Chinese General Practice

Expert consensus on standard operation procedure of oral food challenge

Food and Drug Allergy Prevention Subgroup，Allergy Prevention and Control Committee，Chinese Preventive Medicine Association

2018, 21(27): 3281-3284. DOI: 10.12114/j.issn.1007-9572.2018.00.201

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Anticoagulation Therapy for Chinese Elderly Patients with Atrial Fibrillation　#br#

YAN Jing-jing，QIN Ming-zhao

2018, 21(27): 3285-3289. DOI: 10.12114/j.issn.1007-9572.2018.00.079

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Atrial fibrillation （AF） is a common arrhythmia in the elderly，which is an important independent risk factor of ischemic stroke（IS）.Both the prevalence of AF and the incidence of IS related with AF are increasing with age.Moreover，thrombosis-related IS is a major cause of mortality and disability of AF patients.Thankfully，it is accepted that anticoagulantion therapy can reduce the incidence of IS and systemic thromboembolism related with AF，but an unsatisfactory status was reported in China，especially in the elderly patients.We analyzed the status and associated factors of anticoagulation therapy in elderly patients with non-valvular AF in China，with a view to improving physicians and patients' understanding of the importance of anticoagulation therapy.

Research Status and Progress of Comprehensive Assessment of Care Needs of the Elderly

LI Wei-tong，XU Gui-hua

2018, 21(27): 3290-3295. DOI: 10.12114/j.issn.1007-9572.2018.00.189

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Since entering the 21st century，the aging population in China has increased rapidly.Due to lack of scientific and reasonable needs assessment instruments specifically for the elderly domestically，the conditions，self-care ability and needs of this population cannot be objectively assessed，which poses a significant adverse impact on the development of personalized elderly care.Therefore，the study of geriatric assessment instruments is of great significance in evaluating the needs of older people before delivering care，and in formulating supporting policies for elderly care.We comprehensively reviewed the ability assessment scales and needs assessment tools for the elderly at home and abroad，and evaluated their practicability and limitations，and based on this，proposed the promising trend of comprehensive needs assessment for older people，with a view to offer help for solving the problems existing in the comprehensive evaluation of older people's needs domestically and for the development and application of such instruments.

Comprehensive Geriatric Assessment for Screening Risk Factors and Frailty in Elderly Inpatients

JIN Qiu-lu，HU Song，CHEN Rui，MAO Yong-jun

2018, 21(27): 3296-3301. DOI: 10.12114/j.issn.1007-9572.2018.00.150

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Objective　To screen the frailty status and risk factors of the elderly inpatients aged over 80 years by Comprehensive Geriatric Assessment（CGA）.Methods　A total of 173 elderly inpatients aged over 80 years newly admitted to geriatric department in five 3A hospitals in Qingdao were enrolled as the research subjects from December 2016 to April 2017.The patients' frailty was assessed by Fried's frailty phenotype.The subjects were divided into frailty group（72 cases），pre-frailty group（52 cases） and non-frailty group（49 cases）.At the same time，all the subjects were comprehensively evaluated by CGA to analyze the age，sex，educational level，body mass index（BMI），Tinetti score，daily living ability，nutritional risk，cognitive function，depression，comorbidity，multiple drug use，sleep disorder and differences in calcium，phosphorus，albumin and hemoglobin levels.The affecting factors of frailty was studied with ordinal multi-factorial Logistic regression analysis.Results　The education level，daily activity ability，BMI，Tinetti score of the frailty group were lower than those of the pre-frailty group and the non-frailty group（P<0.05）.The nutritional risk，cognitive function，depression incidence and comorbidity in the frailty group were higher than those in the pre-frailty group and the non-frailty group（P<0.05）.The levels of calcium，albumin and hemoglobin in the frailty group were lower than those in the non-frailty group（P<0.05）.Ordinal multi-factorial Logistic regression analysis showed that BMI，comorbidity，multiple drug use and cognitive function were the influencing factors of frailty（P<0.05）.Conclusion　The incidence rate of frailty in elderly inpatients is high.Risk factors of frailty can be screened by CGA from multiple dimensions.In the clinical work of geriatric department，the state of elderly patients should be comprehensively evaluated，and interventions such as nutrition，rehabilitation exercise and adjustment of mentality should be carried out in time to improve the quality of life of elderly inpatients to the greatest extent.

Importance of Performing Continuous Health Management to the Elderly Patients with Multimorbidity in Order to Improve the Quality of Life

YAN Wei，WANG Jie-ping，ZHANG Hong-bo，WU Wei，WANG Fei，ZHANG Jie，ZHANG Xin-huan，ZHU Zhong-hui，DU Xue-ping

2018, 21(27): 3302-3306. DOI: 10.12114/j.issn.1007-9572.2018.00.113

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Compared to patients with single chronic disease，the elderly patients with comorbidity are accompanied by many problems，such as weakness，sarcopenia，malnutrition and tumble，which leads to a decline in their quality of life.In order to reduce disability and enhance the capability in daily lives，patient-centered medical mode is implemented.Therefore，this paper focuses on the correlation between the elderly patients with comorbidity and the quality of life.Hierarchical medical system should be implemented，geriatric syndromes valued，and comprehensive diagnosis and treatment plan formulated by multidisciplinary teams.The intermediate careduring the recovery period of acute disease should be paid attention to，and continuous health management employed so as to prevent and reduce all kinds of acute complications，reduce hospitalization and delay the occurrence of cognitive impairment.The long-term goal of improving quality of life and long-term prognosis will be achieved lasting the end.

