Chinese General Practice

Learning from the Outside World：the Key Value of Developing Mixed Method Research for the Development of General Practice Research in China　

WANG Yang，HAN Jianjun，XU Yanli

2019, 22(23): 2771-2779. DOI: 10.12114/j.issn.1007-9572.2019.00.394

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The basement of mixed methodology is pragmatism.It regards “the problem” as the starting point，and “solving the problem” as the orientation.This methodology can be well matched with the theory of general practice and its influence in this discipline is increasing in Europe and North America in recent years.Chinese general practice was need to be developed，and the development of Chinese general practice needs the development of scientific research in this field.However，Chinese general practitioners often face difficulties in conducting scientific research，such as complex alternative outcome variables，lack of domestic evidence，lack of willingness to spend time in qualitative research，lack of researchers and resources，and unbalanced resource distribution.Mixed methodology can effectively combine qualitative and quantitative research theoretically and help Chinese general practice researchers to improve the quality of their research from three aspects：discovering new variables，improving reliability and validity，and finding innovation points.The author demonstrated the possibility of conducting mixed method research in China through the analysis of a recently published Q1 article.In addition，they also proposed three recommendations of developing mixed method research in the field of Chinese general practice.

Mixed Methods and Survey Research in Family Medicine and Community Cealth　

John W Creswell，Mariko Hirose（writing），WANG Yang（translator），HAN Jianjun，XU Yanli，YANG Hui（reviser）

2019, 22(23): 2780-2785. DOI: 10.12114/j.issn.1007-9572.2019.00.397

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Many family medicine and community health researchers use surveys as an original research methodology.Our purpose is to illustrate how survey research provides an important form of quantitative research that can be effectively combined with qualitative data to form a mixed methods study.We first provide an overview of the key principles in survey research and in mixed methods research.We review the various ways that survey can be used in mixed methods studies，citing options such as beginning a study with a survey，using a survey as the second form of data collection，or combining a survey and a form of qualitative data in a single data collection procedure.Finally，we illustrate in a specific example six steps in conducting a mixed methods study using survey research.In a mixed methods study using a survey，primary care researchers should consider six steps.Step 1.Articulate the rationale for mixed methods study.Step 2.Detail quantitative and qualitative databases.Step 3.Identify a mixed methods design.Step 4.Analyse and report the results of the quantitative and qualitative databases.Step 5.Present and show integration.Step 6.Explicate the value of using mixed methods.The ability to combine and integrate survey research into a mixed methods study provides a more rigorous approach to research than conducting only a survey or conducting just a qualitative interview.While requiring skills beyond traditional survey approaches，surveys in primary care offers an opportunity for a high level of sophistication in research methodology.

Semistructured Interviewing in Primary Care Research：a Balance of Relationship and Rigour　

Melissa DeJonckheere， Lisa M Vaughn（writing），ZHAO Xinyue（translator），HAN Jianjun，XU Yanli，YANG Hui（reviser）

2019, 22(23): 2786-2792. DOI: 10.12114/j.issn.1007-9572.2019.00.398

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Semistructured in-depth interviews are commonly used in qualitative research and are the most frequent qualitative data source in health services research.This method typically consists of a dialogue between researcher and participant，guided by a flexible interview protocol and supplemented by follow-up questions，probes and comments.The method allows the researcher to collect open-ended data，to explore participant thoughts，feelings and beliefs about a particular topic and to delve deeply into personal and sometimes sensitive issues.The purpose of this article was to identify and describe the essential skills to designing and conducting semistructured interviews in family medicine and primary care research settings.We reviewed the literature on semistructured interviewing to identify key skills and components for using this method in family medicine and primary care research settings.Overall，semistructured interviewing requires both a relational focus and practice in the skills of facilitation.Skills include：（1）determining the purpose and scope of the study；（2）identifying participants；（3）considering ethical issues；（4）planning logistical aspects；（5）developing the interview guide；（6）establishing trust and rapport；（7）conducting the interview；（8）memoing and reflection；（9） analysing the data；（10）demonstrating the trustworthiness of the research；and （11）presenting findings in a paper or report.Semistructured interviews provide an effective and feasible research method for family physicians to conduct in primary care research settings.Researchers using semistructured interviews for data collection should take on a relational focus and consider the skills of interviewing to ensure quality.Semistructured interviewing can be a powerful tool for family physicians，primary care providers and other health services researchers to use to understand the thoughts，beliefs and experiences of individuals.Despite the utility，semistructured interviews can be intimidating and challenging for researchers not familiar with qualitative approaches.In order to elucidate this method，we provide practical guidance for researchers，including novice researchers and those with few resources，to use semistructured interviewing as a data collection strategy.We provide recommendations for the essential steps to follow in order to best implement semistructured interviews in family medicine and primary care research settings.

Risk Factors for Cerebral Microbleeds in Patients with Cerebrovascular Diseases　

SHU Junlong，HUANG Yining，LI Fan，SUN Wei

2019, 22(23): 2793-2797. DOI: 10.12114/j.issn.1007-9572.2019.00.099

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Background　Cerebral microbleeds （CMBs） are an important neuroimaging feature of cerebral small vessel diseases and are found closely associated with the development of symptomatic intracerebral hemorrhage and cognitive impairment.Previous studies mostly focused on the incidence of and risk factors for CMBs in community populations，while few reports on risk factors in diseased populations such as patients with cerebrovascular diseases are available.Objective　To investigate the risk factors for CMBs in patients with cerebrovascular diseases.Methods　Two hundred patients with cerebrovascular diseases hospitalized in the Department of Neurology，Peking University First Hospital between January 2009 and February 2014 were retrospectively selected.Clinical information including gender，age，related vascular risk factors，history of use of antithrombotic agents and severity of cerebrovascular stenosis of these patients were collected.The severity of white matter lesions in bilateral subcortical，basal ganglia and subtentorial areas was evaluated using the Age-Related White Matter Changes （ARWMC） scale.And the severity of CMBs in the aforementioned areas was assessed by the Microbleed Anatomical Rating Scale （MARS）．Results　Among the participants，71（35.5%） demonstrated CMBs，including 35（17.5%） with 1 to 2 CMBs，8（4.0%） with 3 to 4 CMBs and 28（14.0%） with ≥5 CMBs.Univariate Logistic regression analysis results showed that cerebral hemorrhage，obesity，severe white matter lesions，severe subcortical white matter lesions，severe basal ganglia white matter lesions and subtentorial white matter lesions were associated with CMBs （P<0.05）．Correlation analysis found that the severity of subcortical white matter lesions and basal ganglia white matter lesions was positively correlated with the number of CMBs （r=0.338，0.485，P<0.001）．Multivariate Logistic regression analysis showed that cerebral hemorrhage〔OR=3.28，95%CI（1.48，7.23）〕，obesity〔OR=3.86，95%CI（1.32，11.29）〕，severe subcortical white matter lesions 〔OR=2.14，95%CI（1.02，4.48）〕 and severe basal ganglia white matter lesions 〔OR=5.75，95%CI（2.46，13.47）〕 were independent risk factors for CMBs in patients with cerebrovascular diseases （P<0.05）．Conclusion　Cerebral hemorrhage，obesity and severe white matter lesions are independent risk factors for CMBs in patients with cerebrovascular diseases.In particular，severe basal ganglia white matter lesions showed a closer association with CMBs.

