Table of Content

20 December 2018, Volume 21 Issue 36

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Monographic Research

Interpretation of 2018 ESC Guidelines for Management of Cardiovascular Diseases during Pregnancy　

ZHANG Haofeng，ZHANG Jun

2018, 21(36):  4415-4423.  DOI: 10.12114/j.issn.1007-9572.2018.00.351

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Cardiovascular diseases during pregnancy is one of the most severe causes of maternal death.Since the European Society of Cardiology（ESC） issued the Guidelines for the Management of Cardiovascular Diseases during Pregnancy in 2011，new evidences have accumulated，particularly in diagnostic techniques，risk assessment，and the use of cardiovascular drugs.Therefore，the ESC revised the guideline and published a new one in August 2018.It provides detailed introduction of pre-pregnancy counseling，risk assessment，management，diagnosis and treatment of cardiovascular diseases during pregnancy，and drug use during pregnancy，especially risk factors.We are lack of corresponding clinical guidelines in China，but the number of pregnant patients with cardiovascular diseases is rising.In this paper，the main updated points of the guideline are interpreted to provide references for clinical diagnosis and treatment of cardiovascular diseases during pregnancy in China.


Congenital Anomalies in Children Born after ART Pregnancy and Spontaneous Pregnancy　

LI Sha，ZHANG Yunshan

2018, 21(36):  4424-4428.  DOI: 10.12114/j.issn.1007-9572.2018.00.324

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Objective　To compare the congenital malformation of the children conceived by assisted reproductive technology（ART） and those conceived spontaneously and to discuss the risks of ART birth defects.Methods　The ART group was consisted of infertility females and their children（12 935 children），using ART at Tianjin Central Hospital of Gynecology Obstetrics during January 2008 to December 2017.The SP group was consisted of fertility females who conceived spontaneously and their children who had congenital anomalies during the same period. The general condition and congenital malformation were compared between ART defects（139 children）and natural conception defects（453 children），and the risk factors of ART birth defects were analyzed. The general condition included gender，gestational age，delivery method，birth weight and malformation of the newborns，as well as fertilization way，maternal age，number of births，pregnancy complications of the mothers.Results　The multiple pregnancy rate，preterm birth rate and the incidence of low birth weight of ART group were all significantly higher than those of SP group，and the average gestational age and average birth weight of ART group were significantly less than those of SP group（P<0.05）.In ART group，the main malformations appeared in cardiovascular system（33.1%），eye，ear，face and neck（13.5%）and other malformations（10.1%）.In vitro fertilization fresh embryo transfer（IVF-ET，40 children），intracytoplasmic sperm injection fresh embryo transfer（ICSI-ET，20 children）and frozen-thawed embryo transfer（FET，79 children）were performed in ART group. IVF-ET，ICSI-ET and FET were found to have cardiovascular malformation as the most common anomaly，while other malformations，cleft lip and palate，eye，ear，face and neck malformation were the less common anomalies respectively.There were no significant differences in malformation distribution of different gender and maternal age in ART group（P>0.05），while the difference in malformation distribution of different gestational age and number of birth in ART group were significant（P<0.05）.In SP group，the main malformations were found in cardiovascular system（62.9%），digestive system（11.1%）and cleft lip and palate（7.0%）.There was no significant difference in malformation distribution of different gender and number of birth in SP group（P>0.05），while the differences in malformation distribution of different gestational age and maternal age were significant in SP group（P<0.05）.The results of multivariate Logistic regression analysis indicated that gestational age，number of fetuses and pregnancy complications were factors influencing the ART birth defects（P<0.05）.Conclusion　The distributions of birth defects are different between ART and SP birth defects，but both indicate high incidence of cardiovascular system defects. Gestational age，number of birth and pregnancy complications are factors influencing the ART birth defects.


Relationship between Gestational Diabetes and Thyroid Disease in Pregnancy　

LIU Xin，WANG Shuping，LYU Na，QI Caihui，WANG Zhenjing

2018, 21(36):  4429-4433.  DOI: 10.12114/j.issn.1007-9572.2018.00.217

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The incidences of gestational diabetes and thyroid disease in pregnancy are increasing，both can lead to adverse pregnancy outcomes，such as abortion，preterm labor，placental abruption，eclampsia and stillbirth.However，the pathogeneses of the two are not clear yet.Studies show that insulin resistance，certain inflammatory factors，adipocytokines and thyroid antibodies are involved.In recent years，the relationship between gestational diabetes and thyroid disease in pregnancy has achieved wide attention.The determination of the associations between the two，between thyroid autoantibodies and increased risk of gestational diabetes，and the investigation of the effects of early interventions on gestational outcome are a vital basis for early prevention and treatment of gestational diabetes and improvement of gestational outcome.We discussed the relationship between gestational diabetes and thyroid disease in pregnancy，aiming to offer a theoretical basis for reducing the adverse gestational outcome by intensifying thyroid function and thyroid autoantibody tests in the first trimester of pregnancy and timely thyroid hormone treatment if hypothyroidism is detected.


Analysis of Perinatal Complications and Comorbidities in Hebei Province　

WANG Xiaoxiao，LIU Qing，JIN Ying，ZHANG Yingkui，WANG Li

2018, 21(36):  4434-4438.  DOI: 10.12114/j.issn.1007-9572.2018.36.004

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Objective　To understand the perinatal complications and comorbidities in maternal women in Hebei Province in 2016，and explore the influencing factors，in order to provide a scientific basis for policy-making regarding prenatal and postnatal care.Methods　Data on 64 966 maternal women from 22 monitoring sites（hospitals） in Hebei Province collected from 2016-01-01 to 2016-12-31 were gathered through the Maternal and Child Health Monitoring Information Management System of Hebei Province（Network Direct Report）.The data were collected with the "Maternal Case Survey Form" designed by the China Maternal and Child Health Monitoring Office.The perinatal complications/comorbidities，and the factors influencing them，were analyzed.Results　The incidence of perinatal complications/comorbidities in Hebei Province was 52.3%（33 986/64 966） in 2016.The incidence of pregnancy anemia was 36.8%（23 936/64 966），which ranked first in all complications/comorbidities and was followed by pregnancy diabetes mellitus and pregnancy hypertension，whose incidence rates were 5.3%（3 461/64 966） and 5.1%（3 329/64 966），respectively.The incidence of postpartum hemorrhage was 0.4%（283/64 966），and that of other complications/comorbidities was 4.6%（2 977/64 966）.Multivariate Logistic regression analysis showed that age，pregnancy number，number of labor，education level，place of residence，and delivery season were the factors influencing pregnancy anemia（P<0.05）；age，number of labor，education level，and place of residence were the factors influencing pregnancy diabetes（P<0.05）；age，number of labor，education level，place of residence，and delivery season were the factors influencing pregnancy hypertension（P<0.05）；age，education level，and place of residence were the factors influencing postpartum hemorrhage（P<0.05）.Conclusion　The incidence of perinatal complications and comorbidities in Hebei Province is relatively high.Age，number of pregnancy，number of labor，education，place of residence，and delivery season influence perinatal complications/comorbidities.