Adverse Reactions to Antihypertensive Drugs in Older Hypertensive Patients and Targeted Suggestions Concerning Community-based Management

XIANG Yu-fang，NIU Rui，LIU Ying，FENG Bian-ling

2018, 21(27): 3307-3312. DOI: 10.12114/j.issn.1007-9572.2018.00.196

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Objective　To analyze the adverse reactions to antihypertensive drugs in older patients with hypertension（a chronic non-communicable disease），and based on this，giving targeted suggestions from a perspective of community-based management.Methods　This empirical study was conducted between January and June 2017.From Shaanxi End User Data Platform of Hypertensive Patients with Adverse Reactions to Antihypertensive Drugs，the data of 5 405 cases reported from January 2013 to December 2015 were collected.Then age，use of classes of antihypertensive drugs〔with a detailed analysis of 9 most common antihypertensive drugs（nifedipine，amlodipine，captopril，enalapril，metoprolol，indapamide，hydrochlorothiazide，irbesartan，telmisartan）〕，classification of the adverse reactions to these drugs，and major clinical manifestations were analyzed.Results　Of the 5 405 cases，3 621（66.99%）were older than 50 years.The classes of antihypertensive drugs used in them were as follows：（1）calcium ion antagonist（CCBs）：1 364（25.24%）used nifedipine，including 424 used it combinatively，623（11.53%）used amlodipine，including 192 used it combinatively;（2）angiotensin-converting enzyme inhibitors（ACEIs）：1 024（18.94%）used captopril，including 287 used it in combination with other drugs，899（16.63%）used enalapril，including 308 used it in combination with other drugs;（3）β-blockers：380（7.03%）administered metoprolol，including 173 used it combinatively;（4）diuretics：429（7.94%）took indapamide，including 156 took it combinatively，253（4.68%）took hydrochlorothiazide，including 78 took it combinatively;（5）angiotensin Ⅱ receptor blockers（ARBs）：266（4.92%）used telmisartan，including 88 used it combinatively，167（3.09%）used erbesartan，including 45 used it combinatively.Totaled 6 770 adverse drug events occurred，which mainly involved central and peripheral nervous system（22.38%），respiratory system（21.21%）and gastrointestinal system（19.23%）.Adverse reactions caused by CCBs，ACEIs，β-blockers，diuretics，ARBs mainly were central and peripheral nervous system damage（42.59%），respiratory damage（67.90%），gastrointestinal damage（45.78%），gastrointestinal damage（52.53%），central and peripheral nervous system damage（41.25%），respectively.Conclusion　Hypertension is a common chronic disease in older people.Generally，due to concomitant use（including combinative use）of several antihypertensive drugs，they may frequently have adverse reactions involving multiple organs or systems.In view of this，community-based management for this population should be focused on rationally using basic antihypertensive drugs，strengthening the awareness of safety of antihypertensive drugs，actively carrying out health education on hypertension control，enhancing the services for chronic disease，increasing the number of professional care providers，establishing a chronic disease management information platform.

Effects of Pedometer Intervention on Exercise Amount and Sedentary Time in Patients with Type 2 Diabetes

CAI Xue，HAN Jing，JU Chang-ping，CHEN Xiang，QIU Shan-hu，SUN Zi-lin

2018, 21(27): 3313-3318. DOI: 10.3969/j.issn.1007-9572.2018.00.195

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Objective　To investigate the effects of pedometer intervention on exercise amount and sedentary time in patients with type 2 diabetes.Methods　Patients with type 2 diabetes admitted between July 2015 to January 2016 in the Department of Endocrinology of Zhongda Hospital Southeast University were randomly selected and divided into experimental and control groups with a random number table method.Patients in the control group received only routine treatment and care.Patients in the experimental group received a pedometer intervention with routine treatment and nursing care.The duration of the intervention was 7 days.An accelerometer was used to monitor the amount of exercise（in steps），sedentary time and calorie consumption.Results　A total of 47 patients with type 2 diabetes（24 in the experimental group and 23 in the control group） were included.Before the intervention，there were no significant differences between the two groups in age，sex，height，SBP，DBP，glycated hemoglobin（HbA1c），triglyceride（TG），total cholesterol（TC），high-density-lipoprotein cholesterol（HDL-C），low-density-lipoprotein cholesterol（LDL-C），postprandial 2 h/fasting C peptide，peak oxygen consumption（P>0.05）.The body mass and body mass index（BMI） were higher in the control group than the experimental group（P<0.05）.There were no significant differences in the exercise amount，sedentary time，and calorie consumption before and after the intervention in both groups（P>0.05）.Intra-group comparison showed that there was no significant differences before and after intervention in the experimental group（P=0.23），whereas in the control group，the amount of exercise decreased after intervention（P=0.02）.Correlation analysis indicated that the number of steps pre-intervention was negatively correlated with pre-intervention sedentary time and positively correlated with calorie consumption（r=-0.42，P<0.05；r=0.56，P<0.05）.After adjustment for age and BMI，the number of steps pre-intervention was positively correlated with pre-intervention calorie consumption（r'=0.47，P<0.05）.Conclusion　Pedometer intervention helps to maintain the amount of exercise in hospitalized patients with type 2 diabetes；however，it does not significantly decrease sedentary time or increase calorie consumption.

Imaging Characteristics and Factors Influencing Pontine Infarction in Patients with Type 2 Diabetes Mellitus

WANG Hong-xia，LIU Xin，WANG Li-juan，LYU Na

2018, 21(27): 3319-3322. DOI: 10.3969/j.issn.1007-9572.2018.00.091

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Abjective　To analyze the imaging characteristics and factors influencing pontine infarction in patients with the complication of type 2 diabetes mellitus.Methods　A total of 86 patients diagnosed with acute pontine infarction by head MRI at the Department of Neurology of Zhongguancun Hospital of Beijing between March 2015 and March 2017 were included in the study.The patients were divided into a diabetes group（n=38） and a non-diabetes group（n=48） depending on the presence of type 2 diabetes.The imaging characteristics in the two groups were compared，and the influencing factors were analyzed.Results　The incidence of anterior-medial pontine infarction and of lesions extending from the deep pons to the ventral surface of the pons，as well as the incidence of basilar artery stenosis were all higher in the diabetes group than the non-diabetes group（P<0.05）.Multivariate Logistic regression showed that stroke history〔OR（95%CI）=7.139（2.069，24.641），P=0.002〕and basilar artery stenosis〔OR（95%CI）=5.730（1.017，32.289），P=0.048〕 were the risk factors for pontine infarction in the patients with diabetes.Conclusion　Pontine infarction in the patients with type 2 diabetes exhibited characteristic imaging changes.The incidence of anterior-medial pontine infarction and of lesions extending from the deep pons to the ventral surface of the pons and basilar artery stenosiswas higher in patients with type 2 diabetes.Stroke history and basilar artery stenosis were risk factors for pontine infarction in the patients with type 2 diabetes.

