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18 December 2023, Volume 18 Issue 06 Previous Issue   

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Analysis of influence factors on nucleic acid negative conversion time in SARS-CoV-2 Omicron infected patients over 60 years old WEI Yihong, MA Zilin, ZHOU Duan, DENG Bing, TANG Jingyi 2023, 18 (06):  377-382.  DOI: 10.16138/j.1673-6087.2023.06.001 Abstract ( 22 )   HTML ( 35 )   PDF (507KB) ( 14 )   Objective To analyze the influence factors on nucleic acid negative conversion time in severe acute respiratory syndromes coronavirus 2(SARS-CoV-2) Omicron infected patients over 60 years old. Methods The patients over 60 years old infected SARS-CoV-2 Omicron in one designated hospital of Shanghai during April and June of 2022 were enrolled and the information including clinical data and nucleic acid negative conversion time were collected. The patients were divided into ≤14-day group and >14-day group based on nucleic acid negative conversion time, and clinical characteristics of two groups were compared. The correlation between age, time from diagnosis to Paxlovid use and nucleic acid negative conversion time was analyzed. Logistic regression analysis was used to analyze the influence of sex, age, vaccination, basic diseases and time from diagnosis to Paxlovid use on nucleic acid negative conversion time. Results The average day of nucleic acid negative conversion time was 15(12-18) d. As age and time from diagnosis to Paxlovid use increased, nucleic acid negative conversion time increased gradually (P=0.006, P<0.001). The univariate Logistic regression analysis showed that age, malignancy and time from diagnosis to Paxlovid use were related to nucleic acid negative conversion time ≤14 d (P=0.028, P=0.038, P=0.042). The multivariate Logistic regression analysis showed that age and time from diagnosis to Paxlovid use ≤3 d were independently related to nucleic acid negative conversion time ≤14 d (P=0.007, OR=0.802; P=0.003, OR=2.402). Conclusions In SARS-CoV-2 Omicron infected patients over 60 years old, increased age is related to longer nucleic acid negative conversion time, and the patients having malignant tumor also have delayed negative conversion time, while early using Paxlovid (≤3 d) could shorten nucleic acid negative conversion time. Figures and Tables | References | Related Articles | Metrics

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Impact of sarcopenia on quality of life and mobility in elderly patients with chronic obstructive pulmonary disease ZHAO Yajie, HE Qing, XU Zhihong 2023, 18 (06):  383-387.  DOI: 10.16138/j.1673-6087.2023.06.002 Abstract ( 16 )   HTML ( 22 )   PDF (509KB) ( 24 )   Objective To observe the status of sarcopenia in elderly patients with stable chronic obstructive pulmonary disease(COPD), and to explore its effect on quality of life and mobility in COPD patients. Methods A total of 92 patients with stable COPD in the Department of Geriatrics of Ruijin Hospital from July 2019 to April 2021 were selected and divided into sarcopenia group(n=32) and non-sarcopenia group(n=60) according to the Asian diagnostic criteria for sarcopenia. General clinical data were collected. All patients completed the pulmonary function test, grip strength and 6-meter walking speed measurement. The body composition analyzer was used to measure appendicular skeletal muscle (ASM), and the limb skeletal muscle mass index(SMI) was calculated. Symptoms of dyspnea were assessed by modified Medical Research Council Scal (mMRC) and the COPD assessment test (CAT). Pearson’s method or Spearman’s method was used to analyze the correlation between skeletal muscle assessment indexes and COPD disease assessment indexes. Multivariate stepwise Logistic regression was used to analyze the effect on mobility in the COPD patients with sarcopenia. Results The incidence of sarcopenia in the COPD patients was 34.8%. Compared with the non-sarcopenia group, the patients in the sarcopenia group were older (P<0.05), and the hemoglobin, albumin, body mass index (BMI), grip strength, 6-meter walking speed, ASM and SMI were significantly lower(P<0.01). CAT score and mMRC questionnaire score were higher than those in the non-sarcopenia group (P<0.05). BMI was positively correlated with first second forced end-expiratory volume as a percentage of estimated value（FEV1%）(r=0.376, P=0.031） and 6-meter walking speed（r=0.436, P=0.015） in both groups, and negatively correlated with mMRC（r=-0.340, P=0.032） and CAT （r=-0.354, P=0.043）. Logistic regression analysis showed that SMI was an independent risk factor for decreased quality of life and mobility in the COPD patients after adjusting for confounding factors (P<0.05). Conclusions Sarcopenia is a common complication in elderly patients with COPD and is associated with decreased quality of life and mobility. Figures and Tables | References | Related Articles | Metrics

