Chinese General Practice

Multidisciplinary and Stratified Management for Pregnancy Complicated with Heart Diseases　

ZHANG Jun

2019, 22(3): 247-252. DOI: 10.12114/j.issn.1007-9572.2018.00.381

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The incidence of cardiovascular diseases during pregnancy in women with heart disease，including previous and newly diagnosed ones is from 0.5% to 3.0%，and it is one of the important causes of maternal mortality.Pregnancy complicated with heart diseases has always been the primary non-obstetric factor of maternal mortality，which highlights the importance of improving the diagnosis，treatment and management of pregnancy complicating heart disease in reducing maternal mortality and improving both maternal and infant outcomes.Because of its complex etiology，hemodynamic changes，coagulation mechanism changes，and pregnancy complications，the diagnosis and treatment of pregnancy complicated with heart disease involves gynecology，obstetrics，cardiology，cardiac surgery，anesthesiology and critical care medicine.Therefore，effective communication and cooperation among different disciplines is the key to the diagnosis and treatment of pregnant women with heart disease.In addition，not every pregnant woman complicated with heart disease has extremely high-risk pregnancy.Therefore，stratified management is the most basic management concept.Community-level health care services and most institutions with the department of maternal and child healthcare should identify，diagnose and assess risks before and during early pregnancy.

Research Progress on Maternal Folic Acid Level and Pregnancy Outcomes　

ZHANG Ting，LI Guanghui

2019, 22(3): 253-257. DOI: 10.12114/j.issn.1007-9572.2018.00.396

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Folic acid，as an essential B group water-soluble vitamin，plays an important role in embryo development，body growth and metabolism.Lack of folic acid in pregnant women can lead to neural tube malformations，such as spina bifida and encephalomeningocele，and adverse maternal outcomes，such as gestational hypertension，premature birth，and anemia in pregnant women and infants.Excessive folic acid supplementation can also cause problems，such as neurological manifestations of vitamin B12 deficiency.In this paper，the physiological role of folic acid，evaluation methods，effects on maternal and infant outcomes，and related recommendations on folic acid supplementation were discussed.

Advances in the Effects of Maternal Iron Status and Iron Supplementation during Pregnancy on Perinatal Outcome　

YAN Qi，LI Guanghui

2019, 22(3): 258-262.

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Iron deficiency is the most common nutrition problem in the world.The demand for iron is greatly increased in pregnant women，so they are more susceptible to iron deficiency anemia.Iron supplements have been widely used nowadays.But improper use may result in iron overload.And this will also have a negative impact on the perinatal outcome.We reviewed many articles，and summarized the research progress of the impact of maternal iron deficiency，iron deficiency anemia and iron excess during pregnancy on perinatal outcome，and put forward that iron supplementation and the safe dose of iron supplements are very important for women with iron deficiency or low risk of iron deficiency anemia during pregnancy.However，there is no global consensus on the safety of iron supplementation and effective dose of iron supplements for pregnant women，so more relevant studies are needed.

Clinical Features and Maternal and Infant Outcomes in Pregnant Women with Infective Endocarditis：a Literature Analysis　

ZHOU Fating，ZHU Xiaodan，ZHU Hongling，YU Xiaogang，WANG Jing，LI Hua，ZHANG Rong

2019, 22(3): 263-269. DOI: 10.12114/j.issn.1007-9572.2018.00.349

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Background　 Infective endocarditis in pregnancy is quite rare.At present，there are several reported cases，while the characteristics，risk factors，pathogens，treatment，prognosis of mothers and infants are still unclear.Moreover，it is also difficulty for medicines in antibiotics，anesthetics and timing of surgery.Objective　To explore the risk factors，clinical features，and maternal and infant outcomes of infective endocarditis（IE） in pregnancy based on the reviewing of articles about IE in pregnancy published in recent 10 years.It may provide a scientific basis for the treatment of this disease.Methods　Articles about IE in pregnancy published during January 2008 to January 2018 were searched from September 2017 to July 2018，from the electronic databases of PubMed，EMbase，Ovid，Cochrane Library，ENTRAL，CBM，VIP，CNKI and Wanfang Data Knowledge Service Platform.Data extraction was conducted.The clinical characteristics，risk factors and pathogens of IE in pregnancy，maternal and infant mortality from IE in pregnancy were analyzed.Results　A total of 34 articles were included，involving 42 cases of IE in pregnancy.The average onset age was（27.9±5.3） years.The common clinical symptoms were fever（31 cases），cough（13 cases），dyspnea（11 cases），accounting for 73.8%，31.0%，and 26.2% of the total，respectively.The major risk factors for IE in pregnancy were congenital heart disease（13 cases） and intravenous drug abuse（6 cases），accounting for 31.0% and 14.3% of the total，respectively.Left atrioventricular valve was the site mainly involved，often with valve excrescences and abnormal heart murmurs.The rate of positive blood culture results was 84.2%（32 cases），and the detected major pathogenic bacteria were Staphylococcus and Streptococcus.The maternal mortality was 9.5%.Of the 42 fetuses，31（73.8%） healthy ones were delivered and discharged from hospital，3 （7.1%） were dead fetuses，1（2.4%） was aborted medically，and other 7 （16.7%） had unknown outcomes.Conclusion　 IE in pregnancy is quite rare and it has no typical clinical presentations.Moreover，it may easily cause maternal and infant deaths.Therefore，for pregnant women with recurrent fever and abnormal heart murmurs detected during auscultation，echocardiography and blood culture test should be underwent timely，in order to determine whether they have IEF，and for those with a definite diagnosis of IE，multidisciplinary treatment should be performed as soon as possible if necessary.

Ultrasound Weighted Score in Differentiating Benign and Malignant Breast Nodules　

WU Jingping，YU Lei，ZHAO Yuzhen，WANG Ying，GUO Dandan，LIU Jian

2019, 22(3): 270-274. DOI: 10.12114/j.issn.1007-9572.2018.00.328

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Background　The clinical application of breast ultrasound BI-RADS grading system is becoming more and more widespread.However，there is no unified standard for scoring rules.Objective　To evaluate the diagnostic efficacy of weighted score in differentiating benign and malignant breast nodules.Methods　A total of 185 patients，194 nodules（103 malignant nodules and 91 benign nodules） in total underwent breast ultrasonography in the Department of Ultrasound of China-Japan Friendship Hospital were selected from January 2012 to December 2016.The shape，orientation，margin，echo pattern，echo halo，posterior acoustic features，and microcalcification of nodules were described in accordance with the Guidelines for Ultrasound Examination of Superficial Organs in China.Differential diagnosis of benign and malignant breast nodules was carried out.The specificity of each malignant ultrasound sign （irregular shape，non-parallel orientation，irregular margin，low echo，posterior echo attenuation，high echo halo，micro-calcification focus） was studied and the ultrasound signs were scored.The weighted total score was obtained by adding all malignant signs scores.Using 1.5 cm as the standard，the nodules were divided into small nodule（≤1.5 cm，81） and large nodule（>1.5 cm，113）.The value of ultrasound weighted score in the diagnosis of benign and malignant nodules of different sizes was studied.Results　The weighted score of malignant nodules was greater than that of benign nodules （P<0.05）.For all nodules，the weighted score of 5.5 was the best diagnostic cutoff point and the diagnostic sensitivity，specificity，positive predictive value，negative predictive value and accuracy were 87.4%，81.3%，84.1%，85.1%，84.5%，respectively.For small nodules（≤1.5 cm），the best cutoff point was 4.5，and diagnostic sensitivity，specificity，positive predictive value，negative predictive value，and accuracy were 80.5%，65.0%，70.2%，76.5%，72.8%，respectively.For big nodules（>1.5 cm），the best cutoff point was 5.5，and the diagnostic sensitivity，specificity，positive predictive value，negative predictive value and accuracy were 93.5%，90.2%，92.1%，92.0%，92.0%，respectively.The accuracy of weighted scoring in the diagnosis of large nodules was higher than that of small nodules（P<0.001）.Conclusion　The weighted score method has high application value in differentiating benign and malignant breast nodules.In particular，the differential diagnosis between benign and malignant nodules is better than that of small nodules.

