Table of Content

20 September 2019, Volume 22 Issue 27

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Monographic Research

Prevention and Treatment of Chronic Obstructive Pulmonary Disease from the Evolution of GOLD　

LI Fan，SUN Huifen，DUAN Jing，WANG Huanying

2019, 22(27):  3275-3280.  DOI: 10.12114/j.issn.1007-9572.2019.00.383

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According to the latest research，the prevalence of chronic obstructive pulmonary disease（COPD） in Chinese population aged 20 and over is 8.6%，in those aged 40 and over is 13.7%，and in those aged 60 and over is more than 27.0%，and moreover the incidence of COPD will show a further upward trend with the aging of the population，air pollution，and smoking.However，the early diagnosis rate of COPD in primary care institutions is low，and usually the treatment is not standardized.This paper analyzed the clinical hierarchical diagnosis and treatment in the aspects of the primary prevention（causal prophylaxis），secondary prevention（early diagnosis and treatment） and tertiary prevention（clinically standard diagnosis and treatment） of COPD in recent years focusing on the updates and existing problems of GOLD 2019 that have guiding significance for the hierarchical diagnosis and treatment of COPD in primary care.


Standardized Application of Chinese Herbal Medicine in Suspected Acute Liver Failure Caused by Chinese Herbal Medicine　

SHI Jian，YUAN Meng，CHEN Juan

2019, 22(27):  3281-3286.  DOI: 10.12114/j.issn.1007-9572.2019.00.253

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Traditional Chinese medicine（TCM）plays an important role in medicine in China but there are still some shortcomings in selecting targeted and suitable population.Due to the decrease of autoimmunity and poor organ function tolerance in cancer patients，more accurate diagnosis and evaluation of drug regimens should be made in order to maximize the clinical benefits for patients.The authors suggest that it is important to ensure the precise evaluation process and the thinking of Chinese herbal medicine treatment for cancer patients by 1 case with suspected acute hepatic failure caused by TCM，to prevent overtreatment from jeopardizing patients' lives.


Management of Extensively Drug-resistant Acinetobacter Baumannii Colonizes in the Respiratory Tract　

ZHU Sixia，PANG Zaiyuan

2019, 22(27):  3286-3291.  DOI: 10.12114/j.issn.1007-9572.2019.00.087

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Due to the high degree of drug-resistance，extensively drug-resistant Acinetobacter baumannii（XDRAB） is difficult to eliminate by drugs，which increases the risk in clinical treatment.The mortality of the patient is extremely high once bloodstream infection appears.XDRAB has a high detection rate in respiratory tract because it is a respiratory tract colonization bacterium with low virulence，and lax monitoring and control management in hospitals.This paper discussed the following issues：problems existing in the management of respiratory tract colonization of XDRAB，the necessity of respiratory colonization bacteria clearance，the patients who need to remove colonization bacteria，the management of colonization and clearance，and the management of patients who do not need the clearance.Early detection of XDRAB colonization in the respiratory tract and timely clearance or managements of respiratory tract colonization can reduce refractory infections caused by the bacteria and prevent the spread of drug-resistant bacteria.

Research Progress in the Effects of Gut Microbiota on Atherosclerotic Cardiovascular Diseases　

ZHAO Wenyan，CHEN Xi

2019, 22(27):  3292-3297.  DOI: 10.12114/j.issn.1007-9572.2019.00.256

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The morbidity and mortality of cardiovascular disease in the world has been on the rise，among which atherosclerosis cardiovascular diseases（ACVD） is its most common type with a high morbidity，disability and mortality，but current prevention and treatment measures fail to meet clinical needs for ACVD，and new therapeutic strategies are urgently need to be explored.Intestinal flora，as an indivisible "organ" of the human body，has a great influence on the physiological activities of the host.It not only affects the metabolism，neural development，energy homeostasis and immune regulation of the host，but also plays an important role on blood pressure，plasma glucose，serum lipids and the formation of atherosclerotic plaques that are risk factors for ACVD.Therefore，effective regulation of intestinal flora could be a potentially effective method for the prevention and treatment of atherosclerotic diseases.This article reviews the possible mechanisms of intestinal flora affecting atherosclerosis and the commonly used therapeutic measures to regulate dysbacteriosis，in order to provide references for the prevention and treatment of ACVD.


Research Progress on the Relationship between Aging and Its Related Diseases and Gut Microbiota　

LI Nali，YAN Junqing，WEI Jin，WANG Huaizhen

2019, 22(27):  3298-3301.  DOI: 10.12114/j.issn.1007-9572.2019.00.234

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With the increasing trend of global population aging，how to improve the quality of life of the elderly population becomes a global public health problem.As the largest micro-ecosystem of human body，intestinal bacteria play an important role in the process of aging and its related diseases，which has attracted more and more attention of clinicians.This paper summarizes the research progress of senility and intestinal flora at home and abroad，and reviews the factors affecting intestinal flora in the elderly，the characteristics of intestinal flora changes in the elderly，and the metabolites of intestinal flora and their physiological functions and the pathogenic mechanism in order to provide a reference for clinical practice.


Research Progress on the Relationship between Gut Microbiota and Respiratory Diseases　

ZHANG Litao，ZHAO Jing，HAN Hu

2019, 22(27):  3302-3307.  DOI: 10.12114/j.issn.1007-9572.2019.00.425

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Gut microbiota interacts with host immune system in ways that influence the process of diseases.Recent evidence suggests that the gut microbiota plays a key role in immune adaptation and immunologic priming in the gastrointestinal tracts as well as other distal mucosal sites，such as the lung.In this review，we highlight the microbial species that are usually found in healthy gastrointestinal and respiratory tracts，their dysbiosis in diseases and interactions with the gut-lung axis with a particular focus on effects of the intestinal microbiota on respiratory diseases.


