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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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Clinical Focus    2023, 38 (8): 743-748.   DOI: 10.3969/j.issn.1004-583X.2023.08.012 Abstract （238）   HTML （2）    PDF（pc） （896KB）（822）       Knowledge map    Save Reference | Related Articles | Metrics | Comments（0）

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Clinical Focus    2023, 38 (12): 1146-1149.   DOI: 10.3969/j.issn.1004-583X.2023.12.016 Abstract （160）   HTML （6）    PDF（pc） （875KB）（598）       Knowledge map    Save Reference | Related Articles | Metrics | Comments（0）

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Clinical Focus    2024, 39 (2): 188-192.   DOI: 10.3969/j.issn.1004-583X.2024.02.018 Abstract （232）   HTML （9）    PDF（pc） （847KB）（356）       Knowledge map    Save Reference | Related Articles | Metrics | Comments（0）

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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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Clinical Focus    2023, 38 (11): 1034-1037.   DOI: 10.3969/j.issn.1004-583X.2023.11.014 Abstract （132）   HTML （3）    PDF（pc） （842KB）（154）       Knowledge map    Save Reference | Related Articles | Metrics | Comments（0）

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Clinical Focus    2023, 38 (7): 668-672.   DOI: 10.3969/j.issn.1004-583X.2023.07.015 Abstract （197）   HTML （1）    PDF（pc） （848KB）（150）       Knowledge map    Save Reference | Related Articles | Metrics | Comments（0）

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Analysis of risk factors for refractory Mycoplasma pneumoniae pneumonia in children Yu Zeyu, Lin Xi, Chen Zhanghua, Yang Wei, Chen Zhimin, Zhang Hai Clinical Focus    2024, 39 (1): 43-46.   DOI: 10.3969/j.issn.1004-583X.2024.01.007 Abstract （145）   HTML （2）    PDF（pc） （921KB）（105）       Knowledge map    Save Objective To analyze risk factors for refractory M y c o p l a s m a p n e u m o n i a e pneumonia (RMPP) in children. Methods A total of 67 children with RMPP who were admitted in the Department of Paediatrics, Luoyuan County Hospital from January 2020 to September 2023 were enrolled in the case group. During the same period, 134 children with common M y c o p l a s m a p n e u m o n i a e pneumonia and complete clinical data were selected in the control group. Children in both groups were initially treated with macrolide antibiotics. Univariate and multivariate logistic regression analyses were used to analyze the risk factors for RMPP in children. The predictive potentials of risk factors for RMPP in children were assessed by plotting the receiver operating characteristic (ROC) curves. Results Decreased albumin, decreased platelet count, heat peak≥40 ℃, lactate dehydrogenase≥500 U/L, and lobar pneumonia changes on pulmonary imaging were risk factors for RMPP in children. The area under the curve (AUC) and cut-off value of risk factors were as follows: albumin<40 g/L (AUC=0.765, 95% C I=0.803-0.901), lactate dehydrogenase≥500 U/L (AUC=0.753, 95% C I=0.772-0.877), platelet count<120×109/L (AUC=0.821, 95% C I:0.761-0.868), heat peak≥40 ℃ (AUC=0.750, 95% C I: 0.685-0.807), and lobar pneumonia changes on pulmonary imaging (AUC=0.541, 95% C I: 0.469-0.611). Conclusion RMPP should be alerted in children with albumin<40 g/L, platelet count<120×109/L, heat peak≥40 ℃, lactate dehydrogenase≥500 U/L, and lobar pneumonia changes on pulmonary imaging. Table and Figures | Reference | Related Articles | Metrics | Comments（0）

