Table of Content

15 October 2019, Volume 22 Issue 29

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Monographic Research

Interpretation of Nutrition Therapy for Adults with Diabetes or Prediabetes: a Consensus Report　

CHENG Gaiping，YOU Qian

2019, 22(29):  3527-3532.  DOI: 10.12114/j.issn.1007-9572.2019.00.431

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In May 2019，Nutrition Therapy for Adults with Diabetes or Prediabetes：a Consensus Report was published in Diabetes Care.This consensus report intended to provide clinical professionals with evidence-based guidance about individualized nutrition therapy for adults with diabetes or prediabetes.This consensus report included in total of 12 aspects of nutrition therapy and they were effectiveness of diabetes nutrition therapy，macronutrients，eating patterns，energy balance and weight management，sweeteners，alcohol consumption，etc.Focusing on the main contents of the consensus report，this paper compares them with relevant Chinese medical nutrition therapy guidelines and discusses the potential application in light of the actual situation in China.


Vitamin D Deficiency，Gestational Diabetes Mellitus and Its Maternal and Fetal Outcomes　

ZHOU Fang，LI Ping

2019, 22(29):  3533-3538.  DOI: 10.12114/j.issn.1007-9572.2019.00.138

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Gestational diabetes can lead to adverse outcomes in mothers and babies.In recent years，the incidence of gestational diabetes in China has been rising.Vitamin D can improve insulin sensitivity and glucose tolerance，and many studies have shown that vitamin D deficiency is associated with an increased risk of gestational diabetes，while some studies have the opposite conclusion.In addition，most of the studies are observational studies，with few randomized controlled trials.Whether vitamin D supplementation can prevent gestational diabetes is still inconclusive.This article systematically reviewed the risk of vitamin D deficiency and gestational diabetes，and reviewed whether vitamin D supplementation can prevent gestational diabetes，improve glycolipid metabolism and maternal and fetal outcomes in patients with gestational diabetes.


Relationship between Vitamin K and Glucose Metabolism　

REN Ruijun，TAN Jing

2019, 22(29):  3539-3543.  DOI: 10.12114/j.issn.1007-9572.2019.00.551

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Diabetes is a worldwide public health disease that poses a threat to human health.Vitamin K could act on insulin resistance and glucose metabolism via vitamin K-dependent proteins （VKDPS）——osteocalcin （OC），growth arrest-specific 6 protein （Gas-6），and matrix Gla protein （MGP） and adiponectin，inflammatory factors and lipid，which may provide new ideas for the treatment of diabetes.The relationship between vitamin K and glucose metabolism has been tested in many animal experimentations and clinical experiments.


Intracoronary Injection of Atropine versus Temporary Cardiac Pacing for Preventing and Treating Reperfusion Arrhythmia in Emergency PCI for Acute Inferior Myocardial Infarction　

TIAN Kejun，ZHONG Yuting，ZHONG Yiming，WANG Xiaoping，ZHOU Aiqin

2019, 22(29):  3544-3548.  DOI: 10.12114/j.issn.1007-9572.2019.00.422

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Background　In emergency PCI for acute inferior myocardial infarction（AIMI），to prevent and treat the arrhythmia after reperfusion，temporary cardiac pacing or intravenous injection of atropine is often used.But both two methods have insufficiencies.In contrast，intracoronary injection of a small dose of atropine has been found with a remarkable effectiveness and great benefits by First Affiliated Hospital of Gannan Medical University.However，there is no comparative study of intracoronary injection of atropine and intraoperative temporary cardiac pacing for preventing and treating arrhythmia after reperfusion in China.Objective　To compare the efficacy of intracoronary injection of atropine and temporary pacemaker implantation for reperfusion arrhythmia in emergency PCI for AIMI.Methods　122 cases of AIMI who underwent emergency PCI from February 2012 to September 2018 in Cardiovascular Department，First Affiliated Hospital of Gannan Medical University were enrolled.14 cases of them were excluded from intergroup comparison because during the operation，4 received emergency temporary pacemaker implantation due to lack of response to intracoronary injection of atropine，and 10 without bradyarrhythmia following reperfusion did not need to receive the aforementioned two interventions，and the remaining 108 cases were randomized into intracoronary injection of atropine group（n=58），and pre-PCI temporary pacemaker implantation group（n=50）．Onset time of atropine after intracoronary injection（effectiveness criterion：ventricular rate>60 beats/min），time used for temporary pacemaker implantation，and puncture-balloon dilation time，average hospital stay and cost，preoperative and intraoperative average arterial pressure，incidence of bradyarrhythmia，malignant ventricular arrhythmia，maintenance of circulation with dopamine above 10 μg•kg-1•min-1 during and after operation were collected.Results　 The average onset time of atropine after intracoronary injection in the intracoronary injection of atropine group was （11±5）s，which was less than that of temporary pacemaker implantation in the pre-PCI temporary pacemaker implantation group （360±120）s（t=20.54，P<0.001）．Intracoronary injection of atropine group showed less average puncture-balloon dilatation time，average number of hospitalization days per person and average hospitalization expenses per person，lower average arterial pressure and malignant ventricular arrhythmia，and higher incidence rates of bradyarrhythmia than pre-PCI temporary pacemaker implantation group（P<0.05）．Conclusion　Intracoronary injection of atropine has a rapid onset and is helpful to shorten the operation time，reduce hospitalization expenses，and decrease the incidence of malignant ventricular arrhythmia.Moreover，it shows better curative effect in most patients than conventional pre-PCI temporary pacemaker implantation.