Influencing Factors of Quality of Life in Patients with Chronic Hepatitis B Treated with Antiviral Therapy

TAO Junxiu，LI Xiaodong，GAO Xiaolian，LIANG Haili，WU Huikun，XIAO Mingzhong，HE Tangqing，REN Meng，YAN Dengying，YU Manqi

2019, 22(23): 2798-2804. DOI: 10.12114/j.issn.1007-9572.2018.00.459

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Background　The number of patients with chronic hepatitis B （CHB） in China ranks first in the world. Hepatitis B virus is harmful to the human body，and the health-related quality of life （QOL） in such patients is low. Hubei Provincial Hospital of Traditional Chinese Medicine，a determined key research base for liver diseases in the No. 23 Notice released by the State Administration of Traditional Chinese Medicine of the People's Republic of China in 2008，has developed and implemented key liver disease research programs，in order to develop new Chinese medicines with definite curative effect for liver diseases. Objective　To explore the health-related QOL and influencing factors in CHB patients based on a multicenter clinical study. Methods　611 CHB patients who participated in 13 research centers of key diseases in the National Clinical Research Base of Traditional Chinese Medicine （Hubei） from June 2012 to August 2016 were selected. All of them were treated with entecavir for 48 weeks and were followed up for 1 year. General data were collected. The severity of disease was assessed by the TCM Syndrome Scale （TCMSS），and health-related QOL was assessed by both Chronic Liver Disease Questionnaire （CLDQ） and 36-item Short Form Health Survey （SF-36） before and after treatment，respectively. Results　Except for 50 cases （8.2%） of dropouts/ terminators，the remaining 561 cases were included in the final analysis. The mean scores of abdominal symptoms，fatigue，systemic symptoms，activities，emotional function，anxiety，mean CLDQ total score，physical functioning，role physical，bodily pain，general health，vitality，social functioning，role emotional，mental health，physical component score （PCS），mental component score （MCS），and mean SF-36 total score after treatment were all much higher than those at baseline （P<0.05）.The total CLDQ score varied significantly by sex，marital status，comorbidity，and region （P<0.05）. The PCS score differed significantly by sex，comorbidity，and region（P<0.05）.The MCS score changed obviously according to comorbidity and region（P<0.05）.The total score of SF-36 differed significantly by comorbidity，treatment compliance and region（P<0.05）.Age，course of liver disease and TCMSS scores were negatively correlated with the total scores of CLDQ，PCS，MCS and SF-36 （P<0.05）.Multiple linear regression analysis showed that region was the influencing factor of the total scores of CLDQ，MCS and SF-36. The course of liver disease and TCMSS score were the influencing factors of the total scores of CLDQ，PCS，MCS and SF-36 （P<0.05）． Conclusion　Health-related QOL differed significantly by region in CHB patients. Moreover，it was negatively correlated with the duration of liver disease and TCMSS score，indicating that it decreased with the prolongation of duration of liver disease and increase of TCMSS score.

Correlation between Echocardiographic Mechanical Synchrony Parameters and Efficiency of Cardiac Resynchronization Therapy　

WANG Jiayu，ZHANG Ping，LI Xuebin，GUO Jihong

2019, 22(23): 2805-2810. DOI: 10.12114/j.issn.1007-9572.2019.00.245

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Background　Ventricular mechanical synchrony can be evaluated by methods such as echocardiography.A single-center study found that using echocardiography to assess cardiac mechanical synchrony could identify which patients could benefit from cardiac resynchronization therapy （CRT）．However，prospective，multicenter，non-randomized controlled studies have confirmed that cardiac mechanical synchrony parameters cannot be used to screen CRT patients and predict the reactivity.Objective　To explore the role of echocardiographic mechanical synchrony parameters to the clinical efficiency of CRT patients.Methods　We retrospectively studied 124 patients with chronic heart failure who underwent CRT from the Department of Cardiovascular of Peking University People's Hospital from June 2009 to June 2013.Based on the clinical effect and echocardiographic assessments in the six months follow-up after the treatment，we allocated them into non-responders group （34 patients），responders group （48 patients） and super-responders group （42 patients）．General data of the patients were collected，and mechanical synchrony parameters were evaluated by echocardiography before and after the treatment.Multivariate Logistic regression analysis was used to analyze the influencing factors of CRT non-responsers and super-responders.Results　There were no differences in QRS duration，inter-ventricular mechanical delay （IVMD），velocity time integral of aortic valve （VTIAV），and velocity time integral of mitral valve （VTIMV） among three groups in the six months after the treatment （P>0.05）．The differences in left ventricular ejection fraction （LVEF），diastolic filling time/RR interval （DFT/RR），EA peak overlap ratio，septum posterior wall mechanical delay （SPWMD），and left ventricular pre-ejection period （LVPEP）were significant among three groups in the six months after the treatment （P<0.05）．Multivariate Logistic analysis showed that there was a regression relationship between QRS duration prolong after CRT and non-response to CRT〔OR=4.383，95%CI（1.013，18.963）〕；DFT/RR≥55% 〔OR=3.609，95%CI（1.124，11.584）〕 and EA wave peak overlap ratio<10% 〔OR=5.267，95%CI（1.400，19.820）〕 were related to super-response to CRT （P<0.05）．Conclusion　Patients with chronic heart failure have different response to CRT.And 27.4% of patients have no response to CRT，and 33.9% of patients are classified as super-responders to CRT.QRS duration prolong after CRT is related to the non-response to CRT，and DFT/RR≥55% and EA wave peak overlap ratio<10% are related to super-response to CRT.