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Research on the effects of diaphragm relaxation technique combined with resistance breathing training on motor ability of stroke survivors Yu Yifu, Yuan Chunhua Clinical Focus    2023, 38 (11): 1002-1007.   DOI: 10.3969/j.issn.1004-583X.2023.11.007 Abstract （122）   HTML （2）    PDF（pc） （883KB）（99）       Knowledge map    Save Objective To explore the effects of diaphragm relaxation technique combined with resistance breathing training on motor ability of stroke survivors. Methods A total of 60 patients with cerebral apoplexy in the Rehabilitation Department of Zhengzhou Central Hospital were randomly divided into group A, group B and group C. Patients in Group A received routine rehabilitation training, diaphragm relaxation and resistance breathing training; those in group B received routine rehabilitation training and diaphragm relaxation; and those in group C received routine rehabilitation training and resistance breathing training. Maximal inspiratory pressure, peak inspiratory velocity, Fugl-Meyer motor function assessment (FMA), 10-meter walking test (10MWT), Berg balance function (BBS), and limits of stability (LOS) of all subjects were evaluated before intervention and 4, 8, and 12 weeks after rehabilitation training. Statistical data were analyzed. Results Before experiment intervention, there were no significant differences in MIP, PIF, FMA, 10MWT, BBS and LOS among group A, B and C ( P>0.05). After experiment intervention, MIP, PIF, FMA, BBS and LOS in groups A, B and C significantly increased ( P<0.05), but 10MWT significantly decreased at 4, 8 and 12 weeks compared with those before the experimental intervention ( P<0.05). After experiment intervention, there were significant differences in the MIP, PIF, FMA, 10MWT, BBS and LOS at 4, 8 and 12 weeks among group A, B and C ( P<0.05). MIP, PIF, FMA, BBS and LOS of group A were significantly higher than those of group B and C, while 10MWT was significantly lower ( P<0.05). MIP, PIF, FMA, BBS and LOS of group C were significantly higher than those of group B, but 10MWT of group C was significantly lower than that of group B ( P<0.05). Conclusion Diaphragm relaxation technique combined with resistance breathing training has better healing effects than the single training. Diaphragm relaxation technique can be extended as a choice of home rehabilitation exercise for stroke patients. Table and Figures | Reference | Related Articles | Metrics | Comments（0）

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Generative artificial intelligence: Ethical review on the empowerment in medical humanities education Zhao Xin, Liu Yun Clinical Focus    2024, 39 (1): 65-69.   DOI: 10.3969/j.issn.1004-583X.2024.01.012 Abstract （242）   HTML （9）    PDF（pc） （873KB）（98）       Knowledge map    Save Generative Artificial Intelligence (GAI) is emerged as a game-changing technology with far-reaching implications across various fields. It is expected to bring new opportunities for rapid development in numerous areas, including the education sector where GAI has already shown promising results through multi-platform integration. In the future, the iterative development of GAI will give rise to a plethora of potential applications in the field of medical humanities education, enhancing its effectiveness precisely, promoting its development, and creating innovative modes of panoramic experience in the teaching process. However, along with the inherent ethical issues of GAI technology, such as black box algorithms, information cocooning, data privacy and security, and discriminatory algorithms, there will also be risks with distinct medical humanities characteristics that arise from the deep integration of GAI and medical humanities education. For instance, there is a possibility of values being compromised, the diminishing of human dominance, and the imbalance of the binary relationship between teaching and learning due to an excessive reliance on GAI. In order to address these ethical concerns and devise effective countermeasures to mitigate the risks imposed by GAI in empowering medical humanities education, it is necessary to establish clear boundaries and maximize the potential of artificial intelligence. We must also ensure that GAI stays true to its original purpose in this era of rapid technological advancements, and create a conducive ecological environment for its development based on legal regulations. 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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Clinical Focus    2023, 38 (12): 1150-1152.   DOI: 10.3969/j.issn.1004-583X.2023.12.017 Abstract （306）   HTML （4）    PDF（pc） （854KB）（87）       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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Clinical characteristics of patients infected with Omicron and Delta variants in novel coronavirus Huang Huayan, Lin Chunguang, Wu Changru, Chen Yongdong, Huang Huanmou Clinical Focus    2023, 38 (7): 600-605.   DOI: 10.3969/j.issn.1004-583X.2023.07.003 Abstract （172）   HTML （0）    PDF（pc） （1022KB）（80）       Knowledge map    Save Objective To explore the clinical and laboratory characteristics of patients infected with Omicron and Delta variants in novel coronavirus. Methods A retrospective study was conducted, and the clinical data were collected from patients infected with Omicron variant (51 cases) and Delta variant (45 cases) admitted in our hospital from December 2021 to March 2022. The clinical baseline data and chest CT imaging characteristics were compared between the two groups. Results Both groups had the onset of the disease in all age groups, with more children and women in the Omicron variant group than in the Delta variant group (P<0.01). The Omicron variant group was mainly light and the Delta variant group was mainly ordinary, with significant differences between the two groups (P<0.01). However, there was no significant difference in vaccination status between the two groups. Fever and sore throat were the main symptoms in both groups, with the rate of fever significantly higher in the Omicron variant group than the Delta variant group (86.3% vs 51.5%, P<0.01). The number of patients with C-reactive protein (CRP) abnormalities in the Omicron variant group was less than that in the Delta variant group (P<0.01), and there were fewer changes in the first imaging feature of chest CT (2.0% vs 73.3%, P<0.05). After treatment, the nasopharyngeal swab test in the Omicron variant group showed a significantly shorter nucleic acid conversion time compared to the Delta variant group (29.96±8.17 days vs 25.82±10.73 days, P=0.013). In addition, compared with nasopharyngeal swab test, the anal swab test had a significantly shorter nucleic acid conversion time in the Omicron variant group (P<0.01). The serum IgG level was (6.504±1.33) S/CO at admission, which increased to (218.6±14.51) S/CO after one week (P<0.01). Meanwhile, the serum IgM level was (0.05±0.01) S/CO at admission, and it showed an increasing trend after one week, with an average of (1.205±0.22) S/CO (P<0.01). Conclusion Compared with Delta variant, the Omicron variant group was mainly mild, with fever and sore throat as the main manifestations. The pulmonary CT showed less and slight changes in the imaging characteristics of COVID-19. The nasopharyngeal swab test of the Omicron variant group showed a longer nucleic acid conversion time compared to the Delta variant group. In addition, serum levels of IgM and IgG antibodies in patients with Omicron variant were negative or low at admission, which increased significantly 1 week after onset. Table and Figures | Reference | Related Articles | Metrics | Comments（0）

