Chinese General Practice

Interpretation of 2018 AHA Evaluation and Management of Right-sided Heart Failure　

XIE Xiang-kun，XU Ding-li

2018, 21(23): 2773-2776. DOI: 10.12114/j.issn.1007-9572.2018.00.154

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Right-sided heart failure is a complex syndrome with various etiologies，pathogenesis and pathological processes.Evaluation and Management of Right-sided Heart Failure released by AHA in April 2018 elaborated on the pathophysiology，clinical manifestations，evaluation and management of acute and chronic right-sided heart failure.The current manuscript interprets the principles of this scientific statement.

Research Progress of Vaccines in the Treatment of Lung Cancer　

CHEN Ruo-bing，CHEN Tao

2018, 21(23): 2777-2780. DOI: 10.3969/j.issn.1007-9572.2018.00.145

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Lung cancer is the most common malignant tumor in the world with high incidence and mortality.As the most common type of lung cancer，non-small cell lung cancer accounts for 80%-85% of it.At present，the treatment of lung cancer is surgical treatment combined with radiotherapy and chemotherapy.However，surgical treatment is mainly applicable to stage Ⅰ，Ⅱ，and specific stage ⅢA non-small cell lung cancer，while its 5-year overall survival rate is less than 50%.Therefore，it is extremely urgent to find safer and more effective treatments.With the research of immunological mechanism of tumors，immunotherapy has been advocated and the main methods are immunosuppressants，vaccine therapy，which induces specific anti-tumor immunity against specific tumor-associated antigens.This article mainly reviews the vaccine treatment of lung cancer.

Research Progress of Blood Pressure Measurement in Patients with Atrial Fibrillation　

LUO Xiao，HUANG Qing-xia，XU Jin-song

2018, 21(23): 2781-2784. DOI: 10.3969/j.issn.1007-9572.2018.00.155

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The measurement and management of blood pressure in patients with atrial fibrillation have been given great attention all the time，but the measurement of blood pressure is inaccurate or even wrong because of the irregularity of ventricular rate.The design of clinical instruments used in the measurement of blood pressure is usually based on the research of sinus rhythm.This article compares and discusses various existing methods for blood pressure measurement in patients with atrial fibrillation on measurement accuracy，stability，inaccuracy and insufficiency，and practicality so as to provide relevant reference for the clinical practice.

Clinical Study of the Combination of Oral Hypoglycemic Agents with Different Insulin Analogues for the Treatment of Type 2 Diabetes Mellitus with Poor Glycemic Control　#br#

LU Yu-lian，QIAN Tie-yong，CHEN Yi-ding，SHEN Shi-wei，YAO Wei-feng

2018, 21(23): 2785-2789. DOI: 10.12114/j.issn.1007-9572.2018.00.126

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Objective　To compare the clinical efficacy and safety of metformin in combination with insulin Detemir （IDet） and biphasic insulin aspart 30 （BIAsp30） in the treatment of patients with type 2 diabetes mellitus （T2DM） and poor glycemic control when treated with oral hypoglycemic agents alone.Methods　A total of 112 T2DM patients who were admitted to the Second People's Hospital of Wuxi from August 2014 to December 2016，with poor blood glucose control when treated with oral hypoglycemic agents alone were selected as the study subjects and grouped using a random number table into Group A （n=57） and Group B （n=55）．All patients discontinued all hypoglycemic agents other than metformin.Group A received metformin + IDet hypoglycemic regimen，while Group B received metformin + BIAsp30 hypoglycemic regimen.After 12 weeks of treatment，blood glucose，pancreatic islet function，and adverse drug reactions were compared between the two groups.Results　Excluding the dropouts in Group A （n=2） and B （n=1） during treatment，fasting plasma glucose （FPG），postprandial blood glucose （2 hPG） and glycosylated hemoglobin （HbA1c） were not significantly different between the two groups after 12 weeks treatment （P>0.05）；FPG，2 hPG，and HbA1c decreased in Groups A and B （P<0.05），and no statistically significant difference was detected in terms of the compliance rates between the two groups （P>0.05）．There was no significant difference in the homeostasis model assessment of islet β-cell function （HOMA-β） and insulin resistance index （HOMA-IR）（P>0.05）．HOMA-β in both groups increased，while HOMA-IR decreased compared with that before treatment （P<0.05）．There was no significant difference in the following parameters：the dose of insulin analogue in Groups A and B，which was （24.96±3.57） U/d，and （25.18±3.85） U/d，respectively （t=0.309，P=0.758）；intra-group body mass index （BMI） before and after 12 weeks of treatment （P>0.05）；inter-group BMI before and after 12 weeks of treatment （P>0.05）；the incidence of hypoglycemia，transaminase elevation，headache，and gastrointestinal dysfunction between the two groups during the treatment period （P>0.05）．Conclusion　In T2DM patients with poor glycemic control following administration of oral hypoglycemic agents alone，metformin in combination with either IDet or BIAsp30 can achieve a similar hypoglycemic effect without significant changes in body mass.

Relationship of External Insulin and Fasting Insulin Level in Patients with Type 2 Diabetes Mellitus Patients　

LIAO Shi-bo，HUANG Shu-yu，WU Min，ZOU Yi，ZHU Zhao，LI Ling，HUANG Gao，XIANG Cheng

2018, 21(23): 2790-2794. DOI: 10.12114/j.issn.1007-9572.2018.00.083

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Objective　To investigate the effect of exogenous insulin （EIns） on fasting insulin （FIns） levels in patients with type 2 diabetes mellitus （T2DM）．Methods　We selected 447 patients with T2DM hospitalized in Department of Endocrinology，Xiaogan Hospital Affiliated to Wuhan University of Science and Technology from 2016 to 2017.We collected their demographic and laboratory test results.Based on the level of FIns，we divided them into three groups with equal sample size，low FIns group（FIns≤8.1 mU/L），medium FIns group（8.1 mU/L<FIns≤12.0 mU/L） and high FIns group（FIns>12.0 mU/L），149 cases in each group.Results　There were significant differences in the rate of initial treatment，use of EIns，prevalence of ketosis，history of NAFLD，history of hypertension，history of hyperuricemia （gout），history of hyperlipidemia，BMI，HbA1c，G120，Gmax，Tmax，Gr，HOMA-β，HOMA-IR，WBC and eosinophil count among three groups（P<0.05）．Ordinal Logistic regression analysis revealed that EIns 〔OR=3.768，95%CI （2.248，6.314）〕，history of NAFLD 〔OR=1.543，95%CI （1.037，2.295）〕，BMI 〔OR=1.223，95%CI （1.145，1.307）〕，HbA1c 〔OR=0.861，95%CI （0.755，0.983）〕 and Tmax〔OR=0.989，95%CI （0.980，0.997）〕 were the associated factors of FIns （P<0.05）．Conclusion　The use of EIns may promote the elevation of FIns levels in T2DM patients.

