Chinese General Practice

Interpretation of the Global Strategy for the Diagnosis，Management，and Prevention of COPD 2019 by GOLD　

WANG Xiaojuan，FANG Xiangyang

2019, 22(18): 2141-2149. DOI: 10.12114/j.issn.1007-9572.2019.00.064

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The Global Initiative for Chronic Obstructive Lung Disease （GOLD）（2019 Report） was released on November 7，2018.The updates of the report involve the risk factors，diagnosis，prevention of COPD，management of stable COPD，management of exacerbations，and pharmacological and non-pharmacological treatments.The report focuses on the initiation pharmacological treatment，management cycly and follow-up pharmacological management of stable COPD according to the individualized assessment of symptoms and exacerbations.It also emphasizes the use of peripheral blood eosinophil counts as a biomarker to guide the use of inhaled corticosteroid therapy for exacerbation prevention.Here is an interpretation of the report.

Implementation of “Double Heart Medicine” service model——attaching great importance to mental and psychological problems in doctor education and science communication

HU Dayi

2019, 22(18): 2150-2151. DOI: 10.12114/j.issn.1007-9572.2019.00.140

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Best Practice in Psychological Activities in Cardiovascular Prevention and Rehabilitation：Essentials of the GICR-IACPR Position Paper　

MA Wenlin

2019, 22(18): 2151-2155. DOI: 10.12114/j.issn.1007-9572.2019.00.171

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The Italian Association for Cardiovascular Prevention，Rehabilitation and Epidemiology（GICR-IACPR） published a position paper on best psychological practice in cardiovascular prevention and rehabilitation（CPR） in October 2018.Based on the National Institute for Health and Care Excellence（NICE） Guidelines on psychological interventions on anxiety and depression，this position paper divides psychological practice in CPR into three steps：step one includes psychological evaluation and dynamic monitoring；step two includes low-intensity interventions，which are suitable for patients with less severe and/or the recent onset of diseases；step three includes high-intensity interventions，which are available for patients with poor outcomes in low-intensity interventions or worsening conditions over time.Psychological interventions here are divided into two levels according to NICE model.The low-intensity interventions include counseling，psycho-education，self-care，self-management，telemedicine，and self-help.The high-intensity interventions include individual，couples，and/or family and group psychotherapy，such as stress management.This position paper is a summary of a large number of latest literature and guidelines with strong operability.Compared with the psychological prescriptions in the current cardiovascular rehabilitation practice in China，this position paper is more comprehensive and detailed.Therefore，it can provide a normative reference for the psychological staff engaged in CPR in China.

Research Progress on the Relationship between Depression and Coronary Microvascular Disease　

ZHAO Bo，QIN Gang

2019, 22(18): 2156-2160. DOI: 10.12114/j.issn.1007-9572.2019.00.188

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The coronary microvascular system refers to arteries with an inner diameter of less than 0.5 mm，and its number of vessels accounts for 95% of the entire coronary artery tree.The viewpoint that coronary microvascular disease（CMVD）causes angina pectoris in patients has attracted more and more attention.With the continuous development of the bio-psycho-social medical model and the proposal of psycho-cardiology，the adverse effects of psychological disorders on cardiovascular diseases are gradually recognized.This article introduces the definition，epidemiology，pathogenesis and risk factors of CMVD and depression，and summarizes their common pathogenesis and risk factors.It is found that there is a correlation between depression and CMVD，and it is believed that the effective and reasonable treatment of depression can improve the condition of CMVD，and then improve patients' quality of life and prognosis.Therefore，the study of depression and CMVD should be paid more attention by clinicians.

Impact of Anxiety on Prehospital Delay in Patients with Acute Myocardial Infarction　

WANG Zhen，PAN Jiangqi，TU Rongxiang，DING Jie，SHI weiqi，Karl-Heinz Ladwig，MA Wenlin

2019, 22(18): 2161-2165. DOI: 10.12114/j.issn.1007-9572.2019.00.247

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Background　Prehospital delay in seeking treatment in patients with acute myocardial infarction（AMI）is a vital factor on patients outcome.However，most studies focus on demographic factors，clinical symptoms and display of AMI，and cognitive aspects，and there is a lack of systematic research on social-psychological factors.As a common psychological factor，anxiety and its effects over AMI patient's prehospital time（PHT）has not yet been reported.Objective　Our study was to assess the impact of anxiety on PHT of AMI patients in order to provide a basis for the development of prehospital delay intervention strategies for anxiety-related AMI patients.Methods　In this multi-centered，cross-sectional observational study，we enrolled 265 patients diagnosed with AMI from four hospitals（Tongji Hospital of Tongji University，Tenth People's Hospital of Tongji University，Yangpu Hospital Tongji University，People's Liberation Army No.411 Hospital）in Shanghai from April 2016 to February 2017.Data collection included demographic status，symptoms of AMI onset，decision time，transit time，PHT（the time of symptom onset to the arrival at hospital door）．Anxiety was measured with the Generalized Anxiety Disorder-7（GAD-7）．Results　The mean PHT of 265 patients was 150.0（70.0，501.0）min.The results of anxiety assessment showed that a total of 104 patients displayed symptoms of anxiety（mild，n=81； moderate，n=16； severe，n=7）．We found that patients with anxiety were more likely to display sign of depression，cardiac denial and fear of death（P<0.05）．The incidence of feeling of death and dizziness in anxious patients was higher than non-anxious patients（P<0.05）．There was no significant difference in decision time，transit time and PHT between anxious and non-anxious patients（P>0.05）．PHT and decision time in patients with severe anxiety tended to be longer than those with mild anxiety（P<0.05）．There was no significant difference in the transit time of patients with different degrees of anxiety（P>0.05）．Conclusion　Patients with AMI and anxiety are more likely to have depression and cardiac denial.In comparison to patients who are mildly anxious，severely anxious patients with AMI might significantly prolong decision time and PHT，which is more likely to cause the miss of the optimal reperfusion period and affect the prognosis.

Clinical Characteristics of Anxious or Depressed Patients with Coronary Artery Disease　

