Chinese General Practice

Difficulties and Countermeasures of Cardiac Rehabilitation in China

GUO Hangyuan

2019, 22(12): 1381-1384. DOI: 10.12114/j.issn.1007-9572.2019.00.066

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With the continuous development of society and the increasing work pressure，the incidence of cardiovascular diseases is rising gradually and people develop this disease at a younger age.It is no exaggeration to say that cardiovascular disease has now become the "head" of diseases.For the diagnosis and treatment of cardiovascular diseases，China is in full swing.Either in physical examination of ECG，cardiac echocardiography or surgical stent implantation，pacemaker installation，most hospitals in China have well-developed diagnosis and treatment process while we still face a large difficulty in heart rehabilitation.Although the concept of cardiac rehabilitation has been proposed for many years，and its influence has been continuously improved in recent years，it is still unsatisfactory in terms of current coverage and implementation.The importance of cardiac rehabilitation is self-evident in the recovery of cardiovascular diseases.Meanwhile，in order to raise the awareness of cardiac rehabilitation in the whole country and corporate the concept of cardiac rehabilitation into clinics and life for all people，this study summarized some characteristics of cardiac rehabilitation and its current advantages and disadvantages in our country，hoping to attract more people's attention and participation and finally have better，bigger and stronger cardiac rehabilitation.

Risk Assessment Procedures and Management of Clinical Practice for Venous Thromboembolism in Gynecologic Patients　

GAO Hong，WANG Jiandong，TONG Tong

2019, 22(12): 1385-1391. DOI: 10.12114/j.issn.1007-9572.2018.00.345

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As the aging of society and the increasing prevalence of obesity，the incidence rate of venous thromboembolism（VTE） is growing.Although VTE has become a serious complication that threatens the safety of patients during the treatment of gynecological diseases，it can be prevented clinically by effective ways.Scientific risk assessment，reasonable preventive measures，and risk stratification of the severity of VTE disease can help reduce the incidence rate of and mortality from VTE in gynecologic patients.Based on the existing evidence-based studies in combination with relevant subject guidelines and expert opinions，as well as our daily clinical practices，we summarized the risk assessment process and clinical practice for VTE in gynecologic patients，aiming to help general practitioner and gynaecologists quickly assess VTE risk and make correct treatment decisions.

Advantage Analysis of Chinese and Western Medicine Integration in Cardiac Rehabilitation　

ZHANG Jie，GUO Hangyuan，CHI Jufang

2019, 22(12): 1392-1395. DOI: 10.12114/j.issn.1007-9572.2019.00.015

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Cardiovascular diseases have become the number one killer of human health.At present，although more attention has been paid on its treatment in clinical practice，little was paid on its rehabilitation and prevention.Thus，the research on accelerating cardiac rehabilitation is needed urgently.Currently，the guidelines for cardiac rehabilitation in China mostly refer to the ones in foreign countries，but the implementation of some foreign guidelines requires a great deal of equipment and professional guidance，sometimes with a huge investment，which is not suitable to real situation in our country.Therefore，the medical model of cardiac rehabilitation in our country must be fully considered the national conditions.We can utilize the advantage of traditional Chinese medical rehabilitation therapy，while drawing upon and integrating foreign advanced science and human civilization achievement，to finally form a Chinese-Western medical model with Chinese characteristics，and do a good job in cardiac rehabilitation.

Role of Family and Community in Cardiac Rehabilitation　

LUO Hangqi，CHI Jufang，GUO Hangyuan

2019, 22(12): 1396-1400. DOI: 10.12114/j.issn.1007-9572.2019.00.048

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With the arrival of the rising tide of China's aging population，the number of patients with severe cardiovascular disease such as acute myocardial infarction and heart failure has increased significantly.Early cardiac rehabilitation training using community and family support reasonably，is not only conducive to delaying the disease progression，and improving prognosis，but also avoiding the waste of medical resources and reducing national health expenditures.At present，China's health system offering cardiac rehabilitation only consists of some tertiary hospitals，and cardiac rehabilitation services have not been paid enough attention throughout the country，which make a considerable number of patients with severe cardiovascular disease be separated from the normal work and social lives after leaving the hospital，preventing them from returning to society.This article briefly reviews cardiac rehabilitation and the role of community and family in cardiac rehabilitation.

Cardiac Rehabilitation Model under the Medical Treatment Partnership System　

NI Tingjuan，GUO Hangyuan

2019, 22(12): 1400-1404. DOI: 10.12114/j.issn.1007-9572.2019.00.043

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Cardiac rehabilitation benefits patients with cardiovascular diseases，but cardiac rehabilitation in China is still in its infancy.This paper explores the application，analysis and construction of cardiac rehabilitation model under the background of medical treatment partnership system，which is of great significance to the development of cardiac rehabilitation.

Analysis between Indoor Environment and Childhood Asthma and Family Nursing Interventions in Chongqing　

WANG Ling，GUO Rong，YANG Huan，YUAN Xiaoping

2019, 22(12): 1405-1412. DOI: 10.12114/j.issn.1007-9572.2018.00.426

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Background　Bronchial asthma（asthma） is widely considered to be caused by gene and environment，while environmental factors are the major ones in the rising incidence of asthma because gene changes slowly.World Health Organization（WHO） reported that 44% of asthma diseases were caused by environmental factors，such as indoor fuel and second-hand smoking.Family history and allergens are well-known risk factors for asthma.Other factors triggering asthma has been rarely studied，such as indoor humidity，indoor air pollution，bedding，pillow core material and cleanliness，application of range hood and dust cover.Objective　To investigate the influence of indoor environment on the incidence of asthma in children in Chongqing，and to provide evidence for interventions in family nursing.Methods　Children with asthma diagnosed and treated in respiratory center of Children's Hospital of Chongqing Medical University from May to July 2017 were selected.Controls（being diagnosed with no asthma） were matched with cases（being diagnosed with asthma） for age and sex accorded to 1∶1 ratio.This study developed“Questionnaire of Related Factors of Children with Asthma”from Swedish Dampness in Buildings and Health（DBH） with adjustment and supplement of Chinese residential features.Questionnaire included general data，indoor environment（material of pillow core and quilt，cleaning frequency of pillow core and sheet，cleaning of dust cover，frequency of flowers contact，mold growth，water leakage，condensed water，frequency of humidifiers use，passive smoking during pregnancy and in kids，material of ground and wall，ventilation frequency，kitchen fuel，lampblack machine cleaning，air-conditioning filter cleaning，pets feeding，contact frequency of stuffed toys，and exposure frequency of cockroaches and mice）．Logistic regression were used to analyze the correlation variables.Results　We totally distributed 750 questionnaires，730 returned and 18 unqualified，resulting in a 94.9% of valid recovery rate，and with 356 cases in each group.The results of statistical analysis indicated that material of pillow core and quilt，cleaning frequency of pillow core and sheet，contact frequency of flowers，mold growth，water leakage，condensed water，passive smoking during pregnancy and in kids，contact frequency of stuffed toys，and exposure frequency of cockroaches and mice were significantly correlated with the incidence of asthma（P<0.05）．Conclusion　Unfavorable indoor environment（material of pillow core and quilt，cleaning frequency of pillow core and sheet，contact frequency of flowers，mold growth，water leakage，condensed water，passive smoking during pregnancy and in kids，contact frequency of stuffed toys，and exposure frequency of cockroaches and mice） would bring negative impact on respiratory health in children.More attention is needed and active interventions should be taken to improve the existing risk factors and reduce the incidence of asthma in children by lessening indoor environmental pollution.