Relationship between Fasting Plasma Glucose and Peak Insulin Level after Glucose Load in Type 2 Diabetes Mellitus Patients　

LIAO Shi-bo，WU Min，HUANG Shu-yu，ZOU Yi，ZHU Zhao，HUANG Gao，LI Ling，XIANG Cheng

2018, 21(23): 2795-2801. DOI: 10.12114/j.issn.1007-9572.2018.00.133

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Objective　To discuss the relationship between fasting plasma glucose （FPG） and peak insulin level （INSmax） after glucose load in type 2 diabetes mellitus （T2DM） patients.Methods　We selected 548 hospitalized patients with T2DM from Department of Endocrinology，Xiaogan Hospital Affiliated to Wuhan University of Science and Technology from January 2016 to February 2018.According to INSmax，we divided them into low INSmax group（INSmax≤30.0 mU/L，n=183），medium INSmax group（30.0 mU/L<INSmax≤62.5 mU/L，n=182），and high INSmax group（INSmax>62.5 mU/L，n=183）．We collected their clinical data，HbA1c and serum ketone bodies levels，routine blood test results，FPG，30，60，120，180 min blood glucose （GLU） levels （GLU levels measured at 30，60，120，180 min during a 3-hour 75 g oral glucose tolerance test） and fasting insulin （FIns） and 30，60，120，180 min INS levels （INS levels measured at 30，60，120，180 min during a 3-hour insulin response test），the time during which INS was at its peak （tmax），peak GLU level after glucose load （GLUmax） and the time during which GLU was at its peak （tmax），and calculated maximum INS level after glucose load （INSmeasuremax），homeostasis model assessment （HOMA）-β，HOMA-insulin resistance （IR），and the difference between tmax and Tmax （ΔT）．Results　Compared with low INSmax group，both medium and high INSmax groups showed lower male ratio，lower HbA1c level and lower incidence of ketosis but higher use rate of external insulin，higher prevalence of hypertension history，hyperuricemia/gout history，hyperlipidemia history，non-alcoholic fatty liver disease history as well as higher average body mass index （BMI）（P<0.01）．High INSmax group had greater red blood cell distribution width compared with low INSmax group，and lower HbA1c and hemoglobin （Hb） compared with medium INSmax group（P<0.01）．In comparison with other two groups，low INSmax group demonstrated higher FPG and 30，60，120，180 min GLU，GLUmax，Tmax and lower FIns as well as 30，60，120，180 min INS （P<0.05）．Moreover，it presented greater GLUmax and Tmax and less INSmeasuremax，HOMA-β，HOMA-IR and ΔT （P<0.05）．The FPG，30，60，120，180 min GLU and GLUmax was lower while FIns，30，60，120，180 min INS，INSmeasuremax，HOMA-β，HOMA-IR and ΔT were higher in the high INSmax group compared with those of the medium INSmax group（P<0.05）．INSmax was positively correlated with BMI，eosinophils，FIns，30，60，120，180 min INS，HOMA-β，HOMA-IR，INSmeasuremax，and ΔT （P<0.05），but negatively correlated with HbA1c，Hb，FPG，30，60，120，180 min GLU，GLUmax and Tmax （P<0.05）．Multivariate Logistic regression analysis showed that INSmax increased with the growth of HOMA-IR，and with the decrease of FPG and 180 min GLU（P<0.001）．Conclusion　FPG is negatively correlated with INSmax in patients with T2DM，so FPG control is of great significance for improving the secretory reserve of pancreatic islet β-cells.

Clinical Effect of Enalapril Combined with External Counter Pulsation on Inflammatory Factors and Vascular Endothelial Function in Patients with Coronary Slow Flow　

XIE Yan-hui，LIU Shu-zhen，ZHU Wan-jie，SONG Heng-liang，XIAO Ming-yang，ZHANG Juan，WAN Da-guo

2018, 21(23): 2802-2807. DOI: 10.3969/j.issn.1007-9572.2018.00.200

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Objective　To investigate the clinical effect of enalapril combined with external counter pulsation（ECP） on the inflammatory factors and vascular endothelial function in patients with coronary slow flow（CSF），providing a reference for the treatment of this disease.Methods　A total of 90 cases of CSF were enrolled from the Second Affiliated Hospital of Zhengzhou University from December 2013 to June 2017，and divided into the control group（n=30），enalapril group（n=30） and enalapril combined with ECP group（n=30） by block randomization method，treated by basic drug treatment　and symptomatic treatment，basic drug treatment，symptomatic treatment combined with enalapril（5 mg/d） treatment，basic drug treatment，symptomatic treatment，enalapril（5 mg/d） treatment combined with ECP，respectively.We collected their baseline characteristics，measurement results of levels of hypersensitive C-reactive protein（hs-CRP），interleukin-6 （IL-6），lipoprotein-associated phospholipase A2（Lp-PLA2），brachial flow-mediated dilation（FMD），endothelin-1（ET-1） and NO measured before treatment and on the 15th day after treatment，as well as corrected TIMI frame count （cTFC），Seattle Angina Questionnaire （SAQ） score，and duration of treadmill exercise testing（TET） before treatment and 6 months after treatment.Results　The Lp-PLA2，ET-1 decreased significantly but NO increased significantly in enalapril group on the 15th day after treatment，the cTFC decreased significantly in enalapril group 6 months after treatment（P<0.05），the IL-6，Lp-PLA2 ，ET-1 decreased obviously，but FMD，NO increasedand significantly in enalapril combined with ECP group on the 15th day after treatment（P<0.05），the cTFC decreased obviously ，SAQ score increased and the duration of TET prolonged substantially in enalapril combined with ECP group 6 months after treatment（P<0.05）．On the 15th day after treatment compared with the control group，the Lp-PLA2，ET-1 and cTFC increased significantly but FMD，NO decreased significantly in the enalapril group（P<0.05），6 months after treatment the cTFC increased significantly in the enalapril group（P<0.05）．On the 15th day after treatment，the IL-6，Lp-PLA2，ET-1 decreased significantly but NO significantly in the enalapril combined with ECP group than in other two groups （P<0.05）．6 months after treatment，the cTFC decreased significantly but SAQ score，duration of TET increased significantly in the enalapril combined with ECP group than in other two groups （P<0.05）．Conclusion　As the good clinical response achieved in SCF patients showed，enalapril combined with ECP significantly improved SCF，which might be related to the improvement of inflammation and vascular endothelial function.

