Table of Content

21 April 2022, Volume 43 Issue 2

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Basic and Clinical Research on Cardiology

Correlation analysis of soluble advanced glycation end product receptors and renal function in patients with coronary atherosclerotic heart disease

Chen Lu, Guo Xinying, Liu Jian, Du Fenghe, Guo Caixia

2022, 43(2):  167-172.  doi:10.3969/j.issn.1006-7795.2022.02.001

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Objective To evaluate the correlation between soluble receptor for advanced glycation end products (sRAGE) and renal function in patients with coronary atherosclerotic heart disease (CHD). Methods This study was a cross-sectional study. Plasma sRAGE and renal function indexes were detected in patients diagnosed with CHD who underwent coronary angiography in hospital. According to estimated glomerular filtration rate (eGFR), patients were divided into normal renal function group and decreased renal function group. Clinical characteristics and sRAGE levels of the two groups were compared, and the correlation between plasma sRAGE levels and renal function was analyzed by Spearman correlation and Logistic regression. Results A total of 170 patients were enrolled in the study. Correlation analysis showed that sRAGE was positively correlated to creatinine (r=0.152, P=0.048) and blood urea nitrogen (r=0.160, P=0.038), but negatively correlated to eGFR (r=-0.185, P=0.016). There were 109 patients in normal renal function group and 61 patients in decreased renal function group. Compared with the normal renal function group, sRAGE level was increased [(2.00±0.61) μg/L vs (1.70±0.60) μg/L, P=0.003] in the decreased renal function group.Multivariate Logistic regression analysis showed that sRAGE was correlated to decreased renal function in patients with CHD (OR=2.954, 95%CI: 1.030-8.474, P=0.044). Conclusion Plasma sRAGE might be a potential indicator for decreased renal function in CHD patients.

Effect of D-dimer on long-term prognosis in patients with acute myocardial infarction

Su Wen, Li Hongwei, Chen Hui, Li Weiping

2022, 43(2):  173-177.  doi:10.3969/j.issn.1006-7795.2022.02.002

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Objective To investigate the relationship between D-dimer and the risk of cardiac death in patients with acute myocardial infarction (AMI). Methods From January 2013 to January 2020, 3 990 patients admitted in Beijing Friendship Hospital with AMI were included in the present study. Patients were divided into 3 groups according to D-dimer:≤0.50 mg/L, 0.51-0.80 mg/L,≥0.81 mg/L. We used Cox proportional hazard regression to evaluate the influence of D-dimer on cardiac death. Results The patients in D-dimer≥0.81 mg/L group were older, thinner, more likely to be female, had higher prevalence of hypertension, diabetes, and multivessel disease, lower estimated glomerular filtration rate, higher levels of N-terminal pro-brain natriuretic peptide, and more likely to have left ventricular ejection fraction<50%. The cardiac mortality rate was highest in D-dimer≥0.81 mg/L group. After adjusting for other risk factors, D-dimer remained an independent risk factor of cardiac death in patients of AMI (HR=1.71,95%CI: 1.34-2.18,P<0.001). Conclusion Higher level of D-dimer reflected the severity of disease in patients with AMI. In addition, D-dimer was an independent risk factor of cardiac death in patients with AMI.

M2 macrophage promotes myocardial regeneration by modulating nerve regeneration and angiogenesis in neonatal mice

Wang Qian, Zhang Jiakun, Liu Qing, Sun Lin, Li Jingjie

2022, 43(2):  178-186.  doi:10.3969/j.issn.1006-7795.2022.02.003

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Objective To determine the effects of polarized macrophages on myocardial regeneration and repair. Methods Macrophages were isolated from rat bone marrow and polarized to M1 or M2 microphage in vitro. Apical resection surgery was performed in neonatal mice on postnatal day 1 or day 7. M1 or M2 macrophages were directly injected into the resection site post resection to determine the effects of two types of polarized macrophages on myocardial regeneration and repair. Animals were sacrificed seven days after surgery to evaluate the myocardial repair with histological methods. Nerve regeneration and angiogenesis were also determined by immunohistochemistry and molecular biology analysis. Results Compared with control animals, M1 macrophage administration inhibited myocardial repair by aggravating inflammatory response. In contrast, M2 macrophage implantation significantly improved myocardial regeneration and repair by alleviating inflammation, stimulating sympathetic innervation and enhancing angiogenesis in damaged myocardial tissue. M2 macrophage implantation also increase the levels of vascular endothelial growth factor(VEGF) and nerve growth factor(NGF), two critical factors for neo-angiogenesis and sympathetic innervation respectively, in damaged area in a dose-dependent manner. Conclusion Our study demonstrates that M2 macrophage promotes myocardial regeneration and repair in vivo, suggesting that modulating macrophage polarization may provide a novel therapeutic strategy to heart disease.

