Table of Content

20 July 2019, Volume 22 Issue 21

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Monographic Research

Interpretation of the 2018 ESC/ESH Guidelines for the Management of Arterial Hypertension　

CHENG Wenli

2019, 22(21):  2519-2523.  DOI: 10.12114/j.issn.1007-9572.2019.00.224

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As the concept of prevention and treatment of cardiovascular diseases has gradually transferred from passive prevention to active prevention，hypertension，a primary risk factor for cardiovascular diseases，has been receiving more and more attention.The 2018 ESC/ESH Guidelines for the Management of Arterial Hypertension released at the 2018 European Society of Cardiology Congress was based on recent clinical evidence of the benefits of anti-hypertension treatment for cardiovascular diseases.Compared with the 2013 version，hypertension management and control have been significantly updated in the new guidelines，but some previous ideas are still being followed.The new guidelines comprehensively and detailedly elaborates the hypertension diagnosis，blood pressure measurement，risk stratification of hypertension，initiation of antihypertensive treatment，blood pressure treatment targets，hypertension treatment，and management of resistant and secondary hypertension，with efforts intensified in the prevention and control，in particular，the initiation time and threshold value for blood pressure-lowering drug treatment and initiation of drug combination.Besides，priority recommendation of single tablet regimen of fixed compound preparations，and concepts of blood pressure monitoring and comprehensive management in patients with hypertension，are also worthy of clinical reference and learning.


Recent Advances in Intervention Model of Advance Care Planning for Patients with Advanced Cancer　

QIU Yeyin，ZHANG Jianghui，MIAO Jiarui，CHEN Liuliu，DENG Renli

2019, 22(21):  2524-2529.  DOI: 10.12114/j.issn.1007-9572.2019.00.072

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Advance care planning，which focuses on the communication process among patients，medical care personnel and family members of patients，can help people with advanced cancer to express their preference of end-of-life care，decrease excessive treatments and improve their quality of life and dignity.It has already become a part of the conventional treatment in many western developed countries.There is no empirical study on the intervention model of patients with advanced cancer in China.This paper reviews the literature on the intervention models of advance care planning to build a local intervention model for patients with advanced cancer and provide basis for empirical research on this topic.


Analysis of Collaboration Obstacles and Corresponding Strategy Optimization of the Diagnosis and Treatment of Outpatients with Mental Disorders among General Practitioners and Psychiatrists Based on Multiple Interviews　

LIU Zhongren，XU Xiaofeng，XU Tao，ZHANG Hanzhi，YU Dehua

2019, 22(21):  2530-2537.  DOI: 10.12114/j.issn.1007-9572.2019.00.277

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Background　The incidence of mental illness is increasing，and the cost of curing psychological disorders is burdensome，which sets a higher requirement for today's health service system and mode.The collaborative clinic system of general practitioners（GPs） and psychiatrists is of great value for the diagnosis and treatment of psychological disorders，but the current collaboration in China does not work quite satisfactorily.Objective　To discover and analyze the obstacles of the collaborative clinic system of GPs and psychiatrists with the purpose to optimize the collaborative strategies.Methods　A total of 20 GPs and 30 patients with mental disorders or their families from one general hospital（H1），two urban community hospitals（H2，H3） and one suburban community hospital（H4），and 10 psychiatrists from the same areas were randomly selected for the investigation and interviews from August 1st to September 30th in 2018.The interview covered five main aspects of interviewee's cognition，behavior，attitude，questions and opinions related to collaborative diagnosis and treatment system.The interview duration was about half an hour and it was recorded.The recording was transcribed electronically.First，each question was coded at the first level.Then，the corresponding content of each encoding was discussed and condensed to generate the descriptive label for further data induction and classification.Then the subjects were generated by classification，and representative interview speeches were cited by the respondents.Results　（1）GPs had a certain cognition of the collaborative diagnosis and treatment，but the current collaboration with psychiatrists did not work quite well.GPs thought that collaboration was of great significance，but it still faced multiple difficulties involving channels，resources，doctors and patients.GPs suggested that collaboration could be promoted with varied forms including collaborative resources and forms，and improving GPs' own expertise.（2）The psychiatrists carried out collaborative diagnosis and treatments in community，including community clinics，but they thought that the effects of collaboration were different.They thought the collaboration was necessary and beneficial to patients' physical and mental health，as well as their family and social problems.However，psychiatrists also mentioned that there were various problems and difficulties in the current collaboration from aspects of allocation of resources and patients.They advised that collaboration required more mutual learning and communication，expanded publicity and platform construction.（3）The patients or their family members had little cognition of collaboration，and they agreed with collaboration but lack of active suggestions.Most of patients had not accepted the collaborative diagnosis and treatment and many of them were sent to different medical institutions without standard treatments.The patients mainly relied on psychiatric drugs without suitable prescriptions.There was a need for collaborative clinic system in community，but patients distrusted the GPs.There were also other problems such as the lack of psychiatric drugs，or small prescriptions in community clinics.Conclusion　At present，there are problems and obstacles in the collaboration clinic system between GPs and psychiatrists in the diagnosis and treatment of patients with mental disorders，including the incoordinate information and resources between doctors and patients，and lack of effective implementation of collaboration platforms and strategies.The optimization strategies include improving the ability of GP to diagnose and treat mental disorders，improving the collaboration modes and channels，and implementing and utilizing the existing collaboration platforms and resources.Policy encouragement and patient education should also be strengthened.


Analysis of Referrals of Outpatients with Psychological Disorders by General Practitioners and Its Influencing Factors　

XU Xiaofeng，LIU Zhongren，ZHANG Hanzhi，YU Dehua

2019, 22(21):  2537-2542.  DOI: 10.12114/j.issn.1007-9572.2019.00.148

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Background　As psychological disorder has caused more and more problems in the society，the cooperative management of its diagnosis and treatment by psychiatric specialists in the general clinic is considered of great value.The referral process，as an important strategy and method for current collaborative diagnosis and treatment，is deficient and difficult to perform in clinical practice，especially for the utilization of referral routes.At present，studies about this issue are lacking.Objective　To understand and analyze the referrals of outpatients with psychological disorders by general practitioners（GPs）and its influencing factors to address the basis for the strategic optimization and the effective referral usage.Methods　A total of 12 community health service centers/hospitals in Yangpu District，Huangpu District，Putuo District，Pudong New Area，and Jiading District in Shanghai were included by stratified random sampling from August 1st to 30th 2018.According to the inclusion and exclusion criteria，203 general practitioners were selected.A self-designed questionnaire，including GP's demographic characteristics，out-patient referrals，and expected referrals，was used in this study.Results　A total of 190 valid questionnaires out of 203 sent questionnaires were collected with an effective recovery rate of 93.6%.Among 190 GPs，138 of them（72.6%）have suggested their patients to the psychiatric department，only 29 GPs（15.3%）have actually referred their patients.The top 3 situations that GPs consider a referral included difficulties in treatment（143 subjects，75.3%），unclear diagnosis（141 subjects，74.2%），and the primary diagnosis of mental problems or symptoms（131 subjects，68.9%）．Eighty-five subjects（44.7%）had experienced difficulties in referrals.The top three factors that influenced referrals were GPs' lacking of diagnostic assurance（149 subjects，79.3%），lacking of connections with the referred psychiatric specialists or institutions（104 subjects，55.3%），and poor compliance of patients or family members（90 subjects，47.9%）．Sixty-five subjects（60.2%）considered the referral route as the online referral platform；55 subjects（28.9%）understood the referral approaches；93 subjects（48.9%）thought that referrals were practical.83 subjects（43.7%）were aware of the supportive policy in general outpatient clinics；and 170 subjects（89.5%）considered that they were obligated to make referrals.Additionally，73 subjects（38.4%）believed that the key types of psychoactive drugs in their general clinics were generally adequate.Results of multivariate Logistic regression analysis showed that understanding the approach of referral，and the referrals' practical usage were key influencing factors（P<0.05）．Of 190 general practitioners，67.4%（128 cases）expected to have referral channels，53.7%（102 cases）expected expert consultation，and 52.1%（99 cases）expected to have joint clinics with specialists.Conclusion　A great demand for the referral of patients with psychological disorders in the current general clinics cannot be neglected.However，the actual referral is insufficient.Factors causing the difficulty of referrals are the difficulties and lack of confidence of diagnosis and treatment for psychological disorders，the lack of referral approaches，and poor compliance of patients.The actual referrals are determined by the understanding of the referrals ways，and the practical usage of referrals.


