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    20 February 2022, Volume 37 Issue 2
    Safety of clopidogrel combined with statins on acute coronary syndrome in patients based on metabolic pathways by different cytochrome P450 enzyme: a Meta analysis
    Li Jianqin, Sheng Yueyue, Zhou Yinmin, Shi Weiqing, Yang Xingchen
    2022, 37(2):  101-105.  doi:10.3969/j.issn.1004-583X.2022.02.001
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    Objective To evaluate the safety of clopidogrel in combination with statins for acute coronary syndrome (ACS) under different cytochrome P450 enzyme metabolic pathways by Meta-analysis.Methods A computer retrieval was performed in several databases, as Wanfang Data, Chinese Bio-medicine Database, China National Knowledge Infrastructure, VIP database, Science Citation Index (SCI), Pubmed and Embase. The retrieval period from the library construction to April 2020. After evaluating the quality of these literatures, Meta-analysis was conducted by STATA 14.0 for these data.Results At last, 9 eligible papers included 11, 008 patients; of which, 7, 179 patients taking statins metabolized by CYP3A4 ( Atorvastatin and Simvastatin) and 3, 829 patients taking statins not metabolized by CYP3A4 (Rosuvastatin, Fluvastatin and Pravastatin).Meta-analysis demonstrated that Major Adverse Cardiac Events (MACE) were less frequent statin combined with clopidogrel in non-CYP3A4 metabolism than in CYP3A4 metabolism in Europe and America, with statistically significant difference between the two groups (P<0.05). However, there was no statistically significant difference between the two groups in Asian populations (P>0.05), of which, no statistically significant difference was also found in death, myocardial infarction and stroke (P>0.05).Conclusion A combination of statins non-CYP3A4 metabolite clopidogrel is capable of reducing the risk for MACE in European and American populations, but not in Asian populations.

    Zinc adjuvant in treatment of rotavirus enteritis in children and how to effect on short-term recurrence: a Meta analysis
    Zhou Yao, Wei Botao
    2022, 37(2):  106-113.  doi:10.3969/j.issn.1004-583X.2022.02.002
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    Objective To evaluate the efficacy of zinc adjuvant in treatment of rotavirus enteritis in children and how to effect on the recurrence of short-term diarrhea.Methods Literatures on zinc adjuvant treatment of rotavirus enteritis in children were retrieved in the CNKI database, VIP database, WanFang database, Chinese biomedical literature database, as well as PubMed database, Web of Science and Cochrane Library. The data were extracted and evaluated by Review Manager 5.4 and Stata 15.1 software.Results In 15 eligible literatures involved a total of 1793 children (882 in the experimental group and 911 in the control group). Meta-analysis results demonstrated increased total effective rate of zinc adjuvant on rotavirus enteritis in children when treatment group vs control group (RR=1.19, 95%CI[1.15, 1.24], P<0.01); zinc adjuvant reduced the duration of fever (MD=-1.27, 95%CI[-1.54, -0.99], P<0.01), the duration of vomiting (MD=-1.28, 95%CI[-1.70, -0.83], P<0.01), and the duration of the diarrhea (MD=-1.16, 95%CI[-1.51, -0.81], P<0.01) in children with rotavirus enteritis; It also reduced the recurrence rate of short-term diarrhea in children with rotavirus enteritis (RR=0.27, 95%CI[0.19, 0.40], P<0.01).Conclusion Zinc adjuvant on rotavirus enteritis in children is significantly effective, which is capable of reducing the recurrence rate of short-term diarrhea in patients, worthy clinical promotion.

    Influencing factors and predictive indicators of vascular calcification
    Zheng Lihua, Du Runsen, Zhao Yaheng, Liu Peng
    2022, 37(2):  114-118.  doi:10.3969/j.issn.1004-583X.2022.02.003
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    Objective To analyze the predictive factors of vascular calcification, and to explore its effective prediction indicators.Methods A retrospective analysis was performed in totally 467 vascular calcification patients admitted to the Department of Vascular Surgery, the First Hospital of Hebei Medical University from August 2018 to July 2020. Those patients were registered into case group and control group as whether with or without vascular calcification, and the clinical data were collected. Univariate and multivariate Logistic regression analysis were used to explore influencing factors of vascular calcification. Receiver operating characteristic (ROC) curve was drawn to analyze predictive value.Results In 467 cases, there were 191 cases (40.9%, 191/467) with vascular calcification. The independent factors for predicting vascular calcification were albumin/fibrinogen ratio(OR=0.725, 95%CI 0.630-0.834, P<0.01), fibrinogen degradation product (OR=1.626, 95%CI 1.086-2.433, P=0.018), lipoprotein (OR=1.003, 95%CI 1.002-1.004, P<0.01), high density lipoprotein-cholesterol (OR=0.101, 95%CI 0.016-0.630, P=0.014), total cholesterol (OR=4.009, 95%CI 1.619-9.926, P<0.01), low density lipoprotein-cholesterol (OR=0.148, 95%CI 0.042-0.517, P<0.01), and the area under the curve (AUC) related the above parameters were 0.828, 0.780, 0.720, 0.679, 0.570, and 0.563, respectively.Conclusion The independent predictors for vascular calcification were albumin/fibrinogen ratio, fibrinogen degradation product, lipoprotein, high density lipoprotein-cholesterol, total cholesterol, low density lipoprotein-cholesterol, of which, albumin/fibrinogen ratio, fibrinogen degradation product and lipoprotein is better capable of predicting vascular calcification, and albumin/fibrinogen ratio has top advantageous value.

