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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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    Correlation between cardiac troponin and D-dimer levels and mortality in COVID-19 critical illness patients: A meta analysis
    Guo Ru, Liu Ruihong, Lin Xuefeng, Han Xuanmao, Zhang Zhu, Chen Ruiying
    Clinical Focus    2022, 37 (4): 293-298.   DOI: 10.3969/j.issn.1004-583X.2022.04.001
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    Objective To evaluate the correlation between cardiac troponin (cTn) and D-dimer (D-D) levels and mortality in coronavirus disease 2019 (COVID-19) critical illness patients. Methods We searched related researches using COVID-19 and cTn as keyword in PubMed, Wanfang Journal Database, CNKI, VIP Chinese Scientific and Technological Periodical Database (VIP), etc., the period is from January 1, 2020 to December 31, 2021. Two reviewers independently conducted this work. We performed Meta-analysis using RevMan5.3 software, and the results were expressed as relative risk (RR) and its 95% confidence interval (CI). Results There were eligible15 literatures in the analysis, the Newcastle-Ottawa Quality Assessment Scale(NOS) scores were ≥6, and involving 7290 inpatients with COVID-19 critical illness, of which 1820 as the death group and 5470 as the survival group. Meta-analysis results showed that both elevated cTn level (RR=3.13, 95%CI=2.13-4.62, Z=5.76, P<0.01) and up-regulated D-D level (RR=1.69, 95%CI=1.27-2.26, Z=3.60, P=0.0003) of COVID-19 patients had obviously higher mortality. The results of gender subgroup analysis indicated that the mortality of COVID-19 male patients was more prevalent (P<0.01). Conclusion For COVID-19 critical illness patients, both elevated cTn level and up-regulation D-D level are more likely to rise mortality.

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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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    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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    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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    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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    Monitoring significance of CD4 + T lymphocyte count on evaluating frailty status of chronic renal failure in patients
    Li Yingying, Li Ting, Zhang Ming, Fan Minghua, Xing Guangqun
    Clinical Focus    2022, 37 (3): 243-247.   DOI: 10.3969/j.issn.1004-583X.2022.03.008
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    Objective To evaluate the significance of CD4+ T lymphocyte count in the evaluation of nutrition and prognosis of chronic renal failure in patients. Methods Totally 381 chronic renal failure patients were selected from YIDUCLOUD database of the Affiliated Hospital of Qingdao University during 2013 to 2020 for systematic analysis. CD4+ T lymphocyte counts and indicators related to immunity and nutrition of those patients were detected on admission, and acute physiology and chronic health evaluation-Ⅱ (APACHE Ⅱ), sequential organ failure assessment (SOFA) score, and frailty score combined with Edmonton Frailty Scale were performed. As CD4+ T lymphocytes count of admission, patients were divided into three groups: A group of 67 cases (CD4+ T lymphocyte count< 200 cells/μl), B group of 175 cases (200 cells/μl≤CD4+ T lymphocyte count <544 cells/μl), and C group of 139 cases (CD4 + T lymphocyte count≥544 cells/μl). The correlation between CD4+ T lymphocyte counts, immune, nutrition-related indicators, SOFA score, APACHE Ⅱ score, and frailty score were analyzed. Kaplan-Meier survival curve was drawn. Results In this study, the overall proportion of frail patients was 36.5%(139/381), the proportion of frail patients was as high as 53.7%(130/242) at the count of CD4 + T lymphocytes <544 cells/μl, and the frail patients accounted for only 6.5% (9/139) at the count in the normal range. There was no significant difference in general data of admission among groups (all P>0.05), but the differences in serum total protein, prealbumin, albumin, APACHE Ⅱ score, SOFA score, and frailty score were statistically significant (all P<0.01). The difference in survival rate among the three groups was statistically significant (P<0.01). Conclusion Due to interactions of nutritional and immune status in chronic renal failure patients, the frail status cannot be ignored. The immune status of the patient can be improved by monitoring CD4 + T lymphocyte count and timely improving nutritional status, thereby improving the prognosis.

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    The efficacy and safety of different blood pressure target on secondary stroke prevention: A systematic review and meta-analysis
    Wang Xiaoqing, Guo Yijia, Tang Yifang, Tang Qin, Yang Jie
    Clinical Focus    2022, 37 (3): 197-203.   DOI: 10.3969/j.issn.1004-583X.2022.03.001
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    Objective To assess the efficacy and safety of different blood pressure target on secondary stroke prevention. Methods We searched English and Chinese databases, including PubMed, Embase, Cochrane, Wanfang database, China National Knowledge Internet (CNKI), Chongqing VIP, and China Biology Medicine disc (CBM). The search time of database was up to June 1, 2020. Inclusion criteria: in randomized controlled trials (RCT) of stroke recurrence prevention, we included trials comparing BPLDs group (blood pressure-lowering drugs) versus control group (placebo or no treatment); we also included trials comparing intensive blood pressure lowering group with standard blood pressure lowering group (intensive blood pressure lowering defined as blood pressure <130/85 mmHg, standard blood pressure lowering defined as blood pressure <140/90 mmHg). Outcomes index: major vascular event, stroke, and myocardial infarction were used as efficacy outcomes. Vascular death and all-cause death were used as safety outcomes. Results Ten trials were included, with 39, 931 patients were included; of which, six studies were included in BPLDs group and the control group (35, 040 participants), and four studies were included intensive blood pressure lowering group and standard blood pressure lowering group (4, 891 participants). Compared with the control group, the pooled risk ratio (Risk Ratios, RR) of BPLDs was 0.80(95% confidence interval [CI] 0.69 to 0.93; P=0.003) for recurrent stroke, 0.85(95%CI 0.77 to 0.94; P=0.002) for vascular death in BPLDs group; there was no significant difference in the incidence of major vascular event, myocardial infarction and all-cause death between the two groups. Compared with standard blood pressure lowering group, the pooled RRs were 0.78 (95%CI 0.64 to 0.95; P=0.01) for recurrent stroke and 0.82 (95%CI 0.69 to 0.97; P=0.02) for major vascular event in intensive blood pressure lowering group. There was no significant difference in the incidence of myocardial infarction, vascular death and all-cause death between the two groups. Conclusion BPLDs reduce the risk of stroke recurrence and vascular death for stroke patients compared with no antihypertensive treatment. Intensive antihypertensive therapy for stroke patients can further reduce stroke recurrence and major vascular event compared with standard antihypertensive therapy.