Collaboration Bottlenecks and Strategies of General Practitioners' Diagnosis and Treatment for Outpatients with Mental Disorders Based on Meta-analysis　

ZHANG Hanzhi，XU Xiaofeng，LIU Zhongren，QIAN Jie，GE Xuhua，WANG Zhaoxin，YU Dehua

2019, 22(21):  2543-2547.  DOI: 10.12114/j.issn.1007-9572.2019.00.154

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Background　Mental illness seriously endangers the health and life of residents.General practitioners（GPs）' collaborated with the psychiatric specialists is conductive to the diagnosis，treatment and management of mental disorders.But there are still many problems and obstacles in the current collaboration.More optimization strategies still need to be explored.Objective　 To analyze and explore the collaboration bottlenecks and strategies of GPs' diagnosis and treatment for outpatients with mental disorders，to provide theoretical basis for the application and optimization of strategies，so as to promote the diagnosis and treatment of mental diseases in communities.Methods　Searching the title of（“mental” OR “psycho” OR “psychiatry”）AND（“primary care” OR “general practice” OR “general practitioner” OR “family medicine”）in the databases of Web of Science，Pubmed，Elservier，China National Knowledge Infrastructure，WAN-FANGDATA and CQVIP，we retrieved literatures from January 1，2104 to December 31，2017.With the repeated literatures excluded，we analyzed the selected literatures involving the collaboration between general practice and psychiatric department.Results　 We retrieved 157 literatures.Eight of them involved the significance of collaboration，which mentioned its important values of clinical effects，cost saving，disease management，reducing stigma and discrimination，improving skills of GPs and saving general psychiatric resources.Three of them involved the deficiency of the collaboration status.Seventy-two of the literatures involved the collaboration strategies between general practice and psychiatric department，41 of which mentioned system plans，programs and models，31 of which mentioned other ways and channels of non-system strategies of collaboration; however，collaboration strategies were mostly in the construction stage，and their application effects in practice needed further study.Seventy-four of the literatures involved subjects being treated in general practice and psychiatric department，29 of which mentioned adolescents and children，and the rest of which mentioned other kinds of peoples.Sixteen of the literatures involved influencing factors of collaborations，including aspects of economy，manpower，drug prescription and technology，and obstacles in clinic，economy，duty and supervision.Seven of the literatures involved opinions of collaborations from GPs，psychiatrists，staff and patients.Eleven of the literatures involved the training of collaboration; they reported the cooperation between general practitioners and psychiatric specialists and the training of related knowledge and skills，but its long-term application and development in practice needed further study.Four of the literatures explored the collaboration between general practitioners and psychiatrists.Conclusion　GPs had collaboration obstacles and bottlenecks in the diagnosis and treatment of outpatients with mental disorders，including：the inadequacy of GPs' diagnosis and treatment，both GPs and psychiatrists lacking knowledge in collaboration，and many other obstacles influencing the collaboration.This also indicates the optimized strategies lies in program supports and resource optimizing.It is worth noting that the practice and persistence of the collaboration programs is needed.Resource optimization is reflected in rational investment and application of resources related to limited collaboration and policy support.


Cardiac Rehabilitation Referral Model Based on Internet Plus Tertiary Hospitals and Community Health Centers　

SHEN Yuqin

2019, 22(21):  2548-2550.  DOI: 10.12114/j.issn.1007-9572.2019.00.173

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Cardiac rehabilitation has been strongly recommended by international guidelines for its beneficial effects.Referral model between tertiary hospitals and community health service centers is worth exploring，because the community-based cardiac rehabilitation will be the major model.At present，the main hospitals in China to carry out cardiac rehabilitation are tertiary hospitals.In the case of limited rehabilitation hospitals，it is necessary to study the referral mode of cardiac rehabilitation between third-level hospitals and community health centers.This review mainly focused on the existing problems and the solutions of referral model based on the Internet plus tertiary hospitals and community health service centers.We，also put forward personal constructive suggestions. that medical treatment partnership and alliance based on the Internet are feasible referral model of cardiac rehabilitation.The aim was to promote the development of cardiac rehabilitation referral model between third-level hospitals and community health centers based on the Internet.


Effect of 5-ALA Mediated Photodynamic Therapy Combined with Lapatinib on Breast Cancer Cell：a Potential Strategy to Improve HER2-positive Breast Cancer Therapeutic Efficacy　

SUN Bei，ZHANG Li，LIU Xiaodong，TONG Zhongsheng

2019, 22(21):  2551-2556.  DOI: 10.12114/j.issn.1007-9572.2019.00.165

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Background　Photodynamic therapy（PDT）has a good therapeutic effect on proliferative diseases，and it shows high efficiency and small toxic and side effects in anti-tumor treatment.Lapatinib（LAP）is an oral tablet，which mainly acts on human epidermal growth factor receptor 1 and 2（HER1 and HER2），and belongs to double-targeted receptor tyrosine kinase inhibitors.However，the synergistic effect of PDT and LAP is still not clear.Objective　To investigate the inhibitory effect and mechanism of PDT with a novel photosensitizer，5-aminolaevulinic acid（5-ALA）on HER2 positive breast cancer cells SKBR3，and to discuss the therapeutic effect of PDT with LAP on HER2-positive breast cancer，providing evidence for the treatment and research of HER2 positive breast cancer.Methods　This study was conducted from May 2016 to December 2017.SKBR3 cells were randomly divided into blank control group（without intervention），LAP group〔intervened with LAP of different concentration gradients（0.50，1.00，2.00，5.00，10.00 μmol/L）〕and PDT group〔first intervened with 5-ALA of different concentration gradients（0.25，0.50，1.00，2.00，4.00 mmol/L），then were exposed to laser〕，LAP+PDT group〔first intervened with different concentration gradients of LAP（0.50，1.00，2.00，5.00，10.00 μmol/L），then with different concentration gradients of 5-ALA（0.25，0.50，1.00，2.00，4.00 mmol/L），and later were exposed to laser〕，respectively.Half maximal inhibitory concentration（IC50）of LAP and 5-ALA was calculated，respectively，and their optimal concentrations for LAP，PDT and LAP+PDT subgroups were determined.Cell growth inhibition rates in each group at 24，48 hours after intervention with the optimal concentration were estimated and compared.SKBR3 cells in the log-phase of growth were randomly divided into blank control group（without intervention），LAP group（intervened with 1.00 μmol/L LAP），PDT group（intervened with 1.00 mmol/L 5-ALA，followed by laser irradiation），LAP+PDT group（intervened with 1.00 μmol/L LAP，then 1.00 mmol/L 5-ALA，followed by laser irradiation）．Flow cytometry was used to detect the apoptotic status of each group.In addition，fluorescence intensity of green fluorescent protein and mitochondrial membrane potential were detected by Rhodamine 123，and the expression of HER2 was detected by Western blotting.Results　The IC50 of LAP was 1.65 μmol/L，and 1.00 μmol/L（the growth inhibition rate of LAP group was 40.12%）was chosen as the administration concentration of LAP and LAP+PDT groups.The IC50 of 5-ALA was 1.57 mmol/L.The administration concentration of 5-ALA in PDT and LAP+PDT groups was determined as 1.00 mmol/L（the growth inhibition rate of PDT group was 41.23%）．When LAP was 1.00 mmol/L and 5-ALA was 1.00 μmol/L，the growth inhibition rate of LAP+PDT group was 79.71%.Combined treatment Q≈1.23.The growth inhibition rates of LAP，PDT and LAP+PDT groups at 24 and 48 hours were higher than those of blank control group（P<0.05）；the growth inhibition rates of PDT group at 48 hours were higher than those of LAP group（P<0.05）；the growth inhibition rates of LAP+PDT group at 24 and 48 hours were higher than those of LAP group and PDT group（P<0.05）．Compared with the blank control group，the cells in LAP and PDT groups mainly manifested as apoptosis，while those in LAP + PDT group showed obvious apoptosis and necrosis，and the proportion of early apoptosis was very low.The fluorescence intensity of green fluorescent protein in LAP and PDT groups decreased，and that of LAP + PDT group decreased most obviously.Mitochondrial membrane potential in LAP，PDT and LAP + PDT groups was lower than that in blank control group（P<0.05）；mitochondrial membrane potential in PDT group and LAP + PDT group was lower than that in LAP group（P<0.05）；mitochondrial membrane potential in LAP + PDT group was lower than that in PDT group（P<0.05）．The expression of HER2 in blank control group was higher than that of other groups（P<0.05），and it in LAP group was higher than that of PDT and LAP + PDT groups，too（P<0.05），and similar status was found when compared HER2 in PDT group with that of LAP + PDT group（P<0.05）．Conclusion　5-ALA had obvious inhibitory effect on SKBR3 cells，and the inhibitory effect became stronger when PDT was used in combination with LAP.The mechanism is related to the reduction of mitochondrial membrane potential and the expression of HER2 in cancer cells.Therefore，PDT combined with LAP is expected to improve the quality of life and survival rate of HER2-positive breast cancer patients，and has a good application prospect.