SHI Weiqi，LIU Ruhui，NI Yi，WANG Zhen，MA Wenlin

2019, 22(18): 2166-2171. DOI: 10.12114/j.issn.1007-9572.2019.00.167

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Background　Anxiety and depression is common among patients with coronary artery disease（CAD），which protracts the course of disease，affecting the treatment and prognosis，with high rate of missed diagnosis.Clinical characteristics of these patients remain unexplored.Objective　To identify the clinical characteristics of CAD patients with anxiety and depression，which can be helpful for early diagnosis.Methods　In this single-center cross-sectional study，a total of 131 patients diagnosed with CAD in Tongji Hospital of Tongji University from March to July 2013 were enrolled.General Information Questionnaire，Beck Depression Inventory（BDI），Beck Anxiety Inventory（BAI），Symptom Checklist 90（SCL-90，composed of 10 dimensions，including somatization，obsessive-compulsive symptoms，interpersonal sensitivity，depression，anxiety，hostility，terror，paranoia，psychosis and other symptoms） were distributed and completed by the patients independently.Results　A total of 131 questionnaires were distributed，and all were recovered，of which 120 were valid，with an effective response rate of 91.6%.Thirty-nine patients（32.5%） were accompanied by anxiety and/or depression，of which 38（31.7%） had anxiety，seven（5.8%） had depression，and six（5.0%） accompanied by both.In somatization dimension，compared to those without anxiety or depression，the CAD patients with anxiety and/or depression complained more “headaches”“faintness or dizziness”“chest pain” “trouble breathing”“numbness or tingling in parts of your body”“ sense of obstruction in your throat”“feeling weak in parts of your body”“heavy feelings in your arms or legs”（P<0.05）．In the dimension of obsessive-compulsive symptoms，the incidence of “unwanted thoughts or ideas that won't leave your head”“feeling difficult in getting things done”“having to check and double check what you do”“difficulty in making decisions”“your mind going blank”“trouble in concentrating”“having to repeat the same actions such as counting，washing”in CAD patients with anxiety and/or depression were higher than those without anxiety and/or depression （P<0.05）．In the dimension of interpersonal sensitivity，the incidence of “ blaming others for perfection”“feeling inferior to others”“feeling very nervous about others” and “feeling uncomfortable about eating or drinking in public”in CAD patients with anxiety and/or depression were higher than those without anxiety or depression（P<0.05）．In the depression dimension，the prevalence of “loss of sexual interest or pleasure”“thoughts of ending life”“crying easily”“blaming yourself”“feeling lonely”“feeling blue”“worrying too much about things”“feeling no interest in things”“feeling hopeless about the future”“feeling everything is difficult”“feeling of worthlessness”in CAD patients with anxiety and depression was higher than those without anxiety and depression （P<0.05）．In anxiety dimension，“nervous or oversensitive”“suddenly scared for no reason”“heart pounding or racing”“feeling tense or keyed up”“feeling so restless you couldn't sit still”“feeling pushed to get things done”were more common in CAD patients with anxiety and/or depression than those CAD patients without anxiety or depression（P<0.05）．In the dimension of terror，CAD patients with anxiety and/or depression had higher incidence of “feeling afraid in open spaces or on the street”“feeling afraid to travel on buses，subways or trains”“having to avoid certain things，places or activities”“feeling uneasy in crowds in shopping malls or theatres”“feeling nervous when you are left alone”“feeling afraid you will faint in public”than those CAD patients without anxiety or depression（P<0.05）．In paranoid dimension，“feeling that most people cannot be trusted”were more prevalent in CAD patients with anxiety and/or depression than that in those without anxiety or depression（P<0.05）．In the psychosis dimension，for CAD patients with anxiety and/or depression，the prevalence of “the idea that someone else can control your thoughts”“feeling lonely even when you are with people”“having thoughts about sex that bother you a lot”“the idea that you should be punished for your sins”“the idea that something serious is wrong with your body”“never feeling close to others personally”were higher than those without anxiety or depression（P<0.05）．About other symptoms，CAD patients with anxiety and/or depression suffered more from “poor appetite”“trouble in falling sleep”“thoughts of death or dying”“awakening in the early morning”and“ restless or disturbed sleep”than those CAD patients without anxiety or depression（P<0.05）．Conclusion　The incidence of CAD patients with comorbid anxiety and depression is high，among whom the somatization disorders are more common and apparent.Besides，the obsessive-compulsive symptoms，interpersonal sensitivity，terror and psychotic symptoms among CAD patients with anxiety and/or depression are marked，as well as sleep disorders.Therefore，the assessment of anxiety and depression should be strengthened in CAD patients with related symptoms.

Analysis of Psycho-cardiology Cases——Paying Attention to Bi-directional Correlation　

ZHU Ning

2019, 22(18): 2172-2175. DOI: 10.12114/j.issn.1007-9572.2019.00.183

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The concept of psycho-cardiology is gradually recognized by cardiovascular physicians and accepted by patients.However，many clinicians in general hospitals do not know much about it，which causes patients as well as their families are mental and physical exhaustion with still unsolved problems after consuming a lot of medical resources，and even leads to medical disturbance and violence.Based on the analysis of clinical cases，this paper demonstrates the fact that psycho-cardiology diseases are interrelated and mutually reinforcing，which seriously affects the quality of life and prognosis of patients with cardiovascular diseases.It emphasizes the importance of recognizing psycho-cardiology diseases and its identification and treatment，especially in the retrogression of the elderly，in order to enable patients to return to their normal lives，restore their social roles and achieve both physical and mental health.

Risk Factors for the Prognosis of Acute Respiratory Distress Syndrome in the Berlin Definition　

WU Aiping，WANG Jinzhu，HAN Fang，LI Qian

2019, 22(18): 2176-2181. DOI: 10.12114/j.issn.1007-9572.2019.00.039

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Background　Acute respiratory distress syndrome（ARDS） is one of the major causes of death for severe patients.With the deepening of people's understanding about ARDS，the diagnostic criteria for ARDS are also changing.The Berlin definition proposed in 2012 makes the diagnosis of ARDS more accurate.However，the risk factors affecting the prognosis of ARDS in the Berlin definition have been rarely studied.Objective　To explore the risk factors for the prognosis of ARDS in the Berlin definition.Methods　From the Intensive Care Unit，Zhejiang Provincial People's Hospital，177 cases of ARDS in the Berlin definition were enrolled during 2012-10-01 to 2017-09-30.All of them received active treatment.General clinical data，disease and treatment，baseline disease severity scores，and baseline laboratory results were collected.According to the survival outcome at 28 h after ICU admission，they were divided into the survival group and death group.Multivariable Logistic regression analysis was conducted to analyze the risk factors for the prognosis of ARDS.Results　Of the 177 cases，79 survived（44.6%，survival group） and 98 died（55.4%，death group）．Univariate analysis showed that both groups had significant differences in the percent distributions of age，BMI，grade and pathogenetic pathway of ARDS，COPD history，rates of having shock，cumulative fluid balance （CFB） at 72 h after admission，continuous renal replacement therapy，average days of receiving invasive mechanical ventilation，Acute Physiology and Chronic Health Evaluation（APACHE）Ⅱscore，Sequential Organ Failure Assessment（SOFA） score，and average baseline serum creatinine（P<0.05）．Multivariable Logistic regression analysis showed that age>65 years〔OR（95%CI）=2.536（1.120，4.653），P<0.01〕，pulmonary ARDS〔OR（95%CI）=1.055（0.424，3.423），P<0.01〕，severe ARDS〔OR（95%CI）=3.363（1.763，5.236），P<0.01〕，positive CFB at 72 h after admission〔OR（95%CI）=1.163（0.512，3.563），P<0.01〕，APACHEⅡscores of 15-25 〔OR（95%CI）=2.224（1.046，4.255），P<0.01〕，were independent risk factors for death of ARDS，while BMI>24.0 kg/m2〔OR（95%CI）=0.856（0.326，1.563），P<0.05〕was a protective factor.Conclusion　Age>65 years，pulmonary ARDS，severe ARDS，positive CFB at 72 h after admission，APACHEⅡ scores of 15-25,were independent risk factors for death of ARDS while BMI>24.0 kg/m2 was a protective factor.

