Loading...

Table of Content

    15 November 2018, Volume 21 Issue 32
    Monographic Research
    Comparison of Diagnostic Value in Different Pulmonary Function Tests in the Guidelines of Bronchial Asthma
    YIN Shuomiao,CHEN Yuanbin,ZHENG Yanchan,DU Qingzhan,TANG Weiping,ZHOU Mingjuan,LIN Lin
    2018, 21(32):  3911-3914.  DOI: 10.12114/j.issn.1007-9572.2018.00.212
    Asbtract ( )   PDF (1284KB) ( )  
    References | Related Articles | Metrics
    According to the discussion on the pulmonary function examination in Global Initiative for Asthma (GINA) and latest asthma prevention and treatment guidelines in China,Japan,South Korea,Britain,India and Spain,we evaluated and analyzed the clinical value and importance of different pulmonary function test modes 〔such as bronchial dilation test,bronchial provocation test and peak expiratory flow (PEF) test〕.It was concluded that the pulmonary function tests recommended by bronchial asthma guidelines were bronchial dilation test and PEF test,which have high diagnostic value and high degree of acceptance,especially the combination of the two methods are more conducive to the diagnosis and evaluation of asthma.Because of high risk operation and lower specificity,there are some disputes about bronchial provocation test,another important test method,which has less value than bronchial dilation test and PEF test in clinical diagnosis of asthma.

    Recent Developments in the Targets for Intervention in Dyslipidemia Management
    ZHAO Jing,LI Yue,CHENG Ruizhen
    2018, 21(32):  3915-3919.  DOI: 10.12114/j.issn.1007-9572.2018.00.074
    Asbtract ( )   PDF (1337KB) ( )  
    References | Related Articles | Metrics
    The aim of dyslipidemia management is to reduce the risk of atherosclerotic cardiovascular disease.In recent years,changes have been taking place in the concept of dyslipidemia management for dyslipidemia management.However,there is no consensus on the monitoring targets for intervention in dyslipidemia management,control target,dyslipidemia risk grade and recommendations for statins among constantly updated national and international guidelines for the management of dyslipidemia.In order to achieve personalized treatment goals,based on the reviewing of the guidelines for the management of dyslipidemia and the associated new clinical studies,we suggest that the goal of dyslipidemia management should be set up in accordance with the multi-target monitoring results of the patient's conditions,and the reduction of control target should also be appropriate.
    Update on the Diagnosis and Treatment of Gout Based on Guidelines
    CAO Wen,CHEN Guofang,LIU Chao
    2018, 21(32):  3920-3923.  DOI: 10.12114/j.issn.1007-9572.2018.00.059
    Asbtract ( )   PDF (1290KB) ( )  
    References | Related Articles | Metrics
    The study of gout is going deep and the guideline for the management of gout from the British Society for Rheumatology and the management of acute and recurrent gout:a clinical practice guideline from the American College of Physicians were published recently cover the essentials such as the diagnosis of gout,timing for the initiation of therapy,therapies for acute and chronic gout and precautions in the management.Moreover,updates of diagnosis of the genetic level of gout are embodied by newly found risk loci for gout and ultrasound becoming a promising new imaging modality for gout.Furthermore,two uric acid-lowering agents,Lesinurad and Arhalofenate,have been used for the treatment of gout.This article interprets the updated guidelines and reviews the recent developments in gout diagnosis and management,in order to provide a theoretical reference for clinical treatment and preclinical research.
    Influence Factors of Adaptation to Stress among Families of Elderly Patients with Moderate to Severe Dementia:a McCubbin's Family Resilience Model-based Cross-sectional Study
    WANG Qingyan,WU Fan,ZHANG Yuyun,XU Xiaohua,SHENG Yu
    2018, 21(32):  3924-3932.  DOI: 10.12114/j.issn.1007-9572.2018.00.282
    Asbtract ( )   PDF (1190KB) ( )  
    References | Related Articles | Metrics
    Background Providing care for elderly patients with moderate to severe dementia always lays great deal of stress on families,especially the families in which adult children act as the primary caregivers.Family adaptation to stress determines the patient's quality of life.Therefore,improving the adaptation to stress among families of elderly dementia patients (who were taking care primarily by their adult children) in China through finding out the corresponding influence factors is of great significance.Objective To identify the factors and the pathways associated with the adaptation to stress among families of elderly patients with moderate to severe dementia.Methods We conducted this cross-sectional study from October 2017 to March 2018.In accordance with the inclusion criteria,using convenience sampling,we selected 223 elderly patients with moderate to severe dementia who visited the doctor for medical consultation or only for prescribing drugs from Memory Disorders Clinic of hospitals,including Peking Union Medical College Hospital,Xuanwu Hospital Capital Medical University,China-Japan Friendship Hospital,and Old Age Psychiatry Clinic and Memory Disorders Clinic of Beijing Anding Hospital.After enrolled their family members,self-developed General Demographic Questionnaire was used to collect the demographic characteristics of the patients and their family members.A set of measurements,such as Chinese version of Revised Memory and Behavior Problems Checklist (RMBPC) were adopted to measure 12 influence factors of family adaptation to stress derived from the framework of McCubbin's Resiliency Model of Family Stress,Adjustment and Adaptation(hereinafter referred to as Family Resilience Model).The Chinese version of Family Adaptation Scale was used to measure family adaptation.Structural equation modeling (SEM) was performed to identify the influence factors of family adaptation to stress,and analyze their pathways and effects.Results A total of 203 families who returned eligible questionnaires were included in the final analysis,with a response rate of 91.03%.After verification and revision,the pathways regression coefficients of 12 factors (stressor,family schema,family coherence,family paradigms,meanings,situational appraisal,family resources,family support,kin support,community support,social support,problem solving and coping) included in the Family Resilience Model were found to be statistically significant(P<0.05),indicating that all of them were significantly associated with family adaptation.Among these factors,internal support system (consisting of family support and kin support),situational appraisal and family resources were direct influence factors,the others were indirect influence factors.The path coefficients of total effect of the determinants to family adaptation were as follows(from largest to smallest):internal support system(0.673),stressor (-0.427),external support system(0.326),family resources(0.305),appraisal system(0.067),situational appraisal(0.045),problem solving and coping (0.035).Conclusion The results suggest that all the factors included in our Family Resilience Model developed with reference of McCubbin's Family Resilience Model,influence family adaptation,in particular,family support and kin support (internal support system) produce the strongest effect in a direct way,indicating that the adaptation of the families of elderly patients with moderate to severe dementia can be promoted by increasing the family support and kin support.