Role of Gut Microbiome and Intermittent Fasting in the Treatment of Obesity　

WANG Junyu，ZHANG Anren

2019, 22(27):  3308-3311.  DOI: 10.12114/j.issn.1007-9572.2019.00.452

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Obesity and obesity-related metabolic diseases have become killers threatening human health.Recent studies have shown that obesity has a close relationship with gut microbiome，gut microbiome imbalance and lower intestinal barrier function of host can cause abnormal lipid metabolism，which triggers obesity and obesity-induced metabolic disorders.Diet is the main factor affecting gut microbiome，and unreasonable dietary structure leads to gut microbiome imbalance.A number of studies have shown that intermittent fasting can reshape gut microbiome and significantly alleviate metabolic syndrome such as obesity，which is of great significance to human health.This article elaborates the role of gut microbiome and intermittent fasting in the treatment of obesity，and points out that the combination of gut microbiome and intermittent fasting may promote clinical application of obesity research achievements.


Difference of T Scores in Different Parts of Body among People over 50 Years and Its Clinical Significance　

ZHANG Xiaoqian，LI Na，GAO Hongyu，DUANMU Yangyang，HE Yong，HE Li，CHENG Xiaoguang，ZHANG Qiu

2019, 22(27):  3312-3316.  DOI: 10.12114/j.issn.1007-9572.2019.00.059

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Background　 The commonly accepted diagnostic criteria for osteoporosis are based on the results of dual energy X-ray absorptiometry（DXA）．Most of the measurement sites are waist and hip，and the T score is used to diagnose osteoporosis.However，there are few studies on the difference of T score between different sites and its clinical significance.Objective　To study the consistency of T score of dual-energy X-ray absorptiometry（DXA） in different sites of the body over 50 years and to analyze the difference of T score in different sites and its clinical significance.Methods　 The data of 6 945 individuals who underwent routine physical examination and DXA examination at the Physical Examination Center of the First Affiliated Hospital of Anhui Medical University were collected and calculated.The individuals were devided into groups by age，the data of bone mineral density（BMD） in the population was used as a reference value.On this basis，the T scores of L1~4，L2~4，femoral neck and total hip of male and female patients over 50 years were calculated.Results　The peak BMD of male was in the 20~age group，while that of female was in the 30~age group.There were no significant differences in L1~4 and L2~4 T scores among male over 50 years（P>0.05），the T scores of femoral neck and total hip in each age group were lower than that of L1~4 and L2~4，and the T score of total hip was higher than that of femoral neck（P<0.05）．There were no significant differences in L1~4 and L2~4 T scores among different age groups（P>0.05）；T score of femoral neck in 60~age group was lower than that in 50~age group，T score of femoral neck in 70~age group was lower than that in 60~age group and 50~age group，T score of total hip in 70~age group was lower than that in 50~age group，T score of femoral neck and total hip in 80~age group was lower than that in 70~age group，60~age group and 50~age group（P<0.05）．The T score of L1~4 was lower than that of L2~4 among female over 50 years（P<0.05）．In 50~age group and 60~age group，the T score of L1~4 and L2~4 was lower than that of femoral neck and total hip，but T-value of femoral neck in 70~age group and the T score of L1~4 and L2~4 in 80~age group，was higher than that of femoral neck and total hip（P<0.05）．The T score of femoral neck in 50~age group，60 ~ age group and 70~age group was lower than that of total hip（P< 0.05），except for 80~age group.In terms of L1~4 and L2~4 T scores among different age groups，60~，70~ age group was lower than 50~ age group，80~age group was lower than 60~age group and 50~ age group，the difference was statistically significant（P<0.05）．In terms of femoral neck and total hip T scores among different age groups，60~ age group was lower than 50~ age group，70~age group was lower than 60~age group and 50~age group，80~ age group was lower than 70~ age group，60~ age group and 50~age group，the difference was statistically significant（P<0.05）．Conclusion　Among men over 50 years，T scores of different sites are different，and hip is more significant in the diagnosis of osteoporosis；among womenover 50 years，T scores of different sites are different，the diagnosis of osteoporosis should be made by DXR in lumbar spine and hip in people below 70 years，and hip is a more suitable site in people over 70 years.Considering the difference of T value in different parts of different ages, we should select the appropriate location for evaluation.



Efficacy of Interpersonal Psychotherapy on Patients with Postpartum Depression：a Meta-analysis　

LIU Yan，QI Weijing，HU Jie

2019, 22(27):  3317-3322.  DOI: 10.12114/j.issn.1007-9572.2019.00.290

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Background　Postpartum depression（PPD） is a common mental health problem in parturients.Psychotherapies for PPD includes cognitive behavioral therapy，music therapy，Morita therapy and interpersonal psychotherapy（IPT）．In recent years，IPT focuses on the interpersonal relationship of patients with PPD，and the intervention methods of IPT are simple and easy，so the researches on using IPT to treat PPD are increasing.However，most of the current studies on small sample size are still lacking evidence to prove them.Objective　To explore the efficacy of IPT on patients with PPD by the meta-analysis.Methods　December 2017，Searching on networks and online databases such as PubMed（MEDLINE），EBSCO，EMbase，CNKI，Wan Fang Data，SinoMed and VIP database to collect relative randomized controlled trials（RCTs） in which patients with PPD were treated with IPT.The retrieval time was from the beginning of the database to December 26，2017.The retrieval method was a combination of searching subject term and free words.Strict control was carried out by two researchers to guarantee the quality of references and the eligible RCTs were meta-analyzed.Results　A total of 10 RCTs were included.Edinburgh Postnatal Depression Scale（EPDS），Beck Depression Inventory（BDI） and Hamilton Rating Scale for Depression（HRSD） were used as evaluation indicators to divide 10 RCTs into three groups.When HRSD was used as evaluation criteria，and random effect model was used to include two RCTs，Meta analysis results showed that the total effective rate of the experimental group was higher than that of the control group〔SMD=-6.47，95%CI（-9.92，-3.02），P<0.01〕.When Using BDI and EPDS as evaluation criteria，the meta-analysis results showed that the total effective rate of the experimental group was higher than that of the control group after using the fixed-effect model and sensitivity analysis〔SMD=-1.04，95%CI（-1.21，-0.87），P<0.01〕.Conclusion　IPT has a significant intervention effect on PPD.However，due to the small number of included studies and the wide range of intervention time，more rigorous RCTs are needed in the future.