Factors Affecting Treatment Outcomes of Pulmonary Tuberculosis in Xinjiang Uygur Population　

YANG Dan，WEN Jin，LIU Nianqiang，AYINUER·Mohemaiti，QIMANGULI·Wushouer，HU Xin，HAO Yanyan，WANG Jing

2019, 22(12): 1413-1418. DOI: 10.12114/j.issn.1007-9572.2019.00.016

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Background　Tuberculosis is a chronic infectious disease caused by Mycobacterium tuberculosis infection，which is one of the major public health problems in the world.According to the analysis of Chinese Center for Disease Control and Prevention，the reported incidence of tuberculosis in Xinjiang ranked first in China in 2015.Objective　To analyze the factors affecting treatment outcomes of pulmonary tuberculosis in Xinjiang Uygur Population，providing a theoretical basis for the prevention and treatment of pulmonary tuberculosis in Xinjiang.Methods　From March to April 2016，Uygur tuberculosis patients in Xinjiang registered in the National Tuberculosis Network Special Reporting System from July 2014 to June 2015 were selected.General demographic data （age，gender，place of residence，hukou location，occupation） and clinical data （patient source，sputum smear results，type of tuberculosis，type of treatment，treatment outcomes） of the patients were collected retrospectively，and the factors affecting treatment outcomes were analyzed.Results　Of the 24 298 cases registered，29 had a diagnosis change，889 had no reported treatment outcomes，the remaining 23 380 were eventually included in the study.Among the 23 380 cases，1 490 （6.4%） had failed treatment，and 564 died（2.4%） from tuberculosis.Multivariate Logistic regression analysis showed that age ≥60 years〔OR=1.550，95%CI（1.386，1.733）〕，living in rural areas〔OR=1.241，95%CI（1.065，1.446）〕，professional，technical and managerial workers〔OR=2.031，95%CI（1.038，3.974），retirees〔OR=2.050，95%CI（1.073，3.915）〕，referral receivers〔OR=1.812，95%CI（1.190，2.758），follow-up receivers〔OR=1.624，95%CI（1.047，2.517）〕，positive sputum smear results〔OR=1.622，95%CI（1.420，1.854）〕 and retreatment〔OR=1.859，95%CI（1.545，2.237）〕 were risk factors of tuberculosis treatment failure（P<0.05）．Age≥60 years〔OR=2.462，95%CI（2.038，2.975）〕，male〔OR=1.394，95%CI（1.174，1.656）〕，living in rural areas〔OR=1.265，95%CI（1.002，1.598）〕，positive sputum smear results 〔OR=2.027，95%CI（1.652，2.486）〕，retreatment〔OR=1.606，95%CI（1.216，2.121）〕 were risk factors of death due to tuberculosis（P<0.05）．Conclusion　Age，place of residence，occupation，patient source，sputum smear results and treatment type are the influencing factors of tuberculosis treatment failure.Age，gender，place of residence，sputum smear results and treatment type are the influencing factors of death due to tuberculosis.In view of this，relevant departments in Xinjiang should take measures to strengthen the prevention and treatment of tuberculosis in Uygur population，especially the elderly，persons living in rural areas，retirees，tuberculosis referral receivers，tuberculosis follow-up receivers，persons with positive sputum smear results，or those with tuberculosis retreatment.

Particulate Matters（PM2.5/PM10）and COPD Mortality in Pudong New Area of Shanghai　

CHEN Yichen，LI Xiaopan，SUN Lianghong，CHEN Hanyi，QU Xiaobin，ZHANG Ge，CHEN Hua，ZHOU Yi，LIN Tao，SUN Qiao

2019, 22(12): 1419-1425. DOI: 10.12114/j.issn.1007-9572.2019.00.040

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Background　The health hazards of chronic obstructive pulmonary disease（COPD）has caused widespread concern around the world due to its high prevalence rate and high mortality rate，but the study about the relationship between the concentration of particulate matters and daily COPD mortality was still rare.Objective　To explore the relationship between the concentration of particulate matters（PM2.5，PM10）and daily COPD mortality in Pudong New Area，so as to provide a reference to establish intervention measures.Methods　The daily COPD mortality data between 1 January 2013 and 31 December 2017 was originated from the local death surveillance database.The data of air pollution in Shanghai including the concentration of particulate matters（PM2.5，PM10，SO2，NO2）were offered by Shanghai Environmental Monitoring Center，and the data of meteorology in Pudong New Area including temperature，relative humidity，atmospheric pressure and wind speed were received from Meteorological Bureau of Pudong New Area.A generalized additive model（GAM）based on Poisson distribution was performed to analyze the association between particulate matters（PM2.5，PM10）and daily COPD death，and the COPD death data was stratified according to age（young group <80 years，old group≥80 years）and education level（the low educated group without the middle school education，the highly educated group with middle school education and above）．The concentration of particulate matters（PM2.5，PM10）at the day that the COPD death happen，one day before，two days before and three days before the death and the average concentration of particulate matters in the four days were presented as lag0，lag1，lag2，lag3 and lag03，respectively.Results　The concentration of PM2.5 was positively correlated with the concentration of PM10，SO2，NO2 and atmospheric pressure，and negatively correlated with temperature，relative humidity and wind speed（P<0.05）；the concentration of PM10 was positively correlated with the concentration of SO2，NO2 and atmospheric pressure，and negatively correlated with temperature，relative humidity and wind speed（P<0.05）；the concentration of SO2 was positively correlated with the concentration of NO2 and atmospheric pressure，and negatively correlated with temperature，relative humidity and wind speed（P<0.05）；the concentration of NO2 was negatively correlated with air temperature and relative humidity，and positively correlated with atmospheric pressure and wind speed（P<0.05）．Temperature was positively correlated with relative humidity，and negatively correlated with atmospheric pressure（P<0.05）．Relative humidity was negatively correlated with atmospheric pressure and wind speed（P<0.05）．The results of the single pollutant model showed that the effect of PM2.5 on daily COPD mortality was significant at lag0，lag1，lag2 and lag03（P<0.05），and not significant at lag3（P>0.05）；the effect of PM10 was significant at lag0，lag1，lag2，lag3 and lag03（P<0.05）．After stratification according to age，the effect of PM2.5 and PM10 on daily COPD death count was not significant at lag0，lag1，lag2，lag3 and lag03 among young group（P>0.05）；the effect of PM2.5 on daily COPD mortality among the old group was significant at lag0，lag1，lag2 and lag03（P<0.05），and not significant at lag3（P>0.05）；the effect of PM10 was significant at lag0，lag1，lag2，lag3 and lag03 among the old group（P<0.05）．After stratification according to education level，the effect of PM2.5 and PM10 on daily COPD mortality among low educated group was significant at lag0，lag1，lag2 and lag03（P<0.05），and not significant at lag3（P>0.05）；the effect of PM2.5 was significant on daily COPD mortality among highly educated group at lag1（P<0.05），and not significant at lag0，lag2，lag3 and lag03（P>0.05）；the effect of PM10 was significant on daily COPD mortality among highly educated group at lag1 and lag03（P<0.05），and not significant at lag0，lag2 and lag3（P>0.05）．The results of multi-pollutant model showed that the effect of PM2.5 was not significant on the daily COPD mortality among the whole crowd，old group，young group，low educated group and highly educated group after the effect of SO2 and NO2 had been controlled separately and simultaneously（P>0.05）．The effect of PM10 was not significant on the daily COPD mortality among the whole crowd，old group，young group，low educated group and highly educated group after the effect of SO2 had been controlled or the effect of SO2 and NO2 had been controlled simultaneously（P>0.05）．When the effect of NO2 had been independently controlled，the effect of PM10 was not significant among the whole crowd，young group，low educated group and highly educated group（P>0.05），and its effect was significant among the old group（P<0.05）．Conclusion　Increased concentrations of atmospheric particulate matters（PM2.5，PM10）have a significant impact on the mortality of chronic obstructive pulmonary disease（COPD）in Pudong New Area.The old group and the low educated group of patients with chronic obstructive pulmonary disease were more sensitive to the concentration change of particulate matters（PM2.5，PM10），and relative measures should be enhanced to protect the sensitive population from the hazard of particulate matters（PM2.5，PM10）．

