Table of Content

21 June 2023, Volume 44 Issue 3

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A view of sulforaphane interference with microtubules and mitochondrial kinetics in anti-cancer mechanisms

2023, 44(3):  363-369.  doi:10.3969/j.issn.1006-7795.2023.03.001

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Sulforaphanes (SFNs) are naturally active substances extracted from cruciferous plants such as broccoli, cabbage, and carrot. SFNs metabolize to produce sulforaphane N-acetylcysteine (SFN-NAC), sulforaphane cysteine (SFN-Cys) and sulforaphane glutathione (SFN-GSH). Sulforaphane inhibits the growth of many tumor cells and has low toxicity to normal tissues, but its circulating half-life is only 2 h. However, either SFN-NAC or SFN-Cys has a longer half-life in circulation. After injected into mice, SFN-NAC and SFN-Cys are excreted through urine after 72 h. For more than ten years, we have systematically studied the anti-cancer mechanisms of SFN and their metabolites (SFNs). Except for their different half-lives, the anti-cancer mechanisms of SFNs are highly consistent. We found that SFNs are a class of microtubule inhibitors that cause tumor cell growth inhibition and apoptosis by interfering with the structure of microtubules, regulating microtubule dynamic balance, and inhibiting mitochondrial function.

Gender differences and the prediction of type 1 diabetes incidence rate in Beijing from 2013 to 2018

Liu Chang, Guo Moning, Yuan Yingchao, Zheng Jianpeng, Yang Jinkui

2023, 44(3):  370-374.  doi:10.3969/j.issn.1006-7795.2023.03.002

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Objective To study the incidence of type 1 diabetes （T1DM） among males and females among permanent residents in Beijing from 2013 to 2018. Methods From 2013 to 2018, 4 275 new patients with T1DM were diagnosed in 153 centers in 16 districts of Beijing (representing a permanent population of about 20.12 million people per year). The annual incidence of T1DM and the annual incidence rate with 95% confidence interval (CI) by age group and gender were calculated by using Poisson regression and other methods. The relationship was evaluated between the incidence trend of T1DM and the age and gender. We use the gray prediction model (1, 1) ［GM (1, 1)］ to predict the incidence of T1DM in the future. Results The incidence of T1DM in the permanent population of Beijing increased from 3.10 per 100 000 ［95%CI: 3.10 (2.90, 3.30) ］ to 3.60  per 100 000 ［95%CI: 3.60 (3.56, 3.86) ］ within 6 years. The incidence of T1DM increased in both male and female ［annual percentage change (APC) in male: 3.96%, APC in female: 4.4%, (P<0.05)］.  Gender was a risk factor affecting the incidence of T1DM. By 2024, the incidence of new T1DM in Beijing would increase to 4.96  per 100 000 for male, and  for female  5.10  per 100 000. Conclusion The incidence of T1DM in Beijing is relatively low, but the incidence of T1DM in both males and females is increasing rapidly. The incidence of males is higher than that of females, but the incidence of females is more obvious, which urgently needs the attention of the society and the government. Further surveillance and research is needed to better understand possible risk factors and develop prevention strategies.

Analysis of haptoglobin gene polymorphisms and serum haptoglobin levels in patients with diabetes kidney disease

Li Yuyang, Zhu Xiaorong, Liu Jing, Zheng Xiaomin, Yang Jinkui, Yang Fangyuan

2023, 44(3):  375-380.  doi:10.3969/j.issn.1006-7795.2023.03.003

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Objective To investigate the relationship between haptoglobin (Hp) gene polymorphisms, serum Hp levels and diabetic kidney disease（DKD）. Methods Hp genotypes and serum Hp levels were detected by acrylamide gel electrophoresis (PAGE) and BN Ⅱ protein analyzer in 461 patients with type 2 diabetes, who were hospitalized in the Department of Endocrinology，Beijing Tongren Hospital，Capital Medical University from June 2018 to February 2019. The study subjects were divided into two groups: the control group patients with simple diabetes (212 cases) and the case group  patients with complicated  chronic kidney disease (249 cases). The frequency of haptoglobin genotype, allele frequency, serum haptoglobin level and other biological indicators were compared to each other between the two groups, and statistical analysis was performed using PRISM statistical software. Results The results showed that the frequency distribution of the three genotypes Hp1-1, Hp2-1 and Hp2-2 was not statistically different in the two groups (P=0.711). Serum Hp levels were significantly higher in the case group than that in the control group (P<0.05). There were significant differences in serum Hp levels among subjects of different genotypes. In both groups, the Hp1-1 subtype had the highest serum Hp concentration, while the Hp2-2 subtype had significantly lower serum Hp levels (P<0.001). Correlation analysis showed that there was a correlation between serum Hp and hemoglobin levels. Conclusion Serum Hp levels were significantly elevated in patients with diabetic chronic kidney disease, but no significant association was found between Hp genotype and DKD. However, Hp genotype may affect the content of circulating Hp.