Curative Effect of Compound Danshen Dropping Pills Combined with Atorvastatin in the Treatment of Carotid Atherosclerosis　

CAO Duanhua，WANG Tingting，YAN Haiyan，HAN Jingzhe，XI Hongyan

2019, 22(27):  3323-3327.  DOI: 10.12114/j.issn.1007-9572.2019.00.308

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Background　Carotid atherosclerosis is a local manifestation of systemic atherosclerosis.Active and effective preventive measures can effectively reduce the incidence of ischemic cardiovascular and cerebrovascular diseases.Atorvastatin calcium tablet can delay the development of atherosclerotic plaques by lowering lipid，but the effect is slow.In recent years，Chinese Traditional Medicine has been widely used in the treatment of cardiovascular and cerebrovascular diseases.Clinical study on the efficacy of compound danshen dropping pills combined with atorvastatin in the treatment of atherosclerosis is not very in-depth.Objective　To explore the effects of compound danshen dropping pill combined with atorvastatin on plasma pentraxin 3（PTX3） and related indexes of carotid atherosclerotic plaques in patients with carotid atherosclerosis（CAS）．Methods　According to the random number table，156 patients with CAS admitted to Harrison International Peace Hospital from March 2016 to February 2018 were divided into control group and research group，with 78 cases in each group.Patients in the control group were given atorvastatin calcium orally，two tablets/time，one time/day，while those in the research group with compound danshen dripping pill，10 pills/time，three times/day，on the basis of treatment in the control group.The course of treatment was two weeks.The clinical efficacy of the patients after treatment was counted.The levels of PTX3，blood lipid〔total cholesterol（TC），triglyceride（TG），low density lipoprotein cholesterol（LDL-C） and high density lipoprotein cholesterol（HDL-C）〕，endothelial function〔nitric oxide（NO） and vascular endothelin 1（ET-1），soluble intercellular adhesion molecule-1（sICAM-1），thromboxane B2（TXB2）〕 and carotid artery color Doppler flow imaging〔carotid intima-media thickness（IMT），carotid artery diameter（CAD） and carotid atherosclerosis plaque area（CASPA） and integral〕 were detected before and after the treatment.The occurrence of adverse reactions was also observed.Results　The clinical efficacy of the research group was significantly higher than that of the control group（u=2.020，P=0.043）．Compared with indicators before treatment，the levels of plasma PTX3，TC，TG and LDL-C significantly decreased in the two groups after treatment（P<0.05），while HDL-C level significantly increased（P<0.05）．After treatment，the serum NO level in two groups was significantly higher than that before treatment（P<0.05），while the levels of serum ET-1，sICAM-1 and TXB2 were significantly lower than those before treatment（P<0.05）．The IMT，CAD，CASPA and plaque integral in both groups after treatment were significantly lower than those before treatment（P<0.05）．No adverse reactions were observed in all patients during treatment.There was no significant change in liver and kidney function indexes.Conclusion　Compound danshen dripping pill combined with atorvastatin can not only effectively improve the plasma PTX3 level in CAS patients，but also stabilize blood lipids，vascular endothelial function and plaque parameters.As being safe as well.


Effects of Levosimendan on Right Ventricular Function in Patients with Acutely Decompensated Heart Failure　

WANG Yanbo，HAO Guozhen，JIANG Yunfa，FU Xianghua，FAN Weize，MIAO Qing，WANG Qing，LI Hongxiao，GU Xinshun

2019, 22(27):  3328-3332.  DOI: 10.12114/j.issn.1007-9572.2019.00.301

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Background　Many positively inotropic agents are used clinically，but their application scopes may be restricted due to increased treatment-related incidence rate of arrhythmia and case fatality rate.Clinical application and research of levosimendan，a new positively inotropic agent，for the treatment of right ventricular （RV） failure are relatively few.Objective　To investigate the effects of Levosimendan on RV function in patients with acutely decompensated heart failure （ADHF）．Methods　This was a single-center randomized controlled trial.A total of 79 cases of ADHF from the Second Hospital of Hebei Medical University were enrolled during January 2017 to January 2018，and were randomly divided into Levosimendan group （n=40） and control group （n=39）．Besides standardized treatment，Levosimendan group received Levosimendan as a 10-min intravenous bolus infusion at 6–12 μg/kg，followed by a continuous 24-h infusion at 0.1 μg•kg-1•min-1，and control group received treatment with a continuous 24-h intravenous infusion of 0.9% normal saline of the same volume.Laboratory parameters，clinical medications，pre- and post-treatment echocardiographic parameters，24-h urine volume during treatment，in-hospital mortality，length of stay，re-hospitalization within 1 month after discharge of both groups were collected and compared.Results　There were no significant differences in left ventricular end-diastolic diameter （LVEDD） and left atrioventricular valve annulus peak early diastolic velocity （e'） between the two groups after treatment for 24 h （P>0.05）．After 24-h treatment，the values of left ventricular ejection fraction （LVEF），left ventricular peak systolic pressure（S'），right ventricular fractional area change （FAC），and right atrioventricular annulus systolic displacement （TASPE） were significantly higher in Levosimandan group compared with those in the control group （P<0.05）．The values of peak early left ventricular diastolic blood flow velocity （E），E/e' and sPAP were lower in the Levosimendan group than those in the control group （P <0.05）．After 24-h treatment，Levosimendan group showed significantly increased values of LVEF，S'，right ventricular FAC，and TAPSE and significantly decreased values of E，E/e' and SPAP （P<0.05）．In the control group，post-treatment values of LVEDD，LVEF，E，e'，E/e'，S'，right ventricular FAC and TAPSE showed insignificant changes compared with the baseline （P>0.05），but the value of SPAP decreased significantly （P<0.05）．The average 24-h urine volume during treatment in Levosimendan group was more than that in the control group （P<0.05），but in-hospital mortality，length of stay，and re-hospitalization within 1 month after discharge in both groups were similar（P>0.05）．Conclusion　Levosimendan may improve the RV function and decrease the pulmonary artery pressure，without increasing the length of stay and rate of re-hospitalization in patients with ADHF.


