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    30 May 2022, Volume 17 Issue 03 Previous Issue    Next Issue
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    Original article
    Clinical study of leukocyte-to-platelet ratio in early evaluating prognosis of sepsis
    CHEN Min, CHE Zaiqian, CHEN Ying, MA Li, ZHAO Bing, ZHOU Weijun, MAO Enqiang, CHEN Erzhen
    2022, 17 (03):  208-213.  DOI: 10.16138/j.1673-6087.2022.03.007
    Abstract ( 233 )   HTML ( 3 )   PDF (657KB) ( 75 )  

    Objective To investigate the clinical value of white blood cell-to-platelet (WBC/PLT) ratio and related factors in early prognosis evaluation of sepsis. Methods The clinical data of 150 patients diagnosed with sepsis admitted to the emergency intensive care unit (EICU) in Ruijin Hospital, Shanghai Jiao Tong University School of Medicine from June 2018 to June 2020 were prospectively analyzed. According to survival or death, the patients were divided into survival group(n=126) and death group(n=24). The difference of WBC/PLT and clinical and biochemical indexes between two groups in 24 h after onset of sepsis were compared, and the Pearson correlation was used to analyze the correlation between WBC/PLT ratio and risk factors in the patients with sepsis. The Cox regression model was used to evaluate the clinical predictive value of various factors on mortality, and the receiver operating characteristic(ROC) curve was applied to analyze the predictive effect of WBC/PLT ratio on prognosis in the patients with sepsis. Result There was no significant difference in age, gender, infection type and constituent ratio of underlying diseases between the survival or death groups (P>0.05). The proportion of septic shock patients, receiving vasoactive medicines, mechanical ventilation and blood purification in the death group were significantly higher than those in the survival group(P<0.05). The levels of procalcitonin (PCT), urea nitrogen, aspartate aminotransferase (AST), prothrombin time (PT), fibrinogen degradation product (FDP), D-dimer, pro-brain natriuretic peptide(pro-BNP)and sequential organ failure assessment(SOFA) scores in the death group were significantly higher than those in the survival group. The ratio of WBC/PLT in death group (0.56±1.27) was significantly higher than that in survival group(0.15±0.42)(P<0.05). The Pearson correlation analysis showed that the ratio of WBC/PLT was positively correlated with C-reaction protein(CRP), PCT, urea nitrogen, creatinine, pro-BNP, FDP, and D-dimer(P<0.05). The Cox regression model analysis presented that high WBC/PLT ratio, high urea nitrogen level and high SOFA score were independent risk factors for prognosis in the patients with sepsis (P<0.05). The area under ROC curve of WBC/PLT ratio was 0.643(95% CI: 0.516-0.770, P=0.026), and an optimal cut-off value was 0.186, with sensitivity of 37.5% and specificity of 91.3%. Conclusions The WBC/PLT ratio shows high specificity in the prognosis evaluation of sepsis, which can predict the prognosis of patients early, and is worth to be used in clinical practice.

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    Analysis of clinical and histological features of IgG4-related kidney disease
    ZHANG Chunli, XU Jing, PAN Xiaoxia, HU Xiaofan, LI Ya
    2022, 17 (03):  214-219.  DOI: 10.16138/j.1673-6087.2022.03.008
    Abstract ( 224 )   HTML ( 2 )   PDF (848KB) ( 57 )  

    Objective: To analyze the clinical and pathological features of IgG4 related kidney disease (IgG4-RKD), and to provide reference for clinicians to recognize the disease in early stage, diagnose and treat the disease rationally. Methods The general information, laboratory examination index, pathological examination result, treatment, and follow-up in the patients with IgG4-RKD who firstly visited our department from April 2017 to March 2020 were collected and retrospectively analyzed. Results The age of 9 patients with IgG4-RKD ranged from 50 to 71 years old, including 7 males and 2 females. The reasons of the first visit were elevated serum creatinine (6 cases) or pancreatic mass (2 cases) and lacrimal gland enlargement (1 case). One case only had kidney damage; 6, 2 and 2 cases were found 2, 3 or 4 organ damages, respectively (including kidney). The serological characteristics were as follows: the indexes including IgG4(8/8), IgG (8/9), serum creatinine (8/9), erythrocyte sedimentation rate (ESR) (7/8), and IgE (5/9) all increased, while complement C3 (8/9) and complement C4 (3/9) decreased. Abnormal urine tests showed low urinary calcium (5/9), and increased urinary protein (8/9) and α-microglobulin (8/8). Seven patients underwent renal puncture, the results showed all cases had IgG4 deposition, and 6 cases had fine pattern alterations. There were 2 cases treated with glucocorticoid alone, 3 cases with glucocorticoid plus cyclophosphamide, 3 cases with glucocorticoid plus rituximab; and 1 case received plasma exchange combined with glucocorticoid. Conclusions The clinical manifestations of IgG4-RKD are diverse, usually involving multiple systems and organs, and the rate of misdiagnosis is high. Clinicians need to recognize and diagnose the disease as early as possible and conduct effective treatment to delay progression of the disease.

