. Table and Figures | Reference | Related Articles | Metrics | Comments（0）

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Meta analysis on effects of glucocorticoid on the immunotherapy of advanced cancer Ye Qian, Ling Zhai, Liu Shenxiang, Lu Guotao, Yin Xudong Clinical Focus    2022, 37 (7): 591-598.   DOI: 10.3969/j.issn.1004-583X.2022.07.002 Abstract （424）   HTML （0）    PDF（pc） （1634KB）（71）       Knowledge map    Save Objective To evaluate the application of glucocorticoid on the overall survival (OS) and progression-free survival (PFS) of the cancer patients receiving immune checkpoint inhibitors (ICIs). Methods PubMed, Wiley, Web of Science and Cochrane Library databases were applied to search the papers for effects of GC on cancer patients during the therapy period of receiving ICIs published prior to October 2020. Review Manager 5.3 software and Stata 14.0 software were used for statistical analysis. Results A total of 23 studies were included in the meta analysis, Meta-analysis showed that for patients with advanced cancer during the period of ICIs, the application of GC was a risk factor for death (H R=1.54, 95% C I=1.29-1.83) and disease progression (H R=1.82, 95% C I=1.36-2.43). Moreover, the subgroup analysis showed that GC applied to relief tumor-related complications including the cerebraledema and cancer pain increased the risk of death (H R=2.14, 95% C I=1.62-2.81) and disease progression (H R=2.26, 95% C I=1.72-2.96). While GC was used to treat non-tumor-related complications including immune-related adverse events (irAEs), and the difference between the use of GC and no-use or low dose of GC (<10 mg/d) wasn’t statistically significant (P>0.05). Conclusion The application of GC has negative effects on the prognosis of cancer patients receiving immunotherapy when it is used to treat tumor-related complications. Table and Figures | Reference | Related Articles | Metrics | Comments（0）

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Correlations between sleep disorder and cognitive function in elderly patients with mild cognitive impairment Li Zhongmei, Ran Li, Jiang Yi, Guo Zhiwei, Mu Qiwen Clinical Focus    2022, 37 (7): 607-611.   DOI: 10.3969/j.issn.1004-583X.2022.07.004 Abstract （422）   HTML （0）    PDF（pc） （877KB）（138）       Knowledge map    Save Objective To explore the sleep disorders (SD) in elderly patients with mild cognitive impairment (MCI) and corresponding correlations with cognitive function. Methods A total of 171 eligible patients with MCI in a community located in Nanchong, Sichuan from November 2018 to January 2019 were included. The overall sleep conditions of patients was assessed by the Pittsburgh sleep quality index (PSQI). The enrolled patients were divided into MCI with SD group (MCI-SD group) and MCI without SD group (MCI-NSD group) according to scoring results. Montreal cognitive assessment-basic (MoCA-B), mini-mental status examination (MMSE), auditory verbal learning test (AVLT), Boston naming test (BNT), animal verbal fluency test (AFT), trail making test (TMT) were applied to evaluate the overall cognition, memory, language and executive function of MCI patients, and the differences in overall cognitive function and cognitive domain between two groups were comparatively analyzed. Results SD was found in 70 (40.9%) out of 171 MCI patients, and the differences in the gender, age and education level between two groups were not statistically significant (all P>0.05), while the differences in the sleep quality, time of sleep onset, sleep duration, sleep efficiency, night sleep disorders, hypnotic drug and daytime function were statistically significant (all P<0.05). Compared to the MCI-NSD group, MoCA-B, MMSE, and BNT scores of MCI-SD group were significantly lowered, and the total time spent on TMT-A was significantly increased (all P<0.05). The time to fall asleep in the MCI-SD group was negatively correlated with the total score of MMSE and positively correlated with the total time spent in TMT-A; the sleep efficiency was negatively correlated with total scores of MMSE; total scores of PSQI were negatively correlated with total scores of MoCA-B and MMSE and were positively correlated with the total time spent in TMT-A. The total time spent on BNT and TMT-A was considered to be an independent risk factor for MCI patients complicated with SD (all P<0.05). Conclusion MCI patients are found to have higher incidence of SD, and long-term sleep disorder may lead to or aggravate the decline of cognitive dysfunction, especially the impacts on language naming and executive function may be more significant. Table and Figures | Reference | Related Articles | Metrics | Comments（0）