Risk of HPV-16/18 Infections in MSM Population：a Latent Class Analysis　

GONG Zheng，ZHANG Zhanlin，YELEDAN?Mahan，TUO Xiaoqing，CHEN Zhen，GULISIYA?Hailili，DAI Jianghong

2019, 22(29):  3549-3553.  DOI: 10.12114/j.issn.1007-9572.2019.00.057

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Background　In recent years，men who have sex with men （MSM） become a group with a high incidence of sexually transmitted diseases（STDs），especially HPV 16/18 infection incidence remains high.HPV infection will develop into STDs if it is not effectively controlled.So it is important to research the main influencing factors for high incidence of HPV 16/18 infection in MSM.Objective　To explore the risk of HPV 16/18 infection in MSM in Urumqi with latent class analysis （LCA），providing a scientific basis for the delivery of targeted interventions for this population.Methods　From March 2016 to August 2017，a survey was conducted in a snowball sample of 884 MSM in Urumqi.Participants' general demographic characteristics，sexual behavior characteristics and HPV infection-related factors were collected.HPV 16/18 genotypes were detected.Class of risk of HPV16/18 infection was identified by LCA.Results　Nine variables including sex，sexual intercourse pattern，commercial sexual behavior，use of drugs，history of sexually transmitted infections，condom use，anal intercourse，sexual orientation and circumcision were included.The AIC and BIC models with 3 potential categories are the lowest and the best models.According to the characteristics of sexual behavior and the related factors of HPV infection，the patients were divided into low risk group （520 cases），medium risk group （290 cases） and high risk group （74 cases）． The infection rates for these groups were 9.2%，14.5% and 24.3%，respectively，and high risk group showed much higher infection rate than low risk group（P<0.05）． Conclusion　LCA can be used to stratify the risk of HPV-16/18 infections in MSM.