Relativity Study of Insulin-like Growth Factor 1，Insulin Resistance and Type 2 Diabetes with Hypothyroidism　

YAN Yuanyuan，WEI Jianfen，LI Shichao，WANG Baozhuo，ZHAO Aiping

2019, 22(23): 2811-2815. DOI: 10.12114/j.issn.1007-9572.2018.00.458

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Background　Epidemiological studies have shown that diabetic patients are more likely to develop thyroid dysfunction than ordinary people，and the incidence in female patients are higher than that in male patients.The incidence of hypothyroidism is higher than that of hyperthyroidism，and abnormal thyroid function affects glucose-lowering treatment.The diagnosis and treatment of hypothyroidism has important clinical value for diabetes mellitus，and serum insulin-like growth factor-1 （IGF-1） plays an important role in regulating thyroid hormone.Objective　To analyze the difference in IGF-1 and insulin resistance in patients with type 2 diabetes （T2DM） with hypothyroidism.Methods　A total of 100 patients with T2DM admitted to the Department of Endocrinology，North China University of Science and Technology Affiliated Hospital were chosen from August 2017 to May 2018，and 50 of them who had T2DM and hypothyroidism were selected as the observation group and another 50 patients with T2DM only as the control group.Fasting plasma glucose （FPG），2-hour postprandial glucose （PG），fasting insulin （FINS），2-hour insulin （INS），fasting C peptide，2-hour postprandial C peptide，IGF-1，serum total triiodothyronine （T3），serum total thyroxine （T4），thyroid stimulating hormone （TSH），serum free triiodothyronine （FT3），serum free thyroxine （FT4），thyroid peroxidase antibody （TPOAb），thyroglobulin antibody （TgAb），glycosylated hemoglobin （HbA1c），triacylglycerol （TG），total cholesterol （TC），high density lipoprotein （HDL），low density lipoprotein （LDL） and insulin resistance index （HOMA-IR） of the two groups were tested and compared.Results　Female，duration of diabetes，BMI，TSH，TgAb，HbA1c，TG，TC，HDL and HOMA-IR in the observation group were higher than those in the control group，and IGF-1，FT3，FT4 and LDL were lower than those in the control group （P<0.05）.IGF-1 was negatively correlated with age，duration of diabetes，BMI，TgAb and HDL and positively correlated with FPG，2-hour PG，FINS，HOMA-IR （P<0.05）.The results of unconditional two-class logistic regression analysis showed that IGF-1 〔OR=0.970，95%CI（1.954，0.988）〕，HOMA-IR 〔OR=1.342，95%CI（1.051，1.715）〕 were influential factors of T2DM with hypothyroidism （P<0.05）. Conclusion　To detect serum IGF-1 regularly in T2DM patients and evaluate degree of insulin resistance is fairly important for the diagnosis and treatment of T2DM with hypothyroidism if patients have decrease in serum IGF-1 levels and increase in insulin resistance.

Real-time Polymerase Chain Reaction on Diagnosis of Bordetella Pertussis　

WANG Qing，LIU Ying，YUAN Lin，MENG Qinghong，YAO Kaihu

2019, 22(23): 2815-2819. DOI: 10.12114/j.issn.1007-9572.2018.00.443

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Background　The event caused by insufficient potency of pertussis vaccine drawed great public concern．Owing to the limitations of pertussis laboratory test，it is hard to meet the clinical needs of rapid etiological diagnosis．Objective　To evaluate the effect of a commercialized quantitative polymerase chain reaction（Q-PCR）kit on diagnosis of infections caused by bordetella pertussis（BP）．Methods　A total of 302 nasopharyngeal swabs of children with cough but no heat and 50 nasopharyngeal swabs of children clinically diagnosed with pertussis were collected in Beijing Children's Hospital ，Capital Medical University from November 2016 to April 2017.Q-PCR and classical bacterial culture method were used to detect whether 302 children with cough but no heat were infected by BP as well as the corresponding．Positive rates of BP in 50 clinically diagnosed cases by two methods were compared to comprehensively evaluate the clinical value of Q-PCR．Results　Compared with culture method，the sensitivity of Q-PCR in 302 cases was 78.6%（11/14），the specificity 95.8%（276/288），the positive predictive value 47.8%（11/23），and the negative predictive value 98.9%（276/279）．The positive rate detected by Q-PCR was 34.0% (17/50) and that by bacterial culture was 22.0% (11/50). There was no significant difference between the two methods（χ2=3.125，P=0.077）．Conclusion　Compared with culture method，the Q-PCR detection method achieved a higher sensitivity and specificity．Two methods had a similar positive rate in providing etiological diagnosis for patients clinically diagnosed with pertussis.

Accumulation of Skin Type Ⅰ Collagen-linked Advanced Glycation End Products in Patients with Diabetic Foot Ulcers　

LIU Chuanbo，YANG Jianfei，LU Shuliang

2019, 22(23): 2820-2825. DOI: 10.12114/j.issn.1007-9572.2019.00.187

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Background　The advanced glycation end products （AGEs） accumulated on the skin type Ⅰ collagen is the carrier of long-term glycation and oxidative stress “metabolic memory”，which plays an important role in evaluating diabetes metabolic control and predicting diabetic complications.Because of intrinsic fluorescence characteristics of the AGEs，the AGE ReaderTM can noninvasively get the value of skin autofluorescence （SAF），which reflects the total content of all kinds of AGEs in human tissue.The correlation between the AGEs accumulated on skin type Ⅰ collagen and the SAF value which reflects the total amount of skin AGEs in patients with diabetic foot ulcers remains to be studied.Objective　To determine the correlation of accumulation of skin typeⅠ collagen-linked AGEs with SAF in patients with diabetic foot ulcers.Methods　This study was carried out between 11 inpatients with diabetic foot ulcers recruited from Department of Vascular Surgery，Shanghai TCM-integrated Hospital，Shanghai University of Traditional Chinese Medicine，and 8 non-diabetic inpatients with small area burns recruited from Department of Burn Surgery，Ruijin Hospital，Shanghai Jiaotong University School of Medicine between June and August，2014.Skin biopsy samples of both groups were taken from the whole skin tissue of lower-extremity wound margins or donor sites.Histomorphological characteristics of the samples were observed with light microscopy.Level of AGEs accumulated on the skin typeⅠ collagen was examined with double immunofluorescence technique.SAF measurement on the forearm was performed with the AGE ReaderTM.Results　Histomorphological observation revealed that the skin structure of non-diabetic patients was clear and complete，while the skin tissue of diabetic foot ulcer patients was atrophied and thinned，the epidermal cell layer was unclear，collagen fibers in dermis were atrophied and slender，arranged sparsely，loosely and disorderedly，and some of them were even broken and degenerated，and inflammatory cells increased significantly and distributed diffusely.The total optical density fluorescence （orange） co-expressed in skin tissue of diabetic foot ulcer group was higher than that of non-diabetic group〔（10 900±2 973） vs （6 910±1 048），t=4.06，P<0.05〕.The average SAF value of diabetic foot ulcer group was higher than that of non-diabetic group〔（2.68±0.22） AU vs （2.18±0.27） AU，t=4.47，P<0.05〕．Moreover，the extent of AGEs accumulated on skin type Ⅰ collagen was associated with the SAF value in both both diabetic foot ulcer group （r=0.65，P<0.05），and non-diabetic group （r=0.76，P<0.05）．Conclusion　Both AGEs on skin typeⅠ collagen and SAF significantly increased in patients with diabetic foot ulcers，and the two were positively correlated.So SAF may be a simply potential method to evaluate the accumulation of skin AGEs.

