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    Flow cytometry in minimal residual disease detection of acute myeloid leukemia: current status and progress
    Wang Hui, Chen Man
    Clinical Focus    2021, 36 (10): 889-895.   DOI: 10.3969/j.issn.1004-583X.2021.10.005
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    Minimal residual disease(MRD) of acute myeloid leukemia (AML) detected by flow cytometry(FCM) has high sensitivity and coverage, which has been an important biomarker for efficacy evaluation, outcome prediction, and therapy selection. However, a number of questions remain uncertain. This paper introduced the status and problems of FCM detection in AML MRD, discussed the corresponding solutions and precautions with the new hope by the progress of FCM.

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    Clinical Focus    2022, 37 (1): 77-80.   DOI: 10.3969/j.issn.1004-583X.2022.01.015
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    Standardized detection of BCR-ABL mRNA and clinical application in patients with chronic myeloid leukemia
    Qin Yazhen
    Clinical Focus    2021, 36 (10): 884-888.   DOI: 10.3969/j.issn.1004-583X.2021.10.004
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    BCR-ABL mRNA is the molecular marker of chronic myeloid leukemia(CML), and tyrosine kinase inhibitors(TKIs) targeting BCR-ABL mRNA has become the basic drug for CML. BCR-ABL mRNA level is the important indicator for evaluation of TKI efficacy. The mutation in ABL tyrosine kinase domain suggests mechanism of TKI resistance, which could guide the treatment strategy such as the selection of next TKIs. Standardized detection of BCR-ABLmRNA is essential for precisely guiding treatment and the guarantee for CML patients to achieve the best curative effects. Standardization is involved in sample type, testing content, laboratory protocol and report ways. This paper explored the standardized detection of quantification and mutation of BCR-ABL and clinical application in CML patients based on recent literature.

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    Effects of autologous hematopoietic stem cell transplantation in primary central nervous system lymphoma
    Cheng Li, Huang Wenrong
    Clinical Focus    2021, 36 (10): 901-904.   DOI: 10.3969/j.issn.1004-583X.2021.10.007
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    The effects of autologous hematopoietic stem cell transplantation(ASCT) in the whole treatment process remain to be unknown to abundant physicians due to low incidence of primary central nervous system lymphoma(PCNSL). Induction therapy based on high-dose methotrexate(HD-MTX) has significantly improved the early control rate of PCNSL, and many patients receive insufficiently thorough remission. Large-scale international clinical studies show that the rate of complete remission(CR) is less than 50% in most case; while the duration of remission remain short and recur within one year. ASCT, a consolidation therapeutic strategy, is applied to primary or relapsed and refractory PCNSL, significantly improved the rate of complete remission and long-term disease-free survival(PFS); the long-term PFS of newly treated PCNSL patients can hit 70%, and that of relapsed and refractory PCNSL patients can hit 50%. Current clinical practices confirmed that PCNSL is more common in older patients. Elderly PCNSL patients with great organ functions remained to tolerate ASCT, significant benefited from ASCT. High-dose thiotepa is preferred for ASCT conditioning regimen of PCNSL, and TBC regimen with stronger conditioning intensity is patients for young patients with better physical conditioning failing reciveing CR after early induction therapy; Older patients are supported to choose TT-BCNU or reduced TBC conditioning regimen.

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    Diagnosis and treatment of adult Langerhans cell histiocytosis
    Cao Xinxin
    Clinical Focus    2021, 36 (10): 905-909.   DOI: 10.3969/j.issn.1004-583X.2021.10.008
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    Langerhans cell histiocytosis(LCH) is an inflammatory myeloid malignancies with MAPK pathway activation mutations detectable in nearly all patients and a pronounced inflammatory state. The clinical manifestations of LCH are diversity, the most common involved organs included Bones, lungs, pituitary, ect. The primary diagnosis of LCH depends on histopathologic review of lesional tissue biopsy; the gold standard for diagnosis were expression of Cd207 (Langerlin) in immunohistochemistry and birbeck granules(BGs) by electron microscopy. LCH can be devided into localized single-system disease(SS-s), multiple sites within one single system (SS-m), and multisystem(MS) disease according to the scope of clinically involved organs. In terms of clinical classification, Local therapies may be sufficient for SS-s patients, systemic therapies might be better for SS-m or MS patients.

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    Clinical characteristic of Primary biliary cholangitis complicating Sjögren syndrome
    Wang Dandan, Zhang Xiaolan, Deng Zhihua
    Clinical Focus    2022, 37 (1): 30-34.   DOI: 10.3969/j.issn.1004-583X.2022.01.005
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    Objective To investigate the clinical characteristics of primary biliary cholangitis (PBC) complicating Sjögren syndrome (SS). Methods The medical records of patients diagnosed with PBC and primary Sjögren syndrome (pSS) from November 2010 to June 2016 at Second Hospital of Shanxi Medical University were collected to analyze the clinical characteristics of the patients. Results A higher proportion of females and a longer course of disease were found in PBC complicating SS group versus PBC-only group; liver injury-related symptoms and biochemical indicators in the baseline data were milder in PBC complicating SS group in comparison with PBC-only group during diagnosis confirmed; patients diagnosed with PBC at the initial diagnosis and combined with SS at a later stage had more dry mouth symptoms than those of PBC-only patients at the initial diagnosis; anti-SSB antibody positivity rate and fever symptoms were more common in patients with pSS than those with PBC combined. There was no difference in the progression of cirrhosis and hepatic decompensation between PBC complicating SS patients and PBC-only patients at year 1 and 5. Conclusion Although PBC complicating SS in patients have characteristics of both PBC and pSS, those are not identical, and the combination of the two diseases does not accelerate disease progression.

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    Clinical data and genotype of cblC type methylmalonic acidemia: 19 cases report analysis
    Wei Chenxi, Zhao Wanqing, Zhang Yanan
    Clinical Focus    2022, 37 (1): 46-51.   DOI: 10.3969/j.issn.1004-583X.2022.01.009
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    Objective To provide thinking and measures for early diagnosis by exploring the relations between clinical characteristics, laboratory examination and genotypes of cblC type methylmalonic acidemia.Methods The data of clinical manifestation, gene results, tandem mass spectrometry, imageological examination of 19 children with methylmalonic acidemia admitted to the Department of Pediatric Endocrinology and Growth Development, the Second Hospital of Hebei Medical University from 2016 to 2020 were retrospectively analyzed. Results There were 10 male and 9 female patients in out of 19 cases, of which 8 cases were confirmed by neonatal screening. A total of 13 mutations were found by genetic testing, the most common mutations satisfied c.609G>A, followed by the mutations satisfying c.80A>G and c.656_ c.658delAGA. Initial neurological symptoms of 11 cases who were not confirmed by neonatal screening were feeding difficulties, developmental delay, poor response, visual impairment, convulsions, etc. C3 /C0, C3 /C2, urinary methylmalonic acid and homocysteine were significantly elevated in tandem mass spectrometry. Laboratory testing data showed that multiple organs were damaged involving the blood system, nervous and digestive systems, etc. Conclusion The clinical manifestations and laboratory examination of children with cblC type methylmalonic acidemia demonstrate diversely with poor specificity. The genotypes showing the termination or frame-shift mutation normally develop early and have relatively severe symptoms may be show severe neurological complications including the hydrocephalus. The late-onset conditions are mild and have better prognosis by early treatment. late-onset disease of children is easily ignored normally, causing delayed diagnosis on pathogenetic condition. It is necessary to take early diagnosis on cblC type methylmalonic acidemia Attributing to great improvements of the condition and prognosis. Neonatal tandem mass spectrometry screening makes for the early diagnosis, and genotype detection contribute to specific disease classification and targeted treatment, thereby reducing the disability rate and mortality of the disease.