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Effect of omalizumab treatment on serum cytokine profile in allergic asthma patients ZHENG Xiaoyan, SUN Lin, TANG Wei 2023, 18 (06):  388-393.  DOI: 10.16138/j.1673-6087.2023.06.003 Abstract ( 22 )   HTML ( 3 )   PDF (656KB) ( 14 )   Objective To investigate the effect of omalizumab on serum cytokine profile in the patients with allergic asthma. Methods A total of 20 patients with allergic asthma who received omalizumab treatment in the Department of Pulmonary and Critical Care Medicine of Ruijin Hospital were enrolled in this study. Data of spirometry test was collected before and after 4 months of omalizumab treatment to evaluate the improvement of lung function. Serum samples before and after 4 months of omalizumab treatment were collected to measure 29 cytokines using Meso Scale Discovery(MSD). Asthma control was assessed by asthma control test (ACT) score and treatment effectiveness was evaluated by the Global Evaluation of Treatment Effectiveness (GETE) score. Results After 4 months of omalizumab treatment, maximal expiratory flow at 50% of forced vital capacity (MEF50) was significantly improved among 20 patients (P<0.05). Serum interleukin(IL)-17A and IL-23 levels were significantly increased(P<0.05). Asthma control was significantly improved(P<0.01). According to GETE score, omalizumab treatment was effective in 17 patients, but not effective in 3 patients. Conclusions Omalizumab treatment effectively improves asthma control in allergic asthmatics. Increased levels of helper T17 (Th17) cell -related cytokines and recovery of Th17 cell function may be one of the potential therapeutic mechanisms of omalizumab. Figures and Tables | References | Related Articles | Metrics

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Comparison of efficacy and adverse effects of sevelamer with lanthanum carbonate on treatment of hyperphosphatemia in patients undergoing peritoneal dialysis BAO Lingling, HUANG Xiaomin, ZHANG Chunyan, ZHANG Qianying, WANG Zhaohui, XU Tian, REN Hong 2023, 18 (06):  394-399.  DOI: 10.16138/j.1673-6087.2023.06.004 Abstract ( 26 )   HTML ( 3 )   PDF (639KB) ( 14 )   Objective To investigate the efficacy and adverse effects of different non-calcium-phosphate binders on the treatment of hyperphosphatemia in patients with end-stage kidney disease undergoing peritoneal dialysis. Methods A total of 124 patients with hyperphosphatemia undergoing peritoneal dialysis who were initially treated with non-calcium-phosphate binders agent were enrolled in the Department of Nephrology, Ruijin Hospital affiliated to Shanghai Jiao Tong University School of Medicine from May in 2019 to March in 2021. Among them, 61 cases were treated with sevelamer and 63 cases were treated with lanthanum carbonate. Serum phosphorus, serum calcium, parathyroid hormone(PTH), 25-OH-VitD, alkaline phosphatase level and abdominal aortic calcification score (AACS) before and after treatment were compared in sevelamer or lanthanum carbonate treated groups, furthermore, the pill burden and cost were evaluated. Results The median follow-up time was 16.9 (9.0, 27.2) months until the end of October 2021. Serum phosphorus level was (1.70±0.31), (1.52±0.24) and (1.60±0.34) mmol/L at 1st, 3rd and 6th month after treatment, respectively, and significantly decreased than baseline [(2.08±0.31) mmol/L, P<0.05]. After 1 month and 3 months of treatment, the compliance rate in the lanthanum carbonate treated group was higher than that in the sevelamer treated group (27.0% vs 8.2%, P=0.006; 63.5% vs 39.3%, P=0.007); while after 6 months of treatment, there was no significant difference in PTH level and 25-OH-VitD level between sevelam treated group and lanthanum carbonate treated group[324.3 (178.1, 469.7) ng/L vs 304.4 (165.8, 413.3) ng/L, P=0.414; 15.01 (11.98, 22.75) nmol/L vs 20.02 (16.01, 27.19) nmol/L, P=0.376]. There were no significant differences in AACS and cardiac valve calcification score between the two groups before and after treatment. Gastrointestinal side effects such as nausea and vomiting were more common in lanthanum carbonate treated group (15.9% vs 1.6%, P=0.005). Conclusions Compared with sevelamer, lanthanum carbonate has a faster dephosphorization effect and higher initial serum phosphorus compliance rate, but the digestive tract tolerance is poor. Figures and Tables | References | Related Articles | Metrics