Clinical characteristics and risk factors of young and middle-aged patients with calcified aortic valve disease

Ren Chunqi, Kong Yu, Fu Shenggao, Zhu Zhengyan, Du Xin

2022, 43(2):  187-191.  doi:10.3969/j.issn.1006-7795.2022.02.004

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Objective To analyze the clinical characteristics of calcific aortic valve disease in the young and middle-aged patients and explore the possible risk factors in this population group. Methods A total of 141 patients with suspected coronary heart disease aged 18-59 who underwent transthoracic echocardiography and coronary angiography from January 2020 to March 2020 were enrolled in the Department of Cardiology, Beijing Anzhen Hospital,Capital Medical University.Baseline data and associated atherosclerotic risk factors were observed in the patients with calcified aortic valve disease and patients with normal aortic valve. Results Compared with adults with normal aortic valves,the patients with calcified aortic valve disease had higher total cholesterol [(4.45±1.00)mmol/L vs (3.93±0.77)mmol/L, P=0.001)], and lower density lipoprotein cholesterol [(2.73±0.76) mmol/L vs (2.42±0.68) mmol/L P=0.016], and the incidence of coronary heart disease was higher (100% vs 90.7% P=0.03).There are risk factors for atherosclerosis in the young and middle-aged patients with calcified aortic valve disease.The less the risk factors of atherosclerosis, the higher the proportion of smoking, hypertension and abnormal glucose metabolism.Logistic regression analysis of risk factors for calcified aortic valve disease in the young and middle-aged adults showed that high total cholesterol was the influencing factor for calcified aortic valve disease in the young and middle-aged adults (P=0.007, OR=4.882, 95%CI: 1.553-15.347). Conclusion The total cholesterol level and low density lipoprotein-cholesterol level of the young and middle-aged patients with calcified aortic valve disease were higher than those with normal aortic valve at the same age, and more patients with coronary heart disease. High total cholesterol level may be the influencing factor of calcified aortic valve disease in the young and middle-aged patients.

Influence of obesity on the prognosis of patients with STEMI

Miao Zupei, Zhang Yinghua, Xiao Keling, Si Jin, Zhang Haoyu, Li Jing

2022, 43(2):  192-198.  doi:10.3969/j.issn.1006-7795.2022.02.005

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Objective To investigate the effect of obesity level on the prognosis of patients with ST-segment elevation myocardial infarction(STEMI). Methods One thousand five hundreds and fifty-three patients admitted to our hospital from October 2013 to December 2018 were categorized into group A[underweight, body mass index (BMI)<18.5 kg/m²], group B(normal weight, 18.5 kg/m²≤BMI <24 kg/m²), group C(overweight,24.0 kg/m²≤BMI<28.0 kg/m²), and group D(obesity, BMI≥28.0 kg/m²) according to their body mass index (BMI)(kg/m²). Mortality and rates of major adverse cardiovascular and cerebrovascular events (MACCE) were compared between the four groups at hospital and 6-year follow-up. Results Underweight group has more male patients compared with the other three groups, and is older than the other three groups. The overall trend of the rate of revascularization during hospital is rising as BMI increases. The mortality rates of underweight group, normal weight group, overweight group and obesity group during hospitalization were 14.71%, 3.97%, 2.89% and 3.09% (P=0.003), respectively. The mortality of underweight group was significantly higher than the mortality of overweight group and obesity group. The expected five-year all-cause mortality rates shown in the Kaplan-Meier survival curves for patients in underweight group, normal weight group, overweight group and obesity group were 37.0%, 19.5%, 13.8%, and 13.0% (P=0.040), respectively. The expected five-year all-cause mortality is significantly higher in underweight group than in the other three groups. The Cox regression model fitted with restricted cubic spline (RCS) shows that there is a U-shaped relationship between BMI and follow-up death and the risk of MACCE. After correcting the mixed factors with Cox regression model, BMI is not an independent predictor of long-term death or MACCE in STEMI patients. Conclusion The level of obesity had no direct effect on the long-term prognosis of STEMI patients.

Research progress of exosomes miRNA in acute myocardial infarction

Bao Boyi, Li Weiping

2022, 43(2):  199-204.  doi:10.3969/j.issn.1006-7795.2022.02.006

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Exosomes is extracellular vesicles that are released into the extracellular space by the way of exoplasmosis. Exosomes can be used as a carrier to carry miRNA, protein,etc and transmit biological information in long distance. miRNA are endogenous and evolutionarily highly conserved non-coding RNA that combine with target mRNA to form translational repressions to achieve regulation of post transcriptional gene expression, thereby participating in pathophysiological processes such as cell growth and differentiation. Recent studies have shown that exosomes plays a role in the process of acute myocardial infarction by carrying microRNA, and have large prospect in the diagnosis and treatment of acute myocardial infarction. Therefore, this article briefly summarizes the recent research progress of exosomes miRNA in acute myocardial infarction.

Progress of Gastrointestinal Endoscopic Application

The clinical features and endoscopic characteristics of primary gastrointestinal lymphoma

Shao Linlin, Zhu Siying, Xing Jie, Wu Shanshan, Zhu Shengtao, Zhang Shutian

2022, 43(2):  205-209.  doi:10.3969/j.issn.1006-7795.2022.02.007

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Objective To investigate the clinical features and endoscopic characteristics of primary gastrointestinal lymphoma (PGIL). Methods Clinical, endoscopic records and pathological results of PGIL diagnosed by histopathology and immunohistochemistry in Department of Gastroenterology, Beijing Friendship Hospital, Capital Medical University from January 2015 to August 2021 were retrospectively analyzed. Eighty-two patients were enrolled, including 45 males and 37 females, and the median age was 64 years old. Results Fifty-four patients were diagnosed with primary gastric lymphoma (PGL), accounting for 65.9%, and the lesions of most cases involved more than 2 sites. The cases of patients of small intestine lymphoma and colorectum lymphoma were 17 and 11, accounting for 20.7% and 13.4%, respectively. The clinical features were non-specific and varied in patients, of which abdominal pain/discomfort, gastrointestinal bleeding, weight loss and dyspepsia were prominent complains. Anemia and elevated lactate dehydrogenase were found within the blood test of some PGIL patients. Ulcerative lesions with increased brittleness were the most frequent endoscopic features for all the PGIL patients. Most of the pathological types were B cell lymphoma, and diffuse large B-cell lymphoma(DLBCL) was very common. The 5-year accumulate survival rate of gastric lymphoma was better than that of intestinal lymphoma. Conclusions PGIL was particularly prevalent in middle aged male, which was mainly represented with B cell lymphoma and diffuse large B-cell lymphoma was the most common histological subtype. Ulcerative lesions with increased brittleness were the most frequent endoscopic features. It is necessary for clinicians to repeat endoscopy for biopsy and identify the lesions to improve the accuracy of diagnosis.