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Clinical Focus    2023, 38 (7): 663-667.   DOI: 10.3969/j.issn.1004-583X.2023.07.014 Abstract （266）   HTML （1）    PDF（pc） （842KB）（73）       Knowledge map    Save Reference | Related Articles | Metrics | Comments（0）

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Wunderlich syndrome in a patient on haemodialysis with a review of the literature Dai Jing, Chen Huaqian Clinical Focus    2023, 38 (12): 1107-1111.   DOI: 10.3969/j.issn.1004-583X.2023.12.009 Abstract （158）   HTML （1）    PDF（pc） （1755KB）（73）       Knowledge map    Save Objective To analyze the treatment course, etiology, pathogenesis, clinical manifestations and potential causes for the misdiagnosis of Wunderlich syndrome (spontaneous renal rupture). Methods Spontaneous renal rupture during dialysis in a male patient on maintenance hemodialysis and the associated diagnostic and therapeutic treatments were retros pectively analyzed, and relevant literatures were reviewed. Results A 35-year-old male patient admitted for 10 months of maintenance hemodialysisandelevated blood pressure for 2 weeks. He developed the left-sided lumbar pain 30 minutes before the end of the hemodialysis session, which was associated with changes in body position and accompanied by distension of the lower left abdomen and vomiting. Following a comprehensive abdominal CT scan, spontaneous rupture of the left kidney was suspected. The patient was treated with an emergencyl percutaneous superselective arteriography and left renal artery embolization. After receiving successive postoperative treatments including continuous renal replacement therapy, anticoagulant-free hemodialysis, anti-infection therapy, and antihypertensive measures, the patient’s condition was improved and discharged. Conclusion Typically, the occurrence of renal rupture is associated with clear causative factors such as abdominal trauma. However, this patient developed non-specific abdominal pain without obvious causes that should be concerned. At this time, rare causes such as spontaneous renal rupture (Wunderlich syndrome) need to be considered. Due to the atypical manifestations of Wunderlich syndrome, its diagnosis is complicated and prone to the misdiagnosis of renal colic, further leading to delayed treatment and poor prognosis. 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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Clinical Focus    2023, 38 (8): 753-756.   DOI: 10.3969/j.issn.1004-583X.2023.08.014 Abstract （319）   HTML （11）    PDF（pc） （848KB）（72）       Knowledge map    Save Reference | Related Articles | Metrics | Comments（0）

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Clinical Focus    2023, 38 (12): 1140-1145.   DOI: 10.3969/j.issn.1004-583X.2023.12.015 Abstract （276）   HTML （2）    PDF（pc） （945KB）（71）       Knowledge map    Save Reference | Related Articles | Metrics | Comments（0）