Visualization Analysis on Metabolic Syndrome During Pregnancy in China　

FENG Ling，ZHOU Zhou，YANG Xiaodong，QIU Yuqin

2018, 21(36):  4439-4444.  DOI: 10.12114/j.issn.1007-9572.2018.00.270

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Objective　To explain and comprehend the current status of research on gestational metabolic syndrome in China，so as to provide reference for medical researchers in the future.Methods　We searched China national knowledge infrastructure（CNKI） on December 20 2017.Subjects searched were "pregnancy" or "metabolism" or "syndrome"，and published time was "1970—2017".A total of 569 articles on gestational metabolic syndrome were retrieved and their contents were analyzed.Results　The literature on the gestational metabolic syndrome in China has increased gradually，which could be divided into initial exploratory phase，rapid development stage and prosperity stage.The thresholds（3，4，20；3，3，20；3，3，20） were set to obtain 4 keywords：polycystic ovary syndrome，pregnancy complications，pregnancy，pregnancy-induced hypertension syndrome.Yang Huixia，Sun Weijie and Yang Dongzi were the three most productive authors，and Gynecology Department of Peking University First Hospital，Gynecology Department of Sun Yat-sen Memorial Hospital，Sun Yat-sen University，Beijing University of Chinese Medicine and Heilongjiang University of Chinese Medicine were the four strongest contributors by affiliation.Conclusion　The study of gestational metabolic syndrome in China can be studied by combining the ideas of Traditional Chinese Medicine and Western medicine.There is few cooperation between authors and institutions，which was mainly concentrated in universities and hospitals.The research can be extended to communities and primary health medical institutions to promote the future research in gestational metabolic syndrome.



Study on Clinical Characteristics of Thyroid Nodules　

LUO Jingmei，FENG Jiagang，ZHAN Dong，MENG Qi，SHEN Yun

2018, 21(36):  4445-4452.  DOI: 10.12114/j.issn.1007-9572.2018.00.109

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Objective　To analyze the clinical data of patients with thyroid nodules，so as to provide evidence for differentiating benign and malignant nodules.Methods　The clinical data of 646 patients undergoing surgical resection of thyroid nodules at the First Affiliated Hospital of Kunming Medical University from January 2014 to February 2015 were collected.The incidence of malignant nodules were compared in different basic clinical data，medical history，dysipidemia ultrasound features and CT features patients with thyroid nodules.　Thyroid stimulating hormone（TSH），anti-thyroglobulin antibodies（TGAb） and anti-thyroid peroxidase antibodies（TPOAb） levels were compared between the patients with benign and malignant thyroid nodules.The diagnostic value of ultrasonography and CT for thyroid nodules and the influencing factors of malignant thyroid nodules were analyzed.Results　The proportion of malignant nodules varied significantly in age groups（P<0.05），the incidence of malignant nodules were significantly different in patients with different BMI，dietary iodine intake，family history of thyroid cancer，and family history of other malignancies（P<0.05）.All patients received ultrasonography，and the incidence of malignant nodules were significantly different in patients with different properties，hypoechoic conditions，boundaries，shape，blood flow in nodules，longitudinal and transverse diameter ratio，edge angle，calcification and enlargement of cervical lymph nodes（P<0.05）.There were 85 cases undergoing enhanced CT scanning，and the incidence of malignant nodules were significantly different in patients with different boundarie rders and enlargement of cervical lymph nodes（P<0.05）.All patients were given test of serum TSH levels，and a higher TSH level was detected in patients with malignant nodules than that in patients with benign nodules（P=0.006）.A total of 395 patients were given measurement of antithyroid autoantibodies，and the TPOAb titer and TGAb titer were higher in patients with malignant nodules than those patients with benign nodules（P<0.001）.Compared with the postoperative pathology，preoperative ultrasound showed a 97.60% sensitivity，82.77% specificity，and 89.47% diagnostic coincidence rate for differentiating benign and malignant thyroid nodules，and CT scan exhibited a 95.12% sensitivity，68.18% specificity，and 81.18% diagnostic coincidence rate for differentiating benign and malignant thyroid nodules.Multivariate Logistic regression analysis revealed that the development of malignant thyroid nodules was associated with young age，obesity，high dietary iodine intake，irregular nodule morphology as revealed by ultrasound，abundant blood flow in nodules，longitudinal and transverse diameter ratio of 1 and greater，edge angle，calcification and elevated TSH and TPOAb titier levels（P<0.05）.In addition，there were significant differences in abundant blood flow in nodules and calcification between the patients with malignant thyroid nodules in the presence and absence of cervical lymph node metastasis（P<0.05）.Conclusion　Young age（30 to 49 years），obesity，high dietary iodine intake，irregular nodule morphology as revealed by ultrasound，abundant blood flow in nodules，longitudinal and transverse diameter ratio of 1 and greater，edge angle，calcification and elevated TSH and TPOAb titer levels are risk factors of malignant thyroid nodules.Notably，abundant blood flow in nodules and calcification are more likely to occur in thyroid cancer with cervical lymph node metastasis.


