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15 September 2024, Volume 55 Issue 9
  
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  • ZHANG Qun, TAN Ying, ZHU Yanhua, CHEN Yanming
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    Obesity, as a global health issue, presents significant challenges in its treatment and management, particularly the phenomenon of weight regain. This not only undermines the effectiveness of weight loss efforts but may also have further impacts on the physical and mental health of patients. This article delves into the issue of weight regain during the treatment of obesity, analyzing its definition, prevalence, and health implications. It elucidates the biological mechanisms of weight regain from aspects such as the body weight set-point theory, metabolic adaptation, immune cell phenotypic changes, lipid metabolism, and appetite regulation. A comprehensive management strategy is proposed, including lifestyle adjustments, continuous pharmacological treatment, surgical intervention, and multidisciplinary collaboration, aiming to achieve long-term weight control in obese patients. The study emphasizes the continuity and individualization of weight management, providing scientific guidance for clinical practice.

  • XIANG Qing, CAO Jian, LUO Tao, ZHU Xuan, QIN Jie, GUO Yahao, LI Chao
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    Objective To explore the application value of 80 kV deep learning image reconstruction (DLIR) algorithm in coronary CT angiography (CCTA). Methods Sixty patients who underwent CCTA were divided into two groups based on the scanning protocols: 100 kV group (Group A, n = 30) and 80 kV group (Group B, n = 30). In Group A, 60% ASIR-V (A-AV60) and DLIR high-level reconstruction (A-DLIR) was adopted. In Group B, DLIR high-level reconstruction (B-DLIR) was employed. The CT volumetric dose index (CTDIvol) and the dose length product (DLP) were recorded in both groups, and the effective dose (ED) was calculated. Regions of interest (ROI) were placed in the aortic root (AR), left anterior descending coronary artery (LAD), left circumflex coronary artery (LCX), right coronary artery (RCA), and the same-layer pectoral fat area. The CT values and noise values of each ROI were recorded. Signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) were calculated. Subjective evaluation was performed on the original axis, curved planar reconstruction (CPR), volume rendering (VR), and maximum intensity projection (MIP) reconstructions after the second-generation freeze technology (Snapshot Freeze 2, SSF-2), and the images in two groups were subject to subjective image quality evaluation. Results The ED in Group B was reduced by 45.14% compared to that in Group A. The CT values for AR, LAD, LCX, and RCA in the B-DLIR were higher than those in the A-AV60 and A-DLIR groups, and the differences were statistically significant (all P < 0.001). The noise values for AR, LAD and LCX were similar, whereas statistical significance was observed in RCA between the A-DLIR and B-DLIR groups (P < 0.05). The noise values in the A-DLIR and B-DLIR groups were smaller than that in the A-AV60 group, and the differences were statistically significant (both P < 0.001). The SNR and CNR for AR, LAD, LCX and RCA were similar between the A-DLIR and B-DLIR groups, which were higher than those in the A-AV60 group (all P < 0.05). The average subjective evaluation score of image quality in the B-DLIR group was higher than that in the A-AV60 group (P < 0.05), whereas lower than that in the A-DLIR group (P < 0.05). There were no significant differences in clarity, artifact and small branch visibility between the A-DLIR and B-DLIR groups (all P > 0.05). Conclusions During CCTA, the 80 kV DLIR algorithm contributes to yielding high-quality images, further improves the diagnostic efficiency and reduces the irradiation dose.

  • HU Yifang, YANG Yuxin, WANG Can, ZHONG Xue, LIANG Yulian, LONG Shuchen, CHEN Xueer, YE Yujin, WANG Qiong
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    Objective To explore the differences of etiology of recurrent implantation failure (RIF) and recurrent pregnancy loss (RPL). Methods Patients with RIF (n = 315) and patients with RPL (n = 376) admitted to the Reproductive Center of the First Affiliated Hospital of Sun Yat-sen University from June 2018 to June 2021 were included. General and etiological data were collected to compare the differences in baseline data and etiological composition. Relative risk factors of the etiology of these two conditions were identified by multivariate regression analysis. Results Univariate analysis showed a significantly higher proportion of chronic endometritis, endometrial polyps, endometriosis, endometriosis complicated with polyps, diminished ovarian reserve and a significantly lower proportion of unexplained cause in the RIF group than in the RPL group (all P <0.05). Multivariate logistic regression analysis showed that the incidence of chronic endometritis (OR=3.044, 95%CI 1.849-5.011, P < 0.001), endometrial polyps (OR=3.769, 95%CI 1.670-8.510, P < 0.001), endometriosis (OR=3.812, 95%CI 2.131-6.819, P < 0.001) and diminished ovarian reserve (OR=2.175, 95%CI 1.285-3.683, P = 0.004) in the RIF group was significantly higher than that in the RPL group. The proportion of patients with lower anti-Mullerian hormone levels (OR=0.917, 95%CI 0.864-0.973, P = 0.004) in the RIF group was higher compared with that in the RPL group. Conclusion Chronic endometritis, endometrial polyps, endometriosis, decreased anti-Mullerian hormone level and diminished ovarian reserve are more common in RIF patients, and the screening and monitoring of the above lesions should be strengthened in the subsequent practice of assisted reproduction.