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Bioequivalence of aspirin enteric-coated tablet in healthy volunteers Liu Junyu, Zhang Tiancai, Zhang Baie, Li Yizhou, Li Yafei, Liu Hongbin, Duan Liping, Zhang Quanying, Wang Yijun, Meng Fanhua, Sun Min Clinical Focus    2024, 39 (5): 433-439.   DOI: 10.3969/j.issn.1004-583X.2024.05.008 Abstract （277）   HTML （4）    PDF（pc） （1362KB）（68）       Knowledge map    Save Objective To evaluate the bioequivalence and safety of aspirin enteric-coated tablets in healthy Chinese adult. Methods A single-center, randomized, open, two-preparation, two-sequence, four-cycle, fully replicated design was used. The subjects took orally one tablet of test (T) or reference (R) preparation on fasting or fed condition every cycle. The plasma concentration of acetylsalicylic acid (ASA) was determined by liquid chromatography with tandem mass spectrometry (LC-MS/MS) method at different time points, and the bioequivalence and safety of the two formulations were evaluated. Results In the main results for pharmacokinetic parameters of T and R under fed condition, Cmax were (690.97±196.91) and (669.28±337.40) ng·ml-1, AUC0-t were (867.37±228.64) and (821.16±349.85) ng·h·ml-1, AUC0-∞ were (883.48±233.72) and (923.59±287.95) ng·h·ml-1, Tmax were (8.98±2.47) and (10.69±3.75) h. In the main result for pharmacokinetic parameters of T and R under fasting condition, Cmax were (466.83±222.89) and (441.42±211.99) ng·ml-1, AUC0-t were (753.24±269.49) and (678.50±278.85) ng·h·ml-1, AUC0-∞ were (809.11±309.27) and (726.51±267.00) ng·h·ml-1, Tmax were (5.81±2.53) and (6.41±2.47) h. The geometric mean ratios of the main pharmacokinetic parameters Cmax, AUC0-t and AUC0-∞ in the fed group were within the range of 80.00% to 125.00%, therefore the two formulations were bioequivalent. However,the fasting group did not meet the relevant criteria, and the two preparations were not equivalent. During the study period, 0 case and 2 cases of adverse events occurred under the fasting and the fed condition. No serious adverse events occurred. Conclusion The two kinds of aspirin enteric-coated tablets were bioequivalent in human under the fed condition, but not in the human under fasting conditions, and the formulations were safe and well tolerated. 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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Anomalous left coronary artery from the pulmonary artery: A case report and literature review Liu Duo, Li Yanling, Guo Zhaoxia, Li Jianfeng, Zhang Huijuan, Xie Ping Clinical Focus    2023, 38 (7): 618-622.   DOI: 10.3969/j.issn.1004-583X.2023.07.006 Abstract （181）   HTML （0）    PDF（pc） （1146KB）（66）       Knowledge map    Save Objective To explore the diagnosis and treatment of the anomalous left coronary artery from the pulmonary artery (also known as Bland-White-Garland [BWG] syndrome) in the elderly. Methods A retrospective analysis was performed on an elderly patient with BWG syndrome, and the relevant literature was reviewed. Results A 66-year-old male patient presented repeated intermittent chest tightness and shortness of breath within the past 2 years, which was aggravated after exertion and not relieved after rest. Color Doppler ultrasound of the heart and computed tomography angiography (CTA) of the coronary artery confirmed the diagnosis of BWG syndrome. After a comprehensive assessment, the patient was managed by a conservative treatment of medications, and he was recovered well and discharged. During the 1-year follow-up, no adverse cardiovascular events were reported. Conclusion BWG in the elderly is rare, which is easily to be misdiagnosed or missed diagnosed. The diagnosis of BWG depends on multiple imaging examinations. For asymptomatic or mildly symptomatic elderly patients, the risks of surgery may outweigh the potential benefits, and conservative treatment with vasodilators and antiarrhythmic drugs may be used to prevent death. Table and Figures | Reference | Related Articles | Metrics | Comments（0）

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Secondary infection of spontaneous perirenal hemorrhage with fever as the main symptom: A case report and literature review Liu Yan, Liu Qiong, Liang Xiaomei, Liu Bing Clinical Focus    2023, 38 (9): 823-826.   DOI: 10.3969/j.issn.1004-583X.2023.09.009 Abstract （153）   HTML （1）    PDF（pc） （951KB）（66）       Knowledge map    Save Objective To summarize the effective differential diagnosis and treatment of spontaneous perirenal hemorrhage (SPH) with fever as the main symptom. Methods The clinical data of a case of SPH with atypical first manifestations were retrospectively analyzed. Relevant literatures were reviewed as well. Results An elderly male patient was admitted for 10-day fever and 1-week elevation of blood creatinine. He denied trauma and surgery history. Fever was the only clinical manifestation, and lumbar pain, abdominal pain and shock were absent. After laboratory testing and imaging examination, the patient was diagnosed as SPH. Body temperature returned normal after ultrasound-guided puncture drainage and anti-infectious therapy. Conclusion It is necessary for clinicians to master atypical manifestations of SPH, so as to provide references and clinical experiences. Table and Figures | Reference | Related Articles | Metrics | Comments（0）

