Table of Content

15 September 2018, Volume 21 Issue 26

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Monographic Research

Global Burden of Thyroid Cancer

LI Fei，LI She-yu

2018, 21(26):  3155-3159.  DOI: 10.12114/j.issn.1007-9572.2018.00.174

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Thyroid cancer is the fastest growing malignancy throughout the world in recent years.Its burden varies across different regions due to specific clinical and prognostic features.Moreover，the changes in its trend of burden are mainly attributed to overdiagnosis and overtreatment.In China，local characteristics of burden of thyroid cancer call for further investigations in etiology，economic and clinical management with native data.


Reflection on Aspirin for Primary Prevention of Cardiovascular Disease in the Elderly　#br#

GENG Hui，LIU Mei-lin

2018, 21(26):  3160-3163.  DOI: 10.12114/j.issn.1007-9572.2018.00.111

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Aspirin is a commonly used antithrombotic drug for the prevention and treatment of cardiovascular diseases （CVD） in the elderly.However，older people are at high risk of bleeding，and aspirin-related bleeding increases significantly with age.In recent years，the recommendations for aspirin in primary prevention of CVD in foreign guidelines tend to be conservative.In primary prevention，how to select and standardize aspirin use and take into account the benefits and safety should be highly valued.This article reviews the evidence，guidelines and consensus and specific issues concerning aspirin for primary prevention of CVD in the elderly.Low-dose aspirin is recommended in individuals if the benefit exceeds the risk，and the assessment is based on the patient's age，risk factors for CVD and so on.


Effect of High-dose Atorvastatin on the Short-term Prognosis of Acute STEMI Patients with Emergency PCI

WANG Xue-bin，ZHAO Liang-ping，XU Wei-ting，YAO Biao，LUO Xian-yuan，CHEN Jian-chang

2018, 21(26):  3164-3169.  DOI: 10.3969/j.issn.1007-9572.2018.00.252

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Objective　To evaluate the effect of high-dose atorvastatin on the short-term prognosis of patients with acute ST-segment elevation myocardial infarction （STEMI） treated by emergency percutaneous coronary intervention （PCI）.Methods　We enrolled 158 cases of acute STEMI from Department of Cardiovascular，the Second Affiliated Hospital of Soochow University from June 2011 to June 2014.We divided the patients into intensive treatment group（receiving treatment with atorvastatin calcium 80 mg daily before PCI but changed to atorvastatin calcium 40 mg daily after PCI，n=79） and standard treatment group（receiving treatment with atorvastatin calcium 20 mg daily before and after PCI，n=79） based on the random number generated by SPSS 17.0.We collected their baseline characteristics，results of arteriography，data about treatment，adverse major adverse cardiovascular events （MACE） within 30 days after PCI，and the event associated with poor prognosis.Results　After PCI，compared with the standard treatment group，intensive treatment group demonstrated less proportion of patients with TIMI 0-2 flow and cardiac function KillipⅢ-Ⅳ grade（P<0.05）.Moreover，within 30 days after PCI，the intensive treatment group showed much lower incidence of MACE〔1.3%（1/79） vs.11.4%（9/79）〕（χ2=6.832，P=0.009），as well as higher event-free survival rate identified by Kaplan-Meier survival analysis（χ2=6.860，P=0.009）.Multiple Cox regression analysis found that，post-procedural TIMI 0-2 flow 〔HR=5.382，95%CI（1.042，27.789），P=0.044〕 and use of bare metal stents 〔HR=9.829，95%CI（1.917，50.386），P=0.006〕 increased the risk of having MACE while intensive treatment with atorvastatin calcium decreased the risk of having MACE 〔HR=0.106，95%CI（0.011，0.993），P=0.049〕.Two groups had no severe liver and kidney failure，myopathy，new-onset diabetes，or contrast-induced nephropathy.Conclusion　For acute STEMI patients with emergency PCI，intensive treatment with atorvastatin calcium during the perioperative period and early post-procedural period can significantly improve the short-term prognosis by enhancing the level of myocardial perfusion immediately after PCI and reducing the incidence of MACE.


Study on Normal Level of Blood Pressure and Diagnostic Criteria for Hypertension in Adult Women　#br#

XU Chun-qi，SHANG Ya-dong，CHENG Ren-li，WANG Ai-hong，YOU Jia-cong，ZHONG Ping

2018, 21(26):  3170-3174.  DOI: 10.12114/j.issn.1007-9572.2018.00.157

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Objective　To investigate the diagnostic criteria for hypertension in women and understand their normal blood pressure level by comparing the gender differences in blood pressure.Methods　Women at the age of 18-20，21-30，31-40，41-50，51-60，and over 61 years from five villages in Suzhou，Anhui Province，who voluntarily went to the local clinic for examination were selected from May to December 2016，each age group with 150 cases via convenient sampling methods.The same number of male adults of the same age range in each village were enrolled by using the same sampling method and screening criteria.Blood pressure was measured by using a bench-top mercury sphygmomanometer，ventricular septal and/or left posterior wall thickening measured by echocardiography，and left ventricular high voltage and/or left axis deviation measured by electrocardiogram.Results　Except for 51-60 years group，the SBP and DBP of women were significantly lower than that of men （P<0.05）.The proportion of women in 18-20 years，21-30 years，31-40 years groups whose blood pressure were <90/60 mm Hg （1 mm Hg=0.133 kPa）was higher than that of men （P<0.05）.In people whose blood pressure were <90/60 mm Hg，SBP and DBP of female were （85.6±2.4） mm Hg，（55.4±1.0） mm Hg，and SBP and DBP of male were （87.9
±2.4） mm Hg，（58.7±0.7） mm Hg，respectively，and there was a statistically significant difference （t=-2.947，-10.694，P<0.05）.There was no significant difference in the ratio of people whose blood pressure were ≥140/90 mm Hg，120-139/80-89 mm Hg between men and women in all age groups （P>0.05）.In women with blood pressure of 120-139/80-89 mm Hg，incidence of symptoms such as headache，dizziness，palpitation，chest tightness，ventricular septal and/or left posterior wall thickening，and left ventricular high voltage and/or left axis deviation were higher than those of men （P<0.05）.Conclusion　There may be differences in normal blood pressure level and diagnostic criteria for hypertension in different gender.Normal blood pressure level in women maybe lower than that in men.Normal SBP and DBP in women may be 85-120 mm Hg，55-80 mm Hg，respectively.Female whose blood pressure are higher than 120/80 mm Hg may have hypertension.