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Clinical feature of primary Sjögren’s syndrome in elderly YUAN Xiaoya, ZHANG Keke, ZHU Zhenhang, CHENG Fang, ZHAO Futao 2023, 18 (06):  400-403.  DOI: 10.16138/j.1673-6087.2023.06.005 Abstract ( 21 )   HTML ( 1 )   PDF (675KB) ( 10 )   Objective To explore the clinical feature of primary Sjögren’s syndrome (pSS) in the elderly. Methods Totally 117 patients were analyzed retrospectively in our hospital who met the pSS international classification diagnostic criteria in 2012. The patients were divided into the elderly group(≥60 years old, n=50) and the young and middle-aged group (<60 years old, n=67) according to their age, and the clinical data of two groups were analyzed and compared. Results Two groups both showed typical manifestations of dry mouth and (or) dry eyes, while the oral ulcers (14.0%) was more common in the elderly group, and parotid pain (14.9%) was more common in the young and middle-aged group. The positive rates of proteinuria and creatinine elevation in the elderly group were 10.0% and 42.0%, which were significantly higher (P<0.05) than those in the young and middle-aged group (3.0% and 6.0%). However, the positive rates of anti-SSA /SSB and IgG were 52.0% and 34.0% in the elderly group, obviously lower (P<0.05) than those in the young and middle-aged group (86.6% and 55.2%, respectively). There were no significant differences in ANA positivity, erythrocyte sedimentation rate (ESR), blood routine, complements, liver and kidney function between two groups. The positive rate of salivary gland ultrasound (SGUS) in the elderly group was 52.0%, which was lower than that in the middle-aged group (73.1%) (P<0.05), but the positive rate of lip gland biopsy didn’t show statistical difference between two groups. Conclusions Dry mouth and (or) dry eyes symptoms are the most common clinical manifestations in the patients with pSS. More cases in the elderly group have oral ulcers, while more patients in young and middle-aged group show the symptoms of parotid swelling and pain. Ultrasonography of salivary gland is expected to be the preferred method for the diagnosis of non-invasive auxiliary examination in elderly patients with pSS. Figures and Tables | References | Related Articles | Metrics

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Influence of home environment on incidence of home falls in patients with Parkinson’s disease GONG Lei, WANG Jue, ZENG Zhitong, LI Dianyou, SUN Bomin, ZHA Qinghua, QIU Xian 2023, 18 (06):  404-409.  DOI: 10.16138/j.1673-6087.2023.06.006 Abstract ( 22 )   HTML ( 2 )   PDF (680KB) ( 16 )   Objective To investigate the influence of home environment on the incidence of home falls in patients with Parkinson disease (PD). Methods Using a convenience sampling method, 260 patients with PD treated in the functional neurosurgery department of our hospital from May in 2020 to September in 2022 were enrolled as study projects. The patients were divided into non-home fall group and home fall group based on whether they had fallen in the past three months. A questionnaire survey including general information and home falls questionnaire, Movement Disorder Society (MDS) unified PD disease rating scale Ⅲ (UPDRS-Ⅲ), levodopa equivalent daily dose (LEDD) and home falls and accidents screening tool (HOME FAST) was conducted, and the collected data was analyzed. Results There were 57 (22.5%) patients had fallen in the previous three months, 19 (33.3%) patients fell several times, 49 (86.0%) patients fell indoors, 51 (89.5%) patients fell mainly during the daytime, and 49(86.0%) patients fell without accompany. In the home environment, floor (84.5%) and toilet (63.2%) without anti-slip pads were the most common reason to lead to fall. The total score of HOME FAST in the home fall group was lower than that in the non-home fall group [(19.84±3.72) vs (21.27±2.72), t=3.190, P=0.002]. Multivariate Logistic regression analysis showed that sundry objects in the passageway[odds ratio (OR)=1.214, P=0.003] and the lack of handrails beside the stairs (OR=1.333, P=0.028) were the major risk factors of home falls. Conclusions There is high incidence of home falls in PD patient, and the home environment have an impact on the occurrence of home falls. Sundry objects in the passageway and the lack of handrails beside the stairs are the major risk factors of home falls in patients with PD. Figures and Tables | References | Related Articles | Metrics

