Table of Content

20 May 2019, Volume 22 Issue 15

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Monographic Research

Application of Beta Blockers in Hypertension：Insights from European Hypertension Guideline 2018 and Recent Clinical Studies　

LIU Jing

2019, 22(15):  1763-1765.  DOI: 10.12114/j.issn.1007-9572.2019.00.061

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Beta blockers are commonly used antihypertensive drugs.The 2017 American Hypertension Guideline no longer recommends beta blockers as first-line antihypertensive drugs，once again triggering academic controversy and confusion among clinicians.The European Guideline for Hypertension in 2018 put things right，and maintained beta blockers as first-line antihypertensive drugs combined with evidence.Recent clinical studies have also provided the latest evidence of the cardiovascular protective effects of beta blockers.This article was to analyze the rational use of beta blockers in the treatment of hypertension by combing recent recommendations of European and American Hypertension Guidelines and recent research evidence combined with clinical experience，in order to provide reference for clinicians.


Association between Frailty and Sleep Disturbances in the Elderly　

WANG Yuchen，MA Teng，JIANG Xiaoyan，LI Shujuan，WANG Xiaofeng

2019, 22(15):  1766-1771.  DOI: 10.12114/j.issn.1007-9572.2019.00.113

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Background　Frailty，as a comprehensive manifestation of the increased vulnerability of body，is the main problem of aging.Sleep disturbances affects 50% of the elderly，and its effects increase with age.However，the association between frailty and sleep problems is still unclear.Objective　To explore the association between frailty and sleep disturbances in the elderly in China，providing a theoretical basis for the delivery of frailty interventions in this population.Methods　Sleep or frailty data of 1 792 elderly people in the Rugao longevity and aging study，were collected during the period from April to June 2016.Baseline data，sleep status〔evaluated by Pittsburgh Sleep Quality Index（PSQI）scale，with score>10 was defined as sleep disturbances，≤10 as normal〕，and frailty〔evaluated by Laboratory Frailty Index（FI-LAB），FI-LAB<0.1 as non-frailty，0.1-0.2 as slight frailty，>0.2-0.3 as mild frailty，>0.3-0.4 as moderate frailty，and >0.4 as severe frailty〕were also collected.Results　Significant gender-related differences were found in terms of BMI，occupation，marital status，education level，smoking，drinking，self-reported health，PSQI scale score and sleep status（P<0.05）.There were significant differences in gender，smoking，self-reported health status and frailty of the elderly with different sleep status（P<0.05）.Logistic regression analysis showed that FI-LAB was associated with sleep status in both females〔OR=1.238，95%CI（1.020，1.503），P<0.05〕and males〔OR=0.621，95%CI（0.432，0.894），P<0.05〕，the association between severe frailty and sleep status was significant in females〔OR=3.755，95%CI（1.188，11.868），P<0.05〕，while the same association was not found in males〔OR=0.291，95%CI（0.030，2.836），P>0.05〕，after adjusting for age，occupation，marital status，education level，smoking，drinking，and self-reported health.Conclusion　Sleep disturbances is associated with increased risk of frailty in elderly females.


Influencing Factors of Frailty in Elderly Patients with Diabetes and Intervention Strategies　

CHEN Xu，YANG Shuhua，WANG Yuening，LIU Shumin

2019, 22(15):  1772-1777.  DOI: 10.12114/j.issn.1007-9572.2019.00.149

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Background　China has the largest number of diabetics all of the world.In particular，more than 20% of the people aged 60 years and over have type 2 diabetes.Various acute and chronic complications caused by diabetes seriously affect the health status and quality of life of the elders，among them，frailty has become the third major complication，which should be concerned by medical workers.Objective　To investigate the frailty in elderly diabetics，analyze the influencing factors，and explore the targeted intervention measures.Methods　This survey was carried out from January to June 2018 among elderly diabetic endocrinology outpatients selected by convenience sampling from People's Hospital of Ningxia Hui Autonomous Region.During the survey，general sociodemographic characteristics（gender，age，educational level，marital status，level of independence，medical insurance，household monthly income per person，drinking，smoking，regular exercising），and clinical data（course of diabetes，number of hospitalizations due to aggravation of diabetes in the past year，regular pharmaceutical treatment/insulin treatment，coexisted chronic diseases） were collected by self-administered General Sociodemographic Questionnaire and Clinical Questionnaire developed by our research group，respectively.Frailty was assessed by the Frailty Phenotype （proposed and validated by Fried and colleagues in the Cardiovascular Health Study）．Additionally，glycated hemoglobin （HbA1c） was collected by fasting venous blood testing，and BMI was calculated.Ordinal multivariate Logistic regression analysis was adopted to analyze the influencing factors of frailty.Results　Altogether，280 cases participated in the survey，and 278 of them（99.3%） who responded to the survey effectively were included in the final analysis.Of the respondents，there were 127 males（45.7%） and 151 females（54.3%）；130（46.8%） were robust，107（38.5%） were pre-frail，and 41（14.7%） were frail.Ordinal multivariate Logistic regression analysis found that age〔OR=1.273，95%CI（1.039，1.561），P<0.05〕，household monthly income per person〔<1 000 yuan：OR=14.720，95%CI（1.641，132.033），P<0.05；1 000-2 000 yuan：OR=7.631，95%CI（1.153，50.506），P<0.05〕，regular exercise〔OR=0.119，95%CI（0.019，0.734），P<0.05〕，course of diabetes〔OR=1.477，95%CI（1.138，1.915），P<0.05〕，number of hospitalizations due to aggravation of diabetes in the past year〔OR=14.061，95%CI（3.776，52.359），P<0.05〕，number of chronic diseases〔OR=19.779，95%CI（4.677，83.647），P<0.05〕，and HbA1c〔OR=34.207，95%CI（8.208，142.566），P<0.05〕 were the influencing factors of frailty.Conclusion　The frailty of elderly diabetics are affected by age，economic status，exercise status，course of diabetes，blood sugar and complication.Interventions for reducing the risk of frailty should be delivered based on the patients' conditions.


Recent Advances in Cognitive Frailty　

MA Yajun，LIU Hui，HU Zhihao，LI Xiaodong，LI Shujuan

2019, 22(15):  1778-1783.  DOI: 10.12114/j.issn.1007-9572.2019.00.089

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Frailty has been recognized as a risk factor for geriatric adverse events.However，current definition and screening of frailty only reflect the physical and physiological factors，and the concepts and studies related to frailty in cognition and social psychology still need to be supplemented.Introduced in this paper，the International Academy on Nutrition and Aging（I.A.N.A）and the International Association of Gerontology and Geriatrics（I.A.G.G）in 2013 provided the first definition of a “Cognitive Frailty” condition in older adults.The key factors defining include presence of physical frailty and cognitive impairment and exclusion of concurrent dementia or other dementias.Besides the propose and improvement of the concept of cognitive frailty，this paper expounds its possible mechanism and risk factors.In addition，some epidemiological studies involving cognitive frailty are summarized.The paper shows that the presentation of cognitive frailty is an important part of the research process of frailty，and individuals and society should pay enough attention to this new concept，which can make contributions to the formulation of strategies to prevent cognitive frailty in the elderly.Furthermore，in line with the assumptions of the bio-psycho-social model，frailty，as a comprehensive concept，should also include psychological，and social components.So social psychological factors should be taken as the future research direction.