Relationship between Hyperuricemia and Body Mass Index，Waist Circumference and Neck Circumference in the Elderly in Puxing Community　

SUN Dongmei，ZHENG Qinghu，WANG Yongrong，SUN Jing

2019, 22(18): 2182-2188. DOI: 10.12114/j.issn.1007-9572.2018.00.415

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Background　The prevention and treatment of chronic diseases〔including hyperuricemia（HUA）〕in communities are a kind of comprehensive management for such diseases.Many factors，such as obesity，metabolic disorders，cardiovascular disease，cerebrovascular disease，and chronic kidney disease are associated with the risk of increased HUA.However，previous studies linking obesity to HUA have shown different results.Objective　To assess the association between diverse measures of obesity〔body mass index（BMI），waist circumference（WC） and neck circumference（NC）〕and HUA in the elderly in Puxing Community.Methods　Elderly（65-99 years old） people（n=4 364） were recruited from the Puxing Community，Pudong New District，Shanghai.All of them participated in the free physical examination delivered by the Puxing Community Health Center during April to June，2015.A cross-sectional survey was used to collected the data concerning BMI，WC and NC，and other factors associated with HUA〔history of smoking and drinking，hypertension，diabetes，levels of uric acid（UA）fasting plasma glucose（FPG），total cholesterol（TC），triacylglycerol（TG），urea，creatinine（Cr），total bilirubin，ALT and estimated glomerular filtration rate （eGFR）〕．They were divided into high sUA group（n=610） and normal UA group（n=3 754） according to the level of UA （UA>420 μmol/L in men and postmenopausal women was defined as the diagnostic criterion for HUA）．And personal characteristics of both groups were compared.By BMI，the participants were stratified into underweight，normal weight，overweight，and obesity.On the basis of the quartile of WC，they were assigned to A1（WC<82.2 cm for men，<78.0 cm for women），A2（82.2 cm≤WC<88.5 cm for men，78.0 cm≤WC<85.0 cm for women），A3（88.5 cm≤WC<94.0 cm for men，85.0 cm≤WC<92.0 cm for women），A4（WC≥94.0 cm for men，≥92.0 cm for women）．They were also divided into 4 groups according to the quartile of NC，B1（NC<35.0 cm for men，<31.0 cm for women），B2（35.0 cm≤NC<37.0 cm for men，31.0 cm≤NC<33.0 cm for women），B3（37.0 cm≤NC<38.0 cm for men，33.0 cm≤NC<35.0 cm for women），B4（NC≥38.0 cm for men，≥35.0 cm for women）．The relationships of HUA prevalence with BMI，WC and NC were analyzed by sex.Multivariable Logistic regression analyses were also performed to investigate the relationships of HUA prevalence with BMI，WC and NC.Results　The average age，history of hypertension，BMI，WC，NC，systolic and diastolic blood pressure，UA，TG，urea，SCr，total bilirubin，ALT and eGFR，prevalence of overweight and obesity，abdominal obesity，increased NC，hypertension，and decreased eGFR were significant different between high UA group and normal UA group （all P<0.05）．The prevalence of HUA significantly increased with the growth of age，BMI，WC，and NC in both men and women（P<0.05）.After adjusting for sex，age，smoking，drinking，TC，TG，total bilirubin，ALT，hypertension，and diabetes，multivariate Logistic regression analyses of the models established with the BMI，WC and NC data showed that BMI，WC and NC were all associated with HUA（P<0.001）．The prevalence of HUA increased by 42%，38%，29%，respectively，with every 1-standard deviation（3.4 kg/m2） increase in BMI，every 1-standard deviation（9.5 cm） increase in WC，and every 1-standard deviation（3.3 cm） increase in NC.After further adjusting for WC and NC，multivariable Logistic regression analyses found that BMI was associated with HUA（P<0.05）．In addition，male，TG，decreased eGFR，hypertension and diabetes were associated with HUA（P<0.05）．Conclusion　BMI，WC and NC were all associated with HUA.But after adjusting for the latter two，BMI was found to be associated with HUA.Compared with WC and NC，BMI might have a stronger association with HUA.

Emotional and Behavioral Problems in Toddlers with Autism　

WANG Feifei，LI Xue，LIU Jing，JI Zhaozheng

2019, 22(18): 2189-2193. DOI: 10.12114/j.issn.1007-9572.2019.00.038

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Background　Emotional and behavioral problems are common comorbidity of autism.In China，there are few studies on the emotional and behavioral problems in toddlers with autism.Objective　To investigate the emotional and behavioral problems in toddlers with autism by Achenbach Child Behavior Checklist（CBCL，2 to 3 years old）．Methods　A total of 116 toddlers aged 2 to 3 years continuous visited by experts from the research group of the Peking University Sixth Hospital，meeting criteria of autistic disorder in Diagnostic and Statistical Manual of Mental Disorders，Fourth Edition（DSM-Ⅳ） were selected from February 2016 to February 2017，174 normal children according to the ratio of 1:1.5 matched with autistic group in gender and age from Kindergartens in Beijing were included from February 2016 to February 2017.All subjects were evaluated by Achenbach Child Behavior Checklist（CBCL，2 to 3 years old）．Scores of CBCL（2 to 3 years old） and positive rate of CBCL（2 to 3 years old） factors were compared between the two groups.Results　The total score，scores of subscales and scores of each factor of CBCL（social withdrawal，depression，physical complaints，sleep problems，aggressive behavior，destructive behavior） in the autistic group were higher than those in the normal control group（P<0.05）．The positive rate of factors of CBCL（2 to 3 years old），including social withdrawal，depression，physical complaints，aggressive behavior，and destructive behavior in the autistic group was higher than that of the normal control group（P<0.05）．There was no significant difference in the positive rate of sleep problem factors between autism group and normal control group（P>0.05）．Conclusion　Toddlers with autism have more emotional and behavioral problems than normal children，including social withdrawal，depression and aggression.It is needed to pay attention to the emotional and behavioral problems in toddlers with autism.

