Table of Content

20 June 2025, Volume 40 Issue 6

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Interpretation of the 2024 Position Statement on the Use of Different Diagnostic Methods for Sleep Disorders in Adults-Brazilian Sleep Association

Wang Chuangwei, Xie Peifan, Hao Yongci, Liao Ziwei, Wang Wenting, Wang Sheng, Gu Ping

2025, 40(6):  485-491.  doi:10.3969/j.issn.1004-583X.2025.06.001

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As sleep medicine has rapidly evolved in recent years, there has been a steady influx of innovative sleep monitoring technologies and devices. While these advancements have undeniably expanded the horizons for diagnosing and treating sleep disorders, they have also complicated in selecting the most suitable tools. In response to this need, the Brazilian Sleep Association (ABS) published the "2024 Position Statement on the Use of Different Diagnostic Methods for Sleep Disorders in Adults". This statement provided clinicians with official guidance on the appropriate use of various sleep monitoring devices. The present article aims to elucidate the indications, contraindications, and clinical application recommendations for these devices as outlined in the statement. It also offered a scientific foundation for Chinese clinicians to make informed decisions when selecting sleep monitoring devices.

Meta-analysis of the correlation between carotid plaque stability and ischemic stroke assessed by contrast-enhanced ultrasound

Chen Min, Song Xinrong, Ma Bojian, Niu Huimin

2025, 40(6):  492-497.  doi:10.3969/j.issn.1004-583X.2025.06.002

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Objective This was a meta-analysis to assess the correlation between carotid plaque stability and the occurrence of ischemic stroke by contrast-enhanced ultrasound (CEUS). Methods Articles published in both Chinese and English language regarding the correlation between plaque stability and ischemic stroke assessed by CEUS were searched in Chinese National Knowledge Infrastructure (CNKI), Wanfang, CQVIP, China BioMedical Literature Database (CBM), PubMed, Cochrane Library and Embase. Data were analyzed using Stata 17.0 software. Results A total of 10 articles with 1, 053 plaques were included in the meta-analysis. Patients with unstable plaques assessed by CEUS had a significantly higher risk of ischemic stroke than those with stable plaques (RR=3.54, 95%CI 3.00-4.18). Subgroup analyses showed that sample size and criteria for diagnosing ischemic stroke had an effect on the results of CEUS assessment of the relationship between plaque stability and ischemic stroke. The use of ultrasound instruments from the same or different manufacturers did not have a significant effect on the results, but there was a tendency to use ultrasound instruments from the same manufacturer more often than those from different manufacturers. The chosen study population had no effect on the results. Conclusion There is a close correlation between carotid plaque stability assessed by CEUS and the occurrence of ischemic stroke. When CEUS identifies unstable plaques, it can predict ischemic stroke events, yet more high-quality research is needed.

Clinical diagnostic value of NT-proBNP and triglyceride-glucose index combined ith echocardiographic parameters in elderly patients with heart failure