Curative Effect of Tripterygium Glycosides Combined with Irbesartan on IgA Nephropathy with Increased Urinary Podocyte Excretion　

LIANG Yan，ZHANG Xiaoling，LIU Bing，ZHU Qing，SHAO Fengmin

2019, 22(12): 1426-1431. DOI: 10.12114/j.issn.1007-9572.2018.00.403

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Background　IgA nephropathy is the most common primary glomerular disease in the world and a common cause of end-stage renal failure.Currently，Tripterygium glycosides（TG），irbesartan and other immunosuppressants are major drugs used for clinical treatment，but it has not been proved that whether the combination of TG and irbesartan has synergistic effects in thoroughly alleviating the progress of IgA nephropathy.Objective　To discuss the curative effect of TG and irbesartan on IgA nephropathy with increased urinary podocyte excretion.Methods　From Henan Provincial People's Hospital from January 2014 to December 2016，128 IgA nephropathy patients were enrolled according to the inclusion and exclusion criteria of this study，and were divided into the TG group（n=42），irbesartan group（n=40）and combination group（n=46），receiving TG tablets（20 mg，three times a day），irbesartan tablets（150 mg，twice a day），and TG tablets（20 mg，three times a day）combined with irbesartan tablets（150 mg，twice a day），respectively，for 12 weeks.The general information，data concerning blood pressure（systolic and diastolic pressure），laboratory indices〔serum creatinine（Scr），blood urea nitrogen（BUN），serum uric acid（SUA），serum albumin（Alb），total cholesterol（TC），estimated glomerular filtration rate（eGFR），24-hour urinary protein level〕and the number of urinary podocytes before and after the treatment of all participants were collected.Post-treatment improvement in 24-hour urinary protein and adverse reactions caused by treatment were also obtained.Results　Intergroup comparisons demonstrated that combination group presented much higher Alb level and much lower 24-hour urinary protein level compared with other two groups（P<0.05）．Compared with baseline，all groups showed significantly decreased Scr and 24-hour urinary protein levels and obviously increased Alb and eGFR levels after treatment（P<0.05）．The combination group also showed much lower BUN and SUA levels（P<0.05）．The number of urinary podocytes decreased significantly in all groups after treatment（P<0.05）．The combination group had much less urinary podocytes than other two groups after treatment（P<0.05）．The combination group had a notable higher clinical response than other groups（P<0.05）．There was no difference in the incidence of adverse reactions among the three group（P>0.05）．Conclusion　For IgA nephropathy with increased urinary podocyte excretion，TG combined with irbesartan is superior to TG or irbesartan alone.The combination treatment can produce a synergistic effect in reducing the injury of renal podocytes，thereby delaying the progression of the disease.

Different Regimens of Polyethylene Glycol Electrolyte Solution in Bowel Preparation before Colonoscopy for Elderly Patients：a Randomized Controlled Study　

LIU Miao，WANG Hongbo，CHEN Qingbo

2019, 22(12): 1432-1435. DOI: 10.12114/j.issn.1007-9572.2018.00.226

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Background　Elderly patients are prone to adverse reactions and poor intestinal preparation when taking oral drugs for intestinal preparation before electronic colonoscopy.Objective To compare effects of 3 regimens of polyethylene glycol electrolyte solution on elderly patients for bowel preparation before colonoscopy.Methods　Two hundred and twenty-one elderly Patients undergoing colonoscopy from January 2016 to January 2018 in Hubei Cancer Hospital were divided into 3 groups by using random number table method.Group A（n=74）：patients took 205.68 g of polyethylene glycol （3 bags） dissolved in 3 000 ml of water at onetime on the morning before receiving colonoscopy.Group B（n=74）：patients took 274.24 g of polyethylene glycol（4 bags） dissolved in 4 000 ml of water on the night before and the morning of colonoscopy separately，with 2 000 ml each time.Group C（n=73）：patients took 274.24 g of polyethylene glycol（4 bags） dissolved in 4 000 ml water on the night before and the morning of colonoscopy separately，2 000 ml each time，combined with mosapride citrate dispersible tablets，5 mg/tab，tid for one day，only one day.The colonoscopy examination was performed within 4 hours after the end of the taking medicine in all three groups. Intestinal cleaning score，gastrointestinal adverse reaction，detection rate of bowel polyps，the time from the colonoscopy to ileocecal part among 3 groups were compared.Results　The total Ottawa score of A，B and C groups were（3.80+1.22），（3.88+1.26） and （1.16+0.69），respectively.Group C had higher score than Group A and Group B（P<0.05），and there was no significant difference between Group A and Group B（P>0.05）．Gastrointestinal adverse reaction in Group C and Group B was milder than that of Group A（P<0.05）．The intestinal preparation tolerance rate of Group B and Group C was significantly higher than that of group A（P<0.05）．There was no significant difference about detection rate of bowel polyps and the time from the colonoscopy to ileocecal part among 3 groups（P>0.05）．Conclusion　 Polyethylene glycol given two times does not affect intestinal cleaning in elderly patients，but can improve their intestinal preparation tolerance rate and reduce their gastrointestinal adverse reaction.Polyethylene glycol combined with Mosapride is an optimal regimen for intestinal cleansing in elderly patients.