Factors Influencing Acute Pancreatitis Complicated with Pleural Effusion　

ZUO Liting，ZHANG Hairong，CHEN Jian，YANG Ziyun，HE Jiawei，ZHANG Jingli，LI Ruochang

2019, 22(18): 2194-2199. DOI: 10.12114/j.issn.1007-9572.2018.00.268

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Background　Severe acute pancreatitis （SAP） has a rapid progression and high mortality，and early prediction and correct assessment of the severity of acute pancreatitis （AP） are important. At present，the scoring system commonly used in clinical practice is cumbersome and cannot be applied to early evaluation. Studies have shown that pleural effusion（PE） can be a good early predictor of SAP. However，there are few studies on the risk factors of AP complicated with PE. Objective　To explore influencing factors of AP complicated by PE，so as to have a better understanding of risk factors at an early stage，reduce the probability of developing into SAP and improve prognosis.Methods　Retrospective analysis was performed on 326 AP inpatients with complete medical records and chest imaging findings in the Department of Gastroenterology of First Affiliated Hospital of Kunming Medical University from January 2013 to December 2017.The patients were divided into PE group and non-PE group according to whether having concurrent PE.The group was further divided into two subgroups according to the length of hospital stay：the subgroup whose hospitalization time was no more than 7 days（including 7 days） and the subgroup whose hospitalization time was longer than 7 days.Discharge diagnosis，complications（hyperlipidemia，hyperglycemia，abdominal effusion，pulmonary infection，liver and kidney injury，pancreatic pseudocyst，and complicated with two or more diseases），hospitalization time，hospitalization expenses，general information〔age，body mass index，gender，etiology，previous history of pancreatitis，smoking history （>2 cigarettes/d，duration >1 year），history of drinking（average daily intake of alcohol >60 g and duration > 5 years）〕 were compared.Laboratory test indicators within 48 h after admission〔worst values：white blood cell count（WBC），neutrophil percentage （NEU），serum albumin （ALB），serum calcium （Ca），fibrinogen （FIB），blood glucose （GLU），C-reactive protein （CRP），amylase （AMY），lipase（LIP）〕，and other data，including 48 h Ranson score，modified CT severe index（MCTSI） score，bedside index for severity in acute pancreatitis（BISAP） score were also compared between PE group and non-PE group.Then multivariate Logistic analysis was used to analyze the influencing factors of AP complicated with PE.Laboratory test indicators and other data between two subgroups were compared.Results　Of 326 AP patients，137 were in PE group and 189 in non-PE group.There was statistically significant differences in discharge diagnosis，complications，hospitalization time，hospitalization expenses，gender，history of pancreatitis，WBC，NEU，ALB，Ca，FIB，CRP，AMY，LIP，48 h Ranson score，MCTSI score and BISAP score between PE group and non-PE group（P<0.05）．Multivariate Logistic analysis showed that no history of pancreatitis，CRP，MCTSI score and BISAP score were influencing factors of AP complicated with PE（P<0.05）．In PE group，ALB and Ca of the subgroup whose hospitalization time was longer than 7 d were lower than those of the subgroup whose hospitalization time was less than or equal to 7 d，and its GLU and 48h Ranson scores were higher than those of the subgroup whose hospitalization time less than or equal to 7 d（P<0.05）．In non-PE group，the CRP and MCTSI scores of the subgroup whose hospitalization time was longer than 7 d were higher than those of subgroup whose hospitalization time less than or equal to 7 d（P<0.05）．Conclusion　History of pancreatitis，ALB，FIB，CRP，MCTSI score，and BISAP score are factors influencing AP complicated with PE.

Efficacy of Stretta Radiofrequency Ablation and Toupet Fundoplication for Gastroesophageal Reflux Disease：a Comparative Study　

LI Weixue，TIAN Songjun，ZHAN Zhengming，LIN Xiansheng

2019, 22(18): 2200-2205. DOI: 10.12114/j.issn.1007-9572.2019.00.035

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Background　Gastroesophageal reflux disease（GERD）has a series of chronic symptoms and esophageal mucosal damage caused by reflux of gastric contents due to dysfunction of the lower esophageal sphincter.It can cause clinical symptoms such as heartburn，chest pain and acid reflux，affecting the lives of patients.GERD is a common disease that usually requires long-term medical or surgical treatment.The commonly used surgical method is toupet fundoplication，which has a good effect and Stretta radiofrequency ablation has been shown to significantly improve GERD symptoms and quality of life in several studies.Objective　To compare the clinical value of Stretta radiofrequency ablation and toupet fundoplication for GERD.Methods　A total of 118 GERD patients treated with toupet fundoplication or Stretta radiofrequency ablation at Hanyang Hospital Affiliated to Wuhan University of Science and Technology from January 2014 to January 2016 were enrolled.There were 73 patients treated with toupet fundoplication（toupet fundoplication group）and 45 patients with Stretta radiofrequency therapy（Stretta radiofrequency treatment group）．Baseline data of the two groups were analyzed，including reflux condition before and 6 months after treatment，DeMeester score and lower esophageal sphincter（LES）pressure before and after 2，6 months of treatment，and prognosis of disease.Results　At the end of the follow-up，3 patients were lost contact in the toupet fundoplication group and 2 patients lost contactin the Stretta radiofrequency treatment group.A total of 113 patients were included in the study.There was no significant difference in the reflux time and frequency，and percentage of acid reflux time between the two groups before and 6 months after treatment（P>0.05）．There was an interaction between treatment and time on DeMeester score and LES pressure（P<0.05）．The main treatment effect was significant in treatment mode and time on DeMeester score and LES pressure（P<0.05）．The DeMeester score of Stretta radiofrequency treatment group was lower than that of toupet fundoplication group 6 months after treatment，and the LES pressure was higher than that of toupet fundoplication group（P<0.05）．There was no significant difference in dysphagia，abdominal distension，diarrhea，chronic pain，recurrence of GERD，mortality rate and survival curve between the two groups（P>0.05）．Multivariate Cox proportional regression analysis showed that the reflux frequency 6 months after treatment〔RR=1.202，95%CI（1.729，3.981），P=0.031〕，DeMeester score〔RR=1.567，95%CI（1.132，2.170），P=0.001〕and LES pressure〔RR=1.302，95%CI（1.809，2.096），P=0.037〕were influential factors of poor prognosis in the toupet fundoplication group，while the reflux frequency 6 months after treatment〔RR=1.583，95%CI（1.168，2.145），P=0.022〕，DeMeester score〔RR=1.792，95%CI（1.422，2.258），P=0.004〕and LES pressure〔RR=1.653，95%CI（1.365，4.477），P=0.015〕were factors influencing the prognosis of patients in the Stretta radiofrequency treatment group.Conclusion　Compared with traditional toupet fundoplication，Stretta radiofrequency treatment can significantly improve the esophageal pH and pressure in patients with GERD without increasing the risk of prognosis.It is expected to be widely used as an effective treatment for refractory GERD.

Evaluation of Inflammatory Indicators and Related Clinical Value in Community-based Aged Population　