Risk Factors for Rebleeding after Aneurysmal Subarachnoid Hemorrhage　

FAN Jianhua，WANG Zhengze，GAO Lianbo

2019, 22(3): 275-278. DOI: 10.12114/j.issn.1007-9572.2018.00.186

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Background　Subarachnoid hemorrhage（SAH） is a common emergency of the nervous system，intracranial aneurysm rupture is the first cause of spontaneous SAH，and aneurysm rebleeding is the most common and serious acute complication of aneurysmal subarachnoid hemorrhage（aSAH）.However，there is still no consensus on the risk factors of re-bleeding in aSAH patients.Objective　To analyze the risk factors for rebleeding after aSAH，so as to guide the prevention of rebleeding in patients with aSAH.Methods　A retrospective analysis of the clinical data of 200 patients with aneurysmal subarachnoid hemorrhage admitted in the Fourth Affiliated Hospital of China Medical University from January 2010 to July 2017.Subjects were divided into rebleeding group（n=46） and non-rebleeding group（n=154） according to whether there was rebleeding within 1 month after the initial hemorrhage.Hunt-Hess grade and modified Fisher grade were estimated according to the clinical and imaging features，and Univariate analysis and Multivariate Logistic analysis were used to identify the risk factors of rebleeding.Results　Univariate analysis showed that，there were statistical difference in the average systolic blood pressure，Hunt-Hess grade，modified Fisher grade，diameter of the ruptured aneurysm between two groups（P<0.05），while there were no difference in patients' gender，age，glycemia，white blood cell count，and aneurysm locationwere between two groups（P>0.05）．Multivariate Logistic regression analysis showed that the average systolic blood pressure was not related to rebleeding （P>0.05），and Hunt-Hess grade，modified Fisher grade，diameter of the ruptured aneurysm，and posterior circulation aneurysms were risk factors for rebleeding of aSAH（P<0.05）．Conclusion　Hunt-Hess grade，modified Fisher grade，diameter of the ruptured aneurysm，and posterior circulation aneurysms were risk factors for aneurysm rebleeding，which should be actively prevented.

Visceral Fat Area for the Prediction of 10-year Risk of Ischemic Cardiovascular Disease in Populations with Normal BMI and Increased Visceral Fat Undergoing Physical Examination　

WANG Jing，LI Hu，GU Fei，BI Yan，XIANG Meizhen，DING Jie，ZHOU Weihong

2019, 22(3): 279-283. DOI: 10.12114/j.issn.1007-9572.2018.00.076

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Background　Visceral fat is critical for assessing cardiac metabolic risk，but the use of visceral fat area（VFA） to estimate 10-year high risk of having an ischemic cardiovascular diseases（ICVD） is rarely reported.Objective　To identify the cutoff value and sex-specific cutoff VFA for the prediction of 10-year risk of ICVD in populations from Nanjing undergoing physical examination，and to use them to predict the 10-year risk of ICVD in those with normal body mass index（BMI） and increased visceral fat.Methods　We enrolled 3 398 individuals aged 35-59 years who underwent physical examination in Health Management Center，Nanjing Drum Tower Hospital，the Affiliated Hospital of Nanjing University Medical School between June 2016 and June 2017.The simplified prediction models for estimating 10-year risk of ICVD in Chinese adults were used to assess the 10-year risk of ICVD.Human body composition analyzer was adopted to measure the VFA.And the 10-year risk of ICVD in individuals with normal BMI and increased VFA was analyzed.Results　The AUC and cutoff value of VFA were 0.60，85.5 cm2，respectively，for predicting the medium to high 10-year risk of ICVD in the populations undergoing physical examination，0.65，85.5 cm2，respectively，for predicting the medium to high 10-year risk of ICVD for males in the populations，and 0.68，111.9 cm2 for predicting the medium to high 10-year risk of ICVD for females in the populations.230（16.91%） of the 1 360 individuals with normal BMI were found with VFA≥85.5 cm2，including 216 females and 14 males，although females outnumbered males（χ2=150.02，P<0.001）.Compared with males with normal BMI and VFA<85.5 cm2，males with normal BMI and VFA≥85.5 cm2 demonstrated a higher medium to high 10-year risk of ICVD（21.43% vs 5.45%，χ2=3.78，P=0.042），as well as a higher absolute 10-year risk of ICVD〔（6.40±6.77）% vs （3.83±3.38）%；t=2.71，P<0.001〕.Compared with females with normal BMI and VFA<85.5 cm2，females with normal BMI and VFA≥85.5 cm2 showed a higher absolute 10-year risk of ICVD〔（2.04±1.49）% vs （1.65±1.41） %；t=3.46，P=0.010〕.Compared with females with normal BMI and VFA≥85.5 cm2，males with normal BMI and VFA≥85.5 cm2 showed a higher absolute 10-year risk of ICVD（t=7.27，P<0.001）.Conclusion　The cutoff value of VFA estimated by bioelectrical impedance analysis for predicting high 10-year risk of ICVD in populations undergoing physical examination was 85.5 cm2.Increased 10-year risk of ICVD was found in both males and females with normal BMI and increased VFA，and males faced higher risk than females.Therefore，maintaining the normal VFA is of great significance.Moreover，targeted multiple interventions should be delivered in order to reduce the 10-year risk of ICVD.