Diagnostic value of Japan Esophageal Society classification through narrow-band imaging technology combined with magnifying endoscopy for early esophageal cancer

Li Xue, Xing Jie, Zhang Qian, Li Peng, Lyu Fujing, Zhang Shutian

2022, 43(2):  210-215.  doi:10.3969/j.issn.1006-7795.2022.02.008

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Objective To assess the value of narrow-band imaging (NBI) technology combined with magnifying endoscopy (ME) Japan Esophageal Society(JES)classification in the diagnosis of early esophageal cancer. Methods We retrospectively collected 203 suspected early esophageal cancer lesions found by white light endoscopy or biopsy. All lesions were conducted narrow-band imaging magnifying endoscopy(NBI-ME) examination and received endoscopic or surgical treatment in Beijing Friendship Hospital, Capital Medical University from January 2014 to October 2020. The value of JES classification for the diagnosis of invasion depth was analyzed with postoperative histopathology as the “gold standard”. Results The accuracy of JES classification B1 and B2 under NBI-ME in prediction the depth of invasion of early esophageal cancer were 63.5%(95%CI:63.3%-63.8%) and 71.9% (95%CI:71.7%-72.1%), the sensitivity were 65.7% (95%CI:58.0%-73.5%) and 75.0% (95%CI:60.0%-90.0%), and the specificity were 58.3% (95%CI 45.9%-70.8%) and 71.3% (95%CI:64.6%-78.1%), respectively. Comparing the consistency of JES classification under NBI-ME and postoperative pathology to determine the depth of lesions, Kappa value was 0.25 with statistical difference (P<0.01). Conclusion To a certain extent, JES classification could diagnose and predict the depth of early esophageal cancer, with a limited consistency between the prediction results and the gold standard. It is necessary to improve JES classification with more large-sample controlled studies of multi-center large samples.

Correlation between serum Helicobacter pylori antibody typing and gastric mucosal lesions

Su Jiayi, Liu Chuntao, Wang Tieshan, Li Wenkun, Yang Yi, Wu Shanshan, Li Peng, Wu Jing

2022, 43(2):  216-220.  doi:10.3969/j.issn.1006-7795.2022.02.009

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Objective To observe the relationship between Helicobacter pylori (H.pylori) infection with different toxin types and different gastric mucosa lesions, and to explain the clinical significance of antibody typing detection. Methods A total of 568 patients were enrolled who underwent antibody typing of H.pylori and gastroscopy and biopsy from January 2020 to December 2020, and they were grouped by H.pylori infection, age, H.pylori antibody typing, gastroscopic diagnosis and pathological diagnosis. The relationship between H.pylori infection with different toxin types and patients' age, gastroscopic diagnosis and pathological diagnosis was analyzed. Chi-square test was used for statistical analysis. Results The proportion of positive patients greater than or equal to 50 years old, male and H.pylori in chronic atrophic gastritis and intestinal metaplasia group and early gastric cancer group was significantly higher than that in the control group, with a statistical significance (P<0.05). In the chronic non-atrophic stomach group, the positive rates of H.pylori CagA and VacA antibodies in patients<50 years old were significantly higher than those in patients≥50 years old, with statistical significance (P<0.05). However, there was no significant difference in the typing of H.pylori antibody in the chronic atrophic gastritis and intestinal metaplasia group (P>0.05). There were statistically significant differences in H.pylori strain infection among patients with gastric mucosal lesions in the three groups (P<0.05). The infection proportions of high-virulence strain and low-virulence strain in chronic atrophic gastritis and intestinal metaplasia group and early gastric cancer group were higher than those in chronic non-atrophic gastritis group. Conclusion Chronic H.pylori infection is associated with chronic atrophic gastritis, intestinal metaplasia, early gastric cancer and other gastric mucosal lesions, while H.pylori high virulence strain infection is associated with atrophic gastritis, intestinal metaplasia, and early gastric cancer. Chronic atrophic gastritis, intestinal metaplasia, early gastric cancer and other gastric mucosal lesions in patients infected with H.pylori low virulence strain still account for a certain proportion. It remains to explore the reliability of the classification of H.pylori virulence antibody in predicting gastric mucosal lesions in patients and helping to make decisions on whether to eradicate H.pylori.

Application of endocytoscopy in the valuation of colorectal lesions

Ma Mingyang, Wang Jiewei, Li Peng

2022, 43(2):  221-226.  doi:10.3969/j.issn.1006-7795.2022.02.010

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Endocytoscopy (EC) is an ultra-high magnification endoscope. The latest generation of EC can enlarge the image by 520 times. Combined with staining or narrow-band imaging technology, it can observe and diagnose colorectal lesions at the cellular level to achieve in vivo evaluation close to pathological biopsy. We reviewed recent research on EC classification and application of colorectal polyps, tumors, and inflammatory bowel diseases. We also focused on preparation before EC examinations to obtain EC images with better quality.