Effects of Tiotropium Bromide Combined with Respiratory Training on Immune Function and Quality of Life in Patients with Chronic Obstructive Pulmonary Disease in the Early Stable Stage

LIU Xian-bing，LI Fang，ZHU Li-fen，ZHENG Xiao-yan

2018, 21(27): 3323-3328. DOI: 10.3969/j.issn.1007-9572.2018.00.218

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Objective　To determine the effect and clinical significance of tiotropium bromide combined with respiratory training on immune function and quality of life in patients with chronic obstructive pulmonary disease（COPD） during the early stable phase.Methods　Ninety patients with stable COPD who were treated at People's Hospital of Quzhou in Zhejiang from January 2015 to June 2016 were divided into the untreated group（n=30，diagnosed with early-stage stable COPD but refused medical treatment），tiotropium group（n=30，only treated by tiotropium） and combination therapy group（n=30， treated by tiotropium and respiratory training）according to the treatment plan.Thirty healthy individuals were selected as controls during the same period.All patients in the three groups were followed up for 12 months after admission（at the 1st，3rd，6th，9th and 12th month after enrollment）.Peripheral blood lymphocyte subsets（CD3+，CD4+，CD8+，CD4+/CD8+），serum immunoglobulin（IgG，IgA），pulmonary function test，and COPD assessment test（CAT） were performed，and the number of exacerbations was recorded at admission and at each follow-up visit.The changes in related indicators collected during the follow-up period were analyzed and compared.Results　An interaction between grouping and time was observed between CD3+，CD4+，CD8+，CD4+/CD8+，IgG，IgA，FEV1，CAT scores，and annual acute exacerbations（P<0.05）.The main effects of grouping on CD3+，CD4+，CD8+，CD4+/CD8+，IgG，and IgA were significant（P<0.05），and the main effects of time on all indicators were significant（P<0.05）.CD3+ in the 6th，9th and 12th month，CD4+ in the 1st，3rd，6th，9th and 12th month，CD4+/CD8+ in the 1st，3rd，6th，9th and 12th month，IgG in the 6th， 9th and 12th month，and IgA in the 3rd，6th，9th and 12th month，were higher in the combination therapy group than in the untreated group and tiotropium bromide group and were higher in the tiotropium bromide group than in the untreated group（P<0.05）.CD8+ in the 3rd，6th，9th and 12th month，were lower in the combination therapy group than in the untreated group and tiotropium bromide group and were lower in the tiotropium bromide group than in the untreated group（P<0.05）.A positive correlation between CD3+，CD4+，CD8+，CD4+/CD8+，IgA，IgG and FEV1 was observed in all three groups，and a negative correlation between CAT score and the number of acute exacerbations was observed（P<0.05）.Conclusion　In patients with early-stage stable COPD，there is a decline in immune function，and the correlation between lung function and quality of life.In addition，the changes in immune function during this period can reflect the patient's condition.Tiotropium combined with respiratory exercise training can improve immune function，delay the decline of lung function，and reduce the incidence of acute exacerbations.Compared with tiotropium alone，combination therapy results in greater benefits to patients.

Effect of Serum HBV-DNA Load on Liver Function and Endoplasmic Reticulum Stress in Peripheral Blood in Patients with Hepatitis B

LIU Fang，YAN Yu，LI Ya-nan，DAI Liang，XIAO Yong-hong

2018, 21(27): 3329-3333. DOI: 10.12114/j.issn.1007-9572.2018.00.121

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Objective　To analyze the effect of serum hepatitis B virus（HBV）-DNA load on liver function and endoplasmic reticulum stress（ERS）in peripheral blood in patients with hepatitis B，so as to provide evidence for clinical diagnosis and treatment of HBV.Methods　A total of 136 cases of patients with hepatitis B admitted to Tangshan Infectious Disease Hospital from July 2016 to June 2017 were enrolled and were divided into negative group（serum HBV-DNA load <1.0×103 copies/ml），low copy group（1.0×103 copies/ml≤ Serum HBV-DNA load <1.0×105 copies/ml），medium copy group（1.0×105 copies/ml≤ Serum HBV-DNA load <1.0×107 copies/ml），and high copy group（serum HBV-DNA load ≥1.0×107 copies/ml）.A total of 82 non-HBV infection patients admitted to Tangshan Infectious Disease Hospital were selected as the control group.Serum HBV-DNA load，liver function indexes〔alanine aminotransferase（ALT），aspartic acid aminotransferase（AST），Gamma transglutaminase（γ-GT），alkaline phosphatase（ALP）〕，ERS-related indexes〔glucose regulation protein（GRP78），CCAAT/-enhanced protein（CHOP）and cysteine aspartyl-specific protease-12（caspase-12）〕were detected and compared in 5 groups.The correlation of liver function index with serum HBV-DNA load and ERS-related indexes was analyzed.Results　There was no significant difference in ALP in 5 groups（P>0.05）.ALT and AST in low copy group，medium copy group and high copy group were higher than those in control group and negative group（P<0.05）.ALT and AST in medium copy group and high copy group were higher than those in low copy group（P<0.05）.ALT and AST in high copy group were higher than those in medium copy group（P<0.05）.γ-GT in negative group，low copy group，medium copy group and high copy group was higher than that in the control group（P<0.05）.GRP78，CHOP，caspase-12 in negative group，low copy group，medium copy group and high copy group were higher than those in control group（P<0.05）.GRP78 in low copy group was lower than that in negative group（P<0.05），and GRP78 in medium copy group was higher than that in low copy group（P<0.05）.ALT and AST were positively correlated with serum HBV-DNA load（P<0.05），γ-GT and ALP had no linear correlation with serum HBV-DNA load（P>0.05）.There was no linear correlation between ALT，AST，γ-GT，ALP and GRP78，CHOP and caspase-12（P>0.05）.Conclusion　The serum HBV-DNA load in patients with hepatitis B can affect the liver function and induce ERS in peripheral blood，which has a certain practical guiding significance for pathogenesis，clinical diagnosis and treatment of hepatitis B.