Clinical Values of Transvaginal Color Doppler Sonography Combined with Serum miRNA-18a and miRNA-92a in the Diagnosis of Cervical Carcinoma　

SUN Mingxia，JIANG Pengcheng，YU Feng，LIU Caixia，FAN Guilian，ZHANG Hui

2019, 22(12): 1436-1441. DOI: 10.12114/j.issn.1007-9572.2018.00.425

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Background　Approaches for the screening and early diagnosis of cervical carcinoma（CC）include ultrasound，colposcopy，HPV-DNA testing，and thin-layer liquid-based cytology.How to choose an inexpensive，easy-to-use and mini-invasive examination with ideal diagnostic accuracy for CC，is a closely watched clinical issue.Objective　To explore the clinical values of transvaginal color Doppler sonography（TVCDS）combined with serum miRNA-18a and miRNA-92a in the diagnosis of CC.Methods　We enrolled 362 cases from Department of Obstetrics and Gynecology，Beijing Chaoyang Hospital，Capital Medical University，from March 2015 to July 2017，including 122 with a postoperative pathological diagnosis of CC（CC group），120 with a pathological diagnosis of cervical intraepithelial neoplasia（CIN）（CIN group），and 120 with benign uterine lesions（normal group）．Three groups' general data，TVCDS test results and serum miRNA-18a，miRNA-92a were compared.Multivariate Logistic regression analysis was used to analyze the influencing factors of CC.ROC curves of blood flow resistance index（RI），miRNA-18a，and miRNA-92a，either alone or in combination，for the diagnosis of CC were drawn and analyzed.And their diagnostic accuracy was evaluated by comparing the gold standard，postoperative pathological diagnosis results.Results　The incidence of HR-HPV infection in CIN group and CC group was higher than that in normal group（P<0.05），and it was higher in CC group than that in CIN group（P<0.05）．The incidence of menopause in CIN group was lower than that of other two groups（P<0.05）．Cervical manifestations of suspected carcinogenesis were observed in both CC and CIN groups.The margin of the cervix was not complete.The blood flow was richer in CC group than those of the CIN group.The blood flow RI in CIN group and CC group was lower than that in the normal group（P<0.05），and it was lower in CC group than that of the CIN group（P<0.05）．There were no pathological manifestations in the uterine body，ovary and para-uterine tissues among three groups.The serum miRNA-18a and miRNA-92a in CIN group and CC group were higher than those in the normal group（P<0.05）．The serum miRNA-18a and miRNA-92a in CC group were higher than those of the CIN group（P<0.05）．Multivariate Logistic regression analysis showed that age，HR-HPV infection，menopause，blood flow RI，serum miRNA-18a，and serum miRNA-92a were the influencing factors of CC（P<0.05）．The area under the ROC curve of blood flow RI，serum miRNA-18a，serum miRNA-92a，blood flow RI combined with serum miRNA-18a，blood flow RI combined with serum miRNA-92a and blood flow RI combined with serum miRNA-18a and miRNA-92a in diagnosing CC was 0.844，0.880，0.763，0.936，0.886，and 0.940，respectively.The sensitivities were 80.8%，78.7%，64.8%，87.7%，82.8%，and 94.3%，respectively.And the specificities were 68.0%，83.7%，81.8%，85.8%，78.3%，and 81.3%，respectively.Conclusion　The blood flow RI of TVCDS in CC patients decreased, and serum microRNA-18a and microRNA-92a increased.The blood flow RI of TVCDS combined with serum miRNA-18a and miRNA-92a has higher diagnostic accuracy for CC than the blood flow RI of TVCDS，serum miRNA-18a and miRNA-92a alone，and it is easy to perform，which can improve the early diagnosis rate of CC，and is worthy of clinical promotion.

Therapeutic Effect of Intraoperative Intrathecal and Perithecal Injection of Nerve Blocks on Reducing the Radicular Pain Following Surgery for Lumbar Disc Herniation　

LI Yijun，TANG Fubo，ZHANG Jiali，YANG Hui，CHEN Deqiang，DENG Wenshi，HUANG Guozhu，WEI Weibing，CHEN Zhen

2019, 22(12): 1442-1446. DOI: 10.12114/j.issn.1007-9572.2018.00.463

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Background　Traditional sacral canal or intraoperative injection of nerve blocks is an effective treatment for radicular pain caused by lumbar disc herniation（LDH）or inflammation-induced edema soon after the surgery for LDH.However，this treatment has a short duration of action and limited efficacy，and there is still a need for further research.Objective　To explore the clinical efficacy of intraoperative intrathecal and perithecal injection of nerve blocks for reducing the pain following surgery for LDH.Methods　According to the inclusion and exclusion criteria，90 LDH patients who underwent open discectomy for the removal of herniated nucleus pulposus and nerve root canal decompression with foraminal enlargement in the First Affiliated Hospital of Guangxi University of Chinese Medicine from March 2015 to March 2018 were selected.By a random number table，they were divided into group A（n=30，receiving intraoperative intrathecal and perithecal injection of nerve blocks），group B（n=30，receiving intraoperative intrathecal injection of nerve blocks），group C（n=30，receiving no intraoperative injection of nerve blocks）．General data，postoperative bedridden time，postoperative hospital stay，postoperative radicular pain，Visual Analogue Scale（VAS）scores assessed before surgery and on the 1st，3rd，6th，and 10th days after surgery，Japanese Orthopedic Association（JOA）scores assessed before surgery and on the 3rd，6th，and 10th days after surgery，were collected.The incidence of adverse reactions was also obtained.Results　Group A showed much shorter postoperative bedridden time and postoperative hospital stay，and much lower incidence of postoperative radicular pain than groups B and C（P<0.05），as did group B when compared with group C（P<0.05）．Both the treatment method and duration had a significant interaction on the VAS score（P<0.05）．And they produced significant main effects on the VAS score（P<0.05）．The VAS scores on the 1st，3rd，6th，and 10th days after surgery were all significantly lower than the baseline level in all groups（P<0.05）．Group A demonstrated much lower VAS scores on the 1st，3rd，6th，and 10th days after surgery compared with groups B and C（P<0.05），as did group B when compared with group C（P<0.05）．There was an interaction between the treatment method and duration on the JOA score（P<0.05）．The main effects of the treatment method and duration on the JOA score were significant（P<0.05）．The JOA scores on the 3rd，6th，and 10th days after surgery in all groups increased significantly compared with the baseline level（P<0.05）．Group A demonstrated much higher JOA scores on the 6th and 10th days after surgery compared with groups B and C（P<0.05），as did group B when compared with group C（P<0.05）．There were no significant adverse reactions in all groups.Conclusion　Intraoperative intrathecal and perithecal injection of nerve blocks for LDH can achieve a longer duration of pain relief via extending the duration of action of the drugs，which in turn significantly promotes early postoperative recovery，relieves the postoperative radicular pain，and shortens the postoperative bedridden time and postoperative hospital stay，thus increasing the overall efficacy.