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Influencing factors for mild cognitive impairment in type H hypertension patients combined with type 2 diabetes mellitus Xu Yang, Xue Ling Clinical Focus    2023, 38 (10): 887-892.   DOI: 10.3969/j.issn.1004-583X.2023.10.004 Abstract （153）   HTML （2）    PDF（pc） （950KB）（66）       Knowledge map    Save Objective To study the influencing factors for cognitive dysfunction in type H hypertension patients combined with type 2 diabetes mellitus (T2DM). Methods A total of 163 type H hypertension patients combined with T2DM who were treated in the Anshan Central Hospital from September 2021 to September 2022 were recruited. All patients were surveyed with the Montreal Cognitive Assessment (MoCA) and the Mini Mental State Examination (MMSE). According to the scoring results, patients with MoCA < 26 points were included in the mild cognitive impairment group (MCI group), and those with MoCA ≥ 26 points were included in the normal cognitive function group (NMCI group). General data of the two groups of patients were collected, including age, gender, smoking history, drinking history, years of education, body mass index (BMI), duration of hypertension and diabetes, history of other diseases like coronary heart disease and dyslipidemia, systolic blood pressure (SBP) and diastolic blood pressure (DBP). In a fasting state, white blood cell count (WBC), red blood cell count (RBC), hemoglobin (Hb), platelet count (PLT), serum homocysteine (Hcy), total cholesterol (TC), triglycerides (TG), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), apolipoprotein A1 (ApoA-1), apolipoprotein B (ApoB), lipoprotein a (LPa), glycated hemoglobin (HbA1c), fasting plasma glucose (FPG), serum creatinine (Scr), serum uric acid (SUA), and urinary microalbumin (ALB) were measured. Carotid artery color ultrasound were performed to measure the carotid intima-media thickness (CIMT) and plaque formation. The influencing factors for MCI in type H hypertension patients combined with T2DM were analyzed by binary logistic regression, and their prediction values were assessed by the receiver operating characteristic (ROC) curves. Results The age, smoking, hypertension and diabetes course, SBP, FPG, HbA1c, HDL-C, LDL-C, APOA-1, SUA, Hcy, CIMT and plaque detection rate in MCI group were significantly higher than those of NMCI group (P<0.05), and the education level was significantly lower (P<0.05). The results of binary logistic regression analysis showed that age, HDL-C, Hcy, and CIMT were independent risk factors for MCI in type H hypertension patients combined with T2DM. ROC curves showed that the area under the curve (AUC) of age, HDL-C, Hcy, and CIMT in predicting MCI in type H hypertension patients combined with T2DM was 0.975, 0.637, 0.647, and 0.842, respectively. Conclusion Elderly, low HDL-C, high Hcy and CIMT thickening are independent risk factors for MCI in type H hypertension patients combined with T2DM. Monitoring blood lipid and Hcy is beneficial to prevent MCI in this population. Table and Figures | Reference | Related Articles | Metrics | Comments（0）

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Clinical Focus    2024, 39 (1): 88-91.   DOI: 10.3969/j.issn.1004-583X.2024.01.017 Abstract （263）   HTML （7）    PDF（pc） （864KB）（65）       Knowledge map    Save Reference | Related Articles | Metrics | Comments（0）

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Probiotic supplementation on improving glucose metabolism in patients with type 2 diabetes mellitus: A meta-analysis Jin Jiahui, Yang Yang, Qin Tong, He Yuxin, Su Meihua Clinical Focus    2023, 38 (7): 581-587.   DOI: 10.3969/j.issn.1004-583X.2023.07.001 Abstract （298）   HTML （3）    PDF（pc） （1904KB）（64）       Knowledge map    Save Objective To evaluate the effect of probiotics on glucose metabolism in patients with type 2 diabetes mellitus (T2DM), and to elaborate its mechanism of action, so as to provide ideas and approaches for clinical diagnosis and treatment of T2DM. Methods Randomized controlled trials (RCTs) reporting the effect of probiotics on glucose metabolism in T2DM patients published before 31st November 2022 were searched in the online databases of PubMed, Embase, Web of science, CNKI, Wanfang Data Knowledge Service Platform and CQVIP database were searched. Two investigators were independently responsible for literature screening. The included literatures were assessed and data were extracted and analyzed using RevMan 5.4 software. Results A total of 11 studies were included in the study, involving 709 T2DM patients. There were 371 T2DM patients in the experimental group and 338 in the control group. Meta-analysis showed that probiotic supplementation significantly reduced fasting plasma glucose (FPG), hemoglobin A1C (HbA1C), homeostatic model assessment for insulin resistance (HOMA-IR), and fasting insulin levels in the experimental group than those in the control group. Conclusion Probiotic supplementation can improve glucose metabolism in T2DM patients, and probiotics can be used as one of the adjuvant treatments for T2DM patients. Table and Figures | Reference | Related Articles | Metrics | Comments（0）

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Clinical Focus    2023, 38 (7): 659-662.   DOI: 10.3969/j.issn.1004-583X.2023.07.013 Abstract （159）   HTML （0）    PDF（pc） （823KB）（60）       Knowledge map    Save Reference | Related Articles | Metrics | Comments（0）

