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18 July 2022, Volume 17 Issue 04 Previous Issue    Next Issue

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Influence of different diagnostic criteria on the prevalence of hypertension in the population LI Xinni, MA Wenkun, GAO Chengjie, GAO Yajie, JIN Xuejuan, ZHOU Yi, SHEN Chengxing, PAN Jingwei 2022, 17 (04):  273-277.  DOI: 10.16138/j.1673-6087.2022.04.001 Abstract ( 236 )   HTML ( 20 )   PDF (521KB) ( 83 )   Objective To compare the difference in the prevalence of hypertension diagnosed with the 2017 American hypertension diagnostic criteria (American standard) and the Chinese guidelines for the prevention and treatment of hypertension (2018 revised edition, Chinese standard) in the general population. Methods The cluster stratified random sampling method was adopted. The population samples were collected from the population database of physical examination between 2015 and 2019 in Shanghai Sixth People’s Hospital and were stratified by every 10 years. Twenty people including 10 males and 10 females were randomly selected from every year, which was defined as one layer. The information of investigation included medical history investigation, height, weight, blood pressure measurement, blood biochemical index detection, etc. Both the items and information of the physical examination adopted unified and standardized testing methods. According to the definition of hypertension in China standard [≥140/90 mmHg (1 mmHg=0.133 kPa) or taking antihypertensive drugs right now]and in American standard(≥130/80 mmHg or taking antihypertensive drugs right now), the prevalence of hypertension in people in different genders and ages were calculated, respectively. Results The population prevalence of hypertension based on Chinese standard was 27.3%(29.0% in male and 25.7% in female); the population prevalence of hypertension based on American standard was 55.8% (65.3% in men and 46.3% in women); the systolic blood pressure showed a linear increase with age, while the diastolic blood pressure showed an inverted“U” distribution with age; the prevalence of hypertension based on both definitions increased with age in 6 age groups, which were 20-29, 30-39, 40-49, 50-59, 60-69 and 70-79 years. Furthermore, the age groups of 50-59 and 60-69 showed the largest differences in two diagnostic criteria, with an increase of 37.0% and 39.0%, respectively. The prevalence of hypertension in male was higher than female in most age groups except the groups of 60-69 and 70-79 years in Chinese standard and the group of 70-79 years in American standard (all P<0.05). The two diagnostic criteria led to large difference in the diagnostic rate of hypertension in male. Conclusions According to 2017 American standard, the prevalence of Chinese young and middle-aged people diagnosed as hypertension increased significantly compared to Chinese standard of 2018. Therefore, more attention should be given to this group, and the lifestyle and medical interventions should be carried out early to reduce the risk of cardiovascular and cerebrovascular diseases. Figures and Tables | References | Related Articles | Metrics

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The clinical retrospective analysis of 674 hospitalized patients diagnosed with sepsis in a general hospital ZHENG Yuzhen, ZHENG Yanjun, ZHOU Yi, QI Xing, CHEN Weiwei, SHI Wen, ZHOU Weijun, YANG Zhitao, CHEN Ying, MAO Enqiang, CHEN Erzhen 2022, 17 (04):  278-282.  DOI: 10.16138/j.1673-6087.2022.04.002 Abstract ( 261 )   HTML ( 8 )   PDF (493KB) ( 86 )   Objective To investigate the epidemiological characteristics and mortality risk factors of the inpatients diagnosed with sepsis in a general hospital. Methods The patients admitted to Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, from January 1st,2018 to December 31st, 2019 were enrolled and the retrospective study was conducted on the patients diagnosed with sepsis. The patients were divided into survival group and dead group, and their clinical data were analyzed and compared. The Logistic regression analysis was used to identify independent risk factors of death in the patients during hospitalization. Results A total of 674 patients (75.7%) diagnosed with sepsis were included in the study. Most of patients were male (64.8%) and the median age was 65 years. The median length of hospital stay was 23 d. The hospital mortality was 31.5%. The diabetes mellitus(20.8%) was the most common comorbid disease and followed by tumor (15.0%）. The most common site of infection was abdomen (43.6%) and the highest proportion in microorganisms isolated from positive blood cultures was Klebsiella pneumoniae (30.6%). Respiratory tract infection was the main infection site in deceased patients. Through Logistic regression analysis, the independent risk factors of hospital mortality were identified, which were age ≥60 years, low weight, admission from internal medicine wards, multiple organ failure, septic shock and increasing sepsis-related organ failure assessment(SOFA). Conclusions The factors affecting the in-hospital mortality were older age, low weight, multiple organ failure and septic shock. Figures and Tables | References | Related Articles | Metrics