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    Study on the efficacy and safety of different induction therapies in newly diagnosed elderly patients with acute myeloid leukemia and intolerance of intensive chemotherapy
    LUO Dongfeng, YOU Jianhua, LI Xiaoyang, LI Junmin, ZHANG Yunxiang
    2022, 17 (03):  220-226.  DOI: 10.16138/j.1673-6087.2022.03.009
    Abstract ( 234 )   HTML ( 6 )   PDF (769KB) ( 107 )  

    Objective To study and summarize the clinical characteristics of the patients with acute myeloid leukemia (AML) who were intolerant to intensive chemotherapy screened by comprehensive geriatric assessment, and evaluate the efficacy and safety of different chemotherapy regimens for these patients. Methods From June 2018 to May 2021, in a total of 120 patients with newly diagnosed AML in our center, 52 cases screened as intolerance of intensive chemotherapy were selected and their clinical characteristics, induction safety and remission rate were analyzed retrospectively. Results The median age of the selected patients was 67.5 years old, and 9 cases were ≥75 years old. Thirty-eight patients (73%) had previous medical history or at least one comorbidity. Forty-seven cases were de novo AML and 5 cases were secondary AML. 54% cases had bone marrow blasts at the time of diagnose. A total of 50 patients completed cytogenetic and molecular assessment, in which, 4 patients had low-risk karyotypes, 25 patients had intermediate-risk and 21 patients had high-risk karyotypes. Among the high-risk karyotypes, there were 12 cases with complex karyotypes and monosomal karyotypes. The most common gene mutations were nucleophosmin 1(NPM1) (19 cases), DNA methyltransferase 3A (DNMT3A) (14 cases), Fms-related tyrosine kinase 3-internal tandem duplication (FLT3-ITD) (11 cases), ten-eleven translocation 2(TET2) (10 cases) and Runt-related transcription factor 1 (RUNX1) (9 cases). The cytogenetic/molecular risk stratification showed that 43 cases had intermediate (14 cases) or high risk (29 cases), which accounted for 86%. Eleven patients received only supportive treatment. Of 41 patients got chemotherapy, 25 cases received a combination treatment of hypomethylation reagent and venetoclax (HMA+VEN). Other traditional induction included decitabine combined with priming chemotherapy (6 cases), demethylation drug (4 cases), and reduced-dose idarubicin combined with cytarabine, priming chemotherapy and low-dose cytarabine (2 cases). The complete remission rate of HMA+VEN regimen reached 64%, which was better than that (31%) in the patients receiving traditional induction chemotherapy (P=0.004). In addition, the long-term survival of the HMA+VEN treatment group was also significantly better than that of traditional chemotherapy and untreated groups(P=0.001). Conclusions The elderly AML patients with intolerance of intensive induction have the characteristics of advanced age, complicated comorbidities, and adverse prognostic factors in cytogenetics and molecular. The new induction treatment of demethylation drugs and venetoclax has a good effect and will become one of the important regimens for elderly AML patients.

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    Value of D-dimer combined with cystatin C in predicting the occurrence of major adverse cardiovascular events in patients with acute myocardial infarction undergoing percutaneous coronary intervention
    XI Rui, FAN Qin, WANG Fang, TAO Rong, GU Gang
    2022, 17 (03):  227-232.  DOI: 10.16138/j.1673-6087.2022.03.010
    Abstract ( 168 )   HTML ( 3 )   PDF (638KB) ( 87 )  

    Objective To investigate the predictive value of D-dimer combined with cystatin C level in the occurrence of major adverse cardiovascular event(MACE) in the patients with acute myocardial infarction. Methods From January 2014 to December 2017, 287 patients with acute myocardial infarction who received undergoing percutaneous coronary intervention (PCI) were selected. According to the median levels of serum D-dimer and cystatin C after admission, the patients were divided into four groups, group 1: D-dimer<0.33 mg/L, cystatin C<1.06 mg/L; group 2: D-dimer<0.33 mg/L, cystatin C≥1.06 mg/L; group 3: D-dimer≥0.33 mg/L, cystatin C<1.06 mg / L; group 4: D-dimer≥0.33 mg/L, cystatin C≥1.06 mg/L. The multivariate Cox regression analysis was used to analyze the value of D-dimer combined with cystatin C level in predicting the occurrence of MACE. Results The median time of follow up was 2.89 years. The multivariate Cox regression analysis showed that, the incidence of MACE was significantly increased in the group with high D-dimer and cystatin C levels [hazard ratio (HR)=2.71, 95% confidence interval (CI): 1.37-5.36, P<0.01] after adjustment of age, gender and traditional risk factors. Conclusions The D-dimer combined with cystatin C can effectively predict the occurrence of MACE in the patients with acute myocardial infarction undergoing PCI.