  • WEN Jie, ZHANG Huanli, YUN Xia, XU Min, ZHANG Anna, ZHOU Qingbo
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    Objective To analyze the clinical features and prognostic factors of community-acquired pneumonia (CAP) of elderly patients in medical and nursing institutions. Methods Ninety-six CAP patients aged≥80 years admitted to Department of Geriatrics of the Second Hospital of Shandong University South Branch (Jinan Shande Nursing Home) were enrolled. According to the 6-month survival, all patients were divided into the survival group and death group. Baseline data and laboratory data were collected in two groups. CURB-65 scores were calculated and compared between two groups. The risk factors of clinical prognosis were identified by logistic regression analysis. The prognostic value of these risk factors was analyzed by using the receiver operating characteristic (ROC) curve. Results Compared with the survival group, the proportion of patients with hypertension, coronary atherosclerotic heart disease and hemiplegia was higher, and C-reactive protein (CRP), white blood cell count (WBC), D-dimer, N-terminal pro-brain natriuretic peptide (NT-proBNP), urea nitrogen (BUN) and CURB-65 scores were higher in the death group (all P < 0.05). ROC curve showed that the sensitivity, specificity and area under the ROC curve (AUC) of combined detection of CRP, NT-proBNP and CURB-65 for predicting the prognosis of elderly patients with CAP were 72.7%, 84.6% and 0.860 (95% CI 0.790-0.933), respectively. Conclusions CRP, NT-proBNP and CURB-65 score are correlated with clinical prognosis of elderly CAP patients in medical and nursing institutions. Combined detection of these three indicators can improve the prognostic value in elderly CAP patients.

  • GAO Fangfang, FAN Pingming, LÜ Pengfei, WEI Changyuan, JIANG Chaona
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    Objective To analyze the impact of endoscopy surgery and open surgery on the quality of life of breast cancer patients. Methods Three hundred and forty-four female breast cancer patients who underwent two different surgical methods were collected, including 92 cases in the endoscopic surgery group and 252 cases in the open surgery group. Functional Assessment of Cancer Therapy-Breast (FACT-B) was used to investigate the quality of life of patients after surgery in two groups. Results The FACT-B items“I am satisfied with my sex life”“I am able to work (including home work)”“My work (including home work) makes me feel a sense of accomplishment”“I feel sexually attractive”“I still feel like a woman”“I worry about the effect of stress on my disease”were statistically significant in two groups (all P < 0.05),the endoscopic surgery group was superior to the open surgery group. There was no significant difference in the other items between the two groups (all P > 0.05). Conclusion The quality of life of breast cancer patients undergoing endoscopy surgery was better than that of patients undergoing open surgery.

  • ZHONG Liru, LUO Na, TANG Wenjie
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    Objective To investigate the differential diagnostic value of dual-energy CT electron cloud density (Rho) and effective atomic number (Z) between benign and malignant thyroid nodules. Methods Imaging data of 68 patients with pathologically confirmed thyroid nodules at Lingnan Hospital, the Third Affiliated Hospital of Sun Yat-sen University from March to December 2023 were retrospectively analyzed. Among the 68 cases, 31 patients were diagnosed with benign thyroid nodules and 37 with malignant thyroid nodules. All patients underwent plain CT scan combined with enhanced dual-energy CT scan of the neck in the first week before surgery. The arterial-phase and venous-phase electron cloud density maps and effective atomic number maps were reconstructed in the post-processing workstation. Rho and Z values of benign and malignant thyroid nodules were compared by Mann-Whitney U test. Statistically significant dual-energy parameters were analyzed and their differential diagnostic efficiency in diagnosing benign and malignant thyroid nodules was calculated using the receiver operating characteristic (ROC) curve. Results Arterial- and venous-phase Z values and venous-phase Rho were not statistically significant between benign and malignant thyroid nodules (all P > 0.05), whereas arterial-phase Rho value was statistically significant between benign and malignant thyroid nodules (P < 0.05). The arterial-phase Rho of malignant thyroid nodules was higher than that of the benign thyroid nodules, with an area under the ROC curve (AUC) of 0.711(95%CI 0.586-0.836), a sensitivity of 73.0%, and a specificity of 64.5%. The differential diagnostic efficiency was the highest when the arterial-phase Rho was 38.6 Hu. Conclusion Dual-energy CT arterial-phase Rho mapping has certain value in the differential diagnosis of benign and malignant thyroid nodules.