PAN Xiangdong，CHEN Bianling，CHEN Yuanyuan

2019, 22(18): 2206-2210. DOI: 10.12114/j.issn.1007-9572.2019.00.258

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Background　With the aging of the population in Shanghai，the number of patients with chronic diseases observed in the community-based physical examination is increasing year by year.However，it is rarely reported that the status of chronic diseases can be evaluated by the inflammatory indicators during the physical examination.Objective　To determine the scores of inflammatory indicators in the aged population in a community of Shanghai，and evaluate related clinical value.Methods　In this study，we collected the physical examination data of the aged population in a community of Shanghai in July 2017.The general clinical characteristics and biochemical parameters were included.Furthermore，scores of inflammatory indicators，including lymphocyte-monocyte ratio（LMR），neutrophil-lymphocyte ratio（NLR） and platelet-lymphocyte ratio（PLR） were calculated.The prevalence of hypertension，diabetes and hyperlipidemia as well as the ratios of abnormal blood pressure，blood sugar，and blood lipid levels of the aged population included in this study were collected.The differences of LMR，NLR and PLR between participants with normal and abnormal blood pressure，glucose level，and blood lipid level were analyzed.Correlations between NLR and the levels of glycosylated hemoglobin and fasting blood glucose were evaluated.Additionally，the diagnostic values of LMP，NLR and PLR for diabetes were evaluated by receiver operating characteristic（ROC） curve.Results　A total of 380 elderly people met the study criteria，including 157 males and 223 females with age（74.1±7.0）years old.In these participants，the number of cases diagnosed with hypertension was 245（accounting for 64.5% of the total number），diabetes was 81（21.3%），and hyperlipidemia was 17（4.5%）．Whereas，the number of cases with observed abnormal blood pressure was 315（82.9%），abnormal blood glucose level was 157（41.3%），and dyslipidemia was 133（35.0%）．Furthermore，we found that there were no significant differences in LMR，NLR and PLR between participants with normal and abnormal blood pressure level（P>0.05） as well as participants with normal and abnormal blood lipid level（P>0.05）．Similarly，there were no significant differences in LMR and PLR between patients with normal and abnormal blood glucose level（P>0.05）．However，NLR was significantly higher in patients with abnormal blood glucose level than those with normal blood glucose level（P<0.05）．Using Pearson correlation test，we found that NLR in the aged population was not correlated with blood glycosylated hemoglobin level（r=0.051，P=0.322）．In contrast，NLR was positively correlated with fasting blood glucose levels（r=0.151，P=0.003）．Moreover，it was showed that the area under the ROC curve（AUC） of NLR for diagnosis of diabetes was 0.580〔95%CI（0.522，0.638），P=0.008〕；the cut-off point was 1.730；the sensitivity is 59.2%；and the specificity was 55.6%.Whereas，the AUC of LMR and PLR for diagnosis of diabetes were 0.479〔95%CI（0.420，0.538），P=0.486〕 and 0.480〔95%CI（0.421，0.539），P=0.508〕 respectively.Conclusion　The incidence of chronic diseases is high among the aged population in the community.Among all the tested inflammatory indicators，there was a significant difference in NLR between patients with normal and abnormal blood glucose level.Thus，NLR has potential value in screening of diabetes in patients with abnormal blood glucose level during physical examination.

Effect and Mechanism of Probucol on Oxygen-glucose Deprivation/Reoxygenation Injury in Renal Tubular Epithelial Cells　

REN Guangwei，GONG Miao，LI Mingming，NIU Zheli，YANG Hongjuan，SUN Lijun

2019, 22(18): 2211-2216. DOI: 10.12114/j.issn.1007-9572.2019.00.237

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Background　The main pathophysiological basis of renal ischemia/reperfusion injury is lipid peroxidation injury of renal tubular epithelial cells，which directly affects the formation of urine.Probucol is a hypolipidemic drug with strong antioxidant effect. It can reduce the level of lipid peroxidation by increasing the activity of antioxidant enzymes in cells, and has better tissue or cell protective effect. However, there is no report about the effect of probucol on the damage of HK-2 human renal proximal tubule cells（RPTC）induced by oxygen-glucose deprivation/reoxygenation（OGD/R）.Objective　To explore effect and potential mechanism of probucol on OGD/R in HK-2 RPTC，giving new ideas for the new use of old drugs.Methods　From December 2017 to September 2018，HK-2 RPTC were conventionally cultured to adhere on the culture plate completely and then divided into normal control group，OGD/R group，OGD/R+25 μmol/L probucol group，OGD/R+50 μmol/L probucol group，and OGD/R+100 μmol/L probucol group，respectively.The normal control group received no intervention.OGD/R models were established in other four groups.After successfully modeling，OGD/R group were given no intervention，OGD/R+25 μmol/L probucol group，OGD/R+50 μmol/L probucol group，and OGD/R+100 μmol/L probucol group were treated with 25，50 and 100 μmol/L probucol，respectively.At 12，24 and 48 hours after treatment，the proliferation activities of cells in each group were calculated to determine the optimal time and concentration of probucol for subsequent experiments.HK-2 cells were cultured to adhere on the culture plate completely and then divided into normal control group（no treatment），OGD/R group（establishing OGD/R model），probucol group（treatment with the optimal concentration of probucol），and OGD/R + probucol group（first establishing OGD/R model，then intervened with the optimal concentration of probucol）．At the optimal treatment time of probucol，the morphology of cells in each group was observed，and the activities of lactate dehydrogenase（LDH）and glutathione peroxidase（GPX），levels of malondialdehyde（MDA），glutathione（GSH）and GPX4 were detected.Results　The proliferative activities of cells in OGD/R group，OGD/R+25 μmol/L probucol group，OGD/R+50 μmol/L probucol group and OGD/R+100 μmol/L probucol group were lower than those in normal control group at 12，24 and 48 hours after intervention（P<0.05）．The cell proliferation activities of OGD/R+50 μmol/L probucol group and OGD/R+100 μmol/L probucol group at 24 and 48 hours after intervention were higher than those of OGD/R group and OGD/R+25 μmol/L probucol group（P<0.05）．The cell proliferation activities at 24 and 48 hours after intervention increased significantly compared with those at 12 hours after intervention in both OGD/R+50 μmol/L probucol group and OGD/R+100 μmol/L probucol group（P<0.05）．Because the principle of drug use is that under similar action，lower concentration and shorter action time are generally chosen，the following experiment was carried out with 50 μmol/L probucol for 24 hours.In OGD/R group，the number of suspended cells increased，the cells shrank，the volume decreased，the normal morphology lost，and the refractive index decreased.The cells in probucol group had normal morphological structure and complete adherence.In OGD/R+probucol group，the number of suspended cells decreased，but the refractive index of cells was comparatively good.The activities of LDH in OGD/R group and OGD/R+probucol group were higher than those in normal control group（P<0.05）．The activities of LDH in probucol group and OGD/R+probucol group were lower than those in OGD/R group（P<0.05）．The activity of LDH in OGD/R+probucol group was higher than that in probucol group（P<0.05）．The level of MDA in the control group was lower than that of OGD/R group and probucol group（P<0.05）．The level of MDA in OGD/R group was higher than that of probucol group and OGD/R+probucol group（P<0.05）．The level of MDA in OGD/R+probucol group was higher than that in probucol group（P<0.05）．The activity of GPX in OGD/R group was lower than that in normal control group（P<0.05）．The activities of GPX in both probucol group and OGD/R+probucol group were higher than those in OGD/R group（P<0.05）．The activity of GPX in OGD/R+probucol group was lower than that in probucol group（P<0.05）．The level of GSH in OGD/R group was lower than that in normal control group（P<0.05）．The level of GSH in OGD/R group was lower than that of both probucol group and OGD/R+probucol group（P<0.05）．The level of GPX4 in OGD/R group was lower than that in normal control group（P<0.05）．The levels of GPX4 in probucol group and OGD/R+probucol group were higher than those in OGD/R group（P<0.05）．Conclusion　Probucol can protect HK-2 RPTC from OGD/R-induced injury，possibly by activating GPX，especially by increasing the level of GPX4，directly or indirectly inhibiting the excessive production of lipid peroxides.