Prevalence of Depression and Influencing Factors in Patients with Type 2 Diabetes：a Multi-center Study in Beijing，China　

WU Yuxiang，CHENG Yuxia，LI Lijun，JIA Junhong，WANG Wenbo，GUO Xiaohui，WU Yanqiao，LI Yufeng，LIU Yanjun，WANG Aihong

2019, 22(21):  2557-2563.  DOI: 10.12114/j.issn.1007-9572.2019.00.070

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Background　The prevalence of depression is increasing in the growing diabetic patients.Depression is a mental disorder that not only affects the quality of life，but also is not conducive to the control of diabetes mellitus.Objective　To investigate the prevalence and influencing factors of depression in type 2 diabetes mellitus （T2DM） patients in Beijing.Methods　From the year 2016 to 2017，we conducted surveys among T2DM outpatients and inpatients in 6 hospitals in Beijing （306th Hospital of PLA，Fourth Medical Center of PLA General Hospital，Peking University Shougang Hospital，Peking University First Hospital，Research Institute of Petroleum Exploration & Development and Beijing Pinggu Hospital）．We used questionnaires in the surveys，which include a general personal information form 〔sociodemographic characteristics，visiting method，number of annual visits，number of hospitalizations in the past 3 years，satisfaction with life quality，duration of T2DM，body mass index （BMI），blood pressure，fasting blood glucose（FBG），glycosylated hemoglobin （HbA1c），hypoglycemic treatment，comorbidities，diabetic complications〕 and two depression scales〔Patient Health Questionnaire Depression Scale （PHQ-9） combined with Hamilton Depression Rating Scale （HAMD-17）〕.The prevalence of depression was evaluated，and the influencing factors were analyzed by univariate and multivariate Logistic regression analysis.Results　A total of 635 patients participated in the survey，and 615 of them responded effectively，achieving a response rate of 96.85%.Among the respondents，151（24.55%） were found with depression，and other 464 without（75.45%）．There were significant differences between the depressed and non-depressed respondents in gender ratio，education level，occupation，average monthly household income per person，visiting method，number of hospitalizations in the past 3 years，satisfaction with life quality，systolic blood pressure，hypoglycemic treatment，prevalence of coexistence of cardiovascular disease history，and cerebrovascular disease history，prevalence of diabetic retinopathy，diabetic peripheral neuropathy（DPN），diabetic nephropathy，diabetic angiopathy of lower extremities，and diabetic foot（P<0.05）.Multivariate Logistic regression analysis showed that gender 〔female：OR=2.072，95%CI （1.316，3.262），P<0.05〕，average monthly household income per person 〔>1 500-3 000 yuan：OR=0.201，95%CI （0.077，0.522），P<0.05；>3 000-5 000 yuan：OR=0.172，95%CI （0.072，0.413），P<0.05；>5 000-10 000 yuan：OR=0.365，95%CI（0.160，0.835），P<0.05；>10 000 yuan：OR=0.154，95%CI （0.055，0.429），P<0.05〕，visiting method 〔hospitalization：OR=2.592，95%CI （1.613，4.166），P<0.05 〕，satisfaction with life quality〔OR=0.980，95%CI （0.968，0.993），P<0.05〕，FBG〔OR=1.084，95%CI （1.018，1.154），P<0.05〕，history of cardiovascular disease 〔OR=1.642，95%CI （1.006，2.682），P<0.05〕，DPN 〔OR=3.758，95%CI （2.246，6.287），P<0.05〕，were independent influencing factors of depression in T2DM.Conclusion　The prevalence of depression in T2DM patients was 24.55% in Beijing.So psychological screening should be actively conducted in this population，especially those who are women，have low income，a hospitalization，poor level of satisfaction with life quality，poor glycemic control，a history of cardiovascular disease or DPN.


Effect of Non-pulmonary Vein Triggers Ablation on Paroxysmal Atrial Fibrillation in Prognosis of Patients with Low Left Ventricular Ejection Fraction　

CAO Zhongnan，DU Xinping，ZHANG Minghui，ZHANG Xiangcan，WU Qinqin

2019, 22(21):  2564-2570.  DOI: 10.12114/j.issn.1007-9572.2018.00.435

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Background　Non-pulmonary vein triggers ablation combined with pulmonary vein isolation can effectively reduce postoperative complications，but its efficacy and long-term outcome on atrial fibrillation in patients with low left ventricular ejection fraction（LVEF） were still unclear.Objective　To investigate the effects of non-pulmonary vein triggers ablation on prognosis in patients with atrial fibrillation and low LVEF and its influencing factors.Methods　A total of 307 patients with paroxysmal atrial fibrillation who underwent primary catheter ablation admitted to Tianjin Fifth Central Hospital from December 2015 to January 2016 were enrolled and divided according to their LVEF：LVEF≤40 % were in groupⅠ（83 cases），LVEF >40.00% in groupⅡ（224 cases）；the patients in groupⅠwere further divided intoⅠA subgroup（41 cases，non-pulmonary vein triggers ablation combined with pulmonary vein isolation） andⅠB subgroup（42 cases，pulmonary vein isolation）．Pulmonary vein isolation was applied in groupⅡ.The patient's clinical data〔age，gender，duration of disease and treatment history，underlying disease，left atrial diameter（LAD），LVEF，medication history，New York Heart Association （NYHA） cardiac function classification〕were recorded at admission.Surgical parameters（total operating time，fluoroscopy time，ablation time，and proportion of non-pulmonary vein triggers） in each group were recorded during operation.During the follow-up period，the success rate，complications，recurrence of atrial fibrillation after operation of each group were recorded.At the end of follow-up，the LVEF of two subgroups were analyzed and compared with preoperative data.The Kaplan-Meier method was used to draw survival curves of postoperative recurrence of atrial fibrillation and then was compared by Log-rank test.Factors influencing postoperative recurrence of atrial fibrillation in patients with low LVEF were analyzed by multivariate Cox regression analysis.Results　The utilization rate of pacemaker/implantable cardioverter defibrill（ICD），left atrial diameter（LAD），angiotensin converting enzyme（ACE） inhibitor/angiotensin receptor blockers（ARBs），and roportion of patients with non-pulmonary vein triggers in groupⅠwas higher than those in groupⅡ（P<0.05）．The total operation time，fluoroscopy time and ablation time of patients in subgroupⅠA were significantly longer than those in subgroupⅠB（P<0.05）．The success rate of operation in groupⅡwas higher than that in groupⅠ，and success rate of subgroupⅠA was higher than that of subgroupⅠB（P<0.05）．There were significant difference in survival curves of recurrence of atrial fibrillation between groupⅠand groupⅡ（P<0.001）；there were significant difference in survival curves of recurrence of atrial fibrillation between subgroup ⅠA and Ⅱ subgroup（P=0.029）；and there was no significant difference in the incidence of complications between groupⅠand groupⅡ（P=0.875）．The LVEF〔（36.54±4.17）%〕at the end of follow-up in subgroupⅠA was higher than that before operation〔（32.17±2.48）%〕（P<0.001）;There was no significant difference in LVEF in subgroupⅠB before〔（31.94±3.15）%〕and after operation〔（31.86±2.21）%〕（P>0.05）．The results of multivariate Cox regression analysis showed that coronary artery disease，LVEF≤40.00%  and non-pulmonary vein triggers were influencing factors of recurrence of atrial fibrillation（P<0.05）．Conclusion　There are more non-pulmonary vein triggers in patients with atrial fibrillation and low LVEF and pulmonary vein isolation combined with non-pulmonary vein triggers ablation can improve the success rate of patients with low-paroxysmal atrial fibrillation.The coronary artery disease，LVEF≤40.00%  and non-pulmonary vein triggers were the influencing factors of recurrence of atrial fibrillation.


