Chinese General Practice

Chinese Familial Hypercholesterolemia Management Based on Guidelines

WEN Wenhui，KUANG Zemin，WANG Lyuya

2019, 22(5): 494-500. DOI: 10.12114/j.issn.1007-9572.2018.00.430

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Familial hypercholesterolemia （FH） is a lipid-metabolic autosomal dominant genetic disease characterized by elevated low-density lipoprotein cholesterol，which is a serious hazard to cardiovascular health.This article describes the etiology，common diagnostic criteria and current diagnostic rates of FH.At the same time，it outlines the latest international FH guidelines and the guidelines and diagnostic criteria issued in China for FH，and we also summarizes the current treatments of FH.On this basis，we analyzed the work and enlightenment of the treatment and management of FH in China，in order to identify FH at early stage and provide patients with better treatment.

Status Quo and Thinking of the Management and Research of Chronic Non-communicable Diseases in the Large Public Hospital

LIU Si，YIN Geng

2019, 22(5): 501-505. DOI: 10.12114/j.issn.1007-9572.2018.00.164

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Chronic non-communicable diseases management is an important measure to promote people's health.Optimizing and improving the quality of chronic non-communicable disease management is also one of the important measures in the new medical reform.As large public hospitals have an advantage of accumulating outstanding technology and talents，to make full use of the platform，combined with the development of data base，we explore the status and value of large public hospitals in the management of chronic non-communicable diseases in the center of establishing academic general practice，so as to promote the efficiency and quality of chronic non-communicable disease management.

Non-steroidal Anti-inflammatory Drug Use in Elderly：Drug Safety and Precautions

XU Rongzhen，WANG Liuqing，LU Jianxin，ZHANG Shoucheng，WANG Hong

2019, 22(5): 506-510. DOI: 10.12114/j.issn.1007-9572.2018.00.235

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Non-steroidal anti-inflammatory drugs （NSAIDs） are the most common-used clinical painkillers，which have antipyretic，analgesic and anti-inflammatory effects，but also have side effects such as gastrointestinal ulcers.Elderly patients should pay much attention to their side effects and drug interaction because of multiple chronic conditions and decreased immune and metabolic capacity.We reviewed the current situation of the use of NSAIDs in the elderly，including drug safety and precautions.It is concluded that we should balance advantages and disadvantages of NSAIDs by adjusting drug dosage and paying attention to drug interactions.We should try to reduce or avoid adverse reactions while reducing patients' pain.

Recent Advances in Biochemical Markers Commonly Measured in Hospital Settings for Predicting Post-stroke Disability

HE Yudi，LYU Yumei

2019, 22(5): 511-515. DOI: 10.12114/j.issn.1007-9572.2018.00.117

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Stroke is one of the main chronic non-communicable diseases threatening human health.Although the mortality rate has decreased with the development of medical technology，the functional disorders after stroke have seriously affected the quality of life of survivors.Biochemical test is fast and reliable，which can predict the development and prognosis of stroke.We mainly focused on the biochemical markers often detected in hospital settings for predicting post-stroke disability，hoping to offer help for optimizing the allocation of medical resources，and to provide theoretical support for the development of intervention and health management models for patients with post-stroke disability.

Study of the Relationship between TCM Constitution Types & Combinations and Type 2 Diabetes in Community Aged Subjects

LUO Jiali，ZHANG Xiaoxia，BAO Xinyu，XIE Yixian，HUANG Junxuan，PENG Xin，WANG Peixi

2019, 22(5): 516-521. DOI: 10.12114/j.issn.1007-9572.2018.00.172

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Backgroud　The occurrence，development and prognosis of type 2 diabetes are related to pathological constitutions of Chinese medicine.But in this respect，the research is mainly focused on the general population in China，and most of them analysis of single pathological constitutions.Objective　To identify and analyze Traditional Chinese Medicine Constitutions （TCMCs） in elderly community members and their mixed constitutions，in order to determine the relationship between TCMCs （or mixed TCMCs） and the development of type 2 diabetes in elderly members of the community.Methods　From June 2016 to June 2017，1 600 elders living in a community in the Pearl River Delta who underwent routine physical examination in the community medical examination department were selected as the study subjects.The TCMCs were determined using classification and diagnosis basis of constitutions in Chinese medicine，and fasting plasma glucose （FPG） was determined from blood samples.A comparative analysis of the relationship between TCMCs and the development of type 2 diabetes was conducted，and factor analysis was used to assess the mixing and combination of single biased constitutions.Results　A total of 1 540 valid samples were screened from 1 600 samples with an effective rate of 96.25%.Sixty samples with incomplete physical examination data were excluded.The detection rate of diabetes among the 1 540 elderly subjects in the community was 21.49% （331/1 540）．With regard to TCMCs，there were 878 cases （57.01%） of normal constitution，while biased constitutions were observed in 197 cases （12.79%） of phlegm-dampness constitution，192 cases （12.47%） of Yang-deficiency constitution，182 cases （11.82%） of Qi-deficiency constitution，and 170 cases （11.04%） of Yin-deficiency constitution.Following factor analysis，three common factors were extracted from eight types of biased constitutions.Of these，phlegm-dampness，blood stasis，dampness-heat，Qi-stagnation，and special constitution constituted the stasis-dampness mix；Yang-deficiency constitution and Yin-deficiency constitution constituted the deficiency-mix；and Qi-deficiency constitution alone constituted a unique common factor.Phlegm-dampness，Yang deficiency，Yin deficiency，blood stasis，dampness-heat，Qi stagnation，and special constitution were related to the development of type 2 diabetes （P<0.05），with OR values ranked in order as follows：special constitution （OR=4.482），Qi-stagnation constitution （OR=3.129），dampness-heat constitution （OR=2.871），Yang-deficiency constitution （OR=2.201），blood stasis constitution （OR=1.936），Yin-deficiency constitution （OR=1.668），and phlegm-dampness constitution （OR=1.588）．Hydration and the combination of body composition and physical fitness were related to the occurrence of type 2 diabetes （P<0.05），in which the combined OR value of the dampness constitution was 1.360，and the OR value of the combined fitness was 1.729.Conclusion　In community elders，those with special constitution，Qi-stagnation constitution，dampness-heat constitution，Yang-deficiency constitution；mixed phlegm-dampness constitution，dampness-heat constitution，blood stasis constitution，Qi-stagnation constitution，special constitution；or mixed Yang-deficiency constitution and Yin-deficiency constitution，were more likely to develop type 2 diabetes.In community prevention and intervention programs，targeted health guidance should be provided for different constitutions in the elderly，and an integrated health care strategy of Chinese and Western medicine should be adopted to improve their health status.