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Clinical Focus    2022, 37 (12): 1137-1141.   DOI: 10.3969/j.issn.1004-583X.2022.12.014 Abstract （414）   HTML （1）    PDF（pc） （852KB）（101）       Knowledge map    Save Reference | Related Articles | Metrics | Comments（0）

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Clinical Focus    2022, 37 (10): 946-949.   DOI: 10.3969/j.issn.1004-583X.2022.10.013 Abstract （413）   HTML （1）    PDF（pc） （827KB）（103）       Knowledge map    Save Reference | Related Articles | Metrics | Comments（0）

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Clinical Focus    2023, 38 (1): 79-83.   DOI: 10.3969/j.issn.1004-583X.2023.01.013 Abstract （412）   HTML （0）    PDF（pc） （859KB）（85）       Knowledge map    Save Reference | Related Articles | Metrics | Comments（0）

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Impacts of Tai Chi exercise cycle on blood pressure and cardiovascular risk factors in essential hypertension: a systematic review and meta-analysis Yin Yikun, Yin Xunwei, Wang Jialin, Sun Junzhi Clinical Focus    2022, 37 (7): 599-606.   DOI: 10.3969/j.issn.1004-583X.2022.07.003 Abstract （407）   HTML （0）    PDF（pc） （2168KB）（96）       Knowledge map    Save Objective To provide a reasonable exercise intervention program for patients with essential hypertension(EH) by systematically reviewing, the aiming is to assess if the continuous cycle of Tai Chi Chuan exercise impacts the therapeutic effects on EH patients by the meta-analysis. Methods The randomized controlled trials(RCT) of Tai Chi Chuan treating EH were retrieved from electronic databases involving CNKI,WANFANG Database,PubMed,Cochrane Library,Science Direct and Web Of Science,and the meta-analysis was conducted by RevMan5.3 software. Results Twenty-one papers with 2 129 participants were finally selected. Meta-analysis results showed that Tai Chi Chuan exercise lasting over 12 weeks was more conductive to the decreased level of systolic blood pressure [M D=-10.20,95% C I(-14.57,-5.83)] and diastolic blood pressure [M D=5.12,95% C I(-7.63,-2.60)] compared with the control group. Tai Chi Chuan was found to increase the NO content of EH patients [M D=6.87,95% C I(4.83,8.90)], improve blood lipid metabolism level including total cholesterol (TC) [M D=0.51, 95% C I(-0.69,-0.33)], triglyceride (TG)[M D=0.72,95% C I(-1.09,-0.36)],low-density lipoprotein cholesterol (LDL-C) [M D=0.59,95% C I(-0.87,-0.32)] excluding high-density lipoprotein cholesterol (HDL-C). The results of subgroup analysis showed that exercise frequency ≥5 times/week and exercise duration< 60 min/d had better antihypertensive effect. Conclusion Meta-analysis indicate that Tai Chi Chuan exercise with the continuous cycle>12 weeks, the frequency ≥5 times/week and exercise duration< 60min/d demonstrates obvious effect in reducing blood pressure level and improving NO content and lipid metabolism, being worthy of promotion in clinic practices. Table and Figures | Reference | Related Articles | Metrics | Comments（0）