Bayes Discriminant Analysis for In-hospital Death of Aortic Dissection　

ZHANG Weizong，MA Xiang，YUAN Hong，SUN Jindong，HU Haiqiang，SHI Mingjuan，YU Huamin，HE Haiying，YE Li

2019, 22(21):  2571-2576.  DOI: 10.12114/j.issn.1007-9572.2019.00.106

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Background　Aortic dissection（AD） is an acute critical disease of the cardiovascular system characterized by acute onset and high mortality.There is lack of studies in which effective models for predicting the in-hospital outcome in patients with AD are reported.However，there is an urgent clinical need for an effective and reliable model for predicting in-hospital outcomes of AD as AD incidence has recent increases.Objective　To develop Bayes formulas to predict in-hospital death of AD patients，providing a reference for the formulation of effective treatments of this disease.Methods　According to the unified inclusion and exclusion criteria of this study，553 cases of AD were enrolled during January 2010 to December 2015，including 228 from First People's Hospital of Yuhang District，and 325 from the First Teaching Hospital of Xinjiang Medical University.Clinical data such as general personal characteristics，basic signs，and laboratory indices were collected.By the in-hospital outcome，participants were divided into the survival group （n=470） and death group（n=83）．Differential variables were identified based on the results of univariate analysis.A sample set was selected using a computer-based random number generator，and their data were included in the Bayes formulas derived from Bayes discriminant analysis.The remaining participants were defined as a test set，and their data were included in the Bayes formulas to verify the accuracy of the formulas.Results　The participants had a mean age of （51.5±12.3） years，a ratio of male to female of 3.89∶1 and an in-hospital mortality rate of 15.0%（83/553）．The variables finally substituted in the Bayes formulas were onset time（a1），DeBakey types （a2），urea nitrogen （a3），random plasma glucose （a4），glycated serum protein（a5），indirect bilirubin （a6），international normalized ratio （a7），and fibrinogen （a8），and the derived formulas were Q1=-1.174×a1+6.813×a2+0.323×a3+0.213×a4+10.522×a5+0.171×a6+25.656×a7+1.014×a8-39.843 and Q2=-13.336×a1+27.131×a2
-1.928×a3-5.030×a4+35.574×a5-0.658×a6+287.333×a7 -3.509×a8-1 707.601.And the significance of the formulas could be explained as：after putting the aforementioned variables（a1-a8） of an AD patient into the formulas，if the value of Q1 is greater than that of Q2，then the patient is determined as a survivor，otherwise he is a deceased.The formulas were found with an accuracy rate of 98.85% and an error rate of 1.15%（P=0.003）after being tested with the data of the participants in the test set，and were identified with an accuracy rate of 98.73%，and an error rate of 1.27%（P<0.001）after being tested with the data of all the participants.Conclusion　Our Bayes formulas can be used to predict the in-hospital outcome of AD patients from a statistical perspective.


Factors Associated with Elevated Serum CA125 Level in Patients with Cirrhosis　

ZHU Yipeng，LU Gaofeng，SUN Chenyi,LIU Xia，HUANG Lina，WU Jiaxun，LI Min，YANG Jiaojiao，ZHAO Yipin

2019, 22(21):  2577-2581.  DOI: 10.12114/j.issn.1007-9572.2018.00.418

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Background　Serum CA125 in patients with cirrhosis shows different degrees of elevation.But the factors associated with it are not complete clear.It is necessary to determine these factors from multiple angles.Objective　To explore the factors associated with the increase of serum CA125 level in patients with cirrhosis.Methods　A total of 205 inpatients with cirrhosis were recruited from the Second Affiliated Hospital of Zhengzhou University from January 2012 to February 2018.According to serum CA125 level，we divided them into normal CA125 group（n=39） and abnormal CA125 group（n=166），and compared total bilirubin，total bile acid，ALT，AST，prothrombin time（PT），albumin，total protein，prothrombin activity，age and sex between the groups.According to the volume of ascites，we divided them into no-ascites group（n=52），mild ascites group（n=40），moderate ascites group （n=51），and severe ascites group（n=62）．In accordance with the Child-Pugh score，we divided them into Child-Pugh grade A group（5-6，n=46），Child-Pugh grade B group（7-9，n=87），and Child-Pugh grade C group（≥10，n=72）．Abdominocentesis was carried out in 113 cases，and by the level of ascitic nucleated cell count，we divided them into normal nucleated cell count group（n=65） and elevated nucleated cell count group（n=48）．Correlations of serum CA125 with the volume of ascites，Child-Pugh grade，and nucleated cell count level were analyzed.Results　Compare with the normal CA125 group，abnormal CA125 group showed higher total bilirubin，total bile acid and AST and longer PT，but lower albumin，total protein，and prothrombin activity（P<0.05）．No-ascites group showed lower serum CA125 level than other 3 ascites groups（P<0.05），so did the mild ascites group when compared with moderate and severe ascites groups（P<0.05）．The serum CA125 level in the elevated nucleated cell count group was higher than that of the normal nucleated cell count group（P=0.023）．Serum CA125 level was lower in Child-Pugh grade A group compared with that of Child-Pugh grade B and C groups（P<0.05）．And it was lower in Child-Pugh grade B group than that of Child-Pugh grade C group（P<0.05）．The volume of ascites，Child-Pugh grade，and ascitic nucleated cell count level were all correlated with serum CA125 level（P<0.05）．Conclusion　Elevated serum CA125 level is associated with the volume of ascites，Child-Pugh grade and ascitic nucleated cell count.So it can be used to assess the volume of ascites，the degree of liver damage and the possibility of peritonitis complications in cirrhosis.


Comfort Level for In-patients Inhaling Oxygen via Nasal Cannula and Its Influential Factors　

ZHU Yijun，LI Ping，HAN Yinping

2019, 22(21):  2582-2587.  DOI: 10.12114/j.issn.1007-9572.2019.00.054

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Background　A lot of literatures have reported the refusal or the reduction of oxygen use by patients inhaling via nasal cannula which is more often caused by discomfort they have in such process.Some scholars believed that the occurrence of this discomfort was related to the physicochemical properties of oxygen supply apparatus and thus suggested many ways to improve it.However，none of them is simple and with good clinical popularity.A foreign study has suggested that some treatment related factors and individual factors of a specific patient may have impact on the comfort level of oxygen inhaling.China so far does not have any study in this field.Objective　To understand the comfort level for in-patients inhaling of oxygen via nasal cannula，and to further explore and analyze its possible influential factors.Methods　Cluster sampling method was adopted in selecting in-patients from various departments of Changhai Hospital on June 5th，2018.A self-designed questionnaire Survey on In-patients Inhaling of Oxygen via Nasal Cannula was used to conduct a one by one and face to face questionnaire survey on each of those in-patients.The questionnaire included 11 close-ended questions and 1 semi-closed question in total，which mainly covered general information （sex，age，expense categories，level of education，history of chronic rhinitis and times of hospitalization），treatment related factors （position being maintained while receiving oxygen therapy，flow rate of oxygen being inhaled，time for oxygen therapy，frequency of oxygen inhaling and days of oxygen inhaling） and main complaints of discomfort while inhaling oxygen.The evaluation of the comfort level in the case of inhaling oxygen via nasal cannula was conducted by whether or not there was any discomfort reported as a main complaint from the patients inhaling oxygen.Multivariate Logistic regression analysis was adopted to analyze the factors influencing the comfort level for patients inhaling oxygen via nasal cannula.Results　A total of 329 copies of questionnaires were sent and we received 324 copies of effective ones，with an effective response rate of 98.5%.Among 324 patients，187 were male （57.7%），and 137 were female （42.3%）；their age ranged from 23 to 96 years，with average age of （59.1±14.9） years.One hundred and seventy-eight patients were older than 65 years （54.9%）；304 cases （93.8%） had medical insurance；180 patients （55.5%） had the level of education which equals to primary school or below，100 had the level of education of junior or senior middle school（30.9%），and 44 had the level of education of undergraduate or above（13.6%）；22 patients （6.8%） had the medical history of chronic rhinitis；58 patients （17.9%） had a record of multiple hospitalization.Of the 324 patients，275 patients （84.9%） believed that the oxygen therapy was comfortable while 49 patients （15.1%） felt that it was discomfort.The results of multivariate Logistic regression analysis showed that the medical history of chronic rhinitis 〔OR=9.764，95%CI（1.427，66.824），P<0.05〕，flow rate of the oxygen being inhaled 〔OR=3.528，95%CI（2.134，5.830），P<0.05〕，time for oxygen therapy 〔0.5~15.0 h：OR=13.751，95%CI（3.114，60.729），P<0.05；>15.0 h：OR=29.902，95%CI（6.857，130.408），P<0.05〕 and frequency of oxygen inhaling 〔2 times/day：OR=9.252，95%CI（1.383，61.896），P<0.05；≥3 times/day：OR=11.120，95%CI（2.320，53.297），P<0.05〕 were the factors influencing the comfort level for in-patients inhaling oxygen via nasal cannula．Conclusion　The comfort level for in-patients inhaling oxygen via nasal cannula，in general，is acceptable but still there is room for further improvement.Influential factors of oxygen inhalation through nasal cannula include history of chronic rhinitis，oxygen flow rate，time and frequency of oxygen inhalation.Clinical medical care personnel should follow the Guidelines for Emergency Oxygen Therapy for Adults.On the premise that the purpose of oxygen therapy is achieved，they should try to control the flow rate of the oxygen being inhaled，and time and frequency of oxygen inhaling so as to avoid the excessive use of oxygen and reduce the occurrence of discomfort in the process of oxygen therapy，thus increasing the comfort level for inhaling of oxygen via nasal cannula.