Relationship between Cognitive Impairment and Falls in Older People　

MA Yajun，LI Xiaodong，HU Zhihao，JIANG Xiaoyan，WANG Xiaofeng，LI Shujuan

2019, 22(15):  1784-1788.  DOI: 10.12114/j.issn.1007-9572.2019.00.118

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Background　Falls can not only directly cause injuries，but also lead to the fear of falling again，reducing the mobility，flexibility and independence of the elderly.Cognitive impairment has been shown to increase the risk of falls.However，the causal relationship between the two has not been fully elucidated.Objective　To explore the relationship between cognitive impairment and falls in elderly Chinese and provide data support for the research on the influencing factors of falls or cognitive impairment.Methods　From July to September 2018，the cognitive function and fall data of a subcohort（n=1 692）of Rugao Longevity and Aging Study were selected.According to the Revised Hasegawa Dementia Scale（HSD-R）score，the elderly were divided into the non-cognitive impairment group（HSD-R score >21.5 points，n=890）and cognitive impairment group（HSD-R score≤ 21.5 points，n=802）．In accordance with the falls occurred in the past year（from 2015 to 2016），they were assigned to no fall group（having no falls，n=1 316）and fall group（having at least 1 fall，n=376），respectively.General personal data（the first follow-up data in 2016） were compared between those with cognitive impairment and without，and between those with falls and without.Moreover，the occurrence of cognitive impairment was also compared between those with falls and without.And correlation between cognitive function and falls was analyzed.Results　Participants with cognitive impairment and those without showed no significant differences in gender ratio，distributions of age，occupation，education level，marital status，smoking status，drinking status，BMI and self-rated health status（P>0.05）．But those with falls and without demonstrated significant differences in gender ratio，distributions of education level，marital status，and self-rated health status，and cognitive impairment prevalence（P<0.05）．Logistic regression analysis showed that，after adjusting for age，gender，occupation，education level，marital status，smoking status，drinking status and BMI，HSD-R score ≤21.5 points was associated with the occurrence of falls〔OR=1.36，95%CI（1.01，1.84）〕（P<0.05）．Each one-point increase in the HSD-R score〔OR=0.96，95%CI（0.94，0.99）〕was associated with falls（P<0.05）．And each standard deviation of 1 point increase in the HSD-R score〔OR=0.77，95%CI（0.66，0.91）〕was associated with falls（P<0.05）．After adjusting for age，gender，occupation，education level，marital status，smoking status，drinking status，BMI，self-assessed health status，prevalence of hypertension，and prevalence of diabetes，each increase of 1 point in the HSD-R score〔OR=0.97，95%CI（0.95，0.99）〕was associated with falls（P<0.05）．And each standard deviation of 1 point in the HSD-R score〔OR=0.81，95%CI（0.69，0.96）〕was associated with falls（P<0.05）．Conclusion　Female，illiterate，single，and poor self-rated health status were associated with increased risks of cognitive impairment and falls.Cognitive impairment was significantly associated with the occurrence of falls，suggesting that it may be a risk factor for falls.Therefore，cognitive function can be used as one reference indicator for the assessment of the risk of falls in the elderly.Early recognition of cognitive impairment may be conducive to the prevention of falls.


Variation and Significance of Adenosine Triphosphate-Binding Cassette Transporter G2 in Peripheral Blood Mononuclear Cells of Patients with Primary Gouty Arthritis　

WEN Zhong，QING Yufeng，ZHOU Jingguo，XIE Wenguang，YI Ting，ZHU Dan，CHEN Gang，LI Menglan，TONG Xiaoxia

2019, 22(15):  1789-1793.  DOI: 10.12114/j.issn.1007-9572.2018.00.399

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Background　The incidence of gout is steadily rising，which has become a major public health issue.The important role of adenosine triphosphate-binding cassette transporter G2 （ABCG2） in uric acid metabolism has drawn extensive attention and become a research focus in recent years.A study of ABCG2 would therefore be favorable for identifying the molecular biological mechanism of the pathogenesis of gout，so as to provide new approaches for the diagnosis and treatment of gout.Objective　To observe the variation of ABCG2 expression in peripheral blood mononuclear cells （PBMCs） of patients with primary gouty arthritis（GA），and to explore the potential role of ABCG2 in primary GA.Methods　Eighty-two male outpatients and inpatients with primary GA （GA group） were selected from the Department of Rheumatology and Immunology，Affiliated Hospital of North Sichuan Medical College from June 2016 to February 2017，including 41 each with acute GA （AGA subgroup） and intermittent GA （IGA subgroup）．Based on the serum uric acid （SUA） level，the patients were further divided into the group with SUA <420 μmol/L （NUA subgroup，n=31） and the group with SUA≥420 μmol/L（HUA subgroup，n=51）．Primary GA patients were compared to 46 healthy males who received physical examination at the Physical Examination Center of this hospital over the same period （HC group）．The patients were tested for SUA，creatinine，cystatin C （Cys-C），erythrocyte sedimentation rate （ESR），and hypersensitive C-reactive protein （hs-CRP）．RT-qPCR and Western blotting were used to detect the expression of ABCG2 mRNA and protein in PBMCs for all the subjects.Results　The expression of ABCG2 mRNA in PBMCs was higher in GA group than in HC group （P<0.05）．The expression of ABCG2 mRNA and protein in PBMCs was higher in IGA subgroup than in AGA subgroup （P<0.05）；the expression of ABCG2 mRNA and protein in PBMCs was lower in HC group than in IGA subgroup （P<0.05）；there were no significant differences between AGA subgroup and HC group in ABCG2 mRNA or protein expression in PBMCs （P>0.05）．The expression of ABCG2 mRNA and protein in PBMCs was higher in HUA subgroup than in NUA subgroup （P<0.05）；the expression of ABCG2 mRNA and protein in PBMCs was lower in HC group than in HUA subgroup （P<0.05）；there were no significant differences between NUA subgroup and HC group in ABCG2 mRNA or protein expression in PBMCs （P>0.05）．In primary GA patients，the expression of ABCG2 mRNA showed a positive correlation with SUA （r=0.235，P=0.033），a negative correlation with serum creatinine and Cys-C （r=-0.227，-0.229，P=0.044，0.043，respectively），but demonstrated no linear correlation with ESR and hs-CRP （r=-0.181，0.027，P= 0.112，0.824，respectively）．Conclusion　ABCG2 is highly expressed in PBMCs of patients with primary GA，and is involved in uric acid transportation.However，it was not shown to be associated with the  inflammation in primary GA.Expression of ABCG2 in PBMCs is down-regulated in patients with primary GA with renal dysfunction.


Oxidative Stress Protection Mechanism of Taxifolin in H9C2 Cells　

ZENG Zhihui，WANG Xiaoli，YE Yanqiong，WANG Tiantian，SU Qili，ZHAN Jichun，SHEN Jie，ZENG Maojun，ZHAO Mingyi