Effects of H.pylori Infection on Metabolism

LU Li-juan，HAO Ning-bo，LI Xue，LIU Jian-jun，JIANG Ren-xiu，ZHANG De-sheng，WANG Rui-ling

2018, 21(27): 3334-3338. DOI: 10.12114/j.issn.1007-9572.2018.00.015

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Objective　To analysis the effects of H.pylori infection on metabolic indicators in elderly and young/middle-age people.Methods　A retrospective study was conducted，based on the clinical data from 1 828 subjects found to be healthy during physical examinations in the General Hospital of the PLA Rocket Force between May 2017 and June 2017.According to the presence of H.pylori infection，the subjects were divided into an H.pylori-positive group and an H.pylori-negative group.The subjects were further divided into an elderly H.pylori-positive subgroup，an elderly H.pylori-negative subgroup，a young/middle-age H.pylori-positive subgroup，and a young/middle-age H.pylori-negative subgroup，with 60 years of age as the cutoff.The data from physical examinations，including systolic blood pressure，diastolic blood pressure，fasting blood glucose，postprandial blood glucose，alanine aminotransferase，total cholesterol，triacylglycerol，high-density lipoprotein cholesterol，low-density lipoprotein cholesterol，13C breath test and abdominal ultrasound，were collected and analyzed.Results　The level of systolic blood pressure，diastolic blood pressure and postprandial blood glucose，and the rates of systolic blood pressure，diastolic blood pressure and fasting blood glucose in the H.pylori-positive group（n=580） were higher than those in the H.pylori-negative group（n=1 248）（P<0.05）.The rates of abnormal diastolic blood pressure and fasting blood glucose in the elderly H.pylori-positive subgroup（n=143） were higher than the elderly H.pylori-negative subgroup（n=287）（P<0.05）.Systolic blood pressure，diastolic blood pressure，postprandial blood glucose，alanine aminotransferase and triacylglycerol were higher，and high-density lipoprotein cholesterol was lower，in the young/middle-age H.pylori-positive subgroup（n=437） than the young/middle-age H.pylori-negative subgroup（n=961）（P<0.05）.The rates of abnormal systolic blood pressure，diastolic blood pressure，fasting blood glucose and triacylglycerol，the incidence of nonalcoholic fatty liver disease in the young/middle-age H.pylori-positive subgroup were higher than the young/middle-age H.pylori-negative subgroup（P<0.05）.Conclusion　H.pylori infection may affect body metabolism，and the infection has a greater effect on the metabolism of young and middle-age people than elderly people.Eradication of H.pylori should be pursued among young and middle-age infected patients，and elderly patients should be treated individually.

Clinical Value of the Drug Lymphocyte Stimulation Test for Diagnosis of Hypersensitivity Reactions Induced by Antitubercular Drugs

WU Yu-qing，DAI Liang，CHEN Xue-hua，LIAO Yong-mei

2018, 21(27): 3339-3342. DOI: 10.3969/j.issn.1007-9572.2017.00.227

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Objective　To evaluate the value of the drug lymphocyte stimulation test（DLST） for diagnosis of antitubercular drug-induced hypersensitivity.Methods　The case group consisted of 60 patients who developed hypersensitivity reactions during initial anti-pulmonary tuberculosis treatment in the Jiangxi Chest Hospital between January 2015 and December 2016.Sixty patients who received initial anti-pulmonary tuberculosis treatment who experienced no hypersensitivity reactions during the same period were selected as the control group.The drug provocation test（DPT） was used as the gold standard to determine which drug induced hypersensitivity.The value of the DLST for identifying hypersensitivity-inducing drugs among four major anti-TB drugs，isoniazid（INH），ethambutol（EMB），rifampicin（RFP） and pyrazinamide（PZA），was evaluated.Results　The sensitivities of the DLST in diagnosis of hypersensitivity reactions induced by INH，EMB，RFP and PZA were 52.38%，50.00%，43.48% and 58.33%，respectively，and the specificities were 97.98%，99.09%，97.94% and 100.00%，respectively.Conclusion　The DLST has high specificity in identification of hypersensitivity-inducing antitubercular drugs and provides valuable guidance for their clinical application.

Dynamic Observation of Kidney Stone Formation in Wistar Rats

QIAN Cheng，WANG Qin-zhang，CHU Hao，XU Hao，HAO Zhi-qiang，QIAN Biao

2018, 21(27): 3343-3348. DOI: 10.3969/j.issn.1007-9572.2018.00.234

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Objective　To observe the dynamic process of kidney stone formation in Wistar rats.Methods　In March 2016，60 6-week-old SPF male Wistar rats were selected and randomly divided into a normal control（NC） group（n=30） and an ethylene glycol（EG） group（n=30） after 1 week of adaptive breeding.Rats in the NC group were administered a normal amount of drinking water with 2 ml 0.9% sodium chloride by gavage for 2 weeks.Rats in the EG group were administered 1% EG solution with 2 ml 0.9% sodium chloride by gavage for 2 weeks.The general condition of the rats in the two groups was observed for 10 consecutive weeks.Three rats were sacrificed every week.Blood and urine biochemical indicators were measured in both of the groups every week，and the anatomy of the kidneys of the rats was observed with the naked eye and under a dissection microscope.The renal crystallization grade and stone formation were analyzed in both groups.Results　During the observation period，the rats in the EG group exhibited hematuria.One rat died in the 8th week，and another died in the 9th week during the model establishment period.After 1 to 2 weeks of modeling，the rats in both groups were well fed，quiet and docile.After 3 to 8 weeks of modeling，there was no behavioral changes in the NC group，but the rats in the EG group were irritated and lively and active.After 9 to 10 weeks of modeling，the rats in the EG group exhibited mental fatigue，attenuated reactions to acupuncture，reduced activity and reduced food intake，whereas the rats in the NC group showed no behavioral changes.The serum creatinine and serum uric acid were higher in the EG group than in the NC group after 2 to 10 weeks of modeling（P<0.05）.The urea nitrogen was higher in the EG group than in the NC group in the 3rd to 8th week（P<0.05）.The urinary calcium in the EG group was higher than that in the NC group in the 2nd and 4th-10th weeks（P<0.05）.The blood calcium was higher in the EG group than in the NC group in the 5th to 10th week（P<0.05）.The phosphorus and magnesium levels were higher in the EG group than the NC group in the 6th to 10th week（P<0.05）.The urinary pH value of rats in the EG group was lower than that in the NC group（P<0.05）.There were no significant differences in urine specific gravity and urine volume between the two groups（P>0.05）.The ratio of kidney volume was higher in the EG group than the NC group in the 3rd to 10th week，and the difference was statistically significant（P<0.05）.After 1 to 2 weeks of modeling，no significant differences were observed in the kidney between the two groups.After the third week of modeling，the kidneys in the EG group were slightly larger than those in the NC group.After the 6th week of modeling，the kidney enlargement of the rats in the EG group was visible to the naked eye.Under a dissecting microscope，the crystals were found to be distributed in a fan-like shape centered on the renal pelvis.After the 6th week of modeling，the surfaces of the kidneys in the NC rats was observable with the naked eye，and no obvious crystallization was observed under a dissection microscope.The renal crystallization fraction of rats in the EG group was higher than that in the NC group（Z=-5.195，P<0.001）.The incidence of kidney stones in the EG group was higher than that in the NC group，and the difference was statistically significant（χ2=21.172，P<0.001）.Conclusion　A rat kidney stone model established by administration of ethylene glycol（EG） began to form stones in the 3rd week of modeling.Compared with the NC rats，the rats with kidney stones were prone to mental fatigue，decreased activity and dietary intake，marked changes in blood and urine biochemical indicators，and a significantly increased kidney-body ratio.

