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Clinical Focus    2024, 39 (10): 935-939.   DOI: 10.3969/j.issn.1004-583X.2024.10.012 Abstract （108）   HTML （6）    PDF（pc） （803KB）（225）       Knowledge map    Save Reference | Related Articles | Metrics | Comments（0）

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Cortical “ribbon sign” on DWI in adults: A case report and literature review Zhang Yingqiu, Zhang Jin, Ge Shihao, Chen Junmin Clinical Focus    2024, 39 (9): 821-824.   DOI: 10.3969/j.issn.1004-583X.2024.09.010 Abstract （132）   HTML （3）    PDF（pc） （1059KB）（82）       Knowledge map    Save Objective To investigate the clinical characteristics of cortical “ribbon sign” on diffusion-weighted imaging (DWI). Methods The clinical data, relevant examination data, and imaging data of a case of cortical “ribbon sign” were analyzed, and relevant literatures were reviewed. Results The patient was admitted to the hospital due to involuntary grasping of objects with a walking instability for 10 days, and aggravated for 2 days. Brain imaging examination showed cortical “ribbon sign”, manifesting as a high signal intensity along the cerebral sulcus on T1-weighted imaging, DWI and fluid-attenuated inversion recovery sequence. The increase in signal intensity was pronounced on DWI sequence, reflecting the cytotoxic edema of the cerebral cortex. Symptomatic treatment was performed. The patient's symptoms gradually worsened and died about half a year later. Conclusion Cortical ribbon sign is a typical imaging change of laminar necrosis of the cerebral cortex, usually observed in vascular, infectious, metabolic, and toxic nerve system diseases. A deep mining of the pathogenesis and causes of cortical ribbon sign favors the clinical diagnosis and differentiation diagnosis. Table and Figures | Reference | Related Articles | Metrics | Comments（0）

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Association of urinary transferrin with new-onset cardiovascular disease in type 2 diabetes mellitus Ma Jiannan, Tao Jie, Sang Dasen, Wu Shouling, Zhang Qi Clinical Focus    2024, 39 (8): 700-705.   DOI: 10.3969/j.issn.1004-583X.2024.08.004 Abstract （116）   HTML （3）    PDF（pc） （1135KB）（80）       Knowledge map    Save Objective To explore the correlation between urinary transferrin to urinary creatinine ratio (uTRF/Cr) and new onset cardiovascular disease (CVD) in type 2 diabetes mellitus (T2DM). Methods A total of 8 163 T2DM patients who participated in the 6th health examination in Kailuan and underwent urinary transferrin and urinary creatinine detection were recruited. Subjects were divided into the first group (n=2 721), the second group (n=2 721), and the third group (n=2 721) based on baseline uTRF/Cr. The effects of uTRF/Cr on the risk of CVD were analyzed by multivariate Cox regression model. Results The baseline age of the study population was (60.46±9.96) years, with 78.30% of males, and 0.24(0.16-0.47) mg/mmol of baseline uTRF/Cr. The median follow-up time was 3.85(3.43-4.22) years, with 411(6.79%) of CVD events occurred. The cumulative incidence of total CVD events in the first, second and third groups was 3.81%, 4.65%, and 7.29%, respectively. After adjusting for relevant influencing factors, the risk of total CVD events in the second and third groups of uTRF/Cr was 1.12(95%CI 0.86-1.46) times and 1.52(95%CI 1.18-1.97) times that in the first group, respectively. Conclusion Increased uTRF/Cr is an independent risk factor for CVD in T2DM populations, and the risk of CVD increases with increased uTRF/Cr, even before the onset of macroalbuminuria. Table and Figures | Reference | Related Articles | Metrics | Comments（0）

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Changes in pulmonary function, inflammatory factors, and clinical symptoms after smoking cessation in COPD patients with varied HRCT phenotypes Liu Cuicui, Zhu Yafang, Lyu Wenjuan Clinical Focus    2024, 39 (7): 625-629.   DOI: 10.3969/j.issn.1004-583X.2024.07.007 Abstract （129）   HTML （5）    PDF（pc） （857KB）（73）       Knowledge map    Save Objective This study aims to evaluate the advantages of smoking cessation in patients with chronic obstructive pulmonary disease (COPD) across various high-resolution CT (HRCT) phenotypes. Methods We included 272 COPD patients who were smokers and underwent HRCT examination at our hospital's Department of Respiratory and Critical Care Medicine between June 2021 and June 2022. Patients were categorized based on their willingness to quit smoking and their success in doing so, while continuing their basic COPD treatment. A total of 104 successful quitters were selected for this study. These 104 COPD patients were further classified into three types according to the classification of low attenuation areas (LAA) under HRCT and the thickness of the airway wall: Type A (33 cases), Type E (35 cases), and Type M (34 cases). We recorded their lung function indicators (forced expiratory volume in the first second [FEV1], FEV1/forced vital capacity [FVC]), expression levels of inflammatory factors (T helper 17 cells/regulatory T cells [Th17/Treg], tumor necrosis factor alpha [TNF-α]), arterial carbon dioxide pressure (PaCO2), erythrocyte sedimentation rate (ESR), cough score, and number of acute exacerbations. Results ①Lung Function Indicators: Prior to smoking cessation, there was no statistically significant difference in FEV1 and FEV1/FVC among the three groups (P>0.05). Post-cessation, both the A and E groups exhibited higher FEV1 and FEV1/FVC compared to the M group, with a statistically significant difference (P<0.05). ②Cytokine Expression Levels: Prior to smoking cessation, there was no statistically significant difference in Th17/Treg and TNF-α among the three groups (P>0.05). Post-cessation, both the A and E groups demonstrated lower Th17/Treg and TNF-α levels compared to the M group, with a statistically significant difference (P<0.05). ③PaCO2 and ESR: Prior to smoking cessation, there was no statistically significant difference in PaCO2 and ESR among the three groups (P>0.05). Post-cessation, both the A and M groups had lower PaCO2 levels compared to the E group; both the A and E groups had lower ESR levels compared to the M group, with a statistically significant difference (P<0.05). ④Number of Acute Exacerbations and Cough Score: Prior to smoking cessation, there was no statistically significant difference in the number of acute exacerbations and cough score among the three groups (P>0.05). Post-cessation, both the A and M groups experienced fewer acute exacerbations compared to the E group; both the A and E groups had higher cough scores compared to the M group, with a statistically significant difference (P<0.05). Conclusion There are variations in the number of acute exacerbations and therapeutic effects post-smoking cessation among COPD patients with different HRCT phenotypes. Specifically, patients with Type E and Type M exhibit a weaker improvement effect after quitting smoking. However, quitting smoking has a more pronounced improvement effect on the number of acute exacerbations, lung function, and inflammatory factors in patients with Type A. Table and Figures | Reference | Related Articles | Metrics | Comments（0）