Prognostic Value of Procalcitonin，CURB-65 Score and Pneumonia Severity Index in Community-acquired Pneumonia

YANG Lingjing，GAO Lingyun，FU Zewei，LI Xixia，YANG Liqing

2019, 22(5): 522-526. DOI: 10.12114/j.issn.1007-9572.2018.00.276

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Background　Community-acquired pneumonia（CAP）is one of the most important public health problems wordwide．The lower respiratory tract infections，represented by CAP，are reported to be the fourth leading cause of death worldwide.The assessment of disease severity and outcome prediction are necessary in the management of CAP．Objective　To assess the prognostic value of procalcitonin （PCT），CURB-65 score and pneumonia severity index （PSI） in patients with CAP．Methods　A total of 234 patients with CAP admitted to the East Region of the People's Hospital of Sichuan from June 2016 to June 2017 were enrolled in the study.According to the level of serum PCT within 6 hours of admission，patients were divided into group A （PCT<0.10 μg/L，106 cases），group B （0.10 μg/L≤PCT≤0.25 μg/L，39 cases），group C （0.25 μg/L<PCT≤0.50 ug/L，23 cases），and group D（PCT>0.50 μg/L，66 cases）．The CURB-65 score and PSI were used to assess the risk of death，serum PCT was detected，and the incidence of death and severe complications within 30 days were observed.Receiver operating characteristic （ROC） curve was used to analyze the predictive value of serum PCT，CURB-65 score and PSI.Results　The mortality and complication rate in group B，C and D were higher than those in group A （P<0.05），and the mortality and complication rate in group D were higher than those in group B and C （P<0.05）．The ROC curves of the mortality of CAP patients showed that the area under the ROC curve （AUC）of CURB-65 score was 0.868 〔95%CI（0.797，0.939），P<0.001）〕；AUC of PSI was 0.894〔95%CI （0.851，0.948），P<0.001〕；the optimum critical value of PCT was 8.30 μg/L，AUC was 0.900〔95%CI （0.850，0.949），P<0.001〕；the AUC of PCT combined with CURB-65 score was 0.909〔95%CI （0.852，0.966），P<0.001〕 and that of PCT combined with PSI was 0.921〔95%CI （0.879，0.963），P<0.001〕.The ROC curves of complications in CAP patients showed that AUC of CURB-65 score was 0.815〔95%CI （0.727，0.903），P<0.001〕；AUC of PSI was 0.841〔95%CI （0.760，0.923），P<0.001〕；when the optimum critical value of PCT was 1.73 μg/L，AUC was 0.922〔95%CI （0.879，0.964），P<0.001〕；the AUC of PCT combined with CURB-65 score was 0.895〔95%CI （0.829，0.961），P<0.001〕 and that of PCT combined with PSI was 0.903〔95%CI （0.833，0.974），P<0.001〕.The AUC of PCT combined with CURB-65 score that predicted CAP complications was larger than that of CURB-65 score （Z=3.747，P=0.000 2）．Conclusion　Serum PCT can better predict the risk of death and complications of CAP.

Differences of Baseline Levels of Blood Glucose，Lipid Profile and Plasma Fibrinogen of Elderly Patients with Acute Ischemic Stroke in Different Age Groups and Genders

GAO Zhiyu，XIE Yan，SUN Bo，GAO Xuguang

2019, 22(5): 527-533. DOI: 10.12114/j.issn.1007-9572.2018.00.223

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Background　Baseline blood glucose（GLU），lipid profile and plasma fibrinogen（FBG）can be affected by age and gender.The elderly people are at high risk of stroke.Understanding the association with baseline level changes of GLU，lipid profile and FBG and the changes of age and gender is helpful to do better stroke prevention strategies for elderly people.Objective　To analyze level difference and its clinical significance of baseline GLU，lipid profile and plasma FBG in patients 60 years of age or older with acute ischemic stroke（AIS） from different age groups and genders.Methods　A total of 379 patients admitted to Department of Neurology of Zi Chuan District Hospital in Zibo with diagnosis of AIS from October 2013 to October 2014 were selected as study subjects.Patients were divided into three age groups：60 to 69 years old （139 cases），70 to 79 years old （145 cases） and above 80 years old （95 cases）．Based on gender，patients were divided into male group （169 cases） and female group （210 cases）．The level of GLU，triglyceride （TG），total cholesterol （TC），high-density lipoprotein cholesterol （HDL-C），low-density lipoprotein cholesterol （LDL-C） and FBG levels were detected on admission.Abnormality report rate of lab results mentioned above in different age and gender groups was calculated.Results　The levels of GLU，TG，TC and LDL-C decreased with age （P<0.05），while HDL-C and FBG levels increased with age （P<0.05）．The detection rate of abnormal TG levels decreased with age （P<0.05），and the detection rate of abnormal FBG levels increased with age （P<0.05）．As for differences between genders，GLU，TG，TC，HDL-C and LDL-C levels in female group were higher than those of male group （P<0.05）．Abnormality report rate of TG，TC and LDL-C in female group was higher than those of male group，while of HDL-C was lower than male group （P<0.05）．Conclusion　The levels of GLU，blood lipids，FBG and abnormality report rate of elderly patients with AIS in different age groups and genders are different.We should treat elderly people differently according to their age stages and genders when we do primary and secondary stroke prevention.

Relationship between Early Diaphragmatic Thickness at the End of Expiration and Prognosis in Mechanically Ventilated Patients

JIANG Yichun，LIU Zhenmi，ZHONG Zhanggui，YUAN Fenghua，LIU Xiaojun，ZHANG Huadong，LIU Xueyan

2019, 22(5): 534-537. DOI: 10.12114/j.issn.1007-9572.2018.00.221

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Background　Mechanical ventilation （MV） is an important means to rescue patients with respiratory failure，but it can lead to atrophy and functional decline in diaphragm.Studies have found that diaphragmatic atrophy occurred at the early stage of MV，but the correlation between early diaphragmatic atrophy and MV duration and prognosis is still unclear.Objective　To investigate the relationship of the changes in diaphragmatic thickness at the end of expiration （DTee） during respiratory cycles scanned by bedside color Doppler ultrasound with MV duration and length of stay in the ICU in mechanically ventilated patients.Methods　The enrolled 60 cases of MV were from the Intensive Care Unit，Shenzhen People's Hospital between January 2016 and September 2017.All of them received routine treatment.We collected their data about sex，age，primary disease，baseline APACHE Ⅱ score and high-sensitivity C-reactive protein （hs-CRP），MV duration，length of stay in ICU，DTee at baseline，during 5-day MV and immediately before weaning from MV，and the difference between DTee after MV and MV before （ΔDTee） during 5-day MV and immediately before weaning from MV （detected by a kind of color Doppler diagnostic ultrasound produced by SonoScape）． They were divided into diaphragm atrophy group （n=21） and normal diaphragm thickness group （n=39） based on the DTee detected on the 3rd of MV.Results　The DTee decreased with the MV duration （F=108.95，P<0.001）． In all patients，the mean baseline DTee was higher than that measured on the 3rd，4th，5th days of MV，and immediately before weaning from MV，as was the mean DTee measured on the 1st day of MV when compared with that measured on the 4th，5th days of MV，and immediately before weaning from MV，and the mean DTee measured on the 2nd day of MV when compared with that measured immediately before weaning from MV（P<0.05）． ΔDTee tended to increase with MV duration（F=263.10，P<0.001）． The mean ΔDTee between the DTee at baseline and on the 1st of MV was found to be lower than other 4 subsequently measured ΔDTee（P<0.05）． The mean ΔDTee between the DTee on the 3th day of MV was lower than immediately before weaning from MV（P<0.05）.Compared with normal diaphragm thickness group，diaphragm atrophy group demonstrated higher mean hs-CRP level，longer MV duration and length of stay in ICU （P<0.05）． Moreover，the ΔDTee from the 1st day to the 3rd day of MV was positively associated with MV duration （r=0.266，P=0.04）． Conclusion　DTee gradually decreased with the MV duration in mechanically ventilated patients，which was particularly obvious in the first 3 days.The extent of early diaphragm atrophy was related with MV duration and length of stay in ICU.