    Relationship between clinical features, peripheral microcirculatory and severity of coronary artery disease in patients with coronary heart disease
    Duan Liqin
    2022, 37(2):  119-123.  doi:10.3969/j.issn.1004-583X.2022.02.004
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    Objective To explore the relationship between clinical features, peripheral microcirculatory and the severity of coronary artery disease (CAD) in patients with coronary heart disease (CHD).Methods Totally 220 CHD patients admitted to our hospital from March 2016 to March 2021 were assigned into mild and moderate group (n=142) and severe and extremely severe group (n=78). The data of age, gender, body mass index (BMI), diabetes mellitus (DM), and hypertension on admission were collected; the indicators of the two groups were measured on day 1 admission, including folic acid (FA), vitamin B12 (VB12), total bilirubin (TBIL), triglyceride (TG), total cholesterol (TC), high density lipoprotein-cholesterol (HDL-C) and low density lipoprotein-cholesterol (LDL-C). The rewarming test of finger skin was used to measure peripheral microcirculatory; the predictive value of FA, VB12, TBIL, TC, LDL-C, RT for severe and extremely severe CAD in CHD patients was analyzed according to receiver operating characteristic (ROC) curve by comparing the basic data, laboratory index, finger rewarming time (RT) of two groups. The different single factors were included in the Logistic model and quantified to determine the risk factors of severe and extremely severe CAD in CHD patients.Results Compared with mild and moderate group, the proportion of patients with age≥60 and hypertension in severe and extremely severe group was significantly increased; FA, VB12 and TBIL in severe and extremely severe group were significantly decreased; TC, LDL-C and RT were obviously higher; and with statistically significant difference (P<0.05). The areas under curve (AUC) of FA, VB12, TBIL, TC, LDL-C and RT in predicting in the pathogenesis of severe and extremely severe CAD in CHD patients were 0.931, 0.732, 0.869, 0.849, 0.775 and 0.967, respectively (all P<0.05). Multivariate Logistic regression analysis showed that the risk factors of severe and extremely severe CAD in CHD patients were age≥60 years old, hypertension, FA≤6.555 μg/L, VB12≤268.295 ng/L, TBIL≤10.015 μmol/L, TC≥5.015 mmol/L, LDL-C≥2.680 mmol/L, RT≥405.240 s.Conclusion Patients with age≥60 years old and hypertension are more likely to have severe and extremely severe CAD. The levels of FA, VB12, TBIL, TC, LDL-C and peripheral microcirculatory are closely correlated with severity of CAD, which can be used to evaluate the severity of patients.

    Clinical analysis of Staphylococcus infective endocarditis: 46 cases report
    Shi Xiaochun, Liu Xiaoqing
    2022, 37(2):  124-127.  doi:10.3969/j.issn.1004-583X.2022.02.005
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    Objective The purpose of this paper is to explore the clinical and etiological characteristic of patients with staphylococcus infective endocarditis (IE), to provide evidence for diagnosis and treatment.Methods This retrospective study included a cohort of 46 staphylococcus IE patients hospitalized in Peking Union Medical College Hospital from 2011 to 2018.Results The incidence of staphylococcus IE was 46 cases, accounted for 10.8% among 425 IE inpatients at the same time. Fever (97.8%) was the most common clinical presentation, followed by anemia (73.3%) and cardiac murmur (63.0%). Congestive heart failure (52.2%) and embolism (43.5%) were the most common complications. Among 46 staphylococcus strains, 38 stains (82.6%) were S. aureus (percentage of methicillin-resistant was 31.6%), while 8 strains (17.4%) were S. coagulase negative (percentage of methicillin-resistant was 75.0%). Four (8.7%) died during hospitalization. Compared with streptococcus IE, staphylococcus IE was associated with higher prevalence of underlying chronic disease (P=0.008), higher prevalence of complicated septic shock (P<0.01), lower prevalence of left side IE (P<0.01) and higher prevalence of prosthetic valves/devices (P<0.01); abscess formation were more frequent in staphylococcus IE (P=0.005). Inpatients with staphylococcus IE were more likely to have higher mortality and/or non-healing rate (P=0.015).Conclusion Staphylococcus (mostly S. aureus) is an important pathogen of IE. Compared with Streptococcus IE, patients with staphylococcus IE are likely to have more severe disease, more comorbidities and complications, and a poor prognosis. Management of staphylococcus IE is a challenge to physicians.

