Table of Content

20 November 2018, Volume 21 Issue 33

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Monographic Research

Attaching Importance to the Diagnosis of Dementia and Improve the Quality of Life：Interpretation of 2018 NICE Dementia： Assessment，Management and Support for People Living with Dementia and Their Carers

WANG Wei，GAO Fengqiao，ZHANG Hanwen，WANG Xinyu，WANG Senmao

2018, 21(33):  4037-4040.  DOI: 10.12114/j.issn.1007-9572.2018.00.299

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With the arrival of ageing population，dementia has become one of the major diseases threatening the health of the elderly.How to make early diagnosis，early treatment and improve the quality of life of patients with dementia is a major problem of governments，medical workers and the public all over the world.This paper interpreted the guideline Dementia：assessment，management and support for people living with dementia and their carers issued by National Institute of Health and Clinical Excellence in UK in 2018，and summarized the key points of diagnosis，treatment and nursing care of dementia in the guideline，aiming to provide scientific basis for the early stratified diagnosis of dementia in primary care settings and to provide reference for pharmacological and other intervention measures.It provides guidelines for carers of dementia and nursing institutions.


Analysis of Contracted Family Doctor Services in China：from the Perspective of Lateral Contrast and Dynamic Development

LI Tong，ZHU Jiwu，ZHANG Qiu

2018, 21(33):  4041-4046.  DOI: 10.12114/j.issn.1007-9572.2018.00.281

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According to Statistical Yearbooks and literatures，this paper collected and integrated relevant information about the coverage rate，number of contracted residents and other indexes of family doctors in eastern regions （Beijing，Shanghai，Shandong，etc.） and western regions （Sichuan，Shaanxi，Qinghai，etc.）．By analyzing the development of contracted family doctor system in China based on the horizontal contrast and dynamic perspective，this study found that the signing rate of family doctors in each region basically reached the expected goal.However，there were still some problems in practice，such as unbalanced supply and demand，low awareness，unclear positioning and insufficient capital investment of signing system.As a whole，the level of contracted family doctor service in the economic developed areas in eastern China was better than that in the economically backward areas in western China.Besides，Shanghai and Shandong performed the best in the economic developed regions in eastern China.Qinghai and Sichuan performed the best in the economically backward regions in western China.Therefore，the paper puts forward suggestions of learning from Best-Performing provinces to strengthen incentive mechanism，and increase capital investment based on the perspective of lateral contrast and dynamic development.


Reflection on the Delivery of Contracted Family Doctor Services with Careful and Down-to-earth Efforts

ZHU Min，TANG Lan，TONG Xiaowei，MENG Zhongying，ZHANG Xieyi，HU Bing，ZHANG Fang，ZHANG Yi

2018, 21(33):  4047-4052.  DOI: 10.12114/j.issn.1007-9572.2018.00.180

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In response to the call of the national government for further promoting contracted family doctor services（CFDSs），Shanghai Pudong New District Weifang Community Health Center focuses on increasing the number of residents access to CFDSs by a series of measures besides delivering the services with careful and down-to-earth efforts，which brings about significantly enhanced rates of implementing outpatient appointments and making stable visits for obtaining health management，and substantially improved levels of satisfaction with both CFDSs and general practitioners in the contracted residents，as well as an obviously increased rate of their health records being timely updated，truly benefitting the residents.However，further improvement remains an arduous task for us for there are challenges and baffles during the delivery of such services.We summarized our experience of delivering CFDSs，and gave a detailed analysis of the encountered problems and baffles.


Role of the General Practice Department in Tertiary Hospitals in the Development of the Family Doctors Contractual Service

WANG Yong，DUAN Hongyan，LIU Xiaoyu，WANG Liuyi

2018, 21(33):  4053-4056.  DOI: 10.12114/j.issn.1007-9572.2018.00.108

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We described the contributive role played by the general practice department set up in tertiary hospitals in the deepening development of family doctor contractual services in China in an all-round way at present，which is manifested by offering talent support，professional teaching and training，guidance in general practice，chronic management，collaborative research service and so on.


Status of Family Doctor Contractual Service Delivery in Nanjing's Pukou District

XIONG Ting，CHEN Jiaying，HU Dan，MAO Ruhu，ZHOU Shaogu,ZHU Ya

2018, 21(33):  4057-4061.  DOI: 10.12114/j.issn.1007-9572.2018.33.005

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Objective　To investigate the family doctor contractual service delivery status in Nanjing's Pukou District，and to put forward solutions to the major challenges，providing a reference for further extension of this kind of services in the district.Methods　A convenience sample of 31 stakeholders was selected in July 2017，including directors，family doctors and other members in the family doctor team from four community health centers of Qiaolin，Xingdian，Taishan and Tangquan Streets.Face-to-face semi-structured interviews were conducted with a self-designed interview outline for collecting the data mainly about the delivery of contractual services by family doctors in Nanjing's Pukou District，featured and major contractual services，problems faced by the contracted residents during seeking hierarchical medical treatment as well as major challenges in delivering such services.Results　Contractual services from family doctors achieved good acceptance in the local residents，especially in the elderly with chronic diseases，which could be enjoyed after signing the contract with family doctors in the outpatient department of the community health center or at the community.The featured family doctor services included online consultation with family doctors via the family doctor APP；cell-phone numbers of family doctors are publicized for better doctor-patient communication；issuing a contractual service card，by using it，contracted residents can enjoy some discount on certain services.During seeking hierarchical medical treatment，the problems faced by the contracted residents are as follows：they could go to the secondary or tertiary hospitals based on their own demands without referrals from family doctors；family doctor APP did not fully play its role in making appointments and referrals.Major challenges for family doctors during delivering contractual services consisted of the following aspects：the procedure for signing contracts was too complicated；how to set the time limit for mobile phone-based online consultation；contracted residents lacked understanding of the responsibilities of family doctors；health professionals were found with poor motivation for work due to imperfect incentive mechanism；the types of the medicines for contractual services were insufficient；the workload became too heavy after the contractual services were delivered；services that the contracted residents can be accessible via the family doctor APP needed to be further developed.Conclusion　In general，family doctor contractual service delivery is relatively good in this district although there are some challenges.In order to promote the delivery of such kind of services，we put forward the following suggestions.The local government provides adequate funds for the extension of this kind of services；the performance evaluation mechanism for health professionals is to be perfected；medical insurance programs are to be well implemented for ensuring the successful delivery of contractual services as well as the development of hierarchical medical system；trainings about professional knowledge and communication skills for family doctors should be strengthened；more talents should be recruited as family doctors；the types of medicines for community health centers should be enriched；common medicines in medical insurance reimbursement list should be increased；The family doctor APP should be further developed.