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Vitamin D deficiency and orthostatic hypotension in the elderly: A systematic review and meta-analysis Zhao Jiahua, Ma Qinghua, Yu Jianghua Clinical Focus    2024, 39 (10): 869-876.   DOI: 10.3969/j.issn.1004-583X.2024.10.001 Abstract （148）   HTML （6）    PDF（pc） （1279KB）（68）       Knowledge map    Save Objective To study the relationship between vitamin D deficiency, defined as 25-hydroxyvitamin D3 (25 (OH) D3) deficiency and the risk of orthostatic hypotension (OH) in the elderly population. Methods From the establishment of the database to June 2023, a systematic literature search was conducted on Pubmed, Embase, Web of Science, Scopus, and Cochrane databases. Two researchers independently screened the included literatures, extracted data and evaluated the risk of bias of the included studies. Meta-analysis was performed using Stata software (version 17.0) and RevMan5.4 software. Results A meta-analysis was conducted using the random-effect model involving 9,155 participants from 9 cross-sectional studies. Serum 25-hydroxyvitamin D levels were measured by radioimmunoassay (RIA) and liquid chromatography mass spectrometry (LC-MS). The overall analysis results showed that vitamin D deficiency was directly correlated with OH in the elderly population. Compared with individuals with normal vitamin D levels, low serum vitamin D levels significantly increased the risk of OH in the elderly (OR=1.22, 95%CI=1.12-1.33,P<0.05). Conclusion There is a clear correlation between vitamin D deficiency and the risk of OH in the elderly. Table and Figures | Reference | Related Articles | Metrics | Comments（0）

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Efficacy of empagliflozin combined with liraglutide on obese and overweight T2DM patients and its impact on inflammatory factors: A prospective, randomized, open-label, parallel-controlled clinical study Wang Jing, Li Caige, Wang Ting, Liu Zibo, Gai Bin, Jin Yangyu, Zhang Lihui Clinical Focus    2024, 39 (10): 909-914.   DOI: 10.3969/j.issn.1004-583X.2024.10.007 Abstract （138）   HTML （2）    PDF（pc） （419KB）（56）       Knowledge map    Save Objective To investigate the clinical efficacy of empagliflozin combined with liraglutide on obese/overweight patients with type 2 diabetes mellitus (T2DM) and its effects on inflammatory factors and islet function. Methods A total of 58 obese/overweight T2DM patients hospitalized and treated at the Second Hospital of Hebei Medical University from June 2021 to September 2023 were selected as the study subjects. They were randomly assigned into the experimental group (Lira+Empa group) and the control group (Lira group), with 29 cases in each group. Patients in the experimental group received a combination therapy of empagliflozin and liraglutide, while those in the control group received liraglutide monotherapy. Pre- and post-treatment glycometabolic indicators, lipid metabolic indicators, inflammatory factors, islet function indicators, and adverse events were compared between groups. Results After treatment, the levels of fasting plasma glucose (FPG), 2-hour postprandial plasma glucose (2 hPPG), glycated albumin (GA), total cholesterol (TC), triglycerides (TG), low-density lipoprotein cholesterol (LDL-C), body mass index (BMI), interleukin-6 (IL-6), and interleukin-10 (IL-10) in both groups were significantly lower than those before treatment. The levels of FPG, 2 hPPG, GA, BMI, IL-6, and IL-10 in the Lira+Empa group were all significantly lower than those of the Lira group (P<0.05). After treatment, the levels of C-peptide (C-P), fasting insulin (FINS), and homeostasis model assessment of β-cell function (HOMA-β) in both groups were significantly higher than those before treatment, and HOMA-β was significantly higher in the Lira+Empa group than the Lira group (P<0.05). There was no significant difference in the incidence of adverse events between the two groups. Conclusion Compared with liraglutide monotherapy, the combination therapy of empagliflozin and liraglutide can further improve the blood glucose-lowering effect, lower blood sugar levels, promote islet function of patients, reduce body weight, and reduce inflammatory factors in obese/overweight T2DM patients, with a good safety. Table and Figures | Reference | Related Articles | Metrics | Comments（0）

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Clinical Focus    2024, 39 (9): 842-846.   DOI: 10.3969/j.issn.1004-583X.2024.09.015 Abstract （195）   HTML （9）    PDF（pc） （905KB）（52）       Knowledge map    Save Table and Figures | Reference | Related Articles | Metrics | Comments（0）

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A case report of adult MOGAD and literature review Zhong Yuan, Meng Fenglei Clinical Focus    2025, 40 (1): 70-75.   DOI: 10.3969/j.issn.1004-583X.2025.01.011 Abstract （76）   HTML （4）    PDF（pc） （1403KB）（52）       Knowledge map    Save Objective To discuss the clinical manifestations, magnetic resonance imaging (MRI) features, MOG-IgG testing, diagnostic criteria, treatment and prognosis of myelin oligodendrocyte glycoprotein (MOG)-associated disease (MOGAD). Methods We reported a case of adult MOGAD, and reviewed relevant literatures. Results A 38-year-old female presented with headache and blurred vision in both eyes for three days. She had a history of prodromal fever. The head MRI showed lesions and enhancement in the thalamus, basal ganglia, cerebral peduncle, and brainstem. Serum and cerebrospinal fluid antibody testing showed a weak positive MOG IgG at a 1:10 ratio in both serum and cerebrospinal fluid. She was diagnosed with MOGAD, mainly manifested as optic neuritis and brainstem encephalitis. The combination therapy of corticosteroid and rituximab was given, and the patient's symptoms were completely disappeared at the 4-month follow-up. Conclusion MOGAD is a rare, antibody-mediated infl ammatory demyelinating disorder of the central nervous system (CNS) with cardinal features of optic neuritis, myelitis, brainstem encephalitis, cerebral cortical encephalitis (often with seizures) and acute disseminated encephalomyelitis. New diagnostic criteria for MOGAD have recently been proposed by an international panel of experts in 2023. MOG-IgG detection is the key to diagnosing MOGAD. There is no clear guideline for MOGAD treatment. About 50% of patients will experience a recurrence. Table and Figures | Reference | Related Articles | Metrics | Comments（0）

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The risk prediction models for pneumonia in patients with intracerebral hemorrhage: A systematic review Liu Jinteng, Liu Xingyu, Huang Lumei, Pan Hailong Clinical Focus    2025, 40 (1): 5-13.   DOI: 10.3969/j.issn.1004-583X.2025.01.001 Abstract （105）   HTML （4）    PDF（pc） （976KB）（48）       Knowledge map    Save Objective To systematically analyze and evaluate the risk prediction model for pneumonia in patients with intracerebral hemorrhage (ICH). Methods Articles reporting risk prediction model for pneumonia in ICH patients published prior to February 2023 were searched in the online databases of Pubmed, Web of Science, Embase, The Cochrane Library, Scopus, Ovid Medline, CNKI (China National Knowledge Infrastructure), WanFang Data, VIP and CBM (Chinese Biomedical Literature Database). Two researchers were independently responsible for screening literature and extracting data. The quality of the literature included in this study was rigorously evaluated, and both the risk of bias and adaptability were assessed in accordance with the Transparent Reporting of a Multivariable Prediction Model for Individal Prognosis or Diagnosis(TRIPOD), and the Prediction Model Risk of Bias Assessment Tool(PROBAST). Results A total of 12 relevant studies were included, involving 7 registered studies, 1 ovarian case-control study, 3 single-center case-control studies, and 1 retrospective cohort study. Logistic regression and machine learning were used for modeling. Eight studies were validated internally, 2 studies were only validated externally, and 2 studies were validated both. The area under the receiver operating characteristic curve of the model was 0.740-0.920. The range of predictors in the 12 studies ranged from 4 to 11, and the common predictors were the age, the National Institutes of Health Stroke Scale score, the Glasgow Coma Scale score, dysphagia, smoking, chronic obstructive pulmonary disease, and nasogastric tube feeding. Model calibration was performed in 9 studies and not in 3 studies. The model was mainly presented in the form of risk score, risk calculation formula and nomogram. The included studies exhibited moderate quality and a high risk of bias. Conclusion The current model for predicting the risk of pneumonia in ICH patients demonstrates good predictive ability, and the predictive factors are relatively easy to obtain. However, there are also significant defects and high bias. In future research, it is recommended that researchers adhere to the TRIPOD guideline and PROBAST statement when conducting prediction model studies. It is important to summarize the advantages and disadvantages of existing models and to conduct external verification, thus developing a risk prediction model for pneumonia in ICH patients with excellent predictive performance and ease of use. Table and Figures | Reference | Related Articles | Metrics | Comments（0）