Correlation between triglyceride glucose index and severity of coronary artery disease in patients with newly diagnosed coronary heart disease

Gao Xia, Hu Yanjin, Yao Zhi, Wang Guang

2023, 44(3):  381-386.  doi:10.3969/j.issn.1006-7795.2023.03.004

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Objective To explore the association between triglyceride glucose (TyG)  index and degree of coronary artery lesion in patients with newly diagnosed coronary heart disease (CHD).  Methods A total of 290 patients admitted in the department of cardiology, Beijing Chaoyang Hospital, Capital Medical University, for coronary angiography because of chest pain were included in the study. The level of fasting blood glucose (FBG), glycosylated hemoglobin  A1c（HbA1c），triglyceride (TG) and other biochemical indicators were measured, and then the TyG index was calculated by using the value of FBG and TG. All patients were divided into non-CHD group and CHD group based on the coronary angiography results. The patients of CHD group were further stratified into groups based on the number of diseased vessels: single-vessel coronary artery disease（CAD）, double-vessel CAD, and three-vessel/left main CAD according to the degree of stenosis. Multiple Logistic regression analysis was used to evaluate the association of three-vessel/left main CAD and other parameters in CHD patients.  Results The patients of CHD group exhibited higher level of FBG and HbA1c compared with the subjects of non-CHD group ［FBG: （6.12±2.41）mmol/L  vs  （5.33±1.82）mmol/L，P<0.05； HbA1c：6.79%±1.57%  vs  6.32%±1.08%, P<0.05］.  TyG index in the three-vessels/left main disease group（8.87±0.73） was higher than that in the single （8.63±0.62）and double-vessel CAD groups （8.62±0.68）（P<0.05）. Multiple Logistic regression analysis showed age, TyG index, TG, FBG, and HbA1c were independent risk factors for three-vessel/left main CAD, and the adjusted OR value (95% confidence interval) was 2.079 (1.345, 3.213) for each additional SD of TyG index.  Conclusion TyG index was elevated in patients with three-vessel/left main CAD and it was significantly related to the risk of three-vessel/left main CAD.

Higher hemoglobin glycation index is associated with higher risk of carotid plaques

Wei Ying, Wang Guang

2023, 44(3):  387-392.  doi:10.3969/j.issn.1006-7795.2023.03.005

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Objective To investigate the association between hemoglobin glycation index (HGI) and carotid plaques in a large cohort in China.Methods The study recruited participants who underwent physical examinations from April 2016 to August 2021 in Beijing Chaoyang Hospital, Capital Medical University. Fasting blood glucose and hemoglobin A1c (HbA1c) were utilized to calculate the formula of the HGI. The HGI was categorized according to terciles (Q1, Q2, Q3), with Q1 as the reference.  Logistic regression was applied to explore the predictive factors of carotid plaques.Results There were 1 106 participants in the study. Subjects in the highest tercile of HGI had the largest percentage of people who were older than 45 years old. They also showed the most severe metabolic risks, including a higher percentage of hypertension, hyperlipidemia, diabetes, a higher level of total cholesterol, triglyceride, low density lipoprotein-cholesterol, and HbA1c. Participants in the highest tercile of HGI had the largest percentage of people with carotid plaques (Q1∶Q2∶Q3: 23.8%  vs  23.9%  vs  39.6%, P<0.001). After the adjustment of age, gender, body mass index (BMI), hypertension, hyperlipidemia, diabetes, estimated glomerular filtration rate (eGFR), and uric acid, there were 1.47 (95%CI: 0.98－2.20, P=0.06) and 1.66 (95%CI: 1.14－2.43, P=0.008) times higher odds of having carotid plaques among people in the medium and the highest HGI terciles respectively, compared to people in the lowest tercile of HGI.Conclusions Increased HGI was associated with various cardiometabolic risk factors and was an independent predictor of carotid plaques. A calculation of HGI may help to evaluate the personalized risk for cardiometabolic diseases.

Effect of triglyceride-glucose index in evaluating adipose tissue insulin resistance