Prevalence of Sleep Apnea and Its Effects on Prognosis of Patients with Acute ST-elevation Myocardial Infarction

WANG Li，ZHAO Liangping，WANG Yongyuan，XU Weiting，CHEN Jianchang

2018, 21(33):  4062-4066.  DOI: 10.12114/j.issn.1007-9572.2018.33.006

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Objective　To investigate the prevalence of sleep apnea（SA） in patients with acute ST-elevation myocardial infarction（STEMI） and to analyze the effect of SA on the prognosis of acute STEMI patients.Methods　A total of 169 patients with acute STEMI who were admitted to the Second Affiliated Hospital of Suzhou University between June 2013 and June 2015 were selected.All patients underwent emergency percutaneous coronary intervention.During the hospital stay，a portable monitor was used to monitor patient sleep.SA was defined by an apnea-hypopnea index（AHI）≥15 times/h.According to the presence of SA，the patients were divided into SA group and no SA group.All patients were followed up for 12 months，and the occurrence of major adverse cardiovascular and cerebrovascular events（MACCE） was recorded.The MACCE-free survival rate was compared between the two groups，and the factors influencing MACCE in patients with acute STEMI were analyzed.Results　All patients completed the bedside portable sleep monitoring successfully.The SA group included 93 cases（55.0%），and the no SA group included 76 cases（45.0%）.The age in the SA group was greater than that in the no SA group，and the BMI was also greater than that in the no SA group（P<0.05）.All patients completed the 12-month follow-up.MACCE occurred in 15 patients（8.9%）.In the SA group，there were 12 cases of MACCE（12.9%），including one case of cardiac death，three cases of re-hospitalization due to heart failure，six cases of recurrent angina，and two cases of ischemic stroke.In the no SA group，there were three cases of MACCE（3.9%），including one case of target vessel revascularization，one case of re-hospitalization due to heart failure，and one case of ischemic stroke.There was a significant difference in MACCE-free survival between the two groups（χ2=4.186，P=0.047）.Cox regression analysis showed that age〔HR=1.048，95%CI（1.001，1.097），P=0.046〕，BMI〔HR=1.132，95%CI（1.002，1.295），P=0.044〕，and hypertension〔HR=4.255，95%CI（1.193，15.152），P=0.026〕 were independent predictors of MACCE in acute STEMI patients.Conclusion　Patients with acute STEMI have a high incidence of SA，however， SA is not a risk factor for MACCE in patients with acute STEMI；the effect of SA on patients with acute STEMI needs further study.


Progresses in Clinical and Basic Research of Myocardial Injury Caused by Obstructive Sleep Apnea　

LI Zexuan，WANG Xiao，ZHAO Guanqi，FAN Jingyao，HAO Wen，ZHOU Shenghui，GUO Ruifeng，LI Aobo，SHI Han，NIE Shaoping，WEI Yongxiang

2018, 21(33):  4067-4071.  DOI: 10.12114/j.issn.1007-9572.2018.00.262

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Obstructive sleep apnea（OSA） refers to the complete or partial obstruction of the upper airway during sleep，resulting in repeated apnea and/or hypopnea，in turn leading to microarousal，intermittent hypoxia and excessive daytime sleepiness.OSA-induced chronic intermittent hypoxia，can cause sympathetic nervous excitement，endothelial dysfunction，systemic inflammation，oxidative stress and metabolic disorders，can induce or aggravate myocardial injury.Many studies have confirmed that OSA can cause myocardial injury markers increasing，and promote left ventricular remodeling and decreased cardiac function，and is an independent predictor of cardiovascular morbidity and poor prognosis.At present，the pathophysiological mechanism and development of myocardial injury caused by OSA remains to be further studied.The objective of this review was to discuss the clinical and basic research related to OSA and myocardial injury.



Effects of Sleep Quality and Duration on Body Composition in Adults over 50 Years Old in Urumqi

YAO Xuemei，CHENG Weibing，XIAO Hui

2018, 21(33):  4072-4076.  DOI: 10.12114/j.issn.1007-9572.2018.33.008

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Objective　To investigate the effects of sleep quality and sleep time on body composition in adults over 50 years old in Urumqi.Methods　A total of 845 people over the age of 50 who were physically examined at a physical examination center in Urumqi between December 2016 and March 2017 were randomly selected to complete a questionnaire survey and body composition measurements.The questionnaire survey included general conditions，including the Pittsburgh Sleep Quality Index（PSQI，with PSQI scores>7 indicating poor sleep quality and PSQI scores≤7 indicating good sleep quality），and the bioelectrical impedance method was used to measure body composition.The body height，body weight，waist-to-hip ratio，body fat mass，body fat percentage，liposuction quality，muscle mass，limb muscle mass，trunk muscle mass of the subjects were measured，and body mass index（BMI） and fat tissue index（FMI） were calculated.Multivariate Logistic regression was used to analyze the effect of sleep quality and sleep time on obesity and excessive body fat percentage.Results　Among the 845 subjects，162 were males，and 683 were females.The mean age was（64.2±7.7） years.There were 37 men（22.8%） and 231 women（33.8%） with poor sleep quality.The body fat mass，body fat percentage， BMI，obesity prevalence，FMI of women with better sleep quality were all lower than those in women with poor sleep quality（P<0.05）.There were no significant differences in body composition among males in the different sleep quality and sleep time groups（P>0.05）.Body fat mass，body fat percentage， BMI，obesity prevalence，FMI of female sleep time <6 h were higher than sleep time 6-8 h，>8 h（P<0.05）.Multivariate Logistic regression was used to analyze the effects of sleep quality and sleep time on obesity and body fat percentage.After adjustment for age，nationality，education level，monthly income，and marital status，the risk of obesity was higher in women with poor sleep quality than in women with good sleep quality〔OR=1.83，95%CI （1.21，2.76），P<0.05〕.With sleep times of 6-8 h，the risk of obesity and body fat percentage exceeding the standard was higher in women with a sleep time of <6 h〔OR=1.77，95%CI（1.17，2.66），P<0.05；OR=1.65，95%CI（1.16，2.37），P<0.05〕.Conclusion　Sleep quality and sleep time affect body composition in females over 50 years old in Urumqi but do not affect body composition in men.Improving sleep quality and increasing sleep time in middle-aged women will help reduce body fat mass and the incidence of obesity，thereby promoting the health of elderly women.