Clinical Characteristics and Significance of Peripheral Neuropathy in Patients with Chronic Obstructive Pulmonary Disease　#br#

LIU Xian-bin，LI Fang，CHEN Xiao-ping

2018, 21(23): 2808-2813. DOI: 10.3969/j.issn.1007-9572.2017.00.236

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Objective　To investigate the clinical characteristics of peripheral neuropathy in patients with chronic obstructive pulmonary disease（COPD） and the effect of nutritional nerve intervention on patient prognosis.Methods　The study included 120 patients who were diagnosed with COPD and treated in the People's Hospital of Quzhou between June 2015 and June 2016.All patients were examined for myoelectric activity.Patients were divided into a peripheral neuropathy group（n=72） and a non-peripheral neuropathy group（n=48） based on myoelectric activity.The peripheral neuropathy group was further divided into an intervention subgroup（n=36） and a non-intervention subgroup（n=36） using the random number table method.Patients in the intervention subgroup were treated with mecobalamin combined with alpha lipoic acid for 3 weeks.All patients were followed up for 12 months after group assignment.In each follow-up visit，the number of episodes of exacerbation was recorded and the patients received a pulmonary function test，a COPD assessment test（CAT），and evaluation according to the modified British Medical Research Council Dyspnea Scale（mMRC） and Hospital Anxiety and Depression Scale（HAD）．Data were collected and analyzed.Results　The proportion of men or smokers was significantly higher in the peripheral neuropathy group than in the non-peripheral neuropathy group（P<0.05）．The number of annual exacerbation episodes，CAT score，mMRC grade，and patients with anxiety/depression also increased significantly in the peripheral neuropathy group（P<0.05）．FEV1 was lower in the peripheral neuropathy group than in the non-peripheral neuropathy group（P<0.05）．The number of annual exacerbation episodes，CAT score，mMRC grade，the proportion of the patients with anxiety/depression，and the grading of symptoms were significantly higher in symptomatic patients with peripheral neuropathy than in those without symptoms，and FEV1 decreased in symptomatic patients（P<0.05）．There were interactive effects between FEV1，CAT score，mMRC grade，HAD score and treatment，and time in both the intervention subgroup and non-intervention subgroup（P<0.05）．The main effects of treatment and time were significant（P<0.05）．There were no significant differences in baseline FEV1，CAT score，mMRC grade，and HAD score between the intervention subgroup and non-intervention subgroup（P>0.05）．At 1，3，6，9，and 12 months of follow up，FEV1 significantly increased，and CAT score，mMRC grade，and HAD score significantly decreased in the intervention subgroup compared with the non-intervention subgroup（P<0.05）；The proportion of patients with anxiety/depression in the two subgroups at different time points was also significantly different（P<0.05）．The proportion of anxiety/depression patients in the two subgroups did not differ significantly before intervention and at 1 month of follow up（P>0.05）；however，at 3，6，9，and 12 months，the proportion was significantly lower in the intervention subgroup than in the non-intervention subgroup（P<0.05）．In the intervention subgroup，the proportion of patients with anxiety/depression at 6 months was lower than that before intervention as well as at 1 and 3 months，and the proportions at 9 and 12 months were higher than that at 6 months（P<0.003）．Conclusion　Peripheral neuropathy is a common complication of COPD，and is associated with gender，smoking and severity of COPD.The condition significantly affects quality of life and patient prognosis.Most patients are asymptomatic in the early stage，and symptomatic patients often have a severe condition.Neuro-nutrient therapy can improve both prognosis and the quality of life of patients.

Clinical Study on the Timing for Changing Medications in the Treatment of Chronic Myelogenous Leukemia-chronic Phase with Imatinib　

CAI Zhi-mei，CHEN Ze，WANG Ying，WU Xiao-xie，XUE Lian-guo，WEI Ji-feng，ZHAO Li-dong

2018, 21(23): 2814-2817. DOI: 10.3969/j.issn.1007-9572.2017.00.223

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Objective　To dynamically investigate the changes of the breakpoint cluster region-Abelson leukemia virusinternational scale（BCR/ABL）IS values and the reduction in BCR/ABL copy numbers in patients with chronic myelogenous leukemia-chronic phase（CML-CP） at 3 months following imatinib treatment，and given early prognostic evaluation，to explore the optimal timing for changing medications.Methods　A total of 35 first-visit CML-CP patients admitted to the First People's Hospital of Lianyungang from September 2013 to December 2015 were enrolled and given treatment with the first generation tyrosine kinase inhibitor（TKI），imatinib，at a daily dose of 400 mg.The effects of BCR/ABLIS values and BCR/ABL copy number reductions at 3 months after treatment on the molecular responses at 12 months after treatment were evaluated.Results　There were 29 patients with ≤10% BCR/ABLIS at 3 months after imatinib treatment，and there were 10 cases with complete molecular response（CMR） and 14 cases with major molecular response（MMR） at 12 months after treatment，with only five cases failing in molecular remission.Of the six cases with >10% BCR/ABLIS at 3 months after imatinib treatment，only one case achieved MMR and five cases failed in molecular remission at 12 months after treatment.The degree of molecular response at 12 months after imatinib treatment was higher in patients with ≤10% BCR/ABLIS at 3 months after treatment than in those with >10% BCR/ABLIS（u=-2.456，P=0.014）．There were 19 patients with ≥ 90% reductions in BCR/ABL copy numbers at 3 months after imatinib treatment，and all achieved molecular remission at 12 months after treatment，including 10 cases with CMR and nine cases with MMR.Among the 16 cases with < 90% reductions in BCR/ABL copy numbers at 3 months after treatment，five cases achieved MMR and the other 11 cases failed in molecular remission at 12 months after treatment.The degree of molecular response at 12 months after imatinib treatment was greater in patients with ≥ 90% reductions in BCR/ABL copy numbers at 3 months after treatment than in those with < 90% reductions（u=-2.803，P=0.005）．There were 19 patients with ≤10% BCR/ABLIS and ≥ 90% reductions in BCR/ABL copy numbers at 3 months after imatinib treatment，and 10 cases achieved CMR and nine cases achieved MMR.Among the 10 patients with ≤10% BCR/ABLIS and < 90% reductions in BCR/ABL copy numbers at 3 months after imatinib treatment，there were five cases with MMR and five cases with failure in molecular remission at 12 months after treatment，and of the six cases with >10% BCR/ABLIS and < 90% reductions in BCR/ABL copy numbers at 3 months after imatinib treatment，none achieved MMR at 12 months after treatment.In addition，none had >10% BCR/ABLIS and ≥ 90% reductions in BCR/ABL copy numbers at 3 months after imatinib treatment.There was a significant difference in the molecular response among the patients with various BCR/ABLIS values and diverse reductions in BCR/ABL copy numbers at 3 months after imatinib treatment（u=12.977，P=0.002）．Conclusion　Either the BCR/ABLIS value or the reduction of BCR/ABL copy numbers at 3 months after imatinib treatment can be used to predict the molecular response at 12 months after treatment，and the combination of these two indicators seems to be of greater significance.If possible，changing medications can be considered in CML-CP patients with ≤10% BCR/ABLIS and < 90% reductions in BCR/ABL copy numbers，and an early change of the second-generation TKIs may achieve better molecular responses in patients with >10% BCR/ABLIS and < 90% reductions in BCR/ABL copy numbers.