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Clinical Focus    2025, 40 (4): 372-376.   DOI: 10.3969/j.issn.1004-583X.2025.04.014 Abstract （18）   HTML （2）    PDF（pc） （988KB）（48）       Knowledge map    Save Table and Figures | Reference | Related Articles | Metrics | Comments（0）

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Risk prediction model for readmission of chronic obstructive pulmonary disease: A systematic review Zhu Jieyun, Gao Min, Huang Chunli, Pan Dongzan, Wang Qiaoyan, Lu Zhao Clinical Focus    2024, 39 (9): 773-779.   DOI: 10.3969/j.issn.1004-583X.2024.09.001 Abstract （184）   HTML （9）    PDF（pc） （597KB）（47）       Knowledge map    Save Objective To systematically evaluate the risk for readmission in patients with chronic obstructive pulmonary disease (COPD) and provide references for the construction and optimization of prediction model.Methods The literatures on the risk prediction model for COPD readmission were independently screened in China National Knowledge Infrastructure (CNKI), VIP, WanFang Data, Cochrane Library, PubMed, Embase databases from database inception to November 22, 2023 by two researchers. After extracting data, the bias risk and applicability of the models were evaluated using the PROBAST tool. Results Twelve cohort studies representing 21 models were finally included. Eleven studies reported the area under a receiver operator characteristic (ROC) curve (AUC) and one study for the C-index. The AUC ranged from 0.603 to 0.917, with AUC>0.7 for 16 models. Six studies conducted model calibration and eight studies for internal or external validation. The overall applicability of the 12 studies was good, but with a high risk of bias, mainly in the analysis domain. The included studies had significant differences in the predictive factors, with the most common predictive factors of lung function indicators, Charlson comorbidity index, times of hospitalization due to a history of acute exacerbation during the previous year, eosinophil levels, and inhaled drug therapy. Conclusion The performance of the included models varied greatly, with good applicability but high risk of bias. Due to the incomplete screening method, and there were significant differences in predictive factors of the included studies. Future prediction models should focus on lung function, Charlson comorbidity index, times of hospitalization due to a history of acute exacerbation during the previous year, eosinophil levels, and inhaled drug therapy. Table and Figures | Reference | Related Articles | Metrics | Comments（0）

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Clinical Focus    2024, 39 (7): 654-657.   DOI: 10.3969/j.issn.1004-583X.2024.07.013 Abstract （185）   HTML （6）    PDF（pc） （853KB）（44）       Knowledge map    Save Table and Figures | Reference | Related Articles | Metrics | Comments（0）

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Clinical Focus    2024, 39 (7): 658-663.   DOI: 10.3969/j.issn.1004-583X.2024.07.014 Abstract （219）   HTML （7）    PDF（pc） （1030KB）（44）       Knowledge map    Save Table and Figures | Reference | Related Articles | Metrics | Comments（0）

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Efficacy and safety of sotagliflozin in the treatment of type 2 diabetes mellitus: A meta-analysis Yue Jianghong, Wang Heng, Cai Gang, Zhang Xuanming, Peng Xi Clinical Focus    2024, 39 (7): 581-592.   DOI: 10.3969/j.issn.1004-583X.2024.07.001 Abstract （177）   HTML （13）    PDF（pc） （3483KB）（43）       Knowledge map    Save Objective To evaluate the efficacy and safety of sotagliflozin in the treatment of type 2 diabetes mellitus (T2DM). Methods Randomized controlled trials (RCTs) involving sotagliflozin versus placebo (or other oral hypoglycemic agents) in the treatment of T2DM pulished before October 31, 2023 were retrieved in PubMed, Embase, Web of science, Medline, Cochrane Library, the North American Clinical Trial Register, CNKI, Wanfang, VIP, SinoMed and other databases. The extracted Valid data were performed for quality evaluation, and a meta-analysis was conducted using RevMan 5.3 software. Results Fourteen RCTs representing 16, 959 patients were included. The results of meta-analysis showed: In terms of efficacy, compared with the control group, sotagliflozin group presented significantly decreased glycated hemoglobin (HbA1c, MD=-0.45, 95%CI[-0.58, -0.33]; P<0.01) and fasting blood glucose (FBG, MD=-0.66, 95%CI[-1.01, -0.31]; P=0.0002) and 2-h postprandial glucose (2hPG, MD=-1.01, 95%CI[-1.58, -0.44]; P=0.0005), and improved compliance rate of HbA1c <7% (RR=1.88, 95%CI[1.64, 2.15], P<0.01). Compared with control group, sotagliflozin group had decreased systolic blood pressure (SBP, MD=-2.13, 95%CI[-2.81, -1.45], P<0.01) and body mass (BM, MD=-1.40, 95%CI[-1.63, -1.17], P<0.01), but there was no statistical significance in reducing diastolic blood pressure (DBP). In terms of safety, the incidence of hypoglycemic events was similar between the sotagliflozin group and the control group (RR=1.00, 95%CI[0.92, 1.09], P=0.97). However, the incidence of adverse reactions was significantly lower in sotagliflozin group (RR=0.92, 95%CI [0.88, 0.96], P<0.01). Subgroup analysis according to different doses of sotagliflozin showed that compared with the control group, sotagliflozin 200 mg and 400 mg groups could significantly reduce the HbA1c and FBG, improve the compliance rate of HbA1c<7%, and reduce SBP, BM and other indexes (P<0.05), and without increasing the risk of hypoglycemia events (P>0.05). Conclusion Sotagliflozin can significantly reduce HbA1c, FBG, 2hPG, SBP, and BM in T2DM patients without increasing the risk of hypoglycemia or the incidence of adverse reactions. Table and Figures | Reference | Related Articles | Metrics | Comments（0）