    Predictive Value of Osteopontin and Inflammatory Factors in the Progression of Mild Cognitive Impairment
    LIU Ting,LI Dan,ZHANG Yan,MENG Xinling
    2018, 21(32):  3933-3937.  DOI: 10.12114/j.issn.1007-9572.2018.00.283
    Asbtract ( )   PDF (1167KB) ( )  
    References | Related Articles | Metrics
    Objective To evaluate the predictive value of osteopontin(OPN) and inflammatory cytokines in the progression of mild cognitive impairment (MCI) to Alzheimer's disease(AD).Methods Prospective analysis of 60 patients with MCI and 60 patients with non-inflammatory neuropathy (OND) matched by age and sex admitted to Traditional Chinese Medicine Hospital of Xinjiang Uygur Autonomous Region from June 2015 to June 2017 was carried out.The clinical data were collected and condition assessment evaluated by MMSE score.Enzyme linked immunosorbent assay (ELISA) was used to measure the levels of OPN in cerebrospinal fluid (CSF) and serum,interleukin(IL)-1β,IL-6,IL-17A,transforming growth factor (TGF)-β1 and tumor necrosis factor (TNF)-α.All patients were followed up for 1 year.According to whether the disease progressed to AD,subjects were divided into AD group,no-progression group and OND group.Serum OPN level and inflammatory factors were measured again in patients of AD group during follow-up.Results There were 23 cases in AD group,32 cases in no-progression group and 51 cases in OND group.The level of CSF OPN in AD group was significantly higher than that in no-progression group and OND group (P<0.05).There was no significant difference in the levels of IL-1β,IL-6,IL-17A,TGF-β1 and IL-4 among three groups after 1 year of follow-up (P>0.05);the levels of serum OPN and TNF-α in three groups at 1 year of follow-up were statistically significant (P<0.05);the levels of OPN and TNF-α in AD group were higher than those in no-progression group and OND group (P<0.05).The result of correlation analysis showed that the levels of OPN in cerebrospinal fluid and in serum were positively correlated with MMSE score at admission (r=0.348,P<0.001;r=0.631,P<0.001),and the level of TNF-α in serum was negatively correlated with MMSE score (r=-0.435,P<0.001).There were significant differences in MMSE score,CSF OPN and serum OPN in AD group at admission,at diagnosis of AD and after one-year follow-up (P<0.001),as MMSE score was lower at the time of diagnosis of AD and follow-up for one year,and the levels of OPN in cerebrospinal fluid and serum were higher after admission (P<0.05).Conclusion CSF OPN level is a potential biomarker for the early identification of MCI which may progress to AD.Serum and CSF OPN and TNF-α were associated with the severity of dementia in AD.
    Effects of Cognitive Therapy Combined with Physical Exercise on the Elderly with Alzheimer's Disease and Mild Cognitive Impairment:a Meta-analysis 
    CHEN Yujing,DU Shizheng,DING Huan,LI Weitong,XU Guihua
    2018, 21(32):  3938-3945.  DOI: 10.12114/j.issn.1007-9572.2018.00.300
    Asbtract ( )   PDF (1342KB) ( )  
    References | Related Articles | Metrics
    Objective To evaluate the effects of cognitive therapy combined with physical exercise on elderly patients with dementia and mild cognitive impairment(MCI).Methods A systematic search of electronic databases,including Cochrane Library,PubMed,EBSCO,CINAHL,EMBase,CMB,CNKI,Wanfang and VIP Database were conducted on May,2018.All randomized controlled trials(RCTs) on cognitive therapy combined with physical exercise intervention for the elderly with Alzheimer's disease were identified.Two reviewers independently screened abstracts,extracted data and evaluated the quality of articles.Meta analysis of cognitive function,daily living ability,depression level,executive function,memory and attention,and laboratory examination was performed by using RevMan 5.0 software.Results Thirteen trials with a total of 812 subjects were finally included.The results of Meta-analysis showed that the mini-mental state examination(MMSE) score of treatment group was higher than that of control group 〔MD=0.73,95%CI(0.09,1.38),P=0.03〕;the Alzheimer's Disease Assessment Scale-Cognitive section(ADAS-COG) score of MCI patients in treatment group was lower than that of control group 〔MD=-1.30,95%CI(-1.65,-0.95),P < 0.000 01〕;there was no significant difference in ADAS-COG score of AD patients between two groups 〔MD=-0.32,95%CI(-0.69,0.05),P=0.09〕;the score of daily living ability in treatment group was higher than that in control group 〔SMD=0.43,95%CI(0.02,0.85),P=0.04〕;the depression level in treatment group was lower than that in control group 〔SMD=-0.85,95%CI(-1.37,-0.34),P=0.001〕;verbal fluency in treatment group was higher than that in control group 〔SMD=0.81,95%CI(0.38,1.24),P=0.000 2〕.The independent standing and balance ability,disease influence degree,memory and attention,and laboratory examination in treatment group were improved compared to those in treatment group.Conclusion The cognitive therapy combined with physical exercise offers an effective and economical means to improve general function of elderly patients.
    Effects of Early Target-oriented Intervention on Functional Improvement and Survival in Elderly Patients with Severe Sepsis
    CHEN Xiaoyan,HUANG Zhongwei,CUI Qiuxia,JI Yunlan,SHAN Jun
    2018, 21(32):  3946-3950.  DOI: 10.12114/j.issn.1007-9572.2018.32.007
    Asbtract ( )   PDF (1067KB) ( )  
    References | Related Articles | Metrics
    Objective To explore the effects of early target-oriented intervention on functional improvement and survival rate in elderly patients with severe sepsis.Methods A total of 136 elderly patients with severe sepsis who were admitted to the Affiliated Hospital of Nantong University from March 2015 to April 2017 were selected and randomly divided through a random number method into a control group and an observation group with 68 cases each.The control group received routine intervention,while the observation group received early target-oriented intervention.The circulatory function (central venous pressure,mean arterial pressure and heart rate),oxygenation function 〔central venous oxygen concentration (ScvO2),arterial oxygen partial pressure (PaO2),oxygenation index (PaO2/FiO2)〕,and renal function index (urine volume,serum creatinine) before and 6 hours after the intervention in the two groups were recorded.The survival,length of ICU stay,mechanical ventilation time,and total hospital costs in the two groups after 30 days of intervention were statistically analyzed to evaluate functional improvement,survival rate,and treatment for the patients in the two groups.Results There were no significant differences in central venous pressure,mean arterial pressure,heart rate,ScvO2,PaO2,PaO2/FiO2,urine volume,and serum creatinine between the two groups before intervention (P>0.05).After 6 hours of intervention,the central venous pressure,mean arterial pressure,ScvO2,PaO2,PaO2/FiO2,and urine volume in the observation group were higher than those in the control group,and the heart rate and serum creatinine levels in the observation group were lower than those in the control group (P<0.05).In the observation group,the overall survival rate after intervention for 30 days was 69.1% (47/68),which was higher than that in the control group (41.2%) (28/68) (χ2=10.731,P<0.001).The length of ICU stay,mechanical ventilation time,and total hospitalization costs were lower in the observation group than the control group (P<0.05).Conclusion Early target-oriented intervention has significant effects in elderly patients with severe sepsis and can effectively improve patient function and treatment.It can also increase survival rate and is therefore recommended.