Primary Hypertension and Vascular Compression of the Left Rostral Ventrolateral Medulla in Patients with Primary Hemifacial Spasm　

ZHAHG Qian，JIANG Lei，FENG Zhaohai，SHI Xin，MAIMAITIJIANG·Kasimu，HAO Yujun

2018, 21(36):  4453-4458.  DOI: 10.12114/j.issn.1007-9572.2018.00.058

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Objective　To explore the correlation between primary hypertension and vascular compression of the left rostral ventrolateral medulla（VCLRVM） among patients with primary hemifacial spasm（HFS）.Methods　The participants were enrolled from Department of Neurosurgery，the First Affiliated Hospital of Xinjiang Medical University from October 2014 to October 2017，consisting of 205 cases of primary HFS〔110 with left hemifacial spasm（including 35 with primary hypertension） and 95 with right hemifacial spasm（including 45 with primary hypertension）〕，and age- and sex-matched 205 with other cranial nerve diseases（control group） including 60 with primary hypertension.All of them underwent MRI of the internal auditory canal with 3D-FIESTA for identifying the status of VCLRVM.The association between primary hypertension and the prevalence of VCLRVM was investigated by intragroup and intergroup comparisons.Results　In the control group，the left and bilateral RVLM NVC rates of patients with essential hypertension were higher than those without essential hypertension，and the right RVLM NVC rates were lower than those without essential hypertension（P < 0.05）.In the control group，primary hypertension was found to be associated with higher prevalence of vascular compression of the rostral ventrolateral medulla（VCRVM）〔71.7%（43/60）vs 35.9%（52/145）〕（χ2=21.879，P<0.001）. The left RVLM NVC rate of patients with essential hypertension in left HFS subgroup was higher than that of patients without essential hypertension（P < 0.05）. In the left hemifacial spasm subgroup，primary hypertension was identified to be associated with higher prevalence of VCRVM〔91.4%（32/35）vs 46.7%（35/75）〕（χ2=20.081，P<0.001）.Furthermore，it was also associated with higher prevalence of VCLRVM（P<0.05）.In the right hemifacial spasm subgroup，primary hypertension was also found to be associated with higher prevalence of VCRVM〔77.8%（35/45）vs 46.0%（23/50）〕（χ2=10.058，P=0.002）. The left RVLM NVC rate of patients with essential hypertension in right HFS subgroup was higher than that of patients without essential hypertension（P < 0.05）.Compared with the controls，the prevalence of VCLRVM was higher in those with both primary hypertension and left hemifacial spasm（χ2=10.140，P=0.001）.However，the prevalence of VCRRVM in those with both primary hypertension and right hemifacial spasm was similar to that of the controls（χ2=2.917，P=0.088）.Conclusion　VCLRVM was more common in patients with both primary hypertension and left primary HFS.Moreover，it showed a correlation with the primary hypertension.


Bowel Function among Rectal Cancer Patients Receiving Neoadjuvant Chemoradiotherapy before Operation and Temporary Colostomy 　

WEN Yongshan，WU Xiaodan，LIU Qianwen，ZHONG Dongmei，ZHENG Meichun，QIN Huiying

2018, 21(36):  4459-4463.  DOI: 10.12114/j.issn.1007-9572.2018.00.031

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Objective　To investigate the changes in bowel function in patients with middle and low rectal cancer who underwent preoperative neoadjuvant chemoradiation and prophylactic colostomy，to provide evidence of improvement in bowel function in patients with middle and low rectal cancer.Methods　The study was a prospective longitudinal study.Study subjects were chosen through a convenient sampling method.The General Information Questionaire and Chinese version Memorial Sloan-Kettering Cancer Center（MSKCC） Bowel Function Questionnaire were used to conduct the survey study.A total of 97 patients with newly diagnosed middle and low rectal cancer who received neoadjuvant chemoradiation in the Affiliated Cancer Hospital of Sun Yat-sen University between October 2015 and October 2016 completed the questionnaire survey to assess their bowel function at various time points.Results　97，92，84，84 and 82 questionnaires were sent out，at the time of enrollment（T1），1 month after preoperative chemoradiotherapy（T2），the 4th day after colostomy（T3），3 months after colostomy（T4） and 6 months after colostomy（T5），and 97，92，84，82 and 82 questionnaires were recovered respectively. The scores from the Chinese version MSKCC Bowel Function Questionnaire were（69.5±8.9），（63.9±9.0），（59.9±7.2），（63.3±9.3） and（66.3±7.5），respectively.Among them，the total score of Chinese MSKCC intestinal function questionnaire at T1 was higher than that at T2，T3，T4 and T5，the total score at T2，T4 and T5 were higher than that at T3，and the total score at T5 was higher than that at T4（P<0.05）.At T5，the scores of the frequency factor，urgency factor，dietary factor and four items describing abnormal sensation were（17.5±2.7），（17.1±2.2），（15.8±2.4） and（11.7±3.1），respectively.Conclusion　The patients with rectal cancer had the best bowel function at the time of diagnosis followed by 6 months after colostomy，and had the worst bowel function at the 4th day after colostomy.Therefore，clinicians should pay special attention to the bowel symptoms of early postoperative patients and take measures to improve bowel function and quality of life in these patients.


Diagnostic and Prognostic Values of Quantification ELISA Interferon-γ Release Test Assays and Tuberculosis Skin Test for Tuberculosis Patients Undergoing Maintenance Hemodialysis　

LI Hong，XU Mingzhi，CHEN Ruman，AN Na，BAI Yafei，HUANG Xing，WANG Chunli，HE Jiqing，CAI Li，ZENG Xin，HAN Lizhen