Mortality Rate of Four Main Chronic Diseases in Yangzhong City of Jiangsu Province during 2002—2015：a Quantitative Study

TONG Hai-yuan，ZHANG Meng-meng

2018, 21(27): 3349-3353. DOI: 10.3969/j.issn.1007-9572.2018.00.077

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Objective　To analyze the data of the people in Yangzhong city who died between 2002 and 2015 due to circulatory disease，malignant tumor，diabetes，or chronic respiratory disease，and based on this，to calculate the probability of premature death of these diseases，explore the effect of demographic and non-demographic factors on the trend of the mortality rate，contributing to reducing the probability of premature death of major chronic diseases，a goal listed in the local program for achieving Healthy China 2030.Methods　The census records of Yangzhong from 2002 to 2015 were obtained from Yangzhong Public Security Bureau，and the records of deaths due to circulatory system diseases，malignant tumors，diabetes and chronic respiratory diseases in Yangzhong from 2002 to 2015 were obtained from Yangzhong Center for Disease Control and Prevention.The annual crude mortality rate，annual standardized mortality rate，and APC of four kinds of chronic diseases were calculated.Decomposition analysis was performed to examine the mortality differentials.The probability of premature death was calculated by life table method.Results　In Yangzhong City during 2002—2015，the overall annual crude mortality rate，overall annual standardized mortality rate for the 4 main chronic diseases was 648.69/100 thousands，341.26/100 thousands，respectively；the annual contribution ratio of deaths from these diseases presented an upward trend.The annual crude mortality rate of the 4 diseases was on the rise，while the annual standardized mortality rate of the 4 diseases was on the decline，which was caused by the interactions between demographic and non-demographic factors.The probability of premature mortality of each of the 4 chronic diseases showed downward trend during this period，and the probability of premature death in males was higher than that of females，while the average annual rate of change was lower than that of females.It was estimated that the expected probabilities of premature death in both males and females listed in the local program for achieving Healthy China 2030 could be attained in 2030.Conclusion　The deaths in Yangzhong City are mainly caused by these 4 diseases，and the overall mortality of these diseases is relatively high in China.Strengthening non-demographic interventions could effectively reduce the mortality rates of chronic diseases in this region，and during taking measures to reduce the probability of premature death，particular attention needs to be given to males.

Life Quality of Inpatients in the Internal Medicine Department and the Effect of Ward Management-related Factors

SUN Pei，YE Bei-zhu，ZHANG Ping，CHENG Yao，JIANG Hong-wei，SUN Yi，WANG Qiao-feng，XIE Xiao-hua，XI Zhu，LIANG Yuan

2018, 21(27): 3354-3359. DOI: 10.3969/j.issn.1007-9572.2018.00.158

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Objective　To understand the impact of ward management-related factors on the life quality of patients in the Department of Internal Medicine in an effort to provide advice and recommendations for relevant policies.Methods　From July 2014 to April 2015，a stratified cluster sampling method was used to recruit 4 130 inpatients from 77 general hospitals in 7 provinces （municipalities） in China for the investigation and research.The questionnaires were self-designed and included basic questions （demographic characteristics，health-related behavior and family factors，and ward management-related factors） and the European Five-dimensional Health Scale （EQ-5D，including mobility，self-care，daily activities，pain/discomfort，anxiety/depression）.The EQ-5D was used to evaluate the life quality of patients.The impact of ward management-related factors on the life quality of hospitalized patients was analyzed.Results　In the five dimensions of the EQ-5D，the proportions of “little difficulty/very difficult” from high-to-low were anxiety/depression （61.63%），pain/discomfort （56.69%），daily activities （43.68%），mobility （32.45%），and self-care （28.94%）.The results of multivariate Logistic regression analysis showed that the support/help of spouses was an influencing factor on mobility，daily activities，and anxiety/depression dimensions of hospitalized patients on the EQ-5D （P<0.05）.The support/help of parents was an influencing factor on the pain/discomfort dimension of hospitalized patients （P<0.05）.The support/help of children was an influencing factor on daily activities dimension of hospitalized patients （P<0.05）.The support/help of siblings was an influencing factor on self-care and daily activities dimensions of hospitalized patients （P<0.05）.The degree of ward management was an influencing factor on mobility，self-care，daily activities，and pain/discomfort dimensions of hospitalized patients （P<0.05）.The number of family members/relatives visiting the ward was an influencing factor on mobility，self-care，daily activities，and anxiety/depression dimensions of hospitalized patients （P<0.05）.The number of colleagues/friends visiting the ward was an influencing factor on mobility，self-care，and daily activities dimensions of hospitalized patients （P<0.05）.Conclusion　The most serious problem in the life quality of hospitalized patients is anxiety/depression.From the perspective of hospital management，to improve the life quality of hospitalized patients，more attention should be paid to the cleanliness of the ward and the number of family members/relatives and friends/colleagues that visit the patient should be reduced.

Clinicopathological Characteristics of Thyroid Cancer Patients Receiving Surgical Treatment in Peking University Cancer Hospital between 1996 and 2015：a Retrospective Cohort Study

