Table of Content

20 October 2018, Volume 21 Issue 30

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Monographic Research

Pay Attention to High-risk Factors，Standardize Management，and Reasonably Diagnose and Treat Thromboembolic Diseases during Pregnancy——Interpretation of ACOG Practice Bulletin No.196：Thromboembolism in Pregnancy（2018）　

LIN Li，WANG Jing

2018, 21(30):  3659-3664.  DOI: 10.12114/j.issn.1007-9572.2018.00.244

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In recent years，the incidence of thromboembolism in pregnancy is increasing，which is one of the main causes of maternal mortality.In 2018，the American College of Obstetricians and Gynecologists updated its guidelines to provide information regarding the high-risk factors，use of anticoagulant drugs in pregnancy，diagnosis，intrapartum / postnatal management，and so on，and this Practice Bulletin replaces Practice Bulletin No.123（2011）．The clinical recommendations from the ACOG guidelines are interpreted according to evidence-based practices，in order to better guide the clinical work.


Preliminary Analysis of Changes of Pulse Waveform before and after Individualized Constant Power Exercise　

LI Hao，SUN Xingguo，ZHANG Ye，GE Wangang，XI Jianing，CHEN Rong，ZHANG Zhenying，XIA RuiMA Mingxin，WANG Dong，ZOU Yuxin，YANG Ge，FENG Jing，YU Hong，JIANG Liqing

2018, 21(30):  3665-3671.  DOI: 10.12114/j.issn.1007-9572.2018.00.233

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Objective　To investigate the effect of individualized constant power exercise on pulse wave in patients with chronic diseases.Methods　Eleven patients with chronic diseases（blood sugar，blood lipids，and blood pressure abnormalities） managed by our team were enrolled as the patient group in the Beijing Rehabilitation Hospital affiliated to Capital Medical University in June 2017 and eight normal persons were enrolled in the Fuwai Hospital，Chinese Academy of Medical Sciences as the normal group during the same period.The individualized quantitative exercise prescription was developed by cardiopulmonary exercise test，and the radial artery pulse wave was measured before and at 5，15，30，40 min after exercise，with 30 minutes of exercise every day.The original data of pulse wave of subjects was plotted with Origin，and the waveform characteristics of the rise，fall，notch or plateau of the radial artery pulse wave and its changes before and after the exercise were qualitatively analyzed，and the pre- and post-existing notch occurrence rates were compared in two groups.Results　The notch occurrence rate of the patient was lower than that of normal group（P=0.010） before exercise.After exercise，the pulse wave waveform of both groups became higher and narrower.There was no statistical significance in notch occurrence rate of patient group before and after 5 min，15 min，30 min，40 min of exercise（P>0.05）．There was no significant difference in the notch occurrence rate between the patient group and the normal group after 5 min，15 min ，30 min，40 min of exercise（P>0.05）．Conclusion　Individualized constant power exercise can change the pulse wave waveform，which may be an effective indicator for exercise control of chronic diseases and hypertension，but its mechanism needs further study.

How to Stop Symptom-limited Maximal Cardiopulmonary Exercise Testing：a Discussion of Termination by 85% of Maximal Age-predicted Heart Rate and a Specific Systolic Blood Pressure　

SUN Xingguo，DAI Yaqi，ZHANG Ye，CI Zheng，ZHU Jiabao，GE Wangang，LI Hao，LIU Qin，HAO Lu，STRINGER W W

2018, 21(30):  3672-3679.  DOI: 10.12114/j.issn.1007-9572.2018.00.263

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Objective　To analyze the data concerning systolic blood pressure（SBP） and heart rate（HR） in symptom-limited maximal cardiopulmonary exercise tests（CPETs），in order to explore whether it is right or not to use 85% of maximal age-predicted heart rate（85% MPHR） and a specific SBP level to terminate the CPET.Methods　Data of 112 symptom-limited maximal CPETs completed with incremental protocols by 85 participants in the cardiopulmonary exercise laboratory of Ronald Reagan UCLA Medical Center，between January 1974 and January 2004 were collected from the Principles of Exercise Testing and Interpretation （Fourth Edition）．We analyzed 111 CPETs with HR data（the other one was excluded due to lack of corresponding data） and 97 CPETs with intra-arterial blood pressure（the other 15 were excluded due to lack of corresponding data）．We calculated and counted the number and percentage of the CPETs with recorded maximum HR ≥85% MPHR，and compared the differences and percentage differences of exercise duration（time），work rate（WR），HR，breath frequency（f），minute ventilation（V?E），carbon dioxide output（V?CO2），oxygen uptake（V?O2），oxygen pulse （O2P），and respiratory exchange ratio（RER） at peak exercise and while HR reached 85%MPHR using paired t test.We also did the similar calculation and count of the number and percentage of the CPETs with recorded SBP≥210，220 and 250 mmHg，and the comparisons of the differences and percentage differences of the aforementioned parameters between the peak exercise and while SBP≥210，220 and 250 mm Hg.Results　There were 64（58%） CPETs during which the maximum HR ≥85% MPHR，in all of 111 CPETs with recorded HR.There were significant differences for all measurements of time，WR，HR，f，V?E，V?CO2，V?O2，O2P and RER（P<0.001） between the peak and HR≥85% MPHR in these 64 CPETs.There were 39，28 and 9 CPETs during which the peak SBP≥210，220 and 250 mm Hg，respectively，in all of 97 CPETs with recorded intra-arterial BP.There were significant differences for all measurements of 9 parameters（time，WR，HR，f，V?E，V?CO2，V?O2，O2P，and RER）（P<0.05） between the peak exercise and while SBP≥210 and 220 mm Hg in these 39 and 28 CPETs，respectively.However，there were no significant differences for all measurements of the above-mentioned 9 parameters between the peak exercise and SBP≥250 mm Hg（P>0.05） in these 9 CPETs.Conclusion　As not all of （only most of） the participants had a maximum HR ≥85% MPHR，and a minority of them had a SBP ≥210 mm Hg during the CPET，we should not affirm that the participants fail to achieve a maximal effort during CPET even if the maximum HR <85% MPHR and/or peak SBP <210 mm Hg.Moreover，we should not stop the exercise by maximum HR≥85% MPHR and /or peak SBP≥210 or 220 mm Hg.However，we may consider to use the SBP≥ 250 mm Hg as an indicator of termination of CPET.


Can Peak Respiratory Exchange Ratio Be Used as a Predictor for Stopping Symptom-limited Maximal Cardiopulmonary Exercise Testing?　