Efficacy of Eltrombopag Combined with Azathioprine in the Treatment of Refractory Immune Thrombocytopenic Purpura and Its Effect on Cellular Immune Function　

LUO Hongqiang，ZHONG Yonggen，FENG Weiying

2019, 22(21):  2588-2592.  DOI: 10.12114/j.issn.1007-9572.2018.00.450

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Background　The treatment of refractory immune thrombocytopenic purpura（RITP） has always been a major clinical problem.At present，there is no unified safe and effective treatment，and there is a risk of death for some patients with extremely low platelet count.Eltrombopag，as a new drug for increased platelet counts，provides a safe and effective treatment for RITP.Objective　To study the efficacy of Eltrombopag combined with Azathioprine in the treatment of RITP and its effect on cellular immune function.Methods　A total of 46 patients with RITP who were hospitalized in Hematology Department of Shaoxing People's Hospital from January 2013 to January 2018 were selected.They were randomly divided into treatment group and cyclosporine（CSA） group，each with 23 cases.Another 25 healthy persons who had physical examination in our hospital during the same period were selected as the control group.Patients in the treatment group were treated with Eltrombopag combined with Azathioprine.The CSA group was treated with Cyclosporine combined with Danazol.Therapeutic effect was evaluated after 3 months of treatment.The clinical effects of treatment group and CSA group were compared.Th1 cytokines（IL-2，IFN-γ） and Th2 cytokines（IL-4，IL-5），B1 lymphocyte（percentage of CD+19 lymphocyte and CD5+CD+19 lymphocyte），PLT in peripheral blood of treatment group and CSA group were collected before treatment and 3 months after treatment，and compared with the control group.The adverse reactions in the treatment group and CSA group were recorded.Results　The total effective rate was 69.9%（16/23） in the treatment group and 73.9%（17/23） in the CSA group.There was no significant difference in the total effective rate between the two groups（χ2=0.107，P=0.743）．Before treatment，the percentage of IL-2，IFN-γ，CD+19 lymphocyte and CD5+CD+19 lymphocyte in the treatment group and CSA group was higher than that in the control group，while the number of IL-4 and IL-5 and platelet count in the treatment group and CSA group was lower than that in the control group（P<0.05）．After 3 months of treatment，the percentage of IL-2，IFN-γ，CD+19 lymphocyte and CD5+CD+19 lymphocyte in the treatment group and CSA group was lower than that before treatment，while the number of IL-4 and IL-5 and platelet count was higher than that before treatment（P<0.05）．Eight patients in the treatment group and 16 patients in the CSA group suffered from liver function injury.The incidence of liver function injury in the treatment group（34.8%） was lower than that in the CSA group（69.6%），and the difference was statistically significant（χ2=6.527，P=0.013）．Conclusion　Eltrombopag combined with Azathioprine in the treatment of RITP is safe，effective and well tolerated.Eltrombopag combined with Azathioprine may play a therapeutic role by regulating Th lymphocyte and B1 lymphocyte in peripheral blood of patients with RITP，thereby promoting platelet formation.


Epidemiology of Allergic Rhinitis in Tongliao Grassland of Inner Mongolian　

MA Tingting，ZHUANG Yan，LEI Tong，ZHANG Tiejun，BAO Xiuzhi，ZHANG Fangfang，HAI Changjiang，ZHANG Biao，WANG Xueyan

2019, 22(21):  2593-2597.  DOI: 10.12114/j.issn.1007-9572.2019.00.073

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Background　In recent years，the prevalence of allergic rhinitis（AR） is increasing all over the world，but little research has been done on grassland areas in eastern Inner Mongolia，China．Objective　To investigate the prevalence of AR and to analyze the clinical symptoms and allergic causes in Tongliao，Inner Mongolia，so as to provide the basis for the prevention，diagnosis and health management departments to formulate relevant policies．Methods　A total of
2 013 permanent residents in Tongliao City，Jarud Banner and Kailu County were selected by stratified random sampling method from May to August 2015．Questionnaire survey and skin prick test of allergens were conducted by specialists （10 common inhalation allergens were detected in grassland areas）．The diagnosis of AR was mainly based on the related guideline．The questionnaire mainly included basic sociological data （age，sex，nationality，place of residence，region），clinical symptoms （nasal symptoms，eye symptoms，other symptoms），combined diseases，food and drug allergies，and seasonal changes of clinical symptoms．The skin prick test results of allergens in patients with confirmed AR were analyzed.Results　A total of
2 013 questionnaires were sent out，and 1 954 valid questionnaires were recovered，with a recovery rate of 97.1%．Among 1 954 residents，the self-reported AR prevalence rate was 30.8% （601 cases） and the confirmed AR prevalence rate was 18.1%（353 cases）．The average age of 353 AR patients was （45.3±15.0） years；161 were male，192 were female，and the ratio of male to female was 1∶1.2；193 were Han，143 Mongolian，and Han and Mongolian ratio was 1.3∶1．There were significant differences in AR prevalence among residents of different ages，places of residence，and regions （P<0.05）．There were no significant differences in gender and ethnic group in terms of AR prevalence （P> 0.05）．The main nasal symptoms of AR patients were sneezing （95.8%），itching （92.4%） and running nose（85.3%）．Eye itching was the main symptom （61.8%）of eye symptoms．Other symptoms were fatigue （42.5%） and drowsiness （40.5%）．In AR patients，conjunctivitis （64.0%），urticaria （29.5%） and hypertension（17.8%） were main complications．Patients with AR complicated with food allergy accounted for 17.3% （61/353），and those complicated with drug allergy accounted for 24.9% （88/353）．The peak period of clinical symptoms of AR patients in this area in 2015 was April and July，and the peak period of pollen appeared was April and August．The peak period of AR clinical symptoms in April in this area coincided with the peak period of pollen in Spring，but the peak period of AR clinical symptoms in summer was July，which was one month ahead of the peak period of pollen．The first three allergens with positive rate of allergen skin prick test was Artemisia pollen （21.96%），Chenopodiaceae pollen （21.49%） and Humulus pollen （20.06%）．Most patients were allergic to three or more pollens〔71.10%（251/353）〕.Conclusion　The prevalence of AR in Tongliao，Inner Mongolia stays at a high level．Sneezing and itching are the main symptoms of nasal symptoms，itching is the main symptom of eye symptoms，and fatigue and sleepiness are the main symptoms of other symptoms．Conjunctivitis and urticaria are the main complications associated with AR．Pollen exposure is one of the most important factors causing AR，and the influence of Artemisia pollen in spring and summer  can not be ignored.


Clinical Effect of Intrauterine COOK Balloon Tamponade on Hemorrhage from the Lower Uterine Segment Secondary to Placenta Previa during the Cesarean Section　

DUAN Ya，ZHAO Shan，LI Min，JIN Ying，LI Jibin，WANG Li，TANG Zengjun

2019, 22(21):  2598-2601.  DOI: 10.12114/j.issn.1007-9572.2018.00.359

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Background   At present， there are many hemostasis methods for placenta previa complicated with postpartum hemorrhage. Compared with other methods， Balloon packing compression hemostasis is simple， non-traumatic and has obvious hemostasis effect.Objective　To explore the efficacy of intrauterine tamponade with Cook balloon（a double balloon device） versus Bakri balloon on hemorrhage from the lower uterine segment due to placenta previa during the cesarean section.Methods　From Hebei General Hospital，we recruited 78 cases who had hemorrhage from the lower uterine segment due to placenta previa in the cesarean section during January 2012 to January 2018，42 of whom were treated with intrauterine tamponade with Cook balloon（Cook balloon tamponade group），and other 36 were treated with intrauterine tamponade with Bakri balloon（Bakri balloon tamponade group）．The intraoperative indicators（duration of operation，time-to-hemostasis，blood loss during operation，rate of achieving effective hemostasis，blood transfusion rate），and postoperative indicators （total amount of bleeding within 24 hours after operation，duration of antibiotic therapy，rate of postoperative infections，and length of hospital stay） in the two groups were compared.Results　There were no significant differences between the two groups in the average duration of operation，rate of achieving effective hemostasis，and blood transfusion rate（P>0.05）．The average time-to-hemostasis，and average blood loss during operation in Cook balloon tamponade group were significantly less compared with those of Bakri balloon tamponade group（P<0.05）．Furthermore，the average total amount of bleeding within 24 hours after operation was also obviously less in Cook balloon tamponade group compared with that of Bakri group（P<0.05）．However，the average duration of antibiotic therapy，rate of postoperative infections，and average length of hospital stay showed no significant differences between the two groups（P>0.05）.Conclusion　Compared with those using Bakri balloon tamponade，patients used Cook balloon tamponade had less average amount of bleeding within 24 hours after operation，although both groups had similar average duration of operation，duration of antibiotic therapy，rate of postoperative infections and length of hospital stay，indicating that Cook balloon tamponade has better hemostatic effect.