JI Xin-qiang，SUN Jun-yong，LIU Jing

2018, 21(27): 3360-3365. DOI: 10.12114/j.issn.1007-9572.2018.00.001

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Objective　To examine the status and changes of clinicopathological characteristics of thyroid cancer patients with surgical treatment in Peking University Cancer Hospital between 1996 and 2015，providing support for the prevention and treatment of this kind of disease.Methods　The data stemmed from the electronic medical record statistics system of Peking University Cancer Hospital，involving a sample of eligible 3 703 thyroid cancer patients receiving surgical treatment between 1996 and 2015.Descriptive analyses of the data were performed by sex，age，type of thyroid cancer，status of lymphatic metastasis，concomitant diseases，and geographical settings（urban-rural location and regions defined mainly according to the socioeconomic status）.Results　During this period，the annual number of patients undergoing thyroid cancer surgery showed an increasing trend（P<0.05）.Moreover，both male and female patients increased across the period generally（P<0.05）.However，the male-to-female ratio changed a little during the period（P>0.05）.Furthermore，the year-over-year increase rate did not differ significantly by sex（P>0.05）.The number of patients undergoing thyroid cancer surgery increased significantly from the age of 25，peaked at 35 to 54（56.37%），and gradually declined after 55.The male-to-female ratio varied significantly by age group（P<0.05）.The distribution of age group in all participants differed significantly by year（P<0.05），but the average age did not（P>0.05）.Furthermore，the average age of both male and female participants did not varied notably by year（P>0.05）.In terms of type of thyroid cancer，papillary thyroid cancer patients and their occupied proportion of the total participants increased over the period（P<0.05）.Females were more likely to have papillary thyroid cancer compared with males（P<0.05）.With regard to lymphatic metastasis，patients with medullary thyroid cancer had higher rate of lymphatic metastasis than those with papillary thyroid cancer or follicular thyroid cancer（P<0.05）.Compared with males，female papillary thyroid cancer patients demonstrated lower rate of lymphatic metastasis but higher rate of accompanying nodular goiter（P<0.05）.The proportion of rural patients showed an increasing trend（P<0.05），but the distribution of patients by region did not change significantly（P>0.05）.Conclusion　The number of thyroid cancer patients receiving surgical treatment is increasing year by year，coexisting gender and age differences.The main pathological type is papillary carcinoma，and many patients have lymph node metastasis or nodular goiter.Most of them are from north China，in particular，urban patients outnumber rural patients.

Investigation of Acute Pain in Patients with Acute Pancreatitis and Its Influence on Hospitalization Time

JIANG Hua，WANG Xiao-hua，TAO Chun-xia，GU Jie

2018, 21(27): 3366-3369. DOI: 10.12114/j.issn.1007-9572.2018.00.038

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Objective　To investigate the acute pain symptoms in patients with acute pancreatitis and to analyze its influence on hospitalization time.Methods　Patients with acute pancreatitis who were admitted to the First Affiliated Hospital of Soochow University and the Second Affiliated Hospital of Soochow University between November 2015 and June 2016 were selected through a convenient sampling method.The patients' demographic data，clinical materials were collected.The cumulative time of pain was recorded. The degree of pain was assessed using an internationally adapted numerical rating scale （NRS）.Results　A total of 178 questionnaires were distributed，and 160 were returned，of which 150 were valid；the effective recovery rate was 84.3%.The cumulative pain time for the 150 patients was 48（30，60）h，the incidence of moderate-to-severe pain 0 to <2 h after admission was 98.7% （148/150），and the cumulative time of moderate-to-severe pain was 2 （2，2） h.The incidence of moderate-to-severe pain 2 to <12 h after admission was 94.7% （142/150），and the cumulative time of moderate-to-severe pain was 5 （3，8） h.The incidence of moderate-to-severe pain 12 to <24 h after admission was 47.3% （71/150），and the cumulative time of moderate-to-severe pain was 0 （0，4） h.The incidence of moderate-to-severe pain 24 to <48 h after admission was 7.3% （11/150），and the cumulative time of moderate-to-severe pain was 0 （0，0） h.There were significant differences in the incidence of moderate-to-severe pain and severity of pain （NRS scores） in different time periods （0 to<2 h，2 to <12 h，12 to <24 h，and 24 to <48 h）（P<0.05）.The hospitalization time was （11.4±5.5） d.Correlation analysis showed that pleural effusion，ascites fluid，Ranson score，complications，cumulative total pain time，cumulative time of moderate-to-severe pain at 2 to <12 h，incidence of moderate-to-severe pain at 12 to <24 h，incidence of moderate-to-severe pain at 24 to <48 h，and NRS scores at 24 to <48 h were correlated with hospitalization time （P<0.05）.Multivariate linear regression analysis showed that ascites fluid （B=2.524），Ranson score （B=3.905），cumulative total pain time （B=0.063），and cumulative time of moderate-to-severe pain at 0 to <2 h （B=-3.583） were factors influencing patient hospitalization time （P<0.05）.Conclusion　Patients with acute pancreatitis have a long duration of pain in the acute phase，and the pain is relatively severe.Clinicians should pay attention to the collection of mild pain data and take active and effective measures to intervene to shorten hospitalization time.

Mechanism of Preventive Acupuncture and Moxibustion for Bi-directional Control of Body Fat Based on the Theory of Preventive Treatment of Disease

WEI Yan-hui，SUN Yi-nong，ZHU Shi-peng

2018, 21(27): 3370-3372. DOI: 10.12114/j.issn.1007-9572.2018.00.063

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Preventive acupuncture and moxibustion，important interventions for preventive treatment of disease，refer to using acupuncture and moxibustion to control the risk factors to prevent the onset of disease possibly.The central nervous system（especially the appetite-regulating center in the hypothalamus），plays an important role in the regulation of lipid metabolism，a complicated process with multiple signals and pathways，demonstrating as periphery feeding signals leading to integration and coordination of brain-mediated responses and control of energy homeostasis by neuropeptide pathways.Aquaporin water channels in human salivary glands are of great significance for lipid metabolism.Studies show that saliva contains a variety of neuropeptides，many of which are closely related to feeding，lipid metabolism，and their receptors are widely distributed in the salivary glands or the nerves innervating the salivary glands.Studies support that preventive acupuncture and moxibustion are contributive to the improvement of lipid metabolism.We analyzed the mechanism of action of preventive acupuncture and moxibustion in lipid metabolism regulation from the neurobiological perspective（interpreting the role of involved neuropeptide-water channels in human salivary glands-appetite-regulating center） in an objective and scientific manner.