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    Vascular endothelial function of juvenile idiopathic arthritis in pediatric patients: A systematic review and meta-analysis
    Hu Fangfang, Zhong Shiling, Di Yazhen, Wu Ling
    Clinical Focus    2022, 37 (3): 204-210.   DOI: 10.3969/j.issn.1004-583X.2022.03.002
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    Objective To assess the correlation between brachial artery flow mediated dilatation (FMD) and juvenile idiopathic arthritis (JIA) by systematic review, and to explore vascular endothelial function in JIA children fatherly. Methods A case-control and cross-sectional studies regarding FMD and JIA children were conducted to collect via Computer retrieval of PubMed, Embase, Web of Science, The Cochrane Library, CNKI, WangFang Date, VIP databases and CBM, the retrieval time is from the establishment of database to August 2020. The literature screening, data extraction and bias risk assessment were independently conducted by two participants, meta-analysis was performed using Reviewer Manager 5.3 and Stata 16 software. Results There were 10 literature, 6 case-control studies, and 4 cross-sectional studies including 439 JIA children and 382 healthy controls (control group). The results of meta analysis verified that FMD value of JIA children was significantly lower than that of healthy children in the control group (weight mean difference [WMD]=-3.51, 95%CI=-4.16, -2.85, P<0.01, respectively); the subgroup analysis showed that FMD values of JIA children with polyarticular, oligoarticular, and systemic were significantly lower than those in the control group (WMD polyarticular JIA=-3.30, 95%CI=-4.51, -2.09, P<0.01; WMD oligoarticular JIA=-2.39, 95%CI=-3.63, -1.15, P=0.0002; WMD systemic JIA=-2.02, 95%CI=-2.57, -1.48, P<0.01, respectively). Conclusion Children with JIA retain vascular endothelial dysfunction.

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    Predictive value of procalcitonin clearance and SOFA score on the prognosis of patients with severe sepsis
    Zhang Mengyuan, Zhu Yong
    Clinical Focus    2022, 37 (3): 225-229.   DOI: 10.3969/j.issn.1004-583X.2022.03.005
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    Objective To investigate the predictive value of procalcitonin (PCT), and procalcitonin clearance (PCTc) and the dynamic changes of sequential organ failure assessment (SOFA) score on the prognosis of patients with severe sepsis. Methods The clinical data of 60 patients with severe sepsis were analyzed using a retrospective study. The PCTc were calculated based on the PCT at 0 h, 24 h, 48 h, 72 h and 120 h of enrollment, and the SOFA scores at 0 h and 48 h of enrollment were recorded, and the △SOFA at 48 h was figured out. The patients were divided into survival (n=44) and death group (n=16) according to whether they died at 28 d, and the interclass differences of PCT and PCTc at different time points were analyzed. Multivariate Cox regression analysis was used to explore the influencing factors of the prognosis of these patients, and the receiver operating characteristic (ROC) curve was used to verify the assessment ability of different indicators for the prognosis. Results There were statistically significant differences in PCT between groups, and the interaction between time and treatment factors was statistically significant (all P<0.05), but there was no significant difference between different time points (P>0.05). Compared with the death group, the PCT at 120 h in the survival group was significantly lower (P<0.05). The differences in PCTc between groups were statistically significant, the differences between different time points were statistically significant, and the interaction between time and treatment factors was statistically significant (all P<0.05). PCTc at 24 h, 48 h, 72 h, 120 h in the survival group were significantly higher (all P<0.05). Compared with the death group, the SOFA score of the survival group at enrollment was lower, and the△SOFA score at 48 h was significantly higher (all P<0.05). Multivariate Cox regression analysis showed that age>65 years old, PCTc at 24 h, PCTc at 120 h, SOFA score at enrollment and △SOFA at 48 h was an independent factor for the 28-day death of sepsis patients. The ROC curve results showed that the area under the curve (AUC) of PCTc at 120 h was 0.958, which could be used as a prognostic indicator. Conclusion Compared with the absolute value of PCT, PCTc is an indicator for judging the prognosis of sepsis. PCTc at 24 h, PCTc at 120 h, SOFA score at enrollment and △SOFA at 48 h are the independent influencing factors for the 28 d-death of sepsis patients. PCTc at 120 h can be used as an assessment tool for the prognosis of sepsis patients.

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    Application of endobronchial ultrasound transbronchial lung biopsy with guide sheath and rapid on-site evaluation in the diagnosis of bacteriologically-negative pulmonary tuberculosis
    Xu Jingran, Li Feifei, Xie Chengxin, Gong Hui, Luan Qiyun, Li Li
    Clinical Focus    2022, 37 (3): 220-224.   DOI: 10.3969/j.issn.1004-583X.2022.03.004
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    Objective To evaluate the combination of endobronchial ultrasonography with guide sheath (EBUS-GS), transbronchial lung biopsy (TBLB), and rapid on-site evaluation (ROSE) for the diagnosis of bacteriologically-negative pulmonary tuberculosis (PTB).Methods A total of 70 patients with suspected PTB were enrolled from January 2020 to December 2020 based on clinical symptoms, abnormal radiographic findings, sputum bacteriological examination (smear and culture), and initial sputum molecular detection negative results. The patients randomly divided into two groups: group A underwent EBUS-GS-TBLB (n=34), and group B underwent EBUS-GS-TBLB+ROSE (n=36). The diagnostic rates and biopsy numbers were evaluated between the two groups.Results 16 patients with PTB were detected in group A, and 22 in group B. After the joint ROSE, The PTB diagnostic rate improved from 47.06% to 61.11%(P=0.238), and the mean numbers of biopsy decreased from 4.53±0.50 to 3.08±0.60(P<0.01). The accuracy, sensitivity, specificity, positive predictive value, and negative predictive value of ROSE for the diagnosis of PTB were 86.36%, 86.67%, 85.71%, 92.86%, and 75.00%, respectively, with no serious complications.Conclusion The combination of EBUS-GS-TBLB and ROSE can improve the diagnostic rate, and reduce the biopsy numbers, which is thought of an effective and safe novel diagnostic modality.

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    Expression and clinical significance of SLP-2 in gastric cancer: A meta-analysis
    Tao Jianan, Tian Wangzhao, An Qi, Wang Xuehong, Zhang Shengqi, Liu Ji
    Clinical Focus    2022, 37 (4): 299-304.   DOI: 10.3969/j.issn.1004-583X.2022.04.002
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    Objective To evaluate the correlation of the expression and pathology parameters of SLP-2 in gastric cancer.Methods Two researchers independently collected and screened case-control studies regarding SLP-2 expression in gastric cancer in domestic and foreign databases as PubMed, Cochrane Library, EMbase, CBM, CNKI, WanFang Date and VIP databases, the construction time was until November 2021; they assessed the risk of bias for these data and used Revman5.3 software for a meta-analysis.Results Eligible 8 case-control studies were included, with a total of 1079 patients. Meta-analysis showed that the expression level of SLP-2 in gastric cancer tissues was significantly higher than that in adjacent tissues [OR=6.20,95%CI(4.41,8.73),P<0.01]. In gastric cancer tissues, the expression level of SLP-2 in groups with different degrees of differentiation [OR=1.41,95%CI(1.04,1.93),P=0.03], groups with different depth of invasion [OR=3.84,95%CI(2.70,5.47),P<0.01] and groups with different lymph node Metastasis [OR=2.21,95%CI(1.37,3.56),P=0.001], groups with different blood Metastasis [OR=2.05,95%CI(1.25,3.35),P=0.004], groups with different clinical stage [OR=2.79,95%CI(2.08,3.74),P<0.01] was found had statistical significance. Conclusion There are significant difference in SlP-2 expression between gastric cancer tissues and adjacent tissues, which is correlated with clinicopathological parameters, suggesting that SLP-2 plays a role in gastric cancer incidence. Due to the limited quantity and quality of the above literatures, the conclusions should be verified by more high-quality studies.