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    Coffin-siris syndrome: A case literature review
    Luo Shunchang, Li Sitao, Cai Yao, Shi Congcong, Xiao Xin, Hao Hu
    Clinical Focus    2022, 37 (1): 57-61.   DOI: 10.3969/j.issn.1004-583X.2022.01.011
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    Objective To investigate the clinical and genetic characteristics of child sufferer with Coffin-siris syndrome(CSS). Methods The clinical features, laboratory tests and genetic tests of a case of CSS diagnosed in the Department of Pediatrics, The Sixth Affiliated Hospital, Sun Yat-sen University from February 2018 to February 2019 were collected. The “CSS”, “ARID1B” and “CSS” were selected as key words, the papers collected by China National Knowledge Infrastructure, Knowledge Service Platform of Wanfang Data and PubMed from January 2010 to November 2019 were retrieved. Clinical features and genetic characteristics of children with CSS were summarized. Results The child sufferer with CSS demonstrated unique facial features, specific skeleton & limb deformities, developmental retardation and cognitive delay, mental retardation, hearing and speech disorder, etc. The mutations of ARID1B genes were almost new mutations, and pathogenic variants were almost cut off. The heterozygous mutation of ARID1B gene c.2248C>T (p.R750*) was detected in the child sufferer, and it was an nonsense mutation. The parents did not carry such mutation, indicating that the mutation was a new mutation. Conclusion CSS is mainly caused by the mutation of ARID1B gene, it is almost new mutation, and no significant genotype-phenotype correlation is found. The heterozygous mutation of ARID1B gene c.2248C>T (p.R750*) in this case is classified to be autologous new mutation, no related gene is reported in China, and the gene mutation spectrum of CSS in China is supported to be enriched.

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    Hereditary spherocytosis caused by SPTB gene hybrid mutation: a case report
    Wen Xue, Zhang Zhihua, Zhang Rongjuan, Hao Changlai
    Clinical Focus    2021, 36 (11): 1019-1023.   DOI: 10.3969/j.issn.1004-583X.2021.11.012
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    Retrospective analsis concerned with the clinical data of a patient with hereditary spherocytosis (HS), and SWISS-MODEL software used for protein structure prediction of SPTB gene mutation. The literatures were reviewed. Blood routine of the patient in clinic showed anemia, RBC, WBC and platelet decreased. Gene sequencing analysis proved that heterozygous mutation of SPTB gene c.5551C>T (exon26, NM_001355436) underwent spontaneous mutation. Protein structure prediction was c.5551C>T (p.Q1851X) mutation caused protein truncation mutation, and merged with heterozygous mutation of ANK1 gene c.1495G>T (p.A499S). The mutation site was agnate source, and non-pathogenic gene was confirmed.

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    Levels and clinical significance of RDW, NT-proBNP, BigET-1, HMGB1 in patients with idiopathic pulmonary arterial hypertension
    An Qinyan, Jiang Rong, Kang Bin, Du Ming, Zhou Renming, Zhao Hongjuan, Duan Yi, Lu Fei, Liu Jinming
    Clinical Focus    2021, 36 (11): 1001-1004.   DOI: 10.3969/j.issn.1004-583X.2021.11.008
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    Objective To explore the changes and clinical significance of red blood cell distribution width(RDW), N-terminal pro-brain natriuretic peptide(NT-proBNP), big endothelin-1(BigET-1), high mobility group protein-B1(HMGB1) in patients with idiopathic pulmonary arterial hypertension(IPAH).Methods Totally 80 IPAH patients admitted to our hospital from Nov 2019 to Oct 2020 were enrolled as the observation group,the control group comprised 80 healthy volunteers undergoing physical examination in our hospital during the same period; the aim was to compare RDW, NT-proBNP, BigET-1, HMGB1 as well as echocardiogram indexes between groups; and the correlation of the above indicators was analyzed. Results Compared with control group, RDW, NT-proBNP, BigET-1, HMGB1 in observation group were significantly higher (all P<0.01), left ventricular end diastolic dimension(LVEDD) was notably smaller (P<0.01), right ventricular end diastolic diameter(RVEDD) was significantly larger (P<0.01). Correlation analysis showed that RDW, NT-proBNP, BigET-1, HMGB1 were negatively correlated with LVEDD, left ventricle ejection fraction(LVEF), cardiac index(CI), while positively correlated with RVEDD. Positive correlation existed between NT-proBNP, HMGB1 and pulmonary artery mean pressure(PAMP), pulmonary vascular resistance(PVR)(P<0.05).Conclusion RDW, Nt-proBNP, BigET-1, HMGB1 in IPAH patients are increased, and the indexes are related to LVEDD, PAMP, PVR, and those can be used as references for diagnosis and evaluation of IPAH.

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    Study on standardized diagnosis and treatment of primary immune thrombocytopenia
    Fu Haixia
    Clinical Focus    2021, 36 (10): 896-900.   DOI: 10.3969/j.issn.1004-583X.2021.10.006
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    Primary immune thrombocytopenia(ITP) is an acquired immune-mediated thrombocytopenia disease, and its pathogenesis covers excessive destruction of platelets and insufficient production of platelets by megakaryocytes. Main clinical manifestations involve the bleeding related to thrombocytopenia and fatigue. No specific biomarker is found in the diagnosis of ITP, and other thrombocytopenic diseases should be excluded. The therapy is intended to maintain the safe level of platelets, prevent bleeding and improve the quality-of-life. The indication for therapy is platelet count ≤ 30×10 9/L and/or active bleeding. Patients with some factors may increase the risk of bleeding: increased age, heavy physical activities, blood coagulation factor disorder, uncontrolled hypertension, and taking anticoagulants. These patients need to maintain platelet at a higher level. The first-line therapies involve corticosteroids and intravenous human immunoglobulin. The second-line therapies involve thrombopoietin receptor agonists(TPO-RAs), recombinant TPO(rhTPO), rituximab and splenectomy. All-trans retinoic acid(ATRA) and other third-line treatment should be considered for refractory ITP.

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    Efficacy comparison between pull and surgical technique for removal of peritoneal dialysis catheter
    Cheng Huidong, Si Bolin, Hua Qin, He Jianqiang, Gui Lanlan
    Clinical Focus    2021, 36 (12): 1097-1101.   DOI: 10.3969/j.issn.1004-583X.2021.12.008
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    Objective To compare the effecacy of pull and surgical technique for removal of peritoneal dialysis (PD) catheter. Methods We retrospectively analyzed 88 patients undergone PD catheter removal admitted to Affiliated Hospital of Jiangsu University during the past decade (2011-2020). intra-operative and post-operative were performed on the two groups which comprised 39 (pull technique) and 49 (surgical technique) patients. The tension test of the catheter in pull technique group was conducted to explore resistance of PD catheter. Results In comparative trials, operating duration, pain score and proportion of patients with blood loss than 10 ml of pull technique patients were less than those of surgical technique patients (P<0.05); Similar infection rate was found between groups; decreased fracture (pull) in PD catheter was in opposite to its life extension. Conclusion Pull technique for PD catheter is convenient and safe then worthy of promotion.

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    Correlation of serum sST2 and liver function, platelet level and Ishak score in chronic hepatitis B patients
    Wang Yuanyuan, Cheng Ning, Lin Haiyan
    Clinical Focus    2021, 36 (11): 976-980.   DOI: 10.3969/j.issn.1004-583X.2021.11.003
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    Objective To observe the expression of serum soluble suppression of tumorigenicity-2 (sST2) in patients with chronic hepatitis B (CHB), and to analyze the correlation of sST2 and liver function, platelet(PLT) and Ishak score. Methods Totally 190 inpatients with CHB who met the inclusion criteria were prospectively enrolled from December 2018 to December 2020 in Dalian Sixth People's Hospital. The patients were divided into no fibrosis (29 cases), fibrosis (124 cases), and cirrhosis (37 cases) according to Ishak inflammation score. Thirty healthy controls in the physical examination center during the same period were recruited. Aspartate aminotransferase (AST), alanine aminotransferase (ALT), albumin (ALB), total bilirubin (TBIL), sST2 and PLT were detected, and APRI was counted. Results There were significant differences in serum sST2, AST, ALT, ALB, TBIL, APRI and PLT among four groups (P<0.05). Compared with controls, sST2, AST, ALT and TBIL in CHD patients were significantly higher (P<0.05), while serum ALB was significantly lower (P<0.05). Compared with patients with and without fibrosis, serum sST2, AST, ALT and TBIL of cirrhosis patients were significantly higher (P<0.05), while ALB and PLT were significantly lower (P<0.05). Compared with controls, PLT of cirrhosis patients was significantly lower (P<0.05). Pearson results showed that sST2 of CHB patients was closely related to AST, ALT, ALB, TBIL, PLT and APRI (r=0.939, 0.918, -0.816, 0.795, -0.469, 0.933, P<0.05). Spearman results showed that there was positive correlation between serum sST2 and Ishak score (r=0.885, P<0.05). Multivariate analysis showed that AST, ALT, ALB, TBIL, PLT, and Ishak score were influencing factors for sST2. The AUC values of the area under ROC curve of SST2, APRI and the combined diagnosis of cirrhosis were 0.715, 0.789 and 0.806. The sensitivity were 0.700, 0.780 and 0.810. The specificity 0.903, 0.847, 0.855, respectively. Conclusion For CHB patients, when serum sST2 abnormally elevates, liver fibrosis increases. At the same time, influencing factors for serum sST2 are liver function indexes. PLT and Ishak score, and serum sST2 combined with APRI can improve the predictive value of cirrhosis.