Gut Microbiota Assessed by High-throughput Sequencing and Coronary Heart Disease　

LI Junyan，SUN Zhiyuan，YUAN Yu

2019, 22(29):  3554-3560.  DOI: 10.12114/j.issn.1007-9572.2019.00.036

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Background　Coronary heart disease（CHD） is one of the most common causes of deaths in developed and developing countries．The composition of gut microbiota plays an important role in the pathological process of CHD．More and more evidences show that the imbalance of gut microbiota induce lipid metabolism disorder，low-grade inflammation，insulin resistance and elevated blood pressure，increasing the risk of CHD．Objective　To explore the risk factors for CHD by examining the characteristics（including composition and diversities） of gut microbiota in CHD patients，providing a new diagnostic and treatment method for such patients．Methods　This study was conducted in the First Affiliated Hospital of Xinxiang Medical University during July 2016 to June 2017 between 62 cases of CHD from CCU and Cardiovascular Department and 30 health examinees（control group）．CHD patients were divided into mild CHD group（n=27） and moderate-to-severe CHD group（n=35） by Gensini score．Fecal samples were collected，from which DNA was extracted and amplified by polymerase chain reaction in the bacterial 16S rDNA V3 region，and the final PCR amplification products were analyzed by bioinformatics．Results　Mild CHD group，moderate-to-severe CHD group and control group had no significant differences in PE_reads，Nochimera，AvgLen，GC and Effective（P>0.05）．ACE，Chao1，Shannon and Simpson differed significantly among mild and moderate-to-severe CHD groups and control group（P<0.05），and they were much lower in the former two compared with the latter one showed by pairwise comparisons（P<0.05）．The relative abundances of bacteroidetes and proteobacteria differed significantly among control group and mild and moderate-to-severe CHD groups（P<0.05），and the relative abundances of bacteroidetes in the former one were much higher than the latter one，the relative abundances of proteobacteria in the former one were much lower than the latter one （P<0.05）．The relative abundances of bacteroidia and fusobacteria varied significantly among control group and mild and moderate-to-severe CHD groups（P<0.05），and the relative abundances of bacteroidia were much lower in the moderate-to-severe CHD group compared with the mild CHD group，and the relative abundances of fusobacteria were much higher in the moderate-to-severe CHD group compared with the mild CHD group，and and the relative abundances of bacteroidia were much lower in mild CHD group compared with the control group，and the relative abundances of fusobacteria were much higher in mild CHD group compared with the control group（P<0.05）．Mild and moderate-to-severe CHD groups and control group showed significant differences in the relative abundance of bacteroides （P<0.05）．Moderate-to-severe CHD group had much lower relative abundance of bacteroides than the mild CHD group and control group，as did the mild CHD group compared with the control group（P<0.05）．Metastats analysis showed that significant differences were found between the control group and mild CHD group in terms of the relative abundances of bacteroides，Barnesiella，Desulfovibrio，Escherichia Shigella and Phascolarctobacterium（P<0.05），and between the control group and moderate-to-severe CHD group in terms of the relative abundances of Barnesiella，Dialister，Flavonifractor，Parasutterella and Phascolarctobacterium（P<0.05），and between the mild and moderate-to-severe CHD groups in terms of the relative abundances of Desulfovibrio，Dialister，Escherichia-Shigella，Flavonifractor，and Paraprevotella（P<0.05）．Conclusion　Changes in the diversity and structure of gut microbiota are risk factors for CHD．Therefore，regulation of gut microbiota and fecal microbiota transplantation may be used as the new treatments for CHD．


Influencing Factors of Multidisciplinary Perioperative Pain Management　

ZHANG Haijing，LIU Lihui，ZHOU Zhuo，GUAN Lei

2019, 22(29):  3561-3564.  DOI: 10.12114/j.issn.1007-9572.2019.00.317

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Background　Postoperative pain management not only includes pharmacological pain relief management，but also includes collaborative pain relief management involving surgical，anesthetic，nursing，and rehabilitation healthcare workers as well as the patient himself.Multidisciplinary pain management is a kind of scientific and rational tools for pain diagnosis and treatment.Objective　To develop improvement measures for multidisciplinary pain management on the basis of a postoperative pain management survey.Methods　This survey was implemented in a convenience and volunteer sample of 700 surgical patients who received surgery in Beijing Shijitan Hospital，Capital Medical University during October to December 2015.A questionnaire co-developed by multidisciplinary pain management teams from Peking University People's Hospital，and Beijing Shijitan Hospital，Capital Medical University，was used in the survey for collecting the data about postoperative pain management in the patients.And influencing factors of postoperative pain management status were analyzed.Results　All the questionnaires were completed and returned，and 627 of them were found to be responsive，the response rate was 89.6%.In terms of postoperative pain management，366 cases （58.4%） and 221 cases （35.2%） were very satisfied，and satisfied with it，respectively.And 39 cases（6.2%） thought it was OK，only 1 case（0.2%） was dissatisfied with it.Partial correlation analysis found that age，level of pain，and whether receiving pain relief methods from healthcare workers before consulting them when having pain had low correlations with patient satisfaction with postoperative pain management（P<0.05）．Multivariate Logistic regression analysis showed that age 〔OR=1.360，95%CI （1.093，1.692）〕，level of pain 〔OR=2.043，95%CI （1.369，3.047）〕，and whether receiving pain relief methods from healthcare workers before consulting them when having pain 〔OR=5.531，95%CI（2.396，12.770）〕 were the influencing factors of patient satisfaction with postoperative pain management（P<0.05）．Conclusion　Pain assessment is supposed to be performed based on age.Healthcare workers' active introduction of pain-related knowledge and methods of pain relief can effectively improve patient satisfaction with pain management.