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    Correlation of serum high-sensitivity C-reactive protein and urine microalbumin/creatinine and retinal lesions in diabetic
    Wang Desheng, Sun Zhigang, Ma Zhoupeng
    Clinical Focus    2022, 37 (3): 253-256.   DOI: 10.3969/j.issn.1004-583X.2022.03.010
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    Objective To explore the correlation of serum high-sensitivity C-reactive protein (hs-CRP), urine microalbumin (U-mAlb)/ creatinine (Cr) and diabetic retinopathy (DR), and the risk factors of proliferative diabetic retinopathy (PDR). Methods Totally 150 patients with type 2 diabetes mellitus (T2DM) were divided into three groups: non DR group (NDR group, n=67), non PDR group (NPDR group, n=55) and PDR group (n=28). The subjects were detected the level of fasting venous blood glucose (FPG), glycosylated hemoglobin (HbA1c), hs-CRP and U-mAlb/Cr; the variation of hs-CRP and U-mAlb/Cr in different stages of DR as well as the risk factors associated with PDR were analyzed. Results The levels of hs-CRP and U-mAlb/C rised gradually among the three groups, which in PDR group were most prevalent, following by NPDR group (P<0.05). Spearman correlation analysis showed that the levels of hs-CRP and U-mAlb/Cr were significantly positively correlated with the severity of DR (P<0.05). Logistic regression analysis indicated that the risk factors for PDR were hs-CRP, U-mAlb/Cr and DR disease duration (P<0.05). Conclusion The detection of hs-CRP and U-mAlb/Cr should be emphasize in the diagnosis and treatment of DR, because the high expression of which are significantly positively correlated with the severity of DR.

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    Predictive value of FIB-4 in patients with metabolic-associated fatty liver disease complicated with colorectal adenomatous polyps
    Zhang Limin, Sun Jun
    Clinical Focus    2022, 37 (4): 334-338.   DOI: 10.3969/j.issn.1004-583X.2022.04.009
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    Objective To study the predictive value of FIB-4 index in patients with metabolic-associated fatty liver disease(MAFLD) complicated with colorectal adenomatous polyps. Methods Eligible 183 patients from Department of Gastroenterology, Jinzhou Central Hospital during May 2020 to June 2021 were enrolled. In accordance with pathological type, those with of hyperplastic or inflammatory polyps were included in the control group (44 cases), and those with adenomatous polyps in the adenoma group (139 cases), aiming to compare the interclass differences involving baseline information, FIB-4 index, the risk factors of MAFLD complicated with colorectal adenomatous polyps was analyzed by Multivariate logistic regression, and the predictive value of FIB-4 index for that were assessed by drawing receiver operating characteristic (ROC) curve. Results The adenoma group had older age, longer smoking history and diabetes history, elevated body mass index (BMI), low density lipoprotein cholesterol (LDL-C), alanine aminotransferase (ALT), aspartate aminotransferase (AST), and FIB-4 (vs control group); while High-density lipoprotein cholesterol (HDL-C) and Platelet count (PLT) in adenoma group were lower than those in control group, with statistical significance differences (P<0.05). The difference in drinking history, hypertension history, Fasting blood glucose(FBG), total cholesterol (TC), triglyceride (TG), and uric acid (UA) between groups was no significant (P>0.05). Multivariate logistic regression analysis indicated that age, gender, BMI, AST and FIB-4 index were independent risk factors for MAFLD complicated with colorectal adenomatous polyps (P<0.05). The AUC of FIB-4 index risk assessment was 0.868, and the sensitivity and specificity were 67.6% and 90.9% respectively.Conclusion FIB-4 index should be attention due to its predictive value for MAFLD complicated with colorectal adenomatous polyps, which can help to identify the high-risk population of adenomatous polyps, early diagnosis and early treatment.

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    Analysis on impacts of diabetes on the severity and mortality of patients with COVID-19: A Meta-analysis
    Lin Xinxin, Zhang Chuhan, Kong Haolin, He Muchen, Xu Lin, Yang Zhonghan
    Clinical Focus    2022, 37 (5): 389-399.   DOI: 10.3969/j.issn.1004-583X.2022.05.001
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    Objective Diabetes mellitus (DM) is chronic conditions with devastating multi-systemic complications and may be associated with sensitivity and severe form of Coronavirus Disease 2019 (COVID-19). Abundant studies prove that patients with DM are more vulnerable to be infected with COVID-19 and develop severe cases during the prevalence and spread of novel coronavirus pneumonia. The present study intends to conduct meta-analysis to acertain the correlation between DM and severity as well as mortality in patients with COVID-19.Methods The key words(1)“COVID-19” OR “SARS-CoV-2” OR “Coronavirus” OR “novel coronavirus” AND “clinical characteristics” (2)“COVID-19” OR “SARS-CoV-2” AND “Diabetes” were used to search the data available on PubMed, Embase and CNKI, periodicals and articles in English and Chinese published before Feb, 2021 were screened. RevMan 5.4 software was applied after data extraction to perform Meta-analysis, and the Stata 12.0 software was used to assess the publication bias. Results A total of 82 studies which included 35 715 patients were included. Meta-analysis showed that DM was associated with composite poor outcome(OR 2.29 [2.14, 2.46], P< 0.01; I2: 52%, P<0.01). The risk of severity (OR 2.40 [2.20, 2.62], P< 0.01; I2: 49%, P<0.01) and mortality(OR 2.08[1.70, 2.56], P< 0.01; I2: 60%, P<0.01) of DM patients with COVID-19 were elevated than those of patients without DM. Conclusion DM serves as a critical factor to impact the rate of severe cases of COVID-19 and mortality in patients with COVID-19. The mechanism of how DM impacting the prognosis of COVID-19 is required to be further clarified.

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    Effect of high frequency and low frequency repetitive transcranial magnetic stimulation in the treatment of post-stroke spasticity: A comparative study
    Xia Jing, Chen Miaocun, Lin Min, Hao Youguo
    Clinical Focus    2022, 37 (5): 427-430.   DOI: 10.3969/j.issn.1004-583X.2022.05.007
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    Objective To compare the clinical effect between high frequency and low frequency repetitive transcranial magnetic stimulation (rTMS) in the treatment of post-stroke spasticity. Methods Totally 54 post-stroke spasticity patients were randomely divided into the high frequency group (n=18), the low frequency group (n=18) and the control group (n=18). In addition of 4-week routine treatment (secondary prevention medications+rehabilitation training), the high frequency group were additionally treated with high-frequency rTMS on the affected side, the low frequency group additionally with low-frequency rTMS on the healthy side. The control group did not receive rTMS. The effect assessment was conducted before and after treatment. The therapeutic effect was determined by comparing the motor evoked potentials (MEP) latency of wrist flexor muscles on the affected side, central motor conduction time (CMCT), Fugl-Meyer assessment (FMA) of upper extremity (FMA-UE), Modified Ashworth Scale (MAS), clinical spasticity index (CSI), Modified Barthel Index (MBI).Results The difference was not statistically significant in the related indicators among the three groups before treatment (P>0.05). After treatment, FMA-UE, MBI score in groups were significantly increased, while wrist flexor MAS, CSI, MEP latency, CMCT were apparently decreased (P<0.05). Among the three groups, FMA, MBI were remarkably increased in the frequency groups than in the cortrol group, and wrist flexor MAS, CSI, MEP latency, CMCT were obviously decreased when compared with the cortrol group (P<0.05), the high frequency group was more prevalent (P<0.05). Conclusion For post-stroke spasticity patients, both the high frequency rTMS on the affected side and the low-frequency rTMS on the healthy side can relieve post-stroke spasticity and elevate the FMA-UE score, which is safe and effective. And the high frequency rTMS on the affected side is better than low frequency rTMS on the healthy side.