Clinical Value of Carbohydrate Antigen 19-9，Hemoglobin and Eosinophilic Granulocytes in the Identification of Autoimmune Pancreatitis and Pancreatic Cancer

HAO Yi，ZHANG Xu，LI Hongchao，XIANG Ju

2018, 21(33):  4077-4081.  DOI: 10.12114/j.issn.1007-9572.2018.33.009

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Objective　To explore the clinical value of carbohydrate antigen 19-9（CA19-9），hemoglobin（Hb）and eosinophilic granulocytes（EO） in the identification of autoimmune pancreatitis（AIP） and pancreatic cancer.Methods　 The participants were enrolled from Changsha Medical University from June 2012 to June 2017，including 28 with AIP （AIP group） and 50 with confirmed postoperative pathological diagnosis of pancreatic cancer（pancreatic cancer group）.Two groups' Hb，white blood cell count（WBC），EO，serum amylase，serum lipase，serum　 immunoglobulin（Ig），serum IgG，serum IgG4，serum CA19-9 and serum carcinoembryonic antigen （CEA） were detected and compared.Multivariate Logistic regression analysis was performed to identify the factors associated with pancreatic cancer.Correlation analysis of serum　IgG4 and Hb，EO，serum CA19-9 was carried out.ROC curves of Hb，EO，serum IgG4，serum CA19-9 and serum CA19-9 combined with serum IgG4 in the identification of AIP and pancreatic cancer were drawn and corresponding AUC values were calculated.Results　Compared with the pancreatic cancer group，AIP group demonstrated much lower levels of Hb，serum CA19-9，and serum CEA but significantly higher levels of EO，amylase，lipase，serum Ig，serum IgG，and serum IgG4（P<0.05）.Multivariate Logistic regression analysis showed that Hb〔OR=1.284，95%CI（1.091，2.511）〕，EO〔OR=1.272，95%CI（1.124，1.839）〕，serum IgG4〔OR =1.397，95%CI（1.320，2.479）〕 and serum CA19-9〔OR=1.415，95%CI（1.371，1.754）〕 were independent factors associated with pancreatic cancer.Correlation analysis revealed that Hb（r=0.547，P=0.023），EO（r=0.486，P=0.031） and serum CA19-9（r=0.642，P=0.012） were positively correlated with serum IgG.For distinguishing AIP from pancreatic cancer，the AUC of　Hb，EO，serum IgG4，serum CA19-9，and serum CA19-9 combined with serum IgG4 was 0.701，0.661，0.764，0.803，0.872.Conclusion　Hb，EO，serum IgG4 and serum CA19-9 are the influencing factors of pancreatic cancer.The clinical value of serum CA19-9 combined with serum IgG4 in distinguishing AIP from pancreatic cancer is superior to that of Hb，EO，serum IgG4 or CA19-9 alone，which may be used as a potential clinical diagnostic indicator.


Correlation Study of Urinary Angiotensinogen and Renal Interstitial Inflammatory Cell Infiltration

DOU Yanna，SONG Dongyan,WANG Chunyan，LIU Dong，CHENG Genyang，XIAO Jing，ZHAO Zhanzheng

2018, 21(33):  4082-4087.  DOI: 10.12114/j.issn.1007-9572.2018.00.120

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Objective　To analyse the expression of urinary angiotensinogen（uAGT） and its relationship with renal interstitial inflammatory cell infiltration in patients with kidney failure.Methods　The clinical and renal histopathologic data in 77 patients with kidney failure admitted to the Department of Nephrology，the First Affiliated Hospital of Zhengzhou University were collected between December 2014 to April 2016.Twelve healthy people admitted to this hospital were selected as the control group.The clinical data of the renal failure group and the control group were collected，and the pathological data of the renal failure group were collected.Katafuchi score standard was used for semi quantitative score of glomerular sclerosis，interstitial inflammatory cell infiltration，interstitial fibrosis and tubular atrophy，and the expression level of uAGT was assessed by Enzyme-linked Immunosorbent Assay（ELISA）．The correlation between uAGT and clinical and pathological data was analysed.The receiver operating characteristic （ROC） curve of uAGT for the diagnosis of renal pathological damage was drawn and the area under the ROC curve （AUC） was calculated.Results　The levels of hemoglobin（Hb），serum albumin （Alb），estimated glomerular filtration rate （eGFR），and high density lipoprotein（HDL） in kidney failure group were lower than those in the control group，while levels of urea，uric acid（UA），creatinine（Cr），total cholesterol （TC），triacylglycerol （TG），uAGT in kidney failure group were higher than those in the control group（P<0.05）．There was a negative correlation between uAGT and Hb，Alb，urea，eGFR（rs=-0.427，-0.379，-0.266，-0.254，all P<0.05），and a positive correlation between uAGT and urinary protein in patients with kidney failure（rs=0.445，P<0.001）.There was a　postive correlation between uAGT and glomerular sclerosis（rs=0.270，P=0.018），interstitial inflammatory cell infiltration（rs=0.401，P<0.001），interstitial fibrosis（rs=0.273，P=0.016）and tubular atrophy（rs=0.272，P=0.017），respectively.For diagnosing glomerular sclerosis，greater accuracy，interstitial fibrosis ，and tubular atrophy，the AUC of the uAGT level was 0.627，0.689，0.627，0.639．Conclusions　UAGT increased significantly in patients with renal failure，and the uAGT showed a positive correlation with interstitial inflammatory cell infiltration and can reflected its severity.uAGT level was able to identify interstitial inflammatory cell infiltration with greater accuracy，and may be used as a non-invasive biomarker of interstitial inflammatory cell infiltration in patients with kidney failure.