CI Zheng，SUN Xingguo，DAI Yaqi，ZHANG Ye，GE Wangang，LI Hao，ZHU Jiabao，LIU Qin，HAO Lu，STRINGER W W

2018, 21(30):  3680-3686.  DOI: 10.12114/j.issn.1007-9572.2018.00.252

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Objective　We analyzed the peak respiratory exchange ratio（RER） data of 102 symptom-limited maximal cardiopulmonary exercise tests（CPETs），in order to provide a reference for the determination of the appropriate RER for the stopping of the tests.Methods　Data concerning 112 CPETs performed with incremental protocols by 85 participants were collected from the Principles of Exercise Testing and Interpretation （Fourth Edition）．After the exclusion of 10 CPETs without RER because of inhaling pure oxygen，we analyzed RER related data of 102 CPETs.For CPETs with peak RER ≥1.10，1.15 and 1.20，we calculated and compared the differences of exercise duration，work rate （WR），systolic blood pressure（SBP），heart rate（HR），breath frequency（f），minute ventilation（V?E），carbon dioxide output（V?CO2），oxygen uptake（V?O2），oxygen pulse（O2P） and RER at the peak exercise and while the RER≥1.10，1.15 and 1.20 on the same CPET，using the paired-t test.Results　The mean peak RER of 102 CPETs was （1.21±0.16）（range：0.86-1.77）．Even though there were about one half to more than three quaters of CPETs with peak RER ≥1.10，1.15 and 1.20，there still were 7 CPETs with peak RER <1.0.For 77 CPETs with peak RER ≥1.10，there were significant differences for the parameters of exercise duration，WR，HR，f，V?E，V?CO2，V?O2 ，O2P and RER（P<0.05）．For 60 CPETs with peak RER ≥1.15，there were significant differences for the parameters of exercise duration，WR，HR，f，V?E，V?CO2 and RER（P<0.05）．For 50 CPETs with peak RER ≥1.20，there were significant difference for the parameters of exercise duration，WR，HR，f，V?E and RER（P<0.05）．Conclusion　Although more than half of the CPETs have a peak RER≥1.10，the remaining have a peak RER<1.0.In clinical practice，for ensuring the safety of symptom-limited maximal CPET，close monitoring is emphasized：the overall functional capacity of the patient would be underestimated if his exercise is stopped based on a peak RER reaching a certain level，and the the risk of over exercise would be posed to the patient if the maximal effort is denied based on a peak RER being below a certain level.So a fixed RER can not be used as the absolute predictor of stopping exercise，and we designed a special “Max”testing to identify the CPET as a maximal effort or not.


Impact of Incremental Work Rate on the Peak Respiratory Exchange Ratio during Cardiopulmonary Exercise Testing in Healthy Individuals：a Preliminary Study　

FEI Jiayue，SUN Xingguo，YU Hui，ZHANG Ye，GE Wangang，LI Hao，DENG Wei，ZHAO Yang

2018, 21(30):  3687-3692.  DOI: 10.12114/j.issn.1007-9572.2018.00.253

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Objective　To investigate the effect of different incremental work rates on the peak respiratory exchange ratio（RER） during symptom-limited maximal cardiopulmonary exercise testing（CPET） in healthy individuals，in order to provide a reference for the determination of peak RER as an indicator of achieving a maximal effort and stopping exercise.Methods　Six healthy volunteers who studied and worked at Fuwai Hospital，Chinese Academy of Medical Sciences，were recruited from October to December 2016.After signing the written informed consent，in the Cardiopulmonary Exercise Testing Room，they underwent the symptom-limited maximal CPET at the same period of time in two working days with different incremental work rates（the CPET was performed with an incremental work rate of 10 W/min on the first day，and with an incremental work rate of 30-60 W/min on the second day based on age，sex and predicted values of the CPET）．The mean values of the key parameters（exercise duration，RER，V?O2，WR，HR，O2P，AT，V?E/V?CO2-lowest 90 s，OUEP） and RER at different phases of CPETs with low and high incremental work rates were calculated and analyzed comparatively.Results　The mean exercise duration was longer〔（1 133±150）s vs （491±81）s，P<0.001）〕，mean peak RER was lower〔（1.13±0.08）vs （1.31±0.14），P=0.004〕，mean peak WR was lower〔（157±25） W/min vs （212±48）W/min，P=0.010〕 for symptom-limited maximal CPET performed with an incremental work rate of 10 W/min compared with those of the CPET performed with an incremental work rate of 30-60 W/min.The CPETs performed with incremental work rates of 10 W/min and 30-60 W/min showed no significant differences in the mean values of RER at rest，warm-up and AT（P>0.05），except that the mean RER at peak phase was lower for the former （P<0.05）．Conclusion　The value of peak RER of CPET among the healthy individuals changes significantly according to the incremental work rate.In clinical practice，we should neither simply stop the exercising of the patient when the peak RER reaching a specific level nor deny the maximal effort of the symptom-limited CPET has been achieved if the peak RER does not reach a specific level.


Current Status and Influencing Factors of Loss to Follow-up among Chronic Periodontitis Patients with Long-term Periodontal Therapy　

YANG Haijing，WANG Yonglan，ZHANG Yan，WANG Chunmei

2018, 21(30):  3693-3699.  DOI: 10.12114/j.issn.1007-9572.2018.00.036

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Objective　To investigate and analyze the current status and influencing factors of loss to follow-up among chronic periodontitis patients with long-term periodontal therapy.Methods　280 patients with moderate to severe chronic periodontitis receiving treatment from Department of Periodontology，Tianjin Medical University Dental Hospital during April to June 2015，were recruited by convenient sampling.A self-developed Clinical and Demographic Questionnaire，Self-efficacy Scale for Self-care（SESS），Dental Fear Scale（DFS） were used to obtain data at baseline.The outcome of loss to follow-up within 20 months after the initial treatment of periodontitis was further recorded.Correlations of SESS score with its dimensions score and DFS score were analyzed.Multivariate Logistic regression analysis was conducted to identify the influencing factors of loss to follow-up in patients with long-term periodontal therapy.Results　160 of 280 patients were lost during follow-up period.The score of SESS was positively correlated with the scores of self-efficacy for dentist consultations（SE-DC），self-efficacy for brushing of the teeth （SE-B），self-efficacy for dietary habits （SE-DH），but negatively correlated with the score of DFS （P<0.05）.The score of DFS was negatively correlated with the score of SE-B（P<0.001）.Older age〔OR=1.042，95%CI（1.012，1.074），P=0.006〕，mild conditions〔OR=4.893，95%CI（2.280，10.499），P<0.001〕，non-surgical periodontal treatment〔OR=11.334，95%CI（2.235，57.472），P=0.003〕 and low-level self-efficacy for oral self-care〔OR=71.899，95%CI（23.926，216.062），P<0.001〕 were risk factors of loss to follow-up in chronic periodontitis patients with long-term periodontal therapy.Conclusion　Age，severity of periodontitis，the way of periodontal treatment and the level of self-efficacy for oral self-care are influencing factors of loss to follow-up in chronic periodontitis patients with long-term periodontal therapy.Healthcare professionals should provide targeted interventions to improve maintenance of long-term periodontal health for patients with at least one of the following characteristics：older age，mild conditions，non-surgical periodontal therapy and low-level self-efficacy for oral self-care.