Effects of Sertraline Plus an Additive Therapy with Folic Acid on Serum Brain-derived Neurotrophic Factor and Homocysteine in Depressive Patients　

SU Zou，DING Ying，CHEN Tingting，XU Yan，WANG Chengqiang

2019, 22(27):  3333-3338.  DOI: 10.12114/j.issn.1007-9572.2018.00.402

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Background　Serum folic acid level is associated with the incidence of depression to some extent.Folic acid，as an additive treatment for depression，can significantly improve the clinical depressive symptoms，but the mechanism is unknown.Objective　To investigate the effects of sertraline plus an additive treatment with folic acid on serum levels of brain-derived neurotrophic factor（BDNF） and homocysteine （Hcy） in depressive patients.Methods　According to the inclusion criteria of this study，we enrolled 100 patients with depressive disorder from Department of Psychiatry，Wuhan Second Mental Hospital from January 2017 to January 2018，and assigned 50 of them to the control group and other 50 to the intervention group，respectively，by use of a random number table.Both groups received routine sertraline therapy，the intervention group additionally received folic acid.All the cases were treated for 8 weeks.Intragroup and intergroup comparisons were made at baseline and at the end of the treatment in terms of serum levels of folic acid，BDNF，Hcy，neural function related factors〔astrocyte-derived protein S100B，myelin basic protein （MBP），neuron specific enolase （NSE），and insulin growth factor-1
（IGF-1）〕，Hamilton Depression Rating Scale （HAMD） and Hamilton Anxiety Rating Scale （HAMA） scores and clinical response.Adverse reactions were assessed by the Treatment Emergent Symptoms Scale （TESS）．Results　After treatment，the intervention group showed significantly increased serum folic acid level compared to the baseline（P<0.05），and demonstrated much higher average serum folic acid and BDNF levels but significantly lower average Hcy level compared with the control group （P<0.05）．After treatment，serum levels of S100B and NSE decreased significantly in the two groups compared to the baseline（P<0.05）；intervention group showed much lower average serum levels of S100B and NSE（P<0.05），but similar average MBP and IGF-1 levels （P>0.05） compared with the control group.HAMD and HAMA scores declined significantly in both groups after treatment（P<0.05）．But the intervention group had much lower post-treatment HAMD and HAMA scores than the control group（P<0.05）．The overall response rate of the intervention group was much higher than that of the control group〔96.0%（48/50）vs 82.0%（41/50）〕 （χ2=5.005，P<0.05）．The intervention group and the control group showed no significant difference in the incidence of adverse reactions〔16.0%（8/50）vs 14.0%（7/50）〕 （χ2=0.078，P>0.05）．Conclusion　Sertraline plus an additive treatment with folic acid can effectively increase serum folic acid and BDNF levels in depressive patients，and reduce the serum levels of Hcy，S100B and NSE.


Correlation between Connexin 43 on Spiral Modiolar Artery and Presbycusis　

SI Chao，ZHANG Zhiping，FAN Zhiru，ZHANG Liang，LI Li，SI Junqiang，LI Xinzhi,MA Ketao

2019, 22(27):  3339-3346.  DOI: 10.12114/j.issn.1007-9572.2019.00.311

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Background　Presbycusis is a kind of disease in which hearing threshold increases slowly with age.Spiral modiolar artery（SMA） plays an important role in maintaining cochlear blood supply and hearing production.Connexin 43（Cx43） is widely expressed in the vascular wall and has an important effect on the vasomotor function，but the relationship between its expression in the cochlear spiral artery and presbycusis is still unclear.Objective　The senile deafness guinea pigs induced by D-galactose（D-gal） were studied to explore the relationship between Cx43 on SMA and presbycusis.Methods　In May 2018，36 specific pathogen free（SPF） guinea pigs aged three months without ear diseases were randomly divided into the Control group，NS group and D-gal group with 12 guinea pigs in each group.On the basis of normal feeding，guinea pigs in the D-gal group and NS group were subcutaneously injected with D-gal 500 mg•kg-1•d-1 and 0.9% sodium chloride solution（the same volume as the D-gal group） respectively in the neck and back，while guinea pigs in the Control group were raised normally without any treatment.All guinea pigs in three groups were raised for six weeks in total.Three neonatal guinea pigs born in the Control group were taken and sacrificed to isolate SMA.The primary SMA vascular smooth muscle cells（VSMCs） were cultured by adherence method.After identification，the 3rd generation of SMA VSMCs was used to prepare cell senescence model.SMA VSMCs in control group were normally cultured for 48 h.SMA VSMCs in aged group were normally cultured with 30 g/L D-gal for 48 h.SMA VSMCs in the AAP10 group were pretreated with 100 nmol/L AAP10 and then cultured with 30 g/L D-gal for 48h.Morris water maze test was used to detect the escape latency of guinea pigs on day 1，2，3，4 and 5 and the number of times of crossing the platform on day 6 in the Control group，NS group and D-gal group.The threshold values of auditory brainstem response（ABR），superoxide dismutase（SOD） activity and malondialdehyde（MDA） level of liver tissue，brain tissue and serum，and Cx43 mRNA on SMA and protein were compared among the Control group，NS group and D-gal group.SOD activity，MDA level and Cx43 expression in VSMCs were compared among the control group，aged group and AAP10 group.Results　There was an interaction between group and time in the escape latency of guinea pigs（Finteraction=6.99，Pinteraction<0.05） and the main effects of group and time were significant（Fintergroup=53.43，Ftime=38.15；Pintergroup<0.05，Ptime<0.05）．The escape latency in D-gal group was longer than that in Control group and NS group on day 3，4，and 5（P<0.05）．The number of times of crossing the platform in D-gal group was less than that in Control group and NS group on day 6（P<0.05）．ABR threshold and MDA level of liver tissue，brain tissue and serum in D-gal group was higher and SOD activity of liver tissue，brain tissue and serum was lower than that in Control group and NS group（P<0.01）．SOD activity in VSMCs in aged group was lower and MDA level was higher than that in control group and AAP10 group（P<0.01）．SOD activity in VSMCs in AAP10 group was lower and MDA level was higher than that in control group（P<0.01）．Cx43 mRNA on SMA and protein expression in D-gal group was lower than that in Control group and NS group（P<0.01）．The expression of Cx43 in VSMCs in aged group was lower than that in control group and AAP10 group（P<0.05） and the expression of Cx43 in VSMCs in AAP10 group was lower than that in control group（P<0.05）．Conclusion　The change of Cx43 expression on SMA in guinea pigs induced by D-gal may be related to presbycusis，which lays a foundation for future clinical follow-up research.