Li Xiaohui, Yin Jie, Liu Bing, Yu Hengchi, Zhu Yingna, Ma Chifa, Yuan Mingxia

2023, 44(3):  393-399.  doi:10.3969/j.issn.1006-7795.2023.03.006

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Objective Triglyceride-glucose (TyG) index is a simple surrogate indicator for insulin resistance (IR). Ectopic fat deposition caused by adipose tissue IR (adipose-IR) can lead to glucose and lipid metabolism disorders. This study aimed to investigate the value of TyG index in evaluating adipose-IR. Methods A total of 419 patients with abdominal obesity were enrolled in the study from Beijing Friendship Hospital, Capital Medical University from April 2019 to March 2022. The general clinical data and metabolic related indicators, including fasting plasma glucose, insulin, serum lipid, glycosylated hemoglobin  A1c (HbA1c), free fatty acid were evaluated. According to median value of TyG index, participants were divided into high-TyG group(n=209) and low-TyG group(n=210). The glycometabolic and lipid metabolism indexes and adipose-IR index between the two groups were compared, and Logistic regression analysis was performed with TyG index and adipose-IR index. Results The average age ［(34.28±0.66） years vs （30.86±0.58） years, P<0.001］ and proportion of males (36.36% vs 31.28%, P<0.001) were significantly higher in the high-TyG group than in low-TyG group. Compared with the low-TyG group, the adipose-IR index ［144.3(77.87, 241.9) vs 104.1(63.40, 174.1), P<0.001］ and homeostasis model assessment of insulin resistance (HOMA-IR) index ［9.72(6.28, 14.17) vs 6.00(3.64, 9.84), P<0.001］ were significantly increased in the high-TyG group. The homeostasis model assessment of β-cell function (HOMA-β) index in the high-TyG group was significantly lower than that in the low TyG group (P<0.001). The TyG index positively correlated with adipose-IR index (r=0.310, P<0.001), HOMA-IR index (r=0.432, P<0.001) and HbA1c (r=0.553, P<0.001), and negatively correlated with HOMA-β (r=－0.397, P<0.001). Bivariate Logistic regression analysis revealed that TyG index was an independent influencing factor for adipose-IR, with an odds ratio (OR) of 1.004(95%CI:1.001－1.009). Conclusion TyG index was positively correlated with adipose-IR index. High TyG index predicted more severe adipose-IR. TyG index might be used as a simple method to evaluate adipose-IR in obese patients.

Analysis and treatment of dawn phenomenon in elderly patients with type 2 diabetes mellitus

Zheng Xiaomin, Li Bin, Liu Cuiping, Zhou Yingsheng, Cui Limei

2023, 44(3):  400-406.  doi:10.3969/j.issn.1006-7795.2023.03.007

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Objective To analyze the characteristics and related factors of the dawn phenomenon in elderly patients with type 2 diabetes using the continuous glucose monitoring system and explore the effective therapies. Methods A total of 94 patients with type 2 diabetes aged 65 or older were selected from the Department of Endocrinology, Chuiyangliu Hospital Affiliated to Tsinghua University from July 2019 to March 2020. The general clinical data were collected, clinical biochemical level, fasting C-peptide, and fasting insulin were tested．Fundus photography, arterial ultrasonic doppler and quantitative detection of sensory nerves were performed on the patients.  The continuous glucose monitoring system was carried out for three days. According to the results of continuous glucose monitoring system, 46 cases were divided into patients without dawn phenomenon group(non-dawn phenomenon group, NDP group) and 37 cases with dawn phenomenon group(dawn phenomenon group, DP group). The patients with dawn phenomenon undertook continuous glucose monitoring system again 3 months after adjusting treatment. Results The incidence of DP in elderly patients with type 2 diabetes was 39.36% (37/94). Patients in the DP group had lower body mass index and fasting insulin levels（P=0.029 and P<0.001）, higher fasting blood glucose and hemoglobin A1c （P<0.001 and P=0.032）compared with those in the NDP group. The glycemic variation (GV) metrics in DP group were statistically higher than those in the NDP group（P value all<0.05）．The incidence of diabetic peripheral neuropathy in the DP group (86.49%) was higher than that in the NDP group (67.39%)（P=0.043）. Logistic regression analysis with the dawn phenomenon as the dependent variable showed that low fasting insulin and low body mass index were independent risk factors for dawn phenomenon. Of the 37 patients with DP, 18 were given basal insulin or titrated insulin dose, 11 were given metformin or added dose,  7 were given dipeptidyl peptidase-4 inhibitor (DPP-4i)， and one was given glucagon-like peptide-1 receptor agonist. Five of the patients given insulin and DPP-4i combined with metformin, and another five patients only adjusted their lifestyle. After 3 months of treatment, the fasting blood glucose and the glycemic variation metrics were significantly reduced (P all<0.05), and the fasting blood glucose compliance rate (≤ 7.0 mmol/L) was 72.97% (27/37). Conclusion Dawn phenomenon is common in elderly patients with type 2 diabetes and is the main cause of fasting hyperglycemia. Low fasting insulin and low body mass index were independent risk factors for dawn phenomenon. Dawn phenomenon is associated with large glycemic variation and may lead to an increased risk of diabetic peripheral neuropathy. Basal insulin, metformin, and DPP-4i are clinically effective methods to improve dawn phenomenon.