Iguratimod Regulation of Matrix Metabolism of Rat Degenerative Chondrocytes Induced by IL-1β through Wnt/β-catenin Signaling Pathway　

PENG Yangxizi，KONG Ruina，ZHANG Lanling，ZHAO Dongbao

2019, 22(23): 2826-2832. DOI: 10.12114/j.issn.1007-9572.2019.00.014

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Background　Wnt signaling pathway widely exists in chondrocyte，which shows abnormal activation，leading to the unbalanced proliferation and apoptosis of chondrocyte.As a new anti-inflammatory and immunomodulatory small molecule drug，iguratimod not only regulates immunity and inhibits joint destruction，but also affects bone metabolism.However，there is no study on the mechanism of iguratimod's action on chondrocytes.Objective　To investigate the effects of iguratimod on the proliferation，apoptosis and matrix metabolism of rat chondrocytes induced by IL-1β via the Wnt/β-catenin signaling pathway at the cellular and molecular level.Methods　Ten 2-month-old healthy male SPF Wistar rats were selected.Rat chondrocytes were cultured to the 2nd generation，and by the inducing of IL-1β，the model of degenerative cartilage cells was obtained.The isolated and cultured chondrocytes were divided into 12 groups：normal control group，solvent control group，IL-1β group，iguratimod group A，iguratimod group B，iguratimod group C，celecoxib group A，celecoxib group B，celecoxib group C，IL-1β+Dickkopf-1 （DKK-1） group，iguratimod+DKK-1 group，celecoxib+DKK-1 group.The expression levels of β-catenin，MMP-13，Col2a1，GSK-3β mRNA and protein levels in different groups were detected by qRT-PCR and Western blotting.Results　The average expression level of β-catenin mRNA in chondrocytes in IL-1β+DKK-1 group was lower than that of IL-1βgroup at 12，24，48 and 72 h after culture.The average expression level of MMP-13 mRNA in chondrocytes in IL-1β+DKK-1 group was lower than that of IL-1β group at baseline，12，24，48 and 72 h after culture.The average expression level of Col2a1 mRNA in chondrocytes in IL-1β+DKK-1 group was higher than that of IL-1β group at 12，24，48 and 72 h after culture.The average expression level of β-catenin protein in chondrocytes in IL-1β+DKK-1 group was lower than that of IL-1β group at 12，24，48 and 72 h after culture.The average expression level of MMP-13 protein in chondrocytes in IL-1β+DKK-1 group was lower than that of IL-1β group at 12，24，48 and 72 h after culture.The average expression level of Col2a1 protein in chondrocytes in IL-1β+DKK-1 group was higher than that of IL-1β group at 12，24，48 and 72 h after culture.At 24 h after drug intervention，iguratimod group A and celecoxib group A showed lower average expression levels of β-catenin mRNA and MMP-13 mRNA and higher average expression levels of Col2a1 mRNA and GSK-3β mRNA in chondrocytes compared with IL-1β group and IL-1β+DKK-1 group.Iguratimod+DKK-1 group demonstrated lower average expression levels of β-catenin mRNA and MMP-13 mRNA and higher average expression levels of Col2a1 mRNA and GSK-3β mRNA in chondrocytes compared with iguratimod group A.In comparison with celecoxib group A，celecoxib+DKK-1 group presented lower average expression levels of β-catenin mRNA and MMP-13 mRNA and higher average expression levels of Col2a1 mRNA and GSK-3β mRNA in chondrocytes.In comparison with IL-1β group and IL-1β+DKK-1 group，iguratimod group A and celecoxib group A showed lower average expression levels of β-catenin protein，MMP-13 protein and Col2a1 protein and higher average level of GSK-3β protein in chondrocytes.By comparison with iguratimod group A，iguratimod+DKK1 group manifested higher average expression levels of β-catenin protein，Col2a1 protein and GSK-3β protein and lower average expression level of MMP-13 protein in chondrocytes.The average expression levels of β-catenin protein，MMP-13 protein，Col2a1 protein and GSK-3βprotein in chondrocytes in celecoxib+DKK-1 group were higher than those of celecoxib group A.Conclusion　Our study shows that the overexpression of Wnt/β-catenin signaling pathway in IL-1β induced rat degenerative chondrocytes，promotes chondrocyte matrix metabolism，and inhibits the synthesis function.Iguratimod protects the chondrocytes of rats from IL-1β-induced degeneration through the regulation of the Wnt/β-catenin signaling pathway.　

Differences in Demand and Satisfaction of Multi-level Services between Rural and Urban People with Disability Caused by Cerebrovascular Disease　