Effect of Febuxostat on Incidence of Contrast-induced Nephropathy in Patients with Coronary Heart Disease Complicated with Hyperuricemia　

PAN Zhuang，ZHANG Lihua，NIU Shaohui，JIANG Youxu，LI Yuan

2019, 22(29):  3565-3569.  DOI: 10.12114/j.issn.1007-9572.2019.00.172

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Background　The morbidity and mortality of coronary heart disease（CHD） are increasing year by year.More than 1 million people die from CHD every year.Wide application of percutaneous coronary intervention（PCI） for CHD brings about an incidence of contrast-induced nephropathy （CIN） of 2%-30%，which increases the financial burden of patients and society，and affects the prognosis of such patients.Studies have found that there is a close relationship between serum uric acid（sUA） and CIN，and elevated sUA can increase the risk of CIN.Objective　To investigate the preventive effect of uric acid lowering therapy on CIN in patients with CHD complicated with hyperuricemia.Methods　A total of 100 cases of CHD with hyperuricemia receiving PCI treatment were selected from Department of Cardiovascular，the Second Affiliated Hospital of Zhengzhou University from January 2017 to January 2018，and were randomly and evenly divided into experimental group and control group.Both groups received coronary angiography or coronary stent implantation with secondary prevention therapies for CHD，the difference was that the experimental group took oral febuxostat 40 mg 24 hours and immediately before the surgery，while the control group did not take any drugs for lowering uric acid.Levels of serum creatinine（Scr），sUA and serum cystatin C（Cys-C） measured at 48 hours before surgery and 72 hours after surgery，and the incidence of CIN of both groups were collected and compared.Results　The average sUA and Cys-C levels were much lower in the experimental group（P<0.05），while average Scr was similar in both groups at 72 hours after surgery（P>0.05）．Compared with baseline，the average Scr and Cys-C levels at 72 hours after surgery changed insignificantly in the experimental group（P>0.05），but average sUA level decreased（P<0.05）；in the control group，average Scr and sUA levels had little changes（P>0.05），but Cys-C level increased significantly（P<0.05）．The incidence of CIN was 18.0% （9/50） in the experimental group，and 22.0% （11/50） in the control group，showing no significant intergroup difference （χ2=0.250，P=0.617）．Multivariate Logistic regression analysis showed that age 〔OR=1.362，95%CI（1.030，1.802） 〕，LDL-C〔OR=1.988，95%CI（1.239，3.190）〕，contrast agent dosage 〔OR=1.426，95%CI（1.097，1.853） 〕，Cys-C at 72 hours after surgery〔OR=3.374，95%CI（2.482，4.581）〕were all factors associated with CIN （P<0.05）．Conclusion　Although preoperative uric acid lowering treatment could not reduce incidence of CIN，it could inhibit the increase of postoperative Cys-C level.However，its long-term effect on postoperative renal function still needs to be examined by large-scale clinical trials.


Effects of Dioscin on the Growth of Tamoxifen-resistant Breast Cancer Cells　

CHEN Haiyan，DING Xiaoqing

2019, 22(29):  3570-3575.  DOI: 10.12114/j.issn.1007-9572.2019.00.270

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Background　Tamoxifen is a main drug used for endocrine treatment of breast cancer.It is difficult to treat breast cancer resistant to tamoxifen，and new treatments are needed urgently.Diosgenin（Dio） can inhibit the growth of cancer to some extent.Studying the effect of Dio on the growth of tamoxifen-resistant（TAM-R） breast cancer cells can provide a reference for clinical treatment.Objective　To study the effects of Dio on the growth of TAM-R breast cancer cells.Methods　From January 2017 to June 2018，TAM-R breast cancer cells were cultured.Corresponding experiments were carried out on cell growth and apoptosis，autophagy and apoptotic markers，and anti-cancer proteins.The details are as follows：automated cell counters were used to count the number of TAM-R breast cancer cells in six groups（control，Dio 0.625 μg/ml，Dio 0.800 μg/ml，Dio 1.000 μg/ml，Dio 1.250 μg/ml and Dio 2.500 μg/ml） after being treated by different doses of Dio for five days，and to measure the apoptosis of TAM-R breast cancer cells in 6 groups（control，TAM 10-7 mol/L，Dio 1 μg/ml，Dio 2 μg/ml，TAM 10-7 mol/L+Dio 1 μg/ml，and TAM 10-7 mol/L+Dio 2 μg/ml） treated with different doses of TAM and Dio for three days.Immunoblotting was used to detect the effects of different doses of Dio on TAM-R autophagy markers LC3 and Beclin-1，and apoptotic markers Bax，Bim，pAMPK and p53 proteins in four groups（control，Dio 0.80 μg/ml，Dio 1.25 μg/ml，and Dio 2.50 μg/ml）．Autophagy of TAM-R breast cancer cells treated with Dio and its inhibitors and inducers in six groups（control，Rapamycin 20 nmol/L，Chloroquine 10 μmol/L，TAM 10-7 mol/L，Dio 1 μg/ml，and TAM 10-7 mol/L+Dio 1 μg/ml） was observed by autophagic fluorescence microscopy.Results　The number of TAM-R breast cancer cells differed significantly across different groups （P<0.05）．To be specific，the control group had much less TAM-R breast cancer cells than Dio groups（P<0.05）．The number of apoptotic TAM-R breast cancer cells varied obviously across different groups（P<0.05）．Specifically，the control group showed much less apoptotic TAM-R breast cancer cells than other five groups（P<0.05）．Moreover，TAM 10-7 mol/L+Dio 2 μg/ml group showed significantly less TAM-R breast cancer cells than Dio 2 μg/ml group（P<0.05）．The expressions of LC3，Beclin-1，Bax，Bim，pAMPK and p53 varied significantly across the groups （P<0.05）．Fluorescence microscopy showed that autophagic activity level of TAM 10-7 mol/L + Dio 1 μg/ml group was higher than that of Dio 1 μg/ml group and TAM 10-7 mol/L group.Conclusion　Dio could inhibit the growth of TAM-R breast cancer cells，and strengthen the growth inhibition and apoptosis enhancement effects of TAM on such cells.Moreover，both autophagy and apoptotic marker proteins were also influenced.