2018, 21(36):  4464-4470.  DOI: 10.12114/j.issn.1007-9572.2018.00.237

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Objective　To study the diagnostic and prognostic values of quantification ELISA interferon-γ release test（QFT） and tuberculosis skin test（TST） for patients with tuberculosis〔including both latent tuberculosis infection（LTBI） and tuberculosis（TB）〕 undergoing maintenance hemodialysis（MHD） in areas with high prevalence of tuberculosis.Methods　Totaled 198 patients who underwent MHD in Blood Purification Center，Hainan General Hospital，for more than 3 months during 2013—2015 were enrolled.All of them were given a 3-year follow-up.Baseline clinical data were collected.The results of QFT and TST were also obtained and their values in the diagnosis and prediction of the prognosis of these patients were evaluated.Multivariate Logistic regression analysis was performed to investigate the influencing factors for positive results of QFT and TST.The prognosis of patients in 3 years was observed，and survival curves were drawn.Cox proportional hazards regression analysis was carried out to explore the factors associated with the prognosis.Results　156 cases who completed the study were included in the final analysis，including 109 males and 47 females，with an average age of（54.4±16.6）years and an average hemodialysis duration of（1.9±0.4） years.The prevalences of positive QFT，positive TST were 34.6%（54/156），67.9%（106/156），respectively.The results of TST and QFT in identifying TB showed no consistency（Kappa=0.053，P=0.405）.Multivariate Logistic regression analysis revealed that，after adjusting for other factors，sex〔OR=0.345，95%CI（0.144，0.828），P=0.017〕and no BCG vaccine scar〔OR=0.345，95%CI（0.144，0.828），P=0.017〕were risk factors for having a positive QFT result，the sex 〔OR=2.836，95%CI（1.120，7.177），P=0.028〕and the total lymphocyte count〔OR=3.573，95%CI（1.410，12.295），P=0.043〕were risk factors for having a positive TST result.Of the 37 patients identified with LTBI，11（29.7%） developed TB.The 3-year prevalence of TB in these patients was 42 948.7/100 000.The 1-，2-，3- year survival rates were 89.7%，77.6%，and 69.9%，respectively.Crud death rate was（CDR）301.3/1 000.Multivariate Cox proportional hazard regression analysis found that positive QFT results and elevated C-reactive protein（CRP） were unfavorable prognostic factors for the overall survival，while anti-TB treatment and elevated prealbumin were favorable prognostic factors for the overall survival（P<0.05）.Conclusion　In areas with high prevalence of tuberculosis in Hainan Province，among the CKD patients undergoing MHD，males were more likely to have a positive QFT result.The results of TST and QFT in diagnosing TB demonstrated no consistency.Positive QFT results and elevated CRP were unfavorable factors whereas anti-TB treatment and elevated prealbumin were favorable prognostic factors for the overall survival.In this population，the diagnosis of LTBI or TB should be based on epidemiologic data，past medical history，predisposing factors of TB，lung imaging data，exclusion of other infections and results of experimental anti-TB treatment.In addition，diagnostic measures such as histopathological examination and determination of bronchoalveolar lavage fluid concentration should be promoted vigorously.


The Distribution of Age at Menarche and Its Relationship with BMI among Adolescent Girls in Shaanxi　

WANG Zhenjie，LAN Xin，DANG Shaonong

2018, 21(36):  4471-4475.  DOI: 10.12114/j.issn.1007-9572.2018.00.167

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Objective　To investigate the age of menarche in adolescent girls，and to explore the association between BMI and the age at menarche.Methods　A total of 534 adolescent girls（10-19 years old） were randomly selected and investigated from Central Shaanxi，Southern Shaanxi and Northern Shaanxi from July to August 2007.The items of the questionnaire included general data（age，year of education），family background（family size，family income source），physical examination（height，body mass，etc.） to analyze the age distribution of menarche in adolescent maidens.According to the standard of American Center for Disease Control and Prevention（CDC），the BMI of adolescent girls was classified into low body mass（BMI<5%），normal body mass（5%≤BMI<85%），and high body mass（85%≤BMI<95%）.Multivariate Logistic regression analysis was used to analyze the relationship between menarche and BMI.Results　Among the 534 adolescent girls，446 cases（83.5%） had menarche，and 88 cases（16.5%） did not have menarche.The menarche age and its distribution among adolescent girls between rural and urban areas were statistically significant（P<0.05）.The menarche age of adolescent girls in Northern Shaanxi was older than Central Shaanxi and Southern Shaanxi（P<0.05）.The distribution of menarche at age among adolescent girls was statistically significant in different body masses（P<0.05）.The results of multivariate Logistic regression analysis presented that low body mass was positively associated with the age of menarche before and after adjusting the age，area and family background（P<0.05）.The risk of not having menarche increased by 11.39 times in low body mass group compared with normal body mass group.There was a positive correlation between high body mass and the menarche age before adjusting the age，area and family background（P<0.05）.There wasn't a positive correlation between high body mass and the menarche age after adjusting the age，area and family background（P>0.05）.Conclusion　The age of menarche in adolescent girls in Shaanxi province is significantly different between different regions or urban-rural areas.The menarche age of girls are related with their BMI，and the menarche age can be delayed due to lower BMI.


Changes in and Factors Influencing 25-hydroxyvitamin D Levels in Pregnant Women with Hashimoto Thyroiditis　

XIA Wei，ZHANG Chunyan，LI Pengqiu，BAO Mingjing，ZHANG Xuejun，YANG Yan，YANG Yi

2018, 21(36):  4476-4479.  DOI: 10.12114/j.issn.1007-9572.2018.36.011

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Objective　To investigate the levels of 25-hydroxyvitamin D〔25（OH）D〕in pregnant women with Hashimoto thyroiditis（HT） and to analyze factors influencing those levels.Methods　One hundred and two pregnant women with HT who met the study criteria and were treated in the Sichuan Academy of Medical Sciences＆Sichuan Provincial People's Hospital between January 2013 and July 2013 were selected as the HT group.To assess the influence of sunshine exposure，80 pregnant women without HT who were admitted during the same seasons were selected as a control group.The general data，thyroid-related indicators，and 25（OH）D levels of the patients were collected.To analyze the relationship between Vitamin D nutritional status and age，gestational week thyroid related indexes in pregnant women with HT and influencing factors of 25（OH）D level.Results　The levels of TT4，TT3，FT4，FT3 and 25（OH） D in HT group were lower than those in control group，while the levels of TSH，TPOAb and TgAb in HT group were higher than those in control group（P<0.05）. In HT group，FT4 level of vitamin D deficiency patients was lower than that of vitamin D deficiency patients，TSH and TPOAb levels were higher than those of vitamin D deficiency patients（P<0.05）.Spearman rank correlation analysis showed that Vitamin D nutritional status levels were positively correlated with FT4 levels in HT patients（rs=0.24，P<0.05） and negatively correlated with the levels of TSH and TPOAb（rs=-0.21 and -0.27，P<0.05）.Multivariate linear regression showed that FT4（t=2.002，P=0.042） and TPOAb（t=-2.981，P=0.004） were independent predictive factors for 25（OH）D level in pregnant HT patients.Conclusion　25（OH）D levels in pregnant HT patients were significantly lower than those in controls and were closely related to the levels of FT4 and TPOAb，thus suggesting that vitamin D may be involved in the pathogenesis of HT in pregnant women.