Longitudinal Study on the Correlations between Symptom Clusters and Quality of Life in Patients with Gastric Cancer during Chemotherapy　

WANG Dandan，ZHENG Wei，HOU Shouchao，CHEN Dandan，SHI Yanping

2019, 22(3): 284-291. DOI: 10.12114/j.issn.1007-9572.2018.00.265

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Background　Studying the longitudinal developmental changes of the symptom cluster can obtain the pattern of symptom cluster changes and stable symptom cluster，which is conducive to the continuous management of symptoms.At present，there is no longitudinal study report on the symptom cluster of gastric cancer.Objective　To longitudinally study the symptom clusters and quality of life（QOL）in patients with gastric cancer during chemotherapy in order to lay the foundation for guiding clinical management of continuous symptoms and improving patients' QOL.Methods　A longitudinal study was conducted among patients who underwent gastric cancer surgery and postoperative chemotherapy at the Second Affiliated Hospital of Zhengzhou University from September 2016 to May 2017.After completing the written informed consent form，they received questionnaire surveys for collecting the general clinical data with a self-developed General Clinical Data Questionnaire，investigating the symptom clusters with the Chinese version of Memorial Symptom Assessment Scale（MSAS）on the day prior to chemotherapy（T1），on the second day following the 3rd cycle of chemotherapy（T2），and on the second day following the 6th cycle of chemotherapy（T3），and obtaining the status of QOF with the Chinese version of Functional Assessment of Cancer Therapy-General（FACT-G）at T1，T2，T3.The latter two types of surveys achieved a response rate of 98.2%（224/228）at T1，a response rate of 99.1%（221/223）at T2〔the total number（223）of participants dropped by 5 cases（4 were lost to follow up，and 1 died）compared with at T1（228）〕，and a response rate of 98.2%（214/218）at T3〔the total number（218）of participants dropped by 5 cases（3 were lost to follow up，and 2 died）compared with at T2（223）〕.The correlations between symptom clusters and QOL were analyzed.Results　At T1，the average number of symptom clusters was 28.9（27.2，30.7），and the top three symptoms with the highest frequency were weight loss，dry mouth，pain（such as abdominal pain and low back pain）；and the top three symptoms with the highest severity scores were difficult concentrating，body swelling/bloated/abdominal distention，and swelling of arms or legs.At T2，the average number of symptom clusters was 17.8（15.7，20.4），the top three symptoms with the highest frequency were lack of energy，pain（such as abdominal pain，low back pain），and cough；and the top three symptoms with the highest severity scores were lack of energy，sweats，and pain（such as abdominal pain and low back pain）．At T3，the average number of symptom clusters was 21.8（20.7，22.9），and the top three symptoms with the highest frequency were lack of energy，weight loss，and lack of appetite，and the top three symptoms with the highest severity scores were lack of energy，lack of appetite，and sweats.Five symptom clusters（lack of energy，gastrointestinal，psychosomatic，surgery-related，neurological）were found in all the respondents at T2，and 4（lack of energy，gastrointestinal，psychosomatic，neurological）were found in them at T3.The symptoms included in the corresponding symptom clusters differed significantly over the treatment time.At different treatment time points，the differences in physical well-being，social/family well-being，emotional well-being，functional well-being scores and quality of life scores of gastric cancer patients were significant（P<0.05）．At T1，T2 and T3，the severity scores of symptom clusters were negatively correlated with physical well-being，social/family well-being，emotional well-being，functional well-being scores and total quality of life score（P<0.05）．Conclusion　Gastric cancer patients have multiple stable symptom clusters during chemotherapy，such as gastrointestinal symptom cluster，lack of energy symptom cluster，psychosomatic symptom cluster，and neurological symptom cluster，and the more serious these symptoms are，the lower the patients' quality of life will be.

Prevalence of Benign Prostatic Hyperplasia with Fatty Liver Disease and Its Influencing Factors among Male University Teachers　

HUANG Zhijie，HU Yiping，LIU Fengqin，WANG Haoxiang，ZHOU Zhiheng，CHEN Baoxin，OU Wensen，WU Wenlin，YANG Zhipeng，ZHANG Man，ZHONG Yongyi，WANG Jiaji

2019, 22(3): 292-295. DOI: 10.12114/j.issn.1007-9572.2018.00.177

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Background　The incidence of benign prostatic hyperplasia（BPH） or fatty liver disease（FLD） in male university teachers is high，and both diseases are often accompanied.At present，the pathogenesis of the two diseases and the causes of their concomitant diseases are not clear yet.Objective　To explore the prevalence rate of BPH with FLD and its influencing factors among male university teachers，providing a basis for the formulation of targeted prevention and control strategies.Methods　The enrolled 2 136 male university teachers were sampled from individuals undergoing physical examination in the physical examination center of a university hospital in Guangzhou between January 2016 and January 2017，including 500 with BHP（BHP group） and 311 with BHP and FLD （combination group）．Clinical data of these two groups were analyzed comparatively.Influencing factors of BHP combined with FLD were analyzed by using multivariate Logistic regression.Results　Totaled 811 cases（38.0%） were found with BHP，311 of whom （38.4%） were identified with FLD.Those with BHP and FLD demonstrated significantly increased mean levels of BMI，urine protein，fasting blood glucose（FBG），urine specific gravity（USG），uric acid（UA），low-density lipoprotein，triacylglycerol（TG），diastolic blood pressure compared with those with BHP （P<0.05）．Multivariate Logistic regression analysis showed that increased BMI〔OR=1.447（1.306，1.603），P<0.001〕，FBG〔OR=1.694 （1.365，2.103），P<0.001〕，UA〔OR=1.003（1.000，1.006），P<0.05〕and TG〔OR=1.590 （1.186，2.132），P<0.05〕were risk factors for BHP combined with FLD，while increased high-density lipoprotein was the protective factor for BHP combined with FLD〔OR=0.389（0.162，0.931），P<0.05〕.Conclusion　The prevalence rate of BHP combined with FLD is higher than that of BHP among male university teachers.BMI，FBG，TG，UA and high-density lipoprotein are the influencing factors of BHP combined with FLD.

Roles of Particular Species of Gut Microbiota in Chronic Functional Constipation Patients and Their Responses to Treatment with Synbiotics　

HAUNG Linsheng，QU Xiao，KONG Cheng，PAN Dengdeng，ZHANG Xiaohui，SHEN Tongyi，QIN Huanlong

2019, 22(3): 296-301. DOI: 10.12114/j.issn.1007-9572.2018.00.188

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Background　Chronic functional constipation is a common clinical intestinal disease.At present，more and more evidences indicate that microbial treatments have a positive clinical efficacy，but it need to be further explored that how it changes the intestinal microenvironment.Objective　To further explore the roles of particular species of gut microbiota in chronic functional constipation（CFC） and their responses to treatment with synbiotics based on our previous studies.Methods　This study was conducted from July 2016 to March 2017 between the constipation group（6 cases of CFC selected from the 24 participants of our previous studies） and the healthy group（6 controls sampled from the healthy community-dwelling individuals）．Fresh fecal samples were collected with the stool sample collection kit from the constipation patients before and after the treatment with synbiotics and from the controls.All samples were transported with ice and stored in - 80 ℃ refrigerator in laboratory，and analyzed with the metagenomic detection.The abundance of the detected particular species of gut microbiota was analyzed comparatively and their roles were interpreted.Results　A total of 10 species of Bifidobacterium were detected.Compared with the healthy group，the constipation group demonstrated much higher abundance of Bifidobacterium dentium，Bifidobacterium adolescentis and Bifidobacterium animalis before receiving the treatment（P<0.05）．Bifidobacterium animalis increased significantly in the constipation group after treatment（P<0.05）．Totaled 38 species of Lactobacilli were identified.The constipation group showed much lower abundance of both Lactobacillus oris and Lactobacillus reuteri before receiving treatment than the healthy group（P<0.05）．After treatment，the constipation group presented obviously enhanced abundance of Lactobacillus oris（P<0.05）．Moreover，the abundance of Escherichia coli，a species of Escherichia，declined significantly in the constipation group after treatment（P<0.05）．The constipation group demonstrated much lower abundance of 6 species of Prevotella before treatment compared with the healthy group（P<0.05）．Genes of these gut microbiota mainly involve in carbohydrate metabolism.PCoA analysis showed that the distribution of genes of gut microbiota in CFC patients was significantly different from that of the healthy controls，moreover，it showed little changes in the CFC patients after treated by synbiotics.Conclusion　The particular species of gut microbiota in CFC patients were significantly different from those of the healthy people.The treatment with synbiotics plays a positive role in treating CFC might be via improving the metabolic environment of the gut microbiota，for the abundance of the traditional probiotics showed little responses to the treatment.