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Longitudinal cohort study of oral health status and cognitive function in the elderly: A meta-analysis Wang Lin, Wang Ting, Pu Xiaolan, Ju Mei Clinical Focus    2024, 39 (8): 677-683.   DOI: 10.3969/j.issn.1004-583X.2024.08.001 Abstract （187）   HTML （7）    PDF（pc） （1364KB）（42）       Knowledge map    Save Objective To explore the correlation between oral health status and the risk of cognitive dysfunction by meta-analysis. Methods Cohort studies on the correlation between oral health status and cognitive function from inception to August 2023 were searched in PubMed, Web of Science, EMBASE, Scopus, Chinese National Knowledge Infrastructure (CNKI), China Biomedical Literature Database (CBM), Wanfang, VIP and Duxiu databases. Two reviewers independently screened literatures, extracted data and evaluated the quality of included studies. Meta-analysis was performed using RevMan 5.3 and Stata 17.0 software. Results A total of 34 cohorts were included. The results of meta-analysis showed that the risk of cognitive impairment in the elderly with poor oral health status was significantly higher than that in the elderly with good oral health status (RR=1.31, 95%CI 1.18-1.46, P<0.01). The results of subgroup analysis showed that there were significant differences in periodontitis disease, posterior occlusal support, dentition status, and tooth loss (P<0.05), but there was no significant difference in the oral frailty (RR=1.32, 95%CI 0.96-1.81, P=0.09). There was no significant difference in the risk of oral health status and cognitive impairment in the subgroup with a follow-up time>10 years (RR=1.01, 95%CI 0.83-1.23, P=0.90), but a significant difference was detected in the subgroup with a follow-up time ≤10 years (RR=1.48, 95%CI 1.32-1.67, P<0.001). There was no significant difference in the risk of oral health status and cognitive impairment in the moderate quality subgroup (RR=1.05, 95%CI 0.91-1.20, P=0.51), but a significant difference was detected in the high quality subgroup (RR=1.35, 95%CI 1.21-1.51, P<0.01). Conclusion Oral health status is associated with the risk of cognitive dysfunction. Table and Figures | Reference | Related Articles | Metrics | Comments（0）

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Causal relationship between reflux esophagitis and otitis media: a two-sample Mendelian randomization analysis in the European population Hu Rongqiu, Yan Le Clinical Focus    2024, 39 (12): 1089-1094.   DOI: 10.3969/j.issn.1004-583X.2024.12.005 Abstract （50）   HTML （2）    PDF（pc） （1102KB）（42）       Knowledge map    Save Objective Observational studies have shown an association between otitis media (OM) and gastroesophageal reflux disease (GERD). However, traditional studies have biases that limit our understanding of the impact of GERD on OM. Methods A two-sample Mendelian randomization (MR) approach with the random-effects inverse variance weighted model was adopted to analyze genome-wide association study (GWAS) data in the European population from the available online database. The causal relationship between GERD and OM in the European population was analyzed. MR-Egger regression and weighted median were also used as supplements. Sensitivity analysis was performed by Cochran's Q test, MR Pleiotropy RESidual Sum and Outlier test (MR-PRESSO) and Mendelian randomization-Egger (MR-Egger) intercept tests, including horizontal pleiotropy and heterogeneity tests, to ensure the reliability of the study results. Results According to the IVW model, a causal relationship was found between GERD and acute suppurative otitis media (ASOM) ( O R=1.208; 95% C I: 1.030-1.416, P=2.00e-2). A causal relationship between GERD and chronic suppurative otitis media (CSOM) was strongly demonstrated ( O R=2.085, 95% C I: 1.329-3.270, P=1.38e-3). However, there was no causal relationship between GERD and non-suppurative otitis media (NSOM) ( O R=1.151, 95% C I: 0.970-1.366, P=2.50e-1), and a consistent correlation pattern was observed in some MR models. In addition, little evidence of bias was found in the sensitivity analyses. Conclusion The genetic susceptibility of GERD to ASOM and CSOM tends to increase, suggesting that GERD should be checked, and appropriate treatment should be selected when treating OM. Table and Figures | Reference | Related Articles | Metrics | Comments（0）

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Clinical Focus    2024, 39 (9): 855-860.   DOI: 10.3969/j.issn.1004-583X.2024.09.018 Abstract （176）   HTML （5）    PDF（pc） （952KB）（40）       Knowledge map    Save Reference | Related Articles | Metrics | Comments（0）

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Association of TyG index and its derivatives with the risk of diabetic kidney disease in patients with type 2 diabetes mellitus Li Jiawen, Liu Yanlan, Li Yaoshuang, Qiu Huina, Li Fang, Wu Fan, Lin Chenying, Lin Jingna Clinical Focus    2024, 39 (10): 901-908.   DOI: 10.3969/j.issn.1004-583X.2024.10.006 Abstract （166）   HTML （3）    PDF（pc） （1253KB）（34）       Knowledge map    Save Objective To study the correlation of triglyceride-glucose (TyG) and its derivative index with the risk of diabetic kidney disease (DKD) in patients with type 2 diabetes mellitus (T2DM), and to explore its clinical application value. Methods This was a cross-sectional study including 895 T2DM patients hospitalized in the Endocrinology Department of Tianjin People's Hospital from 2018 to 2022. Patients were divided into DKD group (n=326) and non-DKD group (n=569) according to whether they had DKD or not. The clinical data of the two groups were compared. The correlation of TyG, triglyceride glucose-waist circumference (TyG-WC), triglyceride glucose-body mass index (TyG-BMI), and homeostatic model assessment for insulin resistance (HOMA-IR) with DKD was identified. The interaction of TyG and its derivatives with stratification factors was explored. Results There were significant differences in TyG, TyG-WC, TyG-BMI and HOMA-IR between the two groups (P<0.05). TyG and TyG-WC were independent influencing factors of the risk of DKD before and after adjusting for influencing factors (P<0.05). The prevalence of DKD in T2DM patients increased gradually with the increased TyG, TyG-WC and HOMA-IR (trend test P<0.05). In the T3 subgroup of TyG and TyG-WC, the prevalence of DKD was significantly higher than that of T1 subgroup (P<0.05). At varied levels of TyG, it was an independent risk factor for the risk of DKD before and after adjusting for the influencing factors (P<0.05). Conclusion As an independent risk factor for the risk of DKD, continuous and categorical variables of TyG and its derivatives as well as HOMA-IR stably predict DKD in T2DM patients. Table and Figures | Reference | Related Articles | Metrics | Comments（0）

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Clinical Focus    2024, 39 (8): 763-768.   DOI: 10.3969/j.issn.1004-583X.2024.08.014 Abstract （162）   HTML （6）    PDF（pc） （999KB）（34）       Knowledge map    Save Table and Figures | Reference | Related Articles | Metrics | Comments（0）