Temporary Balloon Occlusion of the Abdominal Aorta for Women with Pernicious Placenta Previa and Placenta Accreta Undergoing Cesarean Delivery　

HAN Yuwen，ZHENG Yanli，HAN Yun，XUE Lili

2018, 21(36):  4480-4484.  DOI: 10.12114/j.issn.1007-9572.2018.00.018

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Objective　To investigate the effectiveness of temporary balloon occlusion of the abdominal aorta（TBOAA） in the treatment of women with pernicious placenta previa and placenta accreta undergoing cesarean delivery.Methods　We enrolled 28 women with pernicious placenta previa and placenta accrete undergoing cesarean delivery from Department of Obstetrics and Gynecology，Nantong First People's Hospital from January 2013 to July 2017，including 14 volunteered to use TBOAA before the delivery（TBOAA group），and 14 did not（control group）.We collected and compared two groups' data about duration of cesarean delivery，blood loss during cesarean delivery，total transfusion volume，difference between the hemoglobin level before and after cesarean delivery，gestational weeks，duration of hospitalization，activated partial thromboplastin time（APTT） and D-dimer levels after cesarean delivery，incidence of hysterectomy and neonatal asphyxia.Results　Compared with the control group，the average blood loss during cesarean delivery，average total transfusion volume，and average difference between the hemoglobin level before and after cesarean delivery were all less in the TBOAA group（P<0.05）.Moreover，TBOAA group demonstrated shorter duration of hospitalization after cesarean delivery，and lower　incidence of hysterectomy and neonatal asphyxia（P<0.05）.However，both groups showed no significant differences in duration of cesarean delivery，gestational weeks，APTT and levels of D-dimer after cesarean delivery（P>0.05）.Conclusion　Use of TBOAA before the cesarean delivery could reduce the blood loss during the delivery and total transfusion volume，decrease the incidence of hysterectomy and improve the outcome.However，after the removal of the balloon，there might be still a risk of bleeding，and uterine artery embolization and other interventions might be needed to improve the outcome.


Study on the Health Management Theory and Practice in Urban Community　

ZHOU Guangqing，FU Jing，XIA Yao，ZHAO Ruirui，ZHANG Longsheng，ZHU Hong，LI Wenyuan，DAI Meng

2018, 21(36):  4484-4488.  DOI: 10.12114/j.issn.1007-9572.2018.00.123

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China's health management industry started relatively late but develops rapidly.Under the support of the State's policy of encouraging and supporting social capital to enter the medical and health industry，the health management industry has become one of the key areas.With the increasing number of patients with chronic disease，high cost of medical treatment and high demand for chronic disease service，our country has begun to delegate resources into lower levels and fasten the diagnosis of chronic diseases.The urban community primary health service agencies have become the backbone of the implementation of health management.This article introduced relevant theories of urban community health management.In the status quo of the health management of urban communities in Guangzhou，taking the Chebei Community in Tianhe District as an example，through the five aspects of talent training，technical support，chronic science popularization，brand effect and two-way referral，the practical experience of urban community health management is summed up，which aims to contribute to the construction of standardized urban community health management demonstration base.


Risk Factors for Lung Cancer among Residents over 65 Years Old in a Community in Shanghai：a Cross-sectional Study　

ZHANG Ning，ZHANG Xian，ZHOU Qianjun

2018, 21(36):  4489-4492.  DOI: 10.12114/j.issn.1007-9572.2018.00.312

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Objective　To explore the risk factors for lung cancer among residents over 65 years in Tianping Street community in Shanghai，providing a scientific basis for the development of health education interventions for the prevention and treatment of lung cancer.Methods　From April to June 2017，we enrolled 556 permanent residents from Shanghai's Tianping Street Community by stratified random sampling，and surveyed them with the Self-rated Lung Cancer Risk Scale（SLCRS）.Results　539 responsive scales were obtained，achieving a response rate of 96.9%（539/556）.The median SLCRS score was 85.According to the scoring criteria，153（28.4% of the total respondents） were at high risk of lung cancer，73.2% of whom were males（112 cases） and 26.8%（41 cases） were females.The prevalence of smoking in all the respondents was 27.1%（146/539）.Males had higher prevalence of smoking than females〔53.1%（130/245）vs 5.4%（16/294）〕（χ2=153.433，P<0.05）.Among all smokers，49.3%（72/146） smoked 1-10 cigarettes per day on average，45.0%（67/146） had been smoking for 20-40 years，94.0%（140/146） started smoking after turning 15.20.4% of the female respondents（60/294） smoked 200-299 cigarettes per year passively.Among all the respondents，0.9%（5/539） had a history of organ transplantation，0.6%（3/539） had connective tissue disease，13.2%（71/539） had chronic lung disease，48.4%（261/539） had exposure to oil fumes caused by cooking more than 151 plates of dishes per year，1.9%（10/539） had exposure to miners，0.8%（4/539） had exposure to asbestos，1.5%（8/539） frequently had depression，and 1.9%（10/539） had a family history of lung cancer，and 8.5%（46/539） had a family history of tumor.Conclusion　The prevalence of lung cancer risks among residents aged over 65 living in Tianping Street community in Shanghai can not to be ignored.The major lung cancer risks found are active and passive smoking，oil fume exposure and so on.In order to reduce the incidence of lung cancer and promote the health status of community-dwelling residents，we suggest that family doctors should vigorously promote tobacco control through health education，and deliver targeted and personalized interventions for individuals with lung cancer risk factors.


Role of Respiratory Out-patient Clinic Comprehensive Diagnosis and Treatment Center in Hierarchical Diagnosis and Treatment of Chronic Respiratory Diseases　

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

2018, 21(36):  4493-4497.  DOI: 10.12114/j.issn.1007-9572.2018.00.136

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The respiratory out-patient clinic comprehensive diagnosis and treatment center is an indispensable link in the tiered diagnosis and treatment of chronic respiratory diseases，and a transitional bridge for mutual transfer treatment between the respiratory specialist clinic and the community general clinic.This article introduces the current status and problems of hierarchical diagnosis and treatment of chronic respiratory diseases，and the clinical significance of the respiratory out-patient clinic comprehensive treatment center in the tiered diagnosis and treatment of chronic respiratory diseases：（1）to give clear diagnosis of patients who were early screened by community general practitioners，so as to improve the early diagnosis rate of chronic respiratory diseases to ensure the diagnosis accuracy；（2）to establish standardized treatment programs for patients with chronic respiratory diseases，and provide guidance for the upgrading or downgrading of follow-up treatment programs for retreated patients；（3）to promote the use of aerosol inhalation therapy in treating chronic respiratory diseases and popularize standardized inhalation therapy to community health service centers；（4）to provide training for general practitioners to improve their basic skills in using spirometer，performing non-invasive mechanical ventilation，home oxygen therapy and respiratory rehabilitation training；（5）to carry out health education to improve the patient's cognitive abilities of chronic respiratory disease.This article also introduces the site facilities，staffing and related diagnostic and treatment specifications of this center.