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    Correlation between 25-(OH)D 3 and degree of coronary artery stenosis in patients with coronary heart disease
    Zhao Weifeng, Ma Chunyu
    Clinical Focus    2021, 36 (11): 981-985.   DOI: 10.3969/j.issn.1004-583X.2021.11.004
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    Objective To study the correlation between 25-(OH)D3 and the degree of coronary artery stenosis in patients with coronary heart disease(CHD).Methods Totally 216 patients who underwent coronary angiography(CAG) were divided into control group (43 cases), mild stenosis group (73 cases), moderate stenosis group (53 cases), and severe stenosis group (47 cases) on the basis of the diagnostic criteria for CHD and the Gensini score. The key observations were 25-(OH)D3, total cholesterol(TC), high density lipoprotein-cholesterol (HDL-C), low-density lipoprotein cholesterol(LDL-C), triglyceride(TG), creatinine(Cr) and other indicators. Results Among the four groups, the differences were statistical significance in 25-(OH)D3, male, HDL-C, LDL-C, TC and TG (P<0.05). 25-(OH)D3 was negatively correlated with Gensini score (r=-0.355, P<0.001). Multiple logistic regression showed that high 25-(OH)D3 was protective against coronary stenosis (B=-0.084, P<0.001). Receiver operating characteristic(ROC) curve showed that 25-(OH)D3 had strong predictive value for the occurrence of CHD and severe coronary stenosis. Area under curve(AUC) of the former and the latter was respectively 0.74(95%CI: 0.663-0.817) and 0.72 (95%CI: 0.636-0.804),respectively; the optimal cut-off value was 17.57 ng/ml and 11.42 ng/ml, the sensitivity was 74.4% and 63.8%, and the specificity was 72.3% and 74.6%.Conclusion 25-(OH)D3 had negative correlation with the degree of coronary stenosis. Higher 25-(OH)D3 had a certain protective effect on coronary stenosis. The diagnosis for severe stenosis is significantly higher than for mild and moderate.

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    Searching for an optimal therapy for H.pylori eradication: High-dose proton-pump inhibitor dual therapy vs. bismuth-containing quadruple therapy
    Huang Yehong, Liu Gaifang, Xin Chenxi, Zhao Yunhong, Wu Jing
    Clinical Focus    2022, 37 (3): 230-233.   DOI: 10.3969/j.issn.1004-583X.2022.03.006
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    Objective To compare the eradication rate and adverse incidence of proton pump inhibitor high dose dual therapy with bismuth-containing quadruple therapy for Helicobacter pylori (H.pylori). Methods From January 2021 to August 2021, a total of 208 patients with positive H.pylori admitted to the Department of Gastroenterology, Hebei General Hospital were enrolled and randomly grouped into experimental group (n=105, proton pump inhibitor high dose dual therapy) and control group (n=103, bismuth-containing quadruple therapy). The patients in experimental group were given oral administration of esomeprazole 40 mg two times a day and amoxicillin 750 mg a day, and patients in control group were given esomeprazole 20 mg two times a day, colloidal bismuth subcitrate 220 mg two times a day, amoxicillin 1 000 mg two times a day, Furazolidone 100 mg two times a day. The treatment period for both groups was 14 days; after 4 week, 13C/14C urease breath test (13C/14C-UBT) for detecting H.pylori infection was performed and the eradication rate and adverse incidence were compared.Results The eradication rate of H.pylori for the experimental group and the control group were 77.1% and 82.5% (P=0.334) in intention-to-treat (ITT) analysis; the eradication rate of H.pylori for the experimental group and the control group were 82.7% and 87.6%(P=0.329) in per-protocol (PP) analysis. The incidence of adverse reactions in the experimental group was 9.0%, which was significantly lower than 19.0% in the control group (P=0.042). Adverse reactions in the experimental group were mainly bloating, diarrhea and rash; adverse reactions were mainly oral odor, constipation and abdominal pain in the control group. Conclusion The eradication rate was similar both proton pump inhibitor high dose dual therapy and bismuth-containing quadruple therapy; but proton pump inhibitor high dose dual therapy has significantly lower incidence for adverse reactions, expecting to be optimal eradication program.

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    Analysis of the incidence and risk factors for venous thromboembolism in 145 patients with diffuse large B-cell lymphoma
    Shen Rui, Lei Yanhua, Jia Haokun
    Clinical Focus    2022, 37 (1): 43-45.   DOI: 10.3969/j.issn.1004-583X.2022.01.008
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    Objective To explore the incidence and risk factors for venous thromboembolism (VTE) in 145 patients with diffuse large B-cell lymphoma (DLBCL). Methods Totally 145 DLBCL patients admitted to our hospital from May 2016 to August 2019 were selected and divided into a VTE group (n=22) and a non-VTE group (n=123) as the results in ultrasonography for VTE. Multivariate Logistic regression was used to analyze the risk factors for VTE in DLBCL patients, as well as the difference of recurrence rate, recurrence-free survival rate, and overall survival rate between groups. Results The independent risk factors for VTE were intravenous catheterization, non-complete remission (non-CR) after 3-4 courses of chemotherapy, D-dimer level ≥1.44 μg/ml(OR=5.143, 9.000, 16.514, P<0.05). But performance status (PS) score ≥2 was considered a protective factor (OR=0.170, P<0.05); there was no significant difference in recurrence rate, recurrence-free survival rate, and overall survival rate between groups (P>0.05). Conclusion Independent risk factors for VTE in DLBCL patients were Intravenous catheterization, non-CR after 3-4 courses of chemotherapy, D-dimer ≥1.44 μg/ml, and protective factor for VTE is PS score ≥2.

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    Methylmalonic acidemia: clinical phenotype and genetic characteristics
    Zhao Wanqing, Zhang Yanan, Wei Chenxi, Bai Xinli
    Clinical Focus    2022, 37 (2): 145-149.   DOI: 10.3969/j.issn.1004-583X.2022.02.010
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    Objective To explore the clinical characteristics, laboratory examination and genotype of mut-type methylmalonic acidemia (MMA) to provide basis for the diagnosis and treatment of mut-type MMA.Methods A retrospective analysis of clinical manifestation, general examination, serum and urine metabolism, gene detection results of 18 children with mut-type MMA admitted to the pediatric endocrinology, genetics and metabolism clinic of the Second Hospital of Hebei Medical University from December 2015 to June 2020 was performed.Results Mut-type MMA were common in less than 1 year infant, in those patients, main clinical manifestations presented vomiting, drowsiness, even convulsions, dyspnea and disturbance of consciousness in severe. Gene mutation of 18 children was caused by methylmalonyl-CoA mutase (MUT), detecting totally 20 mutations; the mutation sites were mainly c.729_730insTT, and with diversification of mutation types.Conclusion Mut-type MMA, a atypical clinical manifestations, should be reference urine metabolism, genetic testing is considered to be a reliable evidence for clinical classification with diversification of mutation types.