Clinical Study of Thioctic Acid Sequential Therapy Combined with Epalrestat in the Treatment of Diabetic Painful Neuropathy

LI Dong-feng，ZHANG Qiu

2018, 21(26):  3175-3178.  DOI: 10.12114/j.issn.1007-9572.2018.00.175

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Objective　To investigate the clinical effects of thioctic acid sequential therapy combined with epalrestat in the treatment of diabetic painful neuropathy （PDN）.Methods　A total of 80 patients with PDN admitted to the Department of Endocrinology of Lu'an Second People's Hospital in 2016 were enrolled as the study subjects.The random number table was adopted to divide the patients into the observation group and the control group，each with 40 cases.The observation group was treated with thioctic acid sequential therapy combined with epalrestat for 8 weeks.The control group was treated with mecobalamin sequential therapy combined with epalrestat for 8 weeks.The clinical efficacy of the two groups of patients after treatment was recorded.The motor nerve conduction velocity （MNCV） and sensory nerve conduction velocity （SNCV） of median nerve and common peroneal nerve were measured before and after the treatment.Results　In the observation group，33 cases（82.5%） were markedly effective，6 cases（15.0%） improved，and 1 case（2.5%） failed.In the control group，9 cases （22.5%）were markedly effective，21 cases （52.5%）improved，and 10 cases（25.0%） failed.The clinical efficacy of the observation group was better than that of the control group （u=4.81，P<0.01）.Before the treatment，there was no significant difference in MNCV and SNCV of median and peroneal nerves between the two groups （P>0.05）.After the treatment，the MNCV and SNCV of median nerve and peroneal nerve in the observation group were higher than those in the control group （P<0.05）.The difference in MNCV and SNCV of median and peroneal nerves before and after the treatment in the observation group were higher than those in the control group （P<0.05）.No serious adverse reaction occurred in both two groups.Conclusion　Compared with mecobalamin，the use of thioctic acid sequential therapy combined with epalrestat for the treatment of PDN is more effective and safer，so it is worthy of clinical application.


Characteristics and Risk Factors of Cognitive Impairment in Patients with Non-diabetic Acute Ischemic Stroke

XIONG Yi，JIANG Sen，RU Shan，LEI Jing，ZHANG Xiao-ning

2018, 21(26):  3179-3183.  DOI: 10.12114/j.issn.1007-9572.2018.00.107

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Objective　To investigate the characteristics and risk factors of cognitive impairment in patients with non-diabetic acute ischemic stroke.Methods　We enrolled 96 inpatients with acute ischemic stroke diagnosed by brain MRI from Department of Neurology，the First Affiliated Hospital of Xinjiang Medical University from December 2016 to July 2017.We collected their clinical data and results of laboratory tests.And based on the assessment results of Beijing version of the Montreal Cognitive Assessment（MoCA），we assigned those with MoCA<26 and MoCA ≥26 to cognitive impairment group（n=45），non-cognitive impairment group（n=51），respectively.Results　The mean scores of visuospatial abilities and executive functions，naming ability，attention ability，capacity of calculation，language ability，delayed recollection，level of orientation，abstract thinking ability for the participants were all lower than full credit（P<0.05）.In particular，the mean scores of the visuospatial abilities and executive functions，delayed recollection，abstract thinking ability had a large gap comparied with full credit.Multivariate Logistic regression analysis showed that older age〔OR=1.190，95%CI（1.062，1.333）〕，cerebrovascular stenosis 〔OR=10.449，95%CI（1.696，64.389）〕，FPG >4.7 mmol/L〔OR=41.378，95%CI（2.801，611.350）〕，elevated LDL-C level 〔OR=3.481，95%CI（1.120，10.822）〕，elevated microalbumin level in the urine〔OR=1.067，95%CI（1.009，1.128）〕 were risk factors for cognitive impairment，while increased years of education〔OR=0.505，95%CI（0.326，0.782）〕 and elevated HDL-C level 〔OR=0.020，95%CI（0.001，0.359）〕 were protective factors for cognitive impairment（P<0.05）.Conclusion　Cognitive function is associated with both anterior and posterior circulation infarction in patients with non-diabetic acute ischemic stroke.Intracranial and extracranial vascular stenosis and increased FPG levels are important risk factors for cognitive impairment，so appropriately targeted interventions will benefit the improvement of cognitive function.


Effect of Blood Pressure Control on Arterial Elasticity in Patients with Essential Hypertension Complicated with Microalbuminuria