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    Correlation between asymptomatic erosive esophagitis and colorectal polyps
    SUN Chao, HUANG Jia, ZHU Ying, YAO Weiyan, TANG Yuming
    2022, 17 (03):  233-237.  DOI: 10.16138/j.1673-6087.2022.03.011
    Abstract ( 142 )   HTML ( 3 )   PDF (510KB) ( 107 )  

    Objective To explore the correlation between asymptomatic erosive esophagitis(AEE) and colorectal polyps. Methods In this case-control study, the individuals without gastroesophageal reflux symptoms who underwent esophagogastroduodenoscopy(EGD) and colonoscopy in our hospital for a routine health checkup were included in the study and divided into two groups. The AEE group consisted of the patients with erosive esophagitis and without gastroesophageal reflux symptoms. The control group consisted of age-and gender-matched(1∶3) individuals with neither gastroesophageal reflux symptoms nor endoscopic erosive esophagitis. The results of demographics, gastroscopy, colonoscopy, and histopathology were collected. Results A total of 1 176 patients were included in the study, including 294 cases in AEE group and 882 cases in control group. Compared with the control group, the AEE group was more likely to have colorectal polyps(P<0.001), which were mainly distributed in left colon(P<0.001); and the AEE group was more likely to develop high-risk adenomas(P=0.034). In addition, compared with mild AEE, moderate to severe AEE was more possibly to develop high-risk adenomas (P=0.003) and multiple polyps (P<0.001), and the polyps were mainly distributed in left colon(P=0.038). Conclusions The AEE patients are more likely to have polyps, which are mainly distributed in left colon. The moderate to severe AEE patients are more possibly to have high-risk adenomas.

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    Development of preliminary scales for elderly sarcopenia based on Delphi method
    LI Feika, YANG Wenli, JIANG Qianwen, FANG Fang, BAI Tingting, XU Gang, WU Fang, HE Qing
    2022, 17 (03):  238-242.  DOI: 10.16138/j.1673-6087.2022.03.012
    Abstract ( 396 )   HTML ( 10 )   PDF (521KB) ( 183 )  

    Objective To develop the preliminary scales suitable to the comprehensive assessment scale for elderly sarcopenia in China (including self-evaluation and evaluation from others). Methods Through searching and reviewing literatures, the scales related to sarcopenia were selected and a preliminary item pool was formed. The items were screened through two rounds of Delphi consultation questionnaires completed by 16 domestic experts in related fields. Through analyzing the expert positive coefficient, expert authority level, coordination coefficient of the importance of expert opinions, average value of each index score, coefficient of variation and the full score rate, the preliminary scales for evaluating sarcopenia in the elderly were developed. Results After literature collection and expert discussion, the initial item pools of self-assessment (3 first-level items, 5 second-level items, 21 third-level items) and assessment from others (2 first-level items, 4 second-level items and 17 third-level items) were developed. The expert positive coefficient in the first round of Delphi consultation was 100%, and the coefficient of expert authority was Cr=0.956. In the self-evaluation and evaluation from others, the Kendall coordination coefficients of the importance of experts to all items were 0.424 and 0.449, and χ2 were 133.534 (P<0.001) and 114.591 (P<0.001), respectively. The positive coefficient of expert in second round of Delphi consultation was 100%, and the authority coefficient of expert was Cr=0.968. In self-evaluation and evaluation from others, the Kendall coordination coefficients of the importance of experts to all items were 0.350 and 0.400, and χ2 are 84.119 (P<0.001) and 67.546 (P<0.001), respectively. According to two rounds scores of Delphi consultation and the expert opinions of modification, the item pools of self-assessment (3 first-level items, 5 second-level items and 10 third-level items) and assessment from others(2 first-level items, 4 second-level items and 13 three-level items) were finally formed. Conclusions The preliminary scales for comprehensive assessment of elderly sarcopenia developed through Delphi expert consultation method involved active participation of experts, and presented high level of expert authority, and well concentrated and coordinated opinions from experts.