Efficacy of Gastroscopic Submucosal Dissection in the Adjuvant Diagnosis and Treatment of Primary Gastric Lymphoma

HUANG Shen-an，QIAN Xia，ZHANG Li-hua，SHANG Hong-wei，XIONG Ping，FANG Nian

2018, 21(23): 2818-2822. DOI: 10.3969/j.issn.1007-9572.2018.00.187

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Objective　To investigate the role of endoscopic submucosal dissection （ESD） in the diagnosis and treatment of primary gastric lymphoma （PGL），and to improve the diagnosis and treatment for PGL.Methods　A total of 16 patients with suspected PGL who were diagnosed and treated at the Third Affiliated Hospital of Nanchang University from October 2014 to July 2017 were selected for this study.The lesions and morphologic characteristics of the patients were recorded during gastroscopy.In addition，Helicobacter pylori （HP） infections，the endoscopic specimen diagnosis rate，PGL treatment，ESD conditions，and the correct rate of endoscopy combined with multipoint deep excavation biopsy and ESD resection were noted.Results　Among the 16 patients，14 patients were treated by ESD resection，2 patients declined ESD resection and were not available for follow-up evaluations，and 12 patients were diagnosed with PGL.Among the 14 patients who were treated by ESD resection，1 had more intra-operative bleeding，but all of patients had no delayed post-operative bleeding or intra- or post-operative perforations.Of the 12 patients were diagnosed with PGL，6 patients had≥ 2 lesions，the lesions of 3 patients were limited to the corpus，the lesions of 2 patients were limited to the antrum，and the lesion of 1 patient was limited to the fundus of the stomach.There were 4 patients with superficial gastric erosions visualized during gastroscopy，4 patients had multiple ulcers，white thin coating on the surface，and visible bleeding，2 patients had enlarged stomach folds and thickening，and 2 patients had mucous prominences，multiple isolations，and erosions or ulcers on the raised surface.Eleven patients were positive for HP test.Among the 12 patients who were diagnosed with PGL，2 patients were diagnosed with PGL based on endoscopic findings，5 patients were diagnosed with PGL by undergoing gastroscopy plus multipoint deep excavation biopsy，and 11 patients were diagnosed with PGL after ESD.The diagnosis correction rate of ESD resection was higher than endoscopy combined with multipoint deep excavation biopsy （χ2=6.750，P<0.05）．Conclusion　The use of ESD resection to assist the diagnosis of PGL can increase the diagnostic correction rate and reduce the misdiagnosis rate.

Detection and Clinical Significance of Serum Matrix Metalloproteinase-9 in Patients with Subcortical Ischemic Vascular Disease　

NI Ming-zhu，YU Feng，WANG Yao，SONG Li-li，LIU Wen-can，XU Wen，WANG Wen-jing

2018, 21(23): 2823-2826. DOI: 10.3969/j.issn.1007-9572.2018.00.207

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Objective　To investigate the expression and clinical significance of serum matrix metalloproteinase-9 （MMP-9） in patients with subcortical ischemic vascular disease （SIVD）．Methods　This prospective study included a SIVD group consisting of 115 patients with SIVD who were treated in the Department of Neurology of Affiliated Provincial Hospital of Anhui Medical University from October 2016 to July 2017，and a control group consisting of 69 persons who underwent physical examination in the hospital during the same period and did not have abnormal findings in head MRI.General clinical data were collected，and blood total cholesterol，triglycerides，low-density lipoprotein cholesterol and high-density lipoprotein cholesterol were detected.Fazekas scores of brain white matter lesions and lacunar infarct （LI） counts were assessed on the basis of head MRI.Serum MMP-9 concentrations were detected with enzyme-linked immunosorbent assays.MMP-9 levels and brain injury levels were compared between the two groups，and the correlation between MMP-9 and brain injury was analyzed.Results　The proportions of patients with hypertension and diabetes in the SIVD group were both higher than those of the control group （P<0.05）．The serum level of MMP-9，Fazekas scores，and LI number in the SIVD group were all higher than those in the control group （P<0.05）．Serum MMP-9 levels in patients with SIVD were positively correlated with the Fazekas score and LI number （rs=0.301，rs=0.395，P<0.001）．Multivariate Logistic regression analysis showed that hypertension 〔OR=5.349，95%CI （2.449，11.685）〕，diabetes〔OR=3.008，95%CI （1.265，7.154）〕，and serum MMP-9 level 〔OR=1.014，95%CI （1.009，1.019）〕 were all independent influencing factors for SIVD （P<0.05）．Conclusion　Elevated serum MMP-9 levels may be an independent risk factor for SIVD，and serum MMP-9 levels correlated with the severity of SIVD.This study may provide new directions for the prevention and treatment of cerebrovascular disease.

Effects and Clinical Outcomes of Percutaneous Radiofrequency Thermocoagulation of the Gasserian Ganglion at Different Temperatures for Single Branch of Trigeminal Neuralgia　

FANG Sheng-chun，GONG Wei-yi，LU Hai-yan，TANG Yuan-zhang，ZHOU Guo-ming，NI Jia-xiang