XIAO Jin-cui，LIU Da-nan，LI Zhi-jing，WANG Xiao-yu

2018, 21(26):  3184-3189.  DOI: 10.3969/j.issn.1007-9572.2018.00.245

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Objective　To investigate the effect of blood pressure control on arterial elasticity in patients with essential hypertension complicated with different degrees of microalbuminuria.Methods　We enrolled 114 inpatients with essential hypertension and microalbuminuria from Department of Cardiology and Hypertension，the Affiliated Hospital of Guizhou Medical University from June 2016 to June 2017.According to the level of urine albumin-to-creatinine ratio （UACR），they were divided into group Ⅰ （30 mg/g≤UACR<100 mg/g） including 25 cases of well controlled hypertension 〔systolic blood pressure （SBP） <140 mm Hg （1 mm Hg=0.133 kPa） and diastolic blood pressure （DBP） <90 mm Hg 〕 and 25 cases of poorly controlled hypertension （SBP≥140 mm Hg and/or DBP≥90 mm Hg），group Ⅱ （100 mg/g≤UACR<200 mg/g） including 17 cases of well controlled hypertension and 17 cases of poorly controlled hypertension，group Ⅲ （200 mg/g≤UACR<300 mg/g） including 15 cases of well controlled hypertension and 15 cases of poorly controlled hypertension.In accordance with the hypertension control status，the patients were divided into poorly controlled hypertension group （57 cases） and well controlled hypertension group （57 cases）.We collected their data about blood pressure，fasting blood glucose （FBG），total triacylglycerol （TG），cholesterol （TC），high-density lipoprotein cholesterol （HDL-C），low-density lipoprotein cholesterol （LDL-C），UACR，indicators of blood vessel elasticity〔brachial-ankle pulse wave velocity （BaPWV），carotid-femoral artery pulse wave velocity （C-FPWV），central systolic pressure （CSP）〕.Results　Compared with those with well controlled hypertension，patients with poorly controlled hypertension were older，and they demonstrated much lower FBG，but significantly higher SBP，pulse pressure，UACR，BaPWV，C-FPWV and CSP （P<0.05）.Group Ⅰ showed much lower levels of C-FPWV and CSP compared with group Ⅱ （P<0.05）.Moreover，it exhibited much lower levels of C-FPWV，CSP，pulse pressure and BaPWV compared with group Ⅲ （P<0.05）.Group Ⅱ demonstrated significantly lower levels of BaPWV，C-FPWV and CSP compared with group Ⅲ （P<0.05）.In group Ⅰ，those with well controlled hypertension showed much lower SBP，DBP，pulse pressure，UACR，C-FPWV and CSP than those with poorly controlled hypertension （P<0.05）.In group Ⅱ，the SBP，pulse pressure，UACR，C-FPWV and CSP were much lower in those with well controlled hypertension instead of those with poorly controlled hypertension（P<0.05）.In group Ⅲ，those with well controlled hypertension were found with obviously lower SBP，pulse pressure，C-FPWV，CSP and higher DBP instead of those with poorly controlled hypertension （P<0.05）.Stepwise multiple linear regression analysis found that FBG was associated with C-FPWV in those with well controlled hypertension （β=0.526，P<0.05）；age，SBP，pulse pressure，and UACR were associated with C-FPWV in those with poorly controlled hypertension （β=0.031，β=0.034，β=0.048，β=0.023，P<0.05）；DBP，pulse pressure，and UACR were associated with CSP in those with well controlled hypertension （β=0.349，β=0.225，β=0.111，P<0.05）；age，pulse pressure，and UACR were associated with CSP in those with poorly controlled hypertension （β=0.321，β=0.243，β=0.113，P<0.05）.Conclusion　Impaired arterial elasticity exists in patients with essential hypertension combined with microalbuminuria，which is aggravated with the increased severity of microalbuminuria，and is directly related to poor pressure control.Impaired arterial elasticity is associated with microalbuminuria and blood pressure control.


Age-specific Analysis of Risk Factors，Etiological Type and Prognosis of Pontine Infarction Patients

WANG Hong-xia，LIU Xin，WANG Li-juan，LYU Na，LI Xiao-gang

2018, 21(26):  3190-3193.  DOI: 10.3969/j.issn.1007-9572.2018.00.243

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Objective　To investigate the risk factors，etiological type and prognosis of pontine infarction patients of different age groups.Methods　We enrolled 74 pontion infarction patients from Department of Neurology，Beijing Zhongguancun Hospital from March 2015 to March 2017 and assigned 37 younger than 65 years old of them to the young-to-middle-aged group，and other 37 aged ≥65 to elderly group，respectively.We collected and analyzed their baseline characteristics，such as demographic data，past medical history，laboratory findings and imaging findings as well as modified Rankin Scale （mRS） score.Results　Compared with the young-to-middle-aged group，elderly group demonstrated higher percentage of patients with diabetes but lower percentage of patients with hyperlipidemia（P<0.05）.Moreover，elderly patients were found with higher levels of mean glycosylated hemoglobin and systolic pressure and lower level of mean triacylglycerol（P<0.05）.Two groups presented no significant differences in types of etiology for pontine infarction（χ2=2.303，P=0.316）.To be specific，young-to-middle-aged group and elderly group showed similar prevalence of large-artery-occlusive disease-related pontine infarction〔5.4%（2/37） vs.16.2%（6/37）〕，similar prevalence of basilar artery branch disease related-pontine infarction〔45.9%（17/37） vs.43.3%（16/37）〕 and similar prevalence of small vessel disease-related pontine infarction〔48.7% （18/37） vs.40.5% （15/37）〕.Young-to-middle-aged group and elderly group also presented similar rate of poor short-term prognosis〔27.0% （10/37） vs.29.7% （11/37）〕（χ2=0.111，P>0.05）.Conclusion　Hypertension，hyperlipidemia，and history of smoking and drinking were major risk factors for pontion infarction in young-to-middle-aged people，while diabetes was the major risk factor for pontion infarction in elderly people.Pontion infarction in young-to-middle-aged people was mainly due to small vessel disease，whereas that in elderly people was mainly due to basilar artery branch disease.Poor short-term prognosis was found in 1/3 of the young-to-middle-aged patients and elderly patients with pontion infarction.