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Identification of latent class of sleep quality and analysis of differences of quality of life in liver cirrhosis patients with different sleep quality JIANG Pingmei, XIANG Xiaogang, CAI Xiaolan, XUE Min, QIAN Zhuping 2023, 18 (06):  410-415.  DOI: 10.16138/j.1673-6087.2023.06.007 Abstract ( 23 )   HTML ( 1 )   PDF (682KB) ( 14 )   Objective To identify the classification characteristics of sleep quality in liver cirrhosis patients, and explore the difference of quality of life(QOL) among the patients with different sleep quality categories. Methods A total of 221 liver cirrhosis patients in the infectious disease department of our hospital were selected as the research subjects from June 2020 to June 2021 by using convenient sampling method, in which Pittsburgh sleep quality index (PSQI) and chronic liver disease questionnaire(CLDQ) were investigated. Results According to sleep quality，the patients with liver cirrhosis were divided into 4 potential categories, which were sleep disorder group (24.4%), good sleep quality group (43.9%), lack of sleep group (12.7%) and prolonged sleep latency-daytime sleepy group (19.0%); and the incidence of sleep disturbance in 4 groups was 98.2%, 4.1%, 60.7% and 76.2%, respectively. Using good sleep quality group as reference, the score of QOL among the other groups of potential categories showed significant difference (P<0.05); the multiple linear stepwise regression suggested that daytime dysfunction, poor subjective sleep quality and sleep disorder were the main sleep problems affecting life quality(P<0.05). Conclusions There is heterogeneity in the sleep quality of cirrhosis patients, and the decreased QOL is generally consistent with poor sleep quality. It is necessary to learn the characteristics and differences of different sleep quality categories and improve the quality of sleep and life through targeted intervention. Figures and Tables | References | Related Articles | Metrics