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Study on influencing factors and prevention for the complications of the “pull technique” technique for peritoneal catheter extubationremoval and the prevention Lin Zexing, Guo Hancheng, Yao Chunmeng, Xiao Liangxiang, Dai Yunxin, Wu Sai, Wang Fuzhen, Xie Zugang, Yao Cuiwei Clinical Focus    2025, 40 (1): 39-43.   DOI: 10.3969/j.issn.1004-583X.2025.01.006 Abstract （98）   HTML （22）    PDF（pc） （407KB）（34）       Knowledge map    Save Objective To investigate the postoperative complications of the “pull” technique for peritoneal tube extubation in peritoneal dialysis (PD) patients and its influencing factors, and to further optimize the “pull” technique to reduce the incidence of complications. Methods From September 1, 2018 to October 31, 2023, 98 PD patients in peritoneal dialysis centers of four hospitals, including Zhongshan Hospital Xiamen University, and 339 PD patients extubated using the “pull” technique reported at home and abroad were analyzed. Literatures with a small sample size or unclear descriptions were excluded. The clinical data were compared. Results Complications occurred in 13 of the 98 patients in the dialysis center. Multivariate logistic regression analysis showed that body mass index (BMI) was an independent risk factor for the complications after the “pull” technique for peritoneal cathether extubation (P<0.05). Compared with the cases reported in literatures, the proportion of PD catheter rupture and abdominal wall bleeding in our study group was significantly larger (P<0.05). There were 7 cases of PD catheter rupture out of 98 patients, which may be related to the number of traction, traction angle and traction intensity. Among the 98 patients, there were 8 cases reporting the distance between the outer cuff and the skin outlet less than 2 cm or the infection of the outlet and the outer cuff before extubation, and no complications were observed after the modified “pull” technique for peritoneal cathether extubation. Due to repeated infection and prolapse of shallow cuff in 7 cases, Seldinger puncture catheterization combined with the “pull” technique for peritoneal cathether extubation was used to replace the PD catheter. Conclusion The “pull” technique for peritoneal catheter extubation is a safe and reliable technique with few and treatable complications. Table and Figures | Reference | Related Articles | Metrics | Comments（0）

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Risk factors for constipation in patients with chronic kidney disease in Gansu province: a single-center study Pu Qian, Cheng Gang, Dao Jiecao, Qi Zizhao, Dou Lele, Zhao Junfang, Zhang Wenjun, Guo Caixia, Wang Yingying Clinical Focus    2025, 40 (1): 44-53.   DOI: 10.3969/j.issn.1004-583X.2025.01.007 Abstract （86）   HTML （3）    PDF（pc） （1033KB）（33）       Knowledge map    Save Objective To investigate the prevalence of constipation among patients with chronic kidney disease (CKD) in Gansu province, and to analyze potential risk factors. Methods CKD patients in the Department of Nephrology and Dialysis Center & Clinical Medical School of the Second Hospital, Lanzhou University were surveyed by a constipation questionnaire developed according to the Rome III criteria during the two periods of July 2022 to August 2022, and January 2023 to February 2023 via the WJX platform. At the same time, demographics, hemodialysis-related data, laboratory parameters, and use of drugs such as iron and phosphorus binders were collected. Results Totally 279 adult CKD patients older than 18 years were enrolled, including 191 hemodialysis patients and 88 non-dialysis patients. The prevalence of constipation in CKD stage 1-2, 3-4, and 5 patients was 36.2%, 45.8%, and 29.8%, respectively. Univariate Logistic regression analysis showed that primary diabetic nephropathy (OR=4.694, 95% CI 1.436-15.350, P=0.011) was a significant risk factor for constipation in non-dialysis patients. High serum triglyceride (TG) (OR=1.493, 95% CI 1.082-2.060, P=0.015) was a risk factor for constipation in CKD patients receiving hemodialysis. The risk factors for constipation in CKD patients included the use of phosphorus binding agents (OR=1.669, 95% CI 1.001-2.784, P=0.049) and use of iron agents (OR=1.745, 95% CI 1.047-2.909, P=0.033), high serum glucose (Glu)(OR=1.070, 95% CI 1.008-1.135, P=0.026) and TG (OR=1.254, 95% CI 1.017-1.546, P=0.034). Multivariate Logistic regression showed that female (OR=3.258, 95% CI 1.022-10.386, P=0.046) and diabetic nephropathy (OR=13.863, 95% CI 1.815-105.901, P=0.011) were independent risk factors for constipation in non-dialysis patients. In addition, diabetic nephropathy (OR=2.137, 95% CI 1.015-4.499, P=0.046) was a risk factor for constipation in CKD patients. Conclusion Diabetic nephropathy is an independent risk factor for constipation in CKD patients. The female gender represents an independent risk factor for constipation in non-dialysis patients. Table and Figures | Reference | Related Articles | Metrics | Comments（0）

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Clinical Focus    2024, 39 (8): 752-757.   DOI: 10.3969/j.issn.1004-583X.2024.08.012 Abstract （174）   HTML （4）    PDF（pc） （879KB）（31）       Knowledge map    Save Table and Figures | Reference | Related Articles | Metrics | Comments（0）

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Clinical Focus    2024, 39 (10): 945-952.   DOI: 10.3969/j.issn.1004-583X.2024.10.014 Abstract （142）   HTML （8）    PDF（pc） （870KB）（31）       Knowledge map    Save Table and Figures | Reference | Related Articles | Metrics | Comments（0）

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Clinical Focus    2025, 40 (1): 76-81.   DOI: 10.3969/j.issn.1004-583X.2025.01.012 Abstract （89）   HTML （3）    PDF（pc） （863KB）（30）       Knowledge map    Save Reference | Related Articles | Metrics | Comments（0）

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Clinical Focus    2024, 39 (9): 847-850.   DOI: 10.3969/j.issn.1004-583X.2024.09.016 Abstract （165）   HTML （7）    PDF（pc） （885KB）（28）       Knowledge map    Save Reference | Related Articles | Metrics | Comments（0）

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Evidence summary of the application of the diary method in adult ICU patients Wang Yu, Peng Lili, Shi Yao, Du Yunhong, Duan Yuliang, Wang Li Clinical Focus    2024, 39 (9): 780-786.   DOI: 10.3969/j.issn.1004-583X.2024.09.002 Abstract （134）   HTML （4）    PDF（pc） （1158KB）（28）       Knowledge map    Save Objective To systematically screen, evaluate, summarize and extract the optimal evidence for the application of the diary method in adult patients in the intensive care unit (ICU), so as to provide evidence-based basis for the implementation of the diary method in ICU. Methods All the evidence on the application of the diary to adult ICU patients were searched in relevant professional websites and databases at home and abroad, including the guidelines, evidence summary, expert consensus, systematic reviews, clinical decisions, etc. The retrieval time was from the establishment of the database to January 25, 2024. Two researchers independently conducted literature screening, quality evaluation, data extraction, classification and evidence summary according to the topic. Results A total of 13 articles were included, with 1 expert consensus, 2 guidelines and 10 systematic reviews. The optimal evidence for the application of diary method in ICU adult patients was formed, including 8 dimensions (application cognition, application effect, target population, writers, diary content, writing notes, application guidance and diary management) and 32 pieces of evidence. Conclusion Medical staff should carefully select appropriate evidence according to the corresponding clinical situation, and a multidisciplinary team cooperation should be carried out to yield the optimal individualized evidence practice of the diary method in ICU. Table and Figures | Reference | Related Articles | Metrics | Comments（0）