2019, 22(15):  1794-1799.  DOI: 10.12114/j.issn.1007-9572.2019.00.006

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Background　Oxidative stress（OS）is closely related to the occurrence and development of ischemic heart disease（IHD）．Antioxidant is an important prevention and treatment strategy in IHD.The results showed that Taxifolin（Tax）has anti-inflammatory，anti-tumor and anti-OS effects，but its mechanism of anti-OS is not fully understood.Objective　To investigate the protective mechanism of Tax on oxidative stress damage induced by hydrogen peroxide（H2O2）in myocardial cell H9C2 and provide reference for research and development of new drugs for OS damage diseases.Methods　H9C2 cells were randomly divided into control group〔0.1% dimethyl sulfoxide（DMSO）〕，H2O2 treatment group（treated with 200 μmol/ml H2O2 for 12 h），Tax+H2O2 treatment group（pretreated with Tax 100 μmol/ml for 6 h，and then exposed to H2O2 200 μmol/ml for next 12 h），and Tax treatment group（treated with Tax 100 μmol/ml for 6 h）from March 2017 to March 2018.For the control group，H2O2 treatment group and Tax+H2O2 treatment group，we observed the cell morphology by optical microscope，and intracellular reactive oxygen species（ROS）by fluorescence inverted microscope.We detected the expression levels of inducible nitric oxide synthase（iNOS），osteopontin（OPN），and high mobility group protein B1（HMGB1）mRNA through reverse transcription-polymerase chain reaction（RT-PCR）method.For the control group and Tax treatment group，we detected the expression levels of p38，phosphorylated p38（p-p38），racellular signal-regulated kinase（ERK）1/2，phosphorylated ERK（p-ERK）1/2，c-Jun N-terminal kinases（JNK），phosphorylated JNK（p-JNK）of mitogen-activated protein kinase（MAPK）signal transduction pathway by Western blotting.Results　Compared with the control group，the cell shape of the H2O2 treatment group showed hypertrophy，rounder and irregular，while in the Tax+H2O2 treatment group，the shape of the cells was close to fusiform and the degree of cell roundness and hypertrophy was lighter than that in the H2O2 treatment group.The quantity of irregular morphological cells decreased.The green fluorescence of ROS in H2O2 treatment group was significantly higher and brighter than that in the control group，while in the Tax+H2O2 treatment group，the green fluorescence of ROS was less and dimmer.In Tax+H2O2 treatment group，the mRNA expression of iNOS and OPN was less，and the mRNA expression of HMGB1 was more than that in the control group and H2O2 treatment group（P<0.05）．The protein expression of p38 in the Tax treatment group was less，and the protein expression of p-p38，ERK1/2，p-ERK1/2，JNK，p-JNK was more than those in the control group in MAPK signal pathway（P<0.05）．Conclusion　Tax can improve the morphological changes caused by H2O2 and reduce OS level in cells.Tax may play its anti-OS role via stimulating MAPK signaling pathway，activating the mRNA expression of HMGB1，and inhibiting the mRNA expression of oxidative stress related to gene iNOS，OPN.


Nested Case-control Study of Serological Markers Combined with Pediatric Critical Illness Score and Brighton Pediatric Early Warning Score for Predicting Death in Children with Sepsis　

LU Yanhui，LIU Zhenkui，LI Shiyang，WANG Yanfei，LI Chunmei，YUAN Erwei，XING Jing，GUO Weiping

2019, 22(15):  1800-1806.  DOI: 10.12114/j.issn.1007-9572.2018.00.464

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Background　As sepsis in children has no typical clinical manifestations in its early stage，the optimal timing of treatment is often delayed，resulting in poor prognosis and high mortality.In addition，some of its clinical symptoms are similar to those of other diseases，which undoubtedly increases the rate of misdiagnosis.Therefore，early diagnosis is a most effective way for preventing the incidence of death caused by sepsis-related complications.We aimed to explore the indicators that can predict death in children with sepsis with high accuracy.Objective　To evaluate the value of serological indicators combined with pediatric critical illness（PCIS）and Brighton Pediatric Early Warning Score（PEWS）for predicting the risk of death in children with sepsis.Methods　This nested case-control study was performed from December 2015 to December 2016.The participants were 205 children with sepsis who were diagnosed in the First Affiliated Hospital of Hebei North University.Their baseline data，serological indicators，PCIS and Brighton PEWS were collected.The definite diagnosis of sepsis/severe sepsis was defined as the starting point for participating in the study，and death or discharge was defined as the end point for terminating participation.Those who died during the study period were defined as the experimental group.In addition，whenever there was a death in the cohort，sex-，and primary site of infection-matched children who were alive in the cohort with a similar age（less than a 3-year age gap）were selected as the control at a ratio of 1∶1.The factors influencing the death of children were analyzed by multivariate logistic regression analysis.ROC curve analysis was used to analyze the value of PCT，Alb，PCIS and Brighton PEWS in predicting the death of children with sepsis.Results　According to the study design，94 children with sepsis were selected as the final participants，including 47 in the experimental group and 47 in the control group.The fatality rate was 22.9%.The experimental group had higher rates of use of antibiotics within 1 hour after admission，electrolyte disturbance，and shock and average number of MODS involved organs，average PCT，and Brighton PEWS，longer duration of mechanical ventilation，and lower average Alb and PCIS compared with the control group（P<0.05）.The results of multivariate logistic regression analysis showed that application of antibiotics within 1 hour after admission〔OR=1.795，95%CI（1.723，1.870）〕，shock〔OR=1.673，95%CI（1.299，2.154）〕，number of organs involved by MODS〔OR=2.132，95%CI（1.507，3.016）〕，PCT〔OR=1.392，95%CI（1.336，1.450）〕，PCIS〔OR=0.553，95%CI（0.477，0.641）〕and Brighton PEWS〔OR=2.536，95%CI（2.268，2.836）〕were the influencing factor of death in sepsis children（P<0.05）.The AUC of Alb combined with PCIS and Brighton PEWS in predicting the death of children with sepsis was higher than that of each of the three indicators alone（P<0.05）.Conclusion　Alb combined with PCIS and Brighton PEWS can evaluate the death in children with sepsis with high accuracy，which is expected to be used as an auxiliary index for early clinical prediction of sepsis-related death in such a population.


Mutations in the S Gene Region of Hepatitis B Virus and Postoperative Survival in Patients with Hepatitis B Virus-associated Hepatocellular Carcinoma　

WU Chensi，ZHAO Yue，WU Jianhua，WANG Yingnan，ZHANG Fengbin，GAO Liming，ZHAO Lin，ZHANG Weiguo，ZHANG Ruixing

2019, 22(15):  1807-1811.  DOI: 10.12114/j.issn.1007-9572.2019.00.156

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Background　The incidence of hepatocellular carcinoma（HCC） in China is increasing year by year，which is mainly associated with the prevalence of hepatitis B virus（HBV） infection.Many studies have shown that HBV gene mutation is closely related to the pathogenesis of HBV-associated HCC.But there are few reports on the relationship between mutations in the S gene region of HBV and prognosis of patients with HBV-associated HCC.Objective　To investigate the relationships of clinical factors，and HBV S gene mutations （using sequencing analysis） with postoperative survival of
HBV-associated HCC patients.Methods　Participants were 46 cases of HBV-associated HCC who received surgical treatment in the Fourth Hospital of Hebei Medical University during 2007 to 2009.The genomic DNA was extracted from resected HCC tissues.HBV S gene was amplified and sequenced to detect mutations.General data〔age，sex，Child-Pugh score，genotype，number of tumor entities，portal vein tumor thrombus （PVTT），TNM classification，size of tumor〕 were collected.Relationships of general data，and HBV S gene mutations with the survival of the patients were analyzed.Results　 Of the participants，25 were found with HBV genotype B infection，and other 21 with HBV genotype C infection.Postoperative 3-year survival rates differed significantly by PVTT prevalence，TNM classification，and tumor size（P<0.05）．13 loci were identified with a mutation rate of higher than 5％.In particular，postoperative 3-year survival rates significantly varied by the mutations at the 529 and 735 locus（P<0.05）．Analysis with the Cox proportional hazards model found that PVTT and mutations at the 529 locus were independent influencing factors for postoperative survival（P<0.05）．Conclusion　PVTT prevalence and mutation at the 529 locus were identified as independent risk factors for postoperative survival in HBV-associated HCC patients，which may help to clinically identify such patients with poor prognosis，and may contribute to survival prolongation and prognosis improvement.