Research Progress of Fall Risk Assessment among the Elderly　

DAI Ting，ZHANG Mengxi，LI Huan，ZHAO Liping2

2019, 22(27):  3347-3352.  DOI: 10.12114/j.issn.1007-9572.2018.00.413

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Falling is the most common event occurred among the elderly，which often causes serious physical，psychological and social burdens on them. However，it can be prevented and controlled. The fall risk assessment for the elderly helps to identify individuals who have high risk to fall，which is significant for preventing falls and injuries. The purpose of the study is to compare the fall risk assessment tools commonly used in China and abroad and to provide a scientific reference for prevention and control of falls among the elderly.


Risk Factors for In-hospital Clostridium Fifficile Infection in Elderly Inpatients with Pulmonary Infection　

DAI Ning，WANG Huan，SUN Ying

2019, 22(27):  3353-3356.  DOI: 10.12114/j.issn.1007-9572.2019.00.302

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Background　In recent years，the rate of Clostridium difficile infection（CDI） has increased rapidly，and the number of serious infections has increased dramatically，especially in the elderly over 60 years old.However，there are few studies on CDI in the elderly in China.Objective　To analyze the associated factors of in-hospital CDI in elderly inpatients with pulmonary infection，to improve the levels of clinical treatment，prevention and control of this disease.Methods　Participants were recruited from Beijing Friendship Hospital，Capital Medical University，from March 2013 to March 2018，including 70 elderly inpatients with pulmonary infection and in-hospital CDI （CDI group），and other sex- and age-matched 70 pulmonary infection inpatients without in-hospital CDI （control group，no CDI occurred during hospitalization）．Clinical data（basic personal data，antibiotic use and other related data） of both groups were retrospectively collected.Influencing factors of in-hospital CDI were analyzed by multivariate Logistic regression analysis.Results　The rates of having at least 3 underlying diseases，in-hospital nutrition support pattern，Barthel index，use of the 3rd-/4th-generation cephalosporins，use of carbapenems，use of antibiotics for at least 1 month，undergoing surgery with general anesthesia in the past 3 months，use of hormones or immunosuppressive agents，use of proton pump inhibitors，and hypoproteinemia as well mean level of CRP differed significantly between the groups（P<0.05）．Nutrition support pattern 〔nasal feeding：OR=4.528，95%CI（1.079，19.004）〕，Barthel index 〔≤40：OR=13.812，95%CI（1.153，165.500）〕，undergoing surgery with general anesthesia in the past 3 months 〔OR=8.358，95%CI（1.566，44.611）〕，use of carbapenems〔OR=5.496，95%CI（1.073，28.163）〕，use of hormones or immunosuppressive agents 〔OR=13.128，95%CI（2.291，75.242）〕，use of proton pump inhibitors 〔OR=4.980，95%CI（1.112，22.305）〕，and hypoalbuminemia 〔OR=5.351，95%CI（1.488，19.246）〕 were associated with increased risk of in-hospital CDI in elderly inpatients with pulmonary infection（P<0.05）．Conclusion　Risk factors of in-hospital CDI in elderly inpatients with pulmonary infection were nasal feeding，Barthel index ≤ 40，undergoing surgery with general anesthesia in the past 3 months，use of carbapenems，use of hormones or immunosuppressive agents，use of proton pump inhibitors and hypoalbuminemia.More attention should be paid to these patients and individualized treatment should be delivered.


Clinical Efficacy of Warming Acupuncture Combined with Acupoint Injection on Low Endometrial Receptivity of Patients Undergoing Frozen-thawed Embryo Transfer after Transhysteroscopic Resection of Polyps　

SU Wenwu，GAO Xiuan，PAN Jialei，GAO Zhiyun，DENG Fang，HE Wanting

2019, 22(27):  3357-3360.  DOI: 10.12114/j.issn.1007-9572.2019.00.326

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Background　In vitro fertilization-embryo transfer（IVF-ET） is one of the main technologies to treat infertility.The treatment of infertility has rapidly improved since IVF-ET appeared.The clinical pregnancy rate of IVF-ET at home and abroad has reached 30%-40% at present.However，many patients still fail after transferring high-quality embryos.It is generally believed that the reason lies in the uterine environment.Endometrial polyps（EPs） are an important cause of uterine environment deterioration.Low endometrial receptivity（ER） after transhysteroscopic resection of polyps（TCRP） will prolong the treatment cycle and reduce the success rate of IVF-ET.How to improve the endometrial receptivity of these patients and make them get pregnant is an urgent problem to be solved now.Objective　To observe the clinical effect of warming acupuncture combined with acupoint injection on low ER of patients undergoing frozen-thawed embryo transfer（FET） after TCRP，and to explore the mechanism of ER improvement by warming acupuncture combined with acupoint injection.Methods　Twenty-seven female patients with low ER after TCRP due to EPs during IVF-ET pregnancy cycle were enrolled from Traditional Chinese Medicine Department，Foshan Maternal and Child Health Hospital from January 2015 to July 2018.They were divided into observation group（13 cases） and control group（14 cases） by random table method.Both groups were given the Progynova after menstruation.In the control group，patients could received FET after ER recovery.In the observation group，patients were treated with warming acupuncture combined with acupoint injection（human placenta tissue fluid），and they could receive FET after ER recovery.The rate of endometrial type a，rate of endometrial and subendometrial blood flow type A，number of high-quality embryos transferred，time spent on FET and clinical pregnancy rate were compared.Results　There were no significant differences in type a rate of endometrium，type A rate of endometrial and subendometrial blood flow between the observation group and the control group after treatment（P>0.05）．There were no significant differences in the number of high-quality embryos transferred and the clinical pregnancy rate between the two groups（P>0.05）．The time spent on FET in observation group was shorter than that in control group（P<0.05）．Conclusion　Warming acupuncture combined with acupoint injection can shorten time spent on FET of patients with low ER after TCRP.The mechanism may enhance the uterine blood flow perfusion，give ER sufficient energy，improve repairing ability after endometrial injury，thus optimizing the uterine environment，reversing the low ER status，and creating good conditions for embryo implantation.