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    Evaluation of carotid Doppler ultrasonography in degree and hemodynamics of atherosclerosis of chronic kidney disease
    Wang Chao, Wan Duo, Li Sali, Wang Xi
    Clinical Focus    2021, 36 (11): 1009-1012.   DOI: 10.3969/j.issn.1004-583X.2021.11.010
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    Objective To analyze the evaluation of carotid doppler ultrasonography(CDU) in degree of atherosclerosis and hemodynamics of atherosclerosis in patients with chronic kidney disease(CKD).Methods Totally 80 CKD patients admitted to Department of Nephrology, the Second Affiliated Hospital of Shenyang Medical College from June 2020 to January 2021 were prospectively enrolled. The patients were classified into hemodialysis group (n=40), peritoneal dialysis group (n=40), 40 healthy subjects who underwent regular physical examinations during the same period randomly in control group. The key observation was carotid intima-media thickness(CIMT), left common carotid artery(LCCA), left internal carotid artery(LICA), right common carotid artery(RCCA), blood flow velocity(BFV) in right internal carotid artery(RICA), end diastolic velocity(EVD) between groups. Results CIMT in peritoneal dialysis group and hemodialysis group obviously increased in comparing with control group (P<0.05). LCCA, LICA, RCCA, BFV in RICA and EVD decreased notably in control group when compared with peritoneal dialysis group and hemodialysis group (P<0.05), which were significantly lower in hemodialysis group than in peritoneal dialysis group (P<0.05). Conclusion The dialysis type of CKD patients is closely related to atherosclerosis degree. CDU can quantitatively detect the hemodynamic indices, which has positive significance in preventing and treating atherosclerosis in CKD patients.

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    Correlation of current situation of mobile games and sleep quality and emotional state in students of Hebei Medical University
    Li Jianxin, Zhang Meiqi, Wang Ziyang, Sun Yaqi, Wang Yumei
    Clinical Focus    2021, 36 (10): 922-926.   DOI: 10.3969/j.issn.1004-583X.2021.10.011
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    Objective To explore the correlation of current situation of mobile games and sleep quality and emotional state in students of Hebei Medical University, in order to give targeted suggestions to make time length and period of mobile games reasonable.Methods Totally 423 students who came from Departments of Psychiatry, Anesthesiology, and Integrative Medicine of Hebei Medical University were enrolled as research objects.The sociology information of the students as age, gender, place of residence, health status, family income, parents' education level, etc were collected. The current situation of mobile games included two problems time spent on mobile games every day and the most intensive period of using mobile games every day. The former was divided into four groups: <2 hours, 2-4 hours, >4-6 hours and >6 hours, while the latter was divided into five groups: early morning, morning, noon, afternoon and evening. Pittsburgh Sleep Quality Index(PSQI), Epworth Sleepiness Scale(ESS), Self-rating Anxiety Scale(SAS) were used to evaluate sleep quality. Center for Epidemiologic Studies-Depression(CES-D) was used to evaluate emotional state. The influence of the first two problems on their sleep quality and emotional state were analyzed.Results Totally 376 investigators provided valid data, and the effective recovery rate was 88.88%. Time spent on mobile games every day and the most intensive period of using mobile games every day had no effect on sleep quality and emotional state (all P>0.05), while social factors gender, smoking or no-smoking, learning interest, and interpersonal relationship had effects on sleep quality and emotional state, and the difference was statistically significant (all P<0.05).Conclusion Time spent on mobile games every day and the most intensive period of using mobile games every day were not related to sleep quality or emotional state. Male, smoking, low interest in learning, poor interpersonal relationships students spent more time in playing mobile games.

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    Cardiovascular protective effects of sodium-glucose cotransporter 2 inhibitors in type 2 diabetes mellitus patients with severe renal insufficiency: A meta-analysis
    Xu Cangdan, Zhao Xin, Gu Wenyuan
    Clinical Focus    2022, 37 (1): 14-19.   DOI: 10.3969/j.issn.1004-583X.2022.01.002
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    Objective To evaluate the cardiovascular protective effects and adverse reaction of sodium-glucose cotransporter 2 (SGLT2) inhibitors in type 2 diabetes mellitus (T2DM) patients with severe renal insufficiency. Methods We searched three public databases, including Medline, Embase and Cochrane Library, to collect randomized controlled trials on SGLT2 inhibitors in patients with diabetic nephropathy from the inception to August 2021. Results A total of six RCTs were included, including 3679 diabetic patients with severe renal insufficiency. The meta-analysis showed that SGLT2 inhibitor had significantly reduced the risk of hospitalization (HR=0.74, 95% CI=0.55-0.99, P=0.04) and stroke (HR=0.75, 95% CI=0.60-0.93, P=0.008) due to heart failure in comparison with placebo group. The incidence of cardiovascular death (HR=0.89, 95% CI=0.60-1.30, P=0.54) and all-cause death (HR=0.84, 95% CI=0.56-1.28, P=0.43) in the SGLT2 inhibitor group was similar to that in placebo group. As for side effects, there was no significant difference in total adverse events (RR=1.00, 95% CI=0.94-1.07, P=0.96), fracture (RR=2.34, 95% CI=0.52-10.51, P=0.27), urinary tract infection (RR=1.22, 95% CI=0.64-2.35, P=0.54), hypotension (RR=1.32, 95% CI=0.59-2.95, P=0.49), reproductive tract infection (RR=0.67, 95% CI=0.15-2.93, P=0.6) and acute kidney injury (RR=0.96, 95% CI=0.41-2.26, P=0.93) between groups. Conclusion For T2DM patients with severe renal insufficiency, the administration of SGLT2 inhibitors is capable of reducing the risks of hospitalization and stroke due to heart failure, without increasing the risk of adverse events. SGLT2 inhibitors may have a protective and relatively safe effect on their cardiovascular outcomes. Future clinical trials are needed to support the impact of SGLT2 inhibitors on cardiovascular benefits in T2DM patients.

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    Clinical diagnosis and treatment in 1 case of exfoliative dermatitis caused by Pembrolizumab as well as cutaneous toxicity analysis of 44 cases treated with Pembrolizumab contemporaneously
    Huang Jiayuan, Pan Banzhou, Ji Hong, Mei Jingfeng, Fan Zhaohui, Zhou Yun
    Clinical Focus    2022, 37 (2): 150-154.   DOI: 10.3969/j.issn.1004-583X.2022.02.011
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    Objective Clinically, increasing immune-related adverse events cause concern with the promotion and application of immunotherapy. The tolerability profile could be effectively improved by controlling immune-related skin adverse reactions to enhance efficacy.Methods In this article regarding the diagnosis and treatment of severe immune-related adverse skin toxicity in a recent patient was reported. Meanwhile, a skin toxicity analysis were performed on 44 patients who received pembrolizumab in our hospital with a review of the related literature.Results Among 44 patients received pembrolizumab, only a few patients presented itchy skin and rash. The symptomatic treatment effect of hormone was good not affecting the continued use pembrolizumab. One case with severe exfoliative dermatitis withdrew immunotherapy although which resolved by active treatment.Conclusion Although the incidence of immune-related skin adverse reactions is low, it is essential to provide reasonable intervention theoretical basis and practical strategy regarding the diagnosis and treatment of immune-related adverse reactions.

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    Clinical analysis of serum homocysteine in patients with acute ischemic stroke
    Zhou Haitao, Huang Chao, Wang Hao, Liu Ruihua, Du Yanjiao, Ren Xiangyang
    Clinical Focus    2021, 36 (11): 991-995.   DOI: 10.3969/j.issn.1004-583X.2021.11.006
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    Objective To retrospectively analyze the clinical characteristics of serum homocysteine(HCY) in patients with acute ischemic stroke(AIS) for the risk factors associated with increased HCY in AIS secondary prevention. Methods A restrespective study was performed in 1 055 patients diagnozed AIS by diffusion weighted imaging(DWI) and apparent diffusion coefficient(ADC) sequence of cranial MRI in our hospital from January 2019 to December 2019. General informations and HCY levels were based on gender and age. The T test or one-way analysis of variance(ANOVA) method was used to compare the difference between groups and binary Logistic regression method was used to analyze the risk factors for HCY. Results The age range for 1 055 AIS patients was 28 to 98 years, (66.4±11.7) years, HCY 3.7-115.5 μmol/L, (20.1±13.0) μmol/L. The stratified analysis based on gender showed that the age of female was significantly increased when comparing with males, while HCY of female was significantly decreased (all P<0.05). The stratified analysis based on the combination of gender and age showed the difference was not statistically significant in HCY level in males in different age groups (P>0.05). HCY level in females were different and HCY of patients aged over 80 years was significantly increased than aged under 50 years and aged 71-80 years (all P<0.05). Binary logistic regression analysis showed that the independent risk factors for HCY were male, age, and type 2 diabetes mellitus. Conclusion Higher HCY are noted in male, elderly, T2DM of AIS patients, the reduction of HCY may allow the patients to obtain greater benefits in the secondary prevention.