ZHAO Yihao，CHENG Yunfei，LI Jun，ZHENG Xiaoying

2019, 22(23): 2833-2840. DOI: 10.12114/j.issn.1007-9572.2018.00.376

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Background　Services for the disabled have received wide attention in recent years. On the one hand，due to large disabled population，a considerable number of disabled people can not meet their service demand; on the other hand，with the rapid development of economy，the gap between urban and rural areas is gradually widening. Cerebrovascular disease，as the second most common cause of death in the world，has the characteristic of high incidence and disability rate. In China，the economic burden caused by stroke alone is as high as 40 billion RMB per year.Objective　To investigate the demand and satisfaction of multi-level services in people with disability caused by cerebrovascular disease，and analyze the urban-rural differences，providing references for relevant policy-making. Methods　The data was collected from the Second National Sample Survey on Disability conducted in China in 2006，involving a total of 12 583 individuals with disability caused by cerebrovascular disease. Characteristics including gender，age，marital status，education level，nationality，household income per capita，disability level and place of residence were recorded. The demand，utilization and satisfaction of 13 services 〔composed of health services （typeⅠ service），basic survival services （typeⅡservice），self-promotion and personal development services（typeⅢ service），and environmental support services（type Ⅳservice）〕 in the populations were evaluated. Results　Among the 12 583 participants，7 697 （61.2%） were from rural areas and 4 886 （38.8%） from urban areas. Among the participants from rural areas，the demand rates of type Ⅰ，Ⅱ，Ⅲ and Ⅳ services were 94.6%，75.4%，1.6% and 22.2%，respectively，the corresponding utilization rates were 52.5%，13.0%，0.4% and 8.8%，respectively，and the corresponding satisfaction rates were 44.7%，11.7%，0.1% and 2.8%，respectively. In the participants from urban areas，the demand rates of type Ⅰ，Ⅱ，Ⅲ and Ⅳ services were 94.3%，46.7%，1.4% and 31.5%，respectively，the corresponding utilization rates were 72.8%，7.9%，0.3% and 14.8%，respectively，and the corresponding satisfaction rates were 62.8%，6.3%，0.1% and 6.2%，respectively. The demand，utilization and satisfaction rates of type Ⅱ service in rural participants were significant higher than those in urban participants （P<0.05）． The demand rate of type Ⅳ，the utilization and satisfaction rates of type Ⅰ and Ⅳ in rural participants were significant lower than those of urban participants （P<0.05）． Living in urban areas was associated with a higher satisfaction degree of type Ⅰ service 〔OR=1.665，95%CI（1.527，1.816），P<0.001〕 and type Ⅳ service 〔OR=2.040，95%CI（1.646，2.528），P<0.001〕，but a lower satisfaction degree of typeⅡ service 〔OR=0.769，95%CI（0.662，0.894），P=0.001〕. Conclusion　The demand and satisfaction of health and environmental support services for people with disability caused by cerebrovascular disease in urban areas are higher than those in rural areas. The gap between urban and rural areas should be further narrowed，and the satisfaction of health services in rural areas should be strengthened.

Influencing Factors of Health Services Utilization among the Elderly in Elderly Care Institutions：a Study Using Andersen's Behavior Model　

YANG Xi，LI Juanping，ZHENG Kai，HE Pingting，LI Xuefeng，XIONG Linping，WANG Ying

2019, 22(23): 2841-2849. DOI: 10.12114/j.issn.1007-9572.2019.00.079

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Background　In elderly care institutions，the elderly people have a high prevalence of diseases but a low health services use rate.Identification of the influencing factors of health services use in this group，helps to guide the cooperation of community health centers （CHCs） and elderly care institutions in codelivering integrated medical and nursing care，and improve the health services use rate and health status in this population.Objective　To explore the influencing factors for health services use in the elderly in elderly care institutions，providing a reference for decision making during the codelivery of integrated medical and nursing care by CHCs and elderly care institutions.Methods　From September to December 2017，a survey was carried out in the elderly people in two elderly care institutions in the service area of Pudong New Area Dongming Community Health Center，Shanghai.A self-developed questionnaire was used in the survey，which is composed of basic personal conditions，health status，economic conditions，available local health resources and use of heath services.Influencing factors for health services use in the elderly were analyzed with the Andersen's behavior model.Dominance analysis approach was used to compare the relative importance of the independent variables in Logistic model.The adjusted R2 value and relative importance weight of predisposing，enabling and need factors were calculated.Results　Among the 368 cases participating in the survey，353 handed in the questionnaires，and 344 of them returned responsive ones，obtaining a response rate of 93.5%.The most frequently used 3 services were physical examination （95.6%），outpatient services （92.4%），and pharmaceutical services（83.4%）．Multivariate Logistic regression analysis showed that gender and types of occupation were associated with the utilization of physical examination （P<0.05）.Admission time to elderly care institutions，level of nursing care，two-week morbidity，and accessible medical institution were associated with health education and counseling utilization （P<0.05）．Gender，visiting frequency of friends and colleagues，monthly income and medical insurance type were associated with outpatient services utilization （P<0.05）.Types of medical insurance and accessible medical institution were associated with clinical care（P<0.05）.Visiting frequency of children，level of nursing care，and two-week morbidity were associated with emergency services utilization （P<0.05）.Visiting frequency of friends and colleagues，and two-week morbidity were associated with referral services utilization （P<0.05）.Education level，six-month prevalence of chronic diseases and accessible medical institution were associated with pharmaceutical services utilization （P<0.05）.Predisposing factors were the main influencing factors for physical examination services utilization，contributing 67.3% of the total cumulative impacts.Need factors were the main influencing factors for health education and counseling utilization，emergency services utilization and referral services utilization，contributing 58.9%，71.7% and 71.9% of the total cumulative impacts，respectively.And enabling factors were the main influencing factors for the utilization of outpatient services，clinical care，and pharmaceutical services，contributing 42.4%，65.3% and 44.9% of the total cumulative impacts，respectively.Conclusion　The commonly used services in the elderly in elderly care institutions are preventive health care，common and chronic disease diagnosis and treatment.The main influencing factors of the health care utilization vary according to the type of services.In view of this，community-based healthcare organizations should optimize the strategies of delivering services to this group according to their characteristics of decision-making for health care utilization.

Mediation Effect of Big Five Personality Traits between Patient Aggression and Doctor-patient Trust　

ZHAO Jingbo，ZHU Chaohui

2019, 22(23): 2850-2855. DOI: 10.12114/j.issn.1007-9572.2018.00.438

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Background　In recent years，the intensification of doctor-patient conflict and the crisis of doctor-patient trust have occurred from time to time．Scholars at home and abroad have explored the importance of doctor-patient relationship and the influencing factors of doctor-patient trust from different levels．However，it is unclear whether aggression and personality of patients have an impact on doctor-patient trust．Objective　To explore the relationship among aggression of patients，doctor-patient trust and big five personality traits，and big five personality traits' mediator role in patient aggression and doctor-patient trust．Methods　By convenience sampling，patients were extracted from Shenzhen First People's Hospital，Shenzhen Traditional Chinese Medicine Hospital，Shenzhen Guangming New District People's Hospital，Shenzhen Luohu Hospital Group Luohu People's Hospital，Shenzhen Seventh People's Hospital，Women & Children Health Institute Futian，Shenzhen，Shenzhen Fourth People's Hospital，Guangdong Provincial Hospital of Traditional Chinese Medicine from December 2017 to February 2018．The Chinese College Students' version of Buss-Perry Aggression Questionnaire（CC-BPAQ），Chinese version of the Wake Forest Physician Trust Scale（C-WFPTS） and Ten-Item Personality Inventory in China（TIPI-C） were used for investigation．The Mann-Whitney U test was used to compare the differences in aggression，trust in doctors，and big five personality traits among patients by sex．Spearman rank correlation analysis was used to analyze the correlation between patient aggression，doctor-patient trust and big five personality traits．The mediation model was fitted using AMOS 20.0 software，and the mediation effect was analyzed using the Bootstrap program．Results　A total of 500 questionnaires were distributed and 384 responsive ones were returned，achieving a response rate of 76.8%．The CC-BPAQ total score，physical aggression and impulsive subscale scores in male patients were higher than those in female patients（P<0.05）．Sex-specific differences in the hostility and anger subscale scores of CC-BPAQ，C-WFPTS total score，and the scores of its benevolence，and technical ability dimensions，the subscale scores of extroversion，agreeableness，conscientiousness，neuroticism，and openness of TIPI-C in the patients were not significant（P>0.05）．The CC-BPAQ total score was negatively correlated with C-WFPTS total score（rs=-0.173），subscale scores of extroversion（rs=-0.185），agreeableness（rs=-0.296），conscientiousness（rs=-0.237），neuroticism（rs=-0.422），and openness（rs=-0.140）of the TIPI-C（P<0.05）．The C-WFPTS total score showed a positive correlation with the subscale scores of agreeableness（rs=0.207），and neuroticism（rs=0.211）of the TIPI-C（P<0.05）．The estimated indirect effect of patient aggression on trust in physician was -0.33〔95%CI（-0.92，-0.09）〕．The big five personality traits played a complete mediator role between patient aggression and doctor-patient trust．Conclusion　Patient aggression predicted doctor-patient trust via the mediating role of the TIPI-C．Appropriate personality traits are the protective factors for doctor-patient trust．They can prevent patients with high aggressive traits from engaging in aggressive behavior such as violence against doctors，and can effectively improve the level of patient's trust in physicians．