    Correlation between blood lipid and homocysteine and cognitive impairment in Parkinson's disease
    Guo Chang, Shen Huinan, Sun Yimeng, Wang Dongyu
    2022, 37(2):  128-132.  doi:10.3969/j.issn.1004-583X.2022.02.006
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    Objective To investigate the correlation between the levels of blood lipid and homocysteine (Hcy) and the degree of cognitive impairment in Parkinson's disease (PD).Methods A total of 100 PD patients and 50 healthy people admitted to the Department of Neurology of Jinzhou Central Hospital during Sept 2019 - Aug 2021 were respectively registered into PD group and control group. According to the score of Montreal cognitive Assessment(MoCA), patients in PD group were divided into 38 patients with normal cognition (PD-NC), 32 patients with mild cognitive impairment (PD-MCI) and 30 patients with PD dementia (PDD). The aim was to detect levels of blood lipid and serum Hcy of all patients, explore the differences of indicators between groups, and analyze the correlation between the above indicators and the degree of cognitive impairment.Results Compared with control group, PD group had significantly higher level of Hcy (P<0.05), lower levels of total cholesterol (TC), triglyceride (TG) and low density lipoprotein cholesterol(LDL-C) (P<0.05), significant differences existed in the levels of TG, LDL-C and Hcy among PD-NC subgroup, PD-MCI subgroup and PDD subgroup (P < 0.05). Logistic regression analysis showed that Hcy was an independent risk factor for PD cognitive impairment (P<0.05).Conclusion There is a certain correlation between the levels of TG, LDL-C and Hcy and the degree of cognitive impairment for PD patients.

    Predictive value of lung ultrasonography on adjusted therapeutic regimen for patients with pneumonia
    Yu Xin, Liu Zhongyang
    2022, 37(2):  133-136.  doi:10.3969/j.issn.1004-583X.2022.02.007
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    Objective To explore the clinical value of pulmonary ultrasonography on adjusted anti-infection therapeutic regimen for patients with pneumonia.Methods Ninety six patients with pneumonia admitted to the Department of Respiratory Medicine of the 967 Hospital of the People's Liberation Army from December 1, 2019 to February 28, 2021 were recorded consecutively; and lung ultrasound scores (LUS), high-sensitivity C-reactive protein (hs-CRP), white blood cell count (WBC), neutrophil percentage (NEU%), clinical symptoms and antibiotic treatment regimen were recorded respectively on admission and the 3rd Day of treatment. Patients were divided into adjusted group and unadjusted group based on adjusted antibiotics on the 3rd Day of treatment. The change in LUS on admission and the 3rd Day of treatment were compared in groups, and the factors of adjustments on antibiotics were analyzed. Patients were divided into two groups including the ΔLUS≥0 group and ΔLUS<0 group based on the difference in change of LUS (ΔLUS) on the 3 rd Day, and the prognosis of patients in two groups was observed. Results (1) LUS of patients in the adjusted antibiotics group increased after treatment, while the unadjusted group decreased. The difference in LUS between groups before treatment was statistically significant (P=0.089), the difference on the 3rd Day of treatment was statistically significant (P<0.05). (2) Logistic regression analysis showed that ΔLUS (P=0.000; OR=1.563, 95%CI: 1.229-1.987) and difference in hs-CRP (Δhs-CRP)(P=0.001; OR=1.045, 95%CI: 1.018-1.074) were associated with antibiotic adjustment. (3) The predictive value of ΔLUS on antibiotic adjustment was analyzed by receiver operating characteristic (ROC) curve. The results showed the sensitivity, specificity, and the area under ROC curve (AUC) were 81.3%, 82.8%, and 0.806, respectively. AUC was 0.901 after combination of ΔLUS and Δhs-CRP, being greater than ΔLUS and Δhs-CRP, and the predictive value was higher. Conclusion Pulmonary ultrasonography is eligible to be used as one of auxiliary references for adjusted therapeutic regimen, and it is more effective to adjust the therapeutic regimen of pneumonia patients by combining hs-CRP.