    Effects of H-type Hypertension on Bone Metabolism Markers and Inflammatory Factors in Postmenopausal Women with Osteoporosis
    CHEN Yuning,WEI Peng,SHI Bimin,QIAN Ke,DING Yi
    2018, 21(32):  3951-3955.  DOI: 10.12114/j.issn.1007-9572.2018.32.008
    Asbtract ( )   PDF (1054KB) ( )  
    References | Related Articles | Metrics
    Objective To investigate the changes in bone metabolic markers and inflammatory factors in postmenopausal women with H-type hypertension complicated with osteoporosis.Methods A total of 164 postmenopausal women diagnosed with osteoporosis and admitted to the Department of Geriatrics of the Third Affiliated Hospital of Soochow University between January 2015 and June 2016 were selected for this study.The patients were divided into three groups:the A group included 57 patients with only osteoporosis;the B group included 54 patients with osteoporosis complicated with ordinary hypertension;and the C group included 53 patients with osteoporosis complicated with H-type hypertension.The bone densities of the lumbar vertebrae (L1-4),left femoral neck,and femoral trochanter in the two groups were measured.The biomarkers N-terminal propeptide of type Ⅰ collagen (PINP),carboxy-terminal cross-linking telopeptide of type Ⅰ collagen (CTX),and inflammatory cytokine interleukin 6 (IL-6) were tested.Results The bone densities of L1-4,neck,and femoral trochanter in the B and C groups were lower than those in the A group,and the levels of CTX and IL-6 were higher than those in the A group (P<0.05).The bone densities of L1,L2,L4,neck,and femoral trochanter in the C group were lower,and the levels of CTX and IL-6 were higher,than those in the B group (P<0.05).Conclusion Hypertension increases the activity of osteoclasts and the expression of the inflammatory cytokine IL-6 in postmenopausal women.It also moderately increases the activity of osteoblasts;however,the bone resorption effect is significantly greater than the bone formation effect,thus increasing osteoporosis.H-type hypertension further increases the above effect in postmenopausal women,which in turn aggravates osteoporosis.Therefore,strengthening the control of blood pressure is particularly important in patients with H-type hypertension.
    Clinical Application of Coagulation Powder in Patients with Swallowing Dysfunction after Endoscopic Radical Surgery for Esophageal Cancer
    XU Yanzhao,ZHANG Zhen,GUO Qiang,ZHANG Yuefeng,WEN Shiwang,WANG Mingbo,HUANG Chao,TIAN Ziqiang
    2018, 21(32):  3956-3960.  DOI: 10.12114/j.issn.1007-9572.2018.32.009
    Asbtract ( )   PDF (1091KB) ( )  
    References | Related Articles | Metrics
    Objective To observe the effects of coagulation powder on nutritional status,quality of life (QOL),and clinical complications in patients with swallowing dysfunction after endoscopic radical surgery for esophageal cancer.Methods Seventy-eight patients were enrolled at the Fourth Hospital of Hebei Medical University from June 2015 to March 2017.All had swallowing dysfunction caused by laryngeal nerve injury associated with endoscopic radical surgery for esophageal cancer.They all received swallowing therapy and were randomly assigned postoperatively to either a routine diet (the control group,n=38) or a routine diet plus coagulation powder (the experimental group,n=40).The standardized swallowing assessment (SSA) and the EORTC Quality of Life Questionnaire-Core 30 (EORTC-QLQ-C30) were administered before and after treatment.Albumin and hemoglobin were assayed and the occurrence of postoperative aspiration pneumonia and constipation was monitored.Results After 2 and 4 weeks of treatment,the SSA scores of the experimental group were significantly lower than those of the control group (P<0.05).The scores of general health,physical function,emotional function,social function,cognitive function and role function in the experimental group after one month of discharge were higher than those in the control group,and the scores of fatigue, nausea and vomiting,pain,insomnia,dyspnea,loss of appetite,constipation,diarrhea and economic difficulty were lower than those in the control group (P<0.05).After 4 weeks of treatment,the albumin and hemoglobin levels of the experimental group were significantly higher than that of the control group (P<0.05).The incidence of aspiration pneumonia and constipation in the experimental group was lower than that in the control group (χ2=3.921,χ2=4.647,P<0.05).SSA and overall health status scores were negatively correlated in both the experimental group and control group at 4 weeks after treatment (r=-0.805,r=-0.787,P<0.05).Conclusion Including coagulation powder in a comprehensive rehabilitation intervention improved swallowing dysfunction,reduced complications,improved QOL,and promoted patient recovery after endoscopic radical surgery for esophageal cancer.