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Effectiveness of high-frequency vagus nerve stimulation in the treatment of drug-resistant epilepsy: A meta-analysis Wang Caizhen, Miao Lina, Chen Yuan, Li Shuangcheng Clinical Focus    2024, 39 (7): 593-597.   DOI: 10.3969/j.issn.1004-583X.2024.07.002 Abstract （138）   HTML （3）    PDF（pc） （1142KB）（28）       Knowledge map    Save Objective To analyze the efficacy of high-frequency vagus nerve stimulation (VNS) in the treatment of drug-resistant epilepsy (DRE). Methods Randomized controlled trials (RCTs) related to VNS in treating DRE published before September 2023 were independently screened in PubMed, Chinese Biomedical Literature Database (CBM), EMbase, The Cochrane Library, Web of science, Chinese National Knowledge Infrastructure (CNKI) and WanFang Data by two researchers. The extracted data were conducted for a Meta analysis using the RevMan5.3 software. Results Nine RCTS representing 918 patients with DRE were included. High-frequency VNS had a higher effective rate for DRE versus drug treatment or low-frequency VNS ( O R=2.30, 95% C I[1.41,3.75], P=0.0009). The results for subgroup analysis showed that the efficacy of high-frequency VNS in Asian and American subgroups grouped by different intercontinental, non-20-week subgroups grouped by different observation cycles, neck VNS subgroups grouped different stimulation sites, and drug treatment subgroups grouped by different treatment regimens were better than those in control subgroups, with statistically significant differences (P<0.05). Conclusion The high-frequency VNS has a good efficacy for DRE. Table and Figures | Reference | Related Articles | Metrics | Comments（0）

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Effect of treatment regimen containing Bedaquiline for drug-resistant tuberculosis on the QT interval of electrocardiogram Wan Rong, Li Guangmei, Ji Yongjing, Liu Lei, Cui Cancan, Li Mingwu Clinical Focus    2024, 39 (7): 630-634.   DOI: 10.3969/j.issn.1004-583X.2024.07.008 Abstract （111）   HTML （3）    PDF（pc） （855KB）（28）       Knowledge map    Save Objective To explore the effect of treatment regimen containing Bedaquiline for drug-resistant tuberculosis on the QT interval of electrocardiogram. Methods A total of 204 patients with drug-resistant tuberculosis admitted in the Department of Tuberculosis, Kunming Third People's Hospital from August 2018 to December 2022 were selected. Eighty-four patients treated with Bedaquiline-containing regimen were included in the observation group. After excluding 4 dropouts and 2 deaths, 78 cases were finally included in the observation group. A total of 120 patients treated with the regimen without Bedaquiline were enrolled in the control group, and finally 115 were eligible (4 dropouts and 1 death).The QT interval and clinical data of two groups at different stages of treatment were compared. Results Compared with the baseline, the QT interval of electrocardiogram in the observation group was significantly higher at the 2 nd, 4 th, 8 th, 12 th, 16 th, 20 th and 24 th weeks of treatment significantly (P<0.05). The QT period of the observation group was significantly longer than that of the control group at the 16 th, 20 th and 24 th week of treatment(P<0.05). In the observation group, there were 15 cases (19.2%, 15/78 ) with QT interval greater than 500 ms, including 7 cases of background regimen containing clofazimine and moxifloxacin. Conclusion Treatment regimen containing Bedaquiline for drug-resistant tuberculosis prolongs QT interval, but the background regimen containing Clofazimine and Quinolones aggravates the prolonged QT interval. Therefore, electrocardiogram monitoring and cardiac examination should be strengthened when using betamethasone in combination with Clofazimine and Quinolones. Table and Figures | Reference | Related Articles | Metrics | Comments（0）

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Effect of prolonged early empirical antibiotic exposures on hospitalization outcomes of premature infants Xu Yuanyuan, Yu Jianmei, Zhang Xiuli, Li Liangliang, Yin Xiangyun, Li Xianghong Clinical Focus    2024, 39 (8): 728-733.   DOI: 10.3969/j.issn.1004-583X.2024.08.008 Abstract （123）   HTML （2）    PDF（pc） （907KB）（26）       Knowledge map    Save Objective To explore the effect of prolonged early empirical antibiotic exposures on the hospitalization outcome of preterm infants by retrospectively analyzing the clinical data of preterm infants born with gestational age <32 weeks or birth weight < 1500 g, and to further guide the rational application of antibiotics in preterm infants. Methods Clinical data of preterm infants born with gestational age <32 weeks or birth weight <1500 g in the Affiliated Hospital of Qingdao University from January 1, 2018 to December 31, 2020 were collected. They were divided into short-term exposure group (≤5 days) and long-term exposure group (>5 days) according to the duration of empirical antibiotic application in the early postnatal period. The complications during hospitalization between the two groups were analyzed and compared. Results A total of 291 cases were retrospectively included, involving 166 males and 125 females. The median duration of antibiotic use in the short-term and long-term exposure groups was 3 days and 9 days, respectively. Compared with those of the short-term exposure group, cases in the long-term exposure group presented significantly higher incidence of feeding intolerance (FI), and longer duration of half-intestinal feeding, full intestinal feeding and the length of stay (P<0.05). The incidence of bronchopulmonary dysplasia (BPD) and late-onset sepsis (LOS) was significantly higher in the long-term exposure group than that of the short-term exposure group (P<0.05). Univariate Logistic regression analysis showed that prolonged antibiotic exposure was associated with increased incidences of FI, BPD, LOS, and composite outcomes during hospitalization. Multivariate Logistic regression analysis showed that prolonged exposure of empirical antibiotics was an independent risk factor for FI and BPD. Multiple linear regression analysis showed that the duration of antibiotic use was positively correlated with the length of stay and the length of whole intestinal feeding. Conclusion Prolonged early empirical antibiotic exposures can increase the risk of BPD in preterm infants, affect intestinal feeding, and lead to a longer length of stay. Table and Figures | Reference | Related Articles | Metrics | Comments（0）

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Clinical Focus    2024, 39 (7): 664-667.   DOI: 10.3969/j.issn.1004-583X.2024.07.015 Abstract （129）   HTML （8）    PDF（pc） （818KB）（25）       Knowledge map    Save Reference | Related Articles | Metrics | Comments（0）

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Systematic review and meta-analysis of contrast-enhanced ultrasound in diagnosing hepatic echinococcosis Pu Wutao, Xiao Yixin, Tuo Li, Kailibinuer·Muti , Fan Xueting, Chong Le Clinical Focus    2025, 40 (3): 197-204.   DOI: 10.3969/j.issn.1004-583X.2025.03.001 Abstract （83）   HTML （10）    PDF（pc） （2209KB）（25）       Knowledge map    Save Objective To systematically evaluate the diagnostic accuracy of contrast-enhanced ultrasound (CEUS) in diagnosing hepatic echinococcosis. Methods By searching keywords combined with free words, articles reporting CEUS in diagnosing hepatic echinococcosis published before June 2023 were searched in the databases, including Pubmed, EMBASE, Cochrane Library, CBM, CNKI, Wanfang and CQVIP. According to the inclusion and exclusion criteria, eligible articles were screened. Data of general information, true positive, false positive, false negative, and true negative were extracted from the included articles. Using the QUADAS-2 tools to assess the included studies. Meta-disc1.4 and RevMan5.4 software were used for meta-analysis. The pooled sensitivity, specificity, positive likelihood ratio, and negative likelihood ratio were calculated. The diagnostic odds ratio(OR) and area under the SROC curve (AUC) were calculated. Stata14.0 software was used to draw the Galbraith plot to perform heterogeneity analysis on the research data. Results According the inclusion and exclusion criteria, 7 articles were included with 348 patients. The pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, diagnostic OR and AUC of CEUS in diagnosing hepatic echinococcosis was 0.96 (95%CI 0.92-0.98), 0.88(95%CI 0.79-0.93), 5.73 (95%CI 1.24-26.58), 0.07 (95%CI 0.03-0.18), 95.32(95%CI 22.02-412.60), and 0.9767, respectively. According to the pooled sensitivity, specificity and AUC, CEUS had a high diagnostic efficacy in diagnosing hepatic echinococcosis. The Galbraith plot showed that all articles were distributed on both sides of the solid red effect line and within the green confidence interval range, indicating no overall heterogeneity in this study. Conclusion CEUS has a high efficacy in the diagnosis of hepatic echinococcosis and can serve as a new method for clinical diagnosis of hepatic echinococcosis. Table and Figures | Reference | Related Articles | Metrics | Comments（0）