Impact of Coxsackievirus B3 Infection on HL-1 Cardiomyocytes and Mesenchymal Stem Cells　

PENG Jun，WEI Wenjuan，QIAN Zhengming，HUANG Jianzhen，GAO Shilong，ZHANG Zhaocai

2019, 22(3): 301-305. DOI: 10.12114/j.issn.1007-9572.2018.00.249

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Background　Dilated cardiomyopathy（DCM）is characterized by dilated heart chambers and decreased contractile function，with or without heart failure.Myocarditis contributes to dilated cardiomyopathy，and Coxsackie Virus B（CVB）is the commonest virus which could lead to myocarditis.It was widely reported that mesenchymal stem cells（MSCs）applied for acute myocardial infarction and heart failure，but seldom used for the research of myocarditis.Objective　To compare the impact of Coxsackievirus B3（CVB3）infection on HL-1 cardiomyocytes and mesenchymal stem cells in order to find a new treatment for myocarditis.Methods　We carried out this study from June 2015 to June 2017.HL-1 cardiomyocytes and MSCs were cultivated separately to 80% confluence for use.HL-1 cardiomyocytes and MSCs were divided into non-CVB3-infected group（cultured in serum free medium for 1 hour），and CVB3-infected groups〔including 4-hour-infection group（infected with CVB3 for 4 hours），12-hour-infection group（infected with CVB3 for 12 hours），24-hour-infection group（infected with CVB3 for 24 hours）〕，respectively.qPCR was used to detect CVB3 genome copy numbers in infected groups of HL-1 cardiomyocytes and MSCs.HL-1 cardiomyocytes and MSCs were divided into non-CVB3-infected group（cultured in serum free medium for 1 hour），and CVB3-infected group（infected with CVB3）.MTS cell proliferation assay was adopted to determine the cell viability of non-CVB3-infected group and CVB3-infected group of HL-1 cardiomyocytes and MSCs at 4，12，24 h after infection.CVB3 was used to infect HL-1 cardiomyocytes（CVB3-infected HL-1 cardiomyocytes group）and MSCs（CVB3-infected MSCs group）.Plaque assay was employed to measure the viral titers in CVB3-infected groups of HL-1 cardiomyocytes and MSCs.Results　The CVB3 genome copy number differed significantly between non-CVB3-infected HL-1 cardiomyocytes group，4-hour-CVB3-infected HL-1 cardiomyocytes group，12-hour-CVB3-infected HL-1 cardiomyocytes group，and 24-hour-CVB3-infected HL-1 cardiomyocytes group（P<0.05）．Similarly，it varied obviously between non-CVB3-infected MSCs group，4-hour-CVB3-infected MSCs group，12-hour-CVB3-infected MSCs group，and 24-hour-CVB3-infected MSCs group（P<0.05）．The cell viability at 4，12，24 h after infection of non-CVB3-infected HL-1 cardiomyocytes group was much higher than that of the CVB3-infected HL-1 cardiomyocytes group（P<0.05）．The cell viability in CVB3-infected HL-1 cardiomyocytes group varied significantly at different time points（P<0.05），but that of the non-CVB3-infected HL-1 cardiomyocytes group did not（P>0.05）．Non-CVB3-infected MSCs group and CVB3-infected MSCs group showed similar cell viability（P>0.05）．The cell viability of non-CVB3-infected MSCs group and CVB3-infected MSCs group changed significantly at different time points（P<0.05）．The viral titer in CVB3-infected HL-1 cardiomyocytes group was much higher than that of CVB3-infected MSCs group（P<0.05）．Conclusion　CVB3-infected HL-1 cardiomyocytes showed decreased cell viability and replication of CVB3，but CVB3-infected MSCs presented insignificantly changed cell viability and non-replication of CVB3.

Construction of Cognitive Training System of Mild Cognitive Impairment　

DONG Xinxiu，HU Hui，WANG Ling，AI Yating，SHI Yirong，SUN Kaili，LI Mengying

2019, 22(3): 306-311. DOI: 10.12114/j.issn.1007-9572.2018.00.205

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Background　 Evidence-based medical evidence shows that there is no effective long-term treatment for mild cognitive impairment（MCI）.MCI patients can delay or prevent the progression of the disease through early cognitive intervention.However，the content of cognitive training at home and abroad is based on their respective research purposes and actual conditions.The program is currently in the stage of exploration and development，there is no uniform standard，and the evaluation of the intervention effect is therefore controversial.Objective　To construct a cognitive training system of MCI and provide a theoretical basis for the standardization of MCI cognitive interventions.We aim to build a system of MCI cognitive training suitable for China's national condition by further improving the application of cognitive intervention in patients with MCI in communities and providing support and reference for cognitive intervention training in China.Methods　From December 2015 to March 2017，based on the theory and literature research of brain plasticity，MCI cognitive training system was preliminarily constructed and further improved by two rounds of modified Delphi expert consultation method.Results　After two rounds of consultation，a MCI cognitive training system consisting of 8 first-level indicators，25 second-level indicators and 42 third-level indicators was formed.The active coefficients of experts in two rounds were 86.7% and 100.0%，respectively，the effective rates of the questionnaire were 92.3% and 100.0%，respectively.The judgment coefficient of experts in training system was 0.92，the degree of familiarity was 0.54 and the authority degree was 0.73.The coordination coefficients（W） of two rounds of expert consultation were 0.15 and 0.40，respectively，with statistical significance（P<0.05）．Conclusion　The MCI cognitive training system is preliminarily constructed by Delphi expert consultation method.The selected experts have a good representativeness，a high degree of authority，and the opinions of them are coordinated.From the methodology established by the indicator system，the results of this study are reasonable and reliable.