    RIPASA Score,Serum Total Bilirubin and C-reactive Protein for the Diagnosis of Acute Appendicitis
    AI Longlong,ZHANG Yujiang,ZHANG Tongxin,ZHANG Yaojun,AHETIBIEKE·Tabusi,LU Xiaolong
    2018, 21(32):  3961-3966.  DOI: 10.12114/j.issn.1007-9572.2018.00.021
    Asbtract ( )   PDF (1129KB) ( )  
    References | Related Articles | Metrics
    Objective To investigate the value of RIPASA score,serum total bilirubin (TBil) and C-reactive protein (CRP) in the diagnosis of acute appendicitis.Methods We enrolled 250 consecutive appendicitis patients with an acute pain in the lower right abdomen as the complaint at admission from the Second Affiliated Hospital of Xinjiang Medical University from January 2016 to January 2017.Based on the findings of laparoscopic appendectomy and pathological examination of the surgical specimen,150 with acute appendicitis and 100 with non-acute appendicitis were assigned to the acute appendicitis group〔including 18 with simple acute appendicitis (subgroup A),76 with suppurative acute appendicitis (subgroup B) and 56 with acute perforated gangrenous appendicitis (subgroup C)〕,and non-acute appendicitis group,respectively.RIPASA score was assessed and TBil and CRP were measured at admission.ROC analyses of the RIPASA score and TBil and CRP levels for the diagnosis of acute appendicitis,and of TBil and CRP levels for the diagnosis of acute perforated gangrenous appendicitis were performed.Results Compared with non-acute appendicitis group,the RIPASA score,TBil and CRP levels were all higher in the acute appendicitis group (P<0.001).Subgroup A showed lower average RIPASA score compared with other two subgroups (P<0.05).Subgroup C demonstrated higher average TBil level compared with other two subgroups (P<0.05).The average CRP level increased successively in subgroups A,B and C (P<0.05).For the diagnosis of acute appendicitis,the optimal cutoff value,accuracy,sensitivity,specificity,and the area under the ROC curve (AUC) of RIPASA score were 7.5,82.4%,88.7%,73.0%,0.89〔95%CI(0.84,0.93),P<0.001〕,respectively,and those of the TBil level were 14.15 μmol/L,84.4%,88.7%,78.0%,0.86〔95%CI(0.81,0.90),P<0.001〕,respectively,and those of the CRP level were 13.6 mg/L,84.0%,88.0%,78.0%,0.88〔95%CI(0.84,0.92),P<0.001〕,respectively.For the diagnosis of acute perforated gangrenous appendicitis,the optimal cutoff value,accuracy,sensitivity,specificity,and the AUC of TBil level were 20.28 μmol/L,80.0%,89.3%,74.5%,0.89〔95%CI(0.82,0.93),P<0.001〕,respectively,and those of the CRP level were 34.00 mg/L,76.0%,82.1%,72.3%,0.82〔95%CI(0.75,0.88),P<0.001〕,respectively.Conclusion RIPASA score,TBil and CRP were valuable for the diagnosis of acute appendicitis.Moreover,TBil and CRP were shown to be able to predict the acute perforated gangrenous appendicitis.
    Experimental Study of the Roche Automatic Electrochemiluminescence Immunoassay System in the Detection of Thyroid Hormone Levels in Rats and Mice
    WANG Hong,WANG Ranran,ZHAO Defa,SHAN Zhongyan,TENG Weiping,TENG Xiaochun
    2018, 21(32):  3966-3970.  DOI: 10.12114/j.issn.1007-9572.2018.00.152
    Asbtract ( )   PDF (1211KB) ( )  
    References | Related Articles | Metrics
    Objective To investigate the stability and reliability of serum thyroid hormone levels measured by the Roche automatic electrochemiluminescence immunoassay system and to compare the differences in these levels in different strains of rats and mice.Methods From November 2016 to March 2017,we selected 60 Kunming mice and 30 SD rats aged 7–8 weeks;30 Kunming mice aged 7–8 weeks (randomly assigned to the experimental thyroid hormone elevation group,experimental thyroid hormone reduction group and normal thyroid hormone group,10 in each group) and 30 SD rats aged 7–8 weeks (randomly assigned to the experimental thyroid hormone elevation group,experimental thyroid hormone reduction group and normal thyroid hormone group,10 in each group);outbred strains of SD rats,inbred BN rats,outbred Kunming mice,inbred C57BL/B6N mice age 10 weeks,20 in each strain.The automatic electrochemiluminescence immunoassay system was used to detect TT3,TT4,FT3 and FT4.Results The within-assay coefficients of variation (CVs) of serum thyroid function indicators in Kunming mice and SD rats were 0.697%–1.853% and 0.946%–1.253%,respectively,while the inter-assay CVs were 1.389%–2.670% and 1.150%–2.834%,respectively.The levels of TT3,TT4,FT3,and FT4 in the experimental thyroid hormone elevation group of Kunming mice and SD rats were higher than those in the normal thyroid hormone group,while those in the experimental thyroid hormone reduction group were lower than those in the normal thyroid hormone group (P<0.05).The CVs of serum thyroid function indicators were > 5.000% in all strains of rats and mice,while there was a tendency for inbred strains' serum thyroid function indicators to outperform those of the outbred strains.Conclusion The Roche automatic electrochemiluminescence immunoassay system shows stability in the detection of thyroid hormone levels in rats and mice.It distinguished the differences in thyroid functions in the experimental thyroid hormone elevation group,experimental thyroid hormone reduction group and normal thyroid hormone group.
    Mechanism of Licoflavone in Protecting Human Gastric Mucosal Epithelial Cells from Aspirin-induced Injury
    LI Yuewen,WAN Qiang
    2018, 21(32):  3971-3975.  DOI: 10.12114/j.issn.1007-9572.2018.00.176
    Asbtract ( )   PDF (1099KB) ( )  
    References | Related Articles | Metrics

    Objective To investigate the effect of licoflavone on aspirin-induced human gastric mucosal epithelial (GES-1) cell injury and its mechanism.Methods The study was conducted from March to November 2017.GES-1 cells were divided into 6 groups,control group (incubated with DMEM),aspirin group (incubated with 18.5 mmol/L aspirin for 24 h),low-dose,medium-dose and high-dose licoflavone groups (incubated with 18.5 mmol/L aspirin for 24 h after being pre-treated with 3,6,12 mg/L licoflavone for 2 h,respectively),PD98059 group (incubated with 18.5 mmol/L aspirin for 24 h after being pre-treated with 12 mg/L licoflavone for 2 h and with 10 μmol/L PD98059 for 1 h successively).Proliferation inhibition rate was detected by MTT assay,apoptosis rate was measured by flow cytometry,lactate dehydrogenase (LDH),superoxide dismutase (SOD) activities,and malondialdehyde (MDA) content were determined by colorimetry,the protein expressions of p-ERK1/2,Bcl-2 and Bax were measured by western blotting.Results  The control group showed significantly decreased proliferation inhibition rate,apoptosis rate,LDH activity,MDA content,and p-ERK1/2 and Bax expressions,but obviously increased SOD activity and Bcl-2 expression compared with other groups,as did the medium-dose and high-dose licoflavone groups and PD98059 group when compared with the aspirin group,and the PD98059 group when compared with the 3 licoflavone groups (P<0.05).Conclusion  Licoflavone alleviates aspirin-induced GES-1 cell injury through pro-proliferation,anti-apoptosis and anti-oxidative stress via the inhibition of ERK1/2 signaling pathway.