Healthcare Providers' Perspectives on the Admission Criteria for Hospice Care：a Qualitative Study　

ZENG Jie，JIN Lei，SUN Yao，PAN Li，LI Yafang，SHI Baoxin

2019, 22(21):  2602-2605.  DOI: 10.12114/j.issn.1007-9572.2018.00.412

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Background　The number of deaths in China is about 960-990 million a year，of which only a small number receive hospice care services.The referral criteria of hospice care can help healthcare providers identify patients who should be transferred to hospice care，so that end-stage patients can receive hospice care in time.However，up to now，the criteria and methods have not been established to determine patients' entry into hospice care.Objective　To investigate hospice care providers' perspectives on the admission criteria for hospice care，providing a reference for the development of admission criteria for hospice care in China.Methods　In-depth face-to-face interviews were conducted with a purposive sample of 21 hospice care providers from 3 tertiary grade A hospitals during the period between April and May 2018.Discussions were audiotaped and transcribed into a text within 24 hours after the interviews.And Colaizzi method was used to analyze the data.Results　Following the analysis of the interview data，three themes were extracted，including（1） The eligibility for hospice care admission was different among the providers.（2） Condition，psychoemotional status，and informed consent of patients and their families were considered generally as the essential dimensions of the hospice care admission criteria.（3） As no unified admission criteria and ways for hospice care have been developed in China，such admission is usually determined based on patients' disease progression，subjective feelings，and basic conditions，and clinicians' experience.The rationality and scientificalness of this practice，as well as its needs of further improvement，were approved by most of the hospice care providers.Conclusion　The routine admission criteria for hospice care used clinically should be improved further on the basis of retaining the original scientific and reasonable content.For improvement，further studies can use Delphi method.Moreover，mature admission criteria in foreign countries can be referred to develop the domestic admission criteria after being screened and culturally adapted.


Reliability and Validity of the Chinese Version of the Short Abridged Autism Spectrum Quotient-Children's Version　

LI Hongcheng，LI Xue，LIU Jing，JIA Meixiang，YANG Liu，ZHANG Aiwu，PANG Jin

2019, 22(21):  2606-2610.  DOI: 10.12114/j.issn.1007-9572.2019.00.085

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Background　There are few scales for the screening of autism in children in primary care in China.Studies show that the Short Abridged Autism Spectrum Quotient-Children's Version（AQ-Child-Short）is suitable for screening autism in children in primary care.Objective　To test the validity and reliability of the Chinese version of AQ-Child-Short，so as to provide a new effective tool for screening autism in children in primary care in China.Methods　101 children with autism（58 of high-functioning，and other 43 of low-functioning）were enrolled during June to September，2015 and September to December，2017 from those consecutive outpatients of Peking University Institute of Mental Health.They were compared to age-matched 124 normal children selected from an ordinary kindergarten and an ordinary primary school in Tianjin.The Chinese version of AQ-Child-Short was used to screen autism symptoms in all the children，which was administered by a parent who knows the child best（the child's mother in general）．At the same time，10 children were selected from each group，and their another caregiver who knows the child well also filled out the Chinese version of AQ-Child-Short.Two weeks later，10 children were chosen from each group，and received the survey again，the scale was administered by the same caregiver participating in the first round of survey.Discriminant validity and criterion-related validity were used for validity analysis.Inter-rater reliability，retest reliability and internal consistency reliability were used for reliability analysis.Results　There was no significant difference in the mean total score of Chinese version of AQ-Child-Short between high and low functioning autism children（P>0.05）．But the mean total score of Chinese version of AQ-Child-Short of the autism children was higher than that of the normal controls（P<0.05）．The diagnostic accuracy of this scale was compared with the gold standard，namely，the diagnosis made by the chief physician of Pediatric Psychiatry Department，Peking University Institute of Mental Health following the DSM-Ⅳ.ROC analysis of the scale showed that，in diagnosing autism，the AUC of the scale was 0.97（P<0.01），with corresponding sensitivity of 0.94，and specificity of 0.89，when the critical value of the scale's total score was determined as 15.The inter-rater reliability test results show that the intraclass correlation coefficient（ICC）of the total scale score was 0.90（P<0.05）and of the item scores was 0.60-0.86（P<0.05）．The test-retest reliability results show that the ICC of the total scale score was 0.97（P<0.05）and of the item scores was 0.82-0.92（P<0.05）．The Cronbach's α of the scale was 0.85（P<0.01）．Conclusion　The Chinese version of the AQ-Child-Short has good validity and reliability，and high sensitivity and specificity.It could be used as an instrument for screening autism in children.


Removing the Pathogenic Factor from Urine on RASS System and Cytokines in a Rat Model of Acrolein-induced Airway Mucus Hypersecretion　

XU Zongying，SHI Shaohua，YU Han，ZHONG Xianggen

2019, 22(21):  2610-2615.  DOI: 10.12114/j.issn.1007-9572.2019.00.164

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Background　In Synopsis of Prescriptions of the Golden Chamber，Shenqi pills are used in a total of 5 prescriptions，mainly for the treatment of urination problems via warming and nourishing the kidney qi，circulating qi and promoting urination.Objective　To observe the effect of Shenqi pills on renin-angiotensin-aldosterone（RASS）system and cytokines in a rat model of acrolein-induced airway mucus hypersecretion based on the theory of “Treatment of shortness of breath caused by minor case of Fluid-retention syndrome should following the principle of removing pathogenic factors from urine.Linggui Zhugan Decoction and Shenqi pills can be adopted” proposed in Synopsis of Prescriptions of the Golden Chamber.Methods　This study was carried out between April and August 2017.A total of 60 SPF male Sprague-Dawley rats were randomly selected and equally divided into control group，model group，Shenqi pills group，Linggui（poria cocos and cassia twig）group and Shenqi pills without Linggui group.The latter 4 groups were given atomization inhalation of 3 mg/L acrolein，twice daily at an interval of 3 hours for 4 consecutive weeks for establishing the models of acrolein-induced airway mucus hypersecretion，while the control group received atomization inhalation of the same dose of 0.9% sodium chloride solution.From the 5th week of the intervention，Shenqi pills group，Linggui group，and Shenqi pills without Linggui group received 1 ml/100 g Shenqi pills solution for warming the kidney qi and promoting urination，1 ml/100 g Linggui decoction for circulating qi and promoting urination，1 ml/100 g Shenqi pills without Linggui decoction for warming and nourishing the kidney qi，respectively，twice daily for another 4 consecutive weeks，while control and model groups received intragastric administration of the same volume of distilled water.24-hour urine volume，pulmonary function parameters（FEV0.3，FVC，FEV0.3/FVC，PEF），levels of IL-1β，IL-13，TGF-αand TNF-αin bronchoalveolar lavage fluid（BALF），and levels of PRA，plasma angiotensinⅡ and aldosterone（ALD）were collected.Results　24-hour urine volume in the control group was less than that of other groups（P<0.05）．Model group showed less 24-hour urine volume than 3 medicine intervened model groups（P<0.05）．Shenqi pills group had less 24-hour urine volume than Linggui group（P<0.05）．Compared with the control group，model group demonstrated lower average FEV0.3，FVC，FEV0.3/FVC and PEF，and Linggui group showed less average FEV0.3/FVC（P<0.05）．Model group demonstrated lower FEV0.3，FVC，and PEF than Linggui group，and showed lower FEV0.3，FVC，PEF and FEV0.3/FVC ratio than both Shenqi pills and Shenqi pills without Linggui group（P<0.05）．The control group showed lower IL-1β，IL-13，TGF-α and TNF-α in BALF compared with other groups（P<0.05）．The Shenqi pills group showed higher levels of TNF-α in BALF than control group（P<0.05）．And the levels of these 4 parameters were lower in 3 medicine-intervened model groups than those of the model group（P<0.05）．Moreover，Shenqi pills group showed lower levels of IL-1β and TNF-α in BALF than both Linggui and Shenqi pills without Linggui groups（P<0.05）．PRA levels in all groups were similar（P>0.05）．Compared with the control group，model group showed higher plasma angiotensinⅡ and ALD levels（P<0.05），and Linggui and Shenqi pills without Linggui groups showed higher plasma ALD levels（P<0.05）．Model group demonstrated higher plasma angiotensinⅡ and ALD levels than 3 medicine intervened model groups（P<0.05）．Shenqi pills without Linggui group had higher plasma ALD compared with Shenqi pills group（P<0.05）.Conclusion　Shenqi pills showed better effect than Linggui and Shenqi pills without Linggui in regulating IL-1β and TGF-α in BALF.Fluid-retention syndrome can be alleviated by warming and nourishing kidney qi or circulating qi and promoting urination，but the combination of the two can yield better efficacy，namely，the retained excessive old fluid and the new-produced excessive fluid can be removed.The mechanism of removing the pathogenic factor from urine might be related to improve pulmonary functions，inhibit RASS system activation and regulate cytokines associated with mucus hypersecretion.