Weaning from Mechanical Ventilation on Prognosis of Patients with Chronic Obstructive Pulmonary Disease Assisted by Internal and External Combination of "Treatise on Spleen and Stomach"　

WANG Yifei，ZHOU Yang，MA Huanggang，LI Guofa，YE Yanyang，XUAN Lusha，ZHANG Yunhua，LI Yue

2019, 22(12): 1447-1452. DOI: 10.12114/j.issn.1007-9572.2018.00.411

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Background　According to the theoretical basis of "deficiency nourishes the mother" of the five elements of traditional Chinese medicine，the method of "nourishing the spleen and benefiting the lungs" in the treatment of chronic obstructive pulmonary disease（COPD） had been widely used in clinical practice，and had been proved to be of high practical value.Objective　To investigate the effect of weaning from mechanical ventilation in patients with COPD assisted by internal and external combination of "Treatise on Spleen and Stomach".Methods　We enrolled 160 patients with acute COPD who required invasive positive pressure ventilation（IPPV） in the Intensive Care Unit（ICU） of Jiyang branch and Huandong branch of Traditional Chinese Medical Hospital of Zhuji from November 2015 to October 2017 in this prospective randomized controlled trial.Forty-two patients were assigned to the control group by using the random number table method.The remaining patients were divided into lung-spleen qi deficiency group（n=36），spleen-lung deficiency-cold group（n=45） and spleen-stomach yin deficiency group（n=37）．The patients in the control group were treated with 50 ml warm water nasal feeding twice a day.Lung-spleen qi deficiency group were treated with Shenling Atractylodes，spleen-lung deficiency-cold group with Huangqijianzhong decoction，and spleen-stomach yin deficiency group with Ophiopogon decoction.At the same time，the three groups were treated with transcutaneous electrical acupoint stimulation therapy on zusanli and fenglong for 14 days.Respiratory index（f/VT），endogenous positive end-expiratory pressure（PEEPi），lung compliance，and airway resistance at four time points：before intubation（T1），day 1 of invasive positive pressure ventilation（IPPV）（T2），day 5 of IPPV（T3），and before intubation（T4） were recorded.Levels of C-reactive protein（CRP），procalcitonin（PCT），white blood cell count（WBC），albumin（ALB），prealbumin（PA），total protein（TP）were recorded before and after treatment.The primary outcome of all patients were IPPV total time，spontaneous breathing test（SBT），non-invasive positive pressure ventilation，NPPV，utilization rate，tracheal intubation rate after 48 hours，hospital mortality，ICU stay，and hospital stay.Results　There were interactions between treatment methods and practices in f/VT，PEEPi，lung compliance，and airway resistance （P<0.05）．The main effects of treatment methods and time on f/VT，PEEPi，lung compliance and airway resistance were significant（P<0.05）.Lung compliance increased successively at T1，T2，T3 and T4（P<0.05）．At T3 and T4，f/VT of lung-spleen qi deficiency group，spleen-lung deficiency-cold group and spleen-stomach yin deficiency group was lower than that of the control group（P<0.05）．At T4，f/VT of the lung-spleen qi deficiency group was lower than that of the lung-stomach yin deficiency group（P<0.05）．At T3，PEEPi of spleen-lung deficiency-cold group was lower than that of control group（P<0.05）．At T4，PEEPi of the lung-spleen qi deficiency group，spleen-lung deficiency-cold group and long stomach yin deficiency group was lower than that of the control group（P<0.05）．At T3，lung compliance of lung-spleen qi deficiency group and spleen-lung deficiency-cold group was higher than that of control group（P<0.05）．At T4，lung compliance of lung-spleen qi deficiency group，spleen-lung deficiency-cold group and spleen-stomach yin deficiency group was higer than that of the control group（P<0.05）．At T4，airway resistance of the lung-spleen qi deficiency group and spleen-lung stomach yin deficiency group was lower than that of the control group（P<0.05）．After treatment，CRP of the lung-spleen qi deficiency group，spleen-lung deficiency-cold group and spleen-stomach yin deficiency group was lower than that of the control group（P<0.05）；PCT of the lung and stomach yin deficiency group was lower than that of the control group（P<0.05）；ALB in the lung-spleen qi deficiency group and lung-stomach yin deficiency group was lower than that in the control group（P<0.05）；PA and TP of the lung-spleen qi deficiency group，spleen-lung deficiency-cold group，splee-stomach yin deficiency group were lower than those of the control group（P<0.05）．The total IPPV time，SBT times，ICU stay and hospitalization time in the lung-spleen qi deficiency group，spleen-lung deficiency-cold group and splee-stomach yin deficiency group were less than those in the control group（P<0.05）．Conclusion　"Treatise on Spleen and Stomach" internal and external combined treatment can improve the respiratory mechanical index and nutritional index of COPD patients，weaning from mechanical ventilation，and overall prognosis.

Mechanism of Moxibustion Intervention on Promoting Angiogenesis in Tissue with Pressure Injury　

YU Jie，SUN Zhongren，LI Hongling，ZHAO Hui

2019, 22(12): 1453-1460. DOI: 10.12114/j.issn.1007-9572.2018.00.343

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First author：YU Jie，Doctor Medicinae，Attending doctor，lecturer，Master's Supervisor；E-mail: hecafei@sina.com
Background Throughout the general situation of research on moxibustion in the treatment of pressure injury，there are the following issues including“the clinical effect of moxibustion in the treatment of pressure injury is exact without clear molecular mechanism” and “while the molecular mechanism of angiogenesis in tissue with pressure injury in Modern Medicine is more in-depth，but lack of effective treatment means”.It is required to attach great importance to the focus as well as the issues，integrating the modern medical angiogenesis theory with the original features of moxibustion therapy of TCM.It is expected to make up for the unclear molecular mechanism of moxibustion in the treatment of pressure injury and explore the molecular regulatory mechanism of moxibustion intervention on promoting angiogenesis in tissue with pressure injury.Objective　To investigate the molecular regulation mechanism of moxibustion on promoting angiogenesis in tissue with pressure injury，so as to provide theoretical and experimental basis for moxibustion in clinical treatment of pressure injury and skin ulcers.Methods　A total of 120 female healthy clean SD rats were selected in the experiment from December 2015 to March 2017，85 of which were given modeling process and 35 of which were treated as blank group.The models of rats with pressure ulcers in stage 2 to 3 were established by using self-made devices of ischemia reperfusion injury.Successful models of 70 SD female rats with skin ischemia reperfusion injury were randomly divided into model group and moxibustion group，each with 35 SD rats.There were 5 SD rats in the model group and the moxibustion group respectively falling off from the model to the intervention process. In the blank group， 5 SD rats had negative lesions during skin preparation and were removed.The blank group was only given iodophor intervention to simulated model position.The model group was only given conventional iodophor intervention as well.Moxibustion group was given iodophor intervention at first and then direct moxibustion intervention to the local tissue of pressure ulcer with cyclotron operation at the radius of 10 mm，with moxibustion treatment once a day and 15 minutes each time.The protein expression levels of vascular endothelial growth factor（VEGF），RAS and Phospho-ERK1/2（P-ERK1/2） in wound tissues of rats were detected by immunohistochemistry at the first，third，fifth，seventh and tenth day after intervention or treatment.Results　The immunohistochemistry results showed that the positive expression of VEGF protein in skin tissues with pressure injuries was in the cytoplasm which expressed in epithelial cells and macrophages.The positive expression position of both RAS and P-ERK1/2 protein in the skin was located in the cytoplasm.When pressure injury occurred，the expression levels of VEGF and P-ERK1/2 protein in wound tissues gradually increased and then decreased to normal levels.The expression levels of VEGF and P-ERK1/2 protein in moxibustion group and model group both increased at first and then decreased.However，there were significant differences between two groups in the time-point when high peaks of expression levels emerged.The highest peak in moxibustion group appeared in the third day after treatment，while that of model group occurred in the fifth day after iodophor intervention.When pressure injury occured，the expression of RAS protein in wound tissue decreased at first and then increased.The expression of RAS protein in moxibustion group and model group both showed a rising trend.The expression level of VEGF in wound tissues with pressure injuries in model group was higher than that of blank group at the first，third，fifth，seventh and tenth day after intervention（P<0.05）．The expression level of VEGF in wound tissues with pressure ulcers in moxibustion group was significantly higher than that of model group at the third and fifth day after intervention or treatment（P<0.05）．The expression level of RAS in wound tissues with pressure injuries in model group was lower than that of blank group at the first，third，fifth，seventh and tenth day after iodophor intervention（P<0.05）．The expression level of RAS in wound tissues with pressure ulcers in moxibustion group was higher than that of model group at the third，fifth，seventh and tenth day after treatment（P<0.05）．The expression level of P-ERK1/2 in wound tissues with pressure injuries in model group was higher than that of blank group at the third，fifth，seventh and tenth day after iodophor intervention（P<0.05）．The expression level of P-ERK1/2 in wound tissues with pressure ulcers in moxibustion group was higher than that of model group at the third and fifth day after treatment（P<0.05）．Conclusion　Moxibustion intervention can increase the expression level of VEGF protein in wound tissues with pressure injuries，which may increase the expression level of RAS protein and promote the phosphorylated expression level of ERK1/2 protein by activating RAS/RAF/ERK signaling pathway.Hence，moxibustion intervention might enhance the activity of the RAS/RAF/ERK signaling pathway and contribute to the proliferation of vascular endothelial cells as well.