    Analysis and Countermeasure of Human Resources of Community Health Service Centers in the Small and Medium-sized Cities in Midwest China
    PAN Lun,HE Ping,WU Jianhua,DENG Zhongquan,GAO Zhiping
    2018, 21(32):  3976-3981.  DOI: 10.12114/j.issn.1007-9572.2018.00.145
    Asbtract ( )   PDF (1059KB) ( )  
    References | Related Articles | Metrics
    Objective To understand the current situation of human resources of community health service institutions in the small and medium-sized cities in Midwest China,and to analyze existing problems and put forward corresponding suggestions.Methods Luohe City of Henan,Ningguo City of Anhui,Hancheng City of Shaanxi and Panzhihua City of Sichuan were selected by purpose sampling from June to July 2017.Human resources allocation of community health service institutions were investigated by self-made questionnaire.Results In the above four cities,the number of health technical personnel per 10 thousands(5.03),professional (assistant) physicians per 10 thousands (2.11),general physicians per 10 thousands (0.47) were less than those of national average (5.78,2.43,1.51,respectively).From 2014 to 2016,annual average growth rate of number of human resource with bachelor's degree or above and senior title were 1.11%,18.08% in four cities,which were lower than those of township hospitals (24.67%,44.78%).Conclusion The human resources of community health service centers in the small and medium-sized city in the Midwest China have problems such as total amount deficiency,slow growth,unreasonable structure and difficulty in introducing high-level,high-quality talents.The government should pay more attention to the development of community health service by enhancing job attractiveness of general practitioner and carrying forward the medical partnerships to delegate high quality resources,expanding recruitment right of community health service centers,establishing a policy dynamic adjustment mechanism suitable for the development of community health service.
    Calculation of Manpower Cost in Community Integrated Health and Social Care Based on Standardized Value Model
    GAO Bo,ZHAO Shanshan,YAN Haifeng,JIN Minjie,GU Ji,GE Yuanyuan,LU Ping
    2018, 21(32):  3981-3985.  DOI: 10.12114/j.issn.1007-9572.2018.00.238
    Asbtract ( )   PDF (1156KB) ( )  
    References | Related Articles | Metrics
    Objective To calculate the manpower cost of various medical care combined services through various paths based on the medical care service provided by Malu Town Community Health Service Center,Jiading District,Shanghai,so as to provide the basis for the settlement of medical care service in the center,home medical services and various types of nursing homes and the distribution of personnel performance in the center.Methods The executive representatives of departments (Departments of General Medicine,Traditional Chinese Medicine,Stomatology,Rehabilitation,Nursing,Clinical Laboratory,Radiology and Function) involved in Malu Town Community Health Service Center filled forms of manpower cost of service items provided by different departments:manpower and time consumption,technical difficulty and risk level through panel discussion from January to February 2018.At the same time,remuneration data of medical personnel in 2016 and 2017 involved in medical care services were collected and reviewed by the Personnel Department.On the basis of confirmation of similar technical difficulties and risks or the same service items among different departments,the standardized value model was introduced to calculate the labor cost of integrated medical and nursing services.Results The center can provide 572 medical care services,of which 518 items were charged and 511 items are included in the medical insurance project.All the projects can serve the elderly in all kinds of nursing homes.However,283 items can only be provided in the center,and the other 289 can be provided in door-to-door services.The item with lowest human cost was the registration fee service,which was 2.13 yuan;item of the highest human cost was dental fenestration (in bone),extraction of impacted third molar(incomplete eruption),extraction of impacted third molar (bone burial),tooth apiectomy and the closed thoracic drainage,which were 506.27 yuan.Among items which can serve at welfare homes,nursing homes,community nursing homes and elderly people at home,application of cooling had the lowest human cost (6.73 yuan),and blood malaria parasite test had the highest (190.54 yuan).Conclusion This study concludes that Malu Town Community Health Service Center had a rational manpower cost of various medical and health services.This provides a reliable basis for the settlement of medical and health services combined with home medical services and various centers for the elderly,as well as personnel performance distribution in the center.
    Working Status and Turnover Intention of Physicians in Counties under Medical Treatment Partnership System
    JIANG Chunhong,ZHANG Yan
    2018, 21(32):  3986-3991.  DOI: 10.12114/j.issn.1007-9572.2018.00.200
    Asbtract ( )   PDF (1064KB) ( )  
    References | Related Articles | Metrics
    Objective To understand the change of doctors' working status from single hospital development to the medical treatment partnership system in order to provide a basis for promoting the construction of partnership system.Methods Cluster sampling method was used to select physicians from Yicheng People's Hospital,Yicheng Hospital of Traditional Chinese Medicine,Dangyang People's Hospital and Dangyang Hospital of Traditional Chinese Medicine as investigation subjects from April to July 2017.Working status questionnaire of medical staff was used to evaluate work pressure,interpersonal relationship,professional quality,performance assessment and economic income,and turnover intention scale was used to investigate current turnover intention of physicians in counties.Results Of the 210 clinicians,181 returned responsive questionnaires,with a response rate of 86.2%.After the construction of medical treatment partnership system,scores of work pressure,interpersonal relationship,professional quality,performance assessment and economic income of physicians in counties were (1.77±2.63),(2.37±2.63),(2.79±2.85),(1.15±2.39),(0.82±2.08),respectively.Those aged over 50 years had lower scores in interpersonal relations than those <50 years,and lower scores in professional quality than those <39 years (P<0.05).The scores of interpersonal relationship in physicians with bachelor degree or above were higher than that of physicians with college diploma.Doctors with graduate degree or above had higher scores of professional quality than physicians with college diploma,and higher scores of performance assessment than physicians with bachelor degree or below(P<0.05).The scores of working pressure,interpersonal relationship,professional quality,performance assessment and economic income of doctors without budgeted posts were higher than those of the doctors with budgeted posts,and the scores of above dimensions of doctors from non-compact medical treatment partnership system were lower than those of doctors from compact medical treatment partnership system(P<0.05).There was a statistically significant difference in turnover intention among doctors with different results of work pressure,interpersonal relationship and economic income (P<0.05).Conclusion Doctors hold a positive attitude towards the medical treatment partnership system,while the negative influences from the system,such as working pressure,interpersonal relationship and economic income,may increase the turnover intention.Therefore,medical examination under the partnership system should takes into account the business changes after the system is carried out.In the reform of performance assessment,the social value of doctor cooperation should be reflected in order to promote this cooperation.