Qige Decoction for the Inhibition of Lung Metastasis from Esophageal Cancer Based on Theory of Ganrunruyang

SHI Hui-juan，XUE Jian-xiong，SHI Dong-xuan，KONG Ling-yu，LI Jing

2018, 21(27): 3373-3377. DOI: 10.12114/j.issn.1007-9572.2018.00.163

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Objective　To investigate the effect of Qige decoction on the incidence of lung metastasis from esophageal cancer（EC） among a nude mouse model of EC established by injecting EC cells into the tail vein.Methods　This study was implemented from February to October 2017.21 BABL/c nude mice were selected and injected 100μl KYSE-150-Luc poorly differentiated esophageal carcinoma cell lines via the tail vein using 1 ml syringes for establishing nude mice models of EC.They were equally randomized into the control group，Qige decoction group，and Capecitabine group.From the third day after the modeling，the former two groups received intragastric administration of 0.2 ml of 0.9% sodium chloride solution once per day，0.2 ml of Qige decoction（3 913 mg/kg） once per day，respectively，for 12 consecutive weeks，while the Capecitabine group received 0.2 ml of Capecitabine（400 mg/kg） once per day，for 12 weeks but 2 weeks on and 1 week off.The lung metastasis of nude mice was observed by using in vivo small animal imaging.The weight of the mice was measured and recorded.After the sacrifice，the number of lung metastastic nodules was counted，the expression levels of E-cad，KRT8，snail，Connexin43 and WNT2 in lung metastases were detected by Western blotting，and lung metastases were examined by microscopy with H&E staining.Results　During the 12th week after modeling，bioluminescence signal of tumor cells was detected in the lung area，suggesting there were spontaneous lung metastases.Capecitabine group showed much lower ratios of baseline weight to the weight at the end of 4，8，12，16 weeks of intervention when compared to other two groups，as did the control group when compared to the Qige decoction group（P<0.05）.For more detail，the control group showed significantly lower photon intensity compared with other two groups（P<0.05）.All groups demonstrated gray-white lung metastastic nodules，and the control group owned more nodules than other groups（P<0.05）.Western blotting results showed that the control group owned significantly lower expression levels of E-cad，KRT8 and Connexin43 and much higher expression levels of snail and WNT2 when compared to other two groups，so did the Capecitabine group when compared to the Qige decoction group（P<0.05）.Microscopy examination of H&E staining pathological sections of lung metastastic nodules showed that all groups had tumor tissues with a nested growth pattern，and the tumor cells were dense and heterogeneous.No obvious signs of tumor necrosis were found in the 3 groups.Conclusion　Qige decoction could inhibit the lung metastasis from EC，which may be associated with enhanced gap junction inhibition of epithelial-mesenchymal transition.Moreover，Qige decoction was superior to Capecitabine in prolonging the weight control.

Role of All-appointment Service in Hierarchical Medical System from the Perspective of Healthy China Strategy

LAI Guang-qiang，XIA Ping

2018, 21(27): 3378-3380. DOI: 10.3969/j.issn.1007-9572.2018.00.217

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Health in All Policies and Adhering to Co-construction & Sharing with Mobilization of the Whole Society are proposed as two principles in Healthy China 2030 Development Plan.As three essential factors of the hierarchical medical system，hierarchical system，initial diagnosis system and referral system accord with the Health-oriented Full Participation Development Strategy.Based on the Healthy China Strategy，this article analyzes the all-appointment service in the participatory hierarchical medical system that focuses on the public experience and satisfaction.Taking the pilot points in Shenzhen public hospitals as examples，this article elaborates in the aspects of all-appointment service，referral service from the general practice department to the specialized departments，team-based expert diagnose and treatment mode，five categories of emergency treatment，doctor-patient relationship and public satisfaction management.Also this article fully demonstrates that the all-appointment service effectively promotes the construction of hierarchical medical system and ensures the public's sense of fulfillment and satisfaction during the painful period of medical reform.

Manpower Status and Associated Factors of Working Ability among General Practitioner Assistants in Minhang District，Shanghai

ZHAO Fang，ZHANG Tian-ye，YANG Ying-hua，CHENG Jia，GU Hao，LIU Yu-chang，DU Xiao-lei

2018, 21(27): 3381-3384. DOI: 10.3969/j.issn.1007-9572.2018.00.063

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Objective　To investigate the manpower status and associated factors of working ability among general practitioner（GP） assistants in Minhang District，Shanghai，and offer a basis for GP assistant team construction.Methods　This study was conducted from July to August 2016.By purposive sampling，we selected 6 out of 13 community health centers（CHCs）（Zhuanqiao Community Health Center，Wujing Community Health Center，Xinzhuang Community Health Center，Pujiang Community Health Center，Jiangchuan Community Health Center and Huacao Community Health Center） in Minhang District，Shanghai which have employed GP assistants.Then，from which，we selected 170 GP assistants by random sampling and surveyed them using a self-developed questionnaire covering the demographic data，work years，employment status and working ability.The working ability was evaluated by working ability index（WAI）in Chinese version.Univariate analysis and multivariate unconditional Logistic regression analysis were used to analyze the associated factors of working ability.Results　166 GP assistants responded effectively to the survey，with a response rate of 97.6%.The data collected are as follows：sex：85.5%（142/166） were females；age：most of them aged 25-35 years〔23.5%（39/166） were 25-30 years，33.1%（55/166） were 31-35 years〕；educational attainment：the majority of them owned junior college degree，college degree or above〔7.0%（78/166） owned college degree or above，39.8%（66/166）of them owned junior college degree〕；major：the major of 66.3%（110/166） was nursing；profrssional and technical title：the majority of them owned junior title，intermediate titles or above〔40.4%（67/166） owned junior titles，40.4%（67/166） of them owned intermediate titles or above〕；monthly income：56.0%（93/166） of them earned less than 4 000 yuan；working years：49.4%（82/166） of them worked for over 3 years；employment status：72.3%（120/166） of them worked full-timely；mean work ability score：7.7±1.8.Univariate analysis showed that the working ability score between the GP assistants varied significantly by years of working and employment status（P<0.05），but not by sex，age，educational attainment，major，professional and technical title，as well as monthly income（P>0.05）.Multivariate unconditional Logistic regression analysis demonstrated that major，years of working，and employment status were associated factors of the working ability for GP assistants（P<0.05）.Conclusion　The structure of the GP assistant team in Minhang District is characterized by female, full-time and medical background, low income, promotion without professional title and low overall working ability，and major，years of working，and employment status were associated factors of the working ability for GP assistants.The status may be changed by expanding publicity，raising income and opening up the channel for promoting the professional and technical title，which should be improved through full-time employment，series of training and team stability construction.