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M2-sEV inhibit endoplasmic reticulum stress to alleviate chronic intermittent hypoxic-induced H9C2 cardiomyocyte injury HE Meijuan, HE Yanjie, WANG Yun, ZHU Chunxue, HUANG Hanpeng 2023, 18 (06):  416-423.  DOI: 10.16138/j.1673-6087.2023.06.008 Abstract ( 18 )   HTML ( 1 )   PDF (992KB) ( 14 )   Objective To investigate the effect and mechanism of M2 macrophages-derived small extracellular vesicle (M2-sEV) on injury of H9C2 cardiomyocytes induced by chronic intermittent hypoxia (CIH). Methods Interleukin-4(IL-4) was used to induce the polarization of RMa-bm macrophages to M2-type. The mRNA expression levels of M2-type markers CD206 and arginase-1（Arg-1） were detected by quantitative reverse transcription PCR (qRT-PCR). M2-sEV were extracted and identified. The signature proteins CD9, CD63 and CD81 of M2-sEV were detected by Western blotting(WB). H9C2 cells were randomly divided into control（CON） group, CIH group and CIH+M2-sEV group. CCK8 was used to detect cell viability, and qRT-PCR and WB were respectively used to detect mRNA and protein expression of hypoxia-inducible factor-1α (HIF-1α）, IL-6、tumor necrosis factor-α（TNF-α）、transforming growth factor-β（TGF-β） and apoptotic factors(cleaved caspase-3、cleaved caspase-9、Bcl-2、Bax) as well as endoplasmic reticulum stress factors (IRE1α、XBP1、ATF6、GRP78). Results M2-type macrophages were polarized successfully and M2-sEV were extracted successfully. CCK8 showed that M2-sEV increased the proliferation activity of H9C2 cardiomyocytes under CIH. Compared with the CON group, the expression level of HIF-1α, inflammatory factors (IL-6,TNF-α,TGF-β), pro-apoptotic proteins(cleaved caspase-3, cleaved caspase-9, Bax) and endoplasmic reticulum stress factors (IRE1α, XBP1, ATF6, GRP78) were significantly increased in the CIH group(P<0.05) in both mRNA and protein level. The protein level of Bcl-2 in the CIH group was decreased, and the ratio of Bax/Bcl-2 was increased in the CIH group (P<0.05). However, after co-incubating with M2-sEV, the expressions of HIF-1α, inflammatory factors, pro-apoptotic proteins and endoplasmic reticulum stress factors in CIH group were significantly decreased (P<0.05), and the expression of Bcl-2 and the ratio of Bax/Bcl-2 were also decreased (P<0.05). Conclusions M2-sEV can alleviate the injury of H9C2 cell induced by CIH, which is related to the downregulation of endoplasmic reticulum stress, inhibition of inflammation and reduction of apoptosis. Figures and Tables | References | Related Articles | Metrics

Research report

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Analysis of distribution and drug resistance of pathogenic bacteria of bloodstream infection in a tertiary hospital from 2019 to 2022 YANG Siheng, ZHANG Xuewu, HU Guoqi, ZHANG Yan, LI Ziqiang, SHENG Zike, XU Yumin 2023, 18 (06):  424-430.  DOI: 10.16138/j.1673-6087.2023.06.009 Abstract ( 22 )   HTML ( 5 )   PDF (862KB) ( 34 )   Objective To analyze the distribution and the drug resistance of bloodstream infection(BSI) pathogenic bacteria in hospitalized patients in Jieshou People’s Hospital, provide a basis for clinical guidance on the treatment of BSI patients, and prevent and control nosocomial infection in local area. Methods From January in 2019 to December in 2022, 6 727 blood culture samples of inpatients were screened from the laboratory information system (LIS) in our hospital, and 668 (9.93%) strains were isolated, and the distribution and drug resistance of the bacteria were analyzed retrospectively. Statistical analysis was performed using Excel 2021 and WHONET 5.6 software. Results Pathogens were mainly isolated from infection department, intensive care unit, general surgery. BSI caused by respiratory system infection, urinary system infection, and hepatobiliary system infection was the most common, and 30-day mortality rate of patients was 23.50%. Among the 668 isolated strains, 461(69.01%) strains were Gram-negative bacteria, 205(30.69%) strains were Gram-positive bacteria and 2(0.30%) strains were fungi. The top five isolated strains(84.28%) were 274 (41.01%) strains of Escherichia coli, 141(21.10%) strains of coagulase-negative Staphylococcus, 91(13.62%) strains of Klebsiella pneumoniae, 34(5.09%) strains of Staphylococcus aureus and 23(3.44%) strains of Pseudomonas aeruginosa, respectively. The detection rate of Escherichia coli in 2021-2022 was decreased compared with 2019-2020 (P<0.05), while the detection rate of Klebsiella pneumoniae was increased slightly in 2021-2022 compared with 2019-2020 (P>0.05). The resistance rates of Escherichia coli and Klebsiella pneumoniae to carbapenems, piperacillin/tazobactam, and amikacin were low, and the proportion of carbapenem-resistant Enterobacterales (CRE) was low (6.09%). Among Staphylococcus aureus, methicillin-resistant Staphylococcus aureus (MRSA) accounted for a relatively high proportion (76.47%), while Gram-positive bacteria including Enterococcus were not detected to be resistant to vancomycin, linezolid and tigecycline. Conclusions Escherichia coli, Klebsiella pneumoniae in Gram-negative bacteria, and the coagulase-negative Staphylococcus and Staphylococcus aureus in Gram-positive bacteria were the main strains of BSI in local area. The main Gram-negative bacteria were highly sensitive to carbapenems, amikacin, piperacillin/tazobactam. MRSA has a higher detection rate. Figures and Tables | References | Related Articles | Metrics