Prevalence of Drug Resistance and Risk Factors Associated with Gram-negative Bacteria in Patients with Peritoneal Dialysis-associated Peritonitis　

LIU Qingqian，SHU Xiaochen

2018, 21(30):  3700-3703.  DOI: 10.3969/j.issn.1007-9572.2017.00.238

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Objective　To investigate the prevalence of drug resistance and explore the risk factors associated with Gram-negative （G-） bacteria in patients with peritoneal dialysis-associated peritonitis （PDAP） in order to improve clinical diagnosis and treatment.Methods　We collected and retrospectively analyzed the clinical data of 236 patients with PDAP at the First People's Hospital of Kunshan from 2012 to 2016，who met the inclusion criteria.The patients were divided into two groups based on whether they were infected with G- bacteria group （56 cases） or Gram-positive （G+） bacteria group （180 cases）．Patient information and laboratory test results were collected.Drug resistance was measured and extended spectrum β-lactamases （ESBLs） were detected.Multivariate G- regression analysis was used to analyze the influencing factors of PDAP caused by G- bacteria.Results　In G- bacteria-induced PDAP，resistance to cephalosporins and quinones increased every year，whereas resistance to enzyme inhibitors，carbapenems，and aminoglycosides did not change significantly over time.PDAP cases caused by ESBL-producing G- bacteria also increased.Dverage dialysis time，enteric infections，reason for dialysis，nucleated cell court of peritoneal dialysate，nucleated cell court of neutrophil count，serum potassium and procalcitonin were significant differences between the results of G- bacteria group and G+ bacteria group（P>0.05）．Multivariate Logistic regression suggested that average dialysis time，reason for dialysis，and serum potassium and procalcitonin were risk factors for G- bacteria-induced PDAP（P<0.05）．Conclusion　In G- bacteria-induced PDAP，resistance to cephalosporins and quinones increased every year； average dialysis time，reason for dialysis，and serum potassium and procalcitonin  are the influencing factors of G- bacteria-induced PDAP.G- bacteria-induced PDAP may be associated with patient-related factors.Given the increasing prevalence of ESBL-producing G- bacteria，it is necessary to treat G- bacteria-induced PDAP promptly and effectively.


The Application Value and Safety Analysis of Capsule Endoscopy in the Diagnosis of Elderly Small Intestine Diseases　

LIU Xianmin，ZHANG Yu，TIAN Xiaoxiao，ZHU Jingjing，JIN Jianjun

2018, 21(30):  3704-3708.  DOI: 10.3969/j.issn.1007-9572.2018.00.178

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Objective　To investigate the usefulness and safety of capsule endoscopy （CE） for the diagnosis of small intestinal diseases in the elderly.Methods　A total of 137 patients with obscure gastrointestinal bleeding （OGIB），chronic abdominal pain，chronic diarrhea，bloating，discomfort，weight loss，and other symptoms who were examined by CE as an outpatient or inpatient at the First Affiliated Hospital of Henan University of Science and Technology from February 2015 to February 2017 were selected and assigned to two groups based on age：an elderly group（≥60 years old，n=75） and a control
 group（<60 years old，n=62）.The CE results were analyzed retrospectively.Parameters included the duration of CE of the stomach and small intestine，the time required for capsule excretion，the completion rate of the entire small intestine（the proportion of patients for whom the capsule passed through the ileocecal valve into the large intestine after the battery had no more power），the retention rate（the proportion of patients with the capsule in the digestive tract for 2 weeks or more），the image quality of CE，the detection rate of diseases of the small intestine，and the types of lesions observed.Results　The duration of CE in the stomach and small intestine，and the amount of time until capsule excretion from the body were longer in the elderly group than in the control group（P<0.05）.The completion rate of the entire small intestine examination was lower in the elderly group than in the control group（P<0.05）.There was no statistically significant difference in the capsule retention rate between the two groups（P>0.05）.The detection rate of small intestinal diseases was greater in the elderly group than in the control group（61.3%vs.43.5%，respectively，P<0.05）.The diseases of the small intestine in the elderly group were mainly vascular lesions and mucosal damage due to the use of nonsteroidal anti-inflammatory drugs，while those in the control group were mainly intestinal ulcers.In the elderly group，the detection rate of OGIB in the small intestine was higher than that of chronic abdominal pain，chronic diarrhea，and other symptoms（P<0.05）.Conclusion　CE requires a longer running time in the digestive tract of elderly patients，but there was no difference in the capsule retention rate between the elderly patients and young and middle-aged patients.CE is a safe examination method with prognostic value for the detection of small intestine diseases in the elderly，especially OGIB.