Research of Neurostimulation Treatment and Rehabilitation for Mental Disease

Brain derived neurotrophic factor as the predictor of efficacy for repetitive transcranial magnetic stimulation in the treatment of refractory depression

Sun Congcong, Wu Han, Zhou Danna, Jiang Wei, Wang Wen, Yang Chunlin, Ma Xin, Ren Yanping

2022, 43(2):  227-232.  doi:10.3969/j.issn.1006-7795.2022.02.011

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Objective To investigate the predictive effect of brain-derived neurotrophic factor (BDNF) on the efficacy of repetitive transcranial magnetic stimulation (rTMS) in the treatment of refractory depression. Methods Fifty-nine patients with refractory depression were randomly divided into treatment group (34 patients) and control group (25 patients). The treatment group received high frequency (10 Hz) rTMS for 2 weeks, while the control group was treated with sham rTMS stimulation. Hamilton Depression Scale-17 Item (HAMD-17) and Hamilton Anxiety Scale (HAMA) were used to evaluate clinical symptoms. Enzyme linked immunosorbent assay (ELISA) was used to examine the level of serum BDNF. The evaluation time point was baseline, 2 weeks after treatment, and 6 weeks follow-up. Results The scores of HAMD-17 and HAMA in the treatment and control groups decreased with the treatment time (P_time<0.05). There was no significant difference between the two groups (P _group>0.05). The response rate of the treatment group (70.59%) was higher than that of the control group (44%) after 2 weeks, with a statistically significant difference (P _group = 0.04). After treatment, the change of BDNF level in the treatment group was significantly more than that in the control group (P _group<0.05). There was a positive correlation between baseline BDNF level and efficacy (P<0.05). No serious adverse events occurred during the treatment. Conclusion rTMS was effective in the treatment of refractory depression. The treatment effect of rTMS was better in patients with high baseline level of serum BDNF than that with low baseline level. BDNF could be used as a predictor of the antidepressant effect of rTMS.

Study of related factors on self-report effects of rehabilitation in schizophrenia patients

Lian Siyuan, Wu Han, Han Jinxiang, Xiao Cunli, Ren Yanping, Jin Wenqing, Wang Wen, Ma Xin

2022, 43(2):  233-238.  doi:10.3969/j.issn.1006-7795.2022.02.012

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Objective To understand the related factors affecting the self-reported effect of rehabilitation in schizophrenia patients and provide basis for improving rehabilitation technique and the recovery of social function in schizophrenia patients. Methods A cross-sectional survey was used to collect the data of schizophrenia patients undergoing mental rehabilitation training by using a self-made rehabilitation questionnaire. Results The Cronbach's alpha coefficients of the questionnaire internal consistency were 0.768 and 0.874. A total of 102 schizophrenia patients were included and divided into effective group and non-effective group according to the self-reported rehabilitation efficacy. There were 78 patients in effective group and 24 patients in noneffective group. There were significant differences of marital status, resident status, friends, rehabilitation times, rehabilitation time, and interpersonal relationship (all P<0.05) between two groups. Logistic regression analysis showed that marriage (OR=0.083, P=0.019), resident status (OR=0.093, P=0.025), friendship (OR=0.011, P=0.001), and rehabilitation times (OR=1.029, P=0.027) were related with efficacy of rehabilitation. Conclusion Self-reported rehabilitation efficacy is a useful supplement to clinical rehabilitation evaluation. Single, no independent space, no friends, and less rehabilitation times were risk factor of rehabilitation efficacy. Targeted rehabilitation training should be carried out according to the situation of patients in order to improve the efficacy of rehabilitation and promote the recovery of social function in patients.

Comparison on the early efficacy and cognitive effect of magnetic seizure therapy and modified electroconvulsive therapy for depressive episodes

Ren Yanping, Zhang Junyan, Wu Han, Luo Jiong, Yang Chunlin, Ma Xin, Jiang Wei

2022, 43(2):  239-243.  doi:10.3969/j.issn.1006-7795.2022.02.013

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Objective To compare the early efficacy and effect on cognitive function of magnetic seizure therapy (MST) and modified electroconvulsive therapy (MECT) in the treatment of depressive episode. Methods A total of 45 patients with depression were treated with MST or MECT respectively. Hamilton Depression Scale-17 Item (HAMD-17), Hamilton Anxiety Scale (HAMA), and Clinical Global Impression Scale (CGI) was used to evaluate clinical symptoms. The Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) and Mini-mental State Examination (MMSE) were used to evaluate cognitive function. The evaluation time points included baseline, after 3 times and 6 times of treatment. Results Repeated measurement ANOVA showed that there was no significant difference in HAMD-17, HAMA, CGI-S and CGI-I scores between the two groups before and after treatment (P_group >0.05). HAMD-17, HAMA and CGI-S scores decreased along with the extension of treatment time (P_time<0.05). The total score of RBANS in both groups increased gradually with the extension of treatment time (P_time<0.05). At each time point, the total score of RBANS in MST group was higher than that in MECT group, with statistically significant difference between the groups (P_group<0.05), and the therapeutic effect of MST increased with time (P_time<0.05). After 3 and 6 times of treatment, there was no significant difference in HAMD score reduction rate between the two groups. Conclusion The early efficacy of MST was comparable to MECT in the treatment of depressive episode. MST improved the cognitive function of patients after 6 treatment times.