Development and Preliminarily Psychometric Evaluation of Domestic Cold Violence Scale　

YAN Fang，LI Xianhong，ZHANG Ye

2019, 22(3): 312-318. DOI: 10.12114/j.issn.1007-9572.2018.00.273

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Background　With the extensive improvement of people's education，domestic cold violence has also increased.Domestic cold violence has severe harm.It not only destroys the mental and psychological health，but also jeopardize the harmony of marriage lives.Meanwhile，it affects the social solidarity.However，there is no effective tools at this moment in China to measure the domestic cold violence.Objective　To develop and psychometrically evaluate a domestic cold violence scale，so as to assess household cold violence.Methods　According to practical definition of domestic cold violence，the initial items pool（20 items）of the scale were compiled by literature review in October 2015.After discussion by expert committee，the pilot test version of the scale remaining 10 items was developed，which was tested among 20 wives of gay men or bisexual men（known as Tongqi in Chinese for short）who were recruited through the online chatting platform “Lang man zhuan shen tongqi group” in December 2015（with a 100.0% response rate）as pre-investigation.All participants filled out the scale within 2 minutes and expressed that the scale was easy to understand.Then a large-scale test was conducted among 195 Tongqis who met inclusion criteria and were recruited from Internet by Respondent-driven sampling（RDS）method with 15 “seed participants” from February 2016 to March 2017.The Demographic Questionnaire，the testing version of the scale（10 items）and subscale of the Revised Conflict Tactics Scales（CTS-2S）were used to collect data.Four weeks later，20 participants were selected to fill out the questionnaire again by simple random sampling method.Correlation coefficient and extreme group method were performed for item analysis，and then valid questionnaires were randomly divided into two groups.One group was tested by Exploratory Factor Analysis（EFA）in order to evaluate the sub-factors of domestic cold violence scale，and the other group was tested by Confirmatory Factor Analysis（CFA）in order to evaluate the structural validity.The validity of the scale was evaluated by the correlation coefficient of scores of the subscale for the abused and the total score of CTS-2S，and the content validity was calculated by using the scores given by experts.Reliability of this scale was evaluated by homogeneity test，split-half reliability and retest reliability.Results　A total of 178 questionnaires（195 in all）in large-scale investigation were valid，with effective recovery rate of 91.3%.A total of 20 questionnaires were sent out in the second survey，and 15 valid questionnaires were collected，with an effective recovery rate of 75.0%.The correlation coefficient between the item and total score of the testing version scale were 0.515 to 0.793（P<0.05）．Scores of all items in high-score group（n=52）were higher than those in low-score group（n=50）（P<0.05）．The KMO of the testing version scale was 0.854，and Bartlett's test showed that χ2=390.689，P<0.001，indicating that CFA could be performed.Two common factors were extracted according to the principle of Eigen value >1.000 and explained 59.913% of the total variance.However，the load values of three items in the common factor 1 were all lower than 0.400，so they were deleted and the CFA was conducted again limited to extract only one common factor.At this point，54.342% of the cumulative variance was explained，and all the item load values were more than 0.400.The result of CFA showed that the fit index χ2/df，RMSEA，GFI，CFI，NFI，IFI，TLI were 1.726，0.091，0.932，0.950，0.892，0.951，0.925，respectively.The score of the subscale of the CTS-2S was positively related with the total score of the domestic cold violence scale（r= 0.431，P<0.001）．The CVI of this scale was 0.97.The Cronbach's α coefficient，split-half reliability and retest reliability of this scale were 0.848，0.820 and 0.714，respectively.Conclusion　The final version of domestic cold violence scale consists of 7 items.This study shows that the reliability and validity of the domestic cold violence scale is acceptable.Therefore，this scale can be considered to assess the situation of individuals who suffer from cold violence in marriage.

Clinical Study on Improving Quality of Life for Cancer Patients with Cachexia Syndrome Using Nutrition Support and Resistance Exercise　

LI Ling，MA Guixia，SI Zhuangli，WANG Peng，YUAN Huili，MA Wang，GAO Tianhui，WANG Weiwei

2019, 22(3): 319-323. DOI: 10.12114/j.issn.1007-9572.2018.00.339

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Background　Cachexia syndrome is a common symptom in patients with advanced cancer，which seriously affects the quality of life of patients and even accelerates the death.However，there are few reports on the study of nutrition support combined with resistance exercise to improve the quality of life of patients with advanced cancer cachexia syndrome.Objective　To investigate the efficacy of nutrition support combined with resistance exercise for cancer patients with cachexia syndrome.Methods　A total of 286 cancer patients with cachexia syndrome admitted to Palliative and Hospice Care Center of Ninth People's Hospital of Zhengzhou，Oncology Department of First Affiliated Hospital of Zhengzhou University，Oncology Department of Henan Province People's Hospital，Oncology Department of the Medical Group of Zhengzhou First People's Hospital from December 2014 to December 2016 were enrolled in the study.All patients were randomly divided into four groups by using a computer-generated random sequence：control group （n=70），nutrition support group （n=73），resistance exercise group （n=75），and nutrition support combined with resistance exercise group （NR group，n=75）．Patients in four groups were prescribed with megestrol acetate to improve appetite，while control group was given regular diet.Patients in nutrition support group were provided with nutrition support besides regular diet.Patients in resistance exercise group chose diet by themselves and were given resistance exercise，while those in NR group were given both nutrition support and resistance exercise.All patients were treated for eight weeks，with four weeks in hospital and four weeks after discharge.Outcome parameters were measured before and after interventions using the Patient-Generated Subjective Global Assessment （PG-SGA），Multidimensional Fatigue Symptom Inventory-Short Form （MFSI-SF），Hamilton Depression Scale （HAMD），and the Functional Assessment of Cancer Therapy （FACT-G）．Results　Nutrition improvement in nutrition support group，resistance exercise group and NR group at four and eight weeks after intervention was higher than　that in control group （P<0.05）．Moreover，nutrition improvement in NR group was higher than that in nutrition support group and resistance exercise group （P<0.05）．There was no interaction effect between intervention method and time course in terms of patients' MFSI-SF，HAMD and FACT-G scores （P > 0.05）．However，the intervention method and time course had a major impact on MFSI-SF，HAMD and FACT-G scores of patients （P<0.05）．MFSI-SF and HAMD scores of nutrition support group，resistance exercise group and NR group were lower than those of control group when assessed at 4 and 8 weeks after intervention，and FACT-G scores of nutrition support group，resistance exercise group and NR group were higher than that of control group （P<0.05）．MFSI-SF and HAMD scores of NR group were lower than those of nutrition support group，resistance exercise group when assessed at 4 and 8 weeks after intervention，and FACT-G scores of NR group were higher than that of nutrition support group，resistance exercise group（P<0.05）．Conclusion　Nutrition support combined with resistance exercise can delay the development of cachexia syndrome in cancer patients to a certain extent，and it can significantly relieve fatigue，depression，and improve quality of life.Therefore，it is worth promoting in clinical practice.

Advances in the Management of Severe Acute Pancreatitis with Enteral Nutrition　

LI Shuyi，LI Shuangqing

2019, 22(3): 324-328. DOI: 10.12114/j.issn.1007-9572.2018.00.179

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Nutrition support plays an important role in the management of severe acute pancreatitis（SAP） patients.It has been proved that enteral nutrition is superior to parenteral nutrition in SAP patients.But the optimal timing and path of enteral nutrition are still unclear.The efficacy of very early enteral nutrition is still controversial，the idea that nasogastric feeding and nasal jejunal feeding have the same safety and efficacy in nutrition-support therapy is gaining acceptance，but whether early oral feeding is as safe and effective as nasogastric feeding and nasal jejunal feeding remains to be answered.For enteral nutrition formulations，it is still not routinely recommended to add immunological microecological agents，immune-enhancing agents，dietary fiber，and traditional Chinese medicine.Some Chinese scholars have applied radar chart to the assessment of enteral nutrition support in patients with SAP，but it is still a challenge to appropriately carry out the assessment and management of enteral nutrition in patients with SAP.The aforementioned developments are reviewed in detail in this paper.