Expression and Significance of S1PR1 in Primary Testicular Diffuse Large B-cell Lymphoma Tissue　

LIAO Yedan，LI Mei，CHEN Yun，YU Shunling，ZHOU Yonghong，ZHOU Ling，XIE Lin

2019, 22(29):  3576-3579.  DOI: 10.12114/j.issn.1007-9572.2019.00.315

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Background　 Studies have shown that sphingosine-1-phosphate receptor 1 （S1PR1） can be used as a drug target for the treatment of various diseases.Primary testicular diffuse large B-cell lymphoma （PT-DLBCL） is an extranodal lymphoma with a low incidence but a high degree of invasiveness.The overall prognosis is very poor after treating by existing therapies and it is urgent to find new therapeutic targets.Objective　To explore the expression of S1PR1 in pathological tissue of PT-DLBCL，and analyze its relationship with the prognosis of PT-DLBCL，then to find out the potential of S1P/S1PR1 as a therapeutic target for this disease.Methods　 From Yunnan Cancer Hospital，37 cases of PT-DLBCL and 37 cases of diffuse large B-cell lymphoma （DLBCL） were randomly recruited from May 1994 to March 2016.Immunohistochemistry was used to detect the expressional level of S1PR1 in paraffin wax block with the embedded PT-DLBCL and DLBCL tissues.Clinical data of PT-DLBCL cases were reviewed，and relationship of S1PR1 expressional level with the prognosis of PT-DLBCL was analyzed.Results　 S1PR1 expression level was negative in 45.8%（n=17） of the PT-DLBCL cases，and in 70.3%（n=26） of the DLBCL cases.The prevalence of positive S1PR1 expression level was 54.1%（n=20） in the PT-DLBCL cases，and 29.7% （n=11） in the DLBCL cases，showing a significant difference（χ2=4.497，P=0.034）．The median overall survival （OS） was （21.9±4.6） months and the median progression-free survival （PFS） was （10.1±2.3） months in 20 PT-DLBCL patients with S1PR1 positive expression，and in 17 PT-DLBCL patients with S1PR1 negative expression，the median OS was （71.9±9.6） months and the median PFS was （64.6±10.9）months.3 and 5 years OS rates（15.0% and 10.0%） in the positive expression of S1PR1 were lower than those in the negative expression of S1PR1 （52.9% and 35.3%）（χ2=10.971，P=0.001）．3 and 5 years PFS rates（5.0% and 0） in the positive expression of S1PR1 were lower than those in the negative expression of S1PR1 （35.3% and 23.5%）（χ2=15.833，P<0.001）.Conclusion　The expression rate of S1PR1 in PT-DLBCL was higher than that in intranodal DLBCL，and its expression was related to the prognosis of PT-DLBCL.S1P/S1PR1 has the potential as a therapeutic target for the disease.