Prognostic Factors for Cervical Intervertebral Disc Disease

ZHANG Jinrong，WANG Haiyan，MAO Haimin，WEI Yan，CHEN Xiaoqing，ZHANG Cuihong

2018, 21(33):  4088-4093.  DOI: 10.12114/j.issn.1007-9572.2018.00.230

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Objective　To explore the factors for predicting the prognosis of cervical intervertebral disc disease（CIDD），providing evidence for early delivering preventive care for reducing the incidence of long-term complications.Methods　One hundred and thirteen patients who received a confirmed diagnosis of CIDD and treatment from Department of Spinal Surgery，Affiliated Hospital of Nantong University were involved from January 2013 to January 2015.Baseline clinical data（sex，age，duration of suffering from CIDD，duration of smoking，underlying disorders，diagnosis），baseline cervical spine function assessment results〔Japanese Orthopedic Association （JOA） score，visual analogue scale（VAS） score，Neck Disability Index（NDI），cervical range of motion（ROM）〕 and imaging findings were collected and analyzed.Intraoperative data（operative approach，operative segment，operative duration，and intraoperative blood loss） were recorded.All of them were followed up for a period of 2 years and those with end-point events were analyzed.The potential prognostic factors for CIDD were investigated by multivariate Cox regression analysis and their performances were explored by ROC analysis.Results　Multivariate Cox regression analysis showed that the duration of suffering from CIDD，JOA score，VAS score，and NDI were independent factors affecting the prognosis（P<0.05）．Moreover，the duration of suffering from CIDD demonstrated a much smaller AUC compared with other three prognostic factors（P<0.05）．Conclusion　JOA score ，VAS score，combined with NDI　can be used as a predictive evaluation system for CIDD，which is expected to be a guidance for clinical treatment of this disease.


Effect of Different Concentrations of Recombinant Human Erythropoietin on the Function of Human Type Ⅱ Alveolar Epithelial Cells Exposed to Hyperoxia　

DANG Jiawen，DONG Wenbin，LEI Xiaoping，HE Na，GUO Lin

2018, 21(33):  4094-4097.  DOI: 10.12114/j.issn.1007-9572.2018.00.171

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Objective　To study the effect of different concentrations of recombinant human erthropoietin（rhEPO）on reducing the apoptosis of human typeⅡ alveolar epithelial cells（A549 cells）induced by hyperoxia.Methods　From January to December 2017，cultured A549 cells during logarithmic growth phase were randomly divided into the control group（receiving incubation in a 50 ml/L CO2 incubator with a constant temperature of 37 ℃），hyperoxic group（receiving airtight laboratory incubation after passing through the high purity gas mixtures of 900 ml/L O2 and 50 ml/L CO2 supplied for 10 min with a velocity of 3 L/min）and 10，20，50，100 U/ml rhEPO groups（receiving hyperoxic induction after being pretreated for 24 hours in a culture medium containing 10，20，50，100 U/ml rhEPO，respectively）．Each group contained 8 complex pores.24 hours later，the morphological changes of cells in each group were observed by inverted phase contrast microscope，cell proliferation level was measured by cell proliferation assay，and apoptosis rate was detected by flow cytometry.Results　In terms of cell morphology，the hyperoxic group presented rather enlarged intercellular space between remarkably damaged cells，significantly decreased living cells and increased suspended cells；all rhEPO groups showed improvement in damaged cells，in particular，50，100 U/ml rhEPO groups demonstrated morphological changes similar to those of the control group.With regard to cell proliferation level，the control group had higher cell proliferation level than the hyperoxic group and 10，20 U/ml rhEPO groups（P<0.05）；all rhEPO groups showed higher cell proliferation level than the hyperoxic group（P<0.05）；50，100 U/ml rhEPO groups had higher cell proliferation level when compared with 10，20 U/ml rhEPO groups，so did the 100 U/ml rhEPO group when compared with the 50 U/ml rhEPO group（P<0.05）．In respect of cell apoptosis rate，the control group exhibited lower cell apoptosis rate than the hyperoxic group and 10，20 U/ml rhEPO groups（P<0.05）；all rhEPO groups showed lower cell apoptosis rate than the hyperoxic group（P<0.05）；50，100 U/ml rhEPO groups showed lower cell apoptosis rate when compared with 10，20 U/ml rhEPO groups，so did the 100 U/ml rhEPO group when compared with the 50 U/ml rhEPO group（P<0.05）．Conclusion　rhEPO can improve the suppressed proliferation and increased apoptosis of A549 cells caused by hyperoxia，in particular，50 and 100 U/ml rhEPO can effectively protect the A549 cells from hypoxic injury.