Knowledge of Primary Treatment at the Community Level and Analysis of Related Causes in Beijing　

TIAN Ping，HUANG Aiping，MA Yingmin，YUE Lina

2019, 22(15):  1812-1816.  DOI: 10.12114/j.issn.1007-9572.2019.00.151

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Background　One of the core contents of the national medical reform is to implement hierarchical diagnosis and treatment，encourage primary treatment at the community level，and guide the residents to seek medical treatment orderly.It has also regarded the establishment of regional medical treatment partnership system （referred to as medical consortium） and the strengthening of hierarchical diagnosis and treatment as one of the new health care reform policies.However，there is still lack of relevant information about the awareness of community residents about hierarchical diagnosis and treatment，the willingness to seek primary treatment at the community level and their reasons.Objective　To investigate the awareness of primary treatment at the community level in Shijingshan district of Beijing and analyze the relevant reasons，so as to find out the problems existing in the implementation of hierarchical diagnosis and treatment，and guide residents to seek medical treatment in an orderly manner，so as to achieve the purpose of primary treatment in the community.Methods　Using convenience sampling method，residents who visited three core hospitals and 10 community health centers in Beijing from December 2015 to October 2016 were selected as the subjects of the survey.A self-designed structured questionnaire was used to conduct a questionnaire survey among medical staff engaged in the management of the medical consortium.The content of questionnaire included gender，age，monthly income，type of medical insurance，health status （whether there are chronic diseases），residents' awareness of primary treatment in the community，selection of primary treatment at the community level，residents' reasons for choosing primary treatment in the community，residents' expectations of community health service institutions.Results　A total of 680 questionnaires were sent out，674 questionnaires were recovered and 646 valid questionnaires were recovered，with an effective recovery rate of 95.00%.Among 646 residents，336 were males （52.01%） and 310 were females （47.99%）．Eighty-eight cases （13.62%） were aged <40 years，264 cases （40.87%） aged 40-65 years，294 cases （45.51%） aged > 65 years； health status：470 cases （72.76%） had a history of chronic diseases （hypertension，coronary heart disease，diabetes mellitus，and stroke） and 176 cases （27.24%） had no history of chronic diseases.52.94% （342/646） of the residents knew about the primary treatment in the community，and 45.51% （294/646） of the residents chose the primary treatment at the community level.The awareness rate and selection rate of community first-visit among residents with a history of chronic disease were higher than those without a history of chronic disease （P<0.05）．The main reasons for residents to choose community first-visit were more consistent treatment of chronic diseases （56.12%，165/294），close proximity to home，convenient transportation （39.46%，116/294），difficulty in registration and long waiting time （34.69%，102/294） in large hospitals.The main reasons why residents did not choose community first-visit were low medical level of community doctors，risk of delay （68.47%，241/352），inconvenience of two-way referral （64.77%，228/352），incomplete equipment of community examination and laboratory examination （48.01%，169/352）．The proportion of residents with a history of chronic disease not choosing the primary diagnosis in community due to the inconvenience of two-way referral and incomplete community inspection and testing equipment was lower than that of residents without a history of chronic disease （P<0.05）．The main expectations of residents for community health service institutions were：to improve the level of community health care，common diseases and frequently-occurring diseases can be cured in the community health centers（86.68%，560/646）； to increase the publicity of primary treatment at the community level （69.66%，450/646）； to facilitate and expedite referral between community health centers and hospitals in the medical consortium （65.94%，426/646）．Conclusion　The awareness and acceptance rate of hierarchical diagnosis and treatment mode was low.We should promote its publicity to residents，improve the capability of community health institutions to diagnose and treat diseases and referral services，and speed up the construction of two-way referral information system and remote consultation system.


Stroke Volume Variation as a Predictor of Fluid Responsiveness in Patients Undergoing One-lung Ventilation in Video-assisted Thoracic Surgery　

GUO Jun

2019, 22(15):  1817-1822.  DOI: 10.12114/j.issn.1007-9572.2019.00.107

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Background　Although the main indications of stroke volume variability（SVV）have been identified，the usage of SVV to predict fluid responsiveness in one-lung ventilation has raised some controversy.Objective　To evaluate the predictive value of SVV for fluid responsiveness in patients undergoing one-lung ventilation（OLV）with different tidal volumes in video-assisted thoracic surgery.Methods　A total of 72 patients diagnosed with left lung mass and scheduled for video-assisted thoracoscopic lobectomy or radical resection of pulmonary carcinoma in left lung were enrolled in this study from July 2016 to July 2017 at Jinhua Municipal Central Hospital.The patients were randomly divided into two groups using random sequence numbers generated by SPSS 16.0，each with 36 cases：the high tidal volume group（group A）and the low tidal volume group（group B）．After anesthesia induction，patients received two lung ventilation at first，followed by the initiation of the whole left lung isolation，then ventilated with right lung ventilation.All patients received mechanical ventilation on volume-controlled mode.Ventilation parameters：group A：tidal volume was 8 ml/kg，ventilation rate 12 breaths/min，oxygen concentration 100%，respiratory ratio 1∶2，and positive end-expiratory pressure（PEEP）5 cm H2O（1 cm H2O=0.098 kPa）；group B：the tidal volume was 7 ml/kg，and other parameters were as same as that of the group A.Volume loading test was performed at 30 min after starting OLV and when hemodynamic parameters were stable.General information of patients were collected，including sex，age，body mass index，one-lung ventilation time，operation time and intraoperative bleeding volume.Hemodynamic variables，including heart rate（HR），mean arterial pressure（MAP），central venous pressure（CVP），SVV and cardiac index（CI），were measured before（T1）and 5 min after volume loading（T2）．The changing rate of SVV（ΔSVV）and CI（ΔCI） were calculated.A demonstrated increase of ≥15% in cardiac index（ΔCI）was regarded as positive standard，i.e. effective volume expansion and fluid responsiveness of patients.Receiver operating characteristic（ROC）curves for predicting fluid responsiveness of SVV were generated.Results　In the study，data collected from sixty patients who finished volume loading test were analyzed（30 for group A and 30 for group B）．SVV in group B was lower than that in group A at T1（P<0.05）．HR and SVV in group A were lower at T2 than those at T1，CI in group A was higher at T2 than that at T1（P<0.05）；CVP and CI in group B were higher at T2 than those at T1，and SVV in group B was lower at T2 than that at T1（P<0.05）．ΔSVV was negatively correlated with ΔCI in group A and group B（r=-0.838，-0.730，P<0.001）．The results of ROC curve analysis in group A showed that the area under the ROC curve of SVV for predicting fluid responsiveness was 0.744〔95%CI（0.567，0.921）〕，and the sensitivity and specificity were 57.9% and 90.9%，respectively，when the threshold value was 14.5%.The results of ROC curve analysis in group B showed that the area under the ROC curve of SVV for predicting fluid responsiveness was 0.647〔95%CI（0.444，0.850）〕，and the sensitivity and specificity were 70.6% and 61.5%，respectively，when the threshold value was 11.5%.The area under ROC curve of SVV in group A was larger than that in group B（P<0.05）．Conclusion　We found that SVV could predict fluid responsiveness in patients undergoing OLV with different tidal volume.The threshold value was 14.5% for SVV to predict fluid responsiveness when tidal volume was 8 ml/kg.When tidal volume was 7 ml/kg，the accuracy and usage of SVV became weak.


Mortality and Disease Burden of Cancer in Shihezi from 2016 to 2017　

YAN Yizhong，WANG Wenjin，LI Shugang，LIU Jiaming，MA Jiaolong，HU Yunhua，ZHANG Xianghui，WANG Dan，MEN Lintong