Analysis of Factors Affecting Severe Diabetic Foot and Consequent Amputation

AN Jing-si，ZHAO Jin，WANG Xue-ying

2018, 21(26):  3194-3200.  DOI: 10.3969/j.issn.1007-9572.2018.00.238

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Background　The incidence of diabetic foot （DF） disease is high，and DF causes great harm.Awareness of the risk factors for poor prognosis in DF should be improved to aid in disease prevention and control.Objective　To analyze the characteristics of patients with DF and to explore the factors influencing severe DF and DF amputation.Methods　A total of 175 DF patients admitted to the Department of Endocrinology at Jinzhou Central Hospital between March 2012 and March 2017 were selected for this study.General patient data，laboratory test results，and diabetic complications were retrospectively collected.According to the Wagner grading standard of DF，the patients were divided into a light group and a severe group.According to amputation conditions，they were also divided into an amputation group and a non-amputation group.Multivariate Logistic regression analysis was performed to analyze the factors influencing severe DF and DF amputation.Results　The smoking rate in the severe group was higher than that in the light group.The duration of diabetes in the severe group was longer than that in the light group，and the BMI in the severe group was lower than that in the light group.The fasting C-peptide，triglyceride （TG），total cholesterol （TC），low-density lipoprotein cholesterol （LDL-C），serum albumin （Alb），alanine aminotransferase （ALT），aspartate aminotransferase （AST），red blood cell count （RBC），and hemoglobin （Hb） in the severe group were lower than those in the light group，but the homocysteine （Hcy），white blood cell count （WBC），and platelet count （PLT） in the severe group were higher than those in the light group.The incidence of diabetic nephropathy，arteriosclerosis obliterans of lower extremities，and minor amputation in the severe group were higher in the severe group than in the light group （P<0.05）.The multivariate Logistic regression analysis showed that Alb 〔OR=0.754，95%CI（0.650，0.874）〕，PLT 〔OR=1.006，95%CI（1.000，1.011）〕，and Hcy 〔OR=1.702，95%CI（1.376，2.106）〕 were associated with severe DF.In the amputation group，the smoking rate was higher，whereas the BMI was lower，than those in the non-amputation group.The levels of Alb and Hb in the amputation group were lower to those in the non-amputation group.The levels of WBC and PLT in the amputation group were higher than those in the non-amputation group.The incidence of cerebral infarction in the amputation group was higher than that in the non-amputation group （P<0.05）.The multivariate Logistic regression analysis results showed that BMI 〔OR=0.833，95%CI（0.723，0.960）〕 and Alb 〔OR=0.921，95%CI（0.872，0.974）〕 were associated with DF amputation.Conclusion　Elevated PLT and hyperhomocystinemia are risk factors for severe DF.Serum Alb is a protective factor for severe DF，and BMI and serum Alb are protective factors for DF amputation.


Management Models for the Prevention and Control of Diabetes in Shanghai and Taiwan：a Comparative Study

HUANG Ping

2018, 21(26):  3201-3205.  DOI: 10.12114/j.issn.1007-9572.2018.00.125

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Diabetes is a chronic metabolic disorder that greatly threatens people's health.Both Shanghai and Taiwan have established management models for the prevention and control of diabetes based on regional characteristics，the former is characterized by community-based patient self-management，team management combined with hospital-community-diabetes patients seamless integrated management，while the latter is manifested by hospital-based diabetes shared care network management.Both models emphasize patient self-management and multidisciplinary and interdisciplinary team management and the construction，management，and application of supportive databases despite using different referral modes and performance evaluation methods.By comparing the two models，we hope to provide a reference for the development of a better management model for diabetes prevention and control.


Procedure of TCM Management of Diabetes by the Team Mainly Consisting of General Practitioners

ZHANG Hong*，WANG Jian-bo，YAN Hua，SHI Jian-hua，YU Xiao-rui，LIAN Yan-ling

2018, 21(26):  3206-3211.  DOI: 10.12114/j.issn.1007-9572.2018.00.187

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Objective　To study the effect of TCM management of diabetes on type 2 diabetic patients by the team mainly consisting of general practitioners.Methods　We enrolled 269 type 2 diabetic patients from January to June 2017 who were under management of Wudong Team Guyi Community Neighbourhood Committee of Tianlin Street Community Health Center located in Shanghai's Xuhui District.They received 1-year TCM management of diabetes from Wudong Team mainly consisting of general practitioners.The outcome was evaluated from the following 5 aspects at the end of management：（1） incidence of complications；（2） survey results of Knowledge，Attitude and Practice of TCM Prevention and Treatment of Diabetes（KAP），Chinese version of Diabetes Management Self-efficacy Scale （C-DMSES），Chinese version of Problem Areas in Diabetes Scale（PAID）；（3） plasma glucose control status assessed in accordance with fasting plasma glucose（FPG），2-hour postprandial blood glucose（2 hPG） and glycosylated haemoglobin（HbA1c）；（4） degree of renal impairment〔identified based on urine albumin/creatinine ratio （urine ACR），renal impairment was defined as the urine ACR≥30 mg/g〕；（5） mean annual and daily costs.Results　At the end of intervention，the patients showed significantly higher scores of KAP，C-DMSES and PAID，much lower FPG，2 hPG and HbA1c levels，obviously decreased mean annual and daily costs（P<0.05），although the incidence of cerebrovascular disease，cardiovascular disease，peripheral vascular disease，retinopathy，diabetic nephropathy，neuropathy，cataract，diabetic foot and diabetic ketosis，urine ACR，and prevalence of positive urine ACR changed little（P>0.05） compared with baseline.Conclusion　For type 2 diabetic patients，TCM management of diabetes by the team mainly consisting of general practitioners helps control or stabilize the blood glucose，decrease the medical costs.


Effectiveness of a Family Doctor-led Self-management Support Intervention among Diabetic Patients Living at the Rural Urban Fringe：a Randomized Controlled Trial　#br#

WU Hua-feng，WEN Cai-yin，KONG Xiao-ying，SHEN Lu，WU Xiao-ya，WU Wen-wei，LI Qiu-quan，LIAO Xiao-duo，MO Qing-ai，WANG Jia-ji，WANG Hao-xiang

2018, 21(26):  3212-3216.  DOI: 10.12114/j.issn.1007-9572.2018.00.199

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Objective　To evaluate the effectiveness of a family doctor-led self-management support intervention among type 2 diabetic patients living at the rural–urban fringe.First-hand evidence was gathered to help the exploration of appropriate management model for type 2 diabetes mellitus.Methods　The enrolled participants were sampled from the type 2 diabetic patients who received treatment from Nanhai Shishan Community Health Center in Foshan between 2016 and 2017.A total of 342 cases were included.They were assigned to the intervention group (n=171) and control group (n=171) with an allocation ratio of 1：1 by computational random number generators.Both groups received the usual antidiabetic treatment and diabetes management，the intervention group additionally received a responsible intervention led by the family doctor team.The intention to treat analysis was used to evaluate the changes in outcomes including hemoglobin A1c (HbA1c)，blood pressure (BP)，lipid profiles，body mass index (BMI)，lifestyle behaviors，and self-rated efficacy between the two groups at 1-year follow up.Results　The levels of mean HbA1c，systolic blood pressure (SBP) and diastolic blood pressure (DBP)，total cholesterol，low-density lipoprotein cholesterol，high-density lipoprotein cholesterol，triglyceride and BMI were similar in both groups at baseline as well as at 1-year follow up，as were the rates of mastering the method for self-monitoring of blood glucose，having foot care regularly，frequently smoking，frequently drinking，taking antidiabetic drugs on schedule and at the proper dose(P>0.05).Moreover，there were no significant differences in the self-rated mean scores of eating habit，exercise habit，taking antidiabetic drugs on schedule and at the proper dose，having foot care regularly and glycemic control between the two groups at baseline and 1-year follow-up (P>0.05).Conclusion　The family doctor-led self-management support intervention seemed to be ineffective in improving the levels of HbA1c，BP，lipid profiles，lifestyle behaviors and self-rated efficacy among type 2 diabetic patients living at the rural–urban fringe.Further exploration and validation of diabetic management models are needed for improvement.