Bioinformatics Analysis of Genes Related to Bipolar Disorder in Children and Adolescents

YANG Chao，FU Yuewen，ZHANG Li，WANG Yan，YANG Ping

2018, 21(33):  4098-4103.  DOI: 10.12114/j.issn.1007-9572.2018.00.278

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Objective　To explore the mechanism of pediatric bipolar disorder（PBD）and youth bipolar disorder，so as to provide novel thoughts for its basic research and clinic treatment.Methods　Papers published from January 2014 to July 2018 were included via PubMed from February 2018 to July 2018.The key words were “pediatric bipolar disorder sequencing” or “youth bipolar disorder sequencing”，and 32 papers in total were obtained.Data sets using whole-exome sequencing（WES）or transcriptome sequencing techniques in more than 10 patients were included.Finally，5 data sets were selected.Among them，4 WES data sets contained 175 potential PBD related risk genes，and 1 transcriptome sequencing data set contained 41 ones.All these genes were divided into whole-exome group（175）and transcriptome group（41）after de-weighting.Enrichment analysis of biological process（BP）was performed using DAVID，KEGG，Panther and WebGestalt.The enrichment pathway was calculated using KEGG and Panther databases.Results　Nine BP classifications with significant enrichment were obtained in the enrichment analysis of WES，which affected anionic transmembrane transport，chloridion transport，embryo development and cerebromedullary tube upgrowth the most，and some of them were related to adrenal development.Ten BP classifications with significant enrichment were obtained in the enrichment analysis of transcriptome sequencing，and abnormal expression of genes mainly concentrated in histone ubiquitination，synthesis and release of thyroxin，protein folding，and histone modification.The KEGG database stated that the main pathway with significant enrichment of whole-exome group genes were inositol phosphate metabolism and phosphatidyl inositol signal system，and of transcriptome group genes was ubiquitination-regulated protein hydrolysis.The Panther database declared that the main pathway with significant enrichment of whole-exome group genes were angiogenesis-related and Parkinson's disease-related pathways，and of transcriptome group genes could not be found clearly.Conclusion　The gene mutation of PLCD3，DAG1，APLNR，EPAS1 in patients with PBD was associated with embryo development，which is a embryonal system mutation inheriting from parents.The abnormal gene mutation or expression was related to phosphatidyl inositol signal system and angiogenesis.


Plasma Expression and Clinical Significance of the lncRNA MALAT1 in Patients with Hepatocellular Carcinoma

JIA Chunli，YANG Ying，ZHANG Hua，LI Zhipeng，YANG Zhifang，ZHANG Ruili，ZHAO Huarong，MAO Rui，CAI Ceng，BAO Yongxing

2018, 21(33):  4104-4108.  DOI: 10.12114/j.issn.1007-9572.2018.00.148

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Objective　To investigate the expression and clinical significance of metastasis associated lung adenocarcinoma transcript 1（MALAT1），a long non-coding RNA，in the plasma of patients with hepatocellular carcinoma（HCC）．Methods　We collected 120 plasma and 120 serum samples from pathologically diagnosed HCC patients admitted to the First Affiliated Hospital of Xinjiang Medical University between April 2015 and April 2017.The expression of MALAT1 in the peripheral blood plasma of the HCC patients was detected by real-time fluorescence quantitative polymerase chain reaction（RT-qPCR）．Serum MMP9 and VEGF levels were detected by enzyme-linked immunosorbent assay.The patients were divided into high and low expression groups with the median value of MALAT1 as the cut point，and the correlations between MALAT1 expression and clinical characteristics as well as the serum MMP9 and VEGF level were analyzed.Results　There were significant differences in tumor stage and metastasis between the MALAT1 high and low expression groups（P<0.05）．Other clinical characteristics including sex，age，Child-Pugh classification，serum AFP level，pathological grade，HBV infection and cirrhosis conditions were not significantly different between the two groups （P>0.05）．Cox multivariate regression analysis showed that age，tumor stage，Child-Pugh classification，metastasis ，plasma MALAT1 expression levelwere independent risk factors affecting the prognosis of HCC patients（P<0.05）．Survival analysis showed that the survival rates in the MALAT1 high and low expression groups were significantly different（P<0.010）．Spearman correlation analysis showed that the expression level of MALAT1 was positively correlated with the levels of MMP9 and VEGF （P<0.010）．Conclusion　Patients with high expression of plasma MALAT1 have a short survival time and are prone to metastasis.


Blood Concentration Monitoring，Efficacy and Immune Function of Vancomycin in Neonatal Sepsis

XU Jun，LYU Yizhi，LI Zhifei，ZOU Yingjie，TANG Jingjing

2018, 21(33):  4109-4114.  DOI: 10.12114/j.issn.1007-9572.2018.00.169

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Objective　To evaluate the blood concentration monitoring，clinical efficacy and immune function of vancomycin in the treatment of neonatal septicemia.Methods　A total of 50 sepsis infants in the treatment of vancomycin admitted to the Affiliated Hospital of Medical School of Ningbo University from July 2015 to January 2017 were divided into group A（<10 mg/L，n=8），group B（10-20 mg/L，n=34） and group C（>20 mg/L，n=8） according to the trough level of vancomycin by concentration monitoring.In the same period， 50 newborns with non infectious diseases or non immune diseases were selected as control group.Blood concentration，drug sensitivity test indicators，clinical and bacteriological efficacy，adverse reactions of group A，B，C and immune function changes before and after treatment of 4 groups were comparatively analyzed.The area under the receiver operating characteristic（ROC） curve（AUC） was used to evaluate the efficacy of trough level，peak level and AUC24/minimal inhibitory concentration（MIC）　in predicting clinical efficacy.Results　The trough levels，peak levels，AUC24，and AUC24/MIC in group B and C were significantly higher than those in group A（P<0.05）；the trough levels，peak levels，AUC24，and AUC24/MIC in group C were higher than those in group B（P<0.05）．There was no significant difference in clinical efficacy among the three groups（P>0.05），while the bacteriological efficacy in group B and group C were significantly higher than that in group A（P<0.05）．The efficacy of AUC24/MIC for predicting clinical efficacy was higher than that of trough and peak levels（Z=4.153，4.201，P<0.001，<0.001）．The incidence of acute kidney injury in group C was 37.50%，which was significantly higher than that in group A and B（0.00%，0.00%，P<0.05）．Before treatment，the proportions of CD3+，CD4+，CD8+ and IgA，IgG levels in the group A，B，and C were lower than those in the control group（P<0.05），while the proportions of CD64+ and NK cells and IgM levelin the group A，B，and C were higher than those in the control group（P <0.05）．After treatment，the proportions of CD3+，CD4+，CD8+ and IgA，the IgG levels in group B and group C were significantly higher than those in group A，and the proportions of CD64+ and NK cells，as well the level of IgM were significantly lower than those of group A（P<0.05）．After treatment，the immunological parameters of the group A，B，and C improved significantly compared with those before the treatment（P<0.05）．Conclusion　Blood concentration monitoring of vancomycin plays an important role in the treatment of neonatal septicemia；the effect and safety of trough level as 10-20 mg/L are much better and can significantly improve the immune function；the AUC24/MIC>391 can improve the outcomes of neonatal sepsis.