Effects of Cupping Therapy on Protein Kinase C and Phosphoinositide 3-Kinase in Hospitalized Patients with Cardiovascular Diseases　

LAI Jiachun，ZOU Huibiao，DONG Liyun，CHEN Sheng'an，SHEN Guannan，YANG Zefu，ZHAO Xuefeng，XIE Xiangdong，YANG Xili

2019, 22(27):  3361-3365.  DOI: 10.12114/j.issn.1007-9572.2019.00.328

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Background　Current therapeutic options for ischemic cardiovascular diseases mainly include revascularization and pharmaceutical treatments，which are associated with marked short-term effects yet unsatisfactory long-term effects.It has been suggested that transient ischemic attack would induce post-ischemic adaptive changes that are protective for the organism，the mechanism is associated with the activation of protein kinase C （PKC） and phosphoinositide 3-kinase （PI3K），and increased release of endogenous adenosine，etc.Objective　To explore the effects of cupping therapy on serum PKC and PI3K in hospitalized patients with cardiovascular diseases.Methods　In accordance with the inclusion criteria，315 inpatients with cardiovascular disease were selected from Department of Cardiovascular and General，Nanhai District People's Hospital from April 2017 to May 2018.By use of a random number table，they were divided into the control group and experimental group，receiving regular treatment（including lipid-regulating，antiplatelet and blood pressure stabilization therapies），regular treatment with cupping therapy，respectively.Baseline characteristics such as sex ratio，mean age，percents of having smoking history，drinking history，hypertension history，diabetes history and coronary heart disease history，and mean serum PKC and PI3K levels were compared between two groups.The efficacy of treatment was evaluated by changes in mean serum PKC and PI3K levels from baseline to the end of the treatment.If the post-treatment serum PKC and PI3K levels increased by at least 30% of baseline levels，then the treatment is defined as effective.Results　Except for 8 dropouts（3 were discharged prematurely for personal reasons，5 withdrew from cupping therapy early），other 307 cases（158 in the experimental group，149 in the control group） who finished one-week treatment were included in the final analysis.There were no significant differences between the two groups in sex ratio，mean age，percents of having smoking history，history of alcohol intake，history of hypertension，history of diabetes，or history of coronary heart disease （P>0.05）．In terms of serum PKC，there were 28 responders and 121 non-responders in the control group，and 117 responders and 41 non-responders in the treatment group，indicating the experimental group obtained a higher response rate （χ2=97.07，P<0.01）．In terms of serum PI3K，there were 25 responders and 124 non-responders in the control group，and 126 responders and 32 non-responders in the treatment group，indicating higher response rate was achieved in the experimental group （χ2=121.65，P<0.01）．Post-treatment serum PKC and PI3K levels increased significantly in the experimental group compared with baseline（P<0.05）．Conclusion　For hospitalized patients with cardiovascular diseases，cupping therapy in combination with regular treatment could up-regulate serum PKC and PI3K.As a TCM treatment，cupping therapy is easily accepted and shows a significant superiority in clinical application.


Effects of Electro-acupuncture at Ashi Acupoint at Different Time Points on High-frequency Ultrasound Imaging Score and Serum CK in a Rat Model of Gastrocnemius Contusion Injury　

ZHU Shipeng，YUAN Ya，LIU Tong，ZHANG Zhaohui，YE Xinhua，ZHOU Jingzhu，CHEN Huan，ZHANG Qiande

2019, 22(27):  3366-3372. 

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Background　Ashi acupoint is a commonly used acupoint for the treatment of skeletal muscle injury by acupuncture and moxibustion.However，the timing of intervention for acute skeletal muscle injury has not been reported.Objective　To investigate the effects of electro-acupuncture（EA） at Ashi acupoint at different time points on high-frequency ultrasound-based gastrocnemius（GM） contusion injury score，and serum CK in a rat model of GM contusion Injury.Methods　In September 2017，60 male Sprague-Dawley （SD） rats were randomly divided into blank group （n=6），model group （n=18），24 h EA group （n=18） and 72 h EA group（n=18）．Except the blank group，other three groups were treated with the method developed by our research group（put forward in a previous study of ours） for establishing the acute contusion model of GM muscle，and ultrasound imaging technology was used to evaluate the modeling.As rats can not talk like humans，we selected the midpoint of the injured GM muscle abdomen，identified with ultrasound guidance，as the needling site.Except the blank group，6 rats in each group were captured at the 3rd，5th and 7th days（each time different ones were captured） after modeling to receive the following interventions：rats in 24 h EA group，72 h EA group were given the first EA treatment at 24，72 hours after GM muscle injury，respectively.Rats in model group were grasped and fixed by the same way simultaneously，but received no EA treatment.The blank group received no intervention.High-frequency ultrasound examination of injury severity and ultrasound-based GM injury scoring of rats in each group were performed at the 3rd，5th and 7th days after modeling，respectively，then they were sacrificed in batch to test serum CK value.Results　There were no significant differences in ultrasound-based GM injury score evaluated immediately，on the 3rd，5th，and 7th days after modeling among the model group，24 h EA group，and 72 h EA group （P>0.05）．On the 3rd day after modeling，the difference of ultrasound-based GM contusion injury score between the interventional time point and immediately after modeling in the 24 h EA group was higher than model group，72 h EA group （P<0.05）．The serum CK levels on the 3rd，5th and 7th days after modeling in the model group were all higher than those in the blank group （P<0.05）．The serum CK levels in 24 h EA group on the 5th and 7th days after modeling were both higher than the blank group（P<0.05）．In 72 h EA group，the serum CK level was lower than that of the model group on the 3rd day after modeling，and higher than that of blank group on the 5th and 7th days after modeling （P<0.05）．Conclusion　EA at the Ashi acupoint improved the GM contusion injury in rats.And applying EA treatment at 24 hours after injury may promote the repair earlier.