2018, 21(23): 2827-2832. DOI: 10.3969/j.issn.1007-9572.2017.00.195

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Objective　To investigate the effects and clinical outcomes of percutaneous radiofrequency thermocoagulation（RFT） of the gasserian ganglion at different temperatures for patients with single V1，V2 or V3 branch of the trigeminal neuralgia（TN）．Methods　In this study，the sample consists of a total of 550 patients with single branch of TN treated by percutaneous RFT at different temperatures（including 70 ℃ group，75 ℃ group，and 80 ℃ group） in Department of Pain Management，Xuanwu Hospital，Capital Medical University，during 2003 to 2011，of them，the number of patients suffered from single V1，V2 or V3 TN was 38，257 and 255 respectively.The therapeutic efficiency，1-5 year recurrence rate，and facial numbness were evaluated after treatment.Results　The therapeutic efficiency rate of percutaneous RFT at 70℃，75℃，80 ℃ were 10/10，18/20，7/8，respectively，for patients with V1 TN（χ2=1.212，P=0.545），93.1%（54/58），94.4%（167/177），100.0%（22/22），respectively for patients with V2 TN（χ2=1.518，P=0.468），and 87.7%（50/57），94.8%（165/174），95.8%（23/24），respectively，for patients with V3 TN（χ2=3.753，P=0.153），which indicated that the effects of this therapy for V1，V2 or V3 TN were not affected significantly by temperature.The 1-5 year recurrence rate did not differ significantly in patients with V1 TN treated by percutaneous RFT at different temperatures（P>0.05）．And a similar thing was observed in those with V2 TN treated by percutaneous RFT at different temperatures（P>0.05）．However，there was a significant difference in 1-5 year recurrence rate in patients with V3 TN，it was significant lower in 75 ℃ and 80 ℃ groups when compared with 70 ℃ group（P<0.01）．The distribution of facial numbness intensity did not differ significantly in patients with V1 TN treated by percutaneous RFT at different temperatures（P>0.05），but it differed obviously in those with V2 TN or V3 TN（P<0.05）．Specifically，in patients with V2 TN treated by percutaneous RFT，the improvement in facial numbness in those treated at 70 ℃ was better than that of those treated at 75 ℃ and 80 ℃（P<0.01）．Likewise，in patients with V3 TN treated by percutaneous RFT，those treated at 70 ℃ had greater improvement in facial numbness than those treated at 75 ℃ and 80 ℃（P<0.01）．Only one patient with V1 TN treated using RFT at 80 ℃ suffered from corneal ulcer，but was improved after symptomatic treatment.Conclusion　Percutaneous RFT of the gasserian ganglion at 70 ℃ is appropriate for patients with V1 and V2 TN，and percutaneous RFT at 75 ℃ is appropriate for patients with V3 TN.

Relationship between HHIP Gene Polymorphism and Chronic Obstructive Pulmonary Disease Susceptibility in Mongolian Population in Xinjiang，China　

MA Cheng-yuan，GUAN Jian，ZHANG Zhong-hong，LIANG Wen-jin，REN Xia，WANG Yao-lin

2018, 21(23): 2833-2836. DOI: 10.3969/j.issn.1007-9572.2018.00.211

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Objective　To explore the relationship of single nucleotide polymorphism of HHIP gene with chronic obstructive pulmonary disease（COPD） susceptibility in Mongolian population in Xinjiang，China.Methods　The participants enrolled were all from Bayingol Mongolian Autonomous Prefecture Hospital and Bortala Mongolian Autonomous Prefecture Hospital，including 259 inpatients and outpatients（case group） diagnosed as COPD，and 245 healthy controls（control group） underwent physical examination in physical examination center，from January 2016 to June 2017.Pulmonary function parameters such as FEV1%，FVC，and FEV1/FVC were measured.The SNaPshot technique for SNP genotyping was used to detect the polymorphisms（rs1489758，rs1492820） of HHIP gene in peripheral venous blood cells.Results　The patterns of genotype and allele frequencies of rs1489758 and rs1492820 at the HHIP gene differed significantly between the groups（P<0.05）．FEV 1% predicted varied substantially between the patients in the case group by rs1489758 and rs1492820 genotypes （P<0.05）．The factors associated with COPD are genotype GT〔OR=0.582，95%CI（0.396，0.854）〕，allele T 〔OR=0.639，95%CI（0.463，0.884）〕of rs1489758 and genotype GG〔OR=1.975，95%CI（1.153，3.384）〕，allele G〔OR=1.388，95%CI（1.076，1.790）〕of rs1492820（P<0.05）．Conclusion　The two single nucleotide polymorphisms （rs1489758 and rs1492820） at the HHIP gene locus significantly correlate with COPD susceptibility in Mongolian population in Xinjiang，China.

Distribution and Drug Resistance of Pathogens in Adults with Emergency Healthcare Associated Pneumonia in Xinjiang　

CAO Sun-hang，WANG Rui-zhi，LI Dan-dan，YIN Fu-kang，LI Zhuan-yun，WU Na，PENG Peng，YANG Jian-zhong

2018, 21(23): 2837-2843. DOI: 10.12114/j.issn.1007-9572.2018.00.151

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Objective　To analyze the results of the pathogens distribution and antibiogram in patients with emergency healthcare-associated pneumonia （HCAP），so as to provide the basis for rational use of antibiotics in the region.Methods　A total of 783 emergency inpatients with HCAP admitted to the First Affiliated Hospital of Xinjiang Medical University，according to the age distribution，were divided into the younger group（364 cases） and the elderly group（419 cases）from November 2014 to April 2017.The baseline data，specimen culture，pathogens distribution and antibiogram were analyzed.Results　The elderly group was significantly more likely to have hypertension，cardiovascular disease，diabetes mellitus，chronic lung disease，solid organ malignancy，≥ 2 basic diseases and high systolic pressure （P<0.05），whereas younger group were significantly more likely to have nervous system disorders，hematologic deisease，rheumatologic disease，peripheral vascular disease and lower temperature than the elderly group （P<0.05）．Among the 783 patients，783 strains were detected，of which 573 were from sputum culture （73.2%），171 from tracheal or bronchial aspirates （21.8%） and 39 from bronchoalveolar lavage fluid （5.0%）．There were 27 kinds of Gram-negative bacilli，9 kinds of Gram-positive cocci and 1 kind of fungus.Gram-negative bacteria were the most common pathogens in both groups〔86.0%（313/364） and 85.2%（357/419）〕．The order of pathogenic bacteria was Acinetobacter baumannii 〔25.3%（92/394） and 29.1%（122/419）〕，Klebsiella pneumoniae 〔25.8%（94/364） and 21.0%（88/419）〕，Pseudomonas aeruginosa 〔12.1%（44/364） and 9.3%（39/419）〕，Staphylococcus aureus 〔8.5%（31/364） and 8.4%（35/419）〕 and Escherichia coli 〔5.8%（21/364） and 8.8%（37/419）〕，with the drug resistance of Acinetobacter baumannii the most critical.The most Gram negative bacilli was generally drug-resistant to Penicillins，the first and second generation cephalosporin，and sensitive to carbapenem，sulfamethoxazole and polymyxin B.The drug resistance rate of Klebsiella pneumoniae and Escherichia coli to the third generation cephalosporin were 26.4%，62.1%，respectively，and the drug resistance rate of Acinetobacter baumannii，Klebsiella pneumoniae，Pseudomonas aeruginosa and Escherichia coli to carbapenem were 71.5%，1.1%，30.1%，1.7%，respectively.Conclusion　The majority of HCAP patients were elderly men.Age has little influence on the etiology of HCAP.The distribution and drug resistance of HCAP pathogens in this region have regional characteristics，clinicians should rationally use antibiotics according to specific circumstances.