    Effect of Healthcare Reform on the Preferred Health Facility for Initial Consultation for Common Medical Symptoms among Residents in Beijing's Yuetan Area
    LI Ning, DU Xueping, DONG Jianqin
    2018, 21(32):  3991-3993. 
    Asbtract ( )   PDF (1287KB) ( )  
    References | Related Articles | Metrics
    Objective To investigate the effect of China's healthcare reform on the preferred health facility for initial consultation for common medical symptoms among residents in Beijing's Yuetan area,providing a scientific basis for the development of hierarchical medical system and initial consultation system in primary care.Methods From January to April 2017,we conducted a survey in a random sample of 829 permanent residents aged 15 or over in Yuetan area with a self-designed questionnaire for collecting the data about the community health center as the preferred health facility for initial consultation for 17 common medical symptoms (cold,fever,dizziness,headache,palpitation,chest tightness and pain,suffocation and wheezing,abdominal pain,diarrhea,acid reflux,vomiting,constipation,fatigue,low back pain and arthralgia,edema of lower extremity,insomnia,frequent urination) before the implementation of healthcare reform (April 8,2017) and after the implementation of the first round of healthcare reform (increasing the financing for medical service fee,cancellation of the registration fee,adjusting the examination fee) as well as the second round of healthcare reform (increasing the categories of drugs used in community health organizations).Results  809 returned responsive questionnaires,achieving a response rate of 97.6%.Compared with before the healthcare reform,after the implementation of two rounds of healthcare reform,the proportion of residents preferred community health centers (CHCs) for initial consultation for the aforementioned 17 medical symptoms increased significantly (P<0.01).Moreover,compared with after the implementation of the first round of healthcare reform,CHCs were selected for initial consultation by higher proportion of residents for palpitation,chest tightness and pain,fatigue,low back pain and arthralgia and edema of lower extremity,but by lower proportion of residents for suffocation and wheezing after the implementation of the second round of healthcare reform (P<0.01).Conclusion After the implementation of the two rounds of healthcare reform,Yuetan residents were more likely to have the initial consultation in CHCs when they developed the common medical symptoms.
    Impact of Death Due to Major Malignant Tumors on Life Expectancy among the Permanent Residents in Beijing's Fengtai District,2011—2015 
    MA Xiaoman,LI Jie,XIN Zhenjiang,XIE Junqing,BAI Junmei,GUO Xiuhua,LUO Yanxia
    2018, 21(32):  3994-3998.  DOI: 10.12114/j.issn.1007-9572.2018.00.013
    Asbtract ( )   PDF (1260KB) ( )  
    References | Related Articles | Metrics
    Objective To explore the impact of death due to major malignant tumors on life expectancy among the permanent residents in Beijing's Fengtai District from 2011 to 2015.Methods  We collected the data concerning the permanent residents of Beijing's Fengtai District during 2011 to 2015 from Beijing Municipal Public Security Bureau,and the data about the permanent residents of Beijing's Fengtai District who died of 5 major malignant tumors(lung cancer,colorectal cancer,liver cancer,gastric cancer,pancreatic cancer) from National Cause-of-death Registration System.The life table developed by CHIN Long Chiang was used for calculating the life expectancy.Arriaga's method was adopted to decompose the differences in life expectancy by age groups as well as death causes.Results During 2011 to 2015,the average life expectancy of the permanent residents in Fengtai District was 82.34 years old.Women had longer average life expectancy than men.Life expectancy grew in the period 2011—2012,which was mainly attributed to the death toll falling from lung cancer,followed by colorectal cancer,pancreatic cancer and gastric cancer,but the increased liver cancer death toll played a contrary effect.Life expectancy declined in the period 2013—2015,showing a 0.053-year-old decrease,which was due to the increased death toll from lung cancer,while the decreased death toll from colorectal cancer,liver cancer,gastric cancer and pancreatic cancer was counterproductive.Conclusion Lung cancer is most closely related to life expectancy,followed by liver cancer,colorectal cancer,gastric cancer and pancreatic cancer.Therefore,reducing tobacco consumption and smoke inhalation in the kitchen are the key to decreasing cancer mortality.Moreover,the control of risk factors such as bad life habits (tobacco consumption,alcohol consumption and bad eating habits) and obesity and early targeted interventions can lower the age group-specific cancer mortality.
    Single-center Analysis of Spectrum Characteristics of Kidney Disease in Xinjiang from 2008 to 2017
    ZHENG Xiao,XIE Daxing,LU Chen
    2018, 21(32):  3999-4003.  DOI: 10.12114/j.issn.1007-9572.2018.00.216
    Asbtract ( )   PDF (1080KB) ( )  
    References | Related Articles | Metrics
     Objective To analyze the characteristics and changes of renal disease spectrum in Xinjiang in the past 10 years,so as to provide a basis for epidemiological research,clinical diagnosis and prevention.Methods A total of 3 824 patients with renal biopsy were selected in the renal biopsy registration system of the Institute of Nephrology,People's Hospital of Xinjiang Uygur Autonomous Region from 2008 to 2017.Patients were divided into 2008-2012 group (1 402 cases) and 2013-2017 group (2 422 cases) according to the examination time of renal biopsy.The diseases were classified in accordance with Kidney Biopsy Pathology (2nd Edition) and the second edition of pathological classification of glomerular diseases.Gender,age and ethnicity of subjects were recorded,and the changes of renal disease spectrum were compared.Results Of the 3 824 patients,3 082 were primary glomerular disease (PGD) and 1 365 were secondary renal disease (SGD).There were no significant differences in gender and ethnic distribution of IgA nephropathy (IgAN),membranous nephropathy (MN),mesangial proliferative glomerulonephritis (MsPGN),minimal change disease s (MCD) and focal segmental glomerulosclerosis (FSGS) (P>0.05).The difference in age distribution of IgAN,MN,MCD,MsPGN and FSGS was statistically significant (P<0.05).Among them,patients with IgAN were mainly 30 to 49 years old,with MN and FSGS mainly≥50 years old,and with MsPGN mainly 20 to 29 years old.Besides,there were significant differences in gender and age distribution of diabetic nephropathy (DN),hypertensive nephropathy (HT),Henoch-Sch?nlein purpura nephritis (HSPN),and lupus nephritis (LN) (P<0.05).However,there was no significant difference in ethnic distribution of DN,HT,HSPN and LN (P>0.05).Finally,there were significant differences in age,ethnic,and disease spectrum of PGD and SGD between 2008-2012 group and 2013-2017 group (P<0.05).The proportion of IgAN,MN and DN in 2013-2017 group was higher than that in 2008-2012 group,and the proportion of MCD,MsPGN,HT and HSPN was lower than that in 2008-2012 group (P<0.05).Conclusion PGD is the main spectrum of kidney disease in Xinjiang,of which IgAN ranks the first and the number of patients with MN is increasing.DN ranks the first in SGD.