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Long-term effect of hypoglossal nerve stimulation in the treatment of obstructive sleep apnea hypopnea syndrome: A meta analysis Sun Ying, Yu Qin Clinical Focus    2022, 37 (8): 677-684.   DOI: 10.3969/j.issn.1004-583X.2022.08.001 Abstract （401）   HTML （0）    PDF（pc） （2009KB）（259）       Knowledge map    Save Objective To explore the long-term effect of hypoglossal nerve stimulation (HGNS) in the treatment of obstructive sleep apnea hypopnea syndrome (OSAHS). Methods Through the systematic search of China knowledge Network database, Wanfang database, VIP database, Chinese biomedical literature database, Pubmed, Embase, Cochrane Library, the article published by domestic and foreign scholars regarding HGNS, untill to March 2022, were collected. The literatures were screened and extracted by two evaluators independently and the quality of the literatures was evaluated by NOS scale, Meta analysis was carried out by stata12.0 software. Results A total of 12 cohort studies with 776 patients were included. The posttreatment 6-month sleep apnea hypopnea index, (AHI, mean difference [SMD]=-1.47, 95% CI 95% confidence interval [95%CI]-1.68-1.25, P=0.000), oxygen desaturation index (ODI, SMD=-0.77,CI: -0.95--0.58, P=0.000), epworth scale score (ESS, SMD=-1.00, CI: -1.16--0.84, P=0.000), functional qutcomes of sleep questionnaire (FQSQ, SMD=1.10, CI: 0.92~1.28, P=0.000), AHI in 12 months after operation (SMD=-1.250, CI:-1.39--1.10, P=0.000), ODI (SMD=-0.874, CI:-1.114--0.634, P=0.001) and FQSQ (SMD=1.10, CI: 0.96-1.22, P=0.000) were significantly improved than those before treatment. Conclusion Hypoglossal nerve stimulation is effective in the treatment of OSAHS. Table and Figures | Reference | Related Articles | Metrics | Comments（0）

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A network meta-analysis of SGLT2 inhibitors on cardiovascular outcomes in patients with type 2 diabetes Wang Runqing, Wang Qian, Liao Jianxiong Clinical Focus    2022, 37 (12): 1061-1073.   DOI: 10.3969/j.issn.1004-583X.2022.12.001 Abstract （399）   HTML （3）    PDF（pc） （3529KB）（193）       Knowledge map    Save Objective Type 2 diabetes is a chronic disease and heart failure is a common complication of type 2 diabetes, and large studies have demonstrated the role of sodium-glucose cotransporter 2 inhibitors (SGLT2i) in improving cardiovascular outcomes of patients with type 2 diabetes. In this paper, the efficacy effects of five different SGLT2i were indirectly compared by systematic evaluation. Methods PubMed, Web of science, Cochrane Library, CNKI, WanFang, and VIP databases were searched to collect relevant literature with a search time frame of build to July 2022. Two researchers independently screened the literature and extracted the corresponding data, using the composite outcome of heart failure hospitalization and cardiovascular death as the primary outcome indicator, with heart failure hospitalization, cardiovascular death and all-cause death as secondary outcome indicators, and a network meta-analysis was performed using Stata 16.0 as well as the network program package. Results A total of 340 publications were retrieved, eligible 11 publications representing 62 904 patients were included. The five intervention methods were involved, namely: empagliflozin, sotagliflozin, dapagliflozin, ertugliflozin and canagliflozin. There were no statistically significant differences (P>0.05) between the five different SGLT2i in altering the composite outcomes of heart failure hospitalization and cardiovascular death, cardiovascular death, heart failure hospitalization and all-cause death in patients with type 2 diabetes. All five different SGLT2i significantly improved heart failure hospitalization outcomes in patients with type 2 diabetes compared to placebo. There was a statistically significant difference between empagliflozin and sotagliflozin in improving the composite outcome of heart failure hospitalization and cardiovascular death. No significant difference between placebo and the five different SGLT2i in improving the outcome of cardiovascular death or all-cause death. Conclusion There was a trend towards a more significant benefit of empagliflozin and sotagliflozin improving the composite outcome of heart failure hospitalization and cardiovascular death and heart failure hospitalization outcome in type 2 diabetic patients, while for cardiovascular death or all-cause death outcome, there was no statistically significant difference between the five different SGLT2i and placebo, and the exact mechanisms and causes still need to be explored and validated in large studies. Table and Figures | Reference | Related Articles | Metrics | Comments（0）