Analysis of the correlation between levels of cytokines and the clinical active severity in patients with Graves ophthalmopathy

Xie Rongrong, Shi Tingting, Xin Zhong, Cao Xi, Yang Jinkui

2023, 44(3):  407-412.  doi:10.3969/j.issn.1006-7795.2023.03.008

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Objective To explore the correlation between plasma levels of 12 cytokines and the clinical activity of the disease in patients with Graves' ophthalmopathy (GO) in active and inactive phases. Methods A total of 27 patients with GO were enrolled, who were diagnosed in the  Department of Endocrinology,  Beijing Tongren Hospital, Capital Medical University from January 2021 to January 2023. According to their Clinical Activity Score (CAS), the patients were divided into active phase group (14 cases, CAS ≥ 3) and inactive phase group (13 cases, CAS<3)  The levels of 12 cytokines in plasma were measured by multiple microsphere flow immunofluorescence luminescence method, including interleukin (IL)-1β IL-2, IL-4, IL-5, IL-6, IL-8, IL-10, IL-17, IL-12P70, interferon (IFN)-α, IFN-γ, and tumor necrosis factor (TNF)-α. The clinical characteristics such as gender, age, liver and kidney function, thyroid function, and antibody of all the subjects were collected. Results The levels of IL-1, IL-4, IL-5, IL-8, IL-10, IL-17,  IFN-γ and TNF-α  in active GO patients were significantly higher than those in inactive GO patients. Levels of TNF-α and IFN-γ were significantly increased in active GO patients, with statistically significant difference (P<0.05). Spearman correlation analysis showed that IL-1, IL-4, IL-5, IL-8, IL-10, IL-17, TNF-α and IFN-γ were significantly positively correlated with CAS score （P< 0.05）. The univariate logistic regression showed that the elevated levels of IL-1, IL-4, IL-5 and IL-17 increase the risk of active phase. Conclusion The levels of IL-1, IL-4, IL-5, IL-8, IL-10 and IL-17 in active GO patients are significantly higher than those in inactive patients, suggesting that these cytokines may participate in the immune response of the disease. Elevated levels of IL-1, IL-4, IL-5 and IL-17 increase the risk of active phase, indicating a potential of these four cytokines as indicators for judging the activity of GO disease.

Research progress of cathepsin in the mechanism of diabetes and diabetic nephropathy

Li Mingjia, Zhao Miaomiao , Yang Jinkui

2023, 44(3):  413-419.  doi:10.3969/j.issn.1006-7795.2023.03.009

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Cathepsin is one of the most important proteolytic enzymes in mammals, which exists both intracellularly and extracellularly. It participates in various physiological and pathological processes in vivo such as regulating autophagy, cell apoptosis, maintaining extracellular matrix homeostasis, antigen presentation, viral infection and inflammation. In recent years, cathepsin B (CTSB), cathepsin D (CTSD), cathepsin L (CTSL), and cathepsin S (CTSS) have been considered to be the main players in metabolic diseases. They are involved in the pathogenesis and progression of  mellitus (DM） and diabetic nephropathy (DN) and may become potential new targets for prediction and treatment. This article reviews the role and mechanism of CTSB, CTSD, CTSL, and CTSS in DM and DN.

Progress in the pathophysiology of diabetes retinopathy

Feng Xiaotong, Ke Jing, Zhu Lin, Zhao Dong

2023, 44(3):  420-423.  doi:10.3969/j.issn.1006-7795.2023.03.010

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Diabetic retinopathy (DR), one of the important causes of blindness in adults, seriously threatens the life quality of patients with diabetes mellitus and brings heavy economic burden to the society. Previous studies have shown that the impairment of neurovascular unit (NVU) plays an important role in the occurrence and development of DR, including retinal vascular endothelial cells damage, impairment of cell junctions, loss of pericytes, pericyte-endothelial cells communication impairment and so on.

Oncologic and functional outcomes after laparoscopic radical prostatectomy:10-years follow-up

2023, 44(3):  424-432.  doi:10.3969/j.issn.1006-7795.2023.03.011

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Objective To assess long-term urinary control function, sexual function and disease recurrence, overall mortality, and risk of death from prostate cancer after laparoscopic radical prostatectomy(LRP). Methods Oncologic outcomes and functional outcomes were analyzed retrospectively in 99 patients who underwent LRP from June 2009 to December 2013.  Finally 80 patients were included in the study according to the exclusion criteria. Cox regression was used to analyze the risk factors for overall survival(OS), cancer-specific survival(CSS), and radiologic progression-free survival(rPFS) after LRP. Results The 5-year and 10-year OS rates after LRP were 86% and 70%, the CSS rates were 91% and 85%, and PFS rates were 87% and 76%, respectively. Pathological Gleason score and failure to achieve clinical cure after surgery were independent risk factors for OS, pathological Gleason score was an independent risk factor for CSS, and the highest preoperative prostate specific antigen (PSA) level > 20 ng/mL was an independent risk factor for PFS, but failure to achieve clinical cure after surgery had a marginal significance on CSS and PFS. The rate of urinary continence was 76.8%, 21.4% had urinary incontinence to varing degree, 51.8% had no sexual stimulation or arousal, 12.5% had normal sexual activity, and 35.7% had erectile dysfunction insufficient to maintain normal sexual activity, and the incidence of erectile dysfunction was higher in patients without preserving vascular nerve bundles than  those with preservation during LRP. Conclusion The 10-year long-term outcomes of oncology and urinary continence after LRP are similar to the previous reports, LRP is an optimal option to achieve satisfactory oncological and functional outcomes for patients with prostate cancer. 