Effect of High-risk Human Papillomavirus Viral Load on the Expression of Regulatory T Cells in Cervical Lesions

YU Yang，FU Yanli，SUN Xiang

2019, 22(5): 538-543. DOI: 10.12114/j.issn.1007-9572.2018.00.394

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Background　Persistent infection of high-risk human papillomavirus （HR-HPV） is necessary but not sufficient for the occurrence of cervical cancer.Multiple changes in genome，microenvironment and immune system，and inflammation contribute to carcinogenesis.Therefore，the biomarkers of HR-HPV infection detected simply and noninvasively that can accurately and quantitatively reflect the changes in biological behavior of cervical cancer，become a focus of clinical research.Objective　To examine the changes in HR-HPV load and regulatory T Cells （Treg） in the same microenvironment of cervical lesions，and based on this，to discuss their interactions and expressions in the development of cervical lesions.Methods　We enrolled 342 cervical lesions patients with persistent HR-HPV infection from First Affiliated Hospital of Henan Polytechnic University during January 2012 to July 2015，including 55 with chronic cervicitis，73 with cervical intraepithelial neoplasia（CIN）Ⅰ，71 with CINⅡ，72 with CINⅢ and 71 with squamous carcinoma of the cervix （SCC）．QF-PCR was used to detect the HR-HPV load.According to the level of HR-HPV load （copy number of HPV DNA），we divided the participants into 4 groups：low load （HPV DNA 104-105 copies/ml，n=69），medium load （HPV DNA>105-106 copies/ml，n=90），high load （HPV DNA>106-107 copies/ml，n=106）and very high load （HPV DNA>107 copies/ml，n=77）．Flow cytometry was used to determine the number of Treg from cervical samples collected using a cytology brush.Results　There were significant differences in the number of Treg among different load groups （P<0.05）．The number of Treg increased with the growth of HR-HPV load，namely，low load group had less number of Treg than other 3 groups（P<0.05），so did the medium load group when compared with other 2 high groups （P<0.05），and as did the high load group when compared with very high group （P<0.05）．The number of Treg differed significantly in patients with different cervical lesions （P<0.05）．Chronic cervicitis patients had less number of Treg than other patients，so did CINⅠpatients when compared with CINⅡ，CINⅢ and SCC patients，and so did CINⅡpatients when compared with CINⅢ and SCC patients，and as did the CINⅢ patients when compared with SCC patients（P<0.05）．The number of HR-HPV load differed significantly in patients with different cervical lesions（P<0.05）．Chronic cervicitis and CINⅠpatients had less HR-HPV load than other patients，so did CINⅡ and CIN Ⅲ patients when compared with SCC patients （P<0.05）．Clustered boxplot diagram showed that chronic cervicitis and SCC patients were found with a total of 3 slightly abnormal values，but other patients without；the distribution of HR-HPV load was dispersed in SCC patients，but comparatively concentrated in other cervical lesion patients.The distribution of cervical lesions in different HR-HPV load groups was significantly different （P<0.05）．Correlation analysis showed that HR-HPV load was positively correlated with the severity of cervical lesions and the number of Treg （r=0.631，0.683，P<0.05），and there was a positive correlation between the severity of cervical lesions and the number of Treg （r=0.863，P<0.05）．Conclusion　The level of HR-HPV load is not always positively correlated with the severity of cervical lesions.The roles of Treg in the development of different cervical lesions differ by their expressions in the local cervical microenvironment.There are different pathogenicities，which causes immune imbalance，a key link in the development of cervical cancer.

Establishment of Rabbit Models of Liver Fibrosis Induced by Carbon Tetrachloride

LIU Shanshan，XU Lihong，LI Qiong，ZHANG Lina，LIU Fan，YANG Xin，LI Jun

2019, 22(5): 544-548. DOI: 10.12114/j.issn.1007-9572.2018.00.081

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Background There are many methods to establish the animal model of liver fibrosis，and carbon tetrachloride（CCl4）is the most commonly used method．Different ways of administration have a certain influence on the success rate of the model．In this study，subcutaneous injection of pure CCl4 was selected．The aim of this study was to investigate the optimal dose and time interval for the establishment of frabbit models of liver fibrosis．Objective　To explore the optimal mode of administration of CCl4 for the establishment of rabbit models of liver fibrosis．Methods　This study was conducted from April to September in 2015.A total of 46 healthy New Zealand white rabbits were selected and randomly divided into four groups，10 for the G0 group，and 12 for each group of G1，G2 and G3．Rabbits in the G0 group were subcutaneously injected of 0.9% sodium chloride solution with a dose of 0.5 ml/kg，and those in groups G1 and G3 were injected with CCl4 into the subcutaneous tissue of back with a dose of 0.2 ml/kg and 0.5 ml/kg respectively，twice a week，for a period of 16 weeks．For the rabbits in G2 group，they were injected with CCl4 into the subcutaneous tissue of back with the initial dose of 0.3 ml/kg，twice a week，then with the dose of 0.4 ml/kg after three weeks of intervention，and 0.5 ml/kg after five weeks of intervention，which was also the maintenance dose till the end of 16-week intervention．At the 4th，6th，8th，10th，12th，14th week of intervention，one rabbit was randomly selected from each group of G1，G2 and G3 to get sacrificed for their live tissue samples．All the rabbits in groups G1，G2 and G3 and two rabbits in the G0 group were sacrificed at the end of 16-week intervention．If a rabbit died during modeling，the liver tissue sample would be taken for pathological examination at once．Results　The death of rabbits were all happened within three weeks of modeling，and significant differences were found in mortality among the four groups （test statistics=7.004，P=0.048），the mortality of rabbits in group G3 was higher than that in groups G0，G1 and G2 （P<0.001）．At the end of 16-week intervention，there were no significant difference in the rate of successfully modeling between the groups （test statistics=4.747，P=0.165）．Conclusion　A dose-escalation regimen of subcutaneous injection of CCl4 with the initial dose of 0.3 ml/kg，can establish rabbit models of liver fibrosis with low mortality．