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Clinical Focus    2023, 38 (11): 1038-1041.   DOI: 10.3969/j.issn.1004-583X.2023.11.015 Abstract （398）   HTML （12）    PDF（pc） （835KB）（49）       Knowledge map    Save Reference | Related Articles | Metrics | Comments（0）

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Clinical Focus    2022, 37 (10): 957-960.   DOI: 10.3969/j.issn.1004-583X.2022.10.016 Abstract （396）   HTML （2）    PDF（pc） （835KB）（147）       Knowledge map    Save Reference | Related Articles | Metrics | Comments（0）

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Clinical Focus    2022, 37 (10): 942-945.   DOI: 10.3969/j.issn.1004-583X.2022.10.012 Abstract （388）   HTML （2）    PDF（pc） （826KB）（73）       Knowledge map    Save Table and Figures | Reference | Related Articles | Metrics | Comments（0）

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Efficacy and safety of PCSK9 inhibitors on atherosclerotic cardiovascular disease: A meta-analysis Zhang Lei, Lou Haidong, Zhi Yu, Qi Shuying Clinical Focus    2022, 37 (12): 1074-1080.   DOI: 10.3969/j.issn.1004-583X.2022.12.002 Abstract （382）   HTML （5）    PDF（pc） （2352KB）（101）       Knowledge map    Save Objective To systematically evaluate the efficacy and safety of proprotein convertase subtilisin/kexin type 9(PCSK9) inhibitors on atherosclerotic cardiovascular disease (ASCVD). Methods PubMed, Embase, Cochrane Library and Clinical Trails.gov were subject to the computer retrieval from the data of database construction to May 2022. The randomized controlled trials (RCTs) of PCSK9 inhibitors for ASCVD patients were screened and incorporated, and the meta analysis on conforming RCTs was performed with Review Manager 5.4 software. Results A total of 10 RCTs comprising 54 472 patients were enrolled. Efficacy analysis results showed that PCSK9 inhibitors could reduce the level of low-density lipoprotein cholesterol (LDL-C) by 49.26%(95%CI: -54.00 to -44.52, P<0.01) and significantly reduced the other five lipid levels compared with the control group. Percent atheroma volume (PAV) reduced by 1.1% (95%CI: -1.48 to 0.73, P<0.01) and the minimum fibrous cap thickness (FCT) increased by 31.32%(95%CI: 15.82 to -46.82, P<0.01) in the PCSK9 inhibitors group. PCSK9 inhibitors did not reduce the risk of cardiovascular death (RR=0.97, 95%CI: 0.86 to 1.10, P>0.05), and reduced the risk of myocardial infarction (RR=0.73, 95%CI 0.65 to 0.81, P<0.01) and stroke (RR=0.78, 95%CI 0.68 to 0.90, P<0.01). The incidence of serious adverse events (SAEs) between the PCSK9 inhibitors group and control group was similar (RR=0.97, 95%CI 0.95 to 1.00, P>0.05). The incidence of injection site reaction in the PCSK9 inhibitor group was higher (RR=1.57, 95%CI: 1.40 to 1.76, P<0.01). Differences in myalgia, neurocognitive reaction and incidence new-onset diabetes weren't statistically significant when compared to such indexes in the control group (P>0.05). Conclusion PCSK9 inhibitors is capable of significantly reducing the level of LDL-C, incidence of myocardial infarction and stroke without serious adverse reactions. Table and Figures | Reference | Related Articles | Metrics | Comments（0）