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    Literature review on treatment of immune thrombocytopenia secondary to refractory systemic lupus erythematosus with belimumab combined with cyclosporine: A case report and literature review
    Qin Meijie, Tian Maolu, Yang Yuqi, Zha Yan, Yuan Jing
    Clinical Focus    2022, 37 (6): 544-547.   DOI: 10.3969/j.issn.1004-583X.2022.06.012
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    Objective To explore the effects of belimumab on systemic lupus erythematosus (SLE) complicated with refractory hematological damage. Methods A SLE patient mainly featured with refractory hematological damage admitted to Guizhou Provincial People's Hospital was retrospectively analyzed. Results The female patient with more than 1 year history of SLE was admitted to hospital for sub dermal ecchymosis complicated with abdominal pain lasting 10 days, was clearly diagnosed as SLE with refractory blood system damage after hospitalization. The patient's condition was significantly improved without adverse reactions after maintenance therapy with belimumab in addition to basic treatment including cyclosporine. The patient was followed up for more than 1 year, the glucocorticoid dosage was minimized, and no recurrence of disease was found. Conclusion Combination of belimumab with cyclosporine in the treatment of refractory SLE secondary immune thrombocytopenia provides a new treatment option, and more clinical efficacy remains to be observed and evaluated in the long term.

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    Efficacy and safety of Roxadustat on renal anemia in hemodialysis patients:A meta-analysis
    Zhou Ren, Chen Yating, Zhang Yong
    Clinical Focus    2022, 37 (4): 305-310.   DOI: 10.3969/j.issn.1004-583X.2022.04.003
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    Objective To compare the efficacy and safety of roxadustat and erythropoietin in the treatment of renal anemia in hemodialysis patients. Methods Randomized controlled studies of roxadustat and erythropoiet regarding renal anemia in hemodialysis patients from PubMed, Web of Science, Embase, Cochrane Library, CNKI, CBM, VIP and WanFang Data were collected by two researchers, the conduction of the database is by February 2021; the extracted literature were evaluated the quality, and Revman 5.4 software was used for meta analysis. Results A total of 540 patients were included in three articles. In the comparison with the control group, the hemoglobin rate could be improved in roxadustat group (OR=2.82, 95%CI 1.06~7.48, P=0.04), and there was no significant difference in the improvement of hemoglobin level between the two groups (MD=-0.13, 95%CI -0.46~0.20, P=0.43). Roxadustat could significantly improve iron-binding capacity, (MD=35.07, 95%CI 12.45-57.70, P=0.002), but the incidence of adverse events was higher in the roxadustat group than that in the control group(OR=1.98, 95%CI 1.30-3.04, P=0.002).Conclusion Roxadustat can effectively reduce renal anemia in hemodialysis patients, but its safety still should be attention widely.

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    Clinical Focus    2022, 37 (3): 279-284.   DOI: 10.3969/j.issn.1004-583X.2022.03.016
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    Clinical characteristics of Delta variant of SARS-CoV-2 of shipmate
    Huang Huayan, Lin Chunguang, Chen Yongdong, Zeng Qiyi, Wu Changru
    Clinical Focus    2022, 37 (4): 311-314.   DOI: 10.3969/j.issn.1004-583X.2022.04.004
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    Objective To explore the clinical characteristics of the B.1.617.2 (Delta) variant of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) of shipmates, and the protective effect of SARS-CoV-2 vaccines. Methods From August to November 2021, five imported cases of Delta variants of SARS-CoV-2 and 17 shipmates were enrolled, who all visited fixed point isolation endemic area of the First People's Hospital of Fangchenggang, and divided into the vaccinated group (n=10) and the unvaccinated group (n=12), the clinical data of the two groups were retrospectively analyzed. Results Among the 22 shipmates, there were 14 cases of SARS-CoV-2 infection, with the infection rate of 63.6%; the unvaccinated group was more common (P<0.05). Of 14 cases, 12 had clinical symptoms (fever, olfactory and taste loss, cough, chest tightness, expectoration, fatigue, and body aches) except for 2 asymptomatic SARS-CoV-2 infections. The difference was not statistically significant in fever duration between the vaccinated group and the unvaccinated group ([7.62±2.32] days vs [6.25±2.50] days, [P=0.368], respectively); the negative conversion time of SARS-CoV-2 nucleic acid in the unvaccinated group and the vaccinated group was (65.75±25.81) days and (44.00±28.32) days, respectively, and with no statistically significant difference (P=0.211). Conclusion The present data showed that domestic vaccine has a protective effect against the Delta variant of SARS-CoV-2. Both the prolonged time of negative conversion and whether or not vaccination have no correlation.

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    Relationship between serum irisin, manganese-containing superoxide dismutase and cognitive function of patients with chronic insomnia
    Zhai Xiayin, Lan Rui
    Clinical Focus    2022, 37 (4): 329-333.   DOI: 10.3969/j.issn.1004-583X.2022.04.008
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    Objective To detect the levels of serum irisin and manganese-containing superoxide dismutase (MnSOD) of patients with chronic insomnia, and exploring the relationship between the two and cognitive function. Methods Totally 179 patients with chronic insomnia treated in the Department of Neurology of Yellow River Central Hospital from September 2019 to December 2020 were selected, including 86 patients without cognitive impairment (group A) and 93 patients with cognitive impairment (group B). The clinical data of the two groups were retrospectively analyzed. Results Compared with group A, group B exhibited increased pittsburgh sleep quality index (PSQI) score, decreased serum irisin, MnSOD and Montreal cognitive assessment (MoCA) scores (all P<0.05). The positive correlations between serum irisin, MnSOD levels and MoCA scores in chronic insomnia patients with cognitive impairment were found (r=0.493, 0.604, all P<0.05). The decreased levels of serum iris and MnSOD were independent risk factors for cognitive impairment in patients with chronic insomnia (all P<0.05). The areas under the curve (AUC) of serum irisin and MnSOD in predicting cognitive impairment in patients with chronic insomnia were 0.805 and 0.732, respectively, with specificity of 89.5% and 58.1%, and sensitivity of 61.3% and 84.9%, respectively; the AUC, specificity and sensitivity of the combined prediction were 0.897, 95.3% and 59.1%, respectively. Conclusion Serum irisin and MnSOD levels have certain significance for cognitive impairment assessment of patients with chronic insomnia, which are closely related to cognitive function.