Differences of Interpretation Bias among Officers and Soldiers with Different Levels of Anxiety　

ZHANG Xiaomin，CAI Wenpeng，CHEN Aibin，TU Zhihao，LIU Guangyu，DENG Guanghui

2019, 22(23): 2856-2860. DOI: 10.12114/j.issn.1007-9572.2019.00.049

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Background　Anxiety is one of the most common mental problems nowadays，and wrong cognition can lead to anxiety.Therefore，it has become a hotspot of psychology research to alleviate anxiety through cognitive bias modification.The anxiety in military personnel is very important，while few domestic researches pay much attention to military cognitive bias，especially the research on interpretation bias.Objective　To explore differences of interpretation bias among officers and soldiers with high and low levels of anxiety，and investigate whether there is universality across self /non-self relevant situations.Methods　Convenient sampling was applied in the study，selecting 118 military staff who consented to fill out State-Trait Anxiety Inventory （STAI） from August to September in 2018．Those who scored higher by one standard deviation were taken as the high anxiety group（SAI>46，n=24），while those lower by one standard deviation were taken as the low anxiety group（SAI<28，n=21）．Self-made ambiguous scenarios paradigm were used to finish the experiment.The 3-factor mixed experimental design of 2 was used．（groups：high anxiety group & low anxiety group） ×2（related type：self relevant situation & non-self relevant situation） ×2（interpretation titer：positive interpretation & negative interpretation），with groups as inter-subject variable，related type and interpretation titer as inner-subject variables.Scores on different interpretations were used as dependent variables.Results　Interaction of groups and interpretation titer showed significant differences〔F（1，43）=14.290，P<0.01〕，while there was no significant differences between related type and groups〔F（1，43）=0.034，P>0.10〕，related type and interpretation titer〔F（1，43）=0.065，P>0.10〕，and interaction among groups，related type and interpretation titer〔F（1，43）=0.534，P>0.10〕.Simple effect analysis of groups showed significant differences in both positive interpretation〔F（1，43）=8.410，P<0.01〕 and negative interpretation〔F（1，43）=13.380，P<0.01〕.High anxiety group scored lower than low anxiety group in positive interpretation（P<0.05），while higher in negative interpretation（P<0.05）．Conclusion　Compared with low anxiety group，high anxiety group showed no significant difference in interpretation bias under different self-relevant situations.In ambiguous scenarios，officers and soldiers with high level of anxiety scored lower in positive interpretation while higher in negative interpretation than those in the low anxiety group.

Use of Proton Pump Inhibitors and Risk of Dementia or Alzheimer's Disease：a Meta-analysis　

YU Sisi，LUO Zheng，LI Miaomiao，ZHONG Qingling

2019, 22(23): 2861-2865. DOI: 10.12114/j.issn.1007-9572.2018.00.308

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Background　Proton pump inhibitors （PPIs） are drugs that recognized for the treatment of most diseases related to abnormal gastric acid secretion，which are widely used among the elderly.Some prospective studies have indicated that PPI may increase the risk of dementia.However，the results of those studies were inconsistent and controversial.Therefore，it is necessary to determine whether PPI can increase the risk of dementia or Alzheimer's disease （AD） in elderly people.Objective　To evaluate the association between PPI and the risk of dementia or AD systematically.Methods　Prospective cohort studies and case-control studies that reported risk of dementia or AD causing by PPI were searched in PubMed，EMBase and Cochrane Library databases from their inception to February 2018.The Review Manager 5.3 software and STATA 12.0 software were used for Meta analysis.Results　A total of 9 studies were included，including 7 cohort studies and 2 case-control studies，with a total of 622 793 patients.Findings of Meta analysis showed that there was no statistically significant association between PPI use and risk of dementia〔RR=1.17，95%CI（0.89，1.55），P=0.26〕 or AD 〔RR=0.94，95%CI（0.89，1.00），P=0.06〕.Conclusion　Current research shows that there was no correlation between PPI use and the risk of dementia or AD，and using PPI will not increase the risk of having dementia or AD.

Association between Genetic Polymorphisms and Upper Gastrointestinal Injury Risk after Using NSAIDs/Aspirin：a Meta-analysis　