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Clinical Focus    2024, 39 (1): 80-83.   DOI: 10.3969/j.issn.1004-583X.2024.01.015 Abstract （230）   HTML （8）    PDF（pc） （860KB）（60）       Knowledge map    Save Reference | Related Articles | Metrics | Comments（0）

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Clinical Focus    2024, 39 (3): 284-288.   DOI: 10.3969/j.issn.1004-583X.2024.03.016 Abstract （221）   HTML （2）    PDF（pc） （830KB）（59）       Knowledge map    Save Reference | Related Articles | Metrics | Comments（0）

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A case of neurological brucellosis misdiagnosed as amyotrophic lateral sclerosis and literature review Chun Mei, Zhen Jin, Yan Yan, Liu Bin, Li Min, Sun Xia Clinical Focus    2023, 38 (12): 1101-1106.   DOI: 10.3969/j.issn.1004-583X.2023.12.008 Abstract （121）   HTML （4）    PDF（pc） （1225KB）（58）       Knowledge map    Save Objective To explore the clinical features, diagnosis and treatment of neurobrucellosis (NB), and to analyze the causes of misdiagnosis of NB as amyotrophic lateral sclerosis (ALS). To compare the common points between NB and ALS and how to identify them in clinical work. Methods The clinical characteristics and treatment of a patient with NB misdiagnosed as ALS were reported and analyzed in combination with literature review. Results A 58-year-old male patient diagnosed with NB had significantly alleviated symptoms after 2 weeks of treatment, with right proximal limb muscle strength of grade Ⅴ-, distal muscle strength of grade Ⅳ-, left proximal muscle strength of grade Ⅴ-, left distal muscle strength of grade Ⅴ-, bilateral tendon reflexes (+++), and bilateral Babinski's sign (+). He was referred back to the local hospital for continuing anti-Brucella treatment. Conclusion Misdiagnosis of NB as ALS is mainly attributed to the atypical and diverse symptoms and signs of NB, and non-specific signs of intracranial infection, leading to misdiagnosis of other neurological diseases. Table and Figures | Reference | Related Articles | Metrics | Comments（0）

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Meta-analysis of clinical significance of serum total bilirubin level in inflammatory bowel disease Chen Xiaotian, Huo Lijuan Clinical Focus    2023, 38 (8): 677-685.   DOI: 10.3969/j.issn.1004-583X.2023.08.001 Abstract （230）   HTML （1）    PDF（pc） （2559KB）（58）       Knowledge map    Save Objective To systematically evaluate the clinical significance of serum total bilirubin (STB) in patients with inflammatory bowel disease (IBD). Methods Case-control studies on the correlation between STB and IBD published from their inception to November 2022 were searched in online databases, including the PubMed, Embase, Web of Science, Cochrane Library, CNKI, VIP, Wanfang, and Chinese Biomedical Databases (CBM). The quality of recruited articles was assessed using the Newcastle-Ottawa Scale (NOS). RevMan 5.4.1 and Stata13.1 were used for data analysis. Results A total of 14 articles, involving 6067 participants in 18 case-control studies (2972 in IBD group and 3905 in control group) were enrolled in this meta-analysis. STB was significantly lower in IBD patients than that of controls (SMD=-0.80, 95%CI:-0.99, -0.61, P<0.01). STB level in the active stage of IBD was significantly lower than that in remission stage (SMD=-0.76, 95%CI:-1.33, -0.19, P=0.009). STB decreased with the increase of IBD severity (mild vs moderate: SMD=-0.35, 95%CI:-0.52,-0.18, P<0.01; moderate vs severe: SMD=-0.59, 95%CI:-0.78, -0.39, P<0.01; mild vs severe: SMD=-0.88, 95%CI:-1.10, -0.66, P<0.01). STB level was negatively correlated with erythrocyte sedimentation rate (ESR) (r=-0.41, 95%CI:-0.45, -0.35, P<0.01), C-reactive protein (CRP) (r=-0.37, 95%CI:-0.48, -0.26, P<0.01) and clinical score (r=-0.54, 95%CI:-0.70, -0.39; P<0.01), and positively correlated with hemoglobin (Hb)(r=0.45, 95%CI:0.40, 0.50; P<0.01). The risk of IBD in patients with low-level STB within the normal range was 3.15 times higher than that of patients with high-level STB (OR=3.15, 95%CI:2.24, 4.44, P<0.01). Conclusion Low-level STB within the normal range is correlated with the increased risk, disease activity and severity of IBD, which may have reference values for clinical evaluation of IBD. Table and Figures | Reference | Related Articles | Metrics | Comments（0）