Efficacy and safety of transcranial alternating-current stimulation combined with antidepressants in the treatment of depressive episode

Luo Jiong, Sun Congcong, Pan Weigang, Wang Dan, Shi Xiaoning, Wang Qian, Jin Wenqing, Liang Lirong, Yang Chunlin, Ma Xin, Ren Yanping

2022, 43(2):  244-248.  doi:10.3969/j.issn.1006-7795.2022.02.014

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Objective To investigate the efficacy and safety of transcranial alternating current stimulation (tACS) combined with antidepressants in the treatment of depression. Methods Sixty-two patients with depressive episode were randomly divided into treatment group and control group. Both groups took antidepressants. The patients in the treatment group received real tACS while the patients in the control group were treated with sham tACS. The treatment session was 20 times in both groups. The treatment site was prefrontal and bilateral mastoid, with a frequency of 77.5 Hz and intensity of 15 mA. Hamilton Depression Scale-17 Item (HAMD-17) and Hamilton Anxiety Scale (HAMA) were used to evaluate the clinical symptoms at baseline, the end of treatment (4 weeks), and follow-up (8 weeks). Results The scores of HAMD-17 and HAMA in the treatment and control groups at baseline, 4 weeks of treatment, and 8 weeks of follow-up were compared with repeated measurement analysis of variance. The total score of HAMD-17 in the two groups decreased gradually with the extension of treatment and follow-up time (P _time<0.05). The decrease in the treatment group was greater than that in the control group (P _group<0.05), and the effect of treatment increased with the extension of observation time (P_interaction <0.05). The total score of HAMA in both groups decreased gradually with the extension of treatment and follow-up time (P _time<0.05). However, there was no significant difference between the two groups (P _group>0.05). The score reduction rates of HAMD-17 in the treatment and control groups at the end of the fourth week were74.29%±8.40% vs 32.54%±13.30%, respectively. At the end of the 8th week, the score reduction rates of HAMD-17 were 81.00%±10.68% vs 40.27%±12.92%, respectively. The difference was statistically significant (P<0.001). Conclusion tACS combined with antidepressants is effective and safe in the treatment of depressive episodes. It can be used as a new choice for the combined treatment of depressive episodes.

Research advances of modified electroconvulsive therapy for first-episode schizophrenia

Li li, Liu Chaomeng, Ren Yanping, Yang Chunlin, Ma Xin

2022, 43(2):  249-253.  doi:10.3969/j.issn.1006-7795.2022.02.015

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As one of the commonly used physical therapy methods in clinical practice, modified electroconvulsive therapy (MECT) is currently recommended for patients with acute exacerbations of positive symptoms or catatonia. First-episode schizophrenia (FES) usually begins in adolescence or early adulthood, and the prognosis of FES is crucial to the shaping of the patient's personality and the maintenance of social relationships in the later period. Starting from the mechanism of action, this paper summarized the research progresses in the MECT for FES and found that MECT not only takes effect quickly but also shows long-term therapeutic effect in the maintenance period, with good safety. However, there are not enough studies on MECT treatment for FES at present, and the overall quality of the included studies is plain. The reliability of the conclusions needs to be confirmed by multi-center and large sample randomized controlled studies.

Basic Research

Analysis on composition principles of prescriptions for cerebral small vessel disease based on Traditional Chinese Medicine inheritance support system

Wang Hanyu, Zhang Yawen, Guo Xiaoyao, Cheng Hongfa, Zhang Qiuxia

2022, 43(2):  254-259.  doi:10.3969/j.issn.1006-7795.2022.02.016

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Objective To analyze the composition principles of prescriptions of traditional Chinese medicine (TCM) treatment of cerebral small vessel disease. Methods We searched the modern clinical literature of cerebral small vessel disease treated by TCM and Chinese Journal Full-test databases, China Science and Technology Journal Database and China Science Periodical Database from journals during database establishment time to January 2021 and analyzed by association rules analysis, complex system entropy clustering and unsupervised entropy hierarchical clustering with the Traditional Chinese Medicine Inheritance Support System (V2.5). Results A total of 95 prescriptions were collected for the treatment of cerebral small vessel disease. Thirty-two herbs were used more than 10 times in prescription. 4 new prescriptions were formed by further clustering. Conclusion Traditional Chinese medicine treatment for cerebral small vessel disease should be therapy elimination of evils and the restoration of healthy. While the treatment of cerebral small vessel disease is based on activating blood circulation, removing blood stasis, and dredging collaterals, at the same time, we should also pay attention to the use of supportive medicines such as tonifying the kidney and benefiting the Qi.

The role of glucocorticoid receptor in ischemia-reperfusion-induced kidney injury