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Clinical Focus    2023, 38 (3): 273-278.   DOI: 10.3969/j.issn.1004-583X.2023.03.015 Abstract （381）   HTML （2）    PDF（pc） （854KB）（91）       Knowledge map    Save Table and Figures | Reference | Related Articles | Metrics | Comments（0）

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Clinical Focus    2022, 37 (10): 950-952.   DOI: 10.3969/j.issn.1004-583X.2022.10.014 Abstract （381）   HTML （0）    PDF（pc） （819KB）（63）       Knowledge map    Save Reference | Related Articles | Metrics | Comments（0）

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Clinical Focus    2023, 38 (2): 175-180.   DOI: 10.3969/j.issn.1004-583X.2023.02.014 Abstract （380）   HTML （1）    PDF（pc） （1948KB）（106）       Knowledge map    Save Table and Figures | Reference | Related Articles | Metrics | Comments（0）

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Mycoplasma pneumoniae infection in Chengdu in 2021: An epidemiological study Zhang Dawei, Li Xin, Sun Guifeng Clinical Focus    2023, 38 (3): 237-240.   DOI: 10.3969/j.issn.1004-583X.2023.03.007 Abstract （379）   HTML （3）    PDF（pc） （814KB）（138）       Knowledge map    Save Objective To explore the epidemic characteristics and changing trend of mycoplasma pneumoniae (MP) infection in Chengdu in 2021, thus providing references for clinical practice.Methods A total of 10,012 patients in Chengdu, Sichuan Province with respiratory tract infection and examined with a passive agglutination assay for detecting MP antibodies (MP-Ab) in 2021 were recruited. The differences in MP infections of different age groups, male or female patients and at different seasons were observed.Results Totally 3084/10,012 (30.80%) MP-positive samples were detected. Stratified by the sex, the positive rate of MP infection in male patients was significantly lower than that of females (25.84% vs 36.12%, χ2=124.00, P<0.05). The positive rate of MP in juveniles was significantly higher than that in adults and middle-aged and elderly people (43.53% vs 33.83%, 14.03%, χ2=790.13, P<0.05). The positive rate of MP increased with aging in patients of 0-18 years. The highest and lowest positive rate of MP in minors were detected in those aged 15-17 years (61.61%) and infants younger than 1 year (4.08%), respectively. A significant difference in the positive rate of MP was detected in age groups of minors (χ2=388.27, P<0.05). Stratified by the season, the highest and lowest positive rate of MP were detected in autumn (33.67%) and summer (27.01%), respectively. No significant difference was detected in the positive rate of MP between winter and spring (χ2=1.16, P>0.05), which was significantly different between summer and autumn (χ2=28.23, P<0.05). November was the month with the highest positive rate of MP in the whole year (35.85%), and the lowest was February (21.79%). Conclusion The positive rate of MP in female is higher than that in male. Preschool children, school-age children and adolescents are susceptible populations of MP infection. In autumn and the alternating seasons of autumn and winter (i.e., September to December), MP infection is highly prevalent. MP is one of the important pathogens causing respiratory tract infection in Chengdu in 2021. Targeted prevention and control measures should be taken for susceptible populations according to the epidemiological characteristics of MP infection. Meanwhile, health education should be strengthened to prevent and control the spread of MP infection. Table and Figures | Reference | Related Articles | Metrics | Comments（0）