Analysis of risk factors for second primary malignancies after radical prostatectomy for non-metastatic prostate cancer

Zhu Guangyi, Wang Runjin, Xiong Tianyu, Ye Xiaobo, Liu Zhanliang, Cao Fang, Lin Zhemin, Niu Yinong

2023, 44(3):  433-438.  doi:10.3969/j.issn.1006-7795.2023.03.012

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Objective To  investigate the risk factors for secondary primary malignancies (SPM) after radical prostatectomy of non-metastatic prostate cancer. Methods The clinical data of patients diagnosed with T1－4N0M0 prostate cancer from 2010 to 2015 were screened from the Surveillance, Epidemiology, and End Results (SEER) database. Patients were divided into operation group, operation plus radiotherapy group, and operation plus chemotherapy group according to the treatment methods. The incidence and common sites of SPM under different treatment methods were compared. Results A total of 243 094 patients were included in this study, and 19 344 patients (8.0%) developed SPM. The median time for SPM was 36 months.The top five most common organs of SPM were lungs and bronchus, bladder, skin, kidney and renal pelvis, and colorectal. Logistic regression analysis showed that race, age, chemotherapy and radiotherapy were independent factors influencing SPM. The incidence of SPM in the surgery plus chemotherapy group (19.7%) was significantly higher than that in operation group (6.4%) and operation plus radiotherapy group (8.3%) (P<0.05), but  no significant difference of SPM involved system among three group. The mainly four involved systems were digestive system, urinary system, immune system and respiratory system. Conclusion The incidence of SPM is increased in patients receiving surgery plus radiotherapy or surgery plus chemotherapy, especially in the latter group.The SPM distributed at similar sites, but more likely occurred in the digestive system in patients receiving surgery plus radiotherapy. For prostate cancer patients with different treatment methods, attention should be paid to the occurrence of SPM in addition to the vigilance of recurrence and metastasis of prostate cancer.

Effect of different invasion patterns on the prognosis of patients with T3a renal cell carcinoma

Wang Runjin, Ye Xiaobo, Zhang Yudong, Zhu Guangyi, Yang Kun, Niu Yinong

2023, 44(3):  439-448.  doi:10.3969/j.issn.1006-7795.2023.03.013

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Objective To   explore the effect of extrarenal fat invasion (EFI) and renal vein invasion (RVI) on the prognosis of T3a renal cell carcinoma (RCC)  patients, in order to provide a better therapy scheme. Methods The basic and clinicopathological information of 8 965 patients with T3a stage was collected from the Surveillance, Epidemiology, and End Results （SEER） database, to analyze the main risk factor of RVI by Logistic regression. The overall survival (OS) and cancer-specific survival (CSS) of patients in the EFI  and RVI groups were compared after propensity matching (1∶1). Independent risk factor affecting OS and CSS in T3a RCC patients were analyzed by Cox regression. Results A total of 8 965 T3a patients were enrolled in this study, including 4 803 (53.6%) patients in the EFI group and 4 162 (46.4%) patients in the RVI group. Patients with RVI were more likely to develop bone (6.2% vs 4.9%), lung (15.4% vs 9.0%), and liver (2.5% vs 1.5%) metastases (P<0.05). Age, gender, histological type, tumor size, N stage, and M stage were independent risk factors for RVI (all P<0.05). Compared with the EFI group, patients in the RVI group had a worse 5-year OS (64.0% vs 66.6%, P=0.023) and CSS (72.1% vs  75.1%,P=0.005). RVI was an independent factor affecting OS and CSS in T3a patients (P<0.05). Conclusion Although EFI and RVI belong to T3a stage, the long-term prognosis of patients with RVI is worse than with EFI. For patients with RVI, follow-up examination should be strengthened to improve the prognosis.

Prognostic significance of the controlling nutritional status (CONUT)  score in patients with bladder cancer treated with radical cystectomy and ileal conduit

Zhang Yudong, Wei Houyi, Wang Runjin, Jiang Mingxin, Yang Kun, Wang Mingshuai, Wasilijiang Wahafu, Song Liming, Jin Mulan, Xing Nianzeng, Niu Yinong

2023, 44(3):  449-456.  doi:10.3969/j.issn.1006-7795.2023.03.014

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Objective To explore the predictive value of controlling nutritional status (CONUT) score on oncological outcomes of bladder cancer (BC) patients receiving radical cystectomy (RC) with ileal conduit (IC).  Methods Retrospective analysis was performed on 79 BC patients treated with RC and IC in the Department of Urology, Beijing Chaoyang Hospital, Capital Medical University  from March 2014 to June 2020. The CONUT score was calculated based on serum albumin level, total lymphocyte count and total cholesterol level. Kaplan-Meier method and Cox regression analyses were performed to plot cumulative possibility of overall survival (OS) and recurrence-free survival (RFS) and to investigate predictive potential of the CONUT score.  Results During a median follow-up of 24-months, 27 and 33 patients experienced neoplastic recurrence and metastasis， respectively. All eligible 79 participants were divided into high CONUT group (n=31) and low CONUT group (n=48) according to the median CONUT score of 2. No significant differences were detected between the two groups regarding demographic characteristics, underlying diseases, surgical and oncological data, except T staging （P=0.048）and positive margins (P=0.021). Patient in high CONUT group had significantly worse OS and RFS than those in low CONUT group（OS：24 week vs ＞96 week，P=0.0015；RFS：16 week vs ＞96 week，P=0.0046）. Multivariate Cox regression analyses indicated that the CONUT score was an independent predictor of OS and RFS(OS:HR=2.283，95%CI: 1.038-5.018，P=0.040； RFS:HR=2.264，95%CI: 1.058-1.219，P=0.035).  Conclusion The CONUT score is independently associated with oncological outcomes among BC patients treated with RC+IC. A close follow-up with continual vigilance and reassessment for patients with high CONUT score.