Development and Psychometric Evaluation of Health Information Literacy Scale in Traditional Chinese Medicine　

ZHANG Rui，FEI Chaoqing，XIA Haozhi

2019, 22(12): 1461-1467. DOI: 10.12114/j.issn.1007-9572.2018.00.419

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Background　The health information literacy（HIL）focuses on not only the ability to acquire health information but also the ability of evaluation and application.Traditional Chinese medicine（TCM）plays an irreplaceable role in preventing and combating disease as well as maintaining health status for Chinese residents.Evaluating HIL in TCM helps to improve residents' health status effectively.Objective　To develop an instrument for measuring the health information literacy in TCM and test its reliability and validity.Methods　Based on the concept of HIL，the item pool was completed by reviewing relevant literature and scales as well as authoritative questionnaires in health preserving of TCM，including Chinese Citizens' Health Preserving Literacy and Basic Knowledge and Skills of Chinese Citizens' Health Literacy（2015 Edition）at September 2017.After revising in accordance with the expert consultation performed from January to February，2018，the draft of the HIL Scale in TCM 1 consisting of 5 dimensions and 40 items was developed.In March 2018，a pilot study and item analysis with the first version of the scale were performed and then the HIL Scale in TCM was accomplished with 5 dimensions and 36 items.From April to May 2018，220 citizens were selected from 5 communities（Ntu and Garden，Saishi Camphr Garden，Yadong City，Xigang Community and Xianlin Village）for investigation by using convenience sampling to test the validity and reliability of the HIL Scale in TCM.Results　Item analysis of the first draft of HIL Scale in TCM showed that the correlation coefficient between the separate score for each of the following items from 1 to 21，23 to 35，items 38 and 39，and the total score of 40 items was >0.300.The correlation coefficient between the separate score for each of the rest items 22，36，37，40 and total score of 40 items was <0.300.The subjects were categorized into a high-score group（composed of 27% of individuals with the highest total score of the first draft of the HIL Scale in TCM，n=32）and a low-score group（composed of 27% individuals with the lowest total score，n=32）by using item discrimination analysis.The scores in each of the following items from 1 to 21，23 to 35，items 38 and 39 in the high-score group were higher than those of the low-score group（P<0.05）．There were no significant differences in the scores of the rest items 22，36，37 and 40 between the high-score group and the lower-score group（P>0.05）．In summary，the HIL Scale in TCM was finally formed by deleting items 22，36，37 and 40.The item content validity index ranged from 0.79 to 1.00，and the scale content validity index was 0.911.The KMO of the testing version scale was 0.858，and Bartlett's test showed that χ2=4 432.383，P<0.001，indicating that factor analysis could be performed.Using principal component analysis，according to the principle that Eigen value should be over 1.000，five factors were extracted and named as cognitive ability of health preserving information in TCM，retrieving ability of health preserving information in TCM，evaluation ability of health preserving information in TCM，application ability of health preserving information in TCM，and information morality，respectively，which explained 65.293% of the total variance.The factor load of each item ranged from 0.423 to 0.860，all of which were over 0.400.The Cronbach's α of the scale was 0.922.Cronbach's α of each dimension ranged from 0.839 to 0.882.Conclusion　The HIL Scale in TCM consists of 5 domains covering 36 items，including the cognitive ability of health preserving information in TCM（5 items），retrieving ability of health preserving information in TCM（11 items），evaluation ability of health preserving information in TCM（7 items），application ability of health preserving information in TCM（11 items）and information morality（2 items）．The HIL scale in TCM has good validity and reliability and it is also very comprehensible.The scale can be used to evaluate the community citizens' HIL in TCM.

Job Duties of TCM General Practitioners in Primary Medical Institutions from Chongqing，Yunnan and Guizhou，China　

PAN Lun，HE Ping，DENG Fuzhong，YI Minchun，XIAO Wenchong

2019, 22(12): 1468-1473. DOI: 10.12114/j.issn.1007-9572.2018.00.405

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Background　Traditional Chinese medicine（TCM）is of great significance in alleviating the problems of difficult and expensive access to medical services among the masses.There are few investigations on the work tasks of TCM general practitioners（GPs）in primary medical institutions in China.In order to better serve the professional TCM education at the junior college level，our research group conducted sampling surveys in Chongqing Municipality，Yunnan and Guizhou Provinces in western of China.Objective　To explore the job duties of TCM GPs in primary medical institutions in Chongqing，Yunnan and Guizhou，and to provide a basis for the development of TCM education at the junior college level.Methods　This study was conducted during June to August，2017.By use of random sampling，researchers of our group（3 working in Chongqing，1 in Chuxiong，Yunan Province and 1 in Tongren，Guizhou Province）selected 1 district/county from the city that they worked，respectively，and from the district/county，4 primary medical institutions in urban and rural areas were selected randomly，respectively.All the TCM GPs（n=102）in the sampled 12 institutions were enrolled.We surveyed them with a self-developed questionnaire for collecting the general personal data，major job duties（major basic medical services，major basic public health services，most frequently encountered diseases，most frequently encountered symptoms，basic medical services in detail，basic public health services in detail）．All of them returned responsive questionnaires，achieving a response rate of 100.0%.Results　Most of the respondents had a junior college degree（42.2%），and less than 10 years of practice（52.0%），33.3% of them worked in TCM department and 24.5% in rehabilitation department，and 24.5% had on-the-job training certificate for GPs.Major basic medical services accounted for（75.3±21.7）% of the total daily workload of the respondents，and the top 3 services were TCM prescription therapy（65.7%），acupuncture and moxibustion and massage treatment（58.8%），and chronic disease management（39.2%）．Major basic public health services accounted for（24.7±21.7）% of the total daily workload of the respondents，and the top 3 services were health education（55.4%），TCM health management of people aged over 65 and children aged 0-6 years old（54.0%），and health management of patients with chronic diseases（59.0%）．The 5 diseases most frequently encountered by the respondents were upper respiratory tract infection，diabetes，hypertension，digestive tract disease，injury（fracture，etc.）and poisoning.And the 5 symptoms most frequently encountered were joint pain，headache，cough，abdominal pain and insomnia.On average，the respondents served（66.0±49.2）patients per week，spent（25.4±13.6）minutes on treating per patient，and spent（5.7±2.3）hours on consultations per day，and transferred（2.7±1.4）patients per month.20（19.6%）of the respondents had made home visits，with an average monthly number of（2.6±1.8）．The main reason for home visits is that it was inconvenient for patients to go out（the average monthly number of such home visits was 35，accounting for 67.3% of the average monthly total number of home visits）．Oral administration was the first choice of most of the respondents（60.8%）for treating patients with fever.Of the respondents，64.7% performed a physical examination for the residents，64.7% identified residents' TCM physical constitution，60.8% carried out TCM health education，58.8% gave TCM healthcare advices for residents，54.9% participated in chronic disease management and gave corresponding advices for residents，45.1% established health records for residents，29.4% treated children with TCM-based food therapy，and 27.5% taught massage techniques for children.Conclusion　The main duties of the GPs in primary medical institutions in the 3 regions are basic medical services，but they also need to deliver some public health services.Prevention and treatment of the common diseases and frequently-occurring diseases accounting for most of the total basic medical services workload，and to do these adequately，good mastery of the knowledge and techniques of Chinese and western Medicine，and good capabilities of delivering family medicine services and identifying critical and acute illnesses are needed.To train TCM GPs with a junior college degree and to improve their competencies for the role of TCM GPs in primary care，the concept of “task-oriented training with integration of theory and practice learning” should be adhered，and the training program and curriculum system should be revised according to the job duties and capabilities of GPs required by the primary care and the strengths of college education and master-apprentice education.