2019, 22(15):  1823-1829.  DOI: 10.12114/j.issn.1007-9572.2018.00.447

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Background　Cancer has become the major cause of death around the world，and in China，it ranks as the first leading cause of death，bringing heavy burden on the society.In order to better prevent and control cancer，it is of great significance to track its epidemic situation in time.As a corps city，Shihezi has a large amount of aging population，who are at the high risk of having cancer.Using the latest data to reflect the epidemic and disease burden of cancer in this area can provide latest information for local cancer prevention and control.Objective　To provide basis for the prevention and control of cancer in Shihezi by analyzing the burden of patients with cancer diseases from 2016 to 2017.Methods　According to cancer mortality data of causes of death from the death surveillance system in Shihezi Center for Disease Control and Prevention from 2016 to 2017，we calculated mortality，Chinese population standardized incidence rate，world population standardized incidence rate，potential years of life lost （PYLL），PYLL rate，years of life lost （YLL） and YLL rate to evaluate the burden of patients with malignant tumor diseases.Results　From 2016 to 2017，the crude mortality rate，Chinese population standardized incidence rate，and world population standardized incidence rate，of cancer in Shihezi City were 161.4/100 000，103.3/100 000 and 89.5/100 000，respectively.The crude mortality rate，Chinese population standardized incidence rate，and world population standardized incidence rate in male with cancer were higher than those of female （P<0.05）．The crude mortality rate of cancer in Shihezi began to increase significantly at the age of 30 years，reaching tits peak at the age of 70-79 years.Trachea，bronchi，lung cancer had the highest crude mortality rate of 27.5/100 000，accounting for 17.0% of all tumors.It ranked the first in male patients with cancer and the second in female.Breast cancer ranked the first in the crude mortality rate of 25.7/100 000 in female patients with cancer，accounting for 18.2% of all tumors.The PYLL rate of cancer was 16.7‰，and that of male and female were 15.7‰ and 17.6‰，respectively.The three highest PYLL cancer were Trachea，bronchi，lung cancer，breast cancer and liver cancer.The YLL rate of cancer was 22.2‰，and the YLL rates of male and female were 22.3‰ and 22.2‰，respectively.The three highest YLL cancers were Trachea，bronchi，lung cancer，gastric cancer and breast cancer.PYLL and YLL of Trachea，bronchi，lung cancer and gastric cancer mainly occurred in people over 60 years.The proportion of tumors in female reproductive organ was the highest among people aged 45-59 years，and leukemia was the most serious disease burden among people aged 5-14 years.Conclusion　The burden of patients with cancer in Shihezi is severe from 2016 to 2017.We need to focus on the prevention and treatment of lung cancer，liver cancer，gastric cancer and tumors in women's reproductive system.People over 45 years are the key prevention and treatment group，and the prevention of leukemia should be focused on patients from 5 to 14 years.


Epidemiological Characteristics and Trend of Cancer-related Deaths among Working-age Population in Pudong New Area of Shanghai，2002—2015　

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

2019, 22(15):  1830-1835.  DOI: 10.12114/j.issn.1007-9572.2018.00.410

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Background　Cancer is a health threat to humans，which has become a worldwide concern.However，studies about cancer-related deaths in working-age population are still rare.Objective　To explore the epidemiological characteristics and trend of cancer-related deaths in working-age population from 2002 to 2015 in Pudong New Area of Shanghai，so as to provide a reference for the development of corresponding intervention measures.Methods　From January 2002 to February 2016，we collected the data regarding cancer-related deaths among working-age population in Shanghai's Pudong New Area during January 1，2002 to December 31，2015 from Pudong New Area Cause-of-death Surveillance Database.Demographic data were collected from Pudong Branch，Shanghai Public Security Bureau.Cancer-related deaths（number of deaths，crude mortality）during 2002—2015 were analyzed by sex，and age group.And the trend of annual crude cancer mortality during the period was analyzed by sex，age group and cause-of-death category.Results　The number of cancer-related deaths among working-age population in Pudong New Area during 2002 to 2015 was 19 021，and the crude mortality was 74.15 per 100 000 persons.The crude cancer mortality in males was higher than that in females（P<0.005）．The crude cancer mortality increased with age（P<0.005）．The crude cancer mortality during the period showed a trend of fluctuation（APC=-0.20，P=0.420），and the changes in annual crude cancer mortality trend were not significant in both males and females（APCmale=-0.01%，P=0.983；APCfemale=-0.48%，P=0.208）．The crude cancer mortality declined significantly in 30-39，40-49，and 50-59 age groups over the year（APC30-39=-2.96%，P<0.001；APC40-49=-2.90%，P=0.002；APC50-59=-1.59%，P=0.033）．Among the leading causes of cancer-related deaths，the crude lung cancer mortality，crude colorectal cancer mortality，and crude pancreatic cancer mortality showed a significant upward trend year by year（APClung cancer=2.04%，P<0.001；APCcolorectal cancer=1.99%，P=0.019；APCpancreatic cancer=2.35%，P=0.038），and the crude liver cancer mortality and crude gastric cancer mortality declined significantly year by year（APCliver cancer=-3.78%，P<0.001；APCgastric cancer=-2.12%，P=0.004）．Conclusion　The annual crude cancer mortality of working-age population in Pudong New Area showed a trend of fluctuation between 2002 and 2015.In particular，the crude lung cancer mortality，crude colorectal cancer mortality，and crude pancreatic cancer mortality increased over the year.So more attention should be paid to prevent against the deaths caused by lung cancer，colorectal cancer and pancreatic cancer，and corresponding interventions should be taken.


Application of Internet-based Health Station in the Management of Patients with Type 2 Diabetes　

WANG Li，FU Adan，YI Lan，YANG Jing，ZHANG Juan，XIONG Ying，SHUI Guiying，FU Shali

2019, 22(15):  1836-1841.  DOI: 10.12114/j.issn.1007-9572.2019.00.004

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Background　Diabetes is a kind of chronic disease characterized by high blood sugar.Its associated complications severely impairs the life quality of the patients.To provide an important reference for scientific and effective control of the occurrence and development of diabetes，and for improving the quality of life of diabetic patients，we explored an optimal mode of diabetes management.Objective　To explore the effect of health station on the management of type 2 diabetes patients.Methods　Two hundred and forty inpatients with type 2 diabetes from Diabetes Diagnosis and Treatment Center of the Central Hospital of Wuhan，Tongji Medical College，Huazhong University of Science and Technology，were selected from May 2017 to May 2018.They were evenly divided into research group and control group by the random number table，receiving closed-loop diabetes management delivered by Internet-based health station，routine diabetes management，respectively.The intervention effect was evaluated by levels of fasting blood glucose（FBG），2-hour postprandial blood glucose（2 h PG），glycosylated hemoglobin （HbA1c），serum triacylglycerol（TG），total cholesterol（TC），body mass index（BMI），and self-management ability at the end of a 12-month intervention.Results　At baseline，FBG，2 h PG，HbA1c，TG，TC and BMI in the research group were not significantly different from those of the control group（P>0.05）．After the intervention，the levels of all the 6 indices in the research group were significantly lower than those of the control group （P<0.05）．Furthermore，the adherence to medication，meeting glycemic control targets，and rates of eating a controlled diet of the research group were all better than those of the control group （P<0.05）．Conclusion　 Closed-loop diabetes management delivered by Internet-based health station can improve the FBG，HbA1c，blood lipid and BMI，as well as self-management ability in type 2 diabetic patients.


Effect of Multidisciplinary Management on the Psychosomatic Rehabilitation in Type 2 Diabetic Patients in the Community　

HUANG Hualei，LI Li，XU Yongqing，ZHAO Ruie，LU Bin，LI Qin，HENG Yanhong，DONG Hongfang，ZHANG Wei，REN Yuanpeng，ZHU Fenglan，WU Aiqin