Effect of Combined Use of Warfarin with Other Drugs on Anticoagulation in Patients

CAI Liqiu，YANG Lixiong

2018, 21(33):  4114-4117.  DOI: 10.12114/j.issn.1007-9572.2018.00.071

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Objective　To explore the causes of changes in international normalized ratio（INR） in inpatients receiving warfarin in combination with other drugs for anticoagulation and to offer corresponding solutions.Methods　We collected and analyzed the medical records of the inpatients receiving warfarin anticoagulation therapy in a hospital during January 2014 to December 2016.Based on referring to the warfarin package insert and Chinese Expert Consensus on Warfarin Anticoagulation Therapy，we identified the drugs potentially interacted with warfarin，and examined the incidence of bleeding possibly caused by the combined use of warfarin and other drugs.In particular，we detailedly analyzed those with INR>3.00 or with a daily increase of 0.50 in INR undergoing monitoring of INR.Results　Totaled 48 cases were included in the analysis.The analysis of the medications showed that：（1） 15 types of drugs possibly increased the action of warfarin（such as levofloxacin， aspirin enteric-coated tablets， atorvastatin calcium tablets and so on），and 4 types of drugs possibly reduced it（such as hydrochlorothiazide tablets， spironolactone tablets and so on）.（2） Of these 19 types of drugs，warfarin was administered in combination with 1 type of drug，2 types of drugs，3 types of drugs，4 or more types of drugs in 10 cases，8 cases，11 cases，12 cases，respectively.（3） Warfarin was administered in combination with none of these 19 types of drugs in 7 cases.Among 43 cases receiving the monitoring of INR〔average monitoring times of （3.2±1.4）〕，10 had a daily increase of 0.50 in INR，6 had bleeding，involving 8 types of drugs.Conclusion　When warfarin is administered with other drugs for anticoagulation，drugs that may enhance the effect of warfarin include levofloxacin， aspirin enteric-coated tablets， atorvastatin calcium tablets， etc.drugs that may weaken the effect of warfarin include hydrochlorothiazide tablets， spironolactone tablets， etc.the INR should be monitored intensively.In that case，the therapy can be adjusted timely based on the response of the patients.All these are for the improvement of the safety and rationality of clinical medication.


General Practitioners' KAP Questionnaire on Anticoagulation in Patients with Nonvalvular Atrial Fibrillation Using Delphi Method

YE Shasha，PAN Zhigang，LIU Wanwan，ZHU Lingping

2018, 21(33):  4118-4126.  DOI: 10.12114/j.issn.1007-9572.2018.00.295

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Objective　To construct a general practitioners' Knowledge-Attitude-Practice questionnaire（referred as KAP questionnaire）for anticoagulant therapy in patients with non-valvular atrial fibrillation（NVAF），and to lay a foundation for the evaluation of knowledge，attitude and clinical practice among general practitioners in communities in anticoagulation for NVAF patients.Methods　Based on the knowledge-attitude-practice model，an initial KAP questionnaire was formed from October 2017 to January 2018 by searching a large number of domestic and foreign literatures，guidelines for atrial fibrillation（AF）management，and foreign questionnaires about AF.74 entries were divided into three dimensions：knowledge（including entries C1-C24），attitude（including entries D1-D27），and practice（including entries E1-E23）．The Delphi expert consultation questionnaires were sent to expert panel by e-mail.The completion period was 1 week.Two rounds of letter consultation were conducted，with an interval of 4-8 weeks.After the first round consultation，the research group summarized and sorted out expert suggestions，modified the initial KAP questionnaire，and formed the second round consultation.The experts were consulted again，and their opinions tended to be consistent.Their suggestions were summarized and sorted out，and finally KAP questionnaire was determined and formed.Basic information，enthusiasm，suggestion for revisions，degrees of authority，concentration and coordination about experts were recorded in our study.Results　In the first round consultation，15 Delphi expert consultation questionnaires were sent out，and 15 valid questionnaires were collected，with an effective recovery rate of 100.0%.In the second round，15 Delphi questionnaires were sent out，14 valid questionnaires were collected，with an effective recovery rate of 93.3%.The positive coefficient of the expert in the first round consultation was 100.0%，and in the second round consultation was 93.3%.The results of the first round consultation showed that the experts had six suggestions.After the discussion of the research group，C3，C5，C11，C17，C23 and C24 were deleted in the knowledge dimension of initial KAP questionnaire，and other 18 items were saved.D1，D12，D14，D15，D16，D19 and D20 were deleted in the attitude dimension，remaining 21 entries.E3，E6，E8 and E11 were deleted in the behavioral dimension，remaining 19 items.Reserved items were modified according to expert opinions.The results of the second round consultation showed that experts had three suggestions：to merge D6 and D7，D8 and D9，and D22 and D23，adjust initial KAP questionnaire items and delete C22 and E10.The expert authority coefficient（Cr）was 0.87.The concentration degree of expert opinions in the knowledge dimension of initial KAP questionnaire was 3.93 to 4.89 points in the first round consultation，and 4.31 to 4.98 points in the second round consultation.The concentration degree of expert opinions in the attitude dimension was 3.45 to 4.76 points in the first round and 4.19 to 4.94 points in the second round.The concentration degree of expert opinions in the practice dimension was 3.80 to 4.93 points in the first round and 4.15 to 4.91 points in the second round.The coefficient of variation（CV）of knowledge dimension in the initial KAP questionnaire was 0.06 to 0.32 in the first round，and 0.02 to 0.10 in the second round.CV of attitude dimension was 0.09 to 0.47 in the first round，and 0.03 to 0.10 in the second round.CV of practice dimension was 0.04 to 0.38 in the first round and 0.03 to 0.10 in the second round.The W value of first round consultation was 0.221，and significance test χ2 was 241.554，P<0.001.The W value of second round consultation was 0.403，and significance test χ2 was 321.699，P<0.001.Conclusion　The KAP questionnaire constructed in our study includes 3 dimensions of knowledge，attitude and practice，with a total of 52 items.Statistical analysis shows that the positive coefficient and authority of experts are high，the opinions are concentrated，and the results of consultation is scientific，valid and reliable.