Primary Immune Thrombocytopenia with Multiple Intracranial Hemorrhage：Report of One Case and Literature Review　

HUANG Weiqi，ZHOU Yongming

2019, 22(27):  3373-3376.  DOI: 10.12114/j.issn.1007-9572.2019.00.053

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Cerebral hemorrhage and visceral hemorrhage are the most serious complications of primary immune thrombocytopenia （ITP），which are commonly seen in hematonosis patients，with extremely high mortality.We reported the clinical diagnosis and treatment of one case of ITP with multiple intracranial hemorrhages.The patient had been diagnosed with thrombocytopenic purpura for more than 20 years.During this period，she had suffered from 3 times of intracerebral hemorrhage involving multiple compartments and one time of gastrointestinal hemorrhage.As the amount of bleeding was not large，she has good survival，which is rarely seen clinically and may be related to the actions of other hemostatic mechanisms.Moreover，on the basis of the reviewing of related studies，we found some effective prevention and treatment measures for ITP，in order to offer some assistance for clinicians.


Enzyme Replacement Therapy for Infantile Glycogen Storage Disease TypeⅡin Three Cases and Literature Review　

XU Lingling，BA Hongjun，LI Suping，LIANG Yujian，HUANG Xueqiong，ZHANG Lidan，PEI Yuxin，HUANG Huimin，ZHANG Cheng，TANG Wen

2019, 22(27):  3377-3382.  DOI: 10.12114/j.issn.1007-9572.2019.00.347

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Background　Children with infantile glycogen storage disease typeⅡ（GSD Ⅱ） have critical clinical manifestations.Without recombinant human acid alpha-glucosidase replacement therapy，they often die of heart failure or respiratory failure before the age of 1 year.At present，there is a lack of evaluation on the efficacy of enzyme replacement therapy（ERT） for GSD Ⅱ in China.GSD Ⅱ always is the most severe form and is characterized by cardiomyopathy，respiratory distress.And they generally results in death within the first year of life without ERT.Objective　To summarize ERT for infantile GSDⅡ，so as to provide reference for clinical treatment.Methods　Clinical data of three patients with infantile-onset GSD Ⅱ was collected at the First Affiliated Hospital，Sun Yat-sen University from March 2016 to December 2017.Myocardial hypertrophy and myasthenia were found in all patients，and GAA activity in peripheral blood was lower than normal.Recombinant human acid alpha-glucosidase enzyme therapy（20 mg/kg,1 time/14 days） was used in all patients.The vital signs，respiratory status，muscle strength，alanine aminotransferase（ALT），aspartate aminotransferase（AST），lactate dehydrogenase（LDH），creatine kinase（CK） and chest X-ray examination were observed and performed.Results　The main symptoms of three cases were limb weakness and dyspnea at the beginning of treatment.One case successfully weaned from the ventilator and two cases died after giving up treatment.After recombinant human GAA replacement therapy，muscle strength of three children improved significantly，ALT decreased in 2 cases and increased in 1 case；AST decreased in two cases and increased in one case；LDH decreased in one case and increased in two cases；CK decreased in two cases and increased in one case；chest X-ray examination showed large cardiac shadow in three children before treatment；after treatment，chest X-ray examination showed reduced cardiac shadow of children No.1 and No.2，and no significant change in children No.3.After treatment，the interventricular septum thickness decreased in three cases and left ventricular ejection fraction increased in three cases by color Doppler echocardiography.Conclusion　After reviewing literatures，recombinant human GAA replacement therapy for infantile GSD II is safe and effective，and can significantly improve cardiac function，muscle strength and respiratory function in patients.


Characteristics of Rheumatoid Arthritis with Lung Cancer：a Clinical Analysis of Nine Cases　

ZHANG Guohua，WANG Yuhua，ZHANG Lingling，GAO Lan，LUO Junli，ZHAO Miansong

2019, 22(27):  3383-3386.  DOI: 10.12114/j.issn.1007-9572.2019.00.055

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Objective　To investigate the clinical features of rheumatoid arthritis（RA） with lung cancer，increasing clinicians' knowledge of the disease.Methods　General information，clinical manifestations，laboratory indicators，pathological types and clinical stages, treatment and prognosis of inpatients diagnosed as RA with lung cancer，who were admitted to Beijing Shijitan Hospital from January 2011 to December 2017，were retrospectively analyzed.Results　 Of the total RA inpatients treated in the hospital during the same period，the enrolled 9 cases accounted for 0.57%（9/1 561），including 4 males，and 5 females.The average age at RA diagnosis was（53.7±19.6） years （range，25-80 years），and that at lung cancer diagnosis was（73.8±10.8） years（range，58-89 years），indicating that the average interval from RA diagnosis to lung cancer diagnosis was（20.1±19.5） years（range，3-50 years）．Joint swelling and pain were found in all the cases，and joint deformity were found in 2 cases.Initial symptoms of cough and expectoration were found in 3 cases.Rheumatoid factor test was underwent in 8 cases，and 5 of them were detected with positive results.Serum CYFRA21-1 increased in 7 cases，and CEA increased in 6 cases.Adenocarcinoma was the pathological subtype in 7 cases，together with poorly differentiated squamous cell carcinoma in 2 cases.Of the 9 patients, 8 were stage ⅣA patients, and 1 had no stage.Hormone and/or immunosuppressive therapies were given to 6 cases，and chemotherapy and/or targeted therapy were given to 5 cases.8 cases were diagnosed with stage Ⅳ lung cancer，5 of them died later，other 3 had brain and thoracic metastasis despite of active treatment.Conclusion　Patients with RA and lung cancer showed high mortality and poor prognosis with adenocarcinoma as the predominate subtype.In view of this，tumor markers should be regularly monitored in RA patients，which is helpful for early detection of lung cancer and improvement of prognosis.