Serum Hepatitis B Virus RNA Level in Chronic Hepatitis B with Low Level of Hepatitis B Virus DNA and Its Influential Factors　

PENG Yameng，YUAN Hao，ZHOU Yifeng，LONG Zhenyi，WU Sixian

2019, 22(18): 2217-2222. DOI: 10.12114/j.issn.1007-9572.2019.00.020

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Background　The main reason that leads to persistent Hepatitis B virus （HBV） infection is covalent closed circular DNA （cccDNA）．Current laboratory tests can hardy reveal the status of cccDNA in hepatocytes accurately.While HBV RNA，the transcriptome of cccDNA，can indicate the existence of cccDNA.Objective　To investigate the level of serum HBV RNA in chronic hepatitis B （CHB） with low level of HBV DNA replication and analyze its influential factors.Methods　CHB patients with low HBV DNA replication level from the First Affiliated Hospital of Hunan Normal University from May to July 2018 were retrospectively enrolled and divided into two groups according to their HBeAg status.Age，sex，the serum level of alanine aminotransferase（ALT），aspartate aminotransferase （AST），quantitative hepatitis B surface antigen （qHBsAg），HBV DNA，HBV RNA，and incidence of HBV RNA below the lowest limit of detection were compared between the two groups.Influential factors of serum HBV RNA levels and HBV RNA levels below the lower limit of detection were analyzed in CHB patients.The correlation between serum HBV RNA levels and the level of serum ALT，AST，qHBsAg，HBeAg and HBV DNA was analyzed.Results　Among the 72 patients，12 were HBeAg positive while the rest 60 were HBeAg negative.Age of HBeAg positive patients was younger than that of HBeAg negative patients，while the level of serum AST，qHBsAg and HBV RNA were significant higher than those of HBeAg negative patients（P<0.05）.Serum HBV DNA level and the incidence of HBV RNA below the lowest limit of detection in HBeAg positive patients were significantly lower than those of HBeAg negative patients（P<0.05）.The results of multivariate linear regression analysis revealed that HBeAg （B=0.837，t=2.634，P=0.010） was a key factor influencing serum level of HBV RNA in CHB patients（P<0.05）．It also demonstrated that qHBsAg〔OR=1.682，95%CI（1.055，2.681），P=0.029〕and HBeAg〔OR=3.85，95%CI（1.068，13.880），P=0.039〕were influential factors of the incidence of HBV RNA below the lowest limit of detection.Serum level of HBV RNA in CHB patients was correlated with qHBsAg （rs=0.322，P=0.006） and HBeAg （rs=0.235，P=0.047）．Serum level of HBV RNA was positively correlated with qHBsAg（rs=0.848，P<0.001）and HBeAg（rs=0.725，P=0.008）in HBeAg positive patients.Conclusion　The level of serum HBV RNA in CHB patients with low HBV DNA level varies according to HBeAg status.HBeAg status contributes to serum HBV RNA level，and both qHBsAg and HBeAg could cause the level of HBV RNA below the lowest limit of detection.

Clinical and Serological Responses to Bufeihuayu Decoction Adjuvant Therapy in Patients with Non-small Cell Lung Cancer　

FENG Yuan，CHEN Sining，JIANG Ying，ZHOU Ying，LIAO Haifei，FENG Jie，LI Zhanhua，ZHU Lin，LIN Weinan，LI Jianzhe

2019, 22(18): 2223-2229. DOI: 10.12114/j.issn.1007-9572.2018.00.414

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Background　Lung cancer is the first killer threatening human life and health. The incidence of non-small cell lung cancer （NSCLC）accounts for 70% to 80% of lung cancer. Radiotherapy and chemotherapy are the main measures to treat NSCLC，but it is difficult to obtain satisfactory therapeutic effect. Bufeihuayu Decoction is a clinical experience prescription for the treatment of lung cancer. It has certain curative effect on common lung diseases and lung cancer. However，the existing research is limited to the curative effect of Bufeihuayu Decoction on NSCLC，and its mechanism is rarely reported.Objective　To explore NSCLC patients' clinical response and serological response〔changes in serological markers of both nitric oxide（NO） and vascular endothelial growth factor （VEGF）〕to Bufeihuayu decoction，an adjuvant therapy.Methods　This randomized，double-blind study was conducted in 87 cases of NSCLC from Ruikang Hospital Affiliated to Guangxi University of Chinese Medicine from January 2012 to December 2015.Patients were divided into control group（n=43） and observation group（n=44） by randomized parallel control study．Both groups received vinorelbine plus cisplatin，a conventional chemotherapy program as first-line therapy，in addition，the observation group received Bufeihuayu decoction〔for 2 courses of treatment （once daily，3 weeks as a course of treatment）〕.Comparisons were made between the two groups in terms of clinical response〔assessed by TCM syndrome score and quality of life evaluated by the Karnofsky Performance Scale （KPS） and SF-36〕，serological response（evaluated by serum NO and VEGF），immune response（evaluated by peripheral T-lymphocyte subsets） and safety（evaluated by the incidence of toxicity and side effects） during the treatment period.Results　After treatment，compared with the control group，the observation group had much higher overall response rate，and rate of achieving stable disease（P<0.05），significantly lower serum NO and VEGF levels（P<0.05），obviously higher levels of peripheral CD3+ T cells，CD4+ T cells and CD4+/CD8+ ratio，and much lower level of CD8+ T cells（P<0.05）．Moreover，the TCM syndrome score，KPS score and SF-36 score in the observation group were significantly better than those in the control group（P<0.05）．The incidence of alopecia，gastrointestinal reactions，myelosuppression，and diarrhea was much lower than that of the control group（P<0.05）．Conclusion　As an adjuvant therapy to first-line chemotherapy for NSCLC，Bufeihuayu decoction can significantly enhance the overall clinical response，down-regulate the levels of serum NO and VEGF，improve the cellular immune function and quality of life，and reduce the side effects caused by chemotherapy.

Clinical Response and IL-12，IL-10 and IFN-γ Responses to Aitongxiao Granules Combined with Transcatheter Arterial Chemoembolization in Primary Liver Cancer　

LI Ping，LI Mingfen，WEI Wei，ZHANG Rongzhen，YANG Lei，LIN Hongsheng，YIN Jun，DENG Zengfu