The Chinese Version of the Subjective Load Assessment Method and the US National Aeronautics and Space Administration Task Load Index Scales for Assessing the Reliability and Validity of Physicians' Mental Loads in Tertiary Hospitals

MA Linlin，PAN Zhigang

2018, 21(33):  4127-4133.  DOI: 10.12114/j.issn.1007-9572.2018.00.236

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Objective　To verify the reliability and validity of the Chinese version of the Subjective Load Assessment Method （SWAT） and the National Aeronautics and Space Administration Task Load Index （NASA-TLX） scales for assessing the mental load of physicians in tertiary hospitals，and to analyze the differences in mental loads among physicians.The analysis of the differences provided a feasible tool for assessing the mental workload of physicians in Chinese tertiary hospitals.Methods　From November 2014 to January 2015，107 cases of clinical practitioners in the Zhongshan Hospital Fudan University were selected through a convenient sampling method.A questionnaire assessing doctors' general mental state and the Chinese version of the SWAT as well as NASA-TLX scales were used in this study.Reliability was evaluated through internal consistency reliability，split-half reliability，and the correlation between these items and the total score.The validity of the structure was evaluated through structural validity and discriminant validity.Non-parametric tests using multiple independent samples were used to compare differences in brain load levels among physicians from different departments.Results　A total of 107 questionnaires were distributed，and 105 valid questionnaires were returned （two cases were rejected）．The effective recovery rate was 98.1%.The Cronbach's α coefficients of the Chinese version of SWAT and NASA-TLX scales were 0.504 and 0.516，respectively.The split-half reliability coefficients were 0.360 and 0.634，respectively.The correlation coefficient between the scores of items of the Chinese version of SWAT scale and the total score was >0.3 （all P values <0.05）．The correlations between the scores from the Chinese version of NASA-TLX scale of mental needs，physical needs，time requirements，efforts，degree of frustration and total scores were >0.3 （P<0.05 indicating significant differences）．With the Chinese version of the NASA-TLX，the correlation coefficient between the self-performance item score and its total score was less than 0.3.Consequently，this item was omitted in building the C-NASA-TLX scale.The Cronbach's α coefficient was 0.645，and the split-half reliability coefficient was 0.690.The correlation coefficient between item score of　C-NASA-TLX scale and the total score was >0.3 （P<0.05）．The KMO value of the Chinese SWAT scale was 0.552.The Bartlett's spherical test χ2=24.711，P<0.001，thus indicating that it was suitable for factor analysis.A total of one common factor was proposed，and the cumulative variance contribution rate was 51.343%.The load value of each item was in the range of 0.573-0.817.The Chinese version of the NASA-TLX scale had a KMO value of 0.590，and Bartlett's spherical test χ2=117.010，P<0.001，thus indicating that it was suitable for factor analysis.A total of three common factors were extracted.The cumulative variance contribution rate was 76.508%，and the load value of each item was in the interval of 0.602-0.827.The KMO value of the C-NASA-TLX scale was 0.607.Bartlett's spherical test χ2=96.658，P<0.001，thus indicating that it was suitable for factor analysis.A total of two common factors were extracted，the cumulative variance contribution rate was 67.037%，and the load value of each item was in 0.542-0.810.According to the Chinese version of SWAT and the NASA-TLX scale total score and C-NASA-TLX scale total score，the extreme grouping method was used to divide doctors into the following groups：A-high group，A-low group，B-high group，B-low group，C-high group and C-low group.Each group had 28 cases.The Chinese version of SWAT scale's time load，effort load and psychological stress load item scores of the A-high group were higher than those of the A-low group （P<0.05）．The Chinese version of NASA-TLX scale's mental needs，physical demand，and effort level scores of the B-high group were higher than those of the B-low group （P<0.05）．The C-NASA-TLX scale's mental needs，physical needs，time requirements，effort，and frustration levels of the C-high group were higher than those of the C-low group （P<0.05）．There was no statistically significant difference in the scores of the Chinese version of SWAT scale of the doctors in different departments （P>0.05）．The scores of Chinese version of the NASA-TLX scale in different doctors and their mental needs，physical strength，time requirements and self-performance scores were not significantly different （P>0.05）．The scores of Chinese version of the NASA-TLX scale's effort and frustration were compared for different departments，and the differences were statistically significant （P<0.05）．Conclusion　Although the Chinese version of the SWAT scale had good structural validity and project discrimination，the internal consistency was poor.It was deemed unsuitable to use this criterion for evaluating the mental load of physicians in tertiary hospitals.The Chinese version of the NASA-TLX scale and SWAT volume had equivalent reliability.However，the C-NASA-TLX scale had good reliability and validity after removal of the self-performance item，thus indicating that this scale can be applied for the brain load research of physicians in tertiary hospitals.There were no differences in the total brain load of doctors in different departments of tertiary hospitals.