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Effect of pSOFA score combined with C-reactive protein and procalcitonin in prognosis assessment of sepsis children Zhou Bin, Zeng Cizheng, Huang Yuge, Zhong Mianling, Wu Jiayuan Clinical Focus    2022, 37 (7): 616-622.   DOI: 10.3969/j.issn.1004-583X.2022.07.006 Abstract （375）   HTML （0）    PDF（pc） （1048KB）（68）       Knowledge map    Save Objective To evaluat pediatric sequential organ failureassessment (pSOFA) score combined with C-reactive protein (CRP), procalcitonin (PCT), and other infection-related biomarkers of the prognostic assessment in sepsis children. Methods A retrospective observational study was applied to collect the clinical data of 289 sepsis children (2018.8-2019.8) admitted to Pediatric Intensive Care Unit (PICU) of the Hospital. The children were divided into the survival group and death group according to 28-day survival outcomes. The differences in intergroup physiological and laboratory data in pediatric intensive care unit (PICU) within 24 hours of admission were compared, binary logistic regression was applied to analyze high-risk factors impacting the prognosis of sepsis children, the receiver operating characteristic (ROC) curve and the area under ROC curve (AUC) were drawn to assess the effects of the pSOFA scores combined with CRP and PCT in the early diagnosis and prognosis of children with sepsis. Results A total of 289 children including 254 (87.9%) in the survival group and 35 (12.1%) in the death group were included in the study. The comparative differences of children in terms of availability of constantly pumped vasoactive drugs, duration of mechanical ventilation, Glasgow coma scores, gastrointestinal functions, and serum PCT concentration were statistically significant (all P<0.05). Binary logistic regression showed that pSOFA scores and availability of continuously pumped vasoactive drugs were high-risk factors for poor prognosis in children with sepsis (P<0.05); AUCs for CRP and PCT to predict death in children with sepsis was 0.547(95%CI: 0.488-0.606) and 0.667(95%CI: 0.609-0.721), respectively. The AUC of pSOFA+CRP, pSOFA+PCT and pSOFA scores for predicting death of children with sepsis was 0.947 without exception (95%CI: 0.914-0.970), and the differences weren't statistically significant (P>0.05). Conclusion pSOFA scores deliver important value for prognostic evaluation of sepsis children, while pSOFA score combined with CRP and PCT fail to improve the prognostic evaluation of children with sepsis. Table and Figures | Reference | Related Articles | Metrics | Comments（0）

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Relationship between uric acid and prognosis of Chinese patients with acute ischemic stroke: A meta analysis Wang Huixin, Zhao Fangqing, Zhang Xinyan, Hou Xiaowen Clinical Focus    2022, 37 (9): 785-790.   DOI: 10.3969/j.issn.1004-583X.2022.09.003 Abstract （363）   HTML （0）    PDF（pc） （1334KB）（108）       Knowledge map    Save Objective The meta analysis method was applied to comprehensively and systematically evaluate relations between uric acid and prognosis of Chinese patients with acute ischemic stroke.Methods PubMed, Web of Science, Embase, Cochrane Library, CNKI, VIP and Wanfang databases were searched by computer system to collect case-control studies on relation between the level of uric acid and prognosis of patients with acute ischemic stroke in Chinese from database establishment to February 2022. The Meta analysis was performed using STATA 16 software. Results Thirteen literatures representing a total of 11, 046 study subjects (n=8, 016 in the good prognosis group, and n=3 030 in the poor prognosis group) were included in the meta-analysis. The results showed that the uric acid level of patients in the good prognosis group was higher than that of poor prognosis group [WMD=18.44 μmol/L, 95%CI(3.20, 33.68), P<0.05]. The results of sensitivity analysis and publication bias test showed that the study results were stable and reliable.Conclusion The level of uric acid in Chinese may be related to the prognosis of patients with acute ischemic stroke, and the higher level of uric acid in Chinese patients may have a better prognosis. Table and Figures | Reference | Related Articles | Metrics | Comments（0）