SUN Xiaojun，GUO Shilei

2019, 22(23): 2866-2873. DOI: 10.12114/j.issn.1007-9572.2019.00.292

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Background　Non-steroidal anti-inflammatory drugs （NSAIDs） are a class of anti-inflammatory drugs without steroidal structure widely used in clinic practice.Adverse drug reactions need to be concerned for long-term users，the most important of which is upper gastrointestinal injury （UGI）．However，UGT incidence is different among populations，which may be due to genetic polymorphism.Objective　To identify the association of gene polymorphisms with risk of UGI after using NSAIDs/aspirin.Methods　A systematic literature search was conducted in PubMed，EMBase，Cochrane Library，Chinese National Knowledge Infrastructure，Wanfang Data Knowledge Service Platform，VIP，China Biology Medicine disc up to January 8，2018，to identify potential relevant studies about association between genetic polymorphisms and NSAIDs/aspirin-induced UGI.Data extraction and quality evaluation were performed.Meta and bioinformatic analysis was implemented with Haploview 4.2，R 3.4.3，and STATA 14.0.Results　Nineteen studies were included.Meta-analysis showed that SLCO1B1 gene rs2306283 （A>G） mutation in Japanese heterozygote model increased the risk of aspirin-induced UGI 〔OR=1.53，95%CI（1.02，2.30），P=0.04〕.SLCO1B1 gene rs4149056 （T>C） mutation in Japanese showed that single gene 〔OR=0.50，95%CI（0.33，0.75），P<0.05〕，heterozygote 〔OR=0.49，95%CI（0.32，0.76），P<0.05〕 and dominant model 〔OR=0.48，95%CI（0.31，0.73），P<0.05〕 could reduce the risk of aspirin-induced UGI.The mutation of CYP2C9 gene rs1799853 （C>T） in Caucasian population showed that single gene 〔OR=1.42，95%CI（1.11，1.80），P<0.05〕，heterozygote 〔OR=1.38，95%CI（1.05，1.83），P=0.02〕，dominant model 〔OR=1.44，95%CI（1.10，1.88），P=0.01〕 could increase the risk of NSAIDs-induced UGI.The interaction analysis of all the proteins potentially associated with NSAIDs-induced UGI in STRING database showed that these proteins could be divided into two major functional types，including drug metabolic transport-related proteins and inflammatory response-related proteins.Conclusion　Our study confirms that the rs2306283 （A>G） mutation in SLCO1B1 gene may increase the risk of aspirin-induced UGI，the rs1799853 （C>T）mutation in CYP2C9 gene may increase the risk of NSAIDs-induced UGI，and the rs4149056 （T>C）mutation in SLCO1B1 gene exerts a protective effect against aspirin-induced UGI.

Research Status and Frontier Analysis of Pediatric Cardiomyopathy at Home and Abroad　

WAN Yingli，TIAN Jie，HOU Xiaorong

2019, 22(23): 2874-2879. DOI: 10.12114/j.issn.1007-9572.2018.00.377

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Background　Pediatric cardiomyopathy is a disease with poor prognosis，high mortality and disability. Over the years，researchers at home and abroad have actively explored and researched it，and published a large number of related literature. Objective　To analyze the current status and trends of domestic and overseas researches on pediatric cardiomyopathy，and provide a reference for related research. Methods　English literatures on pediatric cardiomyopathy were collected from the Web of Science Core Collection （SCI-Expanded，SSCI，ESCI） and PubMed database，and Chinese ones from CNKI and Wanfang Data Knowledge Service Platform. Literatures published on those databases before April 12，2018 were retrieved. The missing information is supplemented by Notepad++ software. The duplicate Chinese and English literatures were removed using EndNote X7 and CiteSpace 5.2.R1，respectively. Bibliometric analysis of journals containing those literatures was performed using Bibexcel. CiteSpace 5.2.R1 was also used to analyze the publication year，country，institution，journals，research hotspot and frontier of those literatures. Results　A total of 9 816 English literatures in the field of childhood cardiomyopathy were included，which showed an overall upward trend in number but a downward trend from 2014 to 2017. A total of 585 Chinese literatures were included，showing a downward trend in number from 2014 to 2017. And 362 English literatures were published in China，and the number was on the rise，with a large increase from 2015 to 2017.From 1997 to 2017，160 countries or regions published pediatric cardiomyopathy-related literatures，of which the United States ranked the first in number，and China the 9th. The top five research institutions with largest number of English literature were mainly located in the United States，among which Harvard University held the largest number with a more intensive and broader cooperation with other research institutions. Among Chinese research organizations which published Chinese or English literatures about pediatric cardiomyopathy，Shanghai Jiao Tong University published the most literatures with a sparse and relatively narrower cooperation with other research organizations. A total of 9 816 English literatures were published in 1 769 journals，and 585 Chinese literatures in 321 ones. The hotspots or cluster labels in English literatures involved extracorporeal membrane oxygenation，cardiovascular disease，genotype-phenotype correlation，valuable prognostic tool and clinical consequence，while Chinese literatures largely focused on anthracycline-induced cardiotoxicity，ATPase-deficient mitochondrial inner membrane protein ATAD3A，myosin binding protein C，functional mutation，TAZ mutation，childhood leukemia，gene product expression，chronic condition and familial atrial septal defect. The researches about scientific management，clinical outcome，cardiovascular magnetic resonance，ventricular assist devices，genetics and corresponding guidelines were frontier of pediatric cardiomyopathy. Conclusion　Researches about pediatric cardiomyopathy have achieved remarkable results，and the researches in China are gradually meeting the international standard. However，our research level still requires improvement. Inter-institution cooperation should be emphasized in the absence of a stable large-scale research direction.

Allergic Bronchopulmonary Aspergillosis：a Meta-analysis of 244 Cases　

ZHANG Longju，LI Zhu，LIU Xiaoli

2019, 22(23): 2880-2884. DOI: 10.12114/j.issn.1007-9572.2019.00.160

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Background　Allergic bronchopulmonary aspergillosis （ABPA） is often misdiagnosed as asthma，tuberculosis，or other pulmonary diseases by clinicians due to lack of appropriate understanding of this disease.If not properly treated or untreated，ABPA may eventually progress into bronchiectasis and interstitial fibrosis，so early diagnosis and treatment is essential for patients with ABPA.However，available clinical studies about the natural course and treatment of ABPA are comparatively insufficient，and most of them are reports of sporadic cases，so there is a need of systematic summary of the disease.Objective　To summarize the clinical features of ABPA.Methods　We searched CHKD database for studies in Chinese published in General Core Journals of China （GCJC）（edited and published by the Peking University Library and University Library Journal Research Group of Beijing） as of May 2018 in which at least 10 cases of ABPA were reported with“变态反应性支气管肺曲菌病”“变应性支气管肺曲菌病”“过敏性支气管肺曲菌病”“ABPA”as the search terms.From the included studies，we extracted the used diagnostic criteria，and patients' general personal data，clinical manifestations，imaging features，laboratory test results，lung function status，method for identification of the pathogen，misdiagnoses，treatment and outcomes.Results　A total of 11 articles，involving 244 patients，were included.Among the patients，167 （68.4%） were diagnosed as ABPA associated with central bronchiectasis （ABPA-CB） and 77（31.6%） were serologically positive ABPA （ABPA-S）．The diagnosis was made based on the Rosenberg-Patterson 1977 criteria in 3 studies，Greenberger's simplified criteria in 3 studies，and 2008 IDSA practice guidelines for the diagnosis and management of aspergillus in 5 studies.The major clinical manifestations were cough （81.6%，199/244），wheezing （80.3%，188/234），and expectoration（78.7%，192/244）．The most common imaging features （mostly chest CT findings） were patchy shadow（83.5%，182/218），central bronchiectasis（74.2%，175/236），and fleeting infiltrations （47.7%，42/88）．Laboratory tests showed increased total IgE antibody levels in peripheral blood in 209 cases （98.6%，209/212），positive result of Aspergillus antigen skin test in 94 cases （95.9%，94/98），and elevated serum Aspergillus-specific IgE antibody in 147 cases （93.6%，147/157）．Identification of the pathogen was done by bronchoalveolar lavage fluid （BALF） smear or culture in 39 cases （45.3%，39/86），sputum smear or sputum culture in 80 cases （40.6%，80/197），fibrous bronchi microscopic biopsy or mucosal biopsy in 23 cases （23.7%，23/97）．62 cases were once misdiagnosed as bronchial asthma （50.4%，62/123），80 cases as tuberculosis （41.9%，80/191），and 54 cases as bacterial pneumonia（34.0%，54/159）．Most of the cases （82.1%，124/151） were treated mainly by oral glucocorticoid combined with antifungal therapy.Through regular treatment，most patients were relieved，and 185 cases of pulmonary lesions were reduced （82.8%，135/163），but 25 cases had recurrence and aggravation （29.8%，25/84）．Conclusion　Due to lack of specific clinical manifestations，ABPA is easily misdiagnosed and missed.When patients develop wheezing，cough，brown sticky sputum，increased peripheral blood eosinophils，obstructive ventilatory dysfunction，and have imaging features of central bronchiectasis，and a migrating patchy shadow in the lungs，ABPA should be vigilantly considered.