Effects of Community Management Combined with Self-management on Treatment Compliance and Quality of Life in Elderly Patients with Type 2 Diabetes

LI Yun-jing，ZOU Zhe-hua，YI Shuang-yan，YU Chang-ying

2018, 21(26):  3217-3222.  DOI: 10.12114/j.issn.1007-9572.2018.00.191

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Objective　To evaluate the intervention effect of diseases management mode of community management and self-management on compliance and quality of life in elderly patients with type 2 diabetes after discharge.Methods　A total of 200 patients with type 2 diabetes who were discharged from the Department of General Medical，the First Hospital of Qinhuangdao from August 2015 to July 2016 were selected as the study subjects.Random number table was used to divide patients into intervention group （100 cases） and control group （100 cases） in the randomized controlled trial.For the intervention group，community management-self-management intervention was adopted by setting up regular out-patient or home-based follow-ups，providing medication adjustment，patient and family counseling and other services in community health service centers; patients received face-to-face health education before discharge，and self-management training once a month during follow-ups.Patients in the control group were only given routine guidance at discharge.Baseline data of patients were collected and one clinical follow-up 12 months after discharge was conducted to understand drug use，clinical index of patients.We used Diabetes Knowledge Test （DKT） to evaluate diabetes knowledge，Revised Summary of Diabetes Self-Care Activities （SDSCA） Scale to assess self-care ability，and Diabetes Specific Quality of Life （DSQL） Scale to evaluate quality of life.Results　In the control group，3 patients （3.0%） lost contact after discharge，and 3 patients （3.0%） died during the follow-up.In the intervention group，1 patients （1.0%） gave up halfway because of moving away，and 1 patients （1.0%） died during the follow-up.At the end of the follow-up，the usage rate of aspirin /clopidogrel，and statins in the intervention group was higher than that in the control group （P<0.05）.The usage rate of angiotensin converting enzyme inhibitor（ACEI）/angiotensin Ⅱ receptor antagonist（ARB） in the intervention group was higher than that in the control group （P<0.05）.Body mass index （BMI），glycosylated hemoglobin and low density lipoprotein cholesterol （LDL-C） in intervention group were lower than those in control group（P<0.05）.The score of DKT in the intervention group was higher than that in the control group（P<0.05）.Scores of diet，blood-glucose testing，foot care in intervention group were higher than those in control group（P<0.05）.The number of smokers in intervention group was lower than that in the control group（P<0.05）.The physiological function，mental health，treatment and total score of intervention group were lower than those of control group （P<0.05）.Conclusion　Diseases management mode of combining community management with self-management can significantly improve the treatment compliance，self-care ability，clinic index and quality of life of elderly patients with type 2 diabetes.


Operational Status of Hospice Care Wards in Beijing：a Qualitative Study Using Semi-structured Face-to-face Interviews with Relevant Medical Professionals　

GONG Yi-ning，LI Fu-rong，NI Kai-wen，LIU Yu-shi，ZHANG Meng-ze，FU Jia-yu，LIU Yi-yun，HU Jing，LIU Zhong-yi，LI Zhuo，ZHAO Yi-ming

2018, 21(26):  3223-3227.  DOI: 10.12114/j.issn.1007-9572.2018.00.159

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Objective　Hospice care is at a preliminary stage in Beijing.In order to understand the operational status（including the barriers encountered） of hospice care wards in Beijing，we interviewed relevant medical professionals，which may provide some countermeasures for the development of hospice care.Methods　In July 2017，we conducted semi-structured face-to-face interviews about hospice care in a convenience sample of five medical professionals from three medical institutions in Beijing setting up wards and delivering hospice care for those in need.The interview data were coded，classified，briefed，and the themes were summarized.Results　There were no unified criteria for patients being admitted to a hospice care ward.The admitted patients were mainly with advanced cancer.Care options were chosen by many types of decision-making methods.Medical professionals would try to persuade the patient's family members to make the patient aware of his own conditions.Hospice care was given for comfort rather than extending life.The national medical insurance scheme provides normal but not specially favorable reimbursement for the treatment.The beds were in short supply.The development of hospice care needs more investment，and related education activities should be taken.The community and tertiary hospitals play different but complementary roles in delivering hospice care，so the referral system for such patients should be developed vigorously.Conclusion　The development of hospice care including the maintaining the normal operating status of hospice care wards in Beijing requires financial and policy supports.Moreover，unified admission criteria should be established for promoting the normative development of hospice care，death education and other relative educational activities for general populations should be valued and implemented as early as possible，professional talents should be fostered in medical colleges with great efforts，tertiary and community hospitals should be given full play in delivering hospice care，and the referral system for such patients should be implemented actively.


Clinical Analysis of Community-based Care for 111 Cases of Cancer Pain

WANG You-qing，BAI Xiang-li，SONG Xing，LIU Ju-hong

2018, 21(26):  3228-3230.  DOI: 10.3969/j.issn.1007-9572.2018.00.173

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Objective　To analyze the treatment delivered by Beijing Xicheng Desheng Community Health Service Center for patients with cancer pain，providing a reference for community healthcare settings delivering care for such patients.Methods　We collected and conducted a descriptive analysis of the medical records of 111 consecutive inpatients with cancerous pain receiving standardized treatment in Beijing Xicheng Desheng Community Health Service Center from 2012 to 2016 based on the guidelines on cancer pain management （2011 edition）.Results　All the patients 〔52 males and 59 females with an average age of（71.2±12.6）〕 demonstrated different degrees of cancer pain：11 with mild pain，25 with moderate pain，and 75 with severe pain.Pain relief was achieved in 77.5%（86/111） of the patients within 48 h after the treatment，and in 99.1%（110/111） of them within 72 h after the treatment.Conclusion　Community hospitals with standardized systematic training can offer care for improving the quality of life of patients with cancer pain via reducing the suffering.