    Efficacy of Allicin in Treating Elderly Patients with Coronary Heart Disease:a Meta Analysis
    LIU Rui,HE Jia,LIANG Ziyang,LIU Xiufang,HOU Tibao,MO Yunqiu
    2018, 21(32):  4004-4010.  DOI: 10.12114/j.issn.1007-9572.2018.00.027
    Asbtract ( )   PDF (1550KB) ( )  
    References | Related Articles | Metrics
    Objective To perform a meta analysis to evaluate the influence of allicin on the clinical effect for coronary heart disease (CHD) in elderly patients.Methods We searched the following databases:PubMed,EMBase,Cochrane Library,Science Direct,Google Scholar,CNKI,VIP network and the Wanfang Data Knowledge Service Platform.The search cutoff publication date was October 2017.Randomized controlled trials (RCTs) involving the use of allicin in treating elderly individuals with CHD were searched.The included studies underwent quality assessment and data extraction.Stata 11.0 was used for the meta analysis.The evaluated indices included angina remission,total cholesterol (TC),triglyceride (TG),low-density lipoprotein cholesterol (LDL-C),apolipoprotein B (Apo-B),plasma nitric oxide (NO) and blood pressure (BP).Results  A total of nine studies involving 574 patients were included.Meta analysis showed no significant difference in angina remission between the two groups〔RR=1.03,95%CI (0.94,1.13),P=0.559〕.The allicin group had a lower TC level than the control group〔SMD=-1.16,95%CI (-2.23,-0.09),P=0.033〕.There was no significant difference in TG level between the two groups〔SMD=0.70,95%CI (-0.74,2.15),P=0.34〕.The level of LDL-C in the allicin group was lower than that in the control group〔SMD=-0.84,95%CI (-1.66,-0.02),P=0.04〕.The level of Apo-B in the allicin group was lower than that in the control group〔SMD=-0.80,95%CI (-1.06,-0.54),P<0.001〕.The allicin group had a higher plasma NO level than did the control group〔SMD=0.71,95%CI (0,1.43),P=0.049〕.The SBP in both groups was not significantly different〔SMD=-1.04,95%CI (-2.64,0.55),P=0.20)〕,nor was the DBP〔SMD=-1.32,95%CI (-2.81,0.16),P=0.08〕.Conclusion Allicin improves dyslipidemia and increases plasma NO concentrations in elderly patients with CHD.
    Evaluation of Evidence-based Resources for Early Postoperative Functional Exercise in Patients with Breast Cancer
    DING Xiaotong,LI Huiping,YANG Yajuan,SU Dan,ZHANG Ting
    2018, 21(32):  4011-4017.  DOI: 10.12114/j.issn.1007-9572.2018.00.130
    Asbtract ( )   PDF (1095KB) ( )  
    References | Related Articles | Metrics
    Objective To summarize and evaluate the best evidence of early postoperative functional exercise in breast cancer patients.Methods In June 2017,clinical practice guidelines,systematic reviews and related evidence-based resources pertaining to early postoperative functional exercise in breast cancer were retrieved through the Chinese databases,English databases and guideline websites by computer.The publication-data limit was set by May 2017.The literatures screened were read and the literature quality was assessed by two investigators.All data needed were extracted from the literatures that met the quality.Results Nineteen articles were enrolled,including three clinical practice guidelines,nine systematic reviews,and seven related evidence-based resources.The three clinical practice guidelines mainly included principles of functional exercises,forms of instruction,the content of functional exercises,standard requirements and considerations.The 16 systematic reviews and related evidence-based resources mainly included principles of functional exercises,forms of instruction,functions of educators,the content of exercise,effect evaluation of exercise,parameters of exercise and the evaluating indicator.It was suggested that professionals should follow the principle of gradual progress,combined with paper-based materials to guide patients.Preoperative assessment of bilateral upper extremity function should be performed.1-2 days after the operation,the shoulder joint should remain motionless,and activities of fingers,wrists and elbow joints be performed.The time of shoulder joint activity is controversial,so professionals should weigh the pros and cons,according to the patients' situation (such as drainage,wound healing,or subcutaneous effusion) to guide patients with shoulder joint activity at their discretion.If the patient has the factors that affect wound healing and drainage,one week of functional exercise can be delayed (9-10 days after the operation).Conclusion Evidence-based exercise instruction projects have not been found so far in China.Investigators should propose evidence-based guidelines based on the latest best evidence of early functional exercise,clinical context of care,the patient's needs and preferences and professional judgment.
    Intrahospital Emergency Preoperative Procedure Analysis in Patients with Aneurysmal Subarachnoid Hemorrhage Based on Value Stream Mapping
    SHAO Peng,WANG Jun,SUN Xuelian,GUAN Xin,LIANG Xiao,BAO Yuehong,QIN Qinpu,LI Guilin,HU Peng,ZHANG Hongqi
    2018, 21(32):  4018-4021.  DOI: 10.12114/j.issn.1007-9572.2018.00.198
    Asbtract ( )   PDF (1202KB) ( )  
    References | Related Articles | Metrics
    Objective To investigate and analyze the intrahospital emergency preoperative procedure in patients with aneurysmal subarachnoid hemorrhage(aSAH),providing a reference for the optimization of this procedure.Methods We conducted this prospective observational study in a purposive sample of 32 cases of aSAH receiving emergency surgical treatment in Xuanwu Hospital Capital Medical University from October 2017 to February 2018.Our research group followed up the entire intrahospital receiving process which started since the arrival at the emergency triage and ended by entering the operating room or intervention center for receiving procedure,and recorded the duration of each sector of the process,and analyzed the process with a value stream mapping drawn with the standard symbols and the recorded data.Results The overall serving time,overall waiting time before receiving procedure,duration for the entire intrahospital receiving process were 9-104 min,6-3 658 min,15-3 762 min,respectively.The waiting duration was found to be prolonged for 5 sectors,namely,entering the operating room or intervention center,decision-making involving the patient's family members,preoperative preparation,implementing admission procedures,blood sample collection and submission.Conclusion There is great room for improving the intrahospital emergency preoperative procedure in aSAH patients.And close multidisciplinary cooperation,intensive management,patient-centered services,and green channel services are the key improvement measures.