2019, 22(15):  1842-1847.  DOI: 10.12114/j.issn.1007-9572.2019.00.169

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Background　Recently，China has been vigorously promoting diabetes prevention and treatment mainly led by primary healthcare institutions.The Notice on Pilot Implementation of Hierarchical Diagnosis and Treatment of Hypertension and Diabetes（hereinafter referred to as the Notice） issued in 2015 clearly put forward that primary healthcare institutions are responsible for initial clinical diagnosis of hypertension and diabetes，and delivering individualized and standardized treatment according to corresponding guidelines and standards.Moreover，the Notice encouraged community health centers to build a regional healthcare consortium with higher-level hospitals，and cooperate with them using a self-developed reasonable collaborative way，to guide the masses to seek diabetes prevention and treatment services in primary care，gradually realizing initial consultation of diabetes in community care and successful bi-directional referrals for diabetes.Objective　To explore the effect of multidisciplinary management on psychosomatic rehabilitation of community-dwelling diabetic patients，enriching the essence of contracted family doctor services.Methods　 A total of 222 diabetic patients who received follow-up management from Taiping Community Health Station and Huiyang Community Health Station of Taicang Economic-technological Development Area Community Health Center were enrolled from January 2017 to January 2018.By use of coin flipping technique，they were divided into the intervention group（n=110） and control group（n=112），treated with 12-month multidisciplinary management，12-month conventional management，respectively.Changes in blood pressure and glycosylated hemoglobin（HbA1c） from baseline to the end of 3，6，and 12 months of management，and those in GLU and lipids（TG，TC，HDL-C，LDL-C） from baseline to the end of 6，and 12 months of management，and the Quality of Life Questionnaire（SF-36）scores in different dimensionsn at baseline and at the end of management were evaluated.Results　Post-intervention status in both groups showed：significant interaction effects produced by the intervention method and time，and significant main effects brought by both intervention method and time on systolic blood pressure（SBP） were observed（P<0.05）．There was no interaction between the intervention method and time on diastolic blood pressure（DBP）（P>0.05）．Intervention time exerted significant main effect on DBP，while intervention method did not（P>0.05）．HbA1c obtained significant main effects produced by intervention method or intervention time（P<0.05），but no obvious interaction effects produced by them（P>0.05）．GLU received significant interaction effects from intervention method and time，and obvious main effects produced by intervention method or time（P<0.05）．Intervention method and time yielded notable main effects（P<0.05） but no interaction effect（P>0.05） on TG.TC received no obvious interaction effect from intervention method and time（P>0.05），but obtained significant main effect from intervention method（P<0.05） instead of intervention time（P>0.05）．Interaction method and time had significant interaction effects on HDL-C（P<0.05）．Intervention method produced significant main effect on HDL-C（P<0.05），but intervention time did not（P>0.05）．Both intervention method and time exerted main effects on LDL-C（P<0.05），but they had no interaction effect on it（P>0.05）．Post-intervention average scores of 4 subscales of SF-36（role limitations due to physical health problems，vitality，social functioning，and mental health） of the intervention group were significantly higher than those of the control group（P<0.05）.Conclusion　12-month multidisciplinary management showed better effect on improving the levels of HbA1c，blood pressure，blood glucose and blood lipids in type 2 diabetic patients than control group.The improvement of physical health problems，vitality，social functioning，and mental health score in SF-36 was better than that in control group.Multidisciplinary management fully mobilizes patients' enthusiasm for treatment in management， so that diabetes mellitus can be well controlled.


Effect of Contractual Management on Benefit Finding in Patients with Gestational Diabetes Mellitus　

FANG Hui，FAN Shaolei，CUI Hongxia，LI Jing

2019, 22(15):  1847-1850.  DOI: 10.12114/j.issn.1007-9572.2018.00.388

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Background　The incidence of gestational diabetes mellitus（GDM） has been increasing gradually in recent years，which seriously affects the outcome of pregnancy and increases the risk of type 2 diabetes，metabolic syndrome and obesity among mothers and their offspring.Objective　To study the effects of contractual management on benefit finding in patients with GDM.Methods　Using convenient sampling，from Obstetrics Outpatient Clinic，the Third Affiliated Hospital of Zhengzhou University during February to November 2017，we selected 82 cases of GDM who received the services of personal medical card establishment during pregnancy and regular antenatal care，and underwent delivery in this hospital.By use of the random number table，we stratified them into the control group（41 cases） and the intervention group（41 cases），receiving regular antenatal care and health education，regular antenatal care and health education and contractual management，respectively.The scores of the Chinese version of Benefit Finding Scale （BFS-RC） and its domains in both stoups were assessed and compared at baseline and 24 hours after the delivery，respectively.The mode of delivery，gestational weight gain，body weight at delivery，fasting plasma glucose（FPG） and 2-hour postprandial glucose（2 h PG） after delivery were also compared between the two groups.Results　Before intervention，the scores of the Chinese version of BFS-RC and its 6 domains（acceptance，family relationship，worldview，personal growth，social relations，and health behaviors） between the two groups were not different significantly（P>0.05）．After the intervention，they increased significantly in the intervention group rather than the control group with obvious differences （P<0.05）．The rate of cesarean section，gestational weight gain，body weight at delivery，FPG and 2 hPG after delivery were all much lower than those of the control group （P<0.05）．Conclusion　Contractual management can increase the benefit finding in patients with GDM，and helps to control body weight and blood sugar level during pregnancy，and improve the outcome of childbirth.


Protective Effect of Lycium Ruthenicum Procyanidin on Mice Skin Aging Model　

MA Jiayi，GUO Yan，YE Juan，MA Wenyu

2019, 22(15):  1851-1854.  DOI: 10.12114/j.issn.1007-9572.2018.00.461

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Background　Residents in the Qinghai-Tibet Plateau have long been exposed to the environment of high altitude，strong ultraviolet rays and anoxic dryness，so their incidence of photodamaged skin diseases，especially skin photoaging，is high.At the same time，however，Qinghai enjoys its particular vegetation resources because of its unique ecological environment.Therefore，this paper selects local plant，black Chinese wolfberry to study its anti-aging property.Objective　To investigate the protective effect of Qinghai Lycium ruthenicum procyanidin on mice skin aging model.Methods　The experiment was studied from October 2016 to December 2017.Fifty 45-day-old Kunming female mice were randomly divided into 5 groups，with 10 mice in each group.The five groups were Group A（normal group），Group B（skin aging model），Group C（skin aging model+Vitamin E drop），Group D（skin aging model+low-dose Lycium ruthenicum procyanidin） and Group E（skin aging model+high-dose Lycium ruthenicum procyanidin）．Mice in Group A were fed under normal light，and mice in Group B，C，D and E were injected with D-galactose subcutaneously combined with ultraviolet radiation A（UVA） and ultraviolet radiation B（UVB） exposure to establish a skin aging model.On the 11th day of modeling，mice in Group A and Group B were given 0.5 ml/d of 0.9% sodium chloride solution，mice in Group C given 0.5 ml/d of Vitamin E drops，and mice in Group D and Group E given 50 mg?kg-1?d-1 and 100 mg?kg-1?d-1 of Lycium ruthenicum procyanidin，respectively，for 30 days.On the 42nd day，the thickness of dermal layer，changes of collagen fibers and elastic fibers，the expression levels of matrix metalloproteinase-2（ MMP-2） mRNA and matrix metalloproteinase-9（MMP-9） mRNA were detected.Results　Under the light microscope（×40），the layer thickness of mice in Group B was significantly reduced compared with those in Group A，and the thickness of cortical layer of mice in Group C，D and E was slightly thicker than those in group B.Under the light microscope（×400），collagen fibers and elastic fibers of mice in Group B were missing with disordered arrangement and loosely，fractured and curled structure，compared with Group A.The mice in group C，with fractures and curls being still visible，showed more fibrous tissue with mesh arrangement than those in Group B.Compared with Group B and C，Group D and E showed obvious nascent fibrous tissue with neat arrangement and notably reduced fracture and curl.Moreover，the newly grown fiber of mice in Group E was more mature than those in Group D.The expression levels of MMP-2 mRNA and MMP-9 mRNA of mice in Group B were higher than those in Group A，Group D and E（P<0.05），while the expression levels of MMP-2 mRNA and MMP-9 mRNA of mice in group D were higher than those in Group E（P<0.05）．Conclusion　Lycium ruthenicum procyanidins has protective effect on mouse skin aging model and has potential application value of anti-skin aging.