Effect of Self-efficacy on Resilience in Patients with Schizophrenia：Chain Mediating Effect of Self-esteem and Coping Style

LIU Dongwei，ZHOU Yuqiu，SUN Yujing，LI Guohua，CHAI Nannan

2019, 22(5): 549-554. DOI: 10.12114/j.issn.1007-9572.2018.00.301

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Background　As an important indicator of mental health，resilience has long been a research hotspot of positive psychology，and has become one of the most important indicators for the evaluation of schizophrenia outcomes in recent years.Previous studies have shown significant correlation between self-efficacy，self-esteem，coping style and resilience among patients with schizophrenia，but mechanisms among these factors are not clear.Objective　To explore the relationship between self-efficacy and resilience in patients with schizophrenia and the chain mediating effect of self-esteem and coping style.Methods　A total of 367 inpatients and outpatients with schizophrenia in Chifeng Anding Hospital and the Third Hospital of Daqing，were selected from July to December 2017 by convenient sampling method.General Information Questionnaire，General Self-efficacy Scale，Self-esteem Scale，Simplified Coping Style Questionnaire and Connor Davidson Resilience Scale were used in this survey.We used Mplus 7.0 software to establish the structural equation model and the biased correction percentile Bootstrap program to test the mediating effect.Results　A total of 367 questionnaires were sent out and 350 valid questionnaires were returned，with valid response rate of 95.4%.Self-efficacy 1 score was（11.0±2.6），self-efficacy 2 score was（10.2±2.7），self-esteem 1 score was（12.6±2.3），self-esteem 2 score was（14.4±1.7），positive coping style 1 score was（9.3±4.5），positive coping style 2 score was（9.8±4.3），negative coping style 1 score was（6.9±3.1），negative coping style 2 score was（8.0±2.9），resilience score was（18.9±8.2），optimism score was（14.5±5.5），strength score was（6.2±3.0）.There was no linear correlation between self-esteem 1 score and negative coping 1 score and negative coping 2 score（P>0.05），but there was significant positive correlation between the scores of other dimensions（P<0.01）.Fitting index of the model showed good fit with χ2/df= 0.121 7，comparative fitting index（CFI）= 0.996，Tucker-Lewis index（TLI）= 0.993，root mean square error of approximation（RMSEA）=0.032.The mediating effect analysis showed that self-efficacy influenced the resilience through the path of “self-efficacy →positive coping style→resilience”（β=0.213，P<0.001） and “self-efficacy→self-esteem→positive coping style→resilience”（β=0.094，P<0.001）.The path coefficient of direct effect was 0.535 and sum of the mediating path coefficient was 0.307 which indicated that 36.5% of self-efficacy effect on resilience was mediated by the chain mediating effect of self-esteem and positive coping style.Conclusion　Self-efficacy was the predictor of resilience in patients with schizophrenia.High-level self-efficacy can promote the self-esteem of these patients and lead to positive coping style，so as to improve their resilience.

Effects of Rural Resident Quality of Life on Old-age Care Anxiety：the Moderating Effect of the Parent-child Relationship

WANG Jinghui，ZHOU Xue，XIE Fengzhe，SHI Yu，SUN Tao，LI Li，WANG Yanfu，ZHANG Zhong，ZHANG Shue，ZHAI Chuncheng，ZHANG Jiarui，WANG Zhen，YIN Dong，NING Weidong

2019, 22(5): 555-558. DOI: 10.12114/j.issn.1007-9572.2018.00.061

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Background　The improvement of the quality of life of the rural residents is an important reflection of the success of the construction of the New Countryside.It is of great significance to improve the quality of life and to implement the old-age problems of rural residents in order to maintain the sustainable and healthy development and social stability in rural areas.Objective　To explore the effect of quality of life （QOL） on old-age care anxiety in rural residents and to elucidate the moderating effect of the parent-child relationship on QOL and old-age care anxiety.Methods　Between August and October，2016，we used a stratified sampling method to randomly select rural residents from 30 villages in five counties （cities） of Heilongjiang Province.The SF-36 scale was used to investigate the QOL of the rural residents，and the old-age care anxiety and parent-child relationship was assessed on the basis of the following questions：“Are you worried about your future old-age care?”“Are you satisfied with your relationship with your offspring?”.Results　A total of 1 100 questionnaires were distributed，and 941 valid questionnaires were collected （effective response rate：85.54%）．The correlation analysis results showed a negative correlation between QOL and old-age care anxiety （r=-0.315，P<0.01），a positive correlation between QOL and the parent-child relationship （r=0.362，P<0.01），and a negative correlation between old-age care anxiety and the parent-child relationship （r=-0.100，P<0.01）．The results of multiple linear regression analysis revealed that the QOL of rural residents had a negative predictive effect on old-age care anxiety （β=-0.297，P=0.001），and the parent-child relationship played a moderating role between the QOL of rural residents and old-age care anxiety（β=-0.372，P<0.05）．Conclusion　High QOL renders rural residents with fewer worries about their future old-age care.Moreover，the better the parent-child relationship，the lower the implications of QOL on old-age care anxiety.High QOL and a harmonious family environment can provide rural residents with material and spiritual security for their old-age care.

Current Status of Treatment Burden of Patients with Noninfectious Chronic Diseases Based on Ordinal Logistic Regression

YANG Zhipeng，WANG Haoxiang，OU Wensen，WANG Jinming，CHEN Baoxin，HUANG Zhijie，ZHANG Man，OU Weilin，MO Haiyun，WANG Jiaji