An Investigation of the Effect of Integrated Drug Management and Intervention on Drug Usage in Community Patients with Chronic Diseases　

LIU Zhonghua，SHI Ling，KUANG Haidong，YU Bin，LEI Yun

2018, 21(36):  4498-4501.  DOI: 10.12114/j.issn.1007-9572.2018.00.140

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Objective　To study the impact of integrated management and intervention on drug usage in community patients with chronic diseases.Methods　From May 2016 to July 2017，242 patients with chronic diseases treated in the Changfeng Community Health Care Center，Putuo（hereinafter referred to as the "center"）in Shanghai City who met the study inclusion and exclusion criteria were enrolled in this research.Baseline patient data including diseases and drug usage were recorded.Patients provided informed consent，and inappropriate drug use in these patients was recorded using a management and intervention strategy.After 3 months of intervention，drug usage（the number of administered drugs，drug adjustment and reasons）in the patients was investigated when the patients were stable and compared with the baseline data.Results　Diseases recorded were as follows：200 cases（82.6%）had hypertension，122 cases（50.4%）had coronary heart disease，63 cases（26.0%）had diabetes，55 cases（22.7%）had stroke，13 cases（5.4%）had osteoarthritis，12 cases（5.0%）had osteoporosis and 8 cases（3.3%）had chronic obstructive pulmonary disease（COPD）.There was no significant difference in the number of diseases between male and female patients（P>0.05）.Patients aged 80 years and ≥85 years suffered more diseases than patients aged 60 years and <60 years，and patients aged 70 years suffered more diseases than patients aged 60 years，patients aged 80 years also had more diseases than patients aged 65 years（P<0.05）.The number of administered drugs after the intervention was less than the number before the intervention（P<0.05）.Changes in the number of administered drugs were as follows：overall（-23.8%），male（-22.4%），female（-25.0%）；diseases according to their absolute change rates were COPD（-45.0%），stroke（-37.9%），osteoporosis（-28.6%），coronary heart disease（-24.0%），hypertension（-21.9%），osteoarthritis（-14.3%）and diabetes（-7.1%）.Before and after intervention，the number of administered drugs in male and female patients were not significantly different（P>0.05）.The number of administered drugs after the intervention was less than the number before the intervention in both male and female patients（P<0.05）.The number of administered drugs in patients with hypertension，coronary heart disease，stroke，diabetes or COPD after the intervention was less than the number before the intervention（self-comparison）（P<0.05），and both osteoporosis or osteoarthritis showed no significant difference（P>0.05）.Of the 242 patients，the number of drugs administered increased in 9 cases（3.7%），the number of drugs administered decreased in 142 cases（58.7%）and no change in the number of drugs administered was observed in 91 cases（37.6%）.Of 151 cases whose administered drugs were changed，there were 206 drug adjustments；the most common reasons for adjustment included：95 items（46.1%）of disease release，67 items（32.5%）of repeat medication，18 items（8.8%）of adverse reactions，14 items（6.8%）of irrational medication，and 12 items（5.8%）of increasing medication due to treatment requirement.Conclusion　Community patients often have multiple diseases and are administered multiple drugs.Integrated management and intervention can reduce repeat and irrational medications.


In Vitro Evaluation of Antithrombotic and Anticoagulant Effects of Shuxuetong Injection　

CHEN Yanming，XIA Ke，HE Yang，ZHAO Binxiao，ZHANG Zhongbing，JIANG Miao，ZHENG Shunliang，WANG Siyao，ZHOU Jianbo，BAI Fang

2018, 21(36):  4502-4505.  DOI: 10.12114/j.issn.1007-9572.2018.00.346

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Objective　To investigate the in vitro anticoagulant and thrombolytic effects of Shuxuetong Injection.Methods　The human peripheral blood from six healthy donors were collected in Institute of Hematology of Jiangsu Province from May to July 2015.The blood or plasma of the same healthy donors were used and divided into dosing group with 1∶9 volume ratio of Shuxuetong and blood or plasma（9 samples），and control group with 1∶9 volume ratio of 0.9% sodium chloride solution and blood or plasma（9 samples）.Blood parameters，coagulation index，fibrinolysis index，platelet function，and thrombus in vitro of dosing group and control group were evaluated.Results　Leukocyte count and platelet count of control group were higher than those of dosing group（P<0.05）.Erythrocyte count and hematocrit of two groups had no significant difference（P>0.05）.Activated partial thromboplastin time（APTT），prothrombin time（PT） and thrombin time（TT） of dosing group were longer than those of control group（P<0.001）.There was no significant difference in incidenca rate of clot retraction between two groups（P>0.05）.APTT，PT and TT in control group were longer than those before correction（P<0.05），and these in dosing group were shorter than those before correction（P<0.05）.The amount of D-dimer and t-PA in dosing group were higher than those in control group，and the amount of fibrinogen（FIB），euglobulin lysis time（ELT） and PAI-1 were lower than those in control group（P<0.05）.Platelet aggregation rate induced by ADP，ristomycin，collagen and thrombin in dosing group were higher than those in control group（P<0.05）.There was no significant difference in platelet adhesion rate between two groups（P>0.05）.The expression of P-selectin in dosing group was higher than that of control group（P<0.05）.The R time and K time of dosing group were longer than those of control group，and α-angle and maximum amplitude were lower than those of control group（P<0.05）.Conclusion　Shuxuetong Injection can have the effect of anti-coagulation，pro-fibrinolysis，anti-platelet aggregation and thrombosis inhibition in vitro.