The Item Analysis of Pediatric Sleep Questionnaire Based on the Item Response Theory　#br#

TAI Jun，XU Zhi-fei，LI Xiao-dan，DU Jiang-nan，WANG Gui-xiang，MA Jun，HU Pei-jin，YAN Xiao-yan，ZHANG Jie，ZHANG Ya-mei，LIU Yuan-hu，ZHAO Jing，ZHENG Li，CHEN Jun，FENG Guo-shuang，NI Xin

2018, 21(23): 2844-2848. DOI: 10.12114/j.issn.1007-9572.2018.00.129

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Objective　To evaluate the application of Pediatric Sleep Questionnaire （PSQ） by item analysis using item response theory.Methods　Data were obtained from the survey of children at the age of 3-14 years from 7 districts in Beijing from May to July 2015.By using multi-stage stratified cluster random sampling method，a total of 11 420 children from 25 kindergartens，primary and middle schools were selected in 7 districts （Xicheng，Chaoyang，Changping，Shunyi，Fangshan，Huairou and Mentougou）．All the parents of children were recruited to complete the PSQ，which consists of four dimensions related to sleep disordered breathing in children：breathing，sleep，behavior and others.The item response theory with two-parameter Logistic model was used to conduct item analysis to calculate the discrimination and difficulty of every item and draw item characteristics curve.Results　The analysis of two-parameter Logistic model showed that most of the items had a good discrimination，but the items of “Does your child occasionally wet the bed” and “Is your child overweight” had a significant lower discrimination parameter（0.441 and 0.124，respectively） and a higher difficulty parameter （4.378 and 6.172，respectively）．The test information function showed almost the same curves of the questionnaire with or without the two items.Conclusion　A simplified version of PSQ is recommended in Chinese children，although a good evaluation effect in the screening of children's sleep disorder is found.

Establishment of a Risk Prediction Model of Conversion to Open Surgery in Laparoscopic Cholecystectomy Based on a Meta-analysis　

LI Yang，HE Wen-ying，WANG Zhong

2018, 21(23): 2849-2855. DOI: 10.3969/j.issn.1007-9572.2018.00.127

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Objective　Meta-analysis was used to construct a risk model for predicting conversion to open surgery in laparoscopic cholecystectomy（LC）．Methods　The Cochrane Library，PubMed，EMBase，Wanfang Data Knowledge Service Platform，VIP Network and CNKI databases were searched and both nationally and internationally published articles involving conversion to open surgery in LC up to May 2017 were retrieved.The overall risk of conversion to open surgery in LC was calculated by Meta-analysis.The corresponding risk prediction model was established based on natural log（ln） transformation of the overall risk.Results　A total of 25 articles and 34 112 patients were included.Meta-analysis showed that the following variables were significantly different between the conversion group and non-conversion group：sex（male），age（advanced age），history of upper abdominal surgery，time of onset of cholecystitis greater than 72 h，history of cholecystitis，diabetes complications，body mass index（BMI）≥25 kg/m2，gallbladder wall thickening，cholecystolithiasis incarceration，high white blood cell count before surgery，and high level of total bilirubin before surgery，these were the risk factors for conversion to open surgery in LC（OR>1.00，P<0.05）．These 11 risk factors were included in the Logistic prediction model which was expressed as Logit（P）=α+0.49X1+0.80X2+1.31X3+1.42X4+1.41X5+0.75X6+0.46X7+1.52X8+0.87X9+1.16X10+1.04X11.X1，X2，…，X11 expressed as　sex（male），age（advanced age），history of upper abdominal surgery，time of onset of cholecystitis greater than 72 h，history of cholecystitis，diabetes complications，BMI≥25 kg/m2，gallbladder wall thickening，cholecystolithiasis incarceration，high white blood cell count before surgery，and high level of total bilirubin before surgery.Conclusion　Based on Meta-analysis，a Logistic risk prediction model for conversion to open surgery in LC was established.This model can be used to predict the risk of conversion to open surgery in LC.

Awareness and Appropriate Prescribing of Oral Sustained- and Controlled-release Products among Family Doctors：a Survey in Community Settings　#br#

GUO Jie-xin，WANG Jing-yu，DING Jing

2018, 21(23): 2856-2862. DOI: 10.12114/j.issn.1007-9572.2018.00.158

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Objective　To investigate the awareness and appropriate prescribing of oral sustained- and controlled-release products in family doctors，providing a reference for the implementation of prescribing training in community healthcare organizations and for the improvement of rational use of drugs in family doctors.Methods　This face-to-face survey was conducted between June and December 2017 in all the family doctors from Yuetan Community Health Service Center located in Beijing Xicheng district and Xinhua Community Health Service Center located in Beijing Tongzhou district using a self-designed questionnaire consisting of demographic characteristics，awareness and appropriate prescribing of oral sustained- and controlled-release products and methods for improving the appropriate use of oral sustained- and controlled-release products in patients.Results　Sixty-two questionnaires were distributed，and 62 valid questionnaires were collected at the scene.The recovery rate of the questionnaires was 100.0%.They showed high awareness level of oral sustained- and controlled-release products，as indicated by therapeutic and side effects of oral sustained- and controlled-release products were generally mastered by 91.9% （57/62），88.7% （55/62） of them，respectively.All of them encountered patients who could not take oral sustained- and controlled-release products properly and thought that medication guidance was needed in patients.Higher educated family doctors demonstrated a better grasp of the types of drugs suitable for the preparation of sustained- and controlled-release formulations （P=0.003），whether oral sustained- and controlled-release products with or without scar could be taken apart （P=0.022，P=0.003），whether oral sustained- and controlled-release products with scar could be administered by nasal feeding （P=0.030），whether the shell of skeleton-type sustained- and controlled-release formulation could be excreted with the feces （P=0.014） and other aspects.Family doctors who were older or with a higher professional and technical title had a better grasp of prescribing oral sustained- and controlled-release products appropriately based on the patient's conditions and paid more attention to offer medication guidance to the patients （P<0.05）．For the question who refer to the medication guidelines of oral sustained- and controlled-release products for patients is appropriate，53.2% （33/62） of family doctors to choose general practitioners，41.9% （26/62） of family doctors to choose community pharmacists，the family doctors at Yuetan Community Health Service Center were more likely to think that it is more appropriate for community pharmacists to take medication guidance for patients with oral sustained- and controlled-release products，while family doctors at Xinhua Community Health Service Center think more that they were done by general practitioners （P<0.05）．Conclusion　As a whole，the family doctors did not have a comprehensive grasp of the administration ways for oral sustained- and controlled-release products and did not offer proper enough medication guidance to the patients.In view of this，the awareness levels of oral sustained- and controlled-release products among both family doctors and patients are suggested to be taken into account when developing the schemes for training and propaganda of rational use of oral sustained- and controlled-release products，and pharmacists are suggested to participate in the workforce for giving targeted medication guidance.