Analysis of Clinical Characteristics and Prognosis of Children with Glomerulonephritis after Acute Streptococcal Infection with Nephrotic Proteinuria

LI Zhijuan，BAO Ying，HUANG Huimei，TANG Jun，ZHANG Min

2018, 21(33):  4134-4137.  DOI: 10.12114/j.issn.1007-9572.2018.33.019

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Objective　To investigate the clinical characteristics，pathology and prognosis of children with glomerulonephritis after acute streptococcal infection with nephrotic proteinuria.Methods　A retrospective analysis was conducted based on the treatment data of 21 patients（the nephrotic proteinuria group） who were diagnosed with glomerulonephritis after acute streptococcal infection with renal proteinuria and underwent renal biopsy from January 2013 to January 2017 in Xi'an Children's Hospital.In addition，the diagnostic，treatment and prognostic data of 80 non-nephrotic patients with proteinuria （the non-nephrotic proteinuria group） were obtained.The characteristics of renal pathological examination of the nephrotic proteinuria group were summarized，and the clinical data，treatment and prognosis of the two groups were analyzed and compared.Results　Kidney pathological examination in the nephrotic proteinuria group showed that all patients had capillary endoproliferative glomerulonephritis.Nine cases（42.9%） had crescent body formation but the proportion was less than 10.0%.Electron microscopy showed the deposition of "hump"-like electron-dense deposits under the epithelium，and one case had more electron-dense deposits than the others.Immunofluorescence showed that only 9 cases （42.9%） had C3 deposition （≥++） but no IgG deposition，and only 2 cases had significant IgG deposition （≥++）.The incidence of gross hematuria and acute kidney injury（AKI） in the nephrotic proteinuria group was higher than that in the non-nephrotic proteinuria group，while the anti streptococcus hemolysin "O" test positive rate and albumin level were lower than those in the non-nephrotic proteinuria group （P<0.05）.In addition to anti-infective and symptomatic treatment，6 patients in the nephrotic proteinuria group were also given glucocorticoid treatment，while no hormones were administered in the non-nephrotic proteinuria group.Time to disappearance of macroscopic hematuria，resolution of edema，conversion to negative urinary protein，and recovery of complement were longer in the nephrotic proteinuria group than in the non-nephrotic proteinuria group（P<0.05）.Conclusions　The incidence of AKI in children with acute streptococcal glomerulonephritis is high，but the prognosis is good.Only a few cases show hematuria following microscopy．


Diagnosis and Treatment of Chemotherapy-associated Hyponatremia

WANG Huaichong，SONG Xiaokun

2018, 21(33):  4138-4143.  DOI: 10.12114/j.issn.1007-9572.2018.33.020

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Objective　To determine the etiology of hyponatremia induced by chemotherapy，and to establish effective prevention as well as treatment measures.Methods　We analyzed the clinical data of adverse drug reactions following chemotherapy in patients treated with doxorubicin combined with cyclophosphamide.We also assessed the relationship between etiology，diagnosis，treatment，adverse reactions，and proposed treatment recommendations.Results　Cyclophosphamide was the main pathogenic factor in acute severe hypoosmotic hyponatremia following chemotherapy with doxorubicin combined with cyclophosphamide.Hypoosmotic hyponatremia may be related to the mechanism of abnormal antidiuretic hormone secretion.Severe acute hypotonic hyponatraemia can be induced by cyclophosphamide following chemotherapy with AC.The mechanism of cyclophosphamide-induced hyponatremia was related to inappropriate antidiuretic hormone secretion.Conclusion　Chemotherapeutic drugs can lead to hyponatremia with high clinical risk，is occult during early onset and involves different mechanisms，which require further investigation for early diagnosis and timely efficient treatments.


Progress in the Use of Low Protein Diets without Dialysis in the Treatment of Chronic Kidney Disease

WANG Yan，SUN Jianqin

2018, 21(33):  4144-4148.  DOI: 10.12114/j.issn.1007-9572.2018.00.003

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Low protein diet（LPD） is an important element in the comprehensive treatment of chronic kidney disease（CKD）.At present，whether the LPD is beneficial in protecting residual kidney function in patients with CKD is debated.In addition，concerns have been raised regarding the effect of LPD on patient nutritional status.This article reviews recent studies on the effects of protein intake on kidney function and the role of LPD in CKD treatment，and summarizes key points in implementing LPD，to improve the quality of dietary management，slow the progression of the disease，and delay dialysis treatment onset in patients with CKD.Our study also provides a reference for dietitians and clinicians to formulate and implement effective diet treatment plans for patients with CKD.


Risk Factors and Protective Factors for the Progression of Mild Cognitive Impairment Towards Dementia

ZHOU Yuanyuan，ZHOU Xianglian，WANG Jie，WANG Lina

2018, 21(33):  4149-4156.  DOI: 10.12114/j.issn.1007-9572.2018.33.022

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As the aging of the community population has progressed，the prevalence of dementia has increased every year.Because of the poor treatment efficacy for dementia in the middle and late stages，early recognition of cognitive dysfunction has become a focus of research in the field of gerontology.Previous studies on the causes of cognitive dysfunction have primarily focused on mild cognitive impairment （MCI） or dementia.This article focuses on the progression of MCI towards dementia and explores possible cognitive risks and protective factors in the advanced stages，to provide strategies to prevent or slow the progression of cognitive disorders.


Current Status and Outlook of Mobile Health APPs

GONG Hui，YAN Weili，YANG Xiaoqing

2018, 21(33):  4157-4162.  DOI: 10.12114/j.issn.1007-9572.2018.00.010

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This article discusses the current status，development barriers，and development directions of consumer-oriented mobile health applications （mHealth APPs）．Currently，there are more than 165 000 mHealth APPs in the main APP stores.The top two categories are health management and disease management.Other categories include self-diagnosis，medication reminders，patient web portals，and rehabilitation management.These APPs provide end-users with low-cost，high-quality，24/7 access to health information worldwide.However，owing to a lack of supervision，a lack of relevant evidence-based information，and concerns about privacy and security，mHealth APPs still have many areas in which to improve.Future directions may include integrating data into health care systems，providing interactive application platforms，granting access to electronic health records，providing cloud-based storage of personal health records，and delivering prescriptions through APPs.For mHealth APPs to achieve maximum value in healthcare and chronic disease management，all stakeholders in the industry must work together to overcome related obstacles.