Cao Lihui, Huo Xianghui

2025, 40(6):  498-503.  doi:10.3969/j.issn.1004-583X.2025.06.003

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Objective To investigate the diagnostic value of N-terminal pro-B-type natriuretic peptide (NT-proBNP) and triglyceride-glucose (TyG) index combined with transthoracic echocardiography (TTE) parameters in elderly heart failure (HF), and to analyze their independent influencing factors. Methods A retrospective case-control study was conducted, including 99 elderly HF patients (observation group) and 86 healthy controls (control group) aged 60-90 years admitted from February to December 2024. Baseline data, laboratory indicators (NT-proBNP, triglycerides, fasting blood glucose), and TTE parameters (left ventricular ejection fraction [LVEF], left atrial diameter [LAD], left ventricular end-diastolic diameter [LVEDD], and others) were collected. Multivariate Logistic regression identified independent risk factors for HF, and receiver operating characteristic (ROC) curves evaluated the diagnostic performance of individual and combined models. Results The observation group showed significantly higher rates of diabetes (40.4% vs 10.5%), coronary heart disease (90.9% vs 72.1%), NT-proBNP (2825.00 vs 205.45 pg/ml), TyG index (8.68 vs 8.28), triglycerides (1.17 vs 0.97 mmol/L), fasting blood glucose (6.29 vs 5.33 mmol/L), LVEDD (50.10 vs 44.13 mm), left ventricular end-systolic diameter (36.30 vs 30.40 mm), LAD (43.71 vs 35.94 mm), left ventricular end-diastolic volume (117.90 vs 102.0 ml), and left ventricular end-systolic volume (55.50 vs 36.55 ml) compared to the control group (all P<0.05). LVEF was significantly lower in the observation group than in the control group (52.20% vs 63.80%, P<0.05). Multivariate analysis identified that NT-proBNP (OR=1.000, 95%CI: 1.000-1.001), TyG index (OR=12.711, 95%CI: 4.034-40.047), and LAD (OR=1.143, 95%CI: 1.053-1.241) were independent risk factors for HF, while LVEF (OR=0.929, 95%CI: 0.881-0.980) was an independent protective factor (all P<0.05). The combined model (NT-proBNP+TyG+TTE) achieved an area under the curve (AUC) of 0.932(95%CI: 0.899-0.966), surpassing that of an individual indicator (NT-proBNP: 0.882; TyG: 0.749; TTE: 0.868) and dual-indicator models (NT-proBNP+TTE: 0.903)(all P<0.05). Hosmer-Lemeshow test indicated good model fit (P>0.05). Conclusion The combination of NT-proBNP, TyG index, and TTE parameters demonstrates strong diagnostic efficacy for elderly HF. Elevated NT-proBNP, TyG index, increased LAD, and reduced LVEF are independent predictors of HF.

Correlation of JP2 with atrial fibrillation in patients with essential hypertension

Si Huili, Guo Shuang, Dong Haocheng, Li Shuren

2025, 40(6):  504-508.  doi:10.3969/j.issn.1004-583X.2025.06.004

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Objective To investigate the correlation between junctophilin 2 (JP2) and atrial fibrillation (AF) in patients with essential hypertension (EH). Methods A total of 127 EH patients hospitalized in the Department of Cardiology, Hebei General Hospital from 2019 to 2022 were selected. They were divided into the EH + AF group (n=52) and EH group (n=75) according to whether they were complicated with AF. The clinical data of the two groups were compared. Logistic regression was used to analyze the risk factors of AF in EF patients. The value of JP2 and left atrial diameter (LAD) in predicting AF in EH patients was evaluated by the receiver operating characteristic (ROC) curve. Results Compared with the EH group, patients in the EH+AF group had significantly older age, higher N-terminal B-type natriuretic peptide (NT-proBNP), LAD and left ventricular end-systolic diameter (LVESD), but lower estimated glomerular filtration rate (eGFR), JP2 and left ventricular ejection fraction (LVEF) (P<0.05). Univariate logistic regression analysis showed that age, NT-proBNP, LAD and LVEDD were risk factors for AF in EH patients, while eGFR, JP2 and LVEF were protective factors for AF in EH patients (P<0.05). Multivariate logistic regression analysis showed that LAD was an independent risk factor for AF in EH patients, and JP2 was an independent protective factor for AF in EH patients (P<0.05). The ROC curve showed that the area under the curve (AUC) of JP2 in identifying AF in EH patients was 0.825 (95%CI: 0.753-0.897, P<0.001), with a sensitivity of 92.3%, and a specificity of 68.5%. The AUC of LAD in identifying AF in EH patients was 0.805(95%CI: 0.724-0.886, P<0.001), with a sensitivity of 80.8%, and a specificity of 67.1%. The AUC of JP2 combined with LAD in identifying AF in EH patients was 0.918(95%CI: 0.871-0.964, P<0.001), with a sensitivity of 86.5%, and a specificity of 84.9%. Conclusion Decreased JP2 in EH patients is related to the enlargement of LAD and AF, and the combination of JP2 and LAD can better predict AF in EH patients.