Risk Factors of Colorectal Cancer in Songjiang District，Shanghai　

YU Yuting，ZHAO Genming，YU Jianguo，TAO Sha

2018, 21(30):  3709-3713.  DOI: 10.12114/j.issn.1007-9572.2018.00.234

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Background　The morbidity and mortality of colorectal cancer in Shanghai have risen gradually since the 1970s，which seriously harm the health of the residents in Shanghai and become a serious public health problem.Objective　To explore the risk factors of colorectal cancer in Songjiang District of Shanghai，providing scientific evidence for the delivery of targeted preventive interventions.Methods　We conducted this study among the permanent residents aged 50-74 from Shanghai's Songjiang District after obtaining their informed consent in accordance with the regulations for implementing a colorectal cancer screening in Shanghai 2015.All of them underwent fecal occult blood test by colloidal gold agglutination.From them，we enrolled 330 cases who were found with colorectal cancer or precancerous colorectal lesions（case group），and compared them with randomly selected sex-matched 1 016 controls with normal test results（control group）.Then，both groups participated in a face-to-face survey with a questionnaire named Screening for the Risk Factors of Colorectal Cancer in Shanghai's Residents conducted by the workers from Songjiang Center for disease control and prevention and medical professionals from Songjiang District Zhongshan Community Health Center.The questionnaire consists of demographic data such as age，marital status，educational level，BMI（underweight：<18.5 kg/m2，normal weight：18.5-23.9 kg/m2，overweight：24.0-27.9 kg/m2，obese：≥28.0 kg/m2），past medical history，life habits（active smoking and passive smoking in everyday life or at work，alcohol consumption） and employment status.And the risk factors of colorectal cancer were investigated.Results　Univariate analysis revealed that obesity，chronic diarrhea，mucus/blood stool，chronic appendicitis/appendectomy，history of tuberculosis，hypertension，history of intestinal polyps and passive smoking in everyday life or at work were the risk factors of colorectal cancer（P<0.05）．The result of multivariate Logistic regression analysis showed that age，chronic diarrhea，tuberculosis history，intestinal polyp history，smoking were risk factors for colorectal cancer（P<0.05）；after adjusting for the variable of active smoking，age，chronic diarrhea，intestinal polyp history，and passive smoking in everyday life or at work were risk factors for colorectal cancer（P<0.05）．Conclusion　Age，history of chronic diarrhea，history of intestinal polyps，history of tuberculosis，and smoking are risk factors for colorectal cancer in residents of Songjiang District，Shanghai，suggesting targets for improved preventive care.


Characteristics of Local and Non-local Residents with Severe Mental Disorders Under Management Living in Urban Areas in Beijing　

WANG Qi，XIE Zheng

2018, 21(30):  3714-3717.  DOI: 10.3969/j.issn.1007-9572.2018.00.183

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Objective　To investigate the difference between local and non-local residents with severe mental disorders under management living in urban areas，providing evidence for scientific management of such patients in urban areas.Methods　The sample was selected from patients with severe mental disorders under management living in an urban district of Beijing in June 2016.Sociodemographic data （including hukou information） and data concerning illness status and management stemmed from the mental health information system of a mental health center in the district.Logistic regression models were used to explore the difference in management methods between Beijingers and non-Beijingers with severe mental disorders.Results　Beijingers and non-Beijingers with severe mental disorders had differences in age，educational attainment，marital status，employment status，types of severe mental illnesses，duration of suffering from the illness，current treatment status，status and methods of management as well as prevalence of developmental disabilities（P<0.05）.Logistic regression analysis suggested that educational attainment and type of hukou were significantly associated with the interview management methods（outpatient department，entering the household） for patients with severe mental disorders（P<0.05）.Conclusion　Non-Beijingers were middle-aged and young people without disability，while the number of schizophrenic patients with long course and untreated condition was less，and the number of patients with bipolar affective disorder manifested by mood change was more.Educational attainment and type of hukou were significantly associated with the interview management methods for patients with severe mental disorders.The management of patients with severe mental disorders in urban areas should focus on the characteristics of the illness and the utilization of health services to improve the management effect.


Clinical Observation of the Curative Effects of Arthroscopic Peroneus Longus Tendon Reconstruction in Elderly Patients with Acute Anterior Cruciate Ligament Ruptures　

ZUO Jinzeng，SHI Fudong

2018, 21(30):  3718-3722.  DOI: 10.12114/j.issn.1007-9572.2018.00.037

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Objective　To investigate the clinical efficacy of arthroscopic reconstruction of the peroneus longus tendon（PLT） in elderly patients with acute anterior cruciate ligament（ACL） ruptures.Methods　A total of 82 elderly patients with ACL ruptures（invariably closed lesions） who were diagnosed and underwent reconstructive surgery at Tangshan People's Hospital between March 2014 and June 2016 were selected and grouped according to a random number table into a treatment group（n=42） receiving single-bundle two-strand autologous PLT reconstruction under arthroscopy，and a control group （n=40） receiving arthroscopic single-bundle four-strand autologous hamstring tendon reconstruction.Pre-operative，post-operative semi-annual and post- operative annual International Knee Documentation Committee（IKDC） scores and Lysholm scores were compared.The range of motion （ROM） and drawer test results were also compared after a 12-month follow-up of the two groups.Results　Group-specific and time-specific interactions were observed regarding the IKDC scores and Lysholm scores  （P<0.05），and both main effects were significant（P<0.05）．The post-operative semi-annual and annual IKDC scores and Lysholm scores in the treatment group all outnumbered those in the control group（P<0.01）．At 12 months post-operation，the ROM in the treatment group was higher than that in the control group〔（116.3°±21.5°） and （102.7°±22.1°），respectively，P<0.05〕；and the inter-group difference in drawer test results was statistically significant（u=5.248，P=0.041）．Conclusion　Arthroscopic PLT reconstruction in elderly patients with ACL ruptures results in an improvement in Lysholm score，ROM and other measured parameters.


Establishment of L929 Cell Line Overexpressing Nfe2l2 Gene Using Lentiviral Vectors：an Experimental Study　

LIU Cheng，TANG Jianming，LI Yang，YANG Jiang，LI Qiannan，LIU Yaodan，HONG Li

2018, 21(30):  3723-3729.  DOI: 10.12114/j.issn.1007-9572.2018.00.215

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Objective　To establish a L929 cell line overexpressing Nfe2l2 gene using lentiviral vectors，laying a basis for investigating the role of Nfe2l2 gene in ECM remodeling.Methods　From December 2014 to May 2015，Nfe2l2 gene sequence was ligated into the GV341 vector （Ubi-MCS-3FLAG-SV40-puromycin）via restriction enzyme digestion.After amplification，transformation，verification，sequencing and plasmid extraction，the GV341 vector plasmids carrying the target gene，together with lentiviral packaging plasmids Helper 1.0 and Helper 2.0 were used to co-transfect 293T cells，and the lentiviral vector LV-Nfe2l2 was harvested after packaging and virus concentration test.After being infected by LV-Nfe2l2 for 72 h，the L929 cells were screened for stable L929/LV-Nfe2l2 cell lines.The expression of Nfe2l2 was determined by real-time qPCR.Results   Sequence analysis showed that the positive clone of LV-Nfe2l2 was consistent with the target gene Nfe2l2.The optimal conditions for L929 cells to achieve 80% infectious efficiency are as follows：ENi.S medium，MOI of 8-10，infection time of 72 h.Real-time qPCR showed that the abundance of Nfe2l2 gene in L929/ LV-Nfe2l2 cells was high（ΔCt ≤12）．Conclusion   In this study，we successfully established a lentiviral vector overexpressing Nfe2l2 gene；target genes with high expression levels could be obtained by LV-Nfe2l2 infected L929 cells；the screened L929/LV-Nfe2l2 cell line can be used in further experimental studies.