Visualization Analysis and Prospect of General Practitioner Research Based on Knowledge Mapping　

LI Hongyan，HUANGFU Huihui

2019, 22(27):  3387-3394.  DOI: 10.12114/j.issn.1007-9572.2019.00.348

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Background　General practitioners are a major force in safeguarding and maintaining people's health in the new situation.With the development of general practice，studies on general practitioners（GPs）have gradually increased.Evaluating the research on GPs objectively is a prerequisite for advancing the practice of the GP system.Objective　To perform a quantitative study of the number of articles about GPs，distribution of journals，authors，institutions and keywords using Citespace and Ucinet，and to systematically analyze the course and research progress of studies about GPs，and to predict the corresponding research focus and development direction on the basis of literature review，laying a solid basis for further research.Methods　From January to March 2018，we did an advanced retrieval of the articles about GPs included in CNKI database during 1986—2017 using “family doctor or family doctor system or general practitioner or general practitioner system” as the search title，“all journals” as the data source category，and “accurate” as the matching degree.A total of 3 067 articles were searched preliminarily，and the number of articles and journals in which they published were analyzed.After excluding the non-conforming and repetitive ones，1 836 articles closely related with our research topic were included，and the author distribution，institution distribution and keywords distribution were analyzed.Results　From 1986 to 2017，the number of published articles showed an overall growth trend，with local fluctuations.According to the growth rate and changes，the number of articles published in this period can be divided into the following stages：1986—1996 was the budding stage of GPs research；1997—2010 was the exploratory stage of GPs research；2011—2017 was the rapid development stage of GPs research.All of the articles were published in medical journals，1 021of them were published in Chinese General Practice，accounting for the largest percent.BAO Yong（35 articles），LU Xiaoqin（20 articles），ZHAO Yali（20 articles）were the top 3 prolific authors.High levels of cooperation were found in three teams：the team consisting of BAO Yong，DU Xueli，ZHANG An，LIANG Ying，and SUN Wei，the team composed of HU Shanlian，HE Jiangjiang，and XIE Chunyan，and the team of LIANG Hong，LU Wei，ZHANG Yimin，and HUANG Jiaoling.The most prolific period for WU Chunrong，ZHANG An and BAO Yong，FANG Yuting，DU Xueli，and LIANG Ying was 2002—2003，2011—2014，2011—2013，2011—2012，2012—2014，respectively.About 190 institutes published GPs articles，among which the top three were the School of General Practice and Continuing Education，Capital Medical University（41 articles），School of Public Health，Shanghai Jiao Tong University（18 articles），and School of Public Health，Fudan University（17 articles）．The mainly used keywords were general practitioner，family doctor，community health services，and so on.Research contents mainly focused on education，training，hierarchical diagnosis and treatment，health management，influencing factors，contracted services，chronic disease management，etc.The research methods mainly used were qualitative method，questionnaire survey and so on.The keywords were clustered into 17 classes，and were frequently seen in articles about international implementation experience of GP system，GP service model，GPs' performance evaluation，GPs' service capabilities，and effectiveness of GP services.Keywords frontier trend analysis：1986—1996 was the theoretical basis stage of GP research；1997—2010 was the expanding stage of the research scope and transformation stage of from basic theoretical research to applied research；2011—2017 was the stage of gradually turning to GP system implementation effect evaluation and other aspects.Conclusion　GP research is relatively abundant，but there are still some problems，such as insufficient aftereffect analysis，research horizon to be expanded，and relatively lack of dynamic research.It is suggested to constantly strengthen the unity of research in this field，focus on the core issues of GP services，and formulate goals and orientations suitable for contemporary and sustainable development.


Knowledge Mapping Analysis of Research Fields about Family Doctors　

ZHANG Xiaoyan，ZHANG Xiaona，YANG Shiyu

2019, 22(27):  3395-3400.  DOI: 10.12114/j.issn.1007-9572.2019.00.212

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Background　The contracted family doctor service is an important part in the implementation of the hierarchical medical system and the contracted rate，model and service contents are key points explored by scholars.However，there are not many literatures on the visual analysis of research fields about family doctor to detect hot topics and trends in this field.Objective　This study explores relevant research literatures by searching China National Knowledge Infrastructure（CNKI） Database and Wanfang Data Database to detect hot topics and development trends in the research field of family doctors.Methods　On 3 June，2018，family doctors，general practitioners，community doctors were used as the keywords to search related literatures published in CNKI Database and Wanfang Data Database from 2011 to 2018.The hot topics and future trends in the research field of family doctors in China were detected based on the results of analysis，such as the number，geographic location，keyword co-occurrence，research trends，burst terms，and clustering maps of publications.Results　A total of 2 565 publications were retrieved.After excluding newspapers，repeated publications and documents that were clearly unrelated，867 articles were selected as the final source of analysis.The analysis results showed that from the perspective of the number of research institutions，there were 87 research institutions participating in the research of family doctors，and the top ten research institutions in the number of publications were Fudan University（44 publications），Peking University（17 publications） and Capital Medical University（17 publications），Chongqing Medical University（16 publications），Shanghai Pudong Health Development Research Institute（13 publications），Shanghai Jiao Tong University（12 publications），Shanghai Institute of Preventive Medicine（10 publications），Shanghai Pudong New Area Weifang Community Health Service Center（10 publications），Hainan Normal University（10 publications），and Guangzhou Medical University（9 publications）．Geographically，the top ten research institutions in the number of publications like Fudan University，Chongqing Medical University，Shanghai Pudong Health Development Research Institute，Shanghai Jiao Tong University，Shanghai Institute of Preventive Medicine，Shanghai Pudong New Area Weifang Community Health Service Center，Hainan Normal University and Guangzhou Medical University were located in the south of China.From the perspective of keyword co-occurrence，community health services，family doctors，general practice，hierarchical diagnosis and treatment，general practitioners，and health management were frequently occurring，which showed that these aspects were the focus of researches in the field.From the perspective of research trends，from 2011 to 2014 there were macro vocabularies such as community health services，family doctor services，general practice，family doctor system，health management，and contracted services.From 2015 to 2018，diabetes，hierarchical diagnosis and treatment，analysis of influencing factors，contracted family doctor service model，and training appeared.From the perspective of burst terms，community health，general practice，family doctor，health management，and influencing factors emerged.From the perspective of clustering map，after the visual analysis，there were seven clusters including general practitioners，health management，policy advice，family doctor kind services，family doctor services，training，and satisfaction.The research hot topics and development trends in the field of family doctors were health management，general practice education，and contracted family doctor services.Conclusion　Health management，general practice education and contracted family doctor services are the hot topics of research field about family doctors in China.The development tends focus on disease prevention and health management of key populations，general practice education，standardized training，contracted service model and service forms.