The safety and efficacy of low-dose rivaroxaban in elderly patients with renal insufficiency and non-valvular atrial fibrillation

Liu Jia, Yang Fengyu, Guo Mengya, Wu Zhuowei, Zhang Hanwen, Wang Yixuan, Chen Chunhong, Zhang Fang

2025, 40(6):  509-512.  doi:10.3969/j.issn.1004-583X.2025.06.005

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Objective To prospectively explore the safety and efficacy of low-dose rivaroxaban in elderly patients with atrial fibrillation (AF) and renal insufficiency. Methods A total of 79 elderly patients (aged ≥75 years) with non-valvular AF (NVAF) and renal insufficiency admitted from October 2022 to October 2023 were prospectively enrolled. Participants were randomly assigned to the low-dose group (10 mg/day) and the standard-dose group (15 mg/day). Safety and efficacy were evaluated over 6 months of follow-up. Efficacy endpoints consisted of ischemic stroke and peripheral arterial embolism. Safety endpoints included major bleeding and clinically relevant non-major bleeding (e.g., subcutaneous ecchymosis, gingival bleeding, hematuria, fecal occult blood, and conjunctival hemorrhage). Results ①Baseline characteristics showed no significant difference in the CHA2DS2-VASc Score for Atrial Fibrillation Stroke Risk and the HAS-BLED Score for Major Bleeding Risk between groups (P>0.05). However, patients in the low-dose group had a significantly older mean age, fewer cases of prior cerebral infarction/transient ischemic attack (TIA), and lower creatinine clearance compared to the standard-dose group (P<0.05).②Coagulation parameters were analyzed. Pretreatment coagulation index levels were similar between groups (P>0.05). ③Follow-up outcomes did not show new ischemic strokes or peripheral embolisms in either group. Three cases of fecal occult blood, 2 cases of gingival bleeding, and 2 cases of subcutaneous ecchymosis were reported in the standard-dose group. Conclusion Low-dose rivaroxaban demonstrated non-inferior efficacy and a lower bleeding risk compared to standard-dose rivaroxaban in elderly patients with NVAF and renal insufficiency, offering a potential optimization strategy for anticoagulation therapy.

Association of poor living habits and smoking with primary membranous nephropathy

Song Chenlu, Qi Xiaojing, Chen Yipeng, Xing Guangqun

2025, 40(6):  513-518.  doi:10.3969/j.issn.1004-583X.2025.06.006

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Objective To investigate the effects of unhealthy lifestyle and smoking on primary membranous nephropathy (PMN). Methods A total of 227 PMN patients (PMN group) and 58 minimal change nephropathy (MCD) patients (MCD group) who were first diagnosed in the Affiliated Hospital of Qingdao University from October 2016 to March 2023 were retrospectively analyzed. All patients met the pathological diagnostic criteria of PMN or MCD. Clinical data and questionnaire data were collected. In addition, the questionnaire survey data of five other hospitals from January to March 2023 (77 PMN patients and 20 MCD patients) were included to form a multi-center cohort (304 PMN patients and 78 MCD patients).Results There were significant differences in male gender, age, history of hypertension, systolic blood pressure, diastolic blood pressure, high-salt diet, high-fat diet, frequent eating out (restaurant or takeaway), drinking history and smoking history between the two groups in the single-center and multi-center cohorts (P<0.05). In the multi-center cohort, there were significant differences in the cumulative time of smoking, daily smoking volume and smoking index between the two groups (P<0.05), and the proportion of diabetes history, eating midnight snack and full dinner in PMN group was significantly higher (P<0.05). Although the indexes of cholesterol in PMN group were lower than those in MCD group, the levels of serum oxidized low density lipoprotein and malondialdehyde were higher, and the level of catalase was lower (P<0.05).Conclusion Unhealthy lifestyle and smoking may be involved in the occurrence of PMN and may produce a higher oxidative stress state.