Efficacy and Safety of Vonoprazan versus PPI in the Eradication of Helicobacter Pylori：a Meta-analysis　

LUO Hongli，XIAO Shunlin，LI Xiuying，ZHAO Jungang

2019, 22(29):  3580-3585.  DOI: 10.12114/j.issn.1007-9572.2019.00.042

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Background　Eradication of Helicobacter pylori （H.pylori） promotes the healing of peptic ulcer and reduces the incidence of ulcer complications.However，due to increased resistance of H.pylori to antimicrobial drugs and inadequate gastric acid inhibition by some proton pump inhibitors （PPI），the eradication rate of H.pylori is often significantly reduced.Vonoprazan inhibits gastric acid secretion by competing binding sites with potassium ions，which has the characteristics of rapid onset of action，and strong and lasting effect.Objective　To assess the efficacy and safety of vonoprazan-based triple therapy （VTT） versus conventional PPI-based triple therapy （PTT） for the eradication of H.pylori.Methods　Databases of PubMed，EMBase，Cochrane Library，CNKI，VIP and Wanfang were searched from inception to June 30，2018 for clinical studies of VTT（experimental group） versus PTT（control group） for H.pylori eradication.Data extraction and quality assessment of the included studies were conducted following the Cochrane handbook.Meta-analysis was performed by using RevMan 5.2 software.Results　A total of 18 studies with 16 727 patients were included.The results indicated that the eradication rate of VTT was much higher than that of PTT when used as first-line therapy 〔OR=2.34，95%CI（1.94，2.81），P<0.000 01〕.Moreover，subgroup analysis indicated significant superiority of VTT in both patients with clarithromycin-susceptible strains 〔OR=2.03，95%CI（1.30，3.18），P=0.002〕 and those with clarithromycin-resistant strains 〔OR=5.92，95%CI（3.70，9.46），P<0.000 01〕.However，VTT did not show superiority to PTT in second-line therapy 〔OR=1.04，95%CI（0.77，1.40），P=0.81〕.Finally，randomized control trial （RCT） subgroup analysis showed the safety of VTT was better than that of PTT 〔OR=0.71，95%CI（0.53，0.95），P=0.02〕，whereas there was no significant difference in this regard for non-RCT subgroup analysis 〔OR=1.10，95%CI（0.90，1.34），P=0.34〕.Conclusion　The efficacy of vonoprazan is superior to PPI in first-line H.pylori eradication therapy but not in second-line therapy.The safety of vonoprazan appears to be equal or even superior to PPI.Adequate multicenter and high-quality RCT are needed to support our results.



Signal and Evaluation of Adverse Vascular Reactions Associated with Triptans　

ZHOU Hu，YANG Junqing，YU Yue，LYU Yalan，ZHAO Wenlong

2019, 22(29):  3586-3590.  DOI: 10.12114/j.issn.1007-9572.2019.00.008

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Background　Adverse drug reaction （ADR） is one of the major problems in the field of medicine, which may increase the length of stay, economic burden, and risk of death for hospitalized patients.It may even cause major public health incidents, which seriously threaten life and health.Objective　To detect and analyze the ADR signals of triptans after marketing and provide references for clinical rational drug use.Methods　Reporting odd ratio （ROR） was used to investigate adverse reaction signals of triptans in the Adverse Event Reporting System （AERS） of the Food and Drug Administration of the United States from January 2004 to June 2017, and the results were analyzed and evaluated.Results　Totally 5 531 574 reports were found for all drugs, among which 21 905 reports were mainly induced by seven triptan drugs.A total of 502 ADR signals, of which 35 were serious adverse reaction signals, were mainly related to heart, blood and lymphatic system.The high risk signals with clinical reference mainly included coronarospasm 〔ROR=21.17，95%CI（17.00，26.35）〕, cerebral vasoconstriction 〔ROR=35.32，95%CI（25.27，49.37）〕, variant angina 〔ROR=33.00，95%CI（22.96，47.43）〕, vasospasm 〔ROR=25.29，95%CI（17.38，36.81）〕, artery dissection 〔ROR=22.34，95%CI（12.67，39.38）〕, coronary dissection 〔ROR=15.47，95%CI（8.64，27.70）〕, Raynaud's syndrome 〔ROR=4.31，95%CI（2.96，6.35）〕 and others.Conclusion　Studies on ADR signals in the real world are helpful to evaluate the post-marketing safety of drugs and provide references for drug use in clinical medication.