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Clinical Focus    2025, 40 (1): 90-96.   DOI: 10.3969/j.issn.1004-583X.2025.01.015 Abstract （72）   HTML （3）    PDF（pc） （1062KB）（24）       Knowledge map    Save Table and Figures | Reference | Related Articles | Metrics | Comments（0）

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Analysis of risk factors for bronchopulmonary dysplasia in extremely premature/very low birth weight infants Zhao Yipin, Cui Qingyang Clinical Focus    2025, 40 (1): 60-64.   DOI: 10.3969/j.issn.1004-583X.2025.01.009 Abstract （72）   HTML （2）    PDF（pc） （880KB）（24）       Knowledge map    Save Objective To explore the risk factors of bronchopulmonary dysplasia (BPD) in extremely preterm/low birth weight infants and to construct a logistic regression prediction model. Methods Medical records 140 ultra-premature infants/ultra-low birth weight infants hospitalized in Zhoukou Maternal and Child Health Hospital and the neonatal intensive care unit of Zhoukou Hospital of TCM from January 1, 2017 to December 31, 2023 were recruited. A total of 102 cases were finally included according to the inclusion and exclusion criteria. They were divided into BPD group and non-BPD group based on whether BPD occurred. The general data of the two groups were compared, and the pathological causes of ultra-premature infants/ultra-low birth weight infants were analyzed using logistic regression. Results A total of 102 ultra-premature/ultra-low birth weight infants were included in this study, and 59 of them developed BPD, with an incidence of 57.8%. Fetal conditions were as follows. Infants in the BPD group had significantly lower birth weight and gestational age, but higher proportions of 1-min Apgar≤7 points, neonatal pneumonia and neonatal sepsis, and longer mechanical ventilation time than those of the non-BPD group (P<0.05). Maternal conditions were as follows. The proportions of premature amniotic rupture>18 hours, and chorioamnionitis in the BPD group were significantly higher than those of the non-BPD group (P<0.05). Multivariate logistic regression analysis showed that gestational age and birth weight were independent protective factors for BPD in ultra-premature infants/ultra-low birth weight infants, and mechanical ventilation time and chorioamnionitis were independent risk factors for BPD in ultra-premature infants/ultra-low birth weight infants (P<0.05). Based on the results of multiple factors, a logistic regression risk prediction model was constructed. Logit (P) ranged from 0 to 1. The test results showed that the area under the curve (AUC) of the model in predicting extremely preterm/low birth weight infants with concurrent BPD was 0.891 (95%CI: 0.846-0.939), with the chi-square value (χ2) in the Hosmer-Lemeshow test of 6.543(P=0.072). Conclusion Birth weight, gestational age, duration of mechanical ventilation, and chorioamnionitis are all risk factors for the development of BPD in extremely preterm infants/very low birth weight infants. A logistic regression model based on these factors has high predictive value and can be used as an effective clinical model in predicting the occurrence of BPD. It also has certain guiding significance for subsequent clinical decisions. Table and Figures | Reference | Related Articles | Metrics | Comments（0）

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Clinical Focus    2024, 39 (11): 1040-1046.   DOI: 10.3969/j.issn.1004-583X.2024.11.013 Abstract （100）   HTML （3）    PDF（pc） （451KB）（24）       Knowledge map    Save Table and Figures | Reference | Related Articles | Metrics | Comments（0）

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Risk prediction models for weaning failure from mechanical ventilation: A systematic review Hu Feifei, Wang Fang, Wang Yongni, Huang Shini, Ming Yao Clinical Focus    2025, 40 (2): 107-116.   DOI: 10.3969/j.issn.1004-583X.2025.02.002 Abstract （108）   HTML （2）    PDF（pc） （1306KB）（23）       Knowledge map    Save Objective To systematically evaluate the risk prediction models for mechanical ventilation weaning failure. Methods Computerised searches of PubMed, Embase, Web of Science, Cochrane Library, CBM, CNKI, Wanfang and VIP databases were conducted to collect risk prediction models for weaning failure from mechanical ventilation from the establishment of the database to February 2025. The risk of bias and applicability of risk prediction models were evaluated using the prediction model risk of bias assessment tool (PROBAST) after the literatures were independently screened and data extracted by two researchers. Results Twenty-one literatures representing 44 risk prediction models for weaning failure from mechanical ventilation were included. The number of predictors ranged from 3-21, with the most common predictors being the duration of mechanical ventilation, age, and the acute physiology and chronic health evaluation Ⅱ(APACHE Ⅱ). The area under the receiver operating characteristic curve (AUC) of the included models ranged 0.689-0.926. The models had a good overall predictive performance, but the overall risk of bias was high. Conclusion Currently, the risk prediction models for weaning failure from mechanical ventilation has well overall predictive performance, but the clinical applicability of the model requires further validation because most studies have not been externally validated and there are variations in the definitions of outcome metrics. Table and Figures | Reference | Related Articles | Metrics | Comments（0）

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Renal clear cell carcinoma complicated with multiple myeloma: A case report and literature review Tian Xin, Zhao Li, Liu Huijing Clinical Focus    2024, 39 (10): 925-928.   DOI: 10.3969/j.issn.1004-583X.2024.10.010 Abstract （101）   HTML （6）    PDF（pc） （732KB）（23）       Knowledge map    Save Objective To explore the differential diagnosis of kidney cancer with bone metastasis combined with multiple myeloma and to share experience. Methods A case of renal clear cell carcinoma combined with multiple myeloma admitted to the Third Hospital of Hebei Medical University was retrospectively analyzed, and the related literature was reviewed. Results The middle-aged male had the history of renal cancer with 3 years. The patient was treated for “back pain”, and pathological biopsy of vertebral mass after systematic examination revealed that the patient had kidney cancer with bone metastasis complicated with multiple myeloma. Conclusion Clinicians should improve the understanding of the coexistence of these two malignant tumors, especially when new osteolytic lesions are present in patients with renal cell carcinoma, a comprehensive examination is conducted to distinguish bone metastasis and multiple myeloma. Table and Figures | Reference | Related Articles | Metrics | Comments（0）

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Clinical Focus    2024, 39 (9): 861-864.   DOI: 10.3969/j.issn.1004-583X.2024.09.019 Abstract （158）   HTML （9）    PDF（pc） （897KB）（22）       Knowledge map    Save Reference | Related Articles | Metrics | Comments（0）