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    Meta-analysis of PD-1/PD-L1 inhibitors in the treatment of patients with non-small cell lung cancer having brain metastases
    Li Qing, Zhong Wen, Liu Siqiang, Chen Yusheng, Li Hongru
    Clinical Focus    2022, 37 (5): 400-405.   DOI: 10.3969/j.issn.1004-583X.2022.05.002
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    Objective To perfrom a meta-analyze of the efficacy of PD-1/PD-L1 inhibitors versus chemotherapy in the treatment of patients with NSCLC brain metastases. Methods Search of the literature included in Pubmed, Embase, Sciencedirect, Cochrane, X-mol, CNKI, Wanfang and other databases on the Internet. Two researchers screened the literature, extracted data and evaluated the risk of bias and adopted RevMan 5.3 performs meta-analysis on the overall survival (OS) and progress free survival (PFS) of NSCLC brain metastasis.Results A total of 7 RCTs were included, including 440 patients with NSCLC brain metastases. Compared with simple chemotherapy group, PD-1/PD-L1 inhibitors could markedly increase the patient's OS [HR=0.71, 95%CI(0.56, 0.92), P=0.008] and PFS[HR=0.53, 95%CI(0.41, 0.69), P<0.01]; OS [HR=0.41, 95%CI(0.24, 0.70), P=0.001] and PFS [HR=0.44, 95%CI(0.30, 0.63), P<0.01] in PD-1/PD-L1 inhibitors combined with chemotherapy group compared with OS [HR=0.83, 95%CI (0.63, 1.11), P=0.21] and PFS[HR=0.64, 95%CI(0.45, 0.91),P=0.01] in the monotherapy group could more significantly reduce the patient's risk of death and disease progression.Conclusion PD-1/PD-L1 inhibitors alone or in combination with chemotherapy for patients with NSCLC brain metastases have better effect than chemotherapy, and the combined chemotherapy group is better than monotherapy, which is a preferred treatment for patients with NSCLC brain metastases.

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    Relations between aspirin & clopidogrel resistance-relatedgene polymorphisms and corresponding recurrent cerebral infarction
    Liu Debin, Chen Xiaopu, Chen Wenjie, Huang Yinting, He Wenzhen
    Clinical Focus    2022, 37 (4): 320-324.   DOI: 10.3969/j.issn.1004-583X.2022.04.006
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    Objective To observe aspirin & clopidogrel resistance-related gene polymorphisms, and to explore their relations with recurrent cerebral infarction. Methods A total of 98 cerebral infarction patients were selected from the Department of Neurology in our hospital from April 2019 to December 2020, and the relations between aspirin & clopidogrel resistance-related gene polymorphisms and gender & recurrent cerebral infarction were retrospectively analyzed. Results In patients suffering from cerebral infarction, patients severely resistant to aspirin were more likely to have recurrent cerebral infarction on standard anti-platelet therapy than sensitive patients (P<0.05); the patients suffering from the moderate/severe resistance to aspirin with medium/slow metabolism of clopidogrel complicated were more likely to have recurrent cerebral infarction than aspirin sensitivity and (or) fast metabolism of clopidogrel (P<0.05). The difference in the proportion of different clopidogrel drug-related gene phenotypes wasn’t statistically significant (P>0.05); and the difference in the distribution of aspirin & clopidogrel resistance-related phenotypes with different genders wasn’t statistically significant (P>0.05). Conclusion It is crucial to test aspirin & clopidogrel resistance-related phenotypes in the treatment of cerebral infarction, and it is necessary to appropriately adjust the therapeutic regimen according to test results to improve the therapeutic effects on cerebral infarction.

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    Analysis of clinical characteristics of 61 cases of neuromyelitis optica spectrum disorders and the influence of NLR and ELR on disease severity
    Li Yangfan, Li Jian
    Clinical Focus    2022, 37 (5): 431-436.   DOI: 10.3969/j.issn.1004-583X.2022.05.008
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    Objective To investigate the clinical characteristics, neutrophil to lymphocyte ratio and eosinophil to lymphocyte ratio of 61 patients with neuromyelitis optica spectrum disorders (NMOSD). Methods A total of 61 patients admitted to the Department of Neurology, The First Affiliated Hospital of Jinzhou Medical University from June 2017 to June 2021 and diagnosed as acute stage of NMOSD were collected.NMOSD patients’ general clinical information(gender, age), concomitant antibodies were gathered.61 healthy volunteers with matched gender and age were randomly selected from physical examination department as healthy controls(HCs). Routine blood indexes of both groups (neutrophil, eosinophil, monocyte, lymphocyte, platelet, uric acid, cystatin C, C-reactive protein) were collected, and neutrophil to lymphocyte ratio(NLR), eosinophil to lymphocyte ratio(ELR), monocyte to lymphocyte ratio(MLR), platelet to lymphocyte ratio(PLR) were calculated separately according to the above laboratory indicators.The extended disability scale(EDSS) on admission and groups were divided according to the scale results. Cys C, UA, CRP, NLR, ELR, MLR, PLR of NMOSD group and control group, mild- and moderate- severe NMOSD groups were compared.Binary Logistic regression analysis and ROC curve were used analyze the correlation between the above indicators with statistically significant differences and the severity. Results Compared with 61 healthy controls, gender, CRP, NLR, ELR, MLR and PLR of 61 NMOSD patients were statistically significant(P<0.05). In univariate analysis, there were statistically significant differences in the combination of other autoantibodies, NLR and ELR between the mild NMOSD group and moderate severe group(P<0.05). Binary Logistic regression analysis showed, NLR(OR=4.082,95%CI=0.970-7.177,P=0.035), ELR(OR=5.541,95%CI=0.001-8.225,P=0.045), combined with other autoimmune antibodies(OR=0.105,95%CI=0.002-4.997,P=0.038) were independent risk factors affecting the severity in NMOSD patients(P<0.05). NLR combined ELR was the most effective index for evaluating the severity of disease, and the optimal critical value of NLR combined ELR was 0.299, the area under the curve was 0.885, the specificity was 0.765, and the sensitivity was 0.926. Conclusion Patients with other autoimmune antibodies has a significantly high impact on the severity of the disease, and the prognosis is worse.NLR, ELR were effective indicator to evaluate changes in disease severity.