Fire Needle Acupuncture Combined with Normal Acupuncture for 3 Cases Suffering from Parkinson's Disease-associated Pain　

LI Xiaoyuan，WANG Hongjuan，YIN Aibing

2019, 22(3): 329-331. DOI: 10.12114/j.issn.1007-9572.2018.00.162

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Parkinson's disease （PD） is a common neurodegenerative disorder of the central nervous system.PD patients frequently complain about Parkinson's disease-associated pain（PDAP），a non-motor symptom，which has not received enough attention.Moreover，those in the moderate and advanced stages of PD are more likely to suffer from impaired quality of life by chronic PDAP，a manifestation with complex pathogenesis.For the control and treatment of PDAP，increasing the dose of levodopa increases the risk of dyskinesia and risks to health can be brought by the use of analgesics.We used fire needle acupuncture combined with the normal acupuncture to treat 3 cases suffering from different types of PDAP，and good results have been achieved，indicating that the combination therapy is effective.

Application and Evaluation of Auricular Acupoint Sticking Therapy in Poor-vision Children of School-age　

LI Wei，ZHU Jiali，CHENG Chunyan，TAO Huihong

2019, 22(3): 332-336. DOI: 10.12114/j.issn.1007-9572.2018.00.287

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Background　In the treatment experience of general hospital，the ear point embedding method of Traditional Chinese Medicine has definite clinical effect on poor vision.However，it needs to use more indicators suitable for the actual health needs of the community to evaluate the TCM prevention and health care project as the Community Health Service Centers in Pudong New Area.Objective　This study aims to investigate the application and feedback of Traditional Chinese Medicine（TCM） technology，observe the efficacy of auricular acupoint sticking therapy among poor-vision children of school-age and explore the best intervention strategy for community health service centers to carry out auricular intervention for poor eyesight.Methods　A total of 685 pupils（1 116 times，1 822 eyes） from Grade 1 to Grade 5 of Shi Sun Primary School were selected with inclusive criteria.The poor-vision pupils were treated with singular application of auricular acupoint sticking therapy with alternative use on each ear.A course of treatment was 3 months and one treatment in each year.The uncorrected visual acuity and the visual acuity before and after the treatment were examined by national standard visual acuity chart.The information of gender，grade，glasses wearing，inclusion time，intervening time and population mobility was collected and the intervention effect was observed.The influencing factors of intervention efficacy were determined through multivariate logistic regression.Results　Two intervention subjects withdrew from the study and there were 683 pupils（1 114 times，1 818 eyes） participating the study.The Grade 1 and Grade 2 pupils accounted for 27.8% and 25.3%，pupils without glasses for 88.3% and the number of newly enrolled subjects reached the highest in 2012 and 2016，with 143 and 158，respectively.There were 345 pupils treated with one-year intervention，accounting for 50.5%.The number of intervention subjects was larger in 2016 and 2017 and the increased number of intervention subjects was larger in 2014 and 2016，with 123 and 167 pupils，respectively.The last visual acuity of mild poor-vision group，medium poor-vision group and high poor-vision group was higher than their uncorrected visual acuity（P<0.001）．The last visual acuity of glasses-wearing group and without-glasses groups was higher than their uncorrected visual acuity（P<0.001）．The last visual acuity of one-year intervention group，two-year intervention group，three-year intervention group and four-year intervention group was higher than their uncorrected visual acuity（P<0.001）．The intervention effect of mild poor-vision group was better than that of medium poor-vision group and high poor-vision group（P<0.05）．The intervention efficacy of without-glasses group was better than that of glasses-wearing group（P<0.05）．The intervention efficacy of Grade 1 group and Grade 2 group was better than that of Grade 3，4 and 5 groups（P<0.05）．The intervention efficacy of two-year intervention group and three-year intervention group was better than that of one-year intervention group（P<0.05）．The analysis result of multivariate logistic regression showed that grade，glasses wearing，intervening years and uncorrected visual acuity of pupils were factors influencing intervention efficacy（P<0.05）．Conclusion　The TCM ear point embedding method is an effective，simple and safe treatment method for poor vision pupils.The intervention subjects showed high adoption to auricular acupoint sticking therapy，which could be used as a long term TCM preventive health service.

Acupuncture at Wuzangshu Combined with Geshu Acupoints with Fire Needles and Filiform Needles for Chronic Insomnia　

HONG Qiuyang，YANG Huimin，ZHAO Jiping，WANG Shiguang，YAO Jin，YANG Yi

2019, 22(3): 336-340. DOI: 10.12114/j.issn.1007-9572.2018.00.098

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Background　Chronic insomnia affects people's work and life，increases the risk of having disease，reduces work efficiency of patients and causes huge losses of accidents.At present，benzodiazepines are still the main treatment for chronic insomnia.Long-term and high-dose use of benzodiazepines will significantly reduce the responsiveness of these drugs.As human organs can affect people's spirit，viscera function disorder can lead to insomnia.Acupuncturing on Wuzangshu acupoint can adjust Yin and Yang and viscera function.Objective　To investigate the clinical efficacy of acupuncture at Wuzangshu combined Geshu acupoints with fire needles and filiform needles in the treatment of chronic insomnia.Methods　We enrolled 60 cases of chronic insomnia treated in Beijing Shunyi District Hospital of Traditional Chinese Medicine from November 2016 to October 2017，and divided them into fire needle group （n=30） and filiform needle group （n=30） based on the random number table.Both groups received treatment of acupuncture at Baihui，Sishencong，Shenmen，Sanyinjiao and other acupoints with filiform needles，once daily，5 times a week，the fire needle group additionally received acupuncture at Wuzangshu combined Geshu acupoints with fire needles （developed by HE Pu-ren），once every other day，3 times a week.The duration of treatment for both groups was 4 weeks.The clinical response was evaluated at the end of treatment and 1 month after the end of treatment by the Pittsburgh Sleep Quality Index （PSQI），Zung Self-Rating Anxiety Scale （SAS） score，and Zung Self-Rating Depression Scale （SDS） score.Results　 In the fire needle group，7，12，9，2 showed complete，marked，effective，and ineffective clinical response，respectively，while in the filiform needle group，3，9，11，7 showed complete，marked，effective，and ineffective clinical response，respectively，indicating that the former had better clinical response （Z=-2.152，P=0.031）． There was an interaction between treatment method and duration on total PSQI score，SAS score，SDS score （P<0.05）． Treatment method produced significant main effects on total PSQI score，SAS score，and SDS score （P<0.05），so did the treatment duration.Total PSQI score，SAS score，and SDS score were similar in both groups before treatment，but they decreased significantly in the fire needle group at the end of treatment and 1 month after the end of treatment（P<0.05）． PSQI score，SAS score，and SDS score in the fire needle group at the end of treatment and 1 month after the end of treatment declined significantly compared with baseline （P<0.05）． Conclusion　For chronic insomnia，acupuncture at Baihui，Sishencong，Shenmen，Sanyinjiao and other acupoints with filiform needles was inferior to its combination with acupuncture at Wuzangshu combined Geshu acupoints with fire needles and filiform needles.