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Radiofrequency ablation in treating pre-excited atrial fibrillation recurrence: A meta analysis An Jingjing, Wang Xiaojuan, Deng Aiyun Clinical Focus    2022, 37 (10): 899-904.   DOI: 10.3969/j.issn.1004-583X.2022.10.003 Abstract （356）   HTML （0）    PDF（pc） （1334KB）（95）       Knowledge map    Save Objective To explore the effectiveness of radiofrequency ablation (RFA) in treating pre-excited atrial fibrillation(AF) recurrence, aiming to provide theoretical basis for clinical practice. Methods Related studies regarding the treatment of RFA in pre-excited AF recurrence were searched in PubMed, Embase, CNKI, and Wanfang using a computer. Data collection for this study took place from the establishment to March 26, 2022. Two researchers independently screened the literature and extracted information and evaluated the quality of the literature, and R4.1.0 software was applied for Meta-analysis. Results Fourteen studies representing 851 patients were included. After RFA intervention, the overall AF recurrence rate was 0.13(95%CI: 0.08-0.19, P<0.01) in Meta-analysis result. Wherein, the subgroup analysis showed that the AF recurrence rate of accessory pathway (AP) ablation alone and AP+ pulmonary vein isolation (PVI) was 0.15(95%CI: 0.09-0.21, P<0.01) and 0.07 (95%CI: 0.01-0.15, P<0.01), respectively. The AF recurrence rates of unilateral bypass and multiple bypass were 0.19(95%CI: 0.12-0.28, P=0.01) and 0.05(95%CI: 0.00-0.20, P=0.10), respectively; the AF recurrence rates of left side tract and right side tract were 0.14(95%CI: 0.07-0.21, P<0.01) and 0.10(95%CI: 0.06-0.16, P=0.07), respectively; the AF recurrence rates of patients aged ≤40 years old and >40 years old were 0.10(95%CI: 0.01-0.23, P<0.01) and 0.15(95%CI: 0.09-0.21, P<0.01) respectively; the AF recurrence rates of patients with follow-up ≤1 year and >1 year was 0.08(95%CI: 0.02-0.17, P=0.09) and 0.17(95%CI: 0.14-0.21, P=0.17), respectively; the AF recurrence rates of sample size ≤50 cases and >50 cases were 0.18(95%CI: 0.09-0.29, P<0.01) and 0.11(95%CI: 0.06-0.17, P<0.01), respectively; the AF recurrence rates of men and women were 0.10(95%CI: 0.04-0.19, P<0.01) and 0.19(95%CI: 0.12-0.28, P=0.26), respectively; the AF recurrence rates of patients with and without organic heart disease were 0.34(95%CI: 0.15-0.57, P<0.01) and 0.04(95%CI: 0.00-0.10, P<0.01), respectively. Conclusion After RFA, current evidences suggest a higher AF recurrence rate, AP + PVI is superior to AP alone for reducing the recurrence rate, and the age and follow-up time are positively associated with the AF recurrence rate. Table and Figures | Reference | Related Articles | Metrics | Comments（0）