Mechanism of periprostatic adipose tissue affecting the development of prostate cancer

Xiong Tianyu, Niu Yinong

2023, 44(3):  457-462.  doi:10.3969/j.issn.1006-7795.2023.03.015

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Periprostatic adipose tissue (PPAT), the special fat tissue surrounding the prostate gland, has unique characteristics in biological processes such as metabolism and inflammation. PPAT is closely related to the development and progression of prostate cancer. Imaging features of PPAT including PPAT thickness and volume may provide reference for the diagnosis and prognostic evaluation of prostate cancer. There are active interactions between PPAT and prostate cancer cells, which may influence prostate cancer development by several molecular pathways. The research on PPAT promotes our knowledge in the occurrence mechanism of prostate cancer, which is helpful to find new therapeutic approaches. 

An analysis of the clinical symptom-syndrome-medication rule of chronic erosive gastritis based on the ancient and modern medical case cloud platform system

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

2023, 44(3):  463-469.  doi:10.3969/j.issn.1006-7795.2023.03.016

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Objective To form the thinking of syndrome differentiation and treatment based on the integration of theory, law and medicine, data mining techniques are used to analyze the clinical symptoms, common syndromes and medication rules of chronic erosive gastritis. Methods The symptoms and syndromes as well as prescriptions of chronic erosive gastritis in traditional Chinese medicine (TCM) were retrieved from China National Knowledge Infrastructure (CNKI)， Chongqing VIP Information Company Limited （VIP) and Wanfang Database to June 2022.The symptoms of chronic erosive gastritis including picture of the tongue, pulse condition, common syndromes, elements of syndrome and medication rules were analyzed by using the ancient and modern medical records cloud platform(V2.5).Results Totally 207 medical cases of chronic erosive gastritis were collected and standardized，the top five frequency symptoms were belching, mouth bitter, poor appetite, dry mouth, and fatigue. The major properties of the disease were dampness and heat; the pathological lesions of the disease were mainly in the spleen and stomach; the common pattern of TCM were spleen-stomach damp-heat syndrome, spleen-stomach qi deficiency syndrome, liver-stomach disharmony syndrome and deficiency of stomach yin syndrome. These four evidence types accounted for more than 50% of all evidence types.Through the analysis of the syndrome type and medication associations, Radix Scutellariae, Rhizoma Coptidis and Herba Lobeliae Chinensis were used for the spleen-stomach damp-heat syndrome. Radix Codonopsis, Rhizoma Atractylodis Macrocephalae and Radix Aucklandiae were used for the spleen-stomach Qi deficiency syndrome. Pericarpium Citri Reticulatae, Radix Curcumae and Fructus Aurantii Immaturus were used for the liver stomach disharmony syndrome, and Radix Trichosanthis, Radix Paeoniae Alba and Rhizoma Polygonati Odorati were used for the deficiency of stomach Yin. Conclusion The main pathogenesis of chronic erosive gastritis is dampness-heat of spleen and stomach, and the nature of the disease is excess syndrome; clearing away damp-heat and regulating Qi movement can be an important treatment method of this disease. Clinical syndrome differentiation should be based on symptoms and treatment should be prescribed according to the results of syndrome differentiation in order to obtain the best efficacy.

Relationship between peritumoral edema and sedative-induced neurological deficits in patients with supratentorial glioma