Role of Smartphone-based D2P-COPD Platform in the Hierarchical Diagnosis and Treatment of Chronic Obstructive Pulmonary Disease　

LI Fan，GAO Zhen，SHENG Chunfeng，JIANG Jiong，LI Wanling，LIU Jun，ZHANG Jing

2018, 21(30):  3730-3734.  DOI: 10.12114/j.issn.1007-9572.2018.00.030

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Objective　To develop a smartphone-based D2P-COPD platform and to explore its role in the hierarchical diagnosis and treatment of COPD.Methods　This study was conducted in community health centers（CHCs） in Shanghai's Songjiang District，among the patients used smartphone-based D2P-COPD platform for the management of stable COPD sampled from 15 CHCs between November 1，2017 and January 31，2018 （observation group），and those who did not use it sampled from 5 CHCs between April and July 2014 （control group，n=173）．The diagnosis，rates of receiving treatment and standardized treatment during a period of one year follow-up were compared between the two groups.Results　In the observation group，218 were diagnosed with COPD by the community general practitioner using the D2P-COPD platform.The GOLD classification for COPD for them was as follows：18 were in grade 1 stage，104 were in grade 2 stage，59 were in grade 3 stage，and 51 were in grade 4 stage.There was no significant difference in the rate of receiving treatment between observation group and  the control group〔47.7%（104/218）vs 40.3%（64/173）〕（χ2=2.068，P=0.150）．Moreover，the rate of receiving standardized treatment was also higher in the observation group than that of the control group（χ2=65.447，P<0.001）．Conclusion　The smartphone-based D2P-COPD platform is suitable for the hierarchical diagnosis and treatment of COPD.The D2P-COPD screening scale provided by the platform can be used by the community general practitioners（CGPs） for COPD screening，which is contributive to the early diagnosis of COPD.Furthermore，the platform-aided assessment of the patient's conditions helps to improve the rate of standardized pharmacologic treatment prescribed by the CGPs.


Current Situation of Family Doctor Signing Service in Hubei Province　

HE Zhe，SHAO Piaopiao，SHAO Tian，LONG Chengxu，FENG Zhanchun

2018, 21(30):  3735-3740.  DOI: 10.12114/j.issn.1007-9572.2018.30.014

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Objective　To understand the implementation status quo of family doctor signing service in pilot cities of Hubei，so as to find out the existing problems and put forward corresponding suggestions.Methods　The questionnaire was designed on the basis of literature research.The basic situation，personnel composition，income and expenditure，workload of basic public health services，number of required personnel，status of residents' contract signing and team building of family doctors in 14 community health service centers in Wuhan，Xiangyang and Yichang，Hubei were investigated from July to August 2017.Results　Most community health service centers （8/14） were run by the government.The number of people serving in the community health service centers rangeed from 22 500 to 135 700，with a service area of 2.00-33.50 km2.All 14 community health service centers had a certain number of neighborhood committees，4 of which had no community health service stations，and most community health service centers （9/14） had no administrative villages under their jurisdiction.There were about 22 to 129 people employed in the 14 community health service centers，2 of which had more than half of staff with budgeted posts.However，there was a shortage of staff in community health service centers in both Xiangyang and Yichang.The majority of staff in community health service centers were health and technical personnel，with few general practitioners.The total expenditure of six community health service centers in Laodong Street，Panggong，Shiying，Dingzhongmen Street，Nanyuan and Xiba exceeded the total revenue and were in a state of deficit.There were 128 general practitioners in 14 community health service centers，serving 813 900 people，with an average of 6 359 per general practitioner.According to the workload of public health service in 2016 and the effective time of participating in public health service per capita per year，271 health technicians should be engaged in basic public health service in five community health service centers in Dagongqiao，Wanshouqiao，Nanyuan，Xiling and Xiba.However，there were only 156 health technicians in each community.All community health service centers were overloaded.Nine out of twelve community health service centers in Yichang and Xiangyang reached the signing rate of 30.00%-35.00%.While only 6，7 and 9 service centers had 60% or over of signing rate for the elderly，patients with hypertension and patients with diabetics，respectively.Only 6 out of 14 community health service centers were able to provide general practitioners to each team，with an average of 3.8 family doctors per team.Conclusion　The main problem of signing service in pilot cities of Hubei is the shortage of medical staff in communities.It is necessary to expand community talent team to enhance service ability and promote the smooth progress of family doctor signing service.

Status Quo and Countermeasures for Developing Institutions Combining Old-age Care and Medical Care in Guangxi　

WANG Biyan，XU Mingjiang，WU Qijun

2018, 21(30):  3741-3745.  DOI: 10.3969/j.issn.1007-9572.2018.00.206

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Objective　To summarize the typical development model of institutions combining old-age care and medical care in Guangxi；to analyze the main problems currently affecting this development；and to propose targeted policy recommendations.Methods　Using a typical survey method，Guangxi Nanning，Guilin，Beihai，and Liuzhou were selected as the project research areas.In each area，a representative old-age care institution between July and September 2015 was selected.Comprehensive surveys and in-depth interviews with staff were used.In the four old-age care institutions，20%–40% of the staff were randomly sampled to conduct a questionnaire survey，and 1 or 2 of the persons in charge in the investigated old-age care institutions were interviewed in depth.The investigation assessed a combination of medical care and old-age care services；the nature，scale，sources of funds，and fees in old-age care institutions，as well as the educational levels of the staff in those institutions.Results　There were three main modes of combination of medical-care and old-age care services in Guangxi：establishment of medical institutions in old-age care institutions；establishment of nursing homes in medical institutions；and establishment of institutions providing collaborative old-age care and medical care services.There were two types of institutions：public and private.The number of beds has increased each year，but the total number has been insufficient.The main source of funding for infrastructure construction of elderly nursing homes was established by states，but the institutions are run privately，independently of government investment.Each bed in an old-age care institution costs RMB 400–1 200 per month；the nursing fees for first-，second- and third-tier care providers are RMB 400–1 400 per month；and the living expenses are RMB 400–600 per month.In addition，the rehabilitation physiotherapy services in the institutions combining old-age care and medical care，as well as other service costs，make the overall service charges of old-age care combined medical care institutions very high，such that the income of the elderly is insufficient to cover costs.A total of 80% of the staff in old-age care institutions have college education and bachelor's degrees；the doctors are mainly college educated and bachelor's degree holders；nearly 90.0% of nurses are college graduates and below；94.4% of nursing workers have high school degrees and below；and the persons handling logistics are mostly most high school graduates and below，accounting for 83.7%，and the educational level is generally low.Conclusion　The shortage of hospital beds in facilities providing old-age care combined with medical care in Guangxi，the imbalanced structure of the supply side，and the inadequate payment ability of the elderly have affected the development of the medical care and old-age care industry and the quality of nursing care workers.It is recommended that the development of medical and nursing care in Guangxi be promoted through implementing relevant supporting policies，increasing the services provided by institutions combining old-age and medical care，establishing a long-term care insurance system，and establishing a sound training and incentive structure for the elderly.