Value of 18F-FDG PET with Cortex ID Analysis in the Localization of Epileptic Foci Caused by Focal Cortical Dysplasia　

WEI Qiang，CHENG Jie，TIAN Congna，BIAN Yanzhu，YANG Shuangchen，YANG Xin，SONG Guoqing，ZHOU Ruming，QIU Gang

2019, 22(3): 341-346. DOI: 10.12114/j.issn.1007-9572.2018.00.317

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Background　Focal cortical dysplasia（FCD）frequently is associated with medically intractable epilepsy，surgical resection of epileptogenic foci is the main treatment method，and its efficacy and long-term prognosis are closely related to the accurate localization of epileptogenic foci.PET brain imaging plays an important role in the localization of epileptogenic focus.However，PET brain imaging in tradition relied on visual analysis，which was greatly influenced by subjective factors of physicians.Objective　To evaluate the clinical value of 18F-FDG PET with Cortex ID analysis for the preoperative localization of epileptic FCD．Methods　From Hebei General Hospital，34 cases of focal epilepsy were enrolled in this retrospective study from February 2013 to June 2017.All of them received surgical treatment，and postoperative pathological examination detected that the cause of focal epilepsy was FCD.All of the cases underwent 18F-FDG interictal brain PET imaging before surgery.Both visual analysis and Cortex ID analysis were used to analyze the PET images，and the accuracies of imaging results analyzed by these two methods were evaluated by comparing with the findings of postoperative pathological examination.Results　All the cases were found with a total of 41 FCD-induced epileptic foci by pathological examination，but with 29，34 by visual analysis and Cortex ID analysis of the 18F-FDG PET images，respectively.The accuracy of visual analysis and Cortex ID analysis of the images was 70.7%（29/41），82.9%（34/41），respectively，showed no significant difference（χ2=0.191，P=0.295），and demonstrating a fair diagnostic consistency（Kappa=0.396，P=0.007）．Conclusion　The rates of detection of FCD-induced epileptic foci by 18F-FDG PET with visual analysis and Cortex ID analysis were not significantly different and showing a fair consistency in the diagnostic results.Cortex ID analysis method has good repeatability and little subjective influence.

Application of Spatio-temporal Image Correlation and Three-dimensional Ultrasound in the Diagnosis of Fetal Congenital Heart Defects and Extracardiac Malformations　

WANG Yuan，ZHAO Xu，YANG Ya，HE Yijing，JIAO Chunmei，QIU Bing

2019, 22(3): 346-350. DOI: 10.12114/j.issn.1007-9572.2018.00.181

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Background　In prenatal ultrasound diagnosis，fetal congenital heart defects（CHDs） and extracardiac malformations have an important impact on fetal prognosis.Spatio-temporal image correlation ultrasound（STIC） has a good diagnostic accuracy for fetal heart examination.However，it is rare to report on the fetal prognosis in the examination of two-dimensional ultrasound combined with new ultrasound technology.Objective　To examine the potential of STIC and three-dimensional （3D） ultrasound in the diagnosis of fetal CHDs and extracardiac malformations.Methods　The conventional two-dimensional（2D） ultrasound examination during the second and third trimester was conducted among 7 707 pregnant women registered in Peking University Civil Aviation School of Clinical Medicine from March 2015 to November 2017.Thirty-two fetuses were diagnosed with CHD.STIC and 3D ultrasound were performed for the acquisition and analysis of ultrasound volume data.Ultrasound results were used to analyze fetal CHD and extracardiac malformation and outcome，after comparison with neonatal echocardiography or pathological anatomy results.Results　The detection rate of fetal CHD was 0.4%（32/7 707）．The detection rates of fetuses with only one cardiac malformation with extracardiac malformation and those with two or more cardiac malformations with extracardiac malformation were 13.3% （2/15） and 35.3% （6/17），respectively，showing no significant difference （P=0.229）．There were 14 survivors in the study.The survival rate of the fetuses with only one cardiac malformation was much higher than that of those with two or more cardiac malformations〔86.7% （13/15） vs 5.9% （1/17）〕（P<0.05）．The survival rates of the fetuses with CHD plus extracardiac malformation and those with CHD were 12.5% （1/8） and 54.2% （13/24），respectively，showing no significant difference（P=0.053）．Results of the prenatal 3D ultrasound and STIC agreed with pathological anatomy results.By 2D ultrasound，one case of multiple cardiac malformations was found with uncertain anomalous pulmonary venous drainage，but by STIC，it was identified with total anomalous pulmonary venous drainage.Conclusion　Detection rate of fetuses with two or more cardiac malformations with extracardiac malformation was similar to that of those with only one cardiac malformation with extracardiac malformation，but the former group had a lower survival rate.3D ultrasound and STIC can display fetal CHD and combined extracardiac malformations more completely and stereoscopically.Combined with conventional 2D ultrasound，they provide more accurate ultrasonic evidence for early diagnosis and treatment of fetal congenital malformations.

Experimental Study of Low Concentration Contrast Agent Combined with Low Dose MSCT Scanning Technique in Diagnosis of Gastrointestinal Hemorrhage　

ZHAI Ning，YU Peng，GONG Fengling，LI Mengjing，ZHANG Huiying，MA Chunmei，WANG Xingwen

2019, 22(3): 351-356. DOI: 10.12114/j.issn.1007-9572.2018.00.231

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Background　Patients diagnosed with gastrointestinal bleeding by multislice-spiral CT（MSCT） received high doses of radiation and contrast agents.The CT value of iodine contrast agent was increased with the decrease of tube voltage.We tried to determine the optimal scanning scheme to reduce the radiation dose and contrast dose simultaneously on the premise of satisfying the diagnostic requirements.Objective　To explore the feasibility of low-concentration contrast medium of MSCT combined with low-dose scanning technology in the diagnosis of gastrointestinal bleeding model scanning，so as to obtain the optimal scanning scheme and provide research basis for clinical application.Methods　CT values of bleeding points of 30 patients with gastrointestinal bleeding diagnosed by MSCT enhanced examination and confirmed by surgery from May 2014 to October 2016 in North China University of Science and Technology Affiliated Hospital were measured.The average value was （212.1±64.5） HU.Taking the measured CT value of the bleeding point as the reference value，the nonionic contrast agent，ioversol（320 mgI/ ml ） was diluted with 0.9% sodium chloride solution and divided into 4 iodine solutions with different concentrations（6.4，5.76，5.12，and 4.48 mgI / ml，respectively）．The corresponding CT values of 120 kV were（214.7±1.6），（185.9±1.4），（162.2±1.4），and （140.5±2.5） HU，respectively.Different doses of CT enhancement scanning were performed on the bleeding model groups.The control group was 120 kV and 300 mAs.Experimental group：Group A：100 kV，300 mAs；Group B：100 kV，400 mAs；Group C：80 kV，400 mAs；Group D：80kV，465 mAs，and the concentration of contrast agent corresponds to the concentration of 4 iodine solutions.Each concentration was scanned 7 times.Two experienced radiologists used double blind method to read the film，recorded CT volume dose index（CTDIvol） and dose length product（DLP），and calculate effective dose （ED）．The objective noise of the image was measured，the signal-to-noise ratio of the image and subjective score of the image quality calculated，the detection of gastrointestinal bleeding in each group of MSCT recorded，and the CT value of bleeding points measured to evaluate the optimal scanning scheme.Results　CTDIvol was 19.6 mGy in control group，12.4 mGy in experimental group A，16.5 mgy in experimental group B，8.2 mGy in experimental group C，and 9.5 mGy in experimental group D.DLP and ED in experimental groups were lower than those in control group（P<0.05 ）．There was no statistically significant difference in image noise，signal-to-noise ratio and subjective score of image quality between experimental group B and control group（P>0.05）．The image noise of groups A，C and D in the experimental group was higher than that of control group，while the signal-to-noise ratio and subjective score of image quality were lower than those of control group（P<0.05）．The average CT values of the bleeding points in all experimental groups were higher than those of the control group at the same concentration of contrast agent（P<0.05）．Control group（6.4 mgI/ml） and experimental group B（6.4 and 5.76 mgI/ml） had the same detection rate of bleeding.There was no statistically significant difference between experimental group B（5.12 mgI/ml） and control group（6.4 mgI/ml） in detection rate（P>0.05），while experimental group B （4.48 mgI / ml） had lower detection rate than control group（P<0.05）．Conclusion　MSCT double low technique is feasible to diagnose hemorrhage in digestive tract hemorrhage model scanning.Experimental group B（100 kV，400 mAs ） is the optimal scanning parameter.Under the condition of simulated hemorrhage rate of 0.5 ml/min，the optimal contrast agent concentration at the bleeding point of the model under the scanning condition is 5.12 mgI/ml，and the corresponding CT value at the bleeding point is about
（99.4±10.1） HU.