Current Situation of Targeted-area Graduates of General Practice in Guangxi Province　

LIAO Shiguang，YAO Yanbing，LIANG Yingying，LI Ningyu，CHEN Jialiang

2019, 22(12): 1474-1480. DOI: 10.12114/j.issn.1007-9572.2018.00.373

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Background　Based on the background of gradually advancing hierarchical medical system，general practitioner system and resident standardization training，tracking and researching the post-graduation situation of general medical students in Guangxi，and continuously improving resident standardization training of general practitioners，are of great significance to the follow-up development of hierarchical medical system at the grassroots level.Objective　To provide suggestions on the reform and development of community-level general practice through analyzing and discussing major constraints based on the status quo investigation of targeted-area graduates from general practice major in Guangxi Province（hereinafter referred to as targeted-area students）．Methods　A total of 199 targeted-area students who were enrolled from 2010 to 2012 and graduated from 2015 to 2017 were selected from July 2017 to January 2018.Self-made questionnaires were used to carry out the investigation，and the content of the questionnaire covered basic information，registration and transfer，employment，budget position placement，salary，satisfaction，willing to receive further education，willing to serve at community level，and salary expectancy.In the light of data provided by 2017 Guangxi Statistics Annual Report and the per capita GDP，14 cities in Guangxi were divided into high-production area，middle-production area and low-production area.Results　A total of 199 questionnaires were released and all questionnaires received，with an effective recovery rate of 100.0%.Among 199 graduates，41 graduated（20.6%）in 2015，78（39.2%）in 2016，and 80（40.2%）in 2017；56 graduates（28.1%）were sent to high-production area，79（36.7%）to middle-production areaand 64（35.2%）to low-production area．There were no significant differences in time of graduation，signed unit of service，employment，budget position placement，salary，willing to receive further education，work plan after standardized training，work plan after signed service period and salary expectancy（P>0.05）．Targeted-area students graduated in 2017 had higher satisfaction than those graduated in 2015（P<0.05）．There was no significant difference in satisfaction of students in different areas（P>0.05）．The main reason why the Health and Family Planning Bureau failed to place graduates in contracted service units within one month was that relevant departments had no experience（86.3%，44/51）.The major influencing factors for students continuing working at the community level was low salary（92.5%，184/199）．Conclusion　The transfer rate of targeted-area graduates in general practice in Guangxi should be improved，the employment agreement should be further regulated and the budget position placement should be followed up.Despite the higher willingness and satisfaction of targeted-area students of general practice in Guangxi，community healthcare services cannot retain more talents in general practice sector because of low salary and incomplete incentive system of further education and ensuing development.We suggest that the transfer and placement management system should be further perfected，connection should be enhanced among relevant departments and green channel for targeted-area students should be launched for the implementation of policy and follow-up inspection.In addition，the cultivation and incentive system for general practitioners should be carried out and the further education system of general practice graduates should be improved，so as to keep the sustainable development of general practitioners at community level.

Application of Sound Speed Correction Technique in Differentiating Primary Liver Cancer from Hepatic Hemangioma　

ZHANG Xue，SUN Meng，MA Lin，SUN Yuwei，WANG Yihua，MENG Jian，ZHANG Man

2019, 22(12): 1481-1484. DOI: 10.12114/j.issn.1007-9572.2018.00.019

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Background　Primary liver cancer（PLC） is a malignant tumor with high mortality.Hepatic hemangioma（HH） is the most common benign tumor of liver.As the sensitivity and specificity of conventional ultrasound are low，and the contrast-enhanced ultrasound is invasive and its operation is complex，better examination methods for differentiating between PLC and HH are urgently needed.Objective　To discuss the application of sound speed correction（SSC） technique in the differential diagnosis of PLC from HH.Methods　We enrolled 85 eligible patients with solid liver masses（totaled 92 masses） from North China University of Science and Technology Affiliated Hospital from November 2016 to November 2017.According to the pathological results of the biopsy tissue or surgical specimen，39（totaled 44 masses were identified to be PLC） were assigned to the PLC group and 46（totaled 48 masses were identified to be HH） were assigned to the HH group，respectively.All of them underwent color Doppler ultrasound for the determination of the zone speed index（ZSI） of the ROI with SSC technique（for enhancing the quality of the images）.Results　The ZSI value of the masses of the PLC group was greater than that of the masses of the HH group〔（43.0±7.4）m/s vs （22.3±7.4）m/s〕（t=13.303，P<0.001）.For the diagnosis of PLC，the AUC of ZSI was 0.987（>0.700）when the cutoff value was 33 m/s，the corresponding sensitivity was 97.7%，specificity was 91.7%，and Youden's index was 0.894.Conclusion　When the ZSI value is 33 m/s（determined by the color Doppler ultrasound examination with SSC technique），both the sensitivity and specificity of its performance for differential diagnosis of PLC from HH are high，providing a reference for quantitatively differentiating between the two diseases.