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    Effect of extracorporeal diaphragmatic pacing combined with aerobic breathing exercise on pulmonary function in stroke patients with hemiplegia
    XU Yiming, SHEN Honghua, ZHANG Yin, REN Lei
    2022, 17 (03):  243-247.  DOI: 10.16138/j.1673-6087.2022.03.013
    Abstract ( 239 )   HTML ( 3 )   PDF (534KB) ( 93 )  

    Objective: To investigate the effect of extracorporeal diaphragmatic pacing combined with aerobic breathing exercise on diaphragmatic function and pulmonary rehabilitation in the stroke patients with hemiplegia. Methods The study was conducted in 65 patients [age (73.90±3.81) years] with hemiplegia after stroke in the Fourth Rehabilitation Hospital of Shanghai from May 2019 to April 2020. According to using diaphragmatic pacing or not, the patients were divided into aerobic breathing exercise group (control group, n=31) and aerobic breathing exercise + diaphragmatic pacing treatment group (intervention group, n=34). Before and after a 12-week-treatment, the pulmonary function and diaphragmatic ultrasound were used to evaluate all patients, and the difference of parameters before and after treatment in the group and between groups was compared. Results After treatment, the indexes including pulmonary function parameters, diaphragm thickness [(0.22±0.01) cm vs. (0.20±0.02) cm], diaphragmatic calm activity [(1.44±0.13) cm vs. (1.31±0.96) cm], maximum diaphragmatic activity [(3.98±0.49) cm vs. (3.23±0.35) cm] were all significantly improved in the aerobic breathing exercise + diaphragm pacing group (all P<0.001). The forced expiratory volume in one second (FEV1), FEV1/forced vital capacity (FVC) and diaphragmatic activity in the control group were significantly improved (all P<0.005), while the FVC and diaphragm thickness didn’t show statistical difference(P>0.05). The pulmonary function parameters and diaphragmatic function evaluation in the intervention group were significantly ameliorated than those in the control group (all P<0.05). Conclusions The external diaphragmatic pacing combined with aerobic breathing exercise can significantly improve the diaphragmatic activity and lung function in the stroke patients with hemiplegia.

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    A cross-sectional study of falls in peritoneal dialysis patients
    HUANG Xiaomin, ZHANG Qianying, YANG Li, CUI Yan, XU Tian, WANG Ziqiu, WANG Zhaohui, REN Hong, ZHANG Chunyan
    2022, 17 (03):  248-252.  DOI: 10.16138/j.1673-6087.2022.03.014
    Abstract ( 160 )   HTML ( 2 )   PDF (540KB) ( 71 )  

    Objective To explore the risk factors of falls in the patients receiving peritoneal dialysis and provide the basis for their safety managements. Methods A total of 147 patients receiving peritoneal dialysis who matched the requirements from January to December 2019 in the peritoneal dialysis clinic of our hospital were selected. In one year, the incidence of falls was retrospectively investigated through every three months’ evaluation. The Logistic multiple regression was used to analyze the independent risk factors of falls in these patients. Results A total of 51 falls occurred in 32 cases in one year, and the fall rate was 21.8%. The patients were divided into two groups, which were fall group and non-fall group. Comparing fall group with non-fall group, the risk factors for falls were as follows: diabetes (7.8% vs 21.9%, P=0.048), dialysis age [26.0 (11.0, 49.3) months vs 44.4(24.1, 76.8) months, P=0.002], endogenous creatinine clearance rate (CCR)[58.61(50.85,79.16) L/week vs 51.53 (45.39, 59.50) L/week, P=0.001], albumin [(36.6±4.1) g/L vs (34.9±4.3) g/L, P=0.047], phosphorus [1.6 (1.4, 1.9) mmol/L vs 1.7 (1.5, 2.2) mmol/L, P=0.05], 24-hour urine volume [700(60,1 100) mL/24h vs 75(0, 488) mL/24h, P=0.002], ultrafiltration volume of dialysate[600(300, 900) mL/24h vs 800(472,1 160) mL/24h, P=0.002], number of antihypertensive drugs (≤3: 80.9% vs 56.3%, ≥4: 19.1% vs 43.8%, P=0.004 2), amobility (no help 98.3% vs 87.5%, help or crutch 0 vs 12.5% and wheelchair 1.7% vs 0, P=0.021). The Logistic multiple regression analysis showed that diabetes [odds ratio(OR)=6.569, P=0.007], dialysis age(OR=1.022, P=0.011), blood phosphorus(OR=3.372, P=0.024), the use of antihypertensive drugs(OR=3.601, P=0.015), 24-hour urine volume(OR=1.001, P=0.039) were independent risk factors for falls. Conclusions The falls in the patient receiving peritoneal dialysis is the result of multiple factors, and it’s important to adopt necessary measures to prevent falls in these patients.

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