Early Efficacy of High-dose Methylprednisolone Pulse in Treatment of Tuberous Sclerosis Complex with Infantile Spasms　

CHEN Hao，PAN Yangqiong，ZHANG Xiaoli，DU Kaixian，JIA Tianming，LI Xiaoli

2018, 21(36):  4506-4510.  DOI: 10.12114/j.issn.1007-9572.2018.00.266

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Objective　To investigate the efficacy and safety of intravenous high-dose methylprednisolone pulse in treatment of tuberous sclerosis complex（TSC）combined with infantile spasms（IS）.Methods　A retrospective analysis was carried out on 47 children with TSC combined with IS treated in the Third Affiliated Hospital of Zhengzhou University from July 2009 to July 2017，18 cases with duration less than or equal to 2 months and 29 cases longer than 2 months.According to treatment methods，subjects were divided into preferred methylprednisolone group（27 cases）and non-preferred methylprednisolone group（20 cases）.Methylprednisolone group was the first choice for children，and the first choice was high-dose methylprednisolone pulse.The non-preferred methylprednisolone group received high-dose methylprednisolone pulse therapy after failure of other antiepileptic drugs，the other antiepileptic drugs all reached the target dose of more than 2 weeks.The time of spasm controlling and proportion of spasm controllers in the first 5 days were observed.After the treatment，clinical effect in 1 and 2 weeks，EEG outcome in 2 weeks，the relationship between course of disease and clinical effect，and the adverse reactions were recorded.Results　The control time of spasm in the preferred methylprednisolone group was within 1 week of treatment，and the proportion of spasm controllers in the first 5 days was 66.7%（12/18）；the control time of spasm in the non-preferred methylprednisolone group was within 1 week of treatment，and the proportion of spasm controllers in the first 5 days was 57.1%（4/7）.At the 1st and 2nd week of treatment，the total effective rate and complete control rate of methylprednisolone group were higher than those of non-preferred methylprednisolone group（P<0.05）.There was no significant difference in the effective rate of EEG outcome between the two groups（P>0.05）.The complete control rate of EEG outcome in the methylprednisolone group was higher than that in the non-preferred methylprednisolone group（P<0.05）.The total effective rate of clinical efficacy in children with disease course ≤ 2 months was greater than that in patients with disease course > 2 months（P<0.05）.No serious adverse reactions occurred during the pulse treatment of high-dose methylprednisolone in all children.Conclusion　Application of intravenous high-dose methylprednisolone pulse in treatment of TSC combined with IS is simple and effective，and its short-term control effect of spasm is affirmative，with few and light adverse effects.With high safety，simple and feasible treatment，sufficient drug source and low price，it is a recommended application for children who are newly treated or had no response to other treatments.


Effects of Yiqichutanyangyin Decoction on Objective Response Rate and Chemotherapy Side Effects and Progression-free Survival among Patients with Stage Ⅳ Squamous Cell Lung Cancer　

WANG Zhiguang，LIN Lizhu，LIN Juze，SHI Wei，CHEN Xinri，CHEN Lian，ZHANG Shijie，RONG Zhen

2018, 21(36):  4511-4514.  DOI: 10.12114/j.issn.1007-9572.2018.00.222

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Objective　To investigate the effects of Yiqichutanyangyin Decoction on objective response rate（ORR） and chemotherapy side effects and progression-free survival（PFS） among patients with stageⅣ squamous cell lung cancer.Methods　We enrolled 79 inpatients with stage Ⅳ squamous cell lung cancer from Department of Oncology，the First Affiliated Hospital of Guangxi University of Chinese Medicine between August 2013 and September 2016 and randomized them into the treatment group（n=40） and the control group（n=39），receiving chemotherapy with Gemcitabine and Cisplatin（GP） combined with Yiqichutanyangyin Decoction，chemotherapy with GP，respectively.Both groups were treated for 4-6 cycles.The　ORR and chemotherapy side effects and PFS were compared between the groups at the end of treatment.Results　Both groups showed similar ORR（P>0.05）.The treatment group demonstrated lower degree of chemotherapy-reduced nausea and vomiting and less reduction in granulocytes as well as a longer PFS compared with the control group（P<0.05）.Conclusion　For patients with stage Ⅳ squamous cell lung cancer treated by chemotherapy with GP，although Yiqichutanyangyin Decoction could not improve the ORR，but the chemotherapy side effects could be reduced and the PFS could be prolonged.



Prevalence and Associated Factors of Anxiety and Depression in Patients Admitted for Chest Pain　

HAN Beibei，LI Yongguang，LI Shuai，ZHANG Yueli，LI Jingbo，WEI Meng，SHEN Chengxing

2018, 21(36):  4515-4520.  DOI: 10.12114/j.issn.1007-9572.2018.00.095

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Background　Chest pain patients are high-risk population for anxiety and depression，but the associations of anxiety and depression with coronary artery disease（CHD） and causes of chest pain have not been fully investigated.Objective　We carried out this study in order to evaluate the prevalence and associated factors of anxiety and depression in inpatients admitted for chest pain.Methods　We enrolled 358 participants from Shanghai Jiaotong University Affiliated Sixth People's Hospital from December 2016 to October 2017，including 310 consecutive patients admitted to Cardiovascular Department for chest pain（chest pain group） and 48 age- and sex-matched healthy physical examinees without self-reported chest tightness and chest pain（control group）.We collected the data concerning medical history，features of chest pain，and general characteristics（estimated by a self-developed General Questionnaire） of the chest pain patients.Generalized Anxiety Disorder 7（GAD-7） was used to evaluate anxiety，and Patient Health Questionnaire-9（PHQ-9） was applied to evaluate depression in both groups.Comparisons were performed between chest pain patients and controls，between chest pain patients with CHD and those without in terms of the prevalence of anxiety and /or depression，and between chest pain patients with anxiety and/or depression and those without regarding the features of chest pain，coronary stenosis and causes of chest pain.Multivariate Logistic regression analysis was used to determine the associated factors of anxiety and depression in chest pain patients.Results　Compared with the controls，chest pain patients were found with higher prevalence of anxiety，prevalence of depression and prevalence of anxiety and depression（P<0.05）.Chest pain patients with CHD showed lower prevalence of anxiety，prevalence of depression and prevalence of anxiety and depression than those without（P<0.05）.The duration of suffering from chest pain，the time of onset of chest pain，shortness of breath during activity，prevalence of multiple physical symptoms，the proportion of turned better by taking vasodilator drugs within 0.5 hours differed significantly between chest pain patients with anxiety and / or depression and those without（P<0.05）.Multivariate Logistic regression analysis revealed that in chest pain patients，severely stressful life experience and insufficient social support were risk factors while smoking was a protective factor for anxiety（P<0.05），prolonged duration of suffering from chest pain，multiple physical symptoms and insomnia were risk factors for depression（P<0.05）.Conclusion　Patients admitted for chest pain are at high risk of anxiety and depression.Those with at least one of the risk factors（severely stressful life experience，insufficient social support，prolonged duration，coexistence of multiple physical symptoms，insomnia） may possibly have anxiety and/or depression.