Three Years of Change：Survey of Family Doctors Confidence Index in Shanghai Pudong New Area　

TANG Hui-yun，SONG Dao-ping，ZHANG Tao

2018, 21(23): 2863-2866. DOI: 10.12114/j.issn.1007-9572.2018.00.146

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Objective　To understand and explore the changes in the past three years （2014—2017） and the forthcoming three years in the confidence index of family doctors （CIFD） in Shanghai Pudong New Area，and to provide assistance for furtherance of the family doctor system.Methods　All family doctors in the 9 community health service centers surveyed in 2014 were surveyed again using an online questionnaire （www.wjx.cn） in December 2017.The questionnaire was independently designed based on the actual situation in Pudong New Area in Shanghai and the CIFD surveys of the China Medical Tribune General Practice weekly and Gu Yuan Family Doctors' Studio.The main survey included：general practitioner's （GP's） attention to family doctors' work，six major factors influencing family doctor practice，CIFD，changes in the practice status，the ability and demand to engage in family doctor services，the current medical reform policy，the Medical Consortium，the improvement in family doctors' brand influence and other social hot topics.Results　A total of 309 questionnaires were distributed，and 307 valid questionnaires were returned resulting in an effective recovery rate of 99.35%.Of 307 GPs，181 （58.96%） were constantly concerned about family doctors' work，124 （40.39%） were sometimes concerned，and 2 （0.65%） were not concerned.The weights of the six major influencing factors for family doctors' practice，ranked in descending order were：wages and benefits （80 cases，26.06%），personal value realization （76 cases，24.76%），practice environment（57 cases，18.57%），social respect （51 cases，16.61%），career promotion （25 cases，8.14%），and work-life balance （18 cases，5.86%）．The 307 GP's CIFD in 2017 ranged from 0 to 100 points，with an average of （45.1±21.7） points，which was higher than that in 2014 （24.6±22.8） points （t=-1.779，P<0.05）；but lower than the average expected index in 2017 （66.0 ± 20.8） points （t=-2.065，P<0.05），and the average expected value in 2020 （48.2±23.1） points （tpaired=-4.515，P<0.05）．There was a statistically significant difference between the expected CIFDs in 2017 and 2020 in different unit locations （where CIFDs of doctors in suburban units > those in urban and urban fringe areas）（P<0.05）．The differences were statistically significant for the 2017 and 2020 CIFDs of junior，intermediate，sub-senior and above persons；units in urban areas，urban fringe areas and suburban areas；community health work for 3-<10 years，10-20 years，and >20 years （P<0.05）．Conclusion　The 2017 GP's CIFD index in Shanghai Pudong New Area is greater than that in 2014，and this may be attributable to the current income level，practice environment，personal value realization，and career promotion.The expected CIFD value in 2020 is slightly higher.

Comparison of the Efficacies of Endovascular Treatment and Drug Therapy in Treating Symptomatic Intracranial Artery Stenosis　

LIU Yi，YANG Li-hua，WANG Yan-ling，MA Yuan-yuan

2018, 21(23): 2867-2870. DOI: 10.3969/j.issn.1007-9572.2018.00.166

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Objective　To compare the vascular restenosis and treatment outcomes in patients with symptomatic intracranial atherosclerotic stenosis treated with either endovascular treatment or drug therapy，in order to provide a reference for preventing stroke recurrence and choosing optimal treatment plans.Methods　A total of 69 patients with symptomatic intracranial atherosclerotic stenosis treated in the Cangzhou People's Hospital between April 2015 and April 2017 were selected as study subjects.HR-MRI scanning was used to detect intracranial arterial stenosis，and TOF-MRA was used to reconstruct vascular structure and determine the location of stenosis.The patients voluntarily chose to be enrolled in the drug therapy group （37 cases）or endovascular treatment group（32 cases），in which drug therapy or intravascular stent implantation，respectively，were administered.Follow-up visits were conducted 1，2，3，and 6 months after surgery.The incidences of stroke，transient ischemic attack，and restenosis were recorded.Results　There were no deaths in both groups during the follow-up period.In the first month，there were no stroke and restenosis cases in the endovascular treatment group；while in the drug therapy group，there was one case each of stroke and restenosis，although the difference was not significant （P=1.000，1.000）．After the six months，the incidences of stroke and restenosis in the endovascular treatment group were 0 and 12.5% （4/32），respectively，in contrast to 16.2% （6/37） and 35.1% （13/37） in the drug therapy group；the difference was statistically significant （χ2=5.683，P=0.017；χ2=4.735，P=0.030）．Conclusion　Compared with drug therapy，endovascular treatment was associated with a lower incidence of stroke and restenosis in patients with symptomatic intracranial atherosclerotic stenosis.

Clinical Efficacy and Pharmacoeconomics of Concomitant Chemoradiotherapy with Pemetrexed or Etoposide plus Cisplatin for Locally Advanced Lung Adenocarcinoma　