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    Effect of extracorporeal hemopurification for clinical prognosis and cytokine levels of septic: A meta-analysis
    Xiao Liuniu, Zhong Yanxia, Li Shusheng
    Clinical Focus    2022, 37 (1): 5-13.   DOI: 10.3969/j.issn.1004-583X.2022.01.001
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    Objective The purpose of this study is to systematically analyze the effect of extracorporeal hemopurification (EH) for clinical prognosis, and the association between EH-related cytokines levels and clinical prognosis for septic patients. Methods Available studies accessing the effect of extracorporeal hemopurification for septic patients were collected from Pubmed, Web of Science, Cochrane Library and China National Knowledge Internet between January 2010 and January 2020. Relationships between EH and in-hospital mortality (IHM) and length of intensive care unit in sepsis patients were calculated and systematically analyzed by Forest Plot in Review Manager 5.3. We further analyzed the correlation between changing of cytokine levels and clinical prognosis. Results Twenty-eight researches which covered a total of 2587 patients were included in this meta-analysis. The results indicated that EH (hemoperfusion, hemofiltration, hemoadsorption, cytosorb, et. al) could significantly decrease IHM (OR=0.83, P=0.04) without affecting the length of intensive care unit (OR=-0.50, P=0.69). Subgroup analysis suggested that High-volume Hemofltration or Hemoperfusion with Polymyxin B-immobilized cartridge failed to improve IHM (P=0.22; P=0.87); meanwhile, EH showed little therapy efficiency in severe burn septic patients or septic patients with acute kidney injury (P=0.08; P=0.77). During the whole EH period, septic patients with lower cytokine levels at last presented no benefit for a lower risk of IHM (P=0.48), but the length of intensive care unit was significantly decreased (OR=-17.58, P=0.04). Conclusion Routine EH is recommended for septic patients with no contraindication. Controlling relative levels of cytokines during the whole treatment is a useful way to shorten the length of intensive care unit.

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    Relationship between tuberculin test with serum apolipoprotein A-1 and anti-tuberculosis drug-induced liver injury
    Qu Ying, Liu Zhongyang
    Clinical Focus    2022, 37 (1): 39-42.   DOI: 10.3969/j.issn.1004-583X.2022.01.007
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    Objective To explore the relationship between tuberculin test (PPD) with serum apolipoprotein A-1 (ApoA-1) and anti-tuberculosis drug-induced liver injury (ATB-DILI). Methods Totally 541 tuberculosis patients diagnosed at 967 Hospital of the Joint Logistics Support Force of PLA from January 2017 to June 2021 were divided into case group (56 cases) and control group (485 cases) as whether or not ATB-DILI, and the general clinical data of included subjects were recorded. Influencing factors of ATB-DILI were analyzed by binary Logistic regression, and receiver operating characteristic (ROC) curve was used to determine the predictive value of PPD test and serum ApoA-1 for ATB-DILI.Results The patients in case group were more positive PPD test, decreased ApoA-1 level as compared to the patients in control group, and with statistically significant difference between groups (all P<0.05). The ROC curve showed that strong positive PPD test and ApoA-1 level <1.175 g/L could play a part of independent factors for judging ATB-DILI. Conclusion Response intensity of PPD test and ApoA-1 level has certain predictive value for ATB-DILI, and the combination of the two displays a more higher predictive value for ATB-DILI.

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    Dosimetric Verification of SPECT/CT to 125I implantation for Pancreatic Cancer
    Wu Weixia, Xing Mingquan, Zhou Zhigang, Guo Yanyan, Qiu Xiaohui, Li Xiangzhou
    Clinical Focus    2021, 36 (12): 1118-1122.   DOI: 10.3969/j.issn.1004-583X.2021.12.013
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    Objective To explore the feasibility of SPECT/CT imaging applied for dose verification after 125I radioactive seed implantation in pancreatic cancer. Methods Eighteen patients with pancreatic cancer were implanted with 125I seeds, SPECT/CT imaging was implemented in 24 hours after operation, and the hybride image fusion was implemented. CT images of SPECT/CT imaging were imported into TPS to perform post-operative dose verification, and the isodose curve distribution map was acquired. The radioactive concentration degree surrounding the tumor and isodose distribution curve were observed, the coverage of tumor target region was assessed and recorded overall. The delineated target region on TPS was adjusted for dose calculation, and the mean dose of delineated target region was acquired from DVH chart, and repeated operation was implemented. Mean dose of appropriate regions was respectively calculated. Recalculation and obtainment of mean value were implemented. The correlation analysis between the radioactive count value within the unit of radioactive concentration zone and received mean dose was taken. Results Radioactive count per unit volume of radioactive concentration zone was positively correlated to mean dose received (r=0.422, P<0.01). SPECT/CT imaging could visualize surrounding dose of 125I radioactive seeds after implantation to a certain extent. Conclusion SPECT/CT fusion imaging is expected to become a new method of dose verification after implantation of 125I radioactive seeds.

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    Efficacy of magnesium isoglycyrrhizinate in anti-tuberculosis drug-induced liver injury
    Yang Zhibin, Shao Yanfang, Pan Li, Yang Yanxia, Yang Yuxi, Zhao Lihui, Zeng Rongkun, Li Yang, Wang Qiaofeng, Wang Cong, Ma Shiwu
    Clinical Focus    2021, 36 (11): 972-975.   DOI: 10.3969/j.issn.1004-583X.2021.11.002
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    Objective To explore the efficacy of magnesium isoglycyrrhizinate(MgIG) in the treatment of anti-tuberculosis drug-induced liver injury (AT-DILI) and influence on cytokines (IFN-γ, IL-10, TNF-α).Methods The study enrolled 50 patients with mild hepatocellular injury who admitted to Infection Department, the Sixth Affiliated Hospital of Kunming Medical University from February 2016 to December 2019, and the patients met the criteria of AT-DILI. Patients were randomly grouped, 25 patients in observation group treated with MgIG, 25 patients in control group with polyene phosphatidylcholine(PPC). The key observation was liver function (ALT, AST, TBIL) and cytokine levels (IFN-γ, IL-10, TNF-α).Results The total effective rates were significantly higher in observation group than in control group (100% vs 76.0%, P<0.01). Compared with before treatment, IFN-γ, IL-10, and TNF-α in both groups were lower after treatment (all P<0.05), and the indexes were significantly decreased in observation group (all P<0.05). Pearson correlation analysis showed the cytokine levels were positively correlated with ALT in both groups at different time points.Conclusion MgIG can quickly improve liver function in mild AT-DILI, which may relate to the reduction of inflammatory cytokines.

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    Clinical characteristics and drug resistance of community-acquired Acinetobacter baumannii pneumonia
    Zhu Ying, Shu Qianqian, Chen Fuhui
    Clinical Focus    2022, 37 (4): 315-319.   DOI: 10.3969/j.issn.1004-583X.2022.04.005
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    Objective To investigate the clinical features and drug resistance of pathogens in community-acquired pneumonia patients with Acinetobacter baumannii, and to strengthen clinicians' understanding for the pneumonia. Methods From January 2020 to June 2021, a total of 44 pneumonia patients with community-acquired Acinetobacter baumannii pneumonia from the Department of Respiratory Medicine, the Second Affiliated Hospital of Harbin Medical University were enrolled, bacterial identification and drug sensitive test were performed. The clinical data and outcomes were retrospectively analyzed. Results Community-acquired Acinetobacter baumannii pneumonia patients were often accompanied by cardio-cerebral disease and/or chronic lung disease, and their clinical manifestations mainly included cough, expectoration, dyspnea, and fever. In pulmonary CT, polymorphic changes, and bilateral lung involvement were more common. Acinetobacter baumannii exhibited varying degree of drug resistance, the resistance rate of beta-lactamases (carbapenems, piperacillin/tazobactam) and quinolones (ciprofloxacin) was higher, and the rate of carbapenems resistance was as high as 54.5%. Conclusion Patients with community-acquired pneumonia cased by Acinetobacter baumannii are mainly the aged who are usually suffering from cardio-cerebral disease and pulmonary disease in such situation. Furthermore, most of those patients are critically ill, but with a low mortality rate. Drug resistance of the pathogens discovered from those patients varies in different degree. All these characteristics needs to be concerned.