Effects of Community Health Reform on Prescription of Antibiotics in the Community Health Center of Bao'an District of Shenzhen，through an Interrupted Time Series Design with a Comparison Group　

LI Zhen，WANG Yini，JIN Chenggang

2018, 21(30):  3745-3748.  DOI: 10.12114/j.issn.1007-9572.2018.00.064

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Objective　To evaluate the effects of operation reform on the ratio of antibiotic prescriptions in outpatient clinics in the Community Health Center of Bao'an District in Shenzhen City.Methods　The Community Health Center of Bao'an District started service and operation reform on 2009-06-01，and was considered the pilot group.The Community Health Center of the Songgang street community was used as a comparative group.The outpatient electronic data from the two health centers were extracted from the Conggangzheng Community Health Information System （from June 1，2008 to May 31，2010 for the pilot group，and from October 1，2008 to May 31，2010 for the comparative group）.A piecewise regression analysis based on an interrupted time series design with a comparison group was used to compare the antibiotic usage between the two groups.Results　The proportion of antibiotic prescriptions in the pilot group showed a decreasing trend in a fluctuating manner.The average level was 77.00% before the reform and 72.78% after the reform.The proportion of antibiotic prescriptions in the comparative group showed seasonal fluctuations.With controlling for a time trend，the results of the piecewise regression showed that the community health service reform in Shenzhen city led to a 0.77 reduction in the proportion of antibiotic prescriptions in the pilot group every 2 weeks （P=0.047）.Conclusion　The operation reform at the Community Health Center of Bao'an District of Shenzhen effectively controlled the use of antibiotics and improved the rational use of antibiotic drugs.


Effect of Mild Moxibustion on TRPV1 Expression in the Dorsal Root Ganglion in a Mouse Model of Pruritus Ani　

XU Li，GE Qiongxiang，LIN Guoqiang

2018, 21(30):  3749-3752.  DOI: 10.12114/j.issn.1007-9572.2018.00.241

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Objective　To investigate the effect of mild moxibustion on the expression of TRPV1 in the dorsal root ganglion in a mouse model of pruritus ani.Methods　This study was carried out from December 2016 to December 2017.Forty SPF C57BL/6J mice were selected and equally randomized into four groups：blank group，model group，treatment groupⅠ and treatment group Ⅱ.After 1-week adaptive feeding，the hair in perianal region was shorn for all mice，and mice in model group，treatment group Ⅰ and Ⅱ were injected capsaicin（50 mg/kg） subcutaneously into the perianal region to establish the model，while those in the blank group were injected the same dose of 0.9% sodium chloride solution.After successful modeling，mice in treatment group Ⅰ were treated with mild moxibustion applied to areas（45±5） mm away from changqiang acupoint and shenque acupoint after shearing of the hair，for 10 min（skin temperature was kept at 38℃measured by a mercury thermometer），once daily，and those in treatment groupⅡ were treated with mild moxibustion applied to areas（35±5） mm away from changqiang acupoint and shenque acupoint after shearing of the hair，for 10 min（skin temperature was kept at 46 ℃ measured by a mercury thermometer），once daily，whereas those in other two groups were caught and fixed once daily but given no other treatments.After 1-week intervention，all the mice were scarified and dorsal root ganglia were taken out，and the expression levels of TRPV1 protein and TRPV1 mRNA in the dorsal root ganglia were measured by Western blotting and qPCR，respectively.Results　Mice in the model group demonstrated much higher expression levels of TRPV1 and TRPV1 mRNA in the dorsal root ganglion compared with those in the other three groups（P<0.05）．Compared with mice in treatment groupⅠ，those in treatment group Ⅱ showed much lower expression levels of TRPV1 and TRPV1 mRNA in the dorsal root ganglion（P<0.05）．Conclusion　Mild moxibustion could inhibit the expression level of TRPV1 in the dorsal root ganglion in a mouse model of pruritus ani，in particular，moxibustion with a skin temperature maintained at 46 ℃ showed stronger inhibition effect compared with that with a skin temperature maintained at 38 ℃.


Yifeizhuji Decoction Combined with Cyclophosphamide for Reducing the Tumor Volume and Improving the Immunologic Functions in the Lewis Lung Carcinoma Mouse Model　