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Recombinant human thrombopoietin in treatment of acute myeloid leukemia thrombocytopenia after chemotherapy: a real-world study JIANG Tianyi, LIU Fujia, CHENG Wenyan, ZHAO Huijin, SHEN Yang 2022, 17 (04):  283-288.  DOI: 10.16138/j.1673-6087.2022.04.003 Abstract ( 279 )   HTML ( 5 )   PDF (621KB) ( 106 )   Objective To explore the clinical efficacy and safety of recombinant human thrombopoietin(rhTPO) on chemotherapy induced thrombocytopenia(CIT) in the patients with acute myeloid leukemia(AML). Methods A total of 529 AML patients who received initial induction chemotherapy in our hospital were enrolled and were classified into a treatment group (393 cases, receiving rhTPO treatment) and a control group (136 cases, not receiving rhTPO treatment) according to their therapeutic protocols. After chemotherapy, comparisons between two groups were made on the days of the blood platelet count(BPC) less than 10×109/L, 20×109/L, 30×109/L, 50×109/L, the count of infusion thrombocytes, the days of platelet transfusion and the incidence of adverse reactions. Results The days of BPC less than 10×109/L, 20×109/L, 30×109/L, the total account of platelet infusion and the days of platelet transfusion had no difference between two groups (all P>0.05). The days of BPC restored to more than 50×109/L in the treatment group were less than those in the control group significantly（P<0.05）. In the patients with BPC less than 50×109/L on the first visit, both the days of BPC less than 20×109/L and the days of BPC restored to more than 50×109/L in the treatment group after chemotherapy were less than those in the control group (P<0.05). The early mortality and the incidence of bleeding events in treatment group were significantly less than those in the control group (P<0.05). Conclusions rhTPO can be well tolerated, and it is able to reduce the duration of CIT, the early mortality, and the incidence of bleeding events in the patients with AML after chemotherapy. Figures and Tables | References | Related Articles | Metrics

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Management of rectal neurosecretory tumors less than 1 cm in diameter: comparison of two endoscopic procedures LI Weiguang, SUN Yunwei, SUN Jing, ZHANG Benyan, WANG Huafeng, QIAN Aihua 2022, 17 (04):  289-294.  DOI: 10.16138/j.1673-6087.2022.04.004 Abstract ( 249 )   HTML ( 5 )   PDF (1090KB) ( 146 )   Objective To compare the efficacy and safety of endoscopic submucosal resection with ligation (ESMR-L) with non-submucosal injection and endoscopic submucosal dissection (ESD) on management of rectal neuroendocrine tumor (NET). Methods The prospective study included 42 patients who had rectal NET with a diameter ≤1 cm and received endoscopic treatment in Ruijin Hospital, Shanghai Jiao Tong University School of Medicine from October 2020 through October 2021. Twenty-one patients were treated with ESD and 21 patients were treated with non-submucosal injection ESMR-L. The average operation time and histopathological characteristics, such as complete resection rate and the distance between the lower edge of the tumor and the vertical cutting edge, were compared between the two groups. Results The operation time in non-submucosal injection ESMR-L group was significantly shorter than that in ESD group[(10.10±1.37) min vs (29.90±3.81) min, P<0.001]; The lateral and vertical margins of the two groups were both negative, and patients of both group all had the lesions complete resected (P>0.05); The distance from the lower edge of tumor to the vertical cutting edge in non-submucosal injection ESMR-L group was significantly longer than that in ESD group [(1 051.5±561.4) μm vs(612.6±305.4) μm, P=0.038]. Conclusions Compared with the ESD method, non-submucosal ESMR-L method needs shorter operation time while achieving similar rate of complete lesion resection. ESMR-L is therefore a simple, safe and effective treatment for rectal NET with diameter ≤1 cm. Figures and Tables | References | Related Articles | Metrics