2019, 22(5): 559-563. DOI: 10.12114/j.issn.1007-9572.2018.00.206

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Background　With the development of economy and the aggravation of aging，the prevalence of noninfectious chronic diseases（NCD）is increasing.Patients with NCD need to have clinical treatment and health management，such as drug use，self-monitoring，clinical examination，medical treatment and self-management，which may cause a heavy burden on patients.Objective　To explore the status of treatment burden and its influencing factors of patients with NCD in Chang'an Town，Dongguan，Guangdong.Methods　Taking Chang'an Town，Dongguan，Guangdong as the research site，a multistage stratified cluster random sampling was adopted to select 4 to 6 cell from each of the 13 communities，and 50 families were randomly selected from each cell by cluster sampling method.Finally a total of 1 472 patients with NCD were included in the study in July 2016.Patients were investigated using NCD patients treatment burden questionnaire，which included general demographic questionnaire，NCD status questionnaire，health service utilization questionnaire，and Treatment Burden Questionnaire （TBQ）．Results　According to the status of treatment burden，patients were divided into low treatment burden group（721 cases），moderate treatment burden group （540 cases） and heavy treatment burden group （211 cases） by K-means cluster analysis，and TBQ scores of three groups were （24.4±10.5），（53.6±9.3） and （85.1±13.6），respectively.There were significant differences in treatment burden in terms of medical insurance，chronic pain，musculoskeletal and connective tissue diseases，different kinds of chronic diseases，non-hospitalization and hospitalization in 12 months （P<0.05）．The result of Ordinal Logistic regression analysis showed that employee insurance〔OR=-1.046，95%CI （-1.786，-0.306）〕，medical insurance〔OR=-0.767，95%CI （-1.449，-0.086）〕，suffering one chronic diseases 〔OR=-0.364，95%CI （-0.660，-0.070）〕 and hospitalization in 12 months 〔OR=0.605，95%CI （0.250，0.960）〕 were the factors influencing the treatment burden of patients with NCD （P<0.05）．Conclusion　Patients with NCD in Chang'an Town，Dongguan mainly have low treatment burden.Medical institutions should strengthen the monitoring of NCD and health management of patients with NCD，so as to reduce the burden of treatment and improve health of patients.

Deciduous Teeth Health Status and Oral Hygiene Behaviors among 3-5-year-old Urban and Rural Children in Jiangxi Province

ZENG Yixuan，OU Xiaoyan，ZHOU Xiaojun，LI Xing，JIANG Hui

2019, 22(5): 564-569. DOI: 10.12114/j.issn.1007-9572.2018.00.173

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Background　Caries in deciduous teeth has different degrees of influence on children's physical and mental health.Healthy oral hygiene behavior in childhood also has a positive impact on future growth and development.In recent years，there is a lack of literature on analyzing the status quo of health of deciduous teeth among children in urban and rural areas of Jiangxi Province.Objective　To investigate the prevalence of carious deciduous teeth and oral hygiene behaviors among 3-5-year-old children in urban and rural areas of Jiangxi Province，proving an evidence-based reference for the development of appropriate oral hygiene interventions by relevant departments.Methods　In this cross-sectional study carried out between December 2015 and October 2016，by stratified clustering sampling，we enrolled 2 880 3-5-year-old children〔1 428（49.58%） urban children and 1 452（50.42%） rural children〕 from 3 kindergartens randomly sampled from 5 districts and 5 counties of Shangrao，Ganzhou，Yichun，Jiujiang and Nanchang （1 district and 1 county from each city） randomly selected from Jiangxi Province.All of them underwent a dental examination for screening the prevalence of dental caries and a personal interview survey about oral hygiene.Results　The prevalence of caries was 49.13%（1 415/2 880） and the mean DMFT was （2.33±3.55） among all the children.Compared with rural children，urban children demonstrated a lower prevalence of caries〔42.37%（605/1 428） vs 55.79%（810/1 452），χ2=51.866，P<0.05〕，a lower mean DMFT〔（1.79±3.03）vs （2.86±3.92）（Z=-8.156，P<0.001）〕，and lower prevalence of caries in central incisors，lateral incisors，canine teeth，first molars and second molars （P<0.05） in the maxilla，mandible and both maxilla and mandible.Urban and rural children showed significant differences in prevalence of tooth brushing，age of starting tooth brushing，frequency of daily tooth brushing，prevalence of using toothpaste with fluoride，frequency of eating sugary foods，suffering from tooth pain or discomfort over the past 12 months （P<0.05），but not in the rate of seeking hospital care due to dental problems （P>0.05）．Conclusion　In Jiangxi Province，3-5-year-old children from the urban areas had lower caries prevalence and mean DMFT and better oral hygiene behaviors compared with those from rural areas.In order to improve the overall oral health status of children，a high priority should be given to oral health education and interventions for bad oral hygiene behaviors，and development of good oral hygiene behaviors for children in rural areas.

Investigation and Correlation Analysis of Social Support and Mental Health in Community-dwelling Elderly People

GU Ruimeng，SONG Huanxia，LI Jianzhong

2019, 22(5): 570-574. DOI: 10.12114/j.issn.1007-9572.2018.00.392

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Background　With the aggravation of population aging，mental health problems of the elderly have achieved more and more attention.Understanding social support and mental health in community-dwelling elderly people，helps to provide new thoughts for solving mental health problems in this population.Objective　To study the relationship between social support and mental health in community-dwelling elderly people.Methods　This study was conducted in a sample of elderly people aged 60 or over from Nanjing's Gulou District during October to November 2015.A Sociodemographic Questionnaire developed by our research group，Social Support Rating Scale （SSRS） and Geriatric Mental Health Scale（Urban Version）（GMHS-U） were used in a survey for collecting the sociodemographic data，social support and mental health status in the elderly，respectively.SPSS 20.0 was adopted to process and analyze the data.Results　Of the 4 000 elderly people，altogether 3 535 returned responsive questionnaires，giving a response rate of 88.38%.The scores of the SSRS and its 3 dimensions （objective support，subjective support and support utilization） were positively correlated with the scores of the GMHS-U and its 5 dimensions （cognitive efficacy，emotional experience，self-awareness，interpersonal communication，adaptive ability）（P<0.05）．The scores of objective and subjective support and support utilization directly influenced the scores of GMHS-U and all of its dimensions （P<0.05），except that the score of subjective support had no significant direct effect on that of adaptive ability，explaining 6.4% of cognitive efficacy，17.9% of emotional experience，18.2% of self-awareness，19.4% of interpersonal communication，12.9% of adaptive ability，and 20.5% of the score of the GMHS-U.Support utilization had the greatest impact on mental health of the elderly （β=0.278）.Conclusion　The mental health status of community-dwelling elderly people is positively correlated with social support.Moreover，it is influenced most by support utilization.Therefore，to maintain the mental health in this population，attention should be put on improving the social support level during the delivery of community-based care.