ZHANG Na1LIU Xuefang，JIANG Shihong，WANG Qi，TIAN Yange

2018, 21(30):  3753-3756.  DOI: 10.12114/j.issn.1007-9572.2018.00.168

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Objective　To explore the role of yifeizhuji decoction（YFZJD） combined with cyclophosphamide（CTX） in the treatment of lung carcinoma and immune regulation based on observing its effects on the tumor volume，thymus indices and percentage of lymphocytes in the Lewis lung cancer mouse model.Methods　We conducted this study from April to May 2016.55 male C57BL/6 mice were selected，5 of them were inoculated with Lewis lung cancer cells to prepare tumor cell suspension，other 50 were randomly divided into model group（40） and normal control group（10）．Model group mice received subcutaneous inoculation of Lewis tumor cell suspension in the right forelimb armpit to establish the lung cancer mice model.When the models were successfully developed，mice from model group were divided into YFZJD subgroup（10），CTX subgroup（10），YFZJD combined with CTX subgroup（10），model control subgroup（10） by means of random number table.From the second day after modeling，YFZJD subgroup and YFZJD combined with CTX subgroup received a 14-day sequential therapy of intragastric administration of YFZJD（14.95 g/kg per day），and the model control subgroup and the normal control group received a 14-day sequential therapy of intragastric administration of 0.9% sodium chloride solution（with the volume equal to that of YFZJD per day）．The CTX subgroup only received and YFZJD combined with CTX subgroup additionally received intraperitoneal injection of CTX（40 mg/kg） at 72 h and on the 10th day after inoculation.At the end of intervention，the tumor diameter was measured and the tumor volume was calculated；the body weight and thymus weight were measured，the thymus indices were calculated；the percentages of CD4+，CD8+ T-lymphocytes and B cells were detected by flow cytometry.Results　Smaller tumor was found in YFZJD subgroup and YFZJD combined with CTX subgroup instead of the model control subgroup（P<0.05），and in the YFZJD combined with CTX subgroup instead of CTX subgroup（P<0.05）．The normal control group had greater body weight compared with other 4 subgroups（P<0.05）．The YFZJD subgroup had greater thymus weight and higher levels of thymus indices than the normal control group as well as the CTX subgroup（P<0.05）．The percentages of CD4+，CD8+ T-lymphocytes in the model control subgroup were less than those of the normal control group as well as those of other 3 subgroups（P<0.05）．The YFZJD combined with CTX subgroup owned higher percentages of CD4+，CD8+ T-lymphocytes compared with the CTX subgroup（P<0.05）．The model control subgroup demonstrated a higher percentage of B cells compared with the normal control group and other 3 subgroups（P<0.05）．The percentage of B cells in YFZJD subgroup was higher than that of the CTX subgroup（P<0.05）．Conclusion　The combined use of YFZJD with CTX can effectively inhibit the growth of Lewis lung cancer tumor and improve the CTX-induced immunosuppression by upregulating the thymus indices as well as the percentages of CD4+ and CD8+ T-lymphocytes and B cells.


Short-term Clinical Outcome of One-stage Arthroscopically Assisted Anterior，Posterior and Lateral Collateral Ligament Reconstruction for Multi-ligament Knee Injuries　

LUO Gaobin，LI Wei，ZHAO Liangjun，LIN Yicai，WANG Lin，DU Gang

2018, 21(30):  3757-3760.  DOI: 10.3969/j.issn.1007-9572.2018.00.110

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Objective　To explore the short-term clinical outcome of one-stage arthroscopically assisted anterior，posterior and lateral collateral ligament reconstruction and medial collateral ligament（MCL） repair in multiligament knee injuries（MKI），aiming to provide a reference for clinical diagnosis and treatment of this disease.Methods　Totaled 29 cases of MKI（type KD Ⅱ-Ⅳ by Schenck classification） were included from the First Affiliated Hospital of Guangxi Medical University from December 2011 to July 2014.All of them were treated by one-stage arthroscopic surgery：under general anesthesia，arthroscopic examination and debridement were performed through both the medial and lateral approaches；the anterior cruciate ligament（ACL） was reconstructed with the hamstring tendon of the contralateral knee，the posterior cruciate ligament（PCL） and lateral collateral ligament（LCL） were reconstructed with the allogeneic tendon，and the MCL was repaired by suture anchors.In addition，all the cases received individualized rehabilitation trainings.The indicators for evaluating the short-term outcome include postoperative incidence of complications，follow-up results，anterior drawer test（ADT），posterior drawer test（PDT），Bohler sign，Lysholm knee score，IKDC score and range of motion.Results　All the cases were followed up for a mean of（18.5±5.4）（range，12-36） months.During which，the surgical incision of all cases healed by first intention，without infection，osteofascial compartment syndrome，vascular nerve injury associated with surgery or other complications；good range of motion，and good anterior-posterior-lateral stability of the knee were achieved in all cases（as of the last follow-up）.Although postoperative knee joint adhesions occurred in 2 cases，normal range of motion was achieved in 1 after standardized rehabilitation training，and was also achieved in other 1 who was unresponsive to a 3-month rehabilitation training but then received the arthroscopic knee adhesions lysis.Positive results of ADT，PDT and Bohler sign at baseline became negative，and Lysholm knee score，IKDC score and range of motion at baseline were all improved significantly as of the last follow-up（P<0.05）．Conclusion　For MKI，using one-stage arthroscopic surgery to reconstruct both ACL ，PCL and LCL and to repair the MCL can achieve good stability of the knee and significantly improved knee function.


Clinical Characteristics of Incomplete Kawasaki Disease Combined with Coronary Artery Aneurysm　

GENG Lingling，MIAO Feng，LI Xiaoqing

2018, 21(30):  3761-3764.  DOI: 10.12114/j.issn.1007-9572.2018.00.214

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Objective　To retrospectively analyze the clinical characteristics of incomplete kawasaki disease（IKD） with coronary artery aneurysms（CAA）．Methods　From the 997 children with KD treated in Xi'an Children's Hospital between January 2012 and June 2017，we enrolled all the children with IKD and CAA（n=22，IKD+CAA group），all the children with complete kawasaki disease（CKD） and CAA（n=36，CKD+CAA group），and 116 with CKD and normal coronary artery（NCA） （randomly sampled from other 939 cases）．We collected their epidemiological data〔sex，age of onset，duration of suffering from fever，onset season，place of residence（urban/rural area）〕，laboratory data〔white cell count（WBC），hemoglobin（Hb），neutrophils（N），platelet （PLT），albumin （ALB），alanine aminotransferase （ALT），aspartate aminotransferase（AST），calcitonin（PCT） and fibrinogen（FIB）〕 and other data such as prevalence rates of mycoplasma（MP） and EB virus（EBV） infection.Results　Male patients outnumbered female patients，and rural patients outnumbered urban patients in both IKD+CAA and CKD+CAA groups．In both CKD+CAA and CKD+NCA groups，more patients had an onset age of ≥1 rather than < 1，more patients owned a history of suffering from fever < 10 days instead of ≥10 days，and more patients were attacked in summer than in other seasons．All groups showed similar baseline levels of WBC，Hb，N，PLT，ALB，ALT，AST，ESR，PCT，and FIB（P>0.05）．The prevalence rates of MP infection were 9.1%，16.7%，22.4% in IKD+CAA group，CKD+CAA group and CKD+NCA group，respectively.Furthermore，the prevalence rates of EBV infection were 4.5%，8.3%，4.3% in IKD+CAA group，CKD+CAA group and CKD+NCA group，respectively.Conclusion　Men and those from rural areas were more susceptible to IKD combined with CAA.The laboratory values were similar in IKD+CAA group，CKD+CAA group and CKD+NCA group.In addition，the detection of CAA should be strengthened in those with an increased duration of fever，a younger age of onset，or suspected IKD.