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Study on relationship between serum growth stimulation expressed gene 2 and lipoprotein-associated phospholipase 2 and cardiovascular events in maintenance hemodialysis patients GAO Jian, WANG Deqin, ZHOU Yonghua, MIAO Xianjing, CHEN Yu, JING Xin, WANG Yan 2022, 17 (04):  295-300.  DOI: 10.16138/j.1673-6087.2022.04.005 Abstract ( 203 )   HTML ( 3 )   PDF (603KB) ( 82 )   Objactive To explore the association between suppression of growth stimulation expressed gene 2 (ST2), lipoprotein-associated phospholipase A2(LP-PLA2) and cardiovascular events in the patients with maintenance hemodialysis (MHD). Methods A total of 117 MHD patients at our hospital from January 2016 to January 2017 were selected. The serum ST2 and LP-PLA2 levels were measured before hemodialysis. The patients were followed up, and the primary endpoint was occurrence of cardiovascular events. The receiver-operating characteristic curve was analyzed to determine if ST2 and LP-PLA2 were associated with cardiovascular events in MHD patients. The univariate and multivariate Cox regression analysis was used to determine the risk factors of cardiovascular events in the MHD patients. Results The ST2 and LP-PLA2 levels were significantly higher in the patients with cardiovascular events than those without events (all P<0.05). The areas under the curve of ST2 and LP-PLA2 distinguishing the MHD patients with or without cardiovascular events were 0.77 and 0.70, respectively; and it increased to 0.83 when the 2 biomarkers were used in combination. The Kaplan-Meier curve analysis showed that the MHD patients with ST2≤61 μg/L had a significantly longer time free from cardiovascular events than those with ST2>61 μg/L(53 months vs 28 months, P<0.001). Similarly, the MHD patients with LP-PLA2≤266 μg/L had a significantly longer time free from cardiovascular events than those with LP-PLA2>266 μg/L (50 months vs 37 months, P=0.001). The multivariate Cox regression analysis presented the brain natriuretic peptide (BNP) [ hazard ratio(HR)=1.01, P<0.001], ST2>61 μg/L (HR=1.27, P<0.001) and LP-PLA2>266 μg/L (HR=1.92, P<0.001) was independent risk factor for cardiovascular events in the MHD patients. Conclusions The serum ST2 and LP-PLA2 are independent risk factors for cardiovascular events in the MHD patients, and measurement of ST2 and LP-PLA2 may help to evaluate risk stratification. Figures and Tables | References | Related Articles | Metrics