    Application of Healthcare Failure Mode and Effect Analysis in the Hospital Transfer Process for Critically Ill Patients
    SUN Qian,SUN Chunxia,SUN Xiaoyang
    2018, 21(32):  4022-4027.  DOI: 10.12114/j.issn.1007-9572.2018.32.022
    Asbtract ( )   PDF (1066KB) ( )  
    References | Related Articles | Metrics
    Objective To investigate the effects of healthcare failure mode and effect analysis (HFMEA) on improving and optimizing the intrahospital transfer process for critically ill patients.Methods A total of 1 488 critical patients who were transferred from emergency room or ICU between January 2017 and April 2017 in the Third Grade & Class a Hospital in Jiangsu were included in the control group,and 1 632 patients who were transferred between May 2017 and August 2017 were included in the observation group.The empirical transfer method was used in the control group,whereas HFMEA was used in the observation group.The potential failure modes were identified,and their severity and incidence were scored to calculate risk priority numbers (RPN).The decision tree method was used to determine optinal processes,and the associated solutions were developed and implemented.Results The incidence of adverse events in the observation group was 5.94% (97/1 632),which was lower than the 22.58% (336/1 488) in the control group (χ2=180.249,P<0.001).The patient satisfaction in the observation group was 95.96% (1 566/1 632),which was higher than the 77.96% (1 160/1 488) in the control group (χ2=229.378,P<0.001);the satisfaction of the receipt/examination department in the observation group was 94.98%(1 550/1 632),which was higher than the 68.95% (1 026/1 488) in the control group (χ2=364.806,P<0.001).Conclusion The use of HFMEA optimizes the intrahospital transfer process for critically ill patients,reduces the risk of failure in the transfer process,and ensures the safety of critically ill patients.
    Effects of Sensory Integration Training on Early Intervention for Critically Ill Preterm Infants
    MA Dan,LI Na,WANG Qiu,WANG Mengjuan,LUO Rong
    2018, 21(32):  4028-4031.  DOI: 10.12114/j.issn.1007-9572.2018.00.062
    Asbtract ( )   PDF (1082KB) ( )  
    References | Related Articles | Metrics
    Objective To study the effects of sensory integration training on early intervention for high-risk preterm infants.Methods For intervention,we selected 102 preterm infants who were critically ill as a result of brain damage and other high risk factors and were treated in the Department of Rehabilitation Medicine of the West China Second University Hospital of Sichuan University between January 2015 and May 2016.The observation group and control group were subjected to neurodevelopment therapy training,and the observation group received additional home-based sensory integration training,including visual training,auditory stimulation,tactile training,vestibular function training,kinesthetic stimulus,and other training,for a total intervention time of 12 months.In the 3rd,6th and 12th months after the intervention,we used the Test of Sensory Functions in Infants (TSFI) to evaluate the sensory development level and used the Bayley Scales of Infant Development to evaluate the Mental Development Index (MDI) and Psychomotor Development Index (PDI).Results Rehabilitation therapy and time both had an interaction effect on the level of sensory development (P<0.001),and the main effects were both significant (P=0.049,P<0.001).The TSFI scores of the observation group at the 3rd,6th and 12th months were all higher than those of the control group (P<0.05).Rehabilitation therapy and time both had an interaction effect on the MDI (P=0.030),and the main effects were both significant (P=0.049,P<0.001,respectively).Neither rehabilitation therapy nor time had an interaction effect on the PDI(P=0.151),and the main effects were both significant (P=0.008,P<0.001,respectively).Conclusion Sensory integration therapy can improve sensory,motor,and cognitive functions in critically ill preterm 
    infants.
    Early Pulmonary Rehabilitation for Elderly Inpatients with Acute Exacerbation of Chronic Obstructive Pulmonary Disease
    HUANG Feifei,CHEN Lihua,ZHANG Wen,LI Fan
    2018, 21(32):  4032-4036.  DOI: 10.12114/j.issn.1007-9572.2018.00.104
    Asbtract ( )   PDF (2094KB) ( )  
    References | Related Articles | Metrics
    Objective To investigate the clinical efficacy of early pulmonary rehabilitation for hospitalized elderly patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD).Methods We enrolled 120 elderly inpatients with AECOPD from Department of Geriatrics,the Fifth Rehabilitation Hospital of Shanghai from March 2015 to March 2017 and equally divided them into the control group (n=60) and intervention group (n=60) based on the random number table.Both groups received the conventional treatment including anti-inflammatory therapy,expectorant therapy,anti-asthmatic therapy,oxygen therapy and publicity materials about AECOPD rehabilitation.The intervention group additionally received interventions such as health education,relaxation training,respiratory training,exercise training,and ultrashort wave therapy which started within one week after admission.The pulmonary function,mMRC score,COPD Assessment Test(CAT) score,modified Borg score,and 6MWD were measured on the admission,and 6 months after discharge.Results Fifty-three in the control group and 43 in the intervention group who completed the follow-up were included in the final analysis.At 6 months after discharge,FVC,FEV1 and FEV1% decreased significantly in the control group compared with on admission(P<0.05),FVC declined significantly(P<0.05) but FEV1 and FEV1% showed little changes in the intervention group compared with on admission(P>0.05);mMRC score increased significantly in the control group(P<0.05),but changed a little in the intervention group(P>0.05) compared with on admission;CAT score and modified Borg score were much lower while 6MWD was greater in the intervention group compared with the control group(P<0.05).Conclusion Early pulmonary rehabilitation can relieve symptoms,improve quality of life and increase exercise tolerance in elderly patients with AECOPD.