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Application principles of vasodilators in the treatment of acute heart failure Duan Fang, Cui Wei Clinical Focus    2023, 38 (9): 773-778.   DOI: 10.3969/j.issn.1004-583X.2023.09.001 Abstract （237）   HTML （3）    PDF（pc） （422KB）（57）       Knowledge map    Save Acute heart failure (AHF) is one of the common diseases in cardiovascular medicine. Its treatment principles include reducing cardiac preload and afterload, and improving cardiac systolic and diastolic function. Currently, evidences supporting the feasibility of vasodilators in the treatment of AHF are scant. The clinical application of vasodilators remains controversial. This review thoroughly described the pathophysiological basis, populations, and blood pressure control goals of intravenous vasodilators in the treatment of AHF, thus providing references for the clinical application. Table and Figures | Reference | Related Articles | Metrics | Comments（0）

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Screening of glycolysis-related genes for predicting the prognosis of patients with gastric cancer: Based on bioinformatics Zhao Xuhui, Huang Xiaomin, Da Dezhuan, Xu Yan, Cui Xiaodong, Li Hongling Clinical Focus    2024, 39 (1): 20-29.   DOI: 10.3969/j.issn.1004-583X.2024.01.003 Abstract （298）   HTML （6）    PDF（pc） （2487KB）（56）       Knowledge map    Save Objective To construct a glycolysis-related gene model for predicting the prognosis of gastric cancer (GC) patients based on bioinformatics. Methods The messenger RNA expression profiles of GC patients were analyzed in The Cancer Genome Atlas program, and gene sets with significant differences between GC tissues and normal tissues were verified using gene set enrichment analysis. A glycolysis-related genes model for predicting the prognosis of GC patients was constructed using least absolute shrinkage and selection operator regression analysis, and the predictive performance of the model was validated using Kaplan-Meier survival analysis, receiver operating characteristic curve, and univariate and multivariate Cox regression analysis. Gene set variation analysis was performed to analyze the differences in biological pathway states between high-risk and low-risk groups. Results Fourteen glycolysis-related genes (PFKFB2、UHRF1、ACYP1、CLDN9、STC1、EFNA3、NUP50、ADH4、ANGPTL4、PKP2、VCAN、HIF 1A、LHX9、ANKZF1、ALDH3A2) were identified as prognostic markers for GC patients. Based on a risk score derived from these 15 gene features using Cox regression analysis, patients were classified into high-risk and low-risk groups. These 15 gene markers were independent biomarkers for predicting the prognosis, and patients with a low-risk score had a better prognosis. The combination of gene markers and clinical prognostic factors in a Nomogram effectively predicted overall survival and disease-free survival. Conclusion The established panel of 15 glycolysis-related gene markers can serve as reliable tools for predicting the prognosis of GC patients and may provide potential targets for glycolysis-targeted therapy in GC. Table and Figures | Reference | Related Articles | Metrics | Comments（0）