TCM Syndrome-based Analysis of Musculoskeletal Ultrasound Findings of 28 Joints in Rheumatoid Arthritis Patients　

CHEN Guangyao，HU Qi，XU Yuan，ZHENG Sisi，MA Xiao，LUO jing，TAO Qingwen

2019, 22(21):  2616-2620.  DOI: 10.12114/j.issn.1007-9572.2019.00.176

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Background　Previous studies have shown that laboratory，imaging and clinical parameters differ significantly in rheumatoid arthritis（RA）patients by traditional Chinese medicine（TCM）syndrome，and studying these parameters can provide evidence for TCM syndrome differentiation.TCM syndrome-based analysis of musculoskeletal ultrasound findings of 28 joints in RA patients provide evidence for the treatment of this disease according to syndrome differentiation.Objective　To perform a TCM syndrome-based analysis of musculoskeletal ultrasound findings of 28 joints in RA patients，so as to provide a basis for incorporating musculoskeletal ultrasonography into TCM syndrome differentiation system of RA.Methods　From April 2017 to April 2018，120 inpatients and outpatients were selected from Department of TCM Rheumatology，China-Japan Friendship Hospital，and were divided into 4 commonly seen syndromes defined in Guidelines for Clinical Research of New TCM Drugs.Clinical and laboratory data were collected，including age，sex，course of RA，C-reactive protein（CRP），erythrocyte sedimentation rate（ESR），anti-cyclic citrullinated peptide（ACPA），rheumatoid factor（RF）（since anti-ACPA and RF were exponentially increased，it is convenient to process data using ln（ACPA+1）and ln（RF+1）for data statistics），28-tender joint count（TJC28），28-swollen joint count（SJC28），self-rated general health（GH）score，and Disease Activity Score 28（DAS28）．Findings of musculoskeletal ultrasound of 28 joints were also obtained，including synovitis joint count，synovitis score，Power Doppler（PD）joint count，PD score，and bone erosion count.Results　For the TCM syndromes of 120 patients，there were 42 cases of dampness-heat obstruction syndrome，32 cases of deficiency of liver and kidney syndrome，25 cases of cold-dampness obstruction syndrome，and 21 cases of phlegm-stasis obstruction syndrome.The average RA course of patients with deficiency of liver and kidney syndrome was longer than that of those with dampness-heat obstruction syndrome or phlegm-stasis obstruction syndrome（P<0.05）．The average levels of CRP，ESR，ln（RF+1），SJC28，self-rated GH score，DAS28 of patients with dampness-heat obstruction were higher than those of other three groups（P<0.05）．The average TJC28 of patients with dampness-heat obstruction was more than that of those with cold-dampness obstruction or phlegm-stasis obstruction（P<0.05）．Both average synovitis joint count and synovitis score of patients with dampness-heat obstruction and those with deficiency of liver and kidney were larger than those of patients with cold-dampness obstruction and those with phlegm-stasis obstruction（P<0.05）．Patients with dampness-heat obstruction showed greater average PD joint count and PD score compared with other three groups（P<0.05）．The average bone erosion count of patients with dampness-heat obstruction was less than that of those with deficiency of liver and kidney，but greater than that of those with cold-dampness obstruction（P<0.05）．The average bone erosion count of patients with deficiency of liver and kidney was greater than that of those with cold-dampness obstruction or phlegm-stasis obstruction（P<0.05）．Conclusion　Laboratory and clinical parameters are closely related to the TCM syndrome in RA patients.In particular，dampness-heat obstruction syndrome is associated with high RA disease activity.Moreover，TCM syndrome has a certain correlation with the musculoskeletal ultrasound findings of 28 joints in RA patients.The dampness-heat obstruction syndrome is closely related to synovitis and PD，while the deficiency of liver and kidney syndrome is accompanied by more bone erosion joints.


Effect of Anticancer，Antiemesis，Toxicity Attenuation and Synergism of Semen Nelumbinis and Gingerol Composition　

LONG Tengteng，ZHAO Chengjian，JIANG Haiyang，LI Xiaoling，YUE Wang

2019, 22(21):  2621-2625.  DOI: 10.12114/j.issn.1007-9572.2019.00.150

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Background　Vomiting is the most commonly experienced symptom of various diseases in the clinic which can cause water and electrolyte disorders.It is also the most commonly experienced side effects in patients receiving chemotherapy.For managing vomiting induced by chemotherapy and radiotherapy，traditional anti-vomiting treatments have poor efficacies，and combination therapies are often needed.Although chemical preparations such as 5-HT3 receptor antagonist and neurokinin 1（NK1） receptor antagonists are suitable for managing vomiting，their scopes of action are too narrow，and adverse reactions are often severe.Thus，the development of natural，low-toxic，broad-spectrum antiemetic drugs is urgently required.　Objective　To study the anticancer and anti-emesis efficacy of semen nelumbinis and gingerol composition （lotus-ginger composition）．Methods　This study was conducted in 2017.Ninty-six SPF male Kunming mice and 72 healthy CL black adult male minks were selected.Each mouse was inoculated subcutaneously 0.2 ml （containing 2×106 tumor cells） tumorigenic cell suspension （S180 sarcoma，EAC） in the right axilla.The day after inoculation，the mice were randomly and equally divided into the blank control group，cyclophosphamide group，ginerol group and lotus-ginger composition group，receiving intragastric administration of distilled water 0.5 ml，intraperitoneal injection of cyclophosphamide （20 g/kg），intragastric administration of gingerol （10 g/kg，equivalent to crude drug dosage），intragastric administration of lotus-ginger composition（10 g/kg，equivalent to crude drug dosage），respectively，for consecutive 10 days.The tumor mass of mice in each group was compared，and the inhibition rates of tumor were also calculated.Meanwhile，the minks were randomly and equally divided into cisplatin，apomorphine and copper sulphate induced vomiting groups.Cisplatin induced vomiting group was equally divided into four subgroups，the blank control，positive control，gingerol，and lotus-ginger composition subgroups，treated with intragastric administration of 0.9% sodium chloride solution （5 ml），intraperitoneal injection of ondansetron （2 mg/kg），intragastric administration of gingerol （10 g/kg，equivalent to crude drug dosage），intragastric administration of lotus-ginger composition （10 g/kg，equivalent to crude drug dosage），respectively.Cisplatin was administered 30 minutes after treatment with the antiemetic agent or its vehicle，except for the blank control subgroup．The same experimental procedure was performed on apomorphine and copper sulphate induced vomiting groups，receptively，except that apomorphine and copper sulphate were administered to the corresponding subgroups（blank control subgroup was not included） at 30 minutes after treatment with the antiemetic agent or its vehicle.Subgroups of cisplatin，apomorphine and copper sulphate induced vomiting groups were observed the emetic responses and the latency，the number of both retching and vomiting at 6 hours following the administration of cisplatin，apomorphine，copper sulphate，respectively.Results　Compared with the blank control group，the tumor of S180 sarcoma and EAC was lighter in cyclophosphamide group，gingerol group and lotus-ginger composition group（P<0.05）．The inhibition rate of S180 sarcoma in cyclophosphamide group，gingerol group and lotus-ginger composition group was 65.5%，31.9%，and 53.4%，respectively.The inhibition rate of EAC was 64.7%，26.7%，and 54.5%，respectively.Cisplatin evoked emetic response in minks，pretreatment with ondansetron，gingerol，lotus-ginger composition prolonged the latency，reduced the number of retches and vomits induced by cisplatin （P<0.05）．Apomorphine also evoked emetic response in minks，pretreatment with ondansetron，gingerol，lotus-ginger composition prolonged the latency，reduced the number of retches and vomits induced by apomorphine （P<0.05）．Copper sulphate evoked emetic response in minks，too，pretreatment with ondansetron，gingerol，lotus ginger composition prolonged the latency，reduced the number of retches and vomits induced by apomorphine （P<0.05）．Conclusion　The composition can inhibit S180 sarcoma and EAC tumor in mice，it also can inhibit vomitings induced by cisplatin，apomorphine and copper sulphate ，and have synergistic effect and toxicity attenuation in the treatment of cancer．


Satisfaction with TCM-based Body Constitution Identification for Community-dwelling Elderly People：a Survey from the Perspective of Primary Providers　