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    Efficacy and safety of half-dose versus standard-dose of tirofiban for percutaneous coronary intervention in elderly Chinese patients with acute coronary syndrome: a meta-analysis
    Liu Yuanliang, Li Biao, Jiang Zuofeng, Zhu Youfeng, Zhang Shaoheng, Wang Yarong, Li Rongseng, Li Li
    Clinical Focus    2021, 36 (11): 965-971.   DOI: 10.3969/j.issn.1004-583X.2021.11.001
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    Objective To systematically review the effectiveness and safety of half-dose versus standard-dose of tirofiban for percutaneous coronary intervention (PCI) in elderly Chinese patients with acute coronary syndrome (ACS).Methods Randomized controlled trials(RCTs), which were about standard or half dose of tirofiban for elderly Chinese patients with ACS undergoing PCI, and published by Cochrane, PubMed, Embase, Wanfang, and CNKI databases until January 2021 at home and abroad, were retrieved. Secondly, meta-analysis was performed based on the literature review results, and publication bias was evaluated. Results Five articles were included out of 768 retrieved literatures, a total of 596 patients were enrolled, including 300 cases in the half-dose group and 296 cases in the standard-dose group. Meta-analysis showed that, the first, in terms of curative outcomes, there was no statistically significant difference in the incidences of grade III forward-flow of postoperative thrombolysis myocardial infarction (TIMI) and major adverse cardiovascular events(MACE) in clinical between groups (P>0.05). The second, in terms of safety, the incidence of clinical bleeding downregulated notably in half-dose group when compared with standard-dose group, and with statistically significant difference [RR=3.70, 95%CI=(1.89, 5.00), P<0.01]. The difference was not statistically significant in the incidence of thrombocytopenia between groups (P=0.61).Conclusion For elderly Chinese patients with ACS undergoing PCI, on the basis of conventional double antibodies, the safety of half-dose of tirofiban might be better than that of standard-dose, and the efficacy of two doses was equivalent.

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    Safety of lumbar drainage on aneurysm subarachnoid hemorrhage in patients: a meta-analysis
    Ma Hongmei, Li Yuemei, Li Xiaofang, Pan Shiqin
    Clinical Focus    2021, 36 (12): 1067-1072.   DOI: 10.3969/j.issn.1004-583X.2021.12.002
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    Objective To evaluate the effect of lumbar drainage (LD) on cerebral aneurysms subarachnoid hemorrhage (aSAH). Methods A randomized controlled trials (RCTs) of LD on cerebral aSAH were searched from PubMed, Cochrane Library, Elsevier Science Direct, Springer, China academic Journal full-text Database (CNKI),Wanfang, China Biomedical Literature Database (CBM), and other databases. Methodological quality of the included literatures were evaluated by using Cochrane Handbook for Systematic Reviews of Interventions, and Meta-analysis was performed by using RevMan 5.2 software. Results Totally 11 literatures were inclused,including 1216 patients.Meta-analysis results showed that in terms of efficacy and safety of clinical treatment for aSAH was better in continuous LD group (experimental group) than control group, the incidence of neurological impairment was lower than in control group (MD =0.33, 95%CI [0.21-0.51], P<0.01), and the incidence of cerebral vasospasm was lower than in control group (MD =0.20, 95%CI [0.12-0.34], P<0.01), the incidence of hydrocephalus was lower than in control group (MD =0.25, 95% CI [0.14-0.43], P<0.01), the mortality was lower than in control group (MD=0.40, 95%CI [0.23-0.70], P<0.01), but other adverse events were higher than those in control group (SMD=3.24, 95%CI [1.63-6.47], P=0.008). Conclusion The safety of continuous LD for aSAH in patients is better than other treatment methods. We need to consider the unsafety factors will lead to adverse events, due to lower methodology quality is in this literature, the efficacy and safety still need to be further verified.

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    Effects of cerebroprotein hydrolysate on Nrf2 oxidative stress signaling pathway in acute stroke patients
    Liu Ting, Ji Weidong, Yang Qingsong
    Clinical Focus    2021, 36 (11): 996-1000.   DOI: 10.3969/j.issn.1004-583X.2021.11.007
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    Objective To explore the effect of cerebroprotein hydrolysate on nuclear factor-E2 correlation factor 2-cored Keap1-Nrf2/ARE (Nrf2) oxidative stress signaling pathway in patients with acute stroke (AS). Methods Totally 195 AS patients treated in the hospital from October 2017 to October 2020 were divided into study group (n=98) and control group (n=97) according to therapeutic methods. The patients in control group were administered with conventional therapies involving the enhancement of cerebral circulation, improvement of brain function and antiplatelet aggregation, and patients in study group additionally with cerebroprotein hydrolysate on the basis of control group. All patients were treated for 14 days, the efficacy was observed, The key observation was National Institutes of Health Stroke Scale (NIHSS) score, Activity Ability-daily Life (Barthel) Index, inflammatory factors including tumor necrosis factor-α (TNF-α), interleukin-8(IL-8) and interleukin-19(IL-19) oxidative stress indexes including serum superoxide dismutase (SOD), malondialdehyde (MDA), vascular endothelial function such as serum adiponectin (APN), and plasma von Willebrand factor (vWF), protein expressions of Nrf2 oxidative stress signaling pathways Keap1, NQO1, ARE and Nrf2.Results Total effective rate in study group (91.84%) and control group (60.82%) was statistically significant difference (P<0.01). After treatment, NIHSS score were significantly lower in study group than in control group. Barthel index was significantly higher in study group than in control group (P<0.01). TNF-α, IL-8, IL-19, MDA, vWF and Keap1 were significantly lower in study group than in control group. Serum SOD, APN, NQO1, ARE and Nrf2 were significantly higher in study group than in control group(P<0.01). Conclusion For AS patients, cerebroprotein hydrolysate can effectively regulate Nrf2 oxidative stress signaling pathway related proteins, and deliver significant effects in improving the vascular endothelial function, controlling inflammation and oxidative stress, and enhancing the neurological function and quality of life.

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    Correlation analysis between neutrophil percentage-to-albumin ratio and degree of coronary artery stenosis
    Chen Xi, Jiang Shan
    Clinical Focus    2022, 37 (1): 26-29.   DOI: 10.3969/j.issn.1004-583X.2022.01.004
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    Objective To explore the relationship between neutrophil percentage-to-albumin ratio (NPAR) and the degree of coronary artery stenosis. Methods A total of 406 patients who underwent coronary angiography (CAG) in Jinzhou Central Hospital from November 2020 to July 2021 were selected. They were divided into the non-CHD group (84 cases) and the CHD group (322 cases) as the CAG result. Gensini score was used to evaluate the degree of coronary artery stenosis. The independent risk factors for coronary heart disease and the correlation between Gensini score and NPAR were evaluate by Multivariate Logistic regression analysis and Spearman correlation analysis, respectively. Receiver operating characteristic (ROC) curve was drawed to assess the predictive value of NPAR for coronary heart disease. Results The independent risk factors for coronary heart disease are age, gender, high-sensitivity C-reactive protein, NPAR. Gensini score was positively correlated with NPAR (r=0.364, P<0.01); the areas under curve of the ROC curve was 0.687(95%CI 0.632-0.741, P<0.05), and the cutoff value, sensitivity, specificity of NPAR were 1.6128,50.3%, and 85.7%, respectively. Conclusion NPAR is positively correlated with the coronary artery stenosis degree, which has certain predictive value for coronary heart disease.

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    Epstein-Barr virus-driven hemophagocytic lymphohistiocytosis
    Cui Tingting, Zhang Jia, Wang Jingshi, Wang Zhao
    Clinical Focus    2021, 36 (10): 910-915.   DOI: 10.3969/j.issn.1004-583X.2021.10.009
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    Hemophagocytic lymphohistiocytosis (HLH) is the life-threatening result of inflammatory storm caused by immunological dysfunction. With the development of molecular genetics, current studies have an in-depth understanding of the HLH. For some genotype of HLH, epstein-barr virus (EBV) is an important inducement, known as the EBV-driven HLH. Currently, the Tyrosine-protein kinase ITK deficiency, magnesium transporter protein 1 (MAGT1) deficiency, CD27 deficiency, CD70 deficiency, CTP synthase 1 (CTPS1) deficiency and RAS guanyl-releasing protein 1 (RASGRP1) deficiency are found to be the genotype related to the HLH. In this review, we would summarize the epidemiology, pathophysiological characteristics, clinical manifestations and treatment of EBV-driven HLH.