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    Clinical Focus    2022, 37 (3): 285-288.   DOI: 10.3969/j.issn.1004-583X.2022.03.017
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    Clinical characteristics and genotype analysis of the child with Alport syndrome with GJB2 gene mutation-induced deafness: A case report and literature review
    Cheng Yanhui, Bao Ying, Qian Pei, Huang Huimei
    Clinical Focus    2022, 37 (4): 354-357.   DOI: 10.3969/j.issn.1004-583X.2022.04.013
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    Objective To explore the clinical characteristics and genotype of children with Alport syndrome (AS) combined with gap junction protein beta 2 (GJB2) gene mutation induced-deafness. Methods A retrospective analysis of the clinical data and genetic testing results of one child with AS, who admitted to the Department of Nephrology, Xi'an Children's Hospital was performed. Results The children (female) was 3 years old and 8 months old, and the disease started with hematuria and proteinuria. Renal pathology revealed mild mesangial proliferative glomerulonephritis by light microscopy (LM), thin basement membrane nephropathy (TBMN) by electron microscopy (EM), and mild sensorineural deafness in the left ear by hearing test. Genetic testing indicated the presence of C.555 (exon10) -C.568 (exon10) delTGGTCCCACTGGTA (framesshift mutation) in collagen type Ⅳ alpha 5 chain (COL4A5) gene, leading to amino acid change p.P185Pfs*26. The mutation was verified as a new mutation in the family, and neither parent carried it. The American College of Medical Genetics and Genomics (ACMG) guidelines indicated that this mutation type was a pathogenic mutation. This locus had not been reported in the human gene mutation database (HGMDpro). In addition, c.109 (exon2) G > A (missense mutation) in GJB2 gene was also detected, leading to amino acid change p. V37I. Both parents were carriers in the family verification. According to the ACMG guidelines, this mutation type was a pathogenic mutation. This locus had been reported in HGMDpro database. Conclusion Both Alport syndrome and GJB2 gene mutation can lead to hearing loss. When hearing loss in children with AS, we should not only consider the primary disease, but also be alert to the presence of other comorbidities to avoid missed diagnosis and misdiagnosis.

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    Diagnostic value of ultrasound with serology and BRAF testing in the identification of benign and malignant TI-RADS category 4 nodules
    Hu Yuhan, Chen Fei
    Clinical Focus    2022, 37 (4): 339-342.   DOI: 10.3969/j.issn.1004-583X.2022.04.010
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    Objective To explore the diagnostic value of ultrasound with serology and BRAF testing in the identification of benign and malignant thyroid imaging reporting and data system (TI-RADS) category 4 nodules.Methods The data of 102 patients with TI-RADS category 4 nodules form department of ultrasound, the First Affiliated Hospital of Jinzhou Medical University were retrospectively analyzed, and serological and BRAF gene tests were performed in all of them. Patients were divided into benign group and malignant group according to surgical and pathologic findings, the different diagnostic efficacy in differentiating benign and malignant TI-RADS category 4 nodules was evaluated.Results TI-RADS indicated the numbers of hypoechoic rim with internal calcification, blurred boundary, irregular shape of patients with malignant nodules was more than those of patients with benign nodules (P<0.05). The higher thyroid-stimulating hormone (TSH) value of patients with malignant nodules was common (P<0.05). The numbers of BRAF gene mutation of patients with malignant nodules were significantly higher than those of patients with benign nodules (P<0.05). The accuracy (98.04%), sensitivity (97.22%), specificity (100.00%) and diagnostic efficiency (0.926) of ultrasonography, serology and BRAF testing were higher than any of the three alone check (P<0.05).Conclusion The combined of the above three has more clinical value in the identification of benign and malignant TI-RADS category 4 nodules.

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    Predictive value of ApoB/ApoA1 ratio on the extent of coronary artery disease in patients with unstable angina pectoris
    Zhu Jun, Liu Yue, Chen Shuxia, Wang Xian, Zheng Luyan, Gu Jian
    Clinical Focus    2022, 37 (5): 422-426.   DOI: 10.3969/j.issn.1004-583X.2022.05.006
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    Objective To explore the predictive value of ApoB/ApoA1 ratio on the degree of coronary artery lesions in patients with unstable angina (UA). Methods One hundred and seventy six patients with UA who were hospitalized and underwent coronary angiography in the Department of Cardiovascular Medicine, Hebei General Hospital from October 2019 to August 2021 were retrospectively analyzed. Clinical data of the enrolled patients were collected, ApoB/ApoA1 ratio was calculated, and Gensini score was calculated based on coronary angiography results. The median Gensini score of UA patients was used to divide the patients into the high Gensini score group (Gensini score ≥40) and low Gensini score group (Gensini score <40), and clinical data of patients in two groups were compared. Correlation analysis on Gensini scores and ApoB/ApoA1 ratio in UA patients was performed. Binary multivariate Logistic regression was applied to analyze the independent risk factors for high Gensini score. ROC curves were applied to analyze the diagnostic value of ApoB/ApoA1 ratio and other lipid indices for high Gensini score, and the best diagnostic threshold was determined by the Yordon index. Results The ApoB/ApoA1 ratio of patients in the high Gensini score group was significantly higher than that of patients in the low Gensini score group (P<0.01). The Gensini score of UA patients was positively correlated with the ApoB/ApoA1 ratio (r=0.321, P<0.01). Binary multivariate Logistic regression analysis showed that ApoB/ApoA1 ratio was an independent risk factor for severe coronary lesions (Gensini score ≥40) in UA patients (OR=4.593, 95%CI=2.434-8.664, P<0.01). ROC curve analysis showed that the diagnostic value of ApoB/ApoA1 ratio was higher than that of ApoB, TG, TC and LDL-C, with an AUC of 0.723(P<0.01), an optimal diagnostic threshold of 0.69, a sensitivity of 0.644 and a specificity of 0.742.Conclusion The ApoB/ApoA1 ratio is positively correlated with the degree of coronary artery lesion in UA patients, and it has a certain diagnostic and predictive value and serves an independent risk factor for severe coronary artery lesions in UA patients, delivering guiding significance in the clinical diagnosis and treatment of UA.

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    Clinical Focus    2022, 37 (4): 358-363.   DOI: 10.3969/j.issn.1004-583X.2022.04.014
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    Changes of serum Gremlin1 level in pregnant women in the second and third trimester of pregnancy and its relation with gestational diabetes mellitus
    Qi Qi, Jiang Lichen, Sun Rong, Hu Honglin, Zhang Qiu
    Clinical Focus    2022, 37 (3): 257-261.   DOI: 10.3969/j.issn.1004-583X.2022.03.011
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    Objective To explore the changes of serum Gremlin1 level in pregnant women in the second and third trimester of pregnancy and its relation with gestational diabetes mellitus (GDM). Methods From September to November 2020, a total of 175 pregnant women received pregnancy test in the First Affiliated Hospital of Anhui Medical University were enrolled, the patients had finished the oral glucose tolerance test (OGTT) during 24 to 28 weeks of pregnancy. They were divided into GDM group and normal glucose metabolism group (NGT group) by the OGTT results. The interclass clinical data including general data, Gremlin1 level and other biochemical indicators were collected, the differences of clinical data between the two groups were analyzed. Results The pre- and post-pregnancy body weight, pre-pregnancy body mass index (BMI), post-pregnancy BMI, fasting blood glucose (FBG), 1 h blood glucose (1 hBG), 2 h blood glucose (2 hBG), fasting insulin (FINS), 1 h insulin (1 hINS), 2 h insulin (2 hINS), fasting C protein (FCP), 1 h C peptide (1 hCP), 2 h C peptide (2 hCP), homeostasis model assessment of insulin resistance (HOMA-IR), area under curve of glucose (AUC-G), area under the curve for insulin (AUC-I) were higher in GDM group than in NGT group; homeostasis model assessment for beta-cell function index (HOMA-β) and insulin sensitivity index (ISI) in GDM group were lower than those in NGT group (all P<0.05). Serum Gremlin1 level in GDM group was higher than that in NGT group (P<0.05). Pearson correlation analysis showed that serum Gremlin1 level was positively correlated with post-pregnancy BMI, FBG, 1 hBG, 1 hINS, 2 hBG, 2 hINS, 2 hCP, HOMA-IR, AUG-G, AUC-I, and negatively correlated with HOMA-β, ISI (all P<0.05). Multivariate Logistic regression analysis showed that the independent risk factor for GDM was serum Gremlin1 (OR=8.922, 95%CI 1.863-42.736, P<0.05). Conclusion There is a positively correlated between increased serum Gremlin1 with insulin resistance in GDM patients, participating in the glucose metabolism of GDM.