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A retrospective cohort study on the correlation between triglyceride-glucose index and new-onset fatty liver disease XU Doudou, CHEN Ying, LÜ Ankang, WU Beiwen 2022, 17 (04):  301-306.  DOI: 10.16138/j.1673-6087.2022.04.006 Abstract ( 228 )   HTML ( 3 )   PDF (613KB) ( 62 )   Objective To explore the correlation between triglyceride-glucose(TyG) index and new-onset fatty liver disease(FLD) to provide references for the prevention and treatment of FLD. Methods This retrospective cohort study recruited the subjects received physical examination at the physical examination center of our hospital in 2018 by convenience sampling. The participants were divided into four groups according to the quartiles of TyG index: Q1, Q2, Q3, Q4, and they were followed up each year until 2020. A cohort of 958 subjects were included for final analysis. The Cox proportional-hazards regression model and Spearman correlation were used to analyze the association between the TyG index and new-onset FLD. Results The cumulative incidence of FLD increased along with the increase of TyG (P<0.05). After adjusting for multiple factors such as age, gender and body mass index(BMI) with the Cox proportional-hazards regression model, the incidence of FLD in the Q2, Q3, Q4 groups was 2.107 times [95% confidence interval (CI): 1.317-3.373], 2.598 times (95%CI: 1.659-4.069), 3.171 times(95%CI: 2.036-4.938) higher than that in the Q1 group. The Spearman correlation analysis revealed that the TyG index is highest positively related to the new-onset FLD (r=0.302, P<0.001). Conclusions The risk of FLD increased with the increase of TyG, which could be an effective indicator to predict the incidence of FLD. Figures and Tables | References | Related Articles | Metrics

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Effect of serum vitamin D level on renal function in elderly patients with chronic kidney disease ZHANG Xiaoyan, XU Jing, QU Bin 2022, 17 (04):  307-312.  DOI: 10.16138/j.1673-6087.2022.04.007 Abstract ( 240 )   HTML ( 5 )   PDF (577KB) ( 87 )   Objective To investigate the association between vitamin D and chronic kidney disease (CKD) in elderly patients. Methods The clinical and follow-up data of elderly patients aged≥60 years diagnosed with CKD at stage 1-4 were collected in the Department of Nephrology and Department of Geriatrics of Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine from January 2014 to May 2019. The serum 25-hydroxy vitamin D[25(OH)D] level was detected using photochemical method. All patients were divided into vitamin D deficiency group [25(OH)D<50 nmol/L] and non-deficiency group [including sufficient and insufficient levels of 25(OH)D, namely 25(OH)D≥50 nmol/L] according to 25(OH)D level. The baseline clinical and prognostic indicators were compared between two groups. Results Totally 347 elderly CKD patients were enrolled in this study. Compared to the patients with stage 1-2 CKD, the vitamin D level in those with stage 3-4 CKD was significantly lower. The incidence of vitamin D deficiency in the patients with stage 1-2 CKD and stage 3-4 CKD was 46.7% and 67.6%, respectively. Compared with the patients without vitamin D deficiency at stage 3-4 CKD, the patients with vitamin D deficiency at same stage had higher parathyroid hormone, serum uric acid, serum creatinine and rate of estimated glomerular filtration rate(eGFR) decline of at least 30% or progression into end-stage renal disease (16.9% vs 2.9%, P=0.042), and lower serum calcium and eGFR. The multivariate Logistic regression analysis showed that the vitamin D deficiency was an independent risk factor for the patients with stage 3-4 CKD after adjusting gender, age, mean arterial pressure, hemoglobin, albumin, proteinuria, and uric acid. Conclusions The patients with vitamin D deficiency at stages 3-4 CKD had significantly lower eGFR. The vitamin D deficiency is an independent risk factor for onset of CKD at stages 3-4. Figures and Tables | References | Related Articles | Metrics