Major Neuropsychological Developmental Milestones in Premature Infants during Infancy by Age：a Longitudinal Study

SUN Yu，DUAN Yu-wen，WANG Fang-jun，HONG Xin-min，LI Pei-pei，GAO Ming-juan，SHAO Zi-yu

2018, 21(26):  3231-3235.  DOI: 10.3969/j.issn.1007-9572.2018.00.251

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Objective　To explore the major neuropsychological developmental milestones in premature infants during infancy by age.Methods　By the convenience sampling method in a preterm birth cohort of 88 cases（gestational age less than 37 weeks） who were under systematic management of the local MCH institutions in four main urban districts of Hefei（Yaohai，Luyang，Baohe，Shushan） during September 2015 to September 2017.Gestational age < 34 weeks were high-risk group，and gestational age of ≥ 34 weeks but < 37 weeks were low-risk group.We longitudinally monitored the major neuropsychological development milestones in them during infancy by age，and analyzed the differences between the chronological and corrected age for achieving these developmental milestones.Meanwhile，we monitored the outcomes of these infants using warning signs checklist for screening psychological，and behavioral developmental problems.Results　Except 19 were lost to follow up，the other 69（78.4%） were included in the final analysis.There were significant differences in birth weight and inpatient treatment duration between the two groups （P<0.05）.Compared with the normal full-term infants，both high-risk and low-risk groups demonstrated delayed major neuropsychological development milestones according to the chronological age（P<0.05）.Moreover，even though the age of month was corrected，compared with the normal full-term infants，both high-risk and low-risk groups still presented delayed major neuropsychological development milestones，such as vocalizations or smiling in response to teasing，understanding the adults' facial expressions，indicating “rejection”，recognizing familiar people and objects，lifting its head to a 45 degree angle，rolling over，crawling，standing independently in the low-risk group（P<0.05），and visual tracking of around 180 degrees angle，vocalizations or smiling in response to teasing，identifying sound source localization，understanding the adults' facial expressions，indicating rejection，recognizing familiar people and objects，lifting its head to a 45 degree angle，rolling over，sitting independently，crawling，and standing independently in the high-risk group（P<0.05）.Compared with the low-risk groups，the high-risk groups demonstrated delayed major neuropsychological development milestones according to the chronological age（P<0.05），and the high risk groups visual tracking of around 180 degrees angle，understanding the adults' facial expressions，sitting independently month old age later than the low-risk group （P<0.05）.After the age of the month was corrected，there was no significant differences in the rate of development retardation between the groups（P>0.05）.Conclusion　The chronological age for major neuropsychological developmental attainments in premature infants was older than that of the normal infants during infancy.Even though the age was corrected，the premature infants，especially those with high risks，achieved some neuropsychological developmental milestones later than the normal infants during infancy.Therefore，long-term monitoring and early delivery of targeted interventions should be strengthened for the neuropsychological development of premature infants.


Fecal Calprotectin in Response to Transfusion of Red Blood Cell Suspension in Very Low Birth Weight Infants

HE Shan，LI Li，YANG Jing-hui

2018, 21(26):  3236-3239.  DOI: 10.3969/j.issn.1007-9572.2018.00.250

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Objective　To analyze the changes of fecal calprotectin in very low birth weight infants（VLBWI） within 72 h after receiving transfusion of red blood cell （RBC） suspension.Methods　We enrolled 27 VLBWI（birth weight <1 500 g） from NICU，the First People's Hospital of Yunnan Province from January 2016 to January 2017 and divided them into transfusion group（19 with blood transfusion indication receiving RBC suspension transfusion） and non transfusion group（8 did not receive RBC suspension transfusion）.The hematocrit （HCT） was detected.And fecal calprotectin was measured in feces of both groups collected concurrently.In the non transfusion group，1 stools were collected every 24 h for 4 times，and the children in the blood transfusion group collected the last 1 stools before and after blood transfusion，and the feces in 24 h，48 h and 72 h after transfusion.Results　The mean HCT of the transfusion group was lower than that of the control group （t= -5.114，P<0.001）.The 4 measurement results of the fecal calprotectin level for the transfusion group differed significantly（P<0.05），to be specific，the fecal calprotectin level was the lowest at baseline，then increased successively at 24 h，48 h，72 h after RBC suspension transfusion（P<0.05）.Curve fitting analysis demonstrated that the fecal calprotectin level for the transfusion group increased over time（F=33.390，P<0.001）；HCT was found to be negatively correlated increasing with fecal calprotectin level either when the baseline fecal calprotectin level was controlled（r=-0.653，P=0.003） or not（r=-0.696，P=0.001）.Conclusion　After receiving transfusion of RBC suspension，the level of fecal calprotectin of VLBWI was increasing significantly over time.The fecal calprotectin level is of great significance in predicting the intestinal inflammatory responses.For VLBWI，especially those with severe anemia，RBC suspension transfusion might induce intestinal inflammatory reactions，which in turn could increase the risk of having necrotizing enterocolitis.


Effects of Rehabilitation Exercise Intervention on the Pulmonary Function and Quality of Life in Patients with Chronic Obstructive Pulmonary Disease Based on Trans-theoretical Model

CHEN Xu，YANG Xiao-yun，LIU Shu-min

2018, 21(26):  3240-3245.  DOI: 10.3969/j.issn.1007-9572.2018.00.254

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Objective　To explore effects of rehabilitation exercise intervention on the pulmonary function and quality of life in patients with chronic obstructive pulmonary disease（COPD） based on trans-theoretical model（TTM）.Methods　Using a convenient sampling method，98 patients with COPD who visited the Department of Respiratory Medicine in 2015 were selected from the electronic medical record system of Ningxia People's Hospital.A random number table was used to divided the patients into the treatment group and the control group（49 patients in each group）.The patients in treatment group were given the pulmonary rehabilitation exercise intervention based on TTM，while normal pulmonary rehabilitation exercise intervention was given to patients in the control group.Behavioral compliance，quality of life and pulmonary function of patients with COPD were evaluated before the intervention and at 3，6 and 9 months after the intervention.Results　At 6 and 9 months after the intervention，the frequency of pulmonary rehabilitation exercise in the treatment group was higher than that of control group；the CAT score of the treatment group was lower than that of control group；and the behavior stage of pulmonary rehabilitation exercise in the treatment group was better than that of control group（P<0.05）.At 9 months after the intervention，forced expiratory volume in the first second（FEV1）/forced vital capacity（FVC） and percentage of predicted expiratory volume at the first second（FEV1%pred） in the treatment group were higher than that of control group（P<0.05）.Conclusion　Pulmonary rehabilitation exercise intervention based on TTM can effectively improve the pulmonary rehabilitation exercise compliance in COPD patients as well as improve their quality of life and pulmonary function.