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    Diagnosis value of serum lipoprotein α, cystatin-C and uric acid on early diabetic nephropathy
    Gao Shixin, Song Bing, Shi Kexin
    Clinical Focus    2022, 37 (3): 248-252.   DOI: 10.3969/j.issn.1004-583X.2022.03.009
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    Objective To analyze the diagnostic value of serum lipoprotein (α)[LP(α)], cystatin-C (Cys-C) and uric acid (UA) on early diabetic nephropathy (DN). Methods In this retrospective analysis, 150 diagnosed type 2 diabetes mellitus (T2DM) patients admitted to Huludao Central Hospital from January 2020 to August 2021 were enrolled, according to urinary albumin/creatinine ratio (UACR), those patients were assigned into normal albuminuria (NA) group (n=50, UACR: 0~3 mg/mmol), microalbuminuria (MA) group (n=51, UACR: 3~29 mg/mmol), clinical albuminuria (CA) group (n=49, UACR>30 mg/mmol). The general clinical data, correlated clinical indexes, Serum LP(α), Cys-C, UA level were detected and compared among three groups. Pearson's correlation and Logistic regression analysis were used to analyze the correlation between each index and DN; receiver operating characteristic (ROC) curve was used to evaluate the diagnostic value of each index for DN.Results Among three groups, difference was statistically significant in the systolic blood pressure (SBP) and diastolic blood pressure (DBP) (P<0.05); there were significant differences in the serum creatine (SCr), estimated glomerular filtration rate (eGFR), fasting plasma glucose (FPG), glycosylated hemoglobin A1c (HbA1c), Cys-C, UA, LP(α) (P<0.05). LP(α) in MA group significantly increased when compared with NA group, with statistically significant difference (P<0.05). Pearson's correlation showed that serum Cys-C, UA, LP(α) were positively correlated with UACR and SCr, while negatively correlated with eGFR. Logistic regression analysis showed that the independent risk factors for early DN included Cys-C and LP(α). The results of ROC curve analysis showed that serum Cys-C and LP(α) had high diagnostic value for early DN. Conclusion Different degrees of renal damage in T2DM patients were reflected by Serum LP(α), Cys-C and UA, of which LP(α) and Cys-C being independent risk factors for early DN. The highest accuracy emerges in the combined of the three, with high diagnostic efficacy of prediction for early DN.

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    Manifestation and correlation of deceleration capacity and heart rate deceleration runs and heart rate variability of myocardial ischemia in patient
    Yu Dan
    Clinical Focus    2021, 36 (12): 1083-1086.   DOI: 10.3969/j.issn.1004-583X.2021.12.005
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    Objective To investigate the manifestation and correlation of heart rate deceleration capacity(DC), heart rate deceleration runs(DRs) and heart rate variability(HRV) in patients with myocardial ischemia(MI), in order to provide reference for MI. Methods From october 2019 to August 2020, totally 86 patients with chronic MI were enrolled, of which 59 inpatients with asymptomatic myocardial ischemia(SMI) were regarded as treatment group A, 27 patients with angina pectoris(AP) as treatment group B, 60 healthy adults suspected MI admitted to our hospital were comprised control group, 24h dynamic electrocardiogram(DCG) were monitored, the correlation of DC, Drs and HRV were compared in groups. Results DC, DRs (DR4, DR8) were lower in two treatment groups than in control group (all P<0.05); standard deviation(SD) of all normal to normal(NN) intervals(SDNN), standard deviation of the 5-min average of N-N intervals(SDANN), square root of the mean squared difference of successive RR intervals(RMSSD), percetange of adjacent NN intervals differing by more than 50 milliseconds (pNN50) were lower in two treatment groups than in control group (all P<0.05) ; The above indexes were slightly lower in treatment group A than in treatment group B, but the differences were not statistically significant (all P>0.05). A significant positive correlation were found between DC, DR2, DR4, DR8 and SDNN, SDANN, RMSSD, pNN50 in MI patients (all P<0.05). Conclusion The levels of DC, DRs, HRV in MI patients are lower in comparison with healthy people; and DC, DRs are significantly positively correlated with HRV. DC, DRs, HRV can provide reference for clinical examination of MI.

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    Analysis on risk factors of postoperative hemorrhage of endoscopic submucosal dissection in early gastric cancer
    Lu Xunda, Feng Zhijie, Ji Chenguang, Yin Kaige, Liu Li
    Clinical Focus    2021, 36 (12): 1087-1091.   DOI: 10.3969/j.issn.1004-583X.2021.12.006
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    Objective To systematically analyze the risk factors of postoperative hemorrhage of endoscopic submucosal dissection (ESD) in early gastric cancer (EGC). Methods A total of 281 EGC patients who underwent ESD treated in the second Hospital of Hebei Medical University from January 2017 to February 2021 were analyzed retrospectively. These patients were divided into control group and postoperative bleeding group on the basis of occurrence of postoperative hemorrhage. The previous history, inpatient medical records, pathologic diagnosis, report on endoscopy were collected, and the key observation was sex, age, whether or no preoperative antiplatelet therapy, whether with hypertension, diabetes, ischemic angiopathy; tumor location, endoscopic classification, histological classification, tumor diameter, operation time; whether complicated by ulcer, vascular tumor thrombus; whether block resection or complete resection; whether or no postoperative bleeding, as well as the postoperative bleeding time, ect. The risk factors for postoperative hemorrhage of ESD in EGC patients were analyzed by univariate and multivariate Logstic regression. Results There were 16 cases with postoperative bleeding (5.69%, 16/281) in out of 281 EGC patients, with bleeding time was from day 1 to day 9 postoperation; of which 8 cases (50.0%, 8/16) had postoperative bleeding within 24 hours, 10 cases (62.5%, 10/16) had postoperative bleeding within 48 hours, 1 patient had two consecutive bleeding within 48 hours, and 1 patient developed hemorrhagic shock, those patients successed in hemostasis under endoscope.The independent risk factor for postoperative hemorrhage of ESD in EGC patients was preoperative antiplatelet therapy (OR=0.051, 95% CI 0.011-0.230, P<0.01), operation time ≥2 hours (OR=0.048, 95% CI 0.009-0.263, P<0.01) and complication by ulcer (OR=0.038, 95% CI 0.007-0.193, P<0.01). Conclusion Independent risk factor for postoperative hemorrhage of ESD in EGC patients was operation time more than 2 hours, preoperative antiplatelet therapy, complication by ulcer.

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    The standard treatment of acute lymphoblastic leukemia
    Lu Wenyi, Zhao Mingfeng
    Clinical Focus    2021, 36 (10): 874-879.   DOI: 10.3969/j.issn.1004-583X.2021.10.002
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    Acute lymphoblastic leukemia(ALL) is a highly heterogeneous hematological malignancy resulting from clonal proliferation of lymphoid precursor cells. In recent years, with the optimization of risk stratification model and the emergence of new drugs, such as tyrosine kinase inhibitors, monoclonal antibodies, chimeric antigen receptor T cells and other targeted drugs, the outcomes of ALL patients have been greatly improved. This article briefly described the current standards for treatment of ALL. Also, the latest progress in the therapy of ALL were discussed.