Clinical predictive value of urine organic acid metabolites in intrahepatic cholestasis of pregnancy

You Yilan, Chen Lingyan, Miao Keyan, Ni Luohang, Zhang Yan, Xiao Jianping

2025, 40(6):  519-526.  doi:10.3969/j.issn.1004-583X.2025.06.007

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Objective To identify the role of organic acid metabolites in the prediction of intrahepatic cholestasis of pregnancy (ICP) by performing targeted metabolomic analysis of urine samples from pregnant women. Methods A total of 10 pregnant women with ICP from Wuxi Maternity and Child Health Care Hospital were selected as the observation group and 10 healthy pregnant women as the control group. Their general information was collected. Targeted metabolomics studies were carried out on the urine of both groups. Differences in metabolites between the two groups were examined using the Student's t-test, and preliminary screening was performed based on the fold change. The receiver operating characteristic curve was drawn to analyze the diagnostic performance of the initially screened organic acid metabolites and screen out metabolites with high diagnostic performance. Pearson correlation was performed to analyze the correlation of the urine levels of seven organic acid metabolites with liver function indexes and the newborn weight in ICP patients.Results A total of 18 metabolites, such as oleic acid, and linoleic acid in the urine of the observation group significantly differed from those in the control group (P<0.05). The area under the curve (AUC) of 12 metabolites in distinguishing ICP among pregnant women was larger than 0.8, showing good sensitivity and specificity. The AUC of 7 metabolites (nonanoic acid, sebacic acid, oleic acid, linoleic acid, palmitic acid, 3-hydroxypropionic acid, and L-phenylalanine) was larger than 0.9, showing more significant differences between the observation group and the control group and more desirable predictive abilities. The seven metabolites were correlated with some indexes of liver function (total bile acids, aspartate aminotransferase, alanine aminotransferase)(P<0.05). Nonanoic acid and 3-hydroxypropionic acid were correlated with the newborn weight (P<0.05). Conclusion The expression levels of nonanoic acid and sebacic acid in the urine are upregulated in pregnant women with ICP, while those of oleic acid, linoleic acid, palmitic acid, 3-hydroxypropionic acid, and L-phenylalanine are downregulated. These seven metabolites have important clinical predictive value for ICP patients.

Effects of etiology and preoperative course of disease on the efficacy of drug-resistant epilepsy in children

Lin Bincheng, Lin Gangxi

2025, 40(6):  527-531.  doi:10.3969/j.issn.1004-583X.2025.06.008

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Objective To analyze the influence of etiology and preoperative course of disease on the curative effect of children with drug-resistant epilepsy (DRE) in a single center. Methods A retrospective analysis was conducted on 48 pediatric patients with DRE admitted to Xiamen Humanity Hospital Affiliated to Fujian Medical University between January 1, 2021, and December 31, 2022. Clinical data of the patients were collected and they were followed up to analyze the relationship between different etiologies, preoperative disease duration, and treatment outcomes. Additionally, the evaluation of postoperative efficacy was explored. Results There was no significant difference in the efficacy between subgroups of genetic etiology and structural etiology (OR=4.754, 95%CI=0.980-23.074, P=0.053). Logistic regression analysis showed that OR>1, suggesting that genetic causes may increase the risk of poor efficacy compared with structural causes. For every one-year increase in the course of disease before surgery, the treatment effect was significantly improved (P<0.05). Conclusion Genetic causes are associated with an increased risk of poor prognosis of DRE compared to structural causes. For children with non-early-onset epilepsy and lighter seizure burden, a longer preoperative course indicates a better surgical effect.

Acute pulmonary embolism with epilepsy attack as the first clinical manifestation: A case report and literature review