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    The relationship between serum homocysteine levels and SYNTAX score in patients with non-ST-segment elevation myocardial infarction
    Wang Yajie, Lin Wenhua, Jing Rui, Liu Jingjing, Lu Yujie
    Clinical Focus    2022, 37 (4): 325-328.   DOI: 10.3969/j.issn.1004-583X.2022.04.007
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    Objective To explore the relationship between serum homocysteine(HCY) levels and SYNTAX score(SS) in patients with non-ST-segment elevation myocardial infarction (NSTEMI). Methods We performed a retrospective analysis of 298 patients with NSTEMI from the aspects of general clinical features, multiple laboratory indicators including serum HCY level, left ventricular ejection fraction (LVEF) and SS on the echocardiography during hospitalization. SS was also calculated according to the images of angiography for further statistical analysis. The patients were divided into three groups according to the SS value: low- (SS≤22), medium- (22<SS<33),high-SS group(SS≥33), with a comparison of interclass correlation from related data. Results The enrolled 298 NSTEMI patients consisted of 177 patients (59.4%) in the low-SS group, 77 (25.8%) in the medium-SS group, and 44 (14.8%) in the high-SS group. Serum HCY levels were (16.1±9.1) μmol/L, (20.3±9.1) μmol/L, (27.5±9.5) μmol/L in low-, medium-, and high-SS groups, respectively. Serum HCY levels in medium-, high-SS groups were significantly higher than those in low-SS group (P<0.01). The related analysis indicated homocysteine levels were correlated with SS (r=0.358, P<0.01). Conclusion Serum HCY levels were associated with increasing severity of coronary artery disease in the patients with NSTEMI.

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    Difference between remitting seronegative symmetrical synovitis with pitting edema syndrome and seronegative rheumatoid arthritis
    Lin Changyi, Song Minghui, Wu Peicheng
    Clinical Focus    2022, 37 (3): 262-265.   DOI: 10.3969/j.issn.1004-583X.2022.03.012
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    Objective To investigate the difference between remitting seronegative symmetrical synovitis with pitting edema (RS3PE) syndrome and seronegative rheumatoid arthritis (SNRA). Methods During January 2009 to December 2020, a total of 12 patients with RS3PE syndrome (RS3PE group) admitted in our hospital were enrolled, and 36 patients with SNRA (SNRA group) during the same period were collected. In-group general data, clinical features and laboratory indexes were included as comparison. Results Compared with the SNRA group, the patients in the RS3PE group had older aged, more males, higher serum C-reactive protein (CRP), more involved in ankle joints, less involved in small joints and hand joints, and easy to combine tumor (all P<0.05). Conclusion Older men and relatively higher CRP levels are higher risk for combined tumors in patients with RS3PE syndrome, they are more likely to involve the ankle joint. A actively screened for malignancy should be carried out in older, male, and RS3PE syndrome patients with limb edema.

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    Analysis of influencing factors on antidepressants compliance of patients with somatic symptoms disorder
    Qu Junmin, Yang Limin, Yuan Fengying
    Clinical Focus    2022, 37 (3): 266-270.   DOI: 10.3969/j.issn.1004-583X.2022.03.013
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    Objective To analyze the factors affecting the antidepressant compliance of patients with somatic symptoms disorder (SSD). Methods A total of 147 patients with SSD were prospectively enrolled, thay were divided into three groups according to Morisky Medication Adherence Scale (MMAS-8) score: good compliance group (41 cases), medium compliance group (64 cases) and poor compliance group (42 cases), the differences of sex, age, education, residence, life satisfaction, economic status, social support, insight, onset time, symptom severity, comorbidity, complication, treatment effect, adverse reaction and doctor-patient relationship among the three groups were compared. Results There were no significant differences in sex, education level and onset time among the three groups (P>0.05), there were significant differences in age, residence, life satisfaction, economic status, social support, insight, symptom severity, comorbidity, complication, treatment effect, adverse reaction and doctor-patient relationship (P<0.05, P<0.01). Logistic analysis showed that high life satisfaction, good social support, self-insight, severe symptoms and good treatment effect were the protective factors of treatment compliance, complications and severe adverse reactions were risk factors for treatment compliance. Conclusion High life satisfaction, good social support, insight, severe symptoms, good treatment results will improve the treatment compliance of SSD patients, however, complications, adverse reactions will reduce treatment compliance.

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    Literature review on one case of cerebral venous sinus thrombosis mainly featured with isolated headache
    Chang Yajun, Guo Weina, Guo Qiaozhen, Wang Tianjun
    Clinical Focus    2022, 37 (3): 271-274.   DOI: 10.3969/j.issn.1004-583X.2022.03.014
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    Objective To explore the etiology, clinical features, imaging characteristics and therapeutic regimen of cerebral venous sinus thrombosis (CVST). Methods One case of CVST mainly featured with isolated headache was retrospective analyzed, and related literature was reviewed. Results A 28-year-old male patient was admitted to the hospital with a 10-day headache and aggravated for 4 days. Magnetic resonance imaging (MRI) plain scan and enhancement of the head indicated filling defect of the left sigmoid and transverse sinuses, T1 and Flair showed high signal. The thrombosis of left transverse sinus and sigmoid sinus was confirmed by digital subtraction angiography (DSA). The patient recovered well after anti-infection and anticoagulant treatment. A total of 145 CVST patients with complete data in recent 5 years were collected, the most common features, pathogenic factor, disease location were headache accompanied by focal impairment symptom of neurologic system, hyperhomocysteinemia, superior sagittal sinus (SSS) and transverse sinus, respectively.Conclusion CVST patients normally exhibit the symptoms including the headache, hypopsia, limb weakness, epilepsy and disturbance of consciousness, only a few show simple headache. Anticoagulant therapy with vascular intervention is effectively capable of improving the prognosis of CVST patients. It is necessary to pay high attention to the patients with acute single recurrent progressive headache to avoid missed diagnosis and adverse consequences.