Perception of the Contract Responsibility System for Family Doctors in Shanghai's Minhang District：Patient and Physician Perspectives

WANG Jun-yan1，WU Yan，WANG Xi，XU Hui-lin，GUO Qi，SU Hua-lin

2018, 21(27): 3385-3388. DOI: 10.3969/j.issn.1007-9572.2018.00.182

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Objective　To investigate the perceptions of the family doctor responsibility system among community-dwelling patients and family doctors〔working in community health centers（CHCs）〕in Shanghai's Minhang District，providing a reference for further development of family doctor responsibility system（included in the healthcare reform） in Shanghai.Methods　From April to June 2015，we surveyed a total of 400 family doctors with a self-developed questionnaire for family doctors and a convenience sample of 700 community-dwelling residents from 13 CHCs in Shanghai's Minhang District with a self-developed questionnaire for community residents for collecting their characteristics，signing status and main items of family doctor responsibility system needing to be improved，community-dwelling patients' cognition of family doctor responsibility system service，willingness to visit and self-reported level of demands for family doctor responsibility system，and understanding of patients and implementation of family doctor responsibility system by family doctors.Results　657 community-dwelling patients and 363 family doctors responded positively to the survey.Among the community-dwelling patients，65.8%（n=432） knew that family doctor services were carried out in CHCs；the 3 service items needed most were physical examination，public health management，health education and consultation；the 3 service items used most frequently were chronic disease registration and follow-up management，home-based care（including bedside care） and dual referrals.Of those（n=216） who had signed contracts with family doctors，50.0%（108/216）contacted their contracted family doctor for medical care.78.2%（284/363）of the family doctors knew whether the patient they received was the contracted.Both groups thought that the main factors associated with the delivery of family doctor services were professional levels of family doctors，types of medicines covered by the China's Essential Medicine System and rapid and orderly referrals.Conclusion　Community-dwelling patients and family doctors have different views about residents' demands for family doctor services.Family doctor team from CHCs should increase their service capabilities，in order to satisfy residents' growing demand of basic healthcare for better health，and to ensure the development of contract responsibility system for family doctors.

The Influence of General Practice Alliance on the Residents' Willingness to Sign a Family Physician

WANG Zhi-yi，WANA Zhong，WENG Jie，HOU Ruo-nan，WU He，HU Gong-yi，LIN Fei-ke，LIN Ce，CHEN Fang，ZHOU Xuan，CHEN Da-qing

2018, 21(27): 3389-3392. DOI: 10.3969/j.issn.1007-9572.2018.00.184

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Objective　To establish a family doctor service model under the direction of the general hospital team at a tertiary hospital and discuss the impact on community resident of family doctors' willingness to sign contracts.Methods　The residents of two community health service centers（Wutian Community Health Service Center，Nanpu Community Health Service Center） in Wenzhou City were selected to participate in the study between 2017-05-01 and 2017-06-30，and 560 people were recruited from the community using a simple random sampling method.The participants were randomly divided into the community family doctor group（simple community family doctor contracted service model） and the medical general team group（three-tier hospital general team participation family doctor service model） to investigate the willingness of the two groups of residents and family doctors to sign contracts.The survey included the following：the basic situation of the surveyed subjects；the knowledge of family doctor-style services；the willingness to sign contracts；and the factors that influence the signing of contracts.Results　A total of 560 questionnaires were distributed and 540 valid questionnaires were returned，the effective recovery rate was 96.4%.There were no significant differences between the two groups with respect to gender，age，average monthly income，education level，and type of medical insurance （P>0.05）.There was no significant difference in the degree of knowledge of family doctors signing up between the two groups（P>0.05）.The willingness to sign contracts for family doctors in the medical general team group was higher than the community family doctor group（P<0.05）.The acceptable distance to the community family doctor group was believed to be shorter than the medical general team，while the medical travel time that the community family doctor group accepted was shorter than the medical general team （P<0.05）.The surveyed people in the community family doctor group had more concerns about misdiagnoses，missed diagnoses，non-indicated medications，and inconvenience of the referral rate than the medicial general team group（P<0.05）.There was no significant difference in the incidence of bad service attitudes between the two groups （P>0.05）.Conclusion　The family doctor service model under the direction of the general hospital team in a tertiary hospital helps to increase community residents' recognition of primary health service capabilities，effectively promote family doctor signing services，guide residents to stratify medicial treatment，and optimize the use of medical resources.

Advances in the Application of Precision Medicine-based Approach for Guiding the Diagnosis and Treatment of Chronic Hepatitis C

LU Ming-zi，ZHU Wei，ZHANG Xiao-kun，ZHANG Xu

2018, 21(27): 3393-3396. DOI: 10.3969/j.issn.1007-9572.2018.00.078

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Hepatitis C（HCV），with strong infectiousness and highly variable viral genome，has been widely spread，causing global public health problems.Precision medicine，based on individualized treatment，is a hot spot attracting the attention of both the public and the academic realm.A large number of medical frontier technologies are used to develop the precision medical model for the prevention and treatment of specific patients.This paper reviews the impact of HCV genotyping on the diagnosis of hepatitis C，achievements in genomics，proteomics，pharmaco metabonomics and other high-throughput proteomic technologies，biomarkers and potential therapeutic targets related to HCV diagnosis and treatment，as well as the prospect of precision medicine-based approach used for the guide of chronic HCV diagnosis，treatment and prognosis assessment.

Recent Advances in the Correlation between Serum Uric Acid and Nonalcoholic Fatty Liver Disease

WANG Li-ying，LI Qiang

2018, 21(27): 3397-3402. DOI: 10.3969/j.issn.1007-9572.2018.00.232

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In recent years，nonalcoholic fatty liver disease（NAFLD）has been found to be a common cause of chronic liver disease all over the world.With the development of medical studies，NAFLD is no longer considered as a disorder only involves the liver，but main manifestations of the liver secondary to metabolic syndrome（MS）.NAFLD is closely associated with cardiovascular disease，chronic kidney disease and other metabolic diseases，and even can be used as a predictor for systemic disease.Increasing evidence show that elevated serum uric acid（SUA）may play a role in the development of MS，NAFLD and other systemic metabolic disorders.We reviewed the correlations between SUA and NAFLD based on analyzing the pathophysiology of SUA and epidemiological characteristics and mechanisms of NAFLD，with a view to providing theoretical support for early detection，effective management and monitoring of NAFLD.

Advances in Understanding the Molecular Mechanisms of the Cardiovascular Toxicity of Targeted Cancer Therapies

QI Hong-tao，PENG Zong-yu

2018, 21(27): 3403-3406. DOI: 10.3969/j.issn.1007-9572.2018.00.246

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Molecular targeted therapy is a revolutionary approach in cancer treatment that improves the quality of life of patients and prolongs patient life.However，targeted drugs often have cardiovascular toxicity.In this article，we review the adverse cardiovascular events associated with targeted therapies，including cardiac dysfunction and heart failure，arrhythmias，pulmonary hypertension，hypertension，arterial and venous ischemia and hemorrhage.We also summarize the mechanisms that contribute to the cardiovascular side effects of target drugs.

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