Wang Xiaoxiao, Hu Yanfeng, Qi Xiufeng, Zhao Junjie

2025, 40(6):  532-536.  doi:10.3969/j.issn.1004-583X.2025.06.009

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Objective To explore the clinical characteristics and diagnosis and treatment of acute pulmonary embolism (APE) with epilepsy attack as the first clinical manifestation. Methods The diagnosis and treatment of a case of APE with epilepsy attack as the first clinical manifestation were retrospectively analyzed, and the related literatures were reviewed. Results A 59-year-old female patient exhibited non-night epilepsy attack, manifesting as loss of consciousness, falling to the ground, hanging eyes, tight teeth, tongue biting, and incontinence, without limb twitching. She returned to clear consciousness after 10 minutes. After waking up, she felt dizzy, weak in both lower limbs, and unable to recall. Laboratory testing suggested elevated D-dimer, and blood gas analysis showed hypoxemia and respiratory alkalosis. Electrocardiogram showed sinus rhythm, SIQ_ⅢT_Ⅲ, and extensive low, flat, and inverted T waves. Cardiac color Doppler showed moderate pulmonary hypertension, reduced left ventricular diastolic function, and normal contraction function. Color Doppler of lower limbs showed right intermuscular venous thrombosis, and widened left intermuscular veins. The computed tomography pulmonary angiogram (CTPA) showed multiple pulmonary embolisms on both sides, and a mild widening of the main trunk of pulmonary artery. Conclusion The symptoms of APE are diverse and occult. An alert of APE is made in case of a history of epilepsy attack without brain injuries, elevated D-dimer, and sinus rhythm SIQ_ⅢT_Ⅲ, and extensive low, flat, and inverted T waves on electrocardiogram. Cautions should be made to prevent misdiagnoses. A timely treatment favors the prognosis.

A case of pediatric systemic lupus erythematosus complicated with myasthenia gravis

Li Shaoning, Liu Xiaoxue, Li Chongwei, Ma Jijun

2025, 40(6):  537-540.  doi:10.3969/j.issn.1004-583X.2025.06.010

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Objective To explore the clinical characteristics, diagnosis, treatment and prognosis of systemic lupus erythematosus (SLE) complicated with myasthenia gravis (MG) in children, so as to improve clinicians' attention to the coexistence of the two diseases. Methods The clinical data of a pediatric case of SLE combined with MG were retrospectively analyzed, and relevant literatures were reviewed for discussion. Results A 16-year-old female patient with a history of SLE for over 2 years presented due to slurred speech and dysphagia for 1 week. Repetitive nerve stimulation test, neostigmine test, and anti-acetylcholine receptor IgG antibodies were positive, confirming the diagnosis of MG. Treatment regimens included methylprednisolone pulse therapy, intravenous immunoglobulin, oral pyridostigmine bromide, followed by sequential oral prednisone acetate, hydroxychloroquine, mycophenolate mofetil, and aspirin for the primary disease. The patient's symptoms completely resolved after 9 days of hospitalization. At 6 months post-discharge, repetitive nerve stimulation test returned to normal, and no recurrence was observed during 1 year of follow-up.Conclusion The coexistence of SLE and MG is rare in clinical practice, and the underlying mechanisms linking the two conditions remain unclear. For patients with atypical or mild symptoms, relevant tests should be actively conducted to consider this possibility, avoiding clinical misdiagnosis and missed diagnosis.

Neonatal ryanodine receptor type 1-related myopathies: A case report and literature review

Wang Sihan, Li Xianghong, Li Liangliang, Xi Hongmin, Yang Ping, Ma Lili, Yin Xiangyun

2025, 40(6):  541-546.  doi:10.3969/j.issn.1004-583X.2025.06.011

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Objective To report the clinical characteristics and therapies of ryanodine receptor type 1-related myopathies (RYR1-RM), thus enhancing the understanding of RYR1-RM. Methods Clinical characteristics and genetic variant of a patient with RYR1-RM who onset after birth were reported, and the clinical feature of the disease was summarized by reviewing relevant literatures. The pathogenesis and treatment methods were also outlined.Results A male infant, presented soon after birth with edema, hypotonia and poor respiratory effort necessitating assisted long-time ventilation. High-throughput sequencing revealed a novel heterozygous mutation in the RYR1 gene c.14398T>C. RYR1-RM. He was then diagnosed with RYR1-RM. No mutation was found at this site in his parents. A total of 57 cases of RYR1-RM with detailed clinical data were collected. About 50% of patients presented polyhydramnios and decreased fetal movements. Hypotonia, facial involvement, extraocular muscles involvement, dyspnea, feeding problem and orthopaedic complications are the major first manifestations of RYR1-RM. Delayed motor milestones can be found in the later life.Conclusion We reported a patient carried a novel mutation in the RYR1 gene, expanding the genetic spectrum of RYR1-RM. The clinical manifestation of RYR1-RM in neonatal period is variable and involves multiple systems, making it critical to increase awareness of the disease to recognize and treat earlier. Gene detection can be helpful in providing genetic counseling and prenatal diagnosis, which may enhance the quality of management of potential patients.