Survey and Relationship Analysis of Perceived Social Support，Psychological Resilience and Self Esteem in Community-dwelling Empty Nesters

ZHANG Shaobo，KONG Yanling

2019, 22(5): 575-580. DOI: 10.12114/j.issn.1007-9572.2018.00.383

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Background　With the change of population structure and the acceleration of modernization in China, the problem of empty nesters in community is becoming more and more serious. Previous survey studies show that empty nesters have low quality of life and serious psychological problems. How to improve the psychological problems of empty nesters in community and improve their quality of life is the focus of future research.Objective　To evaluate the correlations of perceived social support，psychological resilience and self-esteem in empty nesters on the basis of a survey.Methods　Empty nesters and non-empty nesters from Faculty Community of Qufu Normal University in Qufu City were recruited in December 2016.Demographic characteristics，levels of social support，psychological resilience and self-esteem were collected by a survey with the Demographic Questionnaire，Perceived Social Support Scale（PSSS），Connor-Davidson Resilience Scale （CD-RISC），and Rosenberg Self Esteem Scale （RSES）．Structural equation model was established by AMOS 20.0.And mediation analysis was used to analyze the mediation effect of perceived social support.Results　Of the 434 recruited individuals，400 （including 200 empty nesters and 200 non-empty nesters） responded to the study questionnaires，achieving a response rate of 92.2%.Empty nesters demonstrated lower mean scores of PSSS 〔（56.5±5.3） vs （63.8±6.1）〕（t=12.65，P<0.001），CD-RISC 〔（86.5±8.4） vs （91.6±9.1）〕（t=5.86，P<0.001），and RSES 〔（27.3±2.4） vs （32.4±3.2）〕（t=11.37，P<0.001） compared with non-empty nesters.Pearson correlation analysis showed that PSSS was positively correlated with CD-RISC score （r=0.568，P<0.01），PSSS was positively correlated with RSES score （r=0.637，P<0.01），CD-RISC was positively correlated with RSES score （r=0.625，P<0.01）．Mediation analysis revealed that the effect size of perceived social support between psychological resilience and self-esteem was 0.335，with a 95%CI （0.277，0.393） found by the Bootstrapping.Conclusion　Empty nesters have poor levels of perceived social support，psychological resilience and self-esteem.Perceived social support exerts a strong mediating effect on the relationship between psychological resilience and self-esteem.Therefore，the self-esteem of this population can be enhanced by raising the perceived social support.

Effect of Chinese Online Mindfulness-based Stress Reduction Course on Mindfulness Level and Mood State of General Population

GU Jie，TONG Huiqi，SUN Xiaoming

2019, 22(5): 581-585. DOI: 10.12114/j.issn.1007-9572.2018.00.195

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Background　Mindfulness-based stress reduction（MBSR）has become popular in China.Due to the widespread use of online video platforms，online MBSR courses has emerged.Although studies showed that online MBSR courses can reduce stress，anxiety or depression of cancer patients，mind state，the most common mental health indicator for non-clinical audience，is less focused.Objective　To evaluate the effect of a Chinese online MBSR course on the level of mindfulness and mood state of course participants recruited from a general population and to investigate the correlation between the changes of mindfulness level and mood state.Methods　Chinese speaking self-pay participants were recruited by E-mail and Chinese social media to an Chinese online MBSR course from May to July 2017.The course is led by a senior MBSR tutor on ZOOM platform for 8 weeks，including network group courses and after school exercises.The Five Facet Mindfulness Questionnaire （FFMQ） and Profile of Mood States-short Form （POMS-SF） both in Chinese version were administered at baseline and within 3 days after the completion of the course.The course attendance rate was recorded.　Changes in level of mindfulness and mood state and their correlation were analyzed.Results　A total of 24 questionnaires were distributed and 21 valid questionnaires were collected，with an effective recovery rate of 87.5%.The attendance rate of the course was 100.0% （21/21）．There was an increase in the total score of FFMQ，the score of observing and non-judging after the course （P<0.05）．There was no significant difference in the score of describing，awareness and non-reactivity facets of FFMQ （P>0.05）．There were no significant differences in the score of total mood disturbance （TMD），tension，anger，fatigue，depression，confusion，vigor and self-esteem before and after the course （P>0.05）．Total score difference of FFMQ was negatively correlated with differences of TMD，tension，anger，depression and confusion （P<0.01）．We further looked at the 16 participants （76.2%） who had increased FFMQ score after the course，and the total score of FFMQ was （130.8±15.9） points before the course，which was lower than that of （151.1±13.4） after the course （tpaired=5.47，P<0.001）．Among those with significant increase in FFMQ，we found that their TMD，tension，depression and confusion were significantly lower than that of baseline （P<0.05）．However，anger，fatigue，vigor and self-esteem did not show statistically significant changes （P>0.05）．Conclusion　The Chinese online MBSR course can improve the mindfulness level of participants and stabilize their state of mind.

Investigation of Health Needs and Analysis of Influencing Factors in Patients Who have Returned to Work after Myocardial Infarction

DU Ruofei，WANG Panpan，CHEN Changying

2019, 22(5): 586-590. DOI: 10.3969/j.issn.1007-9572.2018.00.247

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Background　At present，there are about 2.5 million patients with myocardial infarction in China.In the next 15 years，75 million more patients with myocardial infarction are expected.The prevalence of myocardial infarction is on the rise among young people，and most patients are the main component of social productivity.The ability to return to work is one of the indicators of recovery.However，the needs of disease management，disease prevention and work-related problems for patients with myocardial infarction after returning to work have not been met.As their coping ability is poor，patients may still encounter physical and mental problems.Objective　To understand the health needs of patients who have returned to work after experiencing myocardial infarction，and to analyze the factors influencing these needs，to provide a reference for relevant intervention research.Methods　A questionnaire survey was conducted through a convenient sampling method，in patients with myocardial infarction who had returned to work within 2 years after discharge from three Third Grade-associated ＆ Class hospitals in Zhengzhou City between June 2017 and October 2017.The general information and health needs of the participants were surveyed，including their need for guidance regarding disease-related knowledge，medication guidance，dietary guidance，exercise and activity guidance，lifestyle guidance，psychological counseling and the work-associated.Results　A total of 340 questionnaires were distributed，and 326 valid questionnaires were returned.The effective recovery rate was 95.9%.The total score of the health needs was （130.4±8.7）；the disease-related knowledge dimension score was （4.1±0.3）；the medication guidance dimension score was （3.2±0.6）；the dietary guidance dimension score was （3.1±0.7）；the exercise and activity guidance dimension score was （3.1±0.7）；the lifestyle guidance dimension score was （3.3±0.7）；the psychological counseling dimension score was （3.5±0.6）；and the work-associated dimension score was （3.8±0.5）.There were significant differences in education level，family monthly income，time before return to work，number of disease complications，and number of stents installed（P<0.05）.Multiple linear regression analysis showed that the education level（β=4.222），time before return to work（β=-1.832），number of disease complications（β=1.635），and number of stents installed（β=2.573） were factors that affected the health needs of the participants （P<0.05）.Conclusion　Although patients with myocardial infarction recovered and returned to work，they still had a high degree of health needs.Targeted education and guidance should be carried out according to the specific needs of patients to improve the health conditions and quality of life of these patients.