Wang Xiangdong, Jiang Min, Wang Xin, Gong Yongfeng

2022, 43(2):  260-268.  doi:10.3969/j.issn.1006-7795.2022.02.017

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Objective To investigate the changes and role of glucocorticoid receptor(GR) in ischemia-reperfusion(IR)-induced kidney injury. Methods The left renal pedicle of the mouse was clamped for 45 minutes with a microvascular clip to induce kidney injury.The blood urea nitrogen (BUN) and serum creatinine (Scr) levels were detected with the BUN and Scr kits on the 5th,15th,30th and 80th day. Periodic acid-Schiff (PAS) staining and hematoxylin-eosin (HE) staining were used to measure the inflammatory cells infiltration of renal tissues.The expression levels of kidney injury molecular-1 (Kim-1), inflammatory cell markers F4/80 and CD3 were disclosed by immunofluorescence (IF). The mRNA level of GR was detected with real time quantitative PCR (RT-qPCR), and its protein level was measured with IF and Western blotting(WB) technology. After intraperitoneal injection of mifepristone (MF, 50 mg·kg^-1·d^-1) in IR-induced 8 weeks female mice, the levels of BUN and Scr in the experimental group and the control group were measured, and the expression of Kim-1 and F4/80 were detected with IF. Results BUN and Scr level of the IR group was 4.9 and 8.3 times higher than that of the sham group in 5th day after IR.The mRNA level of inflammatory cells markers in the IR group was 3-5 times higher, respectively, than those of the sham group, and the mRNA level of GR was 3.5 times lower than those of the sham group. The protein level of GR also dropped significantly. At the same time of IR treatment, after injection of MF to block GR, BUN and Scr were increased compared with the control group, indicating that blocking GR would lead to aggravated renal function damage after IR. The expression levels of Kim-1 and F4/80 in the experimental group were prominently upregulated, which indicated that when GR was blocked,the inflammatory response was enhanced and the kidney injury was aggravated. Conclusion This study revealed that there was a significant correlation between the expression of GR and the degree of renal injury in IR induced renal injury and blocking GR could aggravate IR-induced renal injury.

Relationship between polymorphism and mutation of LRP5 and SOST gene with bone metabolism in postmenopausal type 2 diabetic mellitus women in Shihezi,Xinjiang

Song Limin, Li Siyuan, Li Jun, Zhao Huirong, Li Jiajia, Wang Shuang

2022, 43(2):  269-274.  doi:10.3969/j.issn.1006-7795.2022.02.018

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Objective To explore the relationship between SOST gene and low density lipoprotein 5 (LRP5) gene polymorphisms and mutations and bone metabolism in postmenopausal T2DM women in Shihezi area, and to provide reference for the occurrence of postmenopausal T2DM with osteoporosis (OP). Methods The subjects were divided into two groups: normal bone mass group and abnormal bone mass group. Then based on whether they were with type 2 diabetes mellitus(T2DM),the patients were divided into four sub groups:normal glucose with bone mass group,normal glucose with abnormal bone mass group,T2DM group with normal bone mass group,and T2DM with abnormal bone mass group. Calcium (Ca), fasting plasma glucose (FPG), triacylglycerol(TG), alkaline phosphatase(ALP) etc. clinical biochemical data were determined by Automatic biochemical analyzer; dual-energy X-ray absorptiometry (DXA) method to detect bone mineral density (BMD); and the polymorphisms of the LRP5 and SOST gene were detected by time-of-flight mass spectrometry (TOF-MS). Results (1)The rs901825 polymorphism of the LRP5 genotype distribution was statistically significant (P<0.05) in group D compared with group A. The rs7125942 polymorphism of the LRP5 genotype distribution was statistically significant (P<0.05) in group B compared with group A. (2)In group D, at the SOST rs10534024 site, BMD of TCC.DEL/TCC.TCC genotype (mutant) was lower than that of DEL.DEL genotype (wild-type)(0.69±0.13 vs 0.76±0.10,P<0.05); LRP5 gene rs7125942 locus, on TG, CC genotype (wild type) and CG genotype (mutant type) were 4.12±0.79 and 3.22±1.04, respectively, the former was significantly higher (P<0.01); In group B, at the SOST rs851054 site, TG of GG genotype (wild-type) was higher than that of AG/AA genotype (Mutant) (2.11±1.19 vs 1.30±0.80,P<0.05). (3)Interaction analysis showed that the interaction between rs851054 of SOST gene and rs7125942 of LRP5 gene affected BMD(femoral neck) (P<0.05). The interaction between SOST gene and LRP5 gene has an effect on BMD (femoral neck) (P<0.01). Multiple linear regression analysis found rs10534024 of SOST gene, TG and body mass index were positively correlated with BMD(L1-4). Rs7125942 of LRP5 gene and menopause duration were negatively correlated with BMD (femoral neck). Conclusion The polymorphism and frequency distribution of LRP5 gene rs901825 and rs7125942 in postmenopausal women in Shihezi may be related to bone metabolism; The genetic mutation of rs7125942 locus of LRP5 gene may be related to lipid metabolism of postmenopausal women. The mutation of rs10534024 of SOST gene may be related to BMD in postmenopausal women in Shihezi. The interaction between SOST gene and LRP5 gene is a risk factor for BMD (femoral neck) reduction.

The study of the mechanism of Xuduan promoting fracture healing based on network pharmacology and molecular docking