Clinical Features and Prognosis of Rectus Sheath Hematoma　

XU Lu，LIU Lei，LI Xinjian

2019, 22(3): 357-360. DOI: 10.12114/j.issn.1007-9572.2018.00.057

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Objective　To analyze the clinical features and prognosis of rectus sheath hematoma（RSH） to improve clinical awareness of RSH and its rate of early diagnosis.Methods　Clinical data from 33 patients with RSH，who were treated in the Departments of Nephrology，Cardiology，Respiratory Medicine，Pediatric Surgery，General Surgery，and Obstetrics & Gynecology of the Affiliated Hospital of Jining Medical University between January 2005 and December 2015，were collected for a retrospective analysis of the etiology and clinical manifestations of RSH and its imaging examination，therapeutic method，treatment methods and prognosis.Results　Of the 33 patients with RSH，17 patients received anticoagulation（13 cases） or antiplatelet （7 cases） therapy；30 patients shared the clinical manifestation of abrupt abdominal pain；30 patients had physical examination findings of fixed hematomas in the abdominal wall accompanied by local tenderness；and the remaining 3 cases were found to have only local tenderness in the absence of fixed hematomas.Within 48 hours after the onset of abdominal pain，29 patients underwent abdominal CT examination（18 patients had undergone abdominal ultrasound examination before CT examination，and 15 were correctly diagnosed）；3 patients underwent ultrasound-guided puncture drainage after conservative treatment of hematoma liquefaction，and the hematoma was fully absorbed；in 26 patients，the hematoma was completely absorbed after conservative treatment；and 1 patient died after the family members declined（because of economic concerns） surgery offered as a treatment because of unstable hemodynamics due to excessive hemorrhage.Conclusion　RSH is a common disease in elderly patients，especially in those receiving anticoagulation and antiplatelet therapy.The typical clinical manifestations are sudden abdominal pain and the presence of abdominal masses.CT examinations are helpful for early diagnosis，and conservative treatment can achieve favorable therapeutic effects for most patients in the absence of unnecessary surgeries.

Evaluation of the Value of FT4/FT3 and Thyroglobulin Combined with Thyroid Hormone Antibodies in the Diagnosis of Subacute Thyroiditis　

LU Na，RAN Xiaodan，LI Yongwei，YANG Yulian

2019, 22(3): 361-365. DOI: 10.12114/j.issn.1007-9572.2018.00.096

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Objective　To explore the diagnostic value of thyroglobulin（Tg） and free thyroxine/free triiodothyronine（FT4/FT3） combined with thyroid hormone antibodies in the diagnosis of subacute thyroiditis.Methods　Eighty-eight patients with subacute thyroiditis who were admitted to the Second Affiliated Hospital of Henan University of Chinese Medicine between August 2014 and August 2017，and who met the inclusion criteria，were selected as a subacute thyroiditis group.Eighty-two healthy volunteers who received physical examinations in the hospital during the same period were selected as a control group.Sixty-six patients with thyrotoxicosis，such as hyperthyroidism，were selected as another thyroid disease group.Thyroid-related markers in all subjects were tested，including Tg，FT4，FT3，thyroid-stimulating hormone（TSH），thyroglobulin-globin（TgAb），thyroid peroxidase antibody（TPOAb），thyrotropin receptor antibody（TRAb），and thyroid microsomal antibody（TMAb）.The correlations among Tg，FT4/FT3 and TSH，TgAb，TPOAb，TRAb，and TMAb，as well as the factors influencing Tg and FT4/FT3，were analyzed.The value of Tg，FT4/FT3，Tg+FT4/FT3，Tg+TPOAb+TRAb，Tg+TPOAb+TMAb，and Tg+FT4/FT3+TPOAb+TMAb in the diagnosis of subacute thyroiditis was evaluated.Results　Tg was negatively correlated with TgAb and TMAb（P<0.05），and FT4/FT3 was negatively correlated with TSH and TMAb（P<0.05） in the patients with subacute thyroiditis.TgAb and TMAb were factors influencing Tg（P<0.05），and TMAb and TSH were factors influencing FT4/FT3（P<0.05） in the patients with subacute thyroiditis.The AUC of the ROC of Tg in the diagnosis of subacute thyroiditis was 0.756，and the sensitivity and specificity were 76.9% and 95.0%，respectively.The AUC of the ROC of FT4/FT3 in the diagnosis of subacute thyroiditis was 0.698，and the sensitivity and specificity were 78.2% and 84.0%，respectively.The AUC of the ROC of Tg+TPOAb+TMAb in the diagnosis of subacute thyroiditis was 0.841，and the sensitivity and specificity were 94.7% and 89.1%，respectively.Conclusion　Tg and FT4/FT3 alone have limited efficacy in the diagnosis of subacute thyroiditis.Tg，FT4/FT3 combined with TPOAb and TMAb significantly improves the diagnostic efficacy for subacute thyroiditis.

Research Status and Trend of Smart Healthcare：a Literature Review　

MI Zehua，QIAN Aibing

2019, 22(3): 366-370. DOI: 10.12114/j.issn.1007-9572.2018.00.194

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Smart healthcare has been applied to healthcare fields since the Smarter Planet initiative launched in 2009.It leads to more convenient，efficient and personalized medical services via advancing the traditional medical management in a smart way.We introduced the concept of smart healthcare，and detailed its help during the achievement of clinical management informatization and regional healthcare informatization，development from disease-centered care to patient-centered care，from treatment of disease to preventive treatment of disease，and from basic electronic healthcare management to personalized electronic healthcare management，described its contribution to the development of wearable devices and healthcare reform，and described its progresses in the eras of Internet of things and big data.Moreover，we elaborated the challenges for developing smart healthcare and put forward targeted solutions from the perspectives of clients，medical institutions as well as decision-making management.

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