Mediating Effect of Life Meaning between Family Functioning and Suicide Risk in Freshmen　

ZENG Haikuan，ZHAO Jiubo，ZHANG Xiaoyuan

2018, 21(36):  4521-4526.  DOI: 10.12114/j.issn.1007-9572.2018.00.099

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Objective　To explore the mediating effects of life meaning between family functioning and suicide risk in freshmen，providing a reference for the delivery of suicide prevention interventions for this population.Methods　In November 2015，all the 2015 admitted full-time undergraduate students（2 900 cases） from Southern Medical University were recruited in this survey using self-developed Demographic Questionnaire，Suicide Behaviors Questionnaire-Revised（SBQ-R），Family APGAR（APGAR） and Meaningful Life Measure（MLM）.The mediating effects of life meaning between family functioning and suicide risk in them were analyzed.Results　A total of 2 787 cases〔including 979 males（35.1%） and 1 808（64.9%） females with a mean age of（18.4±0.8） years〕 returned responsive questionnaires，with a response rate of 96.1%.The mean score for SBQ-R，APGAR and MLM achieved by the respondents was（4.2±1.5），（7.8±2.3），（129.9±17.5），respectively.Both APGAR and MLM scores had significant negative correlation with SBQ-R score（P<0.05）.And there was a significant positive correlation between MLM and APGAR scores（P<0.05）.The suicide risk was influenced directly and significantly by the APGAR score（β=-0.176，P<0.001），and it decreased obviously with the increase of the importance of mediation variable of MLM score（β=-0.270，P<0.001），which indicated that the partial mediating effect of life meaning on the relationship between family functioning and suicide risk was significant，with an effect size of 0.12（accounting for 41% of the total effect）.Conclusion　The life meaning partially mediated the relationship between family functioning and suicide risk in college students.


Analysis of Clinical Features of 22 Cases of Cryptogenic Multifocal Ulcerous Stenosing Enteritis　

LI Wenkun，LIU Kuiliang，WU Jing

2018, 21(36):  4527-4530.  DOI: 10.12114/j.issn.1007-9572.2018.00.028

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Objective　To analyze the clinical features of cryptogenic multifocal ulcerous stenosing enteritis（CMUSE） and to provide a reference for clinical diagnosis and treatment.Methods　A case of CMUSE admitted to Beijing Shijitan Hospital，Capital Medical University in February 2012 was retrieved.And related databases were searched to collect case reports of CMUSE.The general data，clinical manifestations，laboratory tests，imaging examinations，endoscopy and pathology data，treatment methods and outcomes of the patients were summarized and analyzed.Results　Twenty-two cases were collected，comprising 18 confirmed cases and 4 suspected cases.There were 10 males and 12 females with a median age of 32 years.The median time from disease onset to diagnosis was 3 years.Common clinical symptoms included abdominal pain（20 cases），bloating（10 cases），nausea and vomiting（8 cases），black stool（7 cases） and so on.Laboratory tests showed 12 cases of hypoalbuminemia and 11 cases of positive occult blood.There were 11 cases undergoing enteroscopy，9 cases undergoing capsule endoscopy and 8 cases undergoing double contrast radiography of small intestine，and positive findings were found in all cases.Twelve cases received surgical treatment，and seven cases relapsed after operation.Twelve cases received glucocorticoid treatment，among which eight cases experienced remission，and the treatment was ineffective in four cases.One case was responsive to infliximab treatment.Conclusion　CMUSE is a rare disease characterized by multiple small intestine superficial ulcers and intestinal lumen stenosis.Capsule endoscopy and double-balloon enteroscopy are important for the diagnosis of the disease.Hormone treatment is the first-line therapy.Endoscopic balloon dilation is used for treatment，and other treatments include nutritional support and surgery.


Prostate Abscess：Case Report and Review of the Literature　

LI Xianyong，ZHAO Hui，GUAN Runyun，GU Peng，CHEN Yuelong

2018, 21(36):  4531-4536.  DOI: 10.12114/j.issn.1007-9572.2018.36.023

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Objective　To explore the clinical features of prostate abscesses（PA） and provide reference for clinical treatments.Methods　Four PA patients admitted to the First Affiliated Hospital of Kunming Medical University from January 2005 to October 2017 were selected to investigate the clinical features of PA.Using the PubMed database with the title or keyword “prostate abscess OR prostatic abscess” from November 2007 to November 2017.Then，we analyzed the clinical features of PA.Results　Among the 4 patients，2 had a history of diabetes，1 had a history of catheterization，1 had a history of benign prostatic hyperplasia，1 had a sense of volatility following a digital rectal examination，and 2 had bacterial cultures of pus positive for Escherichia.coli.All of the patients recovered after surgery.A total of 379 PA patients were included in the literature search.Among the patients，diabetes（28.0%），urethral tract invasion（12.9%），and immunosuppression（7.1%） were the predominant susceptibility factors for PA.Fever（59.6%），urinary tract irritation（36.7%），and pain（33.5%） were the main symptoms.E.coli（26.4%），Klebsiella pneumonia（13.5%），and Staphylococcus aureus（7.1%） were common pathogens.Most of the patients required surgical intervention.Conclusion　The early symptoms of PA are not specific and are difficult to diagnose.Suspected cases of PA should be promptly diagnosed using transrectal ultrasound，CT，or MRI.The treatment of PA is mainly based on sensitive antibiotics，transrectal puncture and drainage of the PA，and urethral drainage to the top of the PA.



Developments of ANXA2 in Autoimmune Diseases　

WANG Zengzeng，XU Ting，WU Min

2018, 21(36):  4537-4540.  DOI: 10.12114/j.issn.1007-9572.2018.00.185

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Annexin A2（ANXA2）is a member of calcium-dependent membrane-bound protein family，which is closely associated with various diseases such as oncogenesis.Recently，the importance of ANXA2 in autoimmune system diseases has attracted more and more attention.This article describes recent developments in ANXA2 on autoimmune diseases，including rheumatoid arthritis，antiphospholipid syndrome，systemic lupus erythematosus，ankylosing spondylitis，and inflammatory bowel disease.It is believed that ANXA2 is involved in the pathogenesis of various autoimmune diseases and may become a new diagnostic index and therapeutic target for various autoimmune diseases.