Clinical Characteristics and Independent Risk Factors of Pure Tachycardia-induced Cardiomyopathy　

YU Li，CHEN Ting，LI Dan

2019, 22(12): 1485-1487. DOI: 10.12114/j.issn.1007-9572.2018.00.406

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Background　The morbidity of pure tachycardia-induced cardiomyopathy（pTCM） are improving，the differential diagnosis between pTCM and dilated cardiomyopathy（DCM），as well as risk factors of pure tachycardia-induced cardiomyopathy are still not studied systematically.　Objective　To investigate the clinical characteristics and independent risk factors of pTCM.Methods　This study enrolled 42 pTCM inpatients（pTCM group）from Cardiovascular Department，Ningbo Yinzhou No.2 Hospital，from January 2016 to December 2017. They were compared to 43 dilated cardiomyopathy inpatients（DCM group）as well as 57 outpatients with tachycardia but without tachycardia-induced cardiomyopathy（tachycardia group） receiving treatment in the same hospital during the same period.Medical history，clinical data，results of hematological examination and other auxiliary examinations were collected. Comparisons were made between pTCM and DCM groups in terms of sex，age，smoking history，hyperlipidemia history， NT-proBNP，left atrial diameter（LAD），left ventricular end-diastolic dimension（LVDd），left ventricular ejection fraction（LVEF），and between pTCM and control groups in respect of sex，age，body mass index，smoking history，hyperlipidemia history，cardiac troponin I（cTnI），total heart rate measured by 24-hour Holter monitoring，type of tachycardia and percentage of tachycardia. Multivariate Logistic regression analysis was carried out to explore the risk factors of pTCM. Results Compared to the DCM group，pTCM group had greater average age，and higher LVEF，LVD values，and lower NT-proBNP value（P<0.05）． pTCM group showed higher cTnI value，more 24-hour total heart rate，higher percentage of tachycardia than tachycardia group（P<0.05）． Multivariate Logistic regression analysis found that the independent risk factors of pTCM were cTn-I value，24-hour total heart rate，percentage of tachycardia （P<0.05）．Conclusion　Compared to DM patients，pTCM patients are older，have less injury in left ventricular structure and function. The independent risk factors of pTCM are cTnI value，24-hour total heart rate，and percentage of tachycardia.

Clinical Analysis of 10 Cases of Noncompaction of Right Ventricular Myocardium　

WANG Xiuyan，MA Gang，ZHU Jiarong，ZHANG Hong

2019, 22(12): 1488-1491. DOI: 10.12114/j.issn.1007-9572.2018.00.331

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Background　Noncompaction of the ventricular myocardium（NVM）of right ventricle is a relatively rare disease in clinic.Many patients may not have obvious clinical manifestations at the early stage.When patients come to the hospital with pulmonary hypertension or right heart failure，the possibility of diagnosing this disease is often ignored.Objective　To analyze the clinical manifestations and imaging features of patients with NVM of right ventricle，improving cliniciansl awareness of the disease.Methods　Clinical data of 10 patients with a definite diagnosis of NVM of right ventricle were recruited from General Hospital of Ningxia Medical University from January 2007 to February 2017.The demographic characteristics，clinical manifestations，electrocardiogram，echocardiography，other imaging findings，other test，outcomes were analyzed retrospectively.Results　 The 10 cases consisted of 4 females and 6 males，had an average age of（53.5±15.5） years（range：21-80）．4 of them had comorbidities，including 2 had hypertension，and 2 had hypertension and diabetes.The respiratory symptoms of these patients were dyspnea（6 cases），cough（3 cases），chest tightness and expectoration（2 cases），general edema and wheezing （1 case），and other discomforts（1 case）．The electrocardiogram showed atrial fibrillation（4 cases），right bundle branch block（2 cases），tachycardia with occasional premature ventricular contraction（2 cases），pulmonale（1 case），and normal results（2 cases）．Echocardiography showed that all of them had significantly enlarged right atrium and right ventricle，and NVM of right ventricle.Of the 10 patients，9 had thickened right ventricular anterior wall，8 had moderate to severe pulmonary hypertension，and 5 had pericardial effusion，2 had mild pulmonary hypertension.Left ventricular ejection fraction（LVEF） values ranged from 35% to 70% with mean LVEF values （57±13）%.Only 2 of the 10 cases had improved pulmonary ventilation perfusion imaging，and no significant embolization was found.CT pulmonary angiography（CTPA） was performed in 8 cases，and the results showed that all of them had significantly dilated pulmonary artery，6 were also found with bilateral pleural effusion in small amounts，4 were also found with pulmonary congestion.Pulmonary function tests in 8 patients showed normal ventilation function and airway resistance and small airway resistance disorder（6 cases），and normal lung function（2 cases）．Polysomnography in 6 patients indicated nocturnal hypoxemia.The mean nocturnal oxygen saturation（SaO2） was 84%.One of them had a minimum SaO2 of 64% at night.The mean AHI were 6.5 times/h.10 patients were followed up for 5 years，during which one died，but other cases were relieved.Conclusion　For those with unexplained pulmonary hypertension and right heart failure，clinicians should carefully consider whether the patients have NVM of right ventricle.Early diagnosis and treatment of NVM of right ventricle help to prolong the survival and reduce the mortality of the patients.

Research Progress on Heart Rate Control and Its Clinical Significance in Patients with Heart Failure　

ZHANG Suhui，FANG Ligang

2019, 22(12): 1492-1496. DOI: 10.12114/j.issn.1007-9572.2018.00.439

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Heart rate is important for patients with heart failure（HF），but its role varies in specific HF depending on types，pathogeny or stages.It remains controversial about the effect of heart rate control on the different types of HF，especially how to choose the appropriate medicine between the beta-blockers and the new drug，ivabradine.This study reviews the clinical significance of heart rate control varied in different heart types of heart failure，including HF patients with atrial fibrillation（AF），with preserved ejection fraction（HFpEF），at acute stage and in vulnerable period.The aim of the review is to provide reasonable evidence for physicians to make individualized heart rate control of heart failure.

Factors Influencing Perinatal Depression and Community Management　

DI Na，SHI Mingyue，WEI Haiyan，TAO Xia

2019, 22(12): 1497-1500. DOI: 10.12114/j.issn.1007-9572.2018.00.350

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Depression during pregnancy and puerperium in women may cause adverse effects to themselves，the fetus and newborn.Acknowledging risk factors of perinatal depression（PND） and early prevention or reasonable intervention can reduce the incidence of adverse events during pregnancy.At present，there is no clear factors correlated to PND，but a lot of researches on this topic have been studied at domestic and abroad.This paper reviews relevant researches to improve awareness of the public and preventive health personnel for risk factors during pregnancy and intervention strategies.In addition，the research results are related to geographical distribution，but some areas have not done relevant research，which is detrimental to implementing targeted measures for the population in these areas.Therefore，the purpose of this paper is to provide reference for future research by summarizing related factors of PND and analyzing corresponding community management.

Effects of Diabetes Related Therapy on Cognitive Function　

WEI Wei，LU Yuan

2019, 22(12): 1501-1506. DOI: 10.12114/j.issn.1007-9572.2018.00.321

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Dementia and mild cognitive impairment are increasingly affecting people's health，but effective treatment have not been found.Researches have shown that diabetes mellitus was an independent risk factor for cognitive impairment.Diabetes and dementia have a lot of common pathological basis.Therefore，diabetes-related therapy may have a potential impact on the cognitive function in patients with diabetes mellitus，which is important for many diabetic patients with cognitive impairment.This article explored the effects of diabetes-related therapy on cognitive function and sought for beneficial treatment methods.It will provide ideas and references for further treatment and research in this area.

Top 20 POEMs of the past 20 years: a survey of practice-changing research for family physicians

WANG Yang，XU Yanli

2019, 22(12): 1507-1508. DOI: 10.12114/j.issn.1007-9572.2019.00.122

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