    Risk factors for colorectal adenoma
    Guo Yanzhen, Wang Nuojin, Ma Junji
    2022, 37(2):  137-140.  doi:10.3969/j.issn.1004-583X.2022.02.008
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    Objective To study colorectal adenoma-related risk factors to provide early warning for screening and treatment of early colorectal cancer.Methods Totally 1 126 patients undergoing colonoscopy with a pathological diagnosis of colorectal adenoma in the Second Hospital of Hebei Medical University from January 2014 to June 2020 were enrolled as the case group, current 1 800 patients with negative results as the control group. Multivariate Logistic regression analysis was used to assess the pooled data of gender, age, smoking history, drinking history, bowel habits (whether normal, diarrhea, constipation, diarrhea alternating with constipation), total cholesterol, triglyceride to prove its influence for colorectal adenoma. In order to further excuse the interference of confounding factors, a 1∶1 matching was performed between groups, the independent risk factors for colorectal adenoma were explored by multivariate conditional Logistic regression analysis.Results Multivariate Logistic regression analysis showed that the independent risk factors for colorectal adenoma were gender, age, drinking history, smoking history, bowel habits, total cholesterol and triglyceride (P<0.05); while in multivariate conditional Logistic regression analysis those were bowel habits and triglyceride levels. The risk of colorectal adenoma in patients with chronic diarrhea and chronic constipation was higher than that in patients with normal bowel habits (P<0.05), when patients with higher triglyceride versus with normal triglyceride, increased risk of colorectal adenoma in those higher triglyceride(P<0.05).Conclusion The independent risk factors for colorectal adenoma were bowel habits and triglyceride levels. A higher risk of colorectal adenoma was found in patients with chronic diarrhea and/or chronic constipation and/or elevated triglyceride.

    Investigation and analysis on helicobacter pylori infection of children in Qingdao region
    Yu Jinghong, Zhao Yan, Yu Shufeng, Wang Caixia
    2022, 37(2):  141-144.  doi:10.3969/j.issn.1004-583X.2022.02.009
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    Objective To understand the characteristics of Helicobacter pylori(H.pylori) infection of children in Qingdao region, and to provide aids for the prevention and treatment of H.pylori infection of children.Methods Four hundred and ninty children received gastroscopy in the Affiliated Hospital of Qingdao University for “repeated abdominal pain, nausea, vomiting, hematochezia”, and other symptoms from June 2016 to June 2021 in Qingdao region, H.pylori infections of children were examined and evaluated based on the results of histopathological and 13C breath test, and the statistical analysis was implemented according to clinical data gathered.Results The overall infection rate of 490 children with H.pylori in Qingdao region was 21.8%. The infection rate of male and female children was 28.1% and 12.6%, and the difference was statistically significant (P<0.05). None of the infection rate of H.pylori differed significantly in different age groups (P>0.05), while the analysis on children aged 7~14 years old showed that the infection rate of H.pylori increased with the age. The H.pylori infection rate of children with highly educated parents was lower than that of children with low educated parents, and with statistically significant difference (P<0.05); the pathological examination of gastric mucosa in 107 children with H.pylori infection showed that there were 4 cases (3.7%) with mild inflammation, 98 cases (91.6%) with moderate inflammation and 5 cases (4.7%) with severe inflammation for inflammation degree as well as 50 mild cases (46.7%), 54 moderate cases (50.5%) and 3 severe cases (2.8%) for inflammatory activity among 107 children.Conclusion The H.pylori infection rate of children in Qingdao region is high, the H.pylori infection rate increases with the age of children aged 7-14 years old. The H.pylori infection rate in children in Qingdao is correlated with gender and parents' education. Pathological examination of gastric mucosa in children infected with positive H.pylori shows that there are more children with moderate inflammation, and the inflammatory activity is mainly mild and moderate.

    Methylmalonic acidemia: clinical phenotype and genetic characteristics
    Zhao Wanqing, Zhang Yanan, Wei Chenxi, Bai Xinli
    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.

    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
    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.

    A case report and literature review on severe combined immunodeficiency caused by new mutation of RAG1 gene
    Cui Qingyang, Wang Mengbin, Cao Yinli, Tang Chenghe
    2022, 37(2):  155-161.  doi:10.3969/j.issn.1004-583X.2022.02.012
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    Objective To improve the recognition on clinical phenotype and genotype of severe combined immunodeficiency.Methods The clinical data and gene detection results of severe combined immunodeficiency were analyzed retrospectively.Results A 1-month-6-day-old girl was found to have non-growing body mass for over half a month. The infection was complicated after hospitalization and it was difficult to control. Blood routine examination showed that the absolute value of neutrophile granulocytes fluctuated within (0.34-5.51)×109/L. No significant abnormality was noted in bone marrow puncture. The therapeutic effects of granulocyte colony-stimulating factor was unsatisfactory, and lymphocyte subsets conformed to T-B-NK+ immunophenotype. The complete exon sequencing showed that the maternal missense mutations of RAG1 gene satisfied c.1229G>A (p.Arg410Gln) and c.2428A>G (p.Ile810Val) and paternal c.2005 G>A (p.Glu669Lys) missense mutation of RAG1 gene, the former was firstly reported in China, and the second was the first case reported internationally. Conclusion The gene mutation spectrum of SCID in China and abroad has been expanded.