Meta-analysis of the Association of Beta-blocker Use with Falls in the Elderly　

CHEN Shi，YANG Xiangyu，GAO Jing，WU Chenxi，BAI Dingxi，ZHAO Xia，YU Jingya，ZHONG Yizhu

2019, 22(29):  3590-3595.  DOI: 10.12114/j.issn.1007-9572.2018.00.267

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Background　The relationship between antihypertensive drugs and the risk of falls in the elderly is controversial.As a common antihypertensive drug, beta-blocker has a unclear relationship with falls among the elderly.Objective　To systematically evaluate the association between beta-blocker use and falls in the elderly，so as to provide a basis for relevant clinical decision making.Methods　Data of cohort studies and case-control studies of beta-blocker use and falls in the elderly were collected by searching eight electronic databases： PubMed，EMBase，CENTRAL，CINAHL，CBM，CNKI，VIP and Wanfang Data Knowledge Service Platform from inception to November 2017.Two reviewers independently screened studies according to the inclusion and exclusion criteria，extracted data，and assessed methodological quality with the Newcastle-Ottawa Scale （NOS）．Then，data synthesis was performed using RevMan 5.3 software.Results　A total of 13 studies involving 72 539 patients were included （eight cohort studies and five case-control studies）．Meta-analysis of results from cohort studies with a crude OR showed that beta-blocker use did not increase the risk of falls in elderly patients 〔OR=1.07，95%CI（0.98，1.18），P=0.14〕.Moreover，beta-blocker use was still not associated with an increased risk of falls in elderly patients in those studies with an adjusted OR 〔adjusted OR=1.04，95%CI（0.93，1.15），P=0.50〕.Meta-analysis of results from case-control studies with a crude OR showed that beta-blocker use was associated with an increased risk of falls in elderly patients〔OR=1.10，95%CI（1.05，1.15），P<0.000 1〕，while those studies with an adjusted OR indicated that beta-blocker use was not associated with an increased risk of falls in elderly patients 〔adjusted OR=0.95，95%CI（0.90，1.00），P=0.06〕.Conclusion　Meta-analyses of cohort and case-control studies with an adjusted OR showed that beta-blocker exposure did not increase the risk of falls in older adults.In consideration of the quantity and quality of included studies，this result needs to be further confirmed by larger prospective cohort studies.


A Survey of Mobile Phone Dependence and Anxiety，Depression and Sleep Quality amongst Medical College Freshmen　

XU Bixia，ZHANG Bin

2019, 22(29):  3596-3601.  DOI: 10.12114/j.issn.1007-9572.2019.00.126

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Background　With the development of communication technology，mobile phone has become an essential and important carry-on article for college students.Mobile phone can make people more closely connect with each other.However，the development of the internet and various functions of mobile phone may lead to mobile phone dependency in some mobile phone users，especially in college freshmen，a group facing new life，and some of them having no pressures of entering graduate school.Objective　To investigate the association of mobile phone dependency with sleep quality，anxiety and depression in medical college freshmen.Methods　In June 2017，we conducted a survey in a cluster sample of 1 050 freshmen majoring in clinical medicine，stomatology or traditional Chinese medicine of Zhaoqing Medical College.Sociodemographic questionnaire developed by our research group，Chinese version of Mobile Phone Involvement Questionnaire （MPIQ），Pittsburgh Sleep Quality Index（PSQI），Self-rating Anxiety Scale（SAS），and Beck Depression Inventory（BDI）were used in the survey to assess the sociodemographic characteristics，mobile phone dependency，sleep quality，anxiety and depression，respectively.Multiple linear regression was used to examine the associations of mobile phone dependency with sociodemographic factors，sleep quality，anxiety and depression.Results　Altogether，944 of the students responded to the survey，obtaining a response rate of 89.90%.MPIQ score changed significantly according to sex，interest in learning，learning pressure，SAS score and BDI score（P<0.05）．Both interest in learning（r=-0.217），and learning pressure（r=-0.229）were negatively correlated with the MPIQ score（P<0.05）．But SAS score（r=0.114），BDI score（r=0.380）and neck circumference（r=0.110）were all positively correlated with the MPIQ score（P<0.05）．Multiple linear regression analysis showed that sex 〔β=2.713，95%CI（1.394，4.032）〕，interest in learning〔β=-3.040，95%CI（-4.353，-1.728）〕，learning pressure〔β=-3.108，95%CI（-4.374，-1.842）〕，SAS score〔β=2.492，95%CI（0.524，4.459）〕，and BDI score 〔β=1.517，95%CI（1.029，2.005）〕were independent influencing factors for MPIQ score（P<0.05）．Conclusion　Female is associated with higher possibility of having mobile phone dependency.So mobile phone dependency in this group should be paid more attention.Moreover，mobile phone dependency can cause anxiety and depression in medical college freshmen，which should to be highly concerned by families and schools.