Clinical Observation of Jianpi Shengsui Herbal Paste in Post-chemotherapy Cancer-related Fatigue　

ZHAN Pingping，YU Ling，LIN Jietao，LIN Lizhu

2019, 22(15):  1855-1859.  DOI: 10.12114/j.issn.1007-9572.2018.00.462

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Background　Cancer-related fatigue （CRF） is one of the most common uncomfortable symptoms experienced by cancer patients during and after chemotherapy， which seriously affects their quality of life and treatment progress. At present， its pathophysiological mechanism is not clear， and there is a lack of widely recognized and effective interventions.Objective　To observe the clinical efficacy of Jianpi Shengsui Herbal Paste for post-chemotherapy cancer-related fatigue.Methods　In the tumor outpatient or impatient department of First Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine from July 2015 to July 2016，a total of 80 patients with post-chemotherapy cancer-related fatigue who met the research criteria were selected and divided into two groups in the principle of voluntariness，with 38 cases in the treatment group and 42 patients in the control group.Patients in the treatment group received chemotherapy and Jianpi Shengsui Herbal Paste，which was given 3 times/day and 20 g/time，with 21 days as a course and totally 2 courses.Patients in the control group received chemotherapy only，with 21 days as a course，and totally 2 courses.The Fatigue Scale（FS-14） scores（physical fatigue score，mental fatigue score，FS-14 total score），anemia condition and marrow function indexes（hemoglobin level and neutrophil count） were observed and compared during the process.Results　There was a positive correlation between FS-14 total score and anemia（rs=0.882，P<0.001）．For patients with mild anemia in the two groups，the differences of their physical fatigue score，mental fatigue score and FS-14 total score before and after treatment showed no statistical significance（P>0.05）；for patients with mild anemia in the control group，the differences of their physical fatigue score，mental fatigue score and FS-14 total score before and after treatment showed no statistical significance（P>0.05）；and for patients with mild anemia in the treatment group，the differences of their physical fatigue score and FS-14 total score before and after treatment were not statistically significant（P>0.05），but the difference of their mental fatigue score before and after treatment was statistically significant（P<0.05）．For patients with moderate anemia，there was no significant differences in physical fatigue score，mental fatigue score and FS-14 total score between the two groups before treatment （P>0.05）；after treatment，the difference of physical fatigue score in these patients in the two groups showed statistical significance（P<0.05），but the differences of their mental fatigue score and FS-14 total score still had no statistical significance（P>0.05）．In the control group，the difference of physical fatigue scores before and after treatment in patients with moderate anemia was statistically significant（P<0.05）；and the differences of mental fatigue score and FS-14 total score before and after treatment showed no statistical significance（P>0.05）；in the treatment group，the differences of physical fatigue score and FS-14 total score before and after treatment in patients with moderate anemia showed statistical significance（P<0.05），but the differences of the mental fatigue score had no statistical significance（P>0.05）．For the hemoglobin level and neutrophil count of the two groups，their differences before and after treatment showed no statistical significance（P>0.05）．There was no significant difference in neutrophil count and hemoglobin level between the two groups after treatment（P>0.05）．The difference of hemoglobin in treatment group before and after treatment was significant（P<0.05）．Conclusion　Jianpi Shengsui Herbal Paste can alleviate the post-chemotherapy cancer-related fatigue，and improve anemia outcome and the survival quality of patients.


Characteristics of Imaging Findings on Patients with Anti-N-methyl-D-aspartate Receptor Encephalitis　

AN Yanhong，QI Zhigang，ZHAO Zhilian，YAN Shaozhen，LU Jie

2019, 22(15):  1859-1863.  DOI: 10.12114/j.issn.1007-9572.2018.00.400

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Objective　To investigate the clinical and imaging features of anti-N-methyl-D-aspartate receptor （anti-NMDAR） encephalitis.Methods　A total of 53 patients with anti-NMDAR encephalitis admitted to Xuanwu Hospital Capital Medical University from January to February 2015 were enrolled in this study.Their clinical and imaging features were analyzed retrospectively.Results　Among the 53 patients with anti-NMDAR encephalitis，24 were female （45.3%） and 29 were male （54.7%）．Their age ranged from 6 to 72 years with a median age of 23 years （16 cases aged <18 years and 8 cases aged >45 years）．The clinical course was 7 days to 2 years.Patients with abnormal MRI manifestation accounted for 69.8%（37/53），and abnormal signal in cerebral cortex and subcortical white matter， hippocampus， insula， cerebellum， pons， corpus callosum， basal nucleus， cingulate gyrus， thalamus were observed in 12 cases in T2 weighted image （T2WI） and fluid attenuated inversion recovery （FLAIR） sequence.Diffusion weighted imaging （DWI） was performed in ten patients，eight of whom had lightly restricted diffusion.Eleven cases underwent enhanced MRI，two of whom had lightly enhancement.Bilateral or unilateral temporal horn enlargement were shown in 33 cases，six of whom were accompanied by total brain atrophy.18F-FDG PET-CT was performed in seven cases，and three cases had cerebral hypometabolism and MRI showed brain atrophy and hippocampal atrophy.1 case underwent proton magnetic resonance spectroscopy （1H-MRS）．N-acetylaspartic acid （NAA）/creatine （Cr） decreased and choline （Cho）/Cr increased in the abnormal signal region compared with the normal brain area on the opposite side.Conclusion　Multiple brain areas，including limbic system，get involved in anti-NMDAR encephalitis.Enlarged temporal horn observed in more than 60.0% cases revealed by the first MRI examination may suggest that hippocampus was involved early before clinical onset of anti-NMDAR encephalitis.


Gender-specific Differences in Patients with Psoriatic Arthritis　

2019, 22(15):  1864-1868.  DOI: 10.12114/j.issn.1007-9572.2019.00.063

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Objective　To analyze gender-specific differences in clinical characteristics and laboratory results of psoriasis arthritis（PsA）．Methods　This study was conducted following a retrospective design.Participants were 215 cases of PsA who received inpatient treatment from General Hospital of Ningxia Medical University during April 2007 to April 2017.A sex-specific analysis was performed on clinical and laboratory data such as initial manifestations，skin lesion distribution，type of PsA，joint involvement，system involvement，and immunology and inflammatory indicators.Results　Among the 215 patients，the number of males and females was 118，and 97，respectively，with a male to female ratio of 1.22∶1.There were no significant differences in the incidence of arthritis，skin lesions，arthritis and skin lesions as the initial manifestations between males and females（P>0.05）．In terms of skin lesion distribution，the trunk involvement rate of males was lower than that of females〔18.6%（22/118） vs 32.0%（31/97）〕（χ2=5.081，P=0.024）．Both groups showed no significant differences in age of initial onset and course of PsA（P>0.05）．Females showed a higher rate of symmetrical polyarticular type but a lower rate of spondyloarthropathy type than males（P<0.05）．There were no significant gender-specific differences in the rates of asymmetric oligoarticular，distal interphalangeal and mutilative arthritis（P>0.05）．The involvement rates of joints of metacarpophalangeal，ankle，shoulder，knee，wrist and elbow were higher in females（P<0.05），but those of other joints were similar in both groups（P>0.05）．The rate of blood system damage was higher in males（P<0.05），but other rates of lung，heart，eye，and kidney damages were similar in both groups（P>0.05）．Females had a higher rate of ANA titer >1∶100 and higher IgM but a lower rate of HLA-B27（+），and lower levels of IgA，C3，ESR and CRP（P<0.05）．There were no obvious gender-specific differences in the rates of anti-CCP antibody（+），AKA（+），and RF（+），and in the levels of IgG and C4（P>0.05）．Conclusion　Males had a higher prevalence of PsA.The types of PsA，joints and systemic involvement were different between males and females.Male was associated with a higher probability of having HLA-B27（+），and increased IgA，C3，ESR and CRP，while female was associated with a higher probability of having ANA titer > 1∶100 and increased IgM.