YU Ting-ting，LU Xi，SHAN Li

2018, 21(23): 2871-2875. DOI: 10.3969/j.issn.1007-9572.2018.00.180

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Background　Concomitant chemoradiotherapy is a standard treatment for patients with locally advanced non-small cell lung cancer （NSCLC）；however，the ideal combined chemotherapy regimen has not been established.Objective　To compare the efficacy of pemetrexed plus cisplatin （PP） and etoposide plus cisplatin （EP） regimens concomitant with chest radiotherapy in the treatment of locally advanced lung adenocarcinoma，and to compare the pharmacoeconomics of these regimens to provide a reference for choosing treatment regimen in the clinic.Methods　Sixty-four patients diagnosed with locally advanced lung adenocarcinoma and treated in the Radiotherapy Center of the Cancer Hospital Affiliated to Xinjiang Medical University between 2010 and 2015 were selected as study subjects.The patients were divided into EP group （n=34） and PP group （n=30） according to the regimen received.The patients were administered a corresponding chemotherapy regimen and radiotherapy.Short-term efficacy was evaluated after 2 months of treatment；the patients were followed up until December 31，2016 to observe long-term efficacy.The costs of the two regimens were also recorded and compared.Results　There were no significant differences in short-term efficacy，objective remission rate，disease control rate，grade ≥3 hematological adverse reactions，grade 1 or 2 radioactive esophagitis，grade ≥2 radioactive pneumonitis，grade ≥3 digestive tract reactions and grade ≥2 liver function damage between the two groups （P>0.05）．The one-year and two-year survival rates in the EP group were 100.0% and 24.2%，respectively，and the median overall survival time was 21.0 months〔95%CI（19.7，22.3）months〕；the one-year and two-year survival rates in the PP group were 83.3% and 29.6%，respectively，and the median overall survival time was 21.0 months 〔95%CI（18.4，23.6）months〕.Log-rank test did not indicate a significant difference in survival curve between the two groups （χ2=1.896，P=0.169）．The total cost of the PP group was higher than that of the EP group （P<0.05）．Cost-effectiveness analysis showed that the cost/effectiveness of the EP group and the PP group was 267.35 and 599.36，respectively，and the Δ cost/Δ effectiveness was 3 772.84.Conclusion　Radiotherapy combined with the PP versus the EP regimen has similar efficacy and safety in the treatment of locally advanced lung adenocarcinoma，while the EP regimen is more economical than the PP regimen.

An Inquiry Model of General Practice Based on Integrative Medicine Method　

WANG Jian-qiang

2018, 21(23): 2876-2877. DOI: 10.12114/j.issn.1007-9572.2018.00.084

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Undifferentiated diseases and sub-health problems are the major parts in general practice outpatient clinics，which cannot be handled satisfactorily by only focusing on physical diseases.This paper aims to build an inquiry model of general practice by integrating reasons for visit（main symptoms），life history，purposes of visit and other relative factors，in order to enrich the contents of holistic care and lay a good foundation of selecting targeted treatment plans and improving health conditions and satisfaction of patients in the long term.

Syndrome of Inappropriate Antidiuretic Hormone Secretion：Analysis of Three Cases and Literature Review

JI Kai，LIU Hui，WANG Bei-bei，ZHAO Lian-li，CHEN Xin-yan

2018, 21(23): 2878-2881. DOI: 10.3969/j.issn.1007-9572.2018.00.208

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Syndrome of inappropriate antidiuretic hormone secretion （SIADH） is a disorder characterized by a series of clinical manifestations，such as excessive free water retained in the body，increased renal excretion of sodium and dilutional hyponatremia.The syndrome results from inappropriate，continued endogenous secretion or enhanced action of the antidiuretic hormone （ADH） by certain pathological conditions，which makes renal collecting duct be more permeable to water.We summarized the diagnosis and treatment of three patients with SIADH in Shengli Oilfield Central Hospital.Furthermore，based on the reviewing of the corresponding studies，we explored the etiology and key points in the diagnosis and management of this disease，in an attempt to present diagnostic approaches as many as possible to reduce the possibilities of missed diagnosis and incorrect diagnosis of SIADH.

Kimura Disease：Report of Four Cases and Diagnosis Ideas　

LIU Juan，JIANG Li-li，WANG You-lian

2018, 21(23): 2882-2885. DOI: 10.3969/j.issn.1007-9572.2018.00.225

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Kimura disease （KD） is a rare autoimmune-mediated chronic inflammatory disease that is common in young and middle aged men in Asia.The etiology and pathogenesis of the disease are unknown.Clinical misdiagnosis and mistreatment often occur on the basis of symptoms of painless single or multiple subcutaneous soft tissue masses in the head and neck，which can affect lymph nodes and salivary glands.Elevated blood eosinophils and serum immunoglobulin E levels is used to characterize the disease.Although the disease is a benign process for which surgery，radiotherapy and chemotherapy，and drug therapy are effective，the disease duration long，and the condition easily recurs.To investigate KD diagnosis and treatment，this article summarizes the diagnosis and treatment of four cases of KD diagnosed by pathological examination.In addition，a literature review of the clinical manifestations，pathological changes，diagnosis and treatment methods to improve the understanding of this rare disease，and to provide reference for its diagnosis and treatment，is presented.

Advances in Platelet-rich Plasma for Foot and Ankle Conditions with Surgical Treatment　

ZHU Jun-shan，FENG Xiu-zhen，ZHUANG Ru-jie

2018, 21(23): 2886-2890. DOI: 10.3969/j.issn.1007-9572.2018.00.029

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Platelet-rich plasma（PRP） is a new autologous biological preparation with high concentrations of platelets and growth factors.In recent years，a large number of clinical studies have proved that PRP can effectively accelerate the repair of tissues，so it is used for treating tendon，ligament，cartilage and muscle injuries little by little，which also has attracted much attention in the field of foot and ankle surgery.In this article，we systematically reviewed the recent studies about PRP's preparation process and clinical use for foot and ankle injuries，and explored its application prospect.

Recent Advances in Resveratrol-induced SIRT1 for the Improvement of Memory Impairment in Patients with Alzheimer's Disease　

HE Xiao-yi，YU Hai-bing，YAN Yan，HE Yu-qing，DING Yuan-lin，KONG Dan-li

2018, 21(23): 2891-2894. DOI: 10.3969/j.issn.1007-9572.2018.00.153

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Alzheimer's disease（AD） is a central nervous system degenerative disease characterized by gradual decline in cognitive and memory performance.Due to unknown etiology and pathogenesis，there is yet no effective medication for AD.Recent studies have proved that resveratrol plays a role in preventing the occurrence and progression of AD.With neuroprotective effect，resveratrol has been confirmed to be effective for improving the memory impairment in animal models of AD，but the mechanism of action is unknown.SIRT1，a regulator of memory performance，can be activated for improving the memory impairment of AD patients by resveratrol.The relevant recent developments were reviewed in this paper，with a view to providing a reference for treating AD with resveratrol.

Development Status and Prospect of General Practice and Integrative Medicine　

YING Mei-ke，HAN Ting-ting，WANG Yong-chen，REN Jing-jing

2018, 21(23): 2895-2898. DOI: 10.12114/j.issn.1007-9572.2018.00.022

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Both general practice and integrative medicine focus on offering patient-centered optimized care based on the organic integration of a variety of sources available.However，the former is community and family oriented，integrating clinical medicine，preventive medicine，rehabilitation medicine and humanities and social sciences，and the latter is rooted in caring for the whole person，integrating the advanced theories and experiences of practice in various medical fields.This paper begins by introducing the history of general practice and integrative medicine，then expounds the service concept and scope，analyzes the present situation of clinic practice and teaching of the two.Furthermore，the prospect of the two disciplines is discussed.

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