Comparison of Image Quality and Radiation Dose of Diastolic and Systolic Phase Acquisition in Force CT Coronary Angiography Using Prospectively ECG-triggered High-pitch Spiral  Turbo Flash  Mode in Patients with 65-75 bpm Heart Rates　

YANG Jiahu，WANG Junna，FENG Yue，ZHANG Jianjun，HU Hongjie

2018, 21(30):  3765-3770.  DOI: 10.3969/j.issn.1007-9572.2018.00.157

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Objective　To investigate the image quality and radiation dose of Force CT coronary angiography using prospectively ECG-triggered high-pitch spiral Turbo Flash mode in different acquisition phases（diastolic and systolic） in patients with 65-75 bpm heart rates.Methods　We collected 60 patients who underwent Force CT coronary angiography in the Zhejiang Hospital from September to December 2016.According to the acquisition phase，the patients were divided into group A（30 cases，Turbo Flash high-pitch diastolic phase acquisition） and group B（30 cases，Turbo Flash high-pitch systolic phase acquisition）．The subjective and objective image quality of CTA in the two groups was evaluated，and the radiation doses in the two groups were recorded and compared.Results　A total of 779 coronary segments were evaluated in the two groups.In group A，392 coronary segments were evaluated，of which the second obtuse marginal branches（OM2） had the best quality，and the image quality of the middle part of the right coronary artery（RCA） was poorest.In group B，387 coronary segments were evaluated，of which OM2 had the best quality，and the distal part of the left circumflex artery（LCX） was poorest.The image quality of the first diagonal branch（D1） and the proximal and middle parts of the LCX and OM1 in group A were better than those in group B （P<0.05）．There were no significant differences in the CT values of the proximal part of the RCA，proximal part of the left main coronary artery（LM），proximal part of the left anterior descending （LAD），proximal part of the LCX，signal-to-noise ratio （SNR），contrast-to-noise ratio （CNR），aorta CT value，SNR，CNR and image noise between the two groups（P>0.05）．There were no significant differences in volume CT dose index（CTDIvol），dose length product（DLP） and effective dose（ED） between the two groups（P>0.05）．Conclusion　Force CT high-pitch Turbo Flash CTA combined with low-voltage（100 kV） and the ADMIRE iterative reconstruction algorithm can obtain images of coronary branches that meet the requirements for clinical diagnosis，with an effective radiation dose less than 1 mSv.For patients with a 65–75 bpm heat rate，it is recommended to apply diastolic acquisition mode，and the image quality of LCX is better than systolic acquisition.


Establishment and Diagnostic Value of a Thyroid Nodule CT Quantification Scoring System　

CHEN Fei，WANG Guojie2CHEN Xiaobo，YE Ying，WANG Ying

2018, 21(30):  3770-3775.  DOI: 10.12114/j.issn.1007-9572.2018.00.017

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Objective　To establish a thyroid nodule quantification scoring system based on nodular CT signs deduced from the thyroid image reporting and data system，and to explore its diagnostic efficiency for thyroid malignant nodules.Methods　A retrospective study was performed on patients with thyroid nodules who underwent CT examination，and whose diagnoses were confirmed by pathology，at the Fifth Affiliated Hospital of Sun Yat-Sen University.The training set included 85 patients （a total of 134 nodules） who were examined between October 2012 and August 2015；the validation set included 25 patients （a total of 61 nodules） who were examined between September 2015 and June 2016.The differences in 11 CT signs between benign and malignant nodules in the training set were analyzed.The OR values of significantly different CT signs were calculated and scored，and the overall score of each nodule was calculated.The ROC curve for the diagnosis of malignant nodules was plotted，and the best cutoff value was determined.A quantification scoring system was constructed，and its diagnostic value for thyroid nodules was evaluated.Results　Among the 11 CT signs，the number of nodules，nodule shape，nodule boundary，nodule edge，structural composition，calcification type，enhancement mode，thyroid capsule integrity，lymph node metastasis between benign and malignant thyroid nodules，were significantly different（P<0.05）.The AUC of the ROC curve of the scoring system in the diagnosis of malignant nodules was 0.921〔95%CI（0.871，0.971）〕.The best cut off value was 9 points.Pathological examination was used as the gold standard.Categories 1，2，and 3 in the CT quantification scoring system were deemed benign nodules，and categories 4 and 5 were deemed malignant nodules.The sensitivity，specificity，positive predictive value，negative predictive value and accuracy of the scoring system were 86.67%（13/15），89.13% （41/46），72.22% （13/18），95.35%（41/43） and 88.52%（54/61）．The AUC of the ROC curve was 0.872〔95%CI（0.742，1.000）〕.Conclusion　The thyroid nodule quantification scoring system based on nodular CT signs has a high diagnostic efficiency for differentiating benign and malignant thyroid nodules.

One Case Report and Literature Review of Adrenocortical Carcinoma　

SUN Liangxue，CHEN Linxi，MO Licai

2018, 21(30):  3776-3781.  DOI: 10.12114/j.issn.1007-9572.2018.00.161

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Adrenocortical carcinoma is a rare disease with poor prognosis.After retrospecting the history of a case diagnosed adrenocortical carcinoma and researching the literature related，the author provide the reference of the way to heal Adrenocortical carcinoma，by summarizing the diagnosis，surgery method and other adjuvant therapeutic schedule of this disease.


Methimazole-induced Elevation of Serum Creatine Kinase：Report of Three Cases and Literature Review　

CHENG Ying

2018, 21(30):  3781-3784.  DOI: 10.12114/j.issn.1007-9572.2018.00.203

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Methimazole（MMI） is a common anti-thyroid drug.Adverse effects such as allergy，leucopenia and hepatotoxicity associated with MMI are frequently seen，but muscle damage associated with MMI is rare.We reported three cases who suffered from elevated serum CK during MMI treatment of hyperthyroidism，and reviewed the relevant studies，and based on this，explored the possible mechanisms.All these are for increasing clinicians' awareness of the adverse reactions among hyperthyroidism patients with MMI treatment and improving the treatment regimen for better outcome.
Hyperthyroidism；Methimazole；Creatine kinase