Value of Carotid Doppler Ultrasonography in the Evaluation of Restenosis after CEA and CAS　

LIU Xiaoming，BAO Lingyun，FANG Jianhua，MA Chenxia

2019, 22(15):  1869-1873.  DOI: 10.12114/j.issn.1007-9572.2019.00.060

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Background　Doppler ultrasound is a commonly used test to assess the degree of carotid artery stenosis.But for the evaluation of restenosis after carotid endarterectomy （CEA） and carotid artery stenting （CAS），its accuracy needs to be improved.Objective　To explore the value of ultrasound Doppler in evaluating restenosis after CEA and CAS.Methods　106 patients who received CEA and CAS successfully in Affiliated Hangzhou First People's Hospital，Zhejiang University School of Medicine from January 2015 to August 2016 were chosen and checked by carotid Doppler ultrasonography （CDU） and digital subtraction angiography （DSA） at 12 months after surgery.Comparisons of CDU indices，such as PSV，and EDV at the stenotic segment，and PSV-ICA/CCA ratio were made between participants by the degree of restenosis.The diagnostic accuracies of PSV，EDV and PSV-ICA/CCA ratio for restenosis were evaluated by using the DSA diagnosis as the gold standard.ROC analyses of the efficacy（including accuracy，sensitivity，specificity，positive and negative predictive values） of PSV，EDV and PSV-ICA/CCA ratio in diagnosing the restenosis were performed.Results　A total of 33 cases of ≥50% restenosis were detected，including 19 with 50%-69% restenosis and 14 with ≥70% restenosis.PSV，EDV and PSV-ICA/CCA ratio differed significantly between the participants by the restenosis degree（P<0.05）．And they increased with the degree of restenosis，namely，they increased successively in those with mild（<50%），moderate（50%-69%） and severe（≥70%） restenosis（P<0.05）．ROC curve analyses showed that for diagnosing moderate to severe restenosis（≥50%），the AUC of PSV〔AUC=0.977，95%CI（0.936，0.995）〕was significantly higher than that of EDV〔AUC=0.899，95%CI（0.841，0.989）and that of PSV-ICA/CCA ratio〔AUC=0.842，95%CI（0.778，0.903）〕，and the optimal cut-off value was determined as 209 cm/s.For diagnosing severe restenosis（≥70%），the AUC of PSV〔AUC=0.984，95%CI（0.957，1.000）〕 was also significantly higher than that of EDV 〔AUC=0.810，95%CI（0.734，0.912）and that of PSV-ICA/CCA ratio〔AUC=0.912，95%CI（0.805，0.987）〕，and the optimal cut-off value was determined as 285 cm/s.PSV demonstrated higher accuracy，sensitivity and positive predictive value than EDV and PSV-ICA/CCA ratio in diagnosing moderate to severe restenosis（≥50%） and severe restenosis（≥70%）．Conclusion　All the 3 CDU indices，PSV，EDV，and PSV-ICA/CCA ratio are valuable in the evaluation of restenosis after CEA and CAS surgery.In particular，PSV≥209 cm/s and 285 cm/s can be used as reference indices for the diagnosis of moderate to severe restenosis（≥50%） and severe restenosis（≥70%）．


Effectiveness of Multimodal Intraoperative Monitoring during Positioning and Cervical Spine Surgery　

HUA Dehe，HAO Qiquan，GAO Mengliang，SUN Zhongzheng，WANG Yongcai，XIE Zhen，SUN Haiyan

2019, 22(15):  1874-1878.  DOI: 10.12114/j.issn.1007-9572.2019.00.158

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Background　Although multimodal intraoperative monitoring（MIOM）has been widely used in cervical spine surgery，there are few reports about its monitoring effect on mechanical injury during cervical spine surgery and positioning procedures at home and abroad.Objective　To evaluate the role of the MIOM in monitoring changes of spinal cord and the neurological function during positioning and the cervical procedure，ensuring the safety of the operation.Methods　The date of 61 patients undergoing cervical surgery in the Department of Spine Surgery，PKUCare Luzhong Hospital during September 2016 to September 2017 was retrospectively collected.All patients underwent MIOM before and during operation.MIOM data of 61 patients were composed of somatosensory evoked potential（SEP），motor evoked potential（MEP）and electromyography（EMG）from the onset of positioning to the end of the surgical procedure.Results of MIOM and clinical efficacy〔the spinal cord and neurological function of the patients were evaluated by the Japanese Orthopaedic Association（JOA）score before and 7 days after operation，and the improvement rate of JOA score was calculated〕was calculated.The sensitivity，specificity，positive predictive value and negative predictive value of SEP and MEP were calculated.Results　Six of 61 patients showed MEP alarms during positioning or surgery（MEP suddenly disappeared partially or completely），while SEP did not change significantly.All six patients showed MEP alarm during positioning，five of whose MEP was restored to the baseline level after repositioning and no evoked potential alarm was observed during surgical operation later，and one of whose MEP was restored to the baseline level after grafting fusion.MEP was significantly higher compared with the baseline potential in six patients after operation，and no new neurological dysfunction or aggravation of the original neurological dysfunction occurred after operation.However，only one patient（occipital atlanto-atlas fusion）showed MEP alarm during positioning and cervical spine surgery，with partial disappearance of MEP and normal SEP，and no new neurological dysfunction or aggravation of existing neurological dysfunction after surgery.No EMG abnormality was observed in 61 patients with no false negative or false positive records during the monitoring.The sensitivity and specificity of MEP were both 100.0%，while the positive and negative predictive value were 100.0%.The sensitivity，specificity，positive predictive value and negative predictive value of SEP were 0，100.0%，0 and 90.2%，respectively.Postoperative JOA score of the patients was higher than that before surgery（P<0.05）．The improvement rate of JOA score was 12.5%-75.0%，with an average of（42.9±17.6）%.Conclusion　MIOM is a useful tool to prevent cervical spinal cord and nerve root injury in cervical spine surgical procedures and during positioning of patient.MEP showed the highest sensitivity in detecting injuries in cervical spine related to surgery and positioning.The combined application of SEP，MEP and EMG intraoperative monitoring have complementary effects and can help to reduce the risk of neurological deficit and improve the safety of cervical surgery and it can also provide an objective basis for the evaluation of surgical efficacy and the recovery of postoperative neurological improvement．


Research Progress in Fractional Exhaled Nitric Oxide and Asthma-chronic Obstructive Pulmonary Disease Overlap Syndrome　

SUN Jian，SHEN Juxin

2019, 22(15):  1879-1883.  DOI: 10.12114/j.issn.1007-9572.2018.00.416

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Asthma-chronic obstructive pulmonary disease overlap（ACO） is a group of clinical syndromes characterized by asthma and chronic obstructive pulmonary disease.ACO leads to lower quality of life because of its frequent acute exacerbation.The pathogenesis of ACO is unknown，but in essence，it is still a chronic airway inflammatory disease.Fractional exhaled nitric oxide（FeNO） is a new noninvasive airway inflammation detection technique developed in recent years.It is widely used in asthma research because it is closely related to eosinophilic airway inflammation.It is noteworthy that in recent years，FeNO has been found to be associated with the chronic airway inflammation in ACO.The eosinophilic airway inflammation is also associated with the response to inhaled corticosteroids therapy，suggesting that FeNO may be a potential biomarker for monitoring the level of airway inflammation in ACO patients.In this paper，the research progress of the relationship between FeNO and ACO is reviewed.


Research Progress on Psychotropic Medications and Sexual Dysfunction　

YE Zengjie，LIANG Muzi

2019, 22(15):  1884-1888.  DOI: 10.12114/j.issn.1007-9572.2018.00.453

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Patients with psychiatric illness are often troubled by sexual dysfunction and many sexual symptoms resolve as the mental state improves.However，treatment-emergent sexual adverse events tend to persist over time，such as decreased libido，delayed orgasm，and sexual arousal difficulties caused by antidepressants，antipsychotics and mood stabilizers，which is usually ignored by clinicians due to cultural or professional factors.Treatment-emergent sexual dysfunction adversely affects quality of life and may contribute to reducing treatment adherence.Thus，this study is designed to report the treatment effect of three psychosis（schizophrenia，depression and bipolar disorder）on sexual dysfunction，and the management of sexual dysfunction，providing psychiatrists some suggestions about optimal protocol of psychotropic treatment.