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Incidence and risk factors of postoperative multidrug-resistant bacterial infections in liver transplant patients: A meta-analysis He Tian, Han Linqiu, Shi Zuxin, Shen Mingyan Clinical Focus    2024, 39 (11): 965-973.   DOI: 10.3969/j.issn.1004-583X.2024.11.001 Abstract （120）   HTML （4）    PDF（pc） （1400KB）（22）       Knowledge map    Save Objective To identify the incidence and risk factors of postoperative multidrug-resistant bacterial infections in liver transplant patients.Methods A systematic search of the literatures was conducted in the Cochrane Library, CINAHL, Embase, Web of science, Pubmed, SinoMed, China National Knowledge Infrastructure (CNKI), Wanfang Data, and CQVIP up to July 2023. Stata16.0 and RevMan5.4 software were used to perform meta-analysis.Results A total of 13 articles representing 5,877 patients were included, and 40 risk factors were extracted. The results of the meta-analysis showed that the combined incidence of postoperative multidrug-resistant bacterial infections in liver transplant patients was 18%, with an incidence ranging from 3% to 48%. The main risk factors included pre-transplant ICU admission (OR=3.71, 95%CI: 2.52-5.46), colonization rate of carbapenem-resistant Acinetobacter baumannii (CRAB) before liver transplant (OR=10.73, 95%CI: 3.79-30.37), the model for End-Stage Liver Disease (MELD) score (OR=5.85, 95%CI: 0.68-11.2), length of post-transplant ICU stay (OR=4.34,95%CI: 2.84-5.84), post-transplant dialysis (OR=2.61, 95%CI: 1.60-4.25), reoperation (OR=4.22, 95%CI: 2.07-8.63), prolonged prothrombin time (OR=1.01, 95%CI: 0.30-1.54), and biliary complications (OR=3.52, 95%CI: 1.98-6.23).Conclusion The incidence of postoperative multidrug-resistant bacterial infections in liver transplantation patients is high. There are many risk factors to be concerned to reduce the incidence of postoperative multidrug-resistant bacterial infections in liver transplantation patients, thus improving the survival. Table and Figures | Reference | Related Articles | Metrics | Comments（0）

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Efficacy and safety of intracoronary injection of teneplase versus tirofiban on the treatment of acute ST-segment elevation myocardial infarction Zhang Lei, Li Xin, Guo Zhenfeng Clinical Focus    2024, 39 (7): 598-602.   DOI: 10.3969/j.issn.1004-583X.2024.07.003 Abstract （115）   HTML （4）    PDF（pc） （861KB）（22）       Knowledge map    Save Objective To observe and compare the efficacy and safety of intracoronary injection of teneplase and tirofiban in the treatment of acute ST-segment elevation myocardial infarction (STEMI). Methods A retrospective analysis was performed on 46 patients with STEMI who underwent primary percutaneous coronary intervention (PCI) in the Affiliated BenQ Hospital of Nanjing Medical University from August 2021 to August 2023. According to different treatment plans, patients were divided into observation group (n=21, intracoronary injection of teneplase) and control group (n=25, intracoronary injection of tirofiban). The number of stents, thrombolysis in myocardial infarction (TIMI) blood flow grading, TIMI thrombus grading, corrected TIMI blood flow frame count (CTFC), percentage of postoperative 2-hour ST segment regression (STR)≥50%, postoperative N-terminal pro-brain natriuretic peptide (NT-proBNP), left ventricular ejection fraction at 72 hours after PCI, bleeding events and cardiovascular adverse events during hospitalization were compared between the two groups. Results In terms of effectiveness, TIMI thrombus classification and CTFC after intracoronary administration were superior in the observation group than control group (P<0.05), and postoperative left ventricular ejection fraction (LVEF) and postoperative NT-proBNP of observation group were superior to control group (P<0.05). There were no significant differences in the number of stents, TIMI blood flow grade and percentage of postoperative 2-hour STR≥50% between the two groups (P>0.05). In terms of safety, there were no significant differences in the incidence of bleeding events and cardiovascular adverse events during hospitalization between the two groups (P>0.05). Conclusion PCI combined with intracoronary injection of teneplase and tirofiban is safe and effective on treating STEMI, and teneplase is superior to tirofiban. Table and Figures | Reference | Related Articles | Metrics | Comments（0）

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Congenital drug-resistant tuberculosis combined with bronchial granuloma: A case report and literature review Mu Shiyin, Zou Yingxue, Guo Yongsheng, Zhai Jia, Huang Bing Clinical Focus    2024, 39 (8): 747-751.   DOI: 10.3969/j.issn.1004-583X.2024.08.011 Abstract （114）   HTML （7）    PDF（pc） （1369KB）（22）       Knowledge map    Save Objective To report the diagnosis and treatment of a case of congenital drug-resistant tuberculosis combined with bronchial granuloma, thus summarizing the clinical experience and providing references for clinical management. Methods Clinical data of a child with congenital drug-resistant tuberculosis combined with bronchial granuloma admitted to our department on April 22, 2022 were analyzed, including the clinical characteristics, diagnosis and treatment. Results The child was prematurely, vaginally delivered at 34 weeks and 4 days of gestation, in an in vitro fertilization. At 40 days of age, the child developed symptoms of cough, wheezing, and fever, and repeatedly hospitalized for pneumonia. The mother of the child underwent in vitro artificial insemination due to tubal obstruction, and presented a history of obsolete pulmonary tuberculosis. Physical examination on admission showed rapid breathing, positivity for the Hoover's sign, slightly low respiratory sounds in the right lung, and wheezing sounds in both lungs. Lung CT showed multiple inflammatory consolidations and multiple nodules in both lungs, and extensive granulation tissue proliferation in bilateral bronchi on fiberoptic bronchoscopy. The tissue polymerase chain reaction for tuberculosis (TB-PCR) test showed positive Mycobacterium tuberculosis in the alveolar lavage fluid, and second-generation sequencing consistently showed Mycobacterium tuberculosis. The child was treated by oral rifampicin, isoniazid, and linezolid for antituberculosis therapy. One month after discharge, a follow-up lung CT and fiberoptic bronchoscopy showed disease progression. The rifampicin fluorescence quantitative nucleic acid amplification detection(X-pert MTB/RIF) assay indicated rifampicin resistance, and the child was then treated with a quadruple anti-tuberculosis therapy of levofloxacin, linezolid, pyrazinamide, and isoniazid. Fiberoptic bronchoscopy procedures, including granuloma electrocoagulation and resection, cryotherapy, and foreign body forceps extraction were performed for multiple times to relieve airway obstruction. The child had regular follow-up visits and underwent interventional therapy under fiberoptic bronchoscopy for nearly 7 months. At present, the child had a stable breathing, well-ventilated in both lungs, and no adverse drug reactions. The follow-up is ongoing. Conclusion Symptoms of congenital tuberculosis are atypical, and prone to a missed diagnosis. It is necessary to strengthen the application of fiberoptic bronchoscopy in the diagnosis and treatment of tuberculosis. Tubal blockage leading to infertility in women undergoing in vitro fertilization and embryo transfer may be the main cause of congenital tuberculosis. In addition, sputum Mycobacterium tuberculosis and drug resistance gene testing can guide clinical medication in patients with drug-resistant tuberculosis. However, there is currently limited guidance and treatment plans for drug-resistant tuberculosis in infants and young children, and the further research is needed. Table and Figures | Reference | Related Articles | Metrics | Comments（0）