The Influence of Gender Preference and Sex Composition of Surviving Children on the Second Child Fertility Plan

QIU Hongyan，REN Yangjie，HOU Liyan

2019, 22(5): 591-594. DOI: 10.12114/j.issn.1007-9572.2018.00.335

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Background　Most married employees born after 1980 already had one child.Will they decide to have a second child under the current comprehensive two-child fertility policy？Will their gender preference（GP）and living children's sex composition（LCSC）affect the second child fertility plan？Objective　To investigate the influence of GP and LCSC on the second child fertility plan，so as to provide new ideas for studying the mechanism of social psychological factors on fertility intention and childbearing behavior.Methods　Current research design and cluster sampling method was used to analyze 599 married and fertilized employees who were born from January 1 1980 to January 1 1990 and worked in 5 governmental units and 5 enterprises in Yinchuan from November 2016 to November 2017.Quantitative questionnaires were used to collect data，including basic personal and family information and GP for children；actual reproductive behavior of subjects （the number and gender of children already born），and birth planning of subjects （whether they intend to have another child）．Results　Of 599 married occupational groups who were born after 1980 in urban population，245（40.90%） had plans to have a second child，234（39.07%） did not want to have another child，and 120（20.03%） have not decided yet.There were significant differences in GP，and GP and LCSC consistency （χ2=21.020，P<0.001；χ2=22.499，P<0.001）．There were no significant differences in ethnic groups，household registration，educational level，work units and posts（P>0.05），and there were significant differences in gender，monthly income and only-child condition（P<0.05）．The results of multivariate Logistic regression analysis showed that those with inconsistent GP and LCSC，male，undergraduate or above education level would like to bear another children （P<0.05）；those with GP and LCSC consistency，who earned less than 3 000 yuan monthly had not decided whether to bear two children （P<0.05）．Conclusion　Besides social demographic factors，the decision whether to have a second child among married and fertilized employees who were born after 1980 was also influenced by GP and LCSC.

Association between Number of Abortions and Metabolic Syndrome

MIAO Ying，WAN Qin

2019, 22(5): 595-600. DOI: 10.12114/j.issn.1007-9572.2018.00.255

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Backgroud　In recent years，the prevalence of metabolic syndrome（MS）is on the rise.However，the etiology of MS is not yet clear，it is now believed to be the result of interaction between multiple genes and multiple environmental factors.The epidemiological studies on the association between number of abortions and the prevalence of MS are very limited now.Objective　To investigate the association between number of abortions and the prevalence of MS．Methods　Totaled 2 829 women with complete data who participated in the epidemiological investigation of type 2 diabetes in Luzhou region from 2014 to 2016 were selected.Clinical data were collected through a questionnaire survey.All of them underwent physical examination and laboratory test and the results were recorded.Multivariate Logistic regression was used to investigate the association between the number of abortions and the prevalence of MS.Results　Of the 2 829 participants，1 089 had MS（38.49%）．There were significant differences in distribution of number of abortions and artificial abortions between patients with MS and those without MS （P<0.05）.Compared with those without MS，the average age，average body mass index（BMI），waist circumference （WC），hip circumference （HC），systolic blood pressure （SBP），diastolic blood pressure （DBP），fasting plasma glucose （FPG），2-hour postprandial blood glucose（2 hPG），glycosylated hemoglobin （HbA1c），total cholesterol （TC），triglyceride （TG），low-density lipoprotein cholesterol （LDL-C），alanine aminotransferase （ALT），aspartate aminotransferase （AST），gamma-glutamyl transferase （GGT） and creatinine levels increased but the prevalence of alcohol drinking and average high-density lipoprotein cholesterol （HDL-C） levels decreased significantly in those with MS（P<0.05）．Multivariate Logistic regression analysis showed that，after adjusting for age，drinking，BMI，WC，HC，SBP，DBP，FPG，2 hPG，HbA1c，TC，TG，HDL-C，LDL-C，ALT，AST，GGT and creatinine levels，the prevalence of MS in women with one，two，three，more than three times of abortion increased by a factor of 1.582〔95%CI（1.096，2.284），P=0.014〕，1.680〔95%CI（1.148，2.456），P=0.008〕，2.259〔95%CI（1.440，3.545），P<0.001〕，2.266〔95%CI（1.355，3.789），P=0.002〕，respectively，compared with those without a history of abortion.The prevalence of MS in women with one，two，three，more than three times of artificial abortion increased by a factor of 1.465〔95%CI（1.026，2.091），P=0.035〕，1.689〔95%CI（1.156，2.469），P=0.007〕，2.151〔95%CI（1.369，3.380），P=0.001〕，1.947〔95%CI（1.144，3.315），P=0.014〕，respectively，compared with those without a history of artificial abortion.Conclusion　History of abortion/ artificial abortion is strongly associated with an increased risk of MS，and the association is number-dependent.

Efficacy and Safety of Bronchial Thermoplasty for Patients with Refractory Asthma：a Meta Analysis

JIANG Xunsheng，DONG Biwen，ZHANG Zilong

2019, 22(5): 601-605. DOI: 10.12114/j.issn.1007-9572.2018.00.193

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Background　Bronchial thermoplasty（BT） is a new non-drug treatment for refractory asthma on the basis of conventional therapy.It can reduce the contraction of airway smooth muscle，alleviate asthma symptoms and deterioration，and improve asthma control and quality of life.Objective　To evaluate the efficacy and safety of BT in the treatment of refractory asthma （RA） by using a systematic review．Methods　We searched PubMed，EMBase，ClinicalTrials.gov，CNKI，Wanfang Data Knowledge Service Platform and VIP for randomized controlled trials （RCT） published as of February 2017，in which the efficacy and safety of BT in the treatment of RA were reported，and reviewed the studies listed as references of the relevant RCT published in printed journals.Data were extracted from eligible RCT and quality assessment was conducted with Revman 5.3.Results　Five RCT were included.Meta-analysis showed that the FEV1% predicted was similar between RA patients with 1-year BT treatment and those with 5-year BT treatment 〔WMD=-0.75，95%CI （-3.36，1.85），P=0.57〕；compared with the controls，BT-treated patients showed significantly improved peak expiratory flow （PEF）〔WMD=23.98，95%CI （15.12，32.83），P<0.000 01〕，much enhanced Asthma Quality of Life Questionnaire （AQLQ） score〔WMD=0.52，95%CI （0.25，0.78），P=0.000 2〕，obviously increased Asthma Control Questionnaire （ACQ） score〔WMD=-0.52，95%CI （-0.84，-0.20），P=0.002〕，notably longer asymptomatic duration〔WMD=23.63，95%CI （14.92，32.33），P<0.000 1〕and apparently lower rate of hospitalization due to respiratory adverse events during a 1-year treatment period〔OR=3.16，95%CI （1.12，8.93），P=0.03〕.However，both groups showed no significant differences in the frequency of receiving emergency drug therapy 〔WMD=-0.28，95%CI （-3.42，2.85），P=0.86〕.There was no significant difference in hospitalization rate of adverse respiratory reactions between 1 year and 5 years after BT treatment〔OR=1.51，95%CI （0.68，3.38），P=0.31〕.Conclusion　BT can significantly improve the pulmonary function，asthma symptoms and quality of life of RA patients with good safety.