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Relationship between pathological changes under gastroscopy and Helicobacter pylori antibody groups in serum LIU Qinghua, LI Zhen, ZHANG Xiaowei, ZHANG Xinhuan, ZHANG Hong 2022, 17 (04):  313-316.  DOI: 10.16138/j.1673-6087.2022.04.008 Abstract ( 172 )   HTML ( 2 )   PDF (417KB) ( 66 )   Objective To investigate the prevalence of serum Helicobacter pylori(Hp) infection in the patients with upper gastrointestinal symptoms and the relationship between Hp antibody groups and pathological changes under gastroscopy. Methods A total of 705 patients including 389 males and 316 females underwent gastroscopy from August 2018 to January 2020 (age between 13 and 88 years). Four Hp antibodies were detected by immunoblotting, and the infection rates of type Ⅰ and type Ⅱ Hp were multiple compared by sex and age groups(every 10 years old, which were≤30, 31~≤40, 41~≤50, 51~≤60, 61~≤70, ≥71 years). Divided into superficial gastritis, superficial gastritis with erosion, esophagitis, chronic atrophic gastritis, gastric ulcer and gastric cancer groups through gastroscopy. The positive rates of HP antibodies detected between groups were compared, and the data of detected antibodies including toxin-related protein cytotoxin-associated protein(CagA), vacuolating cytotoxin gene(VacA) and CagA+VacA were collected and analyzed. Results The total HP infection rate was 60.6%, and the infection rate of Hp type Ⅰ in was higher than that of Hp type Ⅱ. The HP infection rates in male were 59.4% (231) and 62.0% (196) in female, and didn’t show difference (χ2=0.510, P=0.475). Age into 6 groups with Hp infection rate (P<0.05), Hp Ⅰ infection rate within each age group (P<0.05). The gastric cancer group had highest positive rate of Hp Ⅰ(60.0%), while the esophagitis group had highest rate of Hp Ⅱ (17.5%), significant difference between type Ⅰ positive rate (P<0.05). In the cases with positive Hp Ⅰ, the CagA positive rate in gastric cancer was 70.6%, the VacA positive rate in superficial and erosive gastritis was 17.0%, and the positive rate of CagA+VacA in esophagitis was 52.0%. Conclusions Hp infection is a key cause of the most gastric diseases. Hp Ⅰ is currently the most common type of Hp infection in the clinic, which is more pathogenic. Figures and Tables | References | Related Articles | Metrics

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Effects of activin A on migration and aerobic glycolysis of gastric cancer cells ZHAO Liqin, GUO Weijian, YU Nuoya, WU Junwei, ZHANG Jun 2022, 17 (04):  317-323.  DOI: 10.16138/j.1673-6087.2022.04.009 Abstract ( 276 )   HTML ( 3 )   PDF (1217KB) ( 174 )   Objective To investigate the role of activin A, a member of transforming growth factor-β superfamily cytokine, in regulating migration and aerobic glycolysis of gastric cancer cells, and the prognostic value of the expression of its coding gene inhibin βA(INHBA) in survival of gastric cancer patients. Methods The gastric cells were first titrated with various concentration of activin A and the expression of pSmad2/3 was examined by Western blot(WB) to determine the concentration range of activin A used in the study. The effect of activin A on the migration of gastric cancer cells was monitored by transwell and wound healing assays. The lactate production and glucose uptake of gastric cancer cells were followed to evaluate the role of activin A on the regulation of aerobic glycolysis. The association between activin A and epithelial mesenchymal transformation(EMT)/glycolysis related genes was analyzed in the Cancer Genome Atlas (TCGA) gastric cancer database, and further validated by WB studies. The expression of INHBA in gastric cancer and normal mucosa tissue were analyzed in TCGA, Gene Expression Omnibus(GEO) and other publicly available databases to explore the association of INHBA expression level with patients’ survival. Results The activin A at 20 ng/mL sufficiently upregulate the level of pSmad2/3, and the concentration was thus used in the study. Activin A promoted migration and aerobic glycolysis of gastric cancer cells. There was a significant positive correlation between the expression of INHBA and several EMT related genes, hypoxia inducible factor-1 α(HIF1A), glucose transporter 3 (GLUT3) [SNAI1: r=0.47, P=0;SNAI2: r=0.51, P=0; VIM: r=0.37, P=2.1×10-14; matrix metalloproteinase(MMP)2: r=0.64, P=0; MMP9: r=0.27, P=2.8×10-8; HIF1A: r=0.45, P=0; SLC2A3: r=0.42, P=0]. After treatment with activin A, the expression of snail, slug, vimentin, MMP2 and GLUT3 increased significantly(P<0.05). The expression of INHBA in gastric cancer was significantly higher than that in normal gastric mucosa tissue, and the prognosis of patients with higher expression of INHBA was poor. Conclusions Activin A can promote migration and aerobic glycolysis, which might attribute to its upregulation of EMT related genes and GLUT3. High level of INHBA is indicative of prognosis for gastric cancer patients. Figures and Tables | References | Related Articles | Metrics