Application of Neural Regulation Therapy of Magnetic Stimulation in Rehabilitation of Core Muscle in Children with Cerebral Palsy

BAO Ke-xiu，YANG Zhong-xiu，LI Zhi-lin，LI Xin-jian，WANG Min，WU Ye，QIU Ai-zhen，WU Gai，WANG Ji-ping

2018, 21(26):  3246-3250.  DOI: 10.3969/j.issn.1007-9572.2018.00.096

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Objective　To investigate the effect of magnetic stimulation therapy on the stimulation of the nerve root of the thoracolumbar spinal cord and enhancing the stability of the core muscle group in the rehabilitation of children with cerebral palsy.Methods　Fifty-nine children with cerebral palsy admitted from January 2016 to January 2017 in Xuzhou Children's Hospital were divided into treatment group（n=30） and control group（n=29） by random number table.The control group was treated with traditional rehabilitation method，the treatment group was treated with neural regulation therapy of magnetic stimulation combined with traditional way.After 2 months of treatment，the treatment parameters were adjusted in 18 cases of the treatment group.Before and after treatment，the Gross Motor Function Measure（GMFM），International Classification of Functions，Disability and Health for Children and Youth（ICF-CY） sitting posture holding capacity（d4153） score were used to evaluate the motor function of two groups.Results　There was interaction between time of treatment and GMFM A score（Finteraction=3.999，Pinteraction<0.05）.Time had significant main effect on the scores of GMFM A area，B area and ICF-CY（d4153）（Ftime=29.304，Ftime=6.328，Ftime=9.257，Ptime<0.05）.Treatment had significant main effect on the scores of GMFM A area，B area and ICF-CY（d4153）（Ftreatment=5.158，Ftreatment=17.639，Ftreatment=10.670，Ptreatment<0.05）.The scores of GMFM A area and B area in the treatment group were lower than those in the control group，and the scores of ICF-CY（d4153） in the treatment group were higher than those in the control group 1，2 months after treatment（P<0.05）.After 3 months of treatment，the scores of GMFM A area and B area of 18 infants treated in the treatment group adjusted for treatment parameters were all higher than those of 2 months after treatment（tpair=10.168，tpair=6.230，P<0.001），the ICF-CY（d4153） score was not significantly different from 2 months after treatment（tpair=1.458，P=0.163）.Conclusion　Neural regulation therapy of magnetic stimulation plays a role in the rehabilitation of children with cerebral palsy，which can enhance the stability of the core muscle group and improve the motor function in children，and especially the effects of the first two months is obvious.

Efficacy and Safety of Adjunctive Memantine for Schizophrenia Patients with Antipsychotic Treatment：a Meta-analysis of Randomized，Double-blind，Placebo-controlled Trials　

CAI Dong-bin，YANG Xin-hu，ZHENG Wei，NING Yu-ping，XIANG Yu-tao，WU Zhi-bing

2018, 21(26):  3251-3256.  DOI: 10.3969/j.issn.1007-9572.2018.00.116

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Objective　To examine the efficacy and safety of adjunctive memantine for patients with schizophrenia receiving antipsychotic treatment.Methods　The randomized，double-blind，placebo-controlled trials（RCT） comparing memantine and placebo for patients with schizophrenia published as of July 9，2017 in Chinese were searched from the databases of CNKI，CBM，Wanfang Data Knowledge Service Platform and those in English were searched from PubMed，EMBase，PsycINFO，Cochrane Library by two researchers separately.And relevant printed RCT published during the same period were searched.RCTs screening，data extraction as well as quality assessment were conducted by the two researchers separately.Clinical efficacy，cognitive function，rate of discontinuation and adverse drug reactions were analyzed using RevMan 5.3 software.Results　Nine RCTs with 512 patients（treatment group：n=259；placebo group：n=253） were included.Meta-analyses of total psychopathology 〔SMD=-0.56，95%CI（-1.01，-0.11），P=0.02〕 and negative symptom score 〔SMD=-0.80，95%CI（-1.24，-0.36），P=0.000 4〕 showed the superiority of memantine over placebo，but there was no significant difference between positive symptom score 〔SMD=-0.20，95%CI（-0.48，0.08），P=0.16〕 and general psychopathology scores 〔SMD=-0.27，95%CI（-0.64，0.10），P=0.15〕 of the two groups.Furthermore，meta-analysis of cognitive function assessment showed the superiority of memantine over placebo 〔WMD=3.09，95%CI（1.77，4.42），P<0.000 01〕.Similar rates of discontinuation 〔RR=1.34，95%CI（0.76，2.37），P=0.31〕 and adverse drug reactions were found between the two groups（P>0.05）.Conclusion　This meta-analysis suggests that adjunctive memantine appears to be effective and safe in improving total psychopathology，negative symptom score and neurocognitive function.However，its long-term efficacy and safety are warranted to confirm these findings.