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Study of a refined hydration programme in preventing hemorrhagic cystitis after allogeneic hematopoietic stem cell transplantation WANG Chuangqi, WANG Xi, WANG Wenwei, WU Feifei, ZHANG Yanlin 2023, 18 (06):  431-435.  DOI: 10.16138/j.1673-6087.2023.06.010 Abstract ( 19 )   HTML ( 10 )   PDF (693KB) ( 22 )   Objective To compare the effects of three hydration modalities on prevention of concomitant hemorrhagic cystitis (HC) after allogeneic hematopoietic stem cell transplantation (allo-HSCT). Methods One hundred and forty-five hematologic patients undergoing allo-HSCT in our hospital were randomly divided into group A (49 patients), group B (48 patients) and group C (48 patients), in which group A was treated by the conventional intravenous and oral hydration, group B was treated by the refined intravenous and oral hydration, and the group C received the treatment of refined oral hydration except for necessary intravenous medication. The occurrence of HC, water compliance, water qualification rate and nursing satisfaction were compared among three groups. Results The incidence of HC in groups B and C was lower than that in group A, but the difference between groups B and C was not statistically significant (P>0.05). The total compliance rates of drinking water in the patients of groups B and C were higher than that in group A (P<0.05); the nursing satisfaction of patients in groups B and C was higher than that in group A(P<0.05). Conclusions The refined hydration programmes can reduce the incidence of HC, improve compliance of drinking water and nursing satisfaction in the patient receiving allo-HSCT. The refined oral hydration is safer and more economical, which is a better choice for hydration treatment in the haematological patients. Figures and Tables | References | Related Articles | Metrics

Case report

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Intrahepatic bile duct hamartoma with cholangitis as the first manifestation combined with type 2 diabetes: a case report LIU Chongxiao, HUANG Song, BEI Pengjian, XU Yanhong, LI Xiaohua, ZHANG Hongli 2023, 18 (06):  436-438.  DOI: 10.16138/j.1673-6087.2023.06.011 Abstract ( 19 )   HTML ( 1 )   PDF (415KB) ( 16 )   Figures and Tables | References | Related Articles | Metrics

Medical education

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Discussion on the influence of chatbot based on large-scale language model on medical education PAN Roubai, TAO Rong 2023, 18 (06):  439-446.  DOI: 10.16138/j.1673-6087.2023.06.012 Abstract ( 13 )   HTML ( 1 )   PDF (1013KB) ( 49 )   Figures and Tables | References | Related Articles | Metrics

Review article

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Current status and research progress of subjective cognitive decline in Alzheimer’s disease of preclinical stage YAO Minyi, LIU Yonglin 2023, 18 (06):  447-450.  DOI: 10.16138/j.1673-6087.2023.06.013 Abstract ( 20 )   HTML ( 2 )   PDF (389KB) ( 28 )   References | Related Articles | Metrics

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The role and research progress of microRNA in acute leukemia HUANG Rong, LIU Jing’an, ZHU Yilin, SHI Xiaofeng 2023, 18 (06):  451-456.  DOI: 10.16138/j.1673-6087.2023.06.014 Abstract ( 17 )   HTML ( 2 )   PDF (513KB) ( 14 )   Figures and Tables | References | Related Articles | Metrics

Conference summary

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Proceeding of 17th World Congress on Controversies in Neurology FAN Cunxiu, LE Weidong, WANG Xiaoping 2023, 18 (06):  457-460.  DOI: 10.16138/j.1673-6087.2023.06.015 Abstract ( 15 )   HTML ( 4 )   PDF (618KB) ( 16 )   References | Related Articles | Metrics