The Effectiveness of Biofeedback for Patients with Functional Constipation：a Meta-analysis

WU Xiaodan，ZHONG Jiudi，WEN Yongshan，CHEN Jingyu，DENG Yang，ZHONG Dongmei，ZHENG Meichun

2019, 22(5): 606-611. DOI: 10.12114/j.issn.1007-9572.2018.00.132

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Objective　To systematically evaluate the effectiveness of biofeedback on patients with functional constipation.Methods　From January 2007 to July 2016，randomized controlled trials were retrieved from multiple electronic databases including CNKI，CBM，Wanfang Data Knowledge Service Platform，VIP，PubMed，Cochrane Library，EMBase，Web of Science，JBI，RNAO，Nursing Consult，BIOSIS Previews，Medline and Springerlink.Studies were selected according to inclusion and exclusion criteria，and data were analyzed by RevMan 5.3.Results　A total of 8 RCTs with 688 patients were included.The results of meta-analysis supported the effectiveness of biofeedback on improving the subjective feelings of defecation in patients with functional constipation〔RR=1.47，95%CI（1.03，2.08），P=0.03〕 and reducing the need for digit use during defecation〔RR=0.47，95%CI（0.27，0.81），P=0.007〕.Biofeedback also improved the discharge rate of colonic transit test〔MD=9.83，95%CI（5.18，14.18），P<0.000 1〕，and decreased the anorectal pressure〔MD=-49.70，95%CI（-86.60，-12.79），P=0.008〕.Conclusion　Biofeedback can improve the subjective feelings of defecation in patients with functional constipation and discharge rate of colonic transit test，as well as reduce the need for digit use during defecation and the anorectal pressure with functional constipation.Due to the fact that effectiveness on improving patient satisfaction after treatment and decreasing the anal resting pressure are still not certain，with the heterogeneity of indicators and inadequate included studies，more multi-centered randomized controlled trials with large sample size and good quality are needed in the future to confirm the effectiveness of biofeedback.

Evaluation of Left Ventricular Systolic Function in Patients with Cardiac Syndrome X by 3D Speckle Tracking Imaging

YU Ziheng，CHENG Zhenfeng，LU Kongjie

2019, 22(5): 611-615. DOI: 10.3969/j.issn.1007-9572.2018.00.190

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Background　The pathophysiological mechanism of cardiac syndrome X （CSX） is still not clear.Evaluation data of female ischemic syndrome shows that in coronary angiography，about 50% of women and 17% of men do not have stenosis or coronary artery stenosis <50%.Compared with normal population，CSX patients have a higher incidence of myocardial infarction and stroke.As CSX is easy to progress，coronary lesions tend to be aggravated，so it is particularly important to seek a new evaluation method．Objective　To evaluate the left ventricular systolic function （LVSF） in patients with cardiac syndrome X using three-dimensional speckle tracking imaging （3D-STI）．Methods　The enrolled 60 participants were all from Huzhou Central Hospital from June 2016 to September 2017，including 40 cardiology inpatients with typical chest pain，positive results of treadmill exercise testing but without coronary artery anomalies （identified by coronary arteriongraphy）（study group），and other 20 healthy individuals underwent physical examination in the outpatient （control group）．Echocardiography was performed for examining the left ventricular diastolic and systolic function parameters.Using 3D-STI，the peak values of longitudinal strain （LS），radial strain （RS），circumferential strain （CS），and area strain （AS），and the peak of twist angle （Ptw） and torsion of the left ventricle were measured．Results　LVEDD，LVESD，E/A，E/E'，S'，LVEF were similar in both groups （P>0.05）.RS and CS were similar in both groups （P>0.05），but LS and AS reduced，and Ptw and torsion of the left ventricle increased significantly in the study group （P<0.05）．Univariate Logistic regression analysis showed that LS 〔OR=0.520，95%CI（0.310，0.875）〕 and AS 〔OR=0.463，95%CI（0.280，0.764）〕 were the influencing factors of CSX （P<0.05）；for diagnosing CSX，the AUC of LS was 0.839 and that of AS was 0.853．Conclusion　Using 3D-STI can correctly evaluate the systolic function of different segments of the left ventricle in the normal population or in the CSX population.Moreover，as 3D-STI can detect early abnormal changes in myocardium such as ischaemic myocardium more timely and sensitively than echocardiography，it is recommended for clinical application.
Microvascular angina；Echocardiography，three-dimensional；Ventricular function，left

Effect of Optimal Positive End-expiratory Pressure Guided by Bedside Ultrasound on Oxygenation Index and Hemodynamics in Patients with Acute Respiratory Distress Syndrome

LI Gen，RONG Ling，ZHAO Meijing，SUN Jie

2019, 22(5): 616-620. DOI: 10.12114/j.issn.1007-9572.2018.00.192

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Background　Mechanical ventilation is the main treatment of acute respiratory distress syndrome （ARDS）.With further physiological research on ARDS and understanding of ventilator-associated lung injury，lung protection ventilation strategies，such as lung recruitment，small tidal volume and positive end-expiratory pressure （PEEP），are main treatments at present.The treatment of PEEP after lung recruitment is still controversial.Objective　To analyze the effect of optimal PEEP guided by bedside ultrasound on oxygenation index and hemodynamics in patients with ARDS．Methods　A total of 60 patients with ARDS admitted in Bozhou People's Hospital from October 2015 to October 2017 were divided into control group and observation group，each with 30 cases according to PEEP setting after lung recruitment maneuver.Both groups were treated with increasing positive end expiratory pressure，while the control group adopted the maximum oxygen method and the observation group guided by bedside ultrasound to determine the best PEEP.The best PEEP，oxygenation index and dynamic compliance were observed in two groups，and the changes of heart rate （HR），mean arterial pressure （MAP），and central venous pressure （CVP） levels before and 15 minutes，1 and 2 hours after lung recruitment were monitored.Results　The best PEEP in the observation group was （15.5±1.6） cm H2O ，which was higher than that in the control group （13.3±2.4） cm H2O （t=4.103，P<0.001）．Treatment and treatment time had an interaction with oxygenation index and dynamic compliance （P<0.001）．The effect of treatment on dynamic compliance was significant （P<0.05）．The main effects of time on oxygenation index and dynamic compliance were significant （P<0.001）．The oxygenation index and dynamic compliance level of the observation group at 15 min，1 and 2 hours after lung recruitment were all higher than those of the control group （P<0.05）．Treatment and treatment time had an interaction with CVP （P<0.05）．HR and CVP of two groups at 15 min after lung recruitment were higher，and MAP was lower than those before the lung recruitment （P<0.05）；CVP of the observation group was higher than that of the control group at 15 min after lung recruitment （P<0.05）．Conclusion　The best PEEP was determined by bedside ultrasound after lung recruitment maneuver，which has good effect on improving the oxygenation and respiratory system compliance of ARDS patients，and had no significant side effects on hemodynamics of the body.

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