Lin Nan, Zhang Xingyue, Ma Tingting, Yin Xueke, Li Xuebin

2023, 44(3):  470-474.  doi:10.3969/j.issn.1006-7795.2023.03.017

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Objective The study is to  observe  the relationship between the degree of peritumoral edema in supratentorial gliomas and sedation-induced neurological deficits to provide a reference for exploring the impact of gliomas on the functional connectivity of brain networks.  Methods The study retrospectively included patients with supratentorial gliomas (frontal-temporal-parietal region) diagnosed by brain magnetic resonance imaging. All patients were also confirmed as gliomas by postoperative pathology. The Steinhoff grade of peritumoral edema was recorded, and sedative-induced neurological deficits as a brain stress test were evaluated by the National Institutes of Health Stroke Scale (NIHSS) score change. The NIHSS score change after sedation was defined as positive change (NIHSS change ≥ 2 points) and negative change (NIHSS change<2 points). The association between Steinhoff grades and sedative-induced neurological deficits was analyzed.   Results Of the 76 patients enrolled, 32 (42.1%) were positive on preoperative sedative stress tests, and preoperative Steinhoff classification was not associated with test results (grade Ⅰ: 34.4%  vs  40.9%; grade Ⅱ: 43.8%  vs  38.6%; grade Ⅲ: 21.9%  vs  20.5%, P=0.842). Patients with high-grade glioma had significant higher incidence of positive change in the brain stress test(grade Ⅱ: 40.6%  vs   70.5%; grade Ⅲ-Ⅳ: 59.4%  vs   29.5%, P=0.009). In addition, hospitalization costs were significantly higher in patients with positive changes ［6.65 (4.11－10.30)  thousand Yuan  vs  4.49 (3.46－7.13)   thousand Yuan, P =0.006］, and such patients tended to have lower postoperative Karnofsky Performance Status (KPS) scores (P=0.052).   Conclusion There was no significant association between the degree of peritumoral edema in patients with supratentorial glioma and the positive rate of sedative-induced neurological deficits. However, patients with positive changes in brain stress tests by sedation had significantly higher hospitalization costs and poor postoperative functional status.

Impact of administration route of tranexamic acid on pain and function of early and medium stage after arthroscopic rotator cuff repair

Yu Yang, Zhang Xiaogang, Lin Yuan, Ren Shixiang, Jia Jialin, Zhang Yuhan, Zhang Bo

2023, 44(3):  475-481.  doi:10.3969/j.issn.1006-7795.2023.03.018

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Objective To evaluate the impact of administration route of tranexamic acid on pain and function of early and medium stage after arthroscopic rotator cuff repair. Methods A retrospective analysis of clinical data of patients with rotator cuff tear in Beijing Chaoyang Hospital, Capital Medical University from January 2021 to December 2021. A total of 64 patients met the criteria, including 32 males and 32 females, aged 39－70 years. There were three administration routes of tranexamic acid, including intra-articular injection, intravenous drip and combined administration. Rotator cuff tear was repaired using double-row suture bridge technique. The Visual Analogue Scale （VAS） score and edema degree after surgery 1－3 d were analyzed. Function scores before surgery, 3 months and 6 months after surgery were analyzed. Shoulder range of motion before surgery, 3 d, 3 months and 6 months after surgery were analyzed. Results All patients were successfully operated, no serious complication occurred during or after surgery. Compared with intra-articular injection group and intravenous group, the combined administration group showed better VAS score and edema degree after surgery 1 d and 2 d (P<0.05). Also, a better range of motion 3 d postoperative, including forward flexion, abduction and external rotation, was found (P<0.05). No other significant differences were found. Conclusions Combined administration of tranexamic acid can improve pain, edema, range of motion and function of shoulder after surgery better than intra-articular injection or intravenous drip alone.

Investigation and analysis of migraine diagnosis and treatment in general practitioners

Zhao Huiqing, Zhang Yaqing

2023, 44(3):  482-486.  doi:10.3969/j.issn.1006-7795.2023.03.019

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Objective To evaluate the cognition and diagnosis of migraine of general practitioners, so as to provide reference for further improving the general practitioner’s ability to diagnose and treat migraine. Methods The questionnaire entitled “General Practitioners Migraine Diagnosis and Treatment Status Survey” was designed according to the relevant problems in the diagnosis and treatment of migraine. The demographic characteristics of the respondents and their mastery of the current clinical diagnosis and treatment of migraine were collected. From June 1 to September 30, 2021, 500 general practitioners were selected by the method of cross-sectional survey. A total of 500 questionnaires were sent and 450 (90%) valid questionnaires were collected. The results of 450 questionnaires were summarized and analyzed. Results The survey showed that the average age of 450 respondents was （36.6±7.2） years old, including 208 (46.22%) male general practitioners. 75.81% of the respondents had a bachelor's degree, and 39.72% of them owned intermediate professional titles (32.31% with senior professional titles and the remaining 28.97% with junior professional titles). In clinical practice, 85.58% of general practitioners had treated headache patients. Only 20.66% had studied the International Classification of Headache Disorders, 3rd edition (ICHD-3), and the knowledge of ICHD-3 among respondents from tertiary hospitals was significantly better than that those from primary and secondary hospitals (P<0.000 1). Only about 30% of the subjects correctly answered the duration and diagnostic criteria of migraine attacks. 56.74% of the respondents had considered the use of drugs for migraine prevention, but the knowledge of medication indications and drug choices still were needed. Conclusions There is still a gap in the current knowledge of migraine diagnosis and treatment among general practitioners. In the future, we should further strengthen the general practitioner in professional knowledge training to improve the general practitioner's ability of cognition and diagnosis and treatment on migraine, so as to reduce the disease burden of migraine.