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Clinical Focus    2023, 38 (11): 1042-1047.   DOI: 10.3969/j.issn.1004-583X.2023.11.016 Abstract （106）   HTML （2）    PDF（pc） （899KB）（56）       Knowledge map    Save 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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Systematic evaluation of the incidence and the influencing factors of sleep disorders in breast cancer patients Liu Jiazhu, Liu Rong, Meng Limin, Guo Yinshu, Zhang Xiaobo, Ai Yiqin Clinical Focus    2024, 39 (6): 494-500.   DOI: 10.3969/j.issn.1004-583X.2024.06.002 Abstract （265）   HTML （7）    PDF（pc） （1121KB）（54）       Knowledge map    Save Objective To determine the incidence and the influencing factors of sleep disorders in breast cancer (BC) patients through a systematic evaluation. Methods Articles reporting the influencing factors of sleep disorders in BC patients published before December 2023 were searched in comprehensive databases, such as China National Knowledge Infrastructure (CNKI), Wanfang, VIP, sinomed, PubMed, Web of Science, Cochrane Library, Embase, EBSCO. The eligible data were evaluated using the Agency for Healthcare Research and Quality (AHRQ) and Newcastle-Ottawa scale (NOS). Results Twenty papers representing a total of 4409 cases sample size and 29 influencing factors were included. The results of the systematic evaluation showed that the detection rate of sleep disorders in BC patients was 67%, the main influencing factors were chemotherapy, age, surgery, tumour classification, depression, anxiety, pain, fatigue, and exercise frequency, the secondary influencing factors were radiotherapy, genetics, income, family status, hormone levels, hot flushes, coping styles, environmental changes, and quality of life, and the other influencing factors included ethnicity, number of hospitalisations, physiological function, place of residence, constitutional type, hyperlipidaemia, religious beliefs, previous respiratory disease, self-image, social support and form of medical insurance payment. Conclusion The prevalence of sleep disorders in BC patients is high, and healthcare professionals can identify high-risk factors and intervene early for reducing the risk of sleep disorders in BC patients. 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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Risk assessment of pancreatic cancer in patients with type 2 diabetes mellitus treated with sitagliptin: A meta-analysis of randomized controlled trials Zhu Chenglou, Wu Qiong, Da Mingxu Clinical Focus    2023, 38 (12): 1061-1066.   DOI: 10.3969/j.issn.1004-583X.2023.12.001 Abstract （220）   HTML （17）    PDF（pc） （1492KB）（52）       Knowledge map    Save Objective To evaluate the risk of pancreatic cancer (PC) in patients with type 2 diabetes mellitus (T2DM) who are treated with sitagliptin. Methods Articles reporting the risk of PC in T2DM patients treated with sitagliptin published before July 10, 2022 were searched in the online databases, including EMBASE, MEDLINE, the Cochrane Library, PubMed. STATA 12.0 software was used for meta-analysis. Two investigators were independently responsible for article screen, data collection and quality assessment. Results A total of 11 randomized controlled trials involving 33, 360 T2DM patients were identified. Meta-analysis using a fixed-effect model showed that sitagliptin treatment did not significantly increase the risk of PC in T2DM patients ( R R=0.74, 95% C I: 0.45-1.21, P=0.225). Subgroup analyses showed that the monotherapy ( R R=0.82, 95% C I: 0.39-1.71, P=0.600) and combination regimen of sitagliptin ( R R=0.68, 95% C I: 0.35-1.31, P=0.244) did not significantly increase the risk of PC in T2DM patients. Conclusion Sitagliptin treatment is not associated with the increase in the risk of PC. Table and Figures | Reference | Related Articles | Metrics | Comments（0）

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Efficacy and safety of repetitive transcranial magnetic stimulation treatment on central neurogenic dysphagia: A meta-analysis Xiao Wangjing, Li Xinmeng, Lu Songling, Sun Xuehua Clinical Focus    2023, 38 (7): 588-599.   DOI: 10.3969/j.issn.1004-583X.2023.07.002 Abstract （192）   HTML （1）    PDF（pc） （3151KB）（52）       Knowledge map    Save Objective To systematically analyze the clinical efficacy and safety of repetitive transcranial magnetic stimulation in the treatment of central neurogenic dysphagia. Methods Randomized controlled trials on the treatment of dysphagia by repetitive transcranial magnetic stimulation in domestic and foreign databases were thoroughly searched. The retrieval time ranged from database inception to January 15, 2022. According to the inclusion and exclusion criteria, data were extracted from eligible literatures and analyzed. Literature quality was assessed. Finally, 17 articles (11 English language-published articles and 6 Chinese language-published articles) were included with a total of 857 patients. The Cochrane Collaboration tool and the Physiotherapy Evidence Database were used to evaluate the risk of bias. RevMan software and R language programming were used for statistical analysis. This systematic review was registered on International Prospective Register of Systematic Reviews (PROSPERO; CRD42022304209). Results The results of meta-analysis showed that repetitive transcranial magnetic stimulation significantly reduced the severity of dysphagia (SMD=-0.83, 95%CI: -1.03, -0.63, Z=8.14, P<0.01), improved the Standardized Swallowing Assessment (SSA) score (MD=-3.14, 95%CI: -3.70, -2.57, Z=10.84, P<0.01), the Water Swallow Test (WST) score (MD=0.95, 95%CI: 0.82, 1.07, Z=15.05, P<0.01), the Penetration-Aspiration Scale (PAS) score (MD=-0.41, 95%CI: -0.63, -0.19, Z=3.68, P<0.01), surface electromyography (sEMG) parameters (SMD=-0.47, 95%CI: -0.77, -0.16, Z=2.99, P<0.01) and the Barthel Index (BI) (MD=22.50, 95%CI: 13.67, 31.32, Z=4.99, P<0.01). There were no significant differences in the pharyngeal transit time (PTT) (MD=-0.07, 95%CI: -0.16, 0.02, Z=1.45, P=0.15) and the incidence of adverse events (RR=2.63, 95%CI: 0.85, 8.14, Z=1.68, P=0.09). Conclusion Repetitive transcranial magnetic stimulation has a certain clinical effect in the treatment of central neurogenic dysphagia, which can reduce the severity of dysphagia, improve swallowing safety, efficiency, and daily living ability, without obvious adverse events. However, it does not significantly improve the PTT. More high-quality studies are still needed to verify the above conclusions. Table and Figures | Reference | Related Articles | Metrics | Comments（0）