Hemichorea Associated with Non-ketotic Hyperglycemia：a Report of Two Cases and Literature Review　

GUO Yali，ZHANG Shaojun

2019, 22(23): 2885-2888. DOI: 10.12114/j.issn.1007-9572.2018.00.305

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Objective　To study the clinical manifestation，diagnosis，therapy and mechanism of hemichorea associated with non-ketotic hyperglycemia，so as to enhance awareness and avoid misdiagnosis or missed diagnosis of this disease.Methods　Clinical symptoms，signs and imaging examinations of two patients with hemichorea associated with non-ketotic hyperglycemia admitted to Shanxi Provincial People's Hospital Affiliated to Shanxi Medical University on 31 March 2017 and 17 April 2017 were analyzed，and related literature were reviewed.Results　Two patients were aged women with diabetes，who had acute onset hemichorea of unilateral limb，high blood glucose and negative ketone body.One subject had high signal intensity of T1-weighted MR imaging on the contralateral basal ganglia，and high density of corresponding lesion on CT.After controling glucose positively，choreiform movement of one subject had disappeared，and of the other one relieved obviously.Conclusion　Hemichorea associated with non-ketotic hyperglycemia is a rare complication of diabetes mellitus，which is commonly seen in elderly women with bad controlled diabetes.It is characterized by non-ketotic hyperglycemia，unilateral involuntary choreiform movements，and contralateral basal ganglia hyper-intensity on T1-weighted MR imaging or high density on CT.Timely insulin therapy may reduce the time of improvement and disappearance of choreiform movements，and improve quality of life in patients.

Hypocalcemic Tetany Caused by Hungry Bone Syndrome：a Case Report and Literature Review　

WANG Yuxia，YU Lu，ZENG Qingcui，LIU Xiaofeng，LONG Huaicong

2019, 22(23): 2889-2892. DOI: 10.12114/j.issn.1007-9572.2018.00.407

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Objective　To summarize the essentials for the rescue and treatment of hungry bone syndrome（HBS） on the basis of the clinical profile of a case of hypocalcaemic tetany caused by HBS treated by us with ICU care and the review of the related studies，in order to improve clinicians' ability to diagnose and treat HBS and their awareness of its serious complications. Methods　We retrospectively analyzed the rescue and treatment process of a case of hypocalcaemic tetany caused by HBS，who admitted to Sichuan Academy of Medical Sciences＆Sichuan Provincial People's Hospital in 23 January，2018. Then，we reviewed the related studies searched from the electronic databases of Wanfang Data Knowledge Service Platform，CNKI，and PubMed. On the basis of the above work，we systematically summarized the causes，diagnosis and treatment of HBS. Results　Our case is a 28-year-old male with primary hyperparathyroidism. He had HBS following parathyroidectomy. The postoperative pathological diagnosis was parathyroid adenoma. He did not receive any regular out-of-hospital care in 30 days after being discharged from out hospital. He was readmitted due to severe hypocalcemia，hypocalcaemic tetany caused by HBS，nodal tachycardia，and decreased blood oxygen desaturation，but was relieved after receiving intravenous injection of 10% calcium gluconate and high-dose continuous infusion of 10% calcium gluconate with the infusion pump. A total of 30 articles about HBS were retrieved，4 of them were published in China，and 26 in foreign countries. A total of 122 patients were analyzed，including 4 cases of hypocalcaemic tetany（3 cases of convulsions in hand and foot and 1 case of aphasia due to tongue twitch），1 case of laryngospasm，2 cases of arrhythmia. HBS can be classified into primary，secondary and tertiary HBS. Primary HBS often occurs after parathyroid adenoma resection，and secondary HBS mostly caused by renal failure. Compared with secondary HBS patients，primary HBS patients have a younger average age，and a shorter average duration of HBS（P<0.001），which may be caused by different causes of HBS. Conclusion　As severe hypocalcemia caused by HBS has a high risk of death，clinicians should diagnose it in time. Primary or secondary hyperparathyroidism patients with a long duration of HBS，elevated levels of preoperative serum calcium，alkaline phosphatase，and parathyroid hormone，and severe bone involvement，are prone to postoperative severe HBS，which can lead to death. So preoperative evaluation and postoperative diagnosis are very important，which are conducive to the improvement of prognosis of the patients.

Acute Myelosuppression Secondary to Inflammatory Bowel Disease Treated with Azathioprine and Mesalazine：a Case Report and Literature Review　

YANG Yuanming，ZHENG Huan，HUANG Shaogang，ZHANG Haiyan，LIN Xiaofeng

2019, 22(23): 2893-2896. DOI: 10.12114/j.issn.1007-9572.2019.00.058

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Azathioprine（AZA） is an immunosuppressant that inhibits lymphocyte proliferation and could be used for inflammatory bowel disease（IBD），but has a high incidence of adverse reactions.We reported a case of IBD in December 12，2017 in Gastroenterology Department of Guangzhou University of Chinese Medicine who had acute myelosuppression after being treated with oral AZA for 18 months，then AZA with mesalazine for 2 months，but relieved after our treatment.In particular，routine blood test results were analyzed in detail.By literature review，we found that such patients have been rarely reported in China，whereas widely studied in abroad.Moreover，we summarized the problems resulting from combination medications for IBD，hoping to increase clinicians' knowledge about this disease and enhance their attention to its clinical diagnosis and management.

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