LI Shuting，REN Jianping，YANG Lei，ZHU Yiying，WANG Dahui，SHAO Ping

2019, 22(21):  2626-2631.  DOI: 10.12114/j.issn.1007-9572.2018.00.445

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Background　The aging population is increasing in China.The prevention and treatment of geriatric diseases in this growing population have become an important duty of healthcare institutions.TCM-based body constitution identification becomes a part of health management for the elderly in primary care with ever-growing importance.Therefore，exploring the main factors associated with primary providers' satisfaction with TCM-based body constitution identification for community-dwelling elderly people，is conducive to further development of such services.Objective　To investigate primary providers' satisfaction with TCM-based body constitution identification for community-dwelling elderly people and associated factors，putting forward the corresponding strategies for further development of such services.Methods　By use of stratified random sampling，from September to October 2017，6 community health centers were selected from each city of Hangzhou，Shangyu and Huzhou（totaled 18），and from which，258 health workers with an experience of delivering TCM-based body constitution identification were sampled.They were surveyed with a self-developed questionnaire consisting of demographic information，implementation status of TCM-based body constitution identification（technical standards for TCM health management，available equipments for the delivery of TCM-based body constitution identification，impact of the delivery of TCM-based body constitution identification on oneself），and level of satisfaction with the delivery of TCM-based body constitution identification.Multiple linear regression was used to analyze the influencing factors of primary providers' level of satisfaction with the delivery of such services.Results　Altogether，248 returned responsive questionnaires，achieving a response rate of 96.0%.Most of the respondents aged 30-39 years old（42.3%），had a college degree（61.7%），1-10 working years（37.1%），and an annual income of 50 000-100 000 yuan（70.2%），worked either in general practice or other departments（35.9%），worked as a clinician（32.3%），had a junior professional and technical title（44.8%），and had never participated in a on-the-job training（30.7%）．The 3 dimensions of TCM-based body constitution identification services presented in descending order of score evaluated by the respondents were：technical standards for TCM health management，available equipments for the delivery of TCM-based body constitution identification，and impact of the delivery of TCM-based body constitution identification on oneself.The score of level of satisfaction with the delivery of such services evaluated by the respondents ranged from 20 to 100，with an average of（75.6±14.6）．Multiple linear regression analysis showed that annual income，participating in the on-the-job training，the score of technical standards for TCM health management，the score of available equipments for the delivery of TCM-based body constitution identification were the influencing factors of primary providers' level of satisfaction with the delivery of TCM-based body constitution identification.Conclusion　The 3 dimensions of TCM-based body constitution identification services in descending order of score evaluated by the respondents were：technical standards for TCM health management，available equipments for the delivery of such services，and impact of the delivery of such services on oneself.The average score of level of satisfaction with the delivery of such services evaluated by them was（75.6±14.6），indicating that they had an above-average level of satisfaction with such services.In view of this，the equipments for the implementation of TCM-based body constitution identification should be improved，and the technical approaches should be standardized，and the operation of such services should be enhanced.Moreover，health management talents should be appropriately introduced，on-the-job trainings should be carried out reasonably in relevant health workers，in order to improve primary providers' satisfaction with the delivery of such services and the medical experience of patients.


Changes in the Quality of Life in Patients with Chronic Kidney Disease Stage 5D Following TCM Treatment：a Single-center Survey　

CHE Yueni，YIN Ling，ZHU Yilin，ZHAO Junyi，JIANG Yan，SHENG Meixiao

2019, 22(21):  2632-2637.  DOI: 10.12114/j.issn.1007-9572.2019.00.225

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Background　Patients with chronic kidney disease（CKD） stage 5D often suffer from different levels of functional disability，which causes physical and mental stresses，seriously impairing the prognosis and quality of life（QOL）．Most of treatments for such patients focus on improving their QOL and promoting clinical rehabilitation，by which they can return to normal daily activities.TCM treatment has great potential for improving the QOL of dialysis patients.Objective　To investigate the impact of TCM treatment on the QOL of patients with CKD stage 5D.Methods　Participants with CKD stage 5D were recruited from Department of Nephrology，Affiliated Hospital of Nanjing University of Chinese Medicine from January 2017 to January 2018 in accordance with the inclusion and exclusion criteria of the study.General data were collected，such as dialysis mode，essential information（gender，age，marital status，education level，employment status，primary disease，dialysis duration，comorbidity），laboratory inspection indicators，TCM treatment in the past half year，and types of TCM treatment（herbal decoction，Chinese patent medicine Baoshen Tablets，lavipeditum with herbs，acupoint plaster therapy，auriculotherapy with ear seeds，or moxibustion）．KDQOL-SFTM 1.3 was used in a survey to assess the QOL of patients.Results　Of the 140 participants，132 responded to the survey effectively，achieving a response rate of 94.29%.Among the 132 respondents，80 underwent hemodialysis（HD） and 52 underwent peritoneal dialysis（PD）；86（65.15%） received TCM treatment within six months，including 40 with HD and 46 with PD；60 received Chinese patent medicine，20 received Chinese herbal decoction，15 received lavipeditum with herbs，17 received auriculotherapy with ear seeds，15 received acupoint plaster therapy，and 9 received moxibustion.At least 2 types of TCM treatments were simultaneously administered to 12 HD patients，and 20 PD patients.The percentage of taking Baoshen Tablets was highest in HD patients，followed by that of receiving acupoint plaster therapy.The percentage of taking Baoshen Tablets was also highest in PD patients，followed by that of receiving herbal decoction.HD patients had lower KDTA dimension score than PD patients （P<0.05）．In KDTA dimension，HD patients had lower average item scores in terms of dialysis staff encouragement，and patient satisfaction compared with PD patients （P<0.05）．The KDTA dimension score achieved by those younger than 45 years was higher than that achieved by those aged 60-75，or aged greater than 75 years（P<0.05）．The KDTA dimension score achieved by those without comorbidity was higher than that achieved by those with 1，2 or 3 comorbidities（P<0.05）．Those with TCM treatment had higher KDTA dimension score than those without（P<0.05）．In KDTA dimension，those with TCM treatment had higher average item scores in terms of symptom/problems，effects of kidney disease on daily life，cognitive function，sexual function，sleep，support and encouragement of dialysis staff than those without（P<0.05）．HD patients had lower SF-36 dimension score than PD patients（P<0.05）．In SF-36 dimension，HD patients had lower item scores in terms of physical functioning（P<0.05）．The SF-36 dimension score achieved by those younger than 45 years was higher than that achieved by those aged 60-75，or aged greater than 75 years（P<0.05）．Those with primary education had lower SF-36 dimension score than those with secondary or tertiary education（P<0.05）．The SF-36 dimension score achieved by those without comorbidity was higher than that achieved by those with 1，2 or 3 comorbidities（P<0.05）．Those with TCM treatment had higher SF-36 dimension score than those without（P<0.05）．In SF-36 dimension，those with TCM treatment had higher item scores in terms of physical functioning，pain，general health perceptions，emotional well-being，role limitations caused by emotional health problems，and social functioning than those without（P<0.05）．Conclusion　Dialysis mode，age，education level，and comorbidity were associated with the QOL of patients with CKD stage 5D.TCM treatment has a positive effect on the improvement of the QOL of such patients.


Brucellosis with Cervical Spinal Cord Injury：a Case Report　

LUO Zhun，WANG Wen，CUI Wei

2019, 22(21):  2638-2641.  DOI: 10.12114/j.issn.1007-9572.2019.00.114

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Brucellosis is a zoonosis caused by brucella infection，and cervical spine involvement is rarely seen in clinical settings.This article introduced a rare case of paraplegia induced by brucellosis with severe cervical spinal cord injury，and described his clinical manifestations，imaging findings and treatment.Then we discussed the epidemiological characteristics，ideas for diagnosis and treatment of brucellosis with reference to related literature，pointed out that early active standardized medications can completely control the progression of the disease，and reduce the incidence of sequelae and surgery.



Ohtahara Syndrome Caused by a Novel c.581C>T Mutation in the KCNQ2 Gene：a Case Report and Literature Review

LI Guangxu，YU Shufeng，LU Jun，CHEN Minghui，WANG Danhong，CHEN Xiuling

2019, 22(21):  2641-2644.  DOI: 10.12114/j.issn.1007-9572.2019.00.019

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Ohtahara syndrome （OS） is a rare epileptic encephalopathy，which is also known as early infantile epileptic encephalopathy.It is characterized by neonatal onset，typically frequent and uncontrollable tonic clonic seizure，characteristic suppression-burst patterns on electroencephalography （EEG），and severe psychomotor retardation.In this paper，we summarized the clinical features and gene mutation characteristics of one case with ohtahara syndrome caused by a novel c.581C>T mutation in the KCNQ2 gene.And relevant literature was reviewed to improve the awareness of this rare disease.Identification of gene mutations will be beneficial to early diagnosis，intervention，prognosis evaluation and genetic counseling for ohtahara syndrome.