2019, 22(18): 2230-2236. DOI: 10.12114/j.issn.1007-9572.2018.00.444

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Background　Hepatic arterial chemoembolization（TACE） is an important treatment for advanced primary liver cancer（PLC）．But some patients still have recent disease progression，low quality of life and functional ability for independent living after TACE treatment.Aitongxiao granules，a prescription developed by Professor WEI Ailing，the First Affiliated Hospital of Guangxi University of Chinese Medicine，has been clinically proved to be effective for PLC.But the efficacy of Aitongxiao granules combined with TACE for PLC and natural killer cell immune functions〔including interleukin（IL）-12，IL-10 and gamma interferon（IFN-γ）〕 is still unclear.Objective　To explore the clinical response and responses of IL-12，IL-10 and IFN-γ to Aitongxiao granules combined with TACE in PLC.Methods　This study was a randomized controlled single-blind，single-center test.According to the inclusion criteria，we enrolled 86 cases of PLC and 20 physical examinees（healthy group） from the First Affiliated Hospital of Guangxi University of Chinese Medicine，from June 2014 to February 2016.The PLC patients were equally divided into the experimental group and control group by a random number table.All PCL cases ate low-fat high-quality protein diet and were treated with TACE，the cases in the experimental group additionally took Aitongxiao granules，one dose per day.The treatment for PCL cases lasted for one course of treatment（8 weeks），and the follow-up for them ended on March 5，2018.Comparisons were made between the experimental and control groups in terms of clinical response，TCM syndrome score at baseline，by the end of the 7th day，4th and 8th weeks of treatment，and serum IL-12，IL-10 and IFN-γ levels,quality of life（assessed by EORTC QLQ-C30），before and after treatment，and long-term prognosis 〔total survival（OS） and time-to-progression（TTP）〕 and treatment-related side effects.Results　The overall response rate of the experimental group was much higher than that of the control group 〔83.72%（36/43） vs 65.12%（28/43）〕（χ2=3.909，P=0.048）．The TCM syndrome score decreased significantly in both the experimental and the control groups by the end of the 7th day，4th and 8th weeks of treatment（P<0.05）．The experimental group showed lower TCM syndrome score than the control group by the end of 4th，and 8th weeks of treatment（P<0.05）．At baseline and at the end of treatment，both the experimental and control groups had higher IL-10 levels and lower serum IL-12 and IFN-γ levels compared with the healthy group（P<0.05）．When the treatment ended， serum IL-10 was lower and serum IL-12 and IFN-γ were higher in the experimental group compared with the control group（P<0.05）.When the treatment ended，serum IL-10 decreased significantly but serum IL-12 and IFN-γ increased obviously in both the experimental and control groups（P<0.05）．At the end of treatment，both experimental and control groups had increased mean function score and decreased mean symptom score of EORTC QLQ-C30 compared with baseline（P<0.05）．Moreover，the experimental group showed higher mean function score and lower mean symptom score than the control group（P<0.05）．The median OS and TTP were 17（10，30），11（6，15） months for the control group，and 26（14，30），15（11，22） months for the experimental group.Both the risk of death and risk of disease progression of the experimental group were lower than those of the control group〔HR=0.529，95%CI（0.309，0.919），P=0.019；HR=0.568，95%CI（0.361，0.893），P=0.006〕.Conclusion　Aitongxiao granules combined with TACE has good clinical efficacy for PLC，which can significantly reduce the symptoms，effectively regulate the immune factor levels and improve the long-term prognosis.

Trend of Traditional Chinese Medicine Rehabilitation Service Demand in Regional Communities Based on Geographic Information System Technology　

GUO Jin，ZHOU Chan，HUANG Min，KONG Jiejie，WANG Jun

2019, 22(18): 2237-2242. DOI: 10.12114/j.issn.1007-9572.2018.00.460

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Background　Traditional Chinese Medicine（TCM） plays an important role in the development of rehabilitation services in communities.Geographic Information System（GIS） technology has unique advantages in analyzing trends of demand for TCM rehabilitation services in regional communities compared with other traditional analytical methods.Objective　To provide guidance for the development of TCM rehabilitation services in the community by analyzing demand trends of TCM rehabilitation services in regional community health service centers.Methods　Ten Community health service centers（CHSC） in Huangpu District，Shanghai were selected from July to August 2017 as research subjects to study the trend of historical demand for community rehabilitation services of TCM.Questionnaires were used to collect （1） TCM rehabilitation services being or ever being carried out in the community from 2015 to June 2017；（2） the outpatient volume of TCM rehabilitation services in the community from 2015 to June 2017；（3） the expense of diagnosis and treatment of TCM rehabilitation services in the community from 2015 to June 2017.The data forecast of outpatient service volume and treatment expense in 2017：the related data in the first half of 2017 （up to June）×2.According to Pareto Principle，the types of community TCM rehabilitation services were classified according to annual outpatient volume（forecast） in 2017.ArcGIS 10.5.1（trial version） was used to visualize the spatial distribution of regional TCM diagnosis and treatment programs.Results　There were 29 community TCM rehabilitation services，including 3 services with major demand and 26 services with general demand.From 2015 to 2017，the total outpatient volume of TCM rehabilitation services in regional communities declined from 1.10 million person-times to 0.98 million person-times annually，but its total medical expense increased from 20.68 million yuan to 21.89 million yuan annually.The proportion of outpatient services with major demand represented by acupoint application and infrared radiation declined from 88.3% to 82.9% annually，and the proportion of its expense in total diagnosis and treatment expense decreased from 88.0% to 79.7% annually.In contrast，the proportion of outpatient services with general demand represented by TCM directional penetration and acupuncture and its expense increased year by year.There was an upward trend of outpatient volume of services with major demand at CHSC in the central part of Huangpu District，but a downward trend showed in the eastern and western part of Huangpu District.There was an upward trend of outpatient volume of services with general demand at CHSC in the western and central part of Huangpu District，but a downward trend occurred in the eastern part of Huangpu District.Conclusion　The demand of community TCM rehabilitation services was generally on the rise，and the demand structure is diverse.The demand for acupoint application and infrared radiation showed a declining trend，while the demand for TCM directional penetration and acupuncture were in a rapid growth.The construction of departments with TCM rehabilitation characteristics should adapt to the changing needs of residents.

Congenital Anomalies of the Kidney and the Urinary Tract in High-risk Neonates：an Ultrasound-screening Study　

LI Bo，MA Changjian，LI Wenyan，XU Hong，YIN Yufang，WANG Yuanyuan，JIANG Huafang，GAO Jian