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    Situation of ischemic stroke-related residual dysfunction in patients and its influencing factors in community
    Zhang Qin, Wang Shubin, Su Xuan, Yuan Rui, Gao Mengxi, Guo Liru
    Clinical Focus    2021, 36 (12): 1073-1078.   DOI: 10.3969/j.issn.1004-583X.2021.12.003
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    Objective To survey the situation of residual dysfunction of ischemic stroke (IS) in patients and its influencing factors in community. Methods This study included IS patients who admitted to the community health service centers in Shijiazhuang City ( Taoyuan Community, Yuqiang Community, Dongyuan Community) from May to September 2020. A questionnaire focusing on those target population were performed which supplied by the platform named “Wenjuanxing”. The general address data and stroke-related data was collected by general practitioners in the community, and to screen influencing factors for stroke-related residual dysfunction. Results There are 122 males (52.6%) and 110 females (47.4%) in out of involved 232 IS patients, of which 99 patients (42.7%) had sequelae. Multivariate logistic regression analysis suggested that the main influencing factors for stroke-related residual dysfunction were whether dyslipidemia, coronary heart disease, long-term mental stress, regular exercise, recurrence of stroke, and glucose stability (P<0.05). Conclusion For IS patients, the influencing factors for stroke-related residual dysfunction are dyslipidemia, coronary heart disease, long-term mental stress, recurrence of stroke; Protective factors for those was regular exercise and glucose stability. Proper diet, aerobic exercise and drug intervention is capable controlling patient's glycemia, blood lipids and weight in the normal range, which has positive significance in preventing and reducing stroke-related residual dysfunction.

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    Impact of body mass index in the clinicopathology and prognosis of patients with IgA nephropathy
    Gao Pengli, Chen Lili, Tian Fen, Zhang Jiaqian, Chen Yipeng, Qi Xiaojing, Xing Guangqun
    Clinical Focus    2022, 37 (3): 234-242.   DOI: 10.3969/j.issn.1004-583X.2022.03.007
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    Objective To investigate the impact of body mass index (BMI) on the clinicopathology and prognosis of patients with IgA nephropathy (IgAN). Methods The clinicopathological data and prognosis of 533 primary IgAN patients who were diagnosed by renal biopsy in the Affiliated Hospital of Qingdao University from February 2013 to May 2021 were retrospectively analyzed.Serum creatinine levels doubling and/or entered end-stage renail disease(ERSD) and/or renal replacement therapy and/or death were endpoints.According to the BMI and World Health Organization (WHO) obesity classification, the patients were grouped as follows: low body weight group (BMI<18.5 kg/m2), normal weight group (18.5≤BMI<25.0 kg/m2) and overweight obese group (BMI≥25.0 kg/m2). The differences in clinicopathological and prognosis of of patients in each group were compared.The Kaplan-Meier survival curve was used to assess the cumulative renal survival rate of patients, and the multifactorial Cox regression analysis was used to analyze the risk factors affecting the renal prognosis of IgAN patients with overweight and obesity. Results In 533 IgAN patients, 19 patients (3.6%) were underweight, 267 patients (50.1%) were normal weight, and 247 patients (46.3%) were obese weight. Compared with low body weight group and normal weight group, the overweight obese group showed increased age, systolic blood pressure (SBP), diastolic blood pressure (DBP), angiotensin-converting-enzyme inhibitors(ACEI)/angiotensin II receptor type 1(ARB)use ratio, hemoglobin, 24-hour urinary protein excretion, triglycerides, fasting plasma glucose, blood complement C3 and C4 levels, and uric acid, and decreased HDL-C and eGFR levels (all P<0.05). In comparison of normal group and low group, normal group displayed increased age, SBP, DBP, ACEI/ARB use ratio, uric acid, and decreased eGFR (all P<0.05). LDL-C levels were higher in both the overweight obese group and the normal group than in the low group (all P<0.05). IgM levels were lower and male prevalence and CRP levels were higher in the overweight obese group compared with the normal group (all P<0.05). Neutrophil counts were higher in the low group than in the normal group (P<0.05). In light microscopic examination, low group showed decreased the degree of vascular damage and inflammatory cell infiltration among three groups (all P<0.05). Mesangial deposition of C3 was weakened in the overweight obese group compared with the normal group (P<0.05). Kaplan-Meier survival curve analysis showed that the cumulative renal survival rate was higher in the normal group than in the overweight obese group (Log-rank test, χ 2=8.702, P=0.003), whereas, which was higher in the overweight obese group than in the low group (Log-rank test, χ 2=4.624, P=0.032). 5-year renal survival rates were 69.8%, 75.6%, and 85.9%, for low group, overweight obese group and normal group respectively, with higher 5-year renal survival rates in the normal group than in the overweight obese group (Log-rank test, χ 2=4.996, P=0.025), and higher 5-year survival rates in the overweight obese group than in the low group (Log-rank test, χ 2=5.764, P=0.016). The multifactorial Cox regression analysis showed that 24-hour urinary protein excretion, triglycerides, and hemoglobin were risk factors for endpoint events in IgAN patients with overweight obese.Conclusion Among the IgAN patients, the clinical manifestations of overweight and obesity patients are worst characterized by severer vascular damage and inflammatory cell infiltration, poorer renal prognosis. Thus the therapeutic effect of those patients and follow-up lifestyle and weight management should be emphasized.

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    Risk factors of lung cancer with pulmonary embolism:a meta-analysis
    Huang Ping, Liu Hanyun, Li Yuhong
    Clinical Focus    2021, 36 (12): 1061-1066.   DOI: 10.3969/j.issn.1004-583X.2021.12.001
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    Objective To evaluate the risk factors of lung cancer with pulmonary embolism systematically. Methods By January 2021, pertinent literature on risk factors of lung cancer with pulmonary embolism were included form PubMed, Embase, CNKI, Wanfang database and others. Two researchers independently completed the literature screening, data extraction and quality evaluation of the included literature. RevMan5.4 software and Stata16.0 software were used to conduct meta-analysis. Results A total of 25 studies involving 3480 patients were included. Meta-analysis results show that the risk factors of pulmonary embolism in patients with lung cancer include adenocarcinoma (OR =2.06, 95% CI [1.75, 2.44], P <0.01), tumor stage (stage Ⅲ-Ⅳ)( OR =2.67, 95% CI [2.19, 3.26], P <0.01), chemotherapy (OR =2.69, 95% CI [2.08, 3.47], P <0.01), deep vein catheterization (OR =2.66, 95% CI [1.68, 4.19], P<0.01), albumin<30 g/L(OR=6.65, 95% CI [2.91, 15.18], P<0.01), D dimer>500 g/L (OR =5.87, 95% CI [2.12, 16.27], P <0.01), white blood cells >11×109/L(OR =8.26, 95% CI [4.50, 15.13], P <0.01) and chronic obstructive pulmonary disease(OR =1.51, 95% CI [1.16, 1.95], P <0.01). Conclusion The risk factors for pulmonary embolism with lung cancer are adenocarcinoma, tumor staging (stage Ⅲ-Ⅳ), chemotherapy, deep venous catheterization, albumin <30 g/L, D-dimer >500 ng/mL, white blood cell >11×109/L and chronic obstructive pulmonary disease(COPD). Due to limited quality and quantity of the included studies, more high-quality articles are needed to verify the conclusions.

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    Risk factors of intraoperative acquired pressure injury: A systematic review and meta-analysis
    Song Siping, Jiang Qixia, Liu Xiaoqing
    Clinical Focus    2022, 37 (3): 211-219.   DOI: 10.3969/j.issn.1004-583X.2022.03.003
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    Objective To systematically identify the risk factors of intraoperative acquired pressure injury(IAPI) to provide a basis for the prevention IAPI. Methods A systematic search regarding to IAPI risk factors in PubMed, Web of Science, Cochrane library, OVID, EMBASE, Chinese Biomedical Database(CBM), China National Knowledge Infrastructure(CNKI), Wanfang Data from January 2000 to July 2019 was performed to collect from January 2000 to July 2019. According to the criterias for inclusion and exclusion, screening eligible literature and data, evaluating the quality of included studies were all conducted by independent two reviewers, and using RevMan5.3 and Stata15 for a Meta-analysis. Results Totally 22 studies were recruited, including 267, 152 cases. In the Mate-analysis, 13 risk factors were involved, among which age, gender, body mass index(BMI)<23 kg/m2, operation duration, low preoperative Braden score, lateral position, supine position were the main risk factors for IAPI. Conclusion The older age, BMI <23 kg/m2, lower preoperative Braden score, longer operative duration are related to higher risk for IAPI female patients. Presently, because of insufficient evidence on risk factors of IAPI among patients and sample size of each study varied greatly, the effects of gender, comorbidities, operation position, intraoperative special medication, cardiopulmonary bypass, intraoperative hypotensive episodes are still inconclusive, and more high-quality studies are needed to supplement and improve for future research.

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