Association between sleep efficiency and diabetes mellitus in obstructive sleep apnea syndrome  and primary snoring patients

Xia Ning, Nie Xiuhong, Wang Meiping, Feng Zhihong, Mu Zhijing, Fan Xiaojun

2023, 44(3):  487-496.  doi:10.3969/j.issn.1006-7795.2023.03.020

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Objective To investigate the association between sleep efficiency and diabetes mellitus (DM) in obstructive sleep apnea syndrome (OSA) and primary snoring patients. Methods A total of 3 124 patients who received sleep monitoring in the Sleep Medical Center of Xuanwu Hospital, Capital Medical University from October 2002 to September 2021 were retrospectively analyzed. Sleep efficiency was divided into grade 1 (≥85%), grade 2 (80%-84.9%), and grade 3 (<80%). All participants were divided into OSA group and simple snoring group with apnea hypopnea index (AHI)≥5 times/h. Multivariate Logistic regression models were utilized to investigate the association between sleep quality and diabetes mellitus. Results In OSA patients, after adjusting for potential confounding factors, compared with sleep efficiency ≥ 85%, the prevalence of DM in sleep efficiency < 80% group was significantly higher (OR=1.563, 95%CI:1.005-2.431, P=0.047), but there was no significant difference in primary snoring group (OR=0.957, 95%CI:0.509-1.799, P=0.891). Conclusion There is a significant correlation between poor sleep efficiency and the incidence of DM in OSA patients.

Clinical analysis of renal involvement in eosinophilic granulomatosis with polyangiitis

Li Jie, Zhang Jun, Wang Jing, Hua Lin, Zhang Liming

2023, 44(3):  494-500.  doi:10.3969/j.issn.1006-7795.2023.03.021

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Objective To describe the clinical features of renal involvement with eosinophilic granulomatosis with polyangiitis (EGPA) in patients. Methods Patients who fulfilled the criteria of EGPA managed at the Beijing Chaoyang Hospital， Capital Medical University from May 2005 to December 2021 were retrospectively analyzed. The clinical data of patients with renal involvement were analyzed, the differences between patients with and without chronic kidney disease  were compared. The risk factors of EGPA with renal involvement were analyzed.Results Among 104 patients with EGPA, 55 were males and 49 were females, with a median age of 56 (46， 65) years at the time of diagnosis. Asthma was the most common symptom in 99 patients (95.2%), 82 patients (78.8%) with eosinophilia (>10%), ANCA was positive in 20 patients (19.2%). There were 59 patients (56.7%) with renal involvement, including 30 patients (28.8%) with microscopic hematuria, 11 patients (10.6%) with proteinuria, 38 patients (36.5%) with decreased estimated glomerular filtration rate ［eGFR<80 mL/（min·1.73 m2）］, and 11 patients (10.6%) with chronic kidney disease ［eGFR<60 mL/（min·1.73 m2）］. ANCA positive patients were more likely to have renal involvement than ANCA negative patients. In patients with chronic kidney disease, the hemoglobin level was significantly decreased (U=212.50, P=0.002), and the incidence of heart involvement was significantly increased (χ²=5.610, P=0.018). Multivariate analysis suggested that advanced age and ANCA positive were independent risk factors for EGPA renal involvement. The median follow-up time was 41 (19, 59) months, 6 patients died, 3 with chronic kidney disease. Conclusions Renal involvement in patients with EGPA is mainly manifested by hematuria, proteinuria and a mild decreased renal function. Advanced age and ANCA positive are independent risk factors for renal involvement. Patients with chronic kidney disease have an increased incidence of both anemia and cardiac involvement. 

Clinical characteristic and prognostic analysis of patients with metastatic pancreatic cancer

Guo Jihong, Zhu Ning, Ge Yang, An Guangyu

2023, 44(3):  501-506.  doi:10.3969/j.issn.1006-7795.2023.03.022

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Objective To explore the clinical features and survival of patients with metastatic pancreatic cancer in the real world, and analyze the prognostic factors. Methods A total of 55 patients admitted to Beijing Chaoyang Hospital, Capital Medical University from January 2017 to December 2020 were collected. SPSS 27.0 was used for overall survival (OS) and progression free survival (PFS) analysis by Kaplan-Meier method and Log rank test, and Cox regression model was used for multivariate analysis.  Results The median follow-up time was 55.3 months. We found that the median OS was 7.7 months, with 6-month, 1-year, and 2-year overall survival rates of 61.8%, 34.0% and 11.6%, respectively. First line therapy, Eastern Cooperative Oncology Group （ECOG） score, liver metastasis, pancreatectomy and carbohydrate antigen19-9 （CA19-9） value were significant prognostic factors for OS, and ECOG score, liver metastasis, CA19-9 value, efficacy and infection were significant prognostic factors for PFS in first line therapy.  Conclusion It is very important to take first line therapy for metastatic pancreatic cancer. We recommend selecting a more suitable treatment plan for patients based on their physical condition and clinical pathological characteristics. Our findings suggest that there is no significant difference in prognosis between different regimens. Next generation sequencing （NGS） examination is recommended for patients with metastatic pancreatic cancer, if targeting and immunotherapy opportunities are available to prolong survival.