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Biomarker-based predictive model for calcific aortic valve disease YANG Ling, ZHA Qing, ZHANG Qianru, YE Jiawen, YANG Ke, LIU Yan 2022, 17 (04):  324-329.  DOI: 10.16138/j.1673-6087.2022.04.010 Abstract ( 223 )   HTML ( 3 )   PDF (658KB) ( 84 )   Objective To establish a new biomarker predictive model for calcific aortic valve disease (CAVD) by analyzing the relationship between new serum markers and CAVD. Methods The peripheral blood and clinical data of 446 in-patients in the department of cardiology were collected. The patients were randomly divided into a screening cohort (n=202) and a verification cohort(n=244) by SPSS20.0. The enzyme-linked immunosorbent assay was used to detect the serum concentrations of glucagon-like peptide 1(GLP-1) and osteopontin (OPN). By analyzing the relationship between multiple factors and clinical variables in the screening cohort and CAVD, and verifying it in the verification cohort, the CAVD predictive model was constructed. Results The binary regression analysis showed that multiple factors in the screening cohort were significantly related to CAVD. Based on it, it was determined that high density lipoprotein cholesterol (HDL-C), GLP-1 and OPN could be included in the predictive model, and a nomogram was drawn. Through Pass C statistics [screening cohort: 0.73(95% CI: 0.66-0.80), verification cohort 0.70 (95% CI: 0.64-0.77)] and Hosmer-Lemeshow test (screening cohort: P=0.14, verification cohort: P=0.23), it was found that the discrimination and consistency of the model in the screening and validation cohorts performed well. Decision curve analysis indicated that the biomarker model had a higher net benefit than that in the clinical factor model. In addition, the model showed nice discriminating ability in different gender and age groups. Conclusions GLP-1, OPN and HDL-C levels are significantly correlated with CAVD. Based on it, a CAVD predictive model which performed well in discriminating ability and accuracy was successfully constructed and verified, and provided the possibility for CAVD prediction. Figures and Tables | References | Related Articles | Metrics

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The tele-nursing education and guidance ameliorate coronary plaque progression in patients with type 2 diabetes mellitus XU Qing, SHAO Huiying, CHEN Shuai, QUAN Jinwei, ZHOU Qingfen, WANG Minhui 2022, 17 (04):  330-333.  DOI: 10.16138/j.1673-6087.2022.04.011 Abstract ( 180 )   HTML ( 7 )   PDF (450KB) ( 70 )   Objective To investigate the effects of tele-nursing education and guidance on coronary atherosclerotic plaque progression in patients with type 2 diabetes mellitus (T2DM). Methods This study included 825 T2DM patients who underwent coronary artery angiography and had the coronary plaque reevaluated approximately one year thereafter. The baseline clinical characteristics and laboratory parameters were documented and routine healthcare education was given at hospital. The participants were than divided into tele-nursing education group (n=397), who were offered tele-nursing education and guidance after discharge (once every three months), and control group (n=428). Results Tele-nursing education group had significantly lower ratio of coronary plaque progression than control group (P<0.05). Significant difference was also observed between the two group patients regarding self-management behavior, self-monitering of blood glucose level, self-monitering of blood pressure, and medication compliance (all P<0.05). Multivariate regression analysis revealed that tele-nursing education was independently associated with ameliorated coronary plaque progression in T2DM patients, while smoking, high blood pressure and glucose level were risk factor for the progression of coronary plaque. Conclusions Tele-nursing education and guidance exert positive effect on coronary plaque progression in T2DM patients. Figures and Tables | References | Related Articles | Metrics