Zhang Jin, Wang Dong

2022, 43(2):  275-283.  doi:10.3969/j.issn.1006-7795.2022.02.019

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Objective To analyze the mechanism of Xuduan promoting fracture healing by network pharmacology and molecular docking technology. Methods The active components of Xuduan were acquired through traditional Chinese medicine systems pharmacology database and analysis platform (TCMSP) database by setting the oral drug bioavailability (OB)≥30% and drug like index (DL)≥0.18 as screening criteria, and the target genes of the active components were obtained. The bone fracture related genes were obtained by searching TTD, OMIM, Genecards, Drugbank and PharmGkb databases. The main target genes were obtained by matching the target genes of Xuduan active components with fracture related genes. The results were visualized by EVenn. Gene ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) enrichment analysis of main target genes were analyzed by DAVID database and protein interaction network was constructed by STRING databases. Key genes in main target genes were obtained by degree and betweenness algorithms. Finally, Pymol and Autoduck softwares were used for molecular docking and calculating the minimum binding energy, binding site and fixed active pocket. Results Totally 8 active components and 63 target genes of Xuduan were screened by TCMSP database, and 53 target genes were obtained by deleting repeated target genes. Totally 5 115 genes related to bone fracture were obtained from TTD, OMIM, GeneCards, DrugBank and PharmGkb databases. Totally 34 main target genes were obtained by matching and intersection analysis. The 34 target genes were enriched in 76 biological processes, 20 cellular components and 20 molecular functions through DAVID database analysis. The protein interaction network was constructed by STRING database. A total of 34 genes and 79 connections were included. The average degree parameter was 4.65. Xuduan promoting bone healing key genes were PTGS2, HSP90AA1 and MAPK14 by calculating degree and betweenness in Cytoscape software. The active components with optimal bioavailability, as (E,E)-3,5-Di-O-caffeoylquinic acid, Gentisin and Sylvestroside Ⅲ_qt could bind with the key genes PTGS2, HSP90AA1 and MAPK14 at a less than 0 energy. The binding sites were obtained by Pymol and Autoduck software. Conclusion Through network pharmacology and molecular docking technology, the possible potential mechanism of Xuduan promoting fracture healing were clarified, and its effective components and key genes were predicted.

Clinical Research

Comparison of the correlation between muscle mass corrected by different methods and physical function in older adults with type 2 diabetes mellitus

Xiu Shuangling, Sun Lina, Mu Zhijing, Fu Junling, Zhao Lei

2022, 43(2):  284-288.  doi:10.3969/j.issn.1006-7795.2022.02.020

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Objective To explore effects of muscle mass modified by different methods on physical function in old people with type 2 diabetes mellitus (T2DM). Methods A total of 248 old people with T2DM aged more than 60 years were included in the study. Levels of hemoglobin(Hb), glycosylated hemoglobin A1c(HbA1c), fasting plasma glucose (FPG), vitamin D were measured and grip strength, gait speed, timed go and up (TUG) time were assessed. Body mass index (BMI) was calculated. Furthermore, appendicular skeletal muscle mass(ASM) was assessed by dual energy X-ray absorptiometry (DXA) and were adjusted by height square (ASM/ht²) and BMI (ASM/BMI) accordingly. The influencing factors for physical function were evaluated. Results The partial correlation analysis showed that ASM/BMI was associated with grip strength, gait speed and TUG time (r=0.636, P<0.001;r=0.191, P=0.003;r=- 0.143, P=0.026; respectively), while ASM/ht² was only associated with grip strength (r=0.513, P<0.001). In a multiple logistic analysis, low ASM/BMI was associated with increased risk of low gait speed and long TUG time (OR=4.73,95%CI: 1.54-14.60,P=0.007; OR=2.92,95%CI: 1.12-7.63,P=0.029, respectively), while ASM/ht² had no significant effect on physical function. Conclusion Low ASM/BMI but not low ASM/ht² was significantly associated with poor physical function in older adults with T2DM. ASM/BMI may be a more suitable method of muscle mass correction for T2DM patients.

Icotinib plus antiangiogenic agent as the first-line treatment for advanced EGFR mutant lung adenocarcinoma: a single-center study

Yao Shuyang, Li Xiaoxue, Wang Chunxiu, Zhang Yi

2022, 43(2):  289-293.  doi:10.3969/j.issn.1006-7795.2022.02.021

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Objective To assess the efficacy and safety of icotinib plus antiangiogenic agent for epidermal growth factor receptor (EGFR) mutation non-small cell lung cancer (NSCLC). Methods From June 1, 2018 to December 31, 2019, in the Department of Thoracic Surgery of Xuanwu Hospital, Capital Medical University, we summarized the experience with icotinib plus antiangiogenic agent as the first-line treatment in 37 patients with advanced EGFR mutant lung adenocarcinoma. The patients received icotinib (125 mg, three times per day) combined with bevacizumab (7.5 mg/kg, every three weeks) or icotinib (125 mg, three times per day) combined with anlotinib (10-12 mg, daily, day 1-14) until disease progression or unacceptable toxicity. Each regimen was 21-day per cycle. The median follow-up was 14.5(9.2-30.8)months. Results In this study, 62.2％(23/37) achieved partial remissions and 37.8％ (14/37) achieved stable diseases. The objective response rate was 62.2％(23/37) and disease control rate was 100%. The median progression-free survival was 17.9(95%CI:10.292-25.508)months.One-year overall survival (OS) rate was 83.8％ and 18-month OS 81.1％.According to multivariate analysis, patients with liver metastasis or brain metastasis had significantly worse prognosis (P<0.05). Rash (43.2%, 16/37)and diarrhea(21.6%, 8/37) were predominant adverse events. Conclusion The combination of icotinib and antiangiogenic agent appears to be an efficient and well-tolerated regimen as first-line treatment for advanced EGFR mutant lung adenocarcinoma patients.