Meta-analysis of the Accuracy of Two Bedside Tests for Respiratory Aspiration in Patients with Stroke　

ZHU Ya-fang，ZHANG Xiao-mei，DENG Ying-ying，LEI Qing-mei，YANG Lei，ZHU Min-fang，ZHOU Hong-zhen

2018, 21(26):  3257-3263.  DOI: 10.3969/j.issn.1007-9572.2018.00.199

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Objective　To systematically evaluate the diagnostic value and efficiency of the water swallowing test （WST） and standardized swallowing assessment （SSA） for respiratory aspiration in patients with stroke.Methods　Studies published from 1980 to 2017 regarding the application of WST and SSA for respiratory aspiration in patients with stroke were retrieved through searching of CNKI，VIP，the Wanfang database，Cochrane Library，PubMed and Web of Science.Literature screening was performed by two researchers strictly following the literature inclusion criteria recommended by the Cochrane Collaboration Network.The key information in the included studies，including true positive value，false positive value，true negative value，false negative value，sensitivity and specificity，were extracted.The bias risk of the included studies was assessed.Meta-analysis was conducted in Meta-DiSc version 1.4，Stata 12.0 and RevMan 5.3 software.Results　Fourteen studies were included；the pooled sensitivity of WST （<50 ml） in diagnosing respiratory aspiration in patients with stroke was 0.54 〔95%CI（0.48，0.61）〕，and the pooled specificity was 0.76 〔95%CI（0.69，0.82）〕.The pooled sensitivity of WST （≥50 ml） in diagnosing respiratory aspiration in patients with stroke was 0.80 〔95%CI（0.72，0.86）〕，and the pooled specificity was 0.67 〔95%CI（0.60，0.73）〕.For SSA，the pooled sensitivity and specificity were 0.86 〔95%CI（0.82，0.90）〕 and 0.69 〔95%CI（0.64，0.73）〕.The pooled sensitivity of WST （<50 ml） and SSA were significantly different （Z=-2.449，P<0.05），whereas WST （≥50 ml） and SSA were not significantly different in pooled sensitivity （Z=-0.980，P>0.05）.WST （<50 ml） and WST（≥50 ml） were significantly different in pooled sensitivity （Z=-2.193，P<0.05）.For pooled specificity，WST （<50 ml）
and SSA were not significantly different （Z=-0.735，P>0.05），and WST （≥50 ml），SSA （Z=-0.490，P>0.05），WST （<50 ml） and WST （≥50 ml） all showed no significant differences in pooled specificity （Z=-0.104，P>0.05）.The AUCs of WST （<50 ml），WST （≥50 ml） and SSA in the SROC curves were 0.700，0.818 and 0.858，respectively.Conclusion　The diagnostic efficiency of WST in detecting respiratory aspiration in patients with stroke depends on the drinking amount.The accuracy of WST （≥50 ml） and SSA is better than that of WST （<50 ml）.


Multiple Cerebral Infarction Caused by Subacute Infective Endocarditis：Report of One Case and Literature Review

ZHANG Chun-yang，HUANG Shi-ren，ZHANG Min-min，DENG Ben-qiang

2018, 21(26):  3264-3267.  DOI: 10.3969/j.issn.1007-9572.2018.00.174

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Infective endocarditis（IE） -related stroke is rare in clinic practice.Due to atypical imaging features and clinicians' lack of sufficient understanding of the disease，erroneous diagnosis or missed diagnosis of IE can be performed，which in turn may delay the opportunities for treatment and support，and the prognosis may be deteriorated.We reported a case of stroke associated with IE and reviewed the relevant studies，in order to improve clinicians' understanding of the clinical symptoms and signs of the disease，by which the probabilities of misdiagnosis will be reduced.


Catheter-associated Urinary Tract Infection Caused by Corynebacterium Jeikeium：a Case Report and Literature Review

WANG Feng-xia，LI Bao-song，WANG Tao，JI Bing

2018, 21(26):  3268-3270.  DOI: 10.3969/j.issn.1007-9572.2018.00.191

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Catheter-associated urinary tract infection is a common infection acquired by patients （especially those with long-term indwelling catheters or hypoimmunity） in health care facilities，which is mainly characterized by hydrouria，persistent hematuria with flocculation，with or without systemic symptoms.In this paper，we reported 1 case of retrograde infections of the urinary tract due to indwelling catheters，focusing on analyzing the clinical symptoms，etiological findings and treatment，and reviewed the relevant studies.


Research Progress in Secondary Infection in Severe Acute Pancreatitis

ZHANG Jing-li，ZHANG Hai-rong

2018, 21(26):  3271-3275.  DOI: 10.3969/j.issn.1007-9572.2018.00.192

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 The mortality rate among patients with secondary infection and severe acute pancreatitis （SAP） remains high.A variety of factors lead to intestinal barrier dysfunction along with bacterial translocation of the intestine，thus making necrotic pancreatic tissue and peripancreatic tissue susceptible to secondary infection.Patients with high-risk secondary infection can be identified through indicators based on patient complications，treatment measures and laboratory tests.For patients likely to have secondary infection，early enteral nutrition and rational use of antibiotics can reduce the incidence of infection.However，probiotic treatments for secondary infections remain controversial regarding their effectiveness and safety.In addition，intestinal decontamination and surgical intervention play important roles in preventing secondary infections.This article summarizes the pathogenesis，risk factors，early diagnosis and preventive methods of SAP secondary infection through reviewing the relevant literature，to provide clinicians with new ideas for diagnosis and treatment.

Recent Advances in Metabolic and Bariatric Surgery for Obstructive Sleep Apnea Hypopnea Syndrome in Obese Patients　

JIANG Li-li，CHEN Yi，YUAN Xiang，CHENG Zhong

2018, 21(26):  3276-3280.  DOI: 10.12114/j.issn.1007-9572.2018.00.183

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Obesity is a serious global health problem nowadays.Obesity and its complications pose a huge burden on medical resources.Obstructive sleep apnea hypopnea syndrome （OSAHS） is a disease characterized by repetitive episodes of paused breathing，hypoventilation，reduced blood oxygen saturation and sleep disorders.In recent years，there are increasing evidences that OSAHS may be one of the main causes of obesity，and obesity can lead to other sleep-related diseases.Metabolic and bariatric surgery can significantly reduce the body weight and improve the abnormal metabolism of the obese patients.After surgery，many complications caused by obesity such as type 2 diabetes，hypertension and hyperlipidemia can be relieved and even be cured.Recent researches show that OSAHS in obese patients can be relieved effectively after receiving metabolic and bariatric surgery.In this article，we make a review about the effect of metabolic and bariatric surgery on OSAHS.