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Clinical analysis of 16 cases of venous thromboembolism combined with psychiatric disorders treated with olanzapine Wang Jiaoyan, Zhang Yingchun, Ren Keming, Ma Guofeng, Ying Kejing Clinical Focus    2022, 37 (12): 1108-1113.   DOI: 10.3969/j.issn.1004-583X.2022.12.008 Abstract （355）   HTML （0）    PDF（pc） （443KB）（62）       Knowledge map    Save Objective To improve the early recognition and early diagnosis of venous thromboembolism (VTE) in patients with psychiatric disorders. Methods Clinical symptoms, laboratory and imaging tests, anti-psychotic medication and treatment prognosis of 16 patients with psychiatric disorders combined with VTE who were first diagnosed in the Department of Mental Health, Sir Run Run Shaw Hospital affiliated to Zhejiang University from May 2019 to March 2022 were retrospectively analyzed. Results Among the 16 patients, there were 6 males and 10 females with an average age of 67 years. 13/16 were diagnosed with pulmonary embolism, 4/16 were diagnosed as deep venous thrombosis, and 1 suffered pulmonary embolism complicated with deep venous thrombosis. The diagnosis of pulmonary embolism and deep venous thrombosis was confirmed following the Chinese guidelines for the prevention and treatment of thrombotic diseases 2018 edition. 12 cases of pulmonary embolism were low-risk and one case was high-risk. Two patients had transient chest tightness and shortness of breath before onset, while the remaining 14 patients had no obvious symptoms of chest tightness and shortness of breath. 16 patients had abnormal D-dimer, 9 had hyperlipidemia, 8 had hyperhomocysteinemia, 5 had hyperprolactinemia and 2 had elevated coagulation factor VIII. 10 patients had VTE within the first 6 months of antipsychotic use. 3 cases occurred within 1 year and 3 cases occurred within 5 years. Olanzapine was given to all 16 patients. The risk of thrombosis was low in all 16 patients, as assessed by the Caprini and Padua Thrombosis Risk Assessment Scale. Conclusion The clinical presentation of VTE in patients with psychiatric disorders is atypical that lacks obvious clinical signs and symptoms, easily leading to misdiagnosed and untimely treatment. Conventional VTE prevention assessment scales are not suitable for them. VTE in patients with psychiatric disorders most often occurs within the first 6 months of olanzapine use, which is often associated with abnormal elevations in D-dimer and other metabolic laboratory markers. Concurrent olanzapine use in patients with psychiatric disorders may precipitate VTE and requires significant clinical attention. Table and Figures | Reference | Related Articles | Metrics | Comments（0）

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MDM4rs4245739 gene polymorphism and breast cancer susceptibility:A meta-analysis Jiang Yan, Li Jiayang, Wu Hongyu, Chen Baolin, Cheng Xiaoming, Lyu Junyuan Clinical Focus    2022, 37 (11): 977-984.   DOI: 10.3969/j.issn.1004-583X.2022.11.003 Abstract （355）   HTML （0）    PDF（pc） （1930KB）（50）       Knowledge map    Save Objective To explore associations between MDM4rs4245739 gene polymorphism and breast cancer susceptibility. Methods The papers related to polymorphisms of MDM4rs4245739 and breast cancer susceptibility were searched in PubMed, EMBASE, Cochrane Library, China National Knowledge Infrastructure and Wanfang electronic database. Odds ratios (ORs) and 95% confidence intervals (CIs) were adopted to assess the strength of associations. Publication bias was evaluated by Begg's funnel plot and Egger's linear regression test. Results A total of 6 studies involving 9 814 breast cancer patients and 45 202 healthy individuals were included in the present study. MDM4rs4245739 in the allelic (C vs A: OR=0.84, 95%CI: 0.67-1.05, P =0.118), dominant (AC+CC vs AA: O R=0.86, 95% CI: 0.67-1.11, P =0.245), recessive (AC+AA vs CC: OR=0.90, 95%CI: 0.61-1.32, P =0.585), heterozygous (AC vs AA: OR =0.88, 95%CI: 0.69-1.12, P=0.305), homozygous (CC vs AA: OR =0.90, 95% CI: 0.59-1.39, P=0.649) genetic models show no association with the susceptibility to breast cancer. Moreover, GEPIA data confirmed that the expression level of MDM4 was not associated with the tumor staging and prognosis of breast cancer. Conclusion Neither MDM4rs4245739 gene polymorphism nor MDM4 expression level is associated with the susceptibility and prognosis in breast cancer patients. Table and Figures | Reference | Related Articles | Metrics | Comments（0）

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Clinical Focus    2022, 37 (9): 838-841.   DOI: 10.3969/j.issn.1004-583X.2022.09.015 Abstract （350）   HTML （3）    PDF（pc） （839KB）（137）       Knowledge map    Save Reference | Related Articles | Metrics | Comments（0）

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Clinical Focus    2023, 38 (1): 88-92.   DOI: 10.3969/j.issn.1004-583X.2023.01.015 Abstract （348）   HTML （6）    PDF（pc） （857KB）（119）       Knowledge map    Save Reference | Related Articles | Metrics | Comments（0）