2019, 22(18): 2243-2247. DOI: 10.12114/j.issn.1007-9572.2018.00.420

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Background　Congenital anomalies of the kidney and the urinary tract（CAKUT） is a structural congenital malformation diagnosed in newborns，which is the primary cause of end-stage renal disease in children and adolescents.Objective　 To analyze the incidence of CAKUT in high-risk neonates based on an ultrasound-screening study of the CAKUT in this population，to explore the appropriate subjects and patterns for CAKUT screening.Methods　4 883 high-risk neonates who were born in Weifang Maternal and Child Health Hospital and Anqiu Women and Children's Hospital from July 2012 to July 2014 were selected for ultrasound screening of urinary malformations after getting permission from their parents.The results of screening were analyzed and summarized.The identified CAKUT was classified.And the children with congenital hydronephrosis were followed up regularly.Results　A total of 242 cases of CAKUT were detected，accounting for 4.96%.The detection rate of CAKUT in the neonates delivered in Anqiu Women and Children's Hospital was higher than that of those delivered in Weifang Maternal and Child Health Hospital〔5.43%（225/4 146） vs 2.31%（17/737）；χ2=12.934，P<0.05〕.The male to female ratio of neonates with CAKUT was 2.27∶1.The detection rate of CAKUT in male neonates was higher than that of female neonates〔6.52%（168/2 575） vs 3.21%（74/2 308）；χ2=28.447，P<0.05〕.A total of 230 children with hydronephrosis were screened out，accounting for 95.04% of children with CAKUT，and 205 cases with grade Ⅰ，23 with grade Ⅱ，and 2 with grade Ⅲother types of CAKUT were found in 12 cases（3 cases of renal duplication anomaly，3 cases of cystic renal lesions，2 cases of absence of the kidney，2 cases of ectopic kidney and 2 cases of renal dysplasia）．One-year follow-up showed that the pyelonephrosis in those cases of gradeⅠ andⅡ disappeared spontaneously，and the pyelonephrosis of gradeⅢ cases disappeared after receiving conservative treatment.The 12 cases with other 4 types of CAKUT were transferred to Pediatric Renal Clinic，Weifang Maternal and Child Health Hospital for further follow-up.Two of them were lost to follow up，other 10 cases were found with normal renal functions，urinalysis results and growth and development.Conclusion　The prevalence of CAKUT in high-risk neonates is 4.96% in Weifang，which is higher than that of most domestic and foreign studies.Hydronephrosis is the most common type of CAKUT，and the prognosis is good.It is necessary for high-risk infants to undergo ultrasound screening of urinary malformations after birth.For those with severe hydronephrosis or other types of CAKUT，early referral is suggested.Moreover，improved three-level referral system helps to deliver effective preventive interventions as soon as possible.

MRI Features and Pathology Grade in Ductal Carcinoma in Situ　

XU Xiaoqin，WANG Dengbin，WANG Lijun，LUO Ran，LIU Huanhuan，ZHANG Huayuan，YIN Dongqing

2019, 22(18): 2248-2252. DOI: 10.12114/j.issn.1007-9572.2019.00.226

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Background　Ductal carcinoma in situ （DCIS） is an early lesion with tendency to develop invasive ductal carcinoma.The focus of DCIS research is to identify which type of lesions will develop into invasive cancer.If the problem is addressed，DCIS will be treated more accurately.In this study，MRI characteristics of DCIS were discussed in detail by pathological grade.Objective　To investigate MRI findings and pathology grade in DCIS.Methods　The pathological grade and MRI findings〔breast imaging reporting and data system（BI-RADS） classification，morphology and dynamic contrast-enhanced MRI of lesions，ADC value〕 of 34 cases（35 sides） of DCIS confirmed by surgery and pathology in Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine from January 2015 to January 2018 were retrospectively analyzed.Results　Pathology grade：4 cases of low grade group，and 31 cases of intermediate to high grade.BI-RADS classification：1 case of BI-RADS 3，2 cases of BI-RADS 4A，5 cases of BI-RADS 4B，12 cases of BI-RADS 4C，and 15 cases of BI-RADS 5.Morphology of lesions：6 cases of mass type，29 cases of non-mass enhancement（including 15 cases of segmental distribution，5 cases of regional enhancement，and 4 cases of line-like，and 15 cases of clustered ring and 5 cases of clumped）．Dynamic enhanced performance：10 cases of typeⅠ time-signal intensity curves（TIC），15 cases of typeⅡ and 10 cases of typeⅢ.Four 4 cases of early slow enhancement，2 cases of early moderate enhancement，29 cases of early fast enhancement.ADC value：ADC value was <1.2×10-3 mm2/s in 19 cases，and ≥1.2×10-3 mm2/s in 16 cases.The morphology and ADC value of the lesions were similar in low pathological grade group and intermediate to high pathological grade groups（P>0.05）．There were correlations between non-mass enhancement distribution，non-mass internal enhancement types，type of TIC，early enhancement rate and pathological grade （P<0.05）．Conclusion　MRI findings of DCIS are mainly observed as non-mass enhancement，among which，segmental, regional and linear enhancement, cluster small ring and cluster enhancement are common.The pathological basis is ductal invasion，and the enhancement of the surrounding matrix and ductal wall.MRI observations can reflect the pathological changes，suggest the pathologic grade，and predict whether DCIS is accompanied by infiltration and local recurrence to a certain extent，by which the biopsy and clinical treatment regimens can be modified.

Research Progress on Clinical Application of Humidified High Flow Oxygen Therapy　

WU Yuejiao，YANG Shumei，CHEN Ruilin

2019, 22(18): 2253-2257. DOI: 10.12114/j.issn.1007-9572.2018.00.442

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Humidified high flow nasal cannula（HFNC） is a new oxygen supply device，which can deliver up to 100% humidified and heated oxygen with maximum flow rate of 60 L/min.Compared with standard nasal cannula，HFNC has many advantages.Growing evidence has shown that HFNC is an effective method for the treatment of early respiratory failure in adults associated with different underlying diseases.However，studies have also suggested that improper use of HFNC may delay tracheal intubation and increase mortality，and there also have been reports of severe air leakage events caused by HFNC treatment.Despite the lack of a set of strict and clear guidelines to guide its use，HFNC has become a routine practice applied in different diseases and clinical environments.In this paper，the physiological effect，mechanism of HFNC and its application in a series of clinical environments are reviewed，which provides the basis and reference for the clinical application of HFNC.

Recent Developments in Amyotrophic Lateral Sclerosis and Cholesterol Metabolism　

ZHOU Xiaomeng，CAO Cuifang，LIU Yaling，NIE Xiangyu，ZHANG Ting，QI Weijing

2019, 22(18): 2257-2261. DOI: 10.12114/j.issn.1007-9572.2018.00.344

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Amyotrophic lateral sclerosis is a degenerative disease of the nervous system.Its pathogenesis is not clear and there is no effective treatment.Cholesterol is a main component of the cell membrane，which is vital to the maintenance of the normal function of the cell.The brain is the most cholesterol-rich organ in human body.In recent years，the studies of abnormal brain cholesterol metabolism and neurodegenerative diseases are increasing.This article elaborates the relationship between cholesterol metabolism and amyotrophic lateral sclerosis.

Diagnosis and Treatment of Senile Osteoporosis among General Practitioners　

FEI Xiuwen，ZHENG Jiatang，KONG Yuxia，DONG Aimei

2019, 22(18): 2262-2266. DOI: 10.12114/j.issn.1007-9572.2018.00.421

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Primary osteoporosis is a common age-related chronic bone disease.The prevalence of osteoporosis in people over 50 years is 20.7% in women and 14.4% in men.The incidence of osteoporosis-related fragility fractures has increased year by year，which can cause disability and death，and its medical expenses incurred are enormous.Early osteoporosis lacks specific symptoms.For patients at high risk of osteoporosis in the community，early diagnosis and appropriate intervention can reduce the occurrence of fractures.This article reports on the diagnosis and treatment of a patient with senile osteoporosis in the community.From the perspective of general practitioners，we introduced and analyzed risk assessments，diagnosis and treatment of the disease by relevant literature and guidelines，in order to provide diagnosis and treatment ideas for general practitioners in the community，improve their ability to diagnose and treat osteoporosis，and exert the advantages of primary care in the prevention and treatment of chronic diseases.

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