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    Clinical Focus    2022, 37 (3): 275-278.   DOI: 10.3969/j.issn.1004-583X.2022.03.015
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    Analysis on de novo mutations in PAH genes of the family with phenylalanine hydroxylase deficiency
    Ma Cuixia, Feng Lulu, Li Lixin, Ma Qianqian, Li Yang, Feng Jizhen
    Clinical Focus    2022, 37 (5): 441-446.   DOI: 10.3969/j.issn.1004-583X.2022.05.010
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    Objective To investigate the pathogenesis of a family with phenylalanine hydroxylase deficiency (PAHD) by detecting and analyzing the mutation sites of phenylalanine hydroxylase (PAH) genes of the family. Methods PAH genome sequencing and exon deletion or duplication analysis were performed in the venous blood of probands and their parents by the next-generation sequencing (NGS) and multiplex ligation-dependent probe amplification (MLPA). Results The proband was found to have one missense mutation and one splice deletion, namely c.630t > G in Exon 6 and c.61-1G > A in Exon 2, respectively, which were not reported in Human Gene Mutation Database (HGMD), and were determined as clinically unknown and suspected pathogenic variants in America College of Medical Genetics and Genomics (ACMG) guidelines. The two mutations were predicted to be harmful and unknown in prediction results of information software REVEL, and no abnormal copy number of exon of PAH gene was found in the exon deletion and duplication analysis on the proband by using MLPA. Conclusion Exon 6 c.630T > G and exon 2 c.61-1G > A of PAH gene may be pathogenic mutations of PAHD in the family.

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    Predicting value of neutrophil to lymphocyte ratio combined with GRACE score on in-hospital major adverse cardiovascular events of postoperative PCI in acute STEMI patients
    Wang Jiaqi, Gao Man, Zhang Feifei, Li Yingxiao, Dang Yi, Qi Xiaoyong
    Clinical Focus    2022, 37 (5): 412-417.   DOI: 10.3969/j.issn.1004-583X.2022.05.004
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    Objective To explore the predicting value of neutrophil to lymphocyte ratio (NLR) combined with global registry of acute coronary events (GRACE) score on in-hospital major adverse cardiovascular events (MACE) of postoperative primary percutaneous coronary intervention (PCI) of patients with acute ST-segment elevation myocardial infarction (STEMI). Methods From September 1, 2018 to December 31, 2019, a total of 275 patients with acute STEMI underwent primary PCI who visited the Department of Cardiology, Hebei General Hospital were enrolled and divided into the MACE group (n=35) and the non-MACE group (n=240), postoperative PCI in-hospital MACE included all-cause mortality, cardiogenic shock, in-hospital repeat revascularization, fatal arrhythmia, cardiac arrest. The clinical data was recored, the independent risk factors of in-hospital MACE were analyzed. The receiver operating characteristic (ROC) curve was plotted to analyze the predictive value of NLR, GRACE score and the two combined for in-hospital MACE of postoperative PCI in acute STEMI patients. Results Compared with the non-MACE group, increased age, GRACE score, CRUSADE score and NLR and decreased estimated glomerular filtration rate were detected in the MACE group (all P<0.05). Multivariate Logistic regression analysis showed that GRACE score and NLR were independent risk factors of in-hospital MACE of postoperative PCI in patients with acute STEMI (all P<0.05). ROC curve indicated that GRACE score, NLR had certain predictive value for in-hospital MACE, while the two combined had a greater areas under curve for better predicting in-hospital MACE. Conclusion GRACE score and NLR are independent risk factors for in-hospital MACE of postoperative PCI in acute STEMI patients, the two combined has a greater predictive value for in-hospital MACE.

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    Clinical Focus    2022, 37 (4): 369-372.   DOI: 10.3969/j.issn.1004-583X.2022.04.016
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    Long-term effect of hypoglossal nerve stimulation in the treatment of obstructive sleep apnea hypopnea syndrome: A meta analysis
    Sun Ying, Yu Qin
    Clinical Focus    2022, 37 (8): 677-684.   DOI: 10.3969/j.issn.1004-583X.2022.08.001
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    Objective To explore the long-term effect of hypoglossal nerve stimulation (HGNS) in the treatment of obstructive sleep apnea hypopnea syndrome (OSAHS). Methods Through the systematic search of China knowledge Network database, Wanfang database, VIP database, Chinese biomedical literature database, Pubmed, Embase, Cochrane Library, the article published by domestic and foreign scholars regarding HGNS, untill to March 2022, were collected. The literatures were screened and extracted by two evaluators independently and the quality of the literatures was evaluated by NOS scale, Meta analysis was carried out by stata12.0 software. Results A total of 12 cohort studies with 776 patients were included. The posttreatment 6-month sleep apnea hypopnea index, (AHI, mean difference [SMD]=-1.47, 95% CI 95% confidence interval [95%CI]-1.68-1.25, P=0.000), oxygen desaturation index (ODI, SMD=-0.77,CI: -0.95--0.58, P=0.000), epworth scale score (ESS, SMD=-1.00, CI: -1.16--0.84, P=0.000), functional qutcomes of sleep questionnaire (FQSQ, SMD=1.10, CI: 0.92~1.28, P=0.000), AHI in 12 months after operation (SMD=-1.250, CI:-1.39--1.10, P=0.000), ODI (SMD=-0.874, CI:-1.114--0.634, P=0.001) and FQSQ (SMD=1.10, CI: 0.96-1.22, P=0.000) were significantly improved than those before treatment. Conclusion Hypoglossal nerve stimulation is effective in the treatment of OSAHS.

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    Low-fiber enteral nutrients in effect on intestinal cleanliness and blood glucose and comfort level in diabetes patients
    Yang Minxing, Zhuang Shujie, Han Wenjuan, Zhang Haiyun, Ye Yun
    Clinical Focus    2022, 37 (4): 349-353.   DOI: 10.3969/j.issn.1004-583X.2022.04.012
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    Objective To investigate the effect of low-fiber enteral nutrients on intestinal cleanliness, blood glucose and comfort level of diabetic patients during bowel preparation of time-restricted feeding less than 24 hours. Methods Totally 108 diabetic inpatients underwent colonoscopy were randomly divided into two groups: the control group (n=55), the observation group (n=53). In the dinner on day-0 of microscopic examination, the control group was managed semi-fluid low-fiber food, and low-fiber enteral nutrients in the observation group. The calorie volume of the two groups was same, which calculated from the nutrition department according to the height and weight of these patients. The Ottawa Bowel Preparation scale (oBPs) was employed to assess effects of intestinal cleanliness, from the beginning to end of endoscopic examinationthe, the key observation was blood glucose value, largest amplitude of glycemic excursion (LAGE), the incidence of hypoglycemia and comfort level in the two groups.Results The better intestinal cleanliness was found in the observation group (P<0.05). Except for day-0 17:00 and day-1 13:00 of the microscopic examination, the control group had lower blood glucose values on other time points (P<0.05), and lower incidence of hypoglycemia was detected in the observation group (χ2=3.89, P<0.05), LAGE was lower in the observation group vs the control group (P<0.01); in the comfort level, the observation group indicated higher the satisfaction (P<0.05), with the reduction of defecation frequency and anal pain (P<0.01). Conclusion During bowel preparation, low-fiber enteral nutrients can improve intestinal cleanliness and comfort level, better than semi-liquid low-fiber food, which has merit to reduce blood glucose fluctuations and incidence of hypoglycemia for diabetic patients.

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