A comparative study of self esteem between schizophrenics and normal people

Guo Chengwei, Zhou Jiaojiao, Feng Yuan, Yang Yunping

2022, 43(2):  294-298.  doi:10.3969/j.issn.1006-7795.2022.02.022

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Objective To compare the difference of self-esteem between schizophrenic patients and normal population, and to explore the relationship between self-esteem and symptoms in schizophrenic patients. Methods Totally 90 schizophrenic patients and 30 normal controls were evaluated by Rosenberg Self-esteem Scale and Positive and Negative Syndrome Scale (PANSS). Results There was no significant statistical difference in total score and positive factor score between the two groups (total score P>0.05, positive factor score P>0.05), but there was significant statistical difference in negative factor score between the two groups (P<0.05).The total score of Rosenberg Scale was significantly correlated with the symptoms of concept disorder (P<0.05), the positive factor score was significantly correlated with the scores of concept disorder, excitability and exaggerated symptoms (P<0.05), and the negative factor score was significantly correlated with the scores of excitability and stereotypical thinking symptoms (P<0.05). Conclusion There is no difference in the overall level of self-esteem between schizophrenics and the normal population, but there is difference in the self-esteem component, which is reflected in the higher level of negative self-esteem than the normal population. There was significant correlation between the level of self-esteem and the symptoms of concept disorder.

Prognostic value of peripheral blood inflammation-based markers in metastatic pancreatic cancer

Sun Jing, Shi Youwu, Jia Jun, Yang Ying, Sun Zhiwei, Du Feng, Yu Jing, Xiao Yanjie, Zhang Xiaodong

2022, 43(2):  299-304.  doi:10.3969/j.issn.1006-7795.2022.02.023

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Objective To evaluate significance of the inflammation-based prognostic markers, including neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), lymphocyte-monocyte ratio (LMR), albumin (ALB) and combined inflammation-based markers in metastatic pancreatic cancer. Methods The clinical data of 50 patients with metastatic pancreatic cancer admitted to VIP-Ⅱ Department of Peking University Cancer Hospital from July 2012 to October 2020 were collected retrospectively. Receiver operating characteristic (ROC) curve analysis were performed to determine the cut-off values of NLR, LMR, PLR and prognostic nutritional index (PNI). The accuracy of the prognostic indicators were evaluated by area under curve(AUC). The prognostic significance of the clinical characteristics and inflammation-based markers were evaluated by univariate and multivariate analysis. Results In 50 patients with metastatic pancreatic cancer, the median overall survival was 7.2 months (95%CI:3.568-10.699). The optimal cut-off of inflammation-based markers were: NLR=4.5 (AUC=0.840, 95%CI:0.732-0.948, P<0.001), PLR=138 (AUC=0.671, 95%CI:0.517-0.826, P=0.038), LMR=4.0 (AUC=0.873, 95% CI:0.770-0.975, P<0.001), ALB=41.5(AUC=0.726, 95% CI:0.582-0.870, P=0.006), respectively. Univariate and multivariate analysis showed that NLR≥4.5 (HR=11.936, 95%CI:4.571-31.169, P<0.001), PLR≥138 (HR=2.246, 95%CI:1.045-4.828, P=0.038), ALB<41.5 g/L (HR=3.214, 95%CI:1.463-7.060, P=0.004) were independent risk factors; LMR≥4 (HR=0.336, 95%CI:0.165-0.687, P=0.003) was an independent protective factor. NLR_ALB, PLR_ALB and LMR_ALB were independent prognostic indicators, and the higher the score, the worse the prognosis. Conclusion Peripheral blood inflammation-based marker NLR, LMR, PLR and ALB can be used as prognostic indicators for metastatic pancreatic cancer, the combined inflammation-based markers will promote simple and rapid prognosis assessments and has a certain clinical application prospect.

The prognostic importance of left ventricular systolic function in patients with acute inferior ST-segment elevation myocardial infarction undergoing percutaneous coronary intervention

Sun Hao, Zheng Meili, Guo Zongsheng, Zhang Zhiyong, Li Xiaotao

2022, 43(2):  305-310.  doi:10.3969/j.issn.1006-7795.2022.02.024

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Objective To study the impact of left ventricular (LV) systolic function on outcomes of patients with acute inferior ST-segment elevation myocardial infarction (STEMI) undergoing percutaneous coronary intervention (PCI). Methods Left ventricular ejection fraction (LVEF) was determined in 161 acute inferior STEMI patients undergoing PCI, who were divided into two groups according to LV systolic function: (1) LV systolic dysfunction group (LVEF<50%); (2) normal LV systolic function group (LVEF≥50%). Study primary endpoints included major adverse cardiac events (MACE) defined as the composite of cardiac death, myocardial infarction, and ischemia-driven revascularization, and stroke. Results There was no significant difference in age, gender, medical history, Killip grade and time of symptom onset between the two groups (P>0.05). The average number of disease vessels and thrombus burden were higher in LV systolic dysfunction group (P<0.05), other baseline angiographic and procedural characteristics in this study were similar between the two groups (P>0.05). During the 1-year follow-up, the incidence of MACE was similar between the two groups in this study (Log-rank P>0.05). Conclusion Among patients with acute inferior STEMI undergoing PCI, the incidence of clinical adverse events in patients with LV systolic dysfunction was similar to that in patients with normal LV systolic function during 1-year follow-up.

Review

Research and progress on three types of dietary patterns and chronic diseases

Yang Liuqing, Tian Hongmei, Shi Hanping

2022, 43(2):  311-320.  doi:10.3969/j.issn.1006-7795.2022.02.025

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The incidence of chronic metabolic diseases keeps increasing worldwide which most of the medical care systems cannot be maintained. Despite the complex etiology, many metabolic diseases can still be prevented by changing and practicing an appropriate dietary pattern and involving in physical activities for a long time. A lot of evidence shows that a healthy diet pattern can reduce the risk of diet-related chronic metabolic diseases, such as diabetes, cardiovascular disease, hypertension, obesity, and cancer. This review discusses three dietary patterns which are highly praised globally and interprets the relationship between them and chronic metabolic diseases.