  • XU Fangsheng, MA Shuyu, LIU Rongguang, WANG Meifang, PU Jianfeng
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    Objective To evaluate the application value of ultrasound-guided suprainguinal iliaca fascia block combined with general anesthesia with laryngeal mask in elderly patients undergoing surgery for the great saphenous varicose veins. Methods Sixty elderly patients scheduled for unilateral high ligation and stripping of the great saphenous veins combined with endovenous laser ablation were randomly divided into Group A (general anesthesia with laryngeal mask alone, n = 30) and Group B (ultrasound-guided suprainguinal fascia iliaca block combined with general anesthesia with laryngeal mask, n = 30). Intraoperative anesthetic consumption, hemodynamic fluctuations, and laryngeal mask removal time were recorded. Postoperative changes in static and dynamic Visual Analogue Scale (VAS) pain scores, 15-item Quality of Recovery (QoR-15) scores, Mini-Mental State Examination (MMSE) scores, and adverse events were also evaluated. Results The QoR-15 and MMSE scores at postoperative 24 h in Group B were significantly higher than those in Group A (both P < 0.05). The mean arterial pressure (MAP) and heart rate (HR) during skin incision in Group A were significantly higher than those in Group B (both P < 0.05). The static and dynamic VAS pain scores at postoperative 5 min, 30 min, 6 h, and 12 h in Group B were significantly lower compared to those in Group A (all P < 0.05). In Group B, the consumption of propofol and remifentanil was significantly less, and the laryngeal mask removal time was significantly shorter than those in Group A, with statistically significant differences (both P < 0.05). Conclusion Ultrasound-guided suprainguinal fascia iliaca block combined with general anesthesia with laryngeal mask improves postoperative quality of recovery and cognitive function, reduces anesthetic consumption, shortens extubation time, enhances hemodynamic stability and alleviates postoperative pain, thereby promoting rapid recovery.

  • WU Lin, YUAN Xiaofan, YANG Fan, CHEN Hong
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    The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is still spreading widely around the world, and it is estimated that there are more than 760 million confirmed cases of SARS-CoV-2 infection (COVID-19). Although most of the infected patients can be cured, there are still many patients who experience persistent clinical symptoms such as dizziness, fatigue, weakness, coughing and chest pain, etc. at two to three months or even longer after being infected with SARS-CoV-2. Internationally, this type of discomforts is referred to as long COVID. The emergence of long COVID has brought a new crisis to people’s health, which not only affects the quality of life and work of patients, but also brings great pressure on the health care of the society. Continuously exploring the impact of long COVID and its underlying mechanism, developing health management strategies for long COVID, and better prevention and treatment of long COVID are still the focus of research worldwide. The article introduces the definition of long COVID and reviews recent research progress in its underlying mechanism, common systemic clinical manifestations, risk factors, and health management of long COVID, aiming to provide more ideas for deepening clinicians’ understanding of long COVID.

  • SUN Mengna, XU Ying, REN Chenlu, YAN Yufan, CHEN Zhihao, YANG Hong
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    Genetic variation is one of the important factors leading to the incidence and development of cancer. Copy number variation is an important source of genetic diversity, which can be expressed as gene amplification or deletion in structure, and is related to the occurrence and development of different tumors. High-throughput sequencing and gene chip technology can be adopted to detect the variation of copy number, and provide relevant information about tumor molecular characteristics, prognosis and treatment, which is conducive to more accurate diagnosis and treatment decisions for patients in clinical practice. Ovarian cancer is one of the female reproductive system diseases with the highest mortality rate. Understanding its pathogenesis is of significance for improving the survival rate of ovarian cancer. At present, the specific role and mechanism of copy number variation in ovarian cancer are still unclear. In this article, relevant copy number variation in ovarian cancer was reviewed based on the existing research results, aiming to provide novel ideas and methods for the prevention, diagnosis and treatment of ovarian cancer.

  • PI Sainan, LI Liang, YANG Mo, CHEN Youpeng
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    Patients with chronic liver disease frequently exhibit thrombocytopenia, the etiology of which is intricate and not yet fully understood. As research into the association between chronic liver disease and thrombocytopenia has progressed in recent years, investigators have recognized that the thrombocytopenia in these patients is not solely attributed to splenic hyperfunction but is also modulated to a certain extent by thrombopoietin (TPO). The article posits the possibility of a “liver-derived thrombopoietin-centered gut-liver regulatory network mechanism”, providing a comprehensive review of the role of TPO in platelet regulation, the biological functions of platelets in patients with chronic liver disease, the diagnostic implications of TPO in chronic liver disease and cirrhosis, and the therapeutic applications of TPO and TPO receptor agonists in the treatment of thrombocytopenia in chronic liver disease. This review offers novel insights for both basic science and clinical research.

  • SUN Xuan, JIANG Hui, CHANG Wei
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    Circular RNAs (circRNA) are a class of multifunctional non-coding RNAs with a covalently ring structure, playing a variety of biological roles within cells. Chronic myelogenous leukemia (CML) is a myeloproliferative disorder originating from hematopoietic stem cells and progenitor cells. Although the current research on circRNA in CML is not yet comprehensive, evidence has shown that circRNA plays a significant role in the onset and progression of CML. This review summarizes the involvement of circRNA in CML, particularly focusing on its contribution to tyrosine kinase inhibitors (TKIs) resistance, and discusses the potential utility of circRNA for diagnosing and assessing prognosis in CML. The objective is to provide researchers with an up-to-date overview of the role of circRNA in CML and offer references for future research endeavors.