Influencing Factors of Hearing Habits on Hearing Loss and Related Symptoms among Medical Students　

ZHANG Baodan，WANG Dahui，CHEN Minyan，MA Haiyan，ZHOU Chi，CHEN Yijia，WANG Danni，CHEN Yuan，REN Ying，ZHU Yajun，XU Liangwen

2019, 22(29):  3602-3608.  DOI: 10.12114/j.issn.1007-9572.2019.00.102

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Background　Recently，many studies have assessed the hearing loss （HL） of elderly people，people across occupational groups，and infants，but few have assessed this issue among medical students in China.Objective　To investigate the status of HL and hearing related symptoms among medical students，and to explore the effect of hearing habits on them.Methods　A total of 1 882 students of four-year （freshman-junior students） and five-year （freshman-senior students） graduation systems were selected by cluster sampling in Medical School，Hangzhou Normal University from March to May 2017.The questionnaire survey and pure-tone hearing tests（PTT）were conducted.The questionnaire comprised three parts：demographic characteristics （age，sex，major，grade），the hearing related symptoms（the occurrence of tinnitus，earache and aural fullness in the last year），and hearing habits（whether to use headphones，type of headphones，frequency of headphone usage，time of headphone usage，time of playing games with headphones，maximum volume of headphone，mode of cell phone conversation，noise environment to improve headphone volume，sleeping with headphones listening to music/radio，frequency of going entertainment places）．The sound-pressure levels of background noise measured at a dedicated sound-isolating room in the university laboratory building were below 30 dB.PTT were measured using a calibrated audiometer （AT235） with standard headphones （TDH-39P）．The speech-frequency HL （>25 dB）and high-frequency HL （>25 dB） were assessed.Factors influencing HL and hearing related symptoms were analyzed by multivariate Logistic regression models.Results　A total of 1 882 questionnaires were sent out，1 882 questionnaires were recovered，1 882 questionnaires were valid，with an effective recovery rate of 100.0%.Pure-tone averages of the right ear were higher than those of the left ear at hearing frequency of 0.125，0.250，0.500，1.000，2.000，4.000，6.000 kHz（P<0.05）．The number of students with speech frequency hearing loss （> 25 dB） was 32 （1.7%），high frequency hearing loss （> 25 dB） was 62 （3.3%），tinnitus was 913 （48.5%），earache was 533 （28.3%） and aural fullness was 502 （26.7%）．Among 1 664 medical students（88.4%）who used headphones，there were 963 （57.9%），610 （36.6%） and 91（5.5%） medical students used earplug，in-ear headphones or headset，respectively.The number of students with frequency of using earphones > 2 times/d was 513（27.3%）.Duration of using earphones was >1.0 h/d among 289 medical students（15.4%）．Duration of playing games with using earphones was ≥1 h/d among 547 medical students（29.1%）．Maximum volume of using earphones was ≥60% among 70 medical students（3.7%）．The number of students making phone calls by earphones was 521（27.6%）．Probability to increase earphone volume in a noisy environment was ≥50% among 1 142 medical students（60.7%）．Frequency of sleeping with earphones while listening to music or broadcast was ≥2 times/week among 158 medical students（8.4%）．Frequency of attending entertainment venues was >3 times/month among 36 medical students（1.9%）．The speech-frequency HL and high-frequency HL rates of the tinnitus group were higher than those in the non-tinnitus group（P<0.05）．The speech-frequency HL and high-frequency HL rates did not show any significant difference among ear pain，and aural fullness（P>0.05）．Sex〔female：OR=0.467，95%CI（0.267，0.816）〕was a factor affecting speech-frequency HL among medical students（P<0.05）．Probability to increase earphone volume in a noisy environment〔≥50%：OR=1.567，95%CI（1.282，1.915）〕 was a factor influencing tinnitus among medical students（P<0.05）．Frequency of using earphones〔>2 times/d：OR=1.443，95%CI（1.151，1.810）〕，and duration of using earphones 〔0.5-1.0 h/time：OR=1.447，95%CI（1.151，1.818）；>1.0 h/times：OR=1.648，95%CI（1.214，2.237）〕were factors of ear pain among medical students（P<0.05）．Sex 〔female：OR=1.338，95%CI（1.061，1.686）〕，duration of playing games with earphones〔≥1 h/d：OR=1.315，95%CI（1.053，1.642）〕，probability to increase earphone volume in a noisy environment〔≥50%：OR=1.398，95%CI（1.126，1.735）〕，and frequency of attending entertainment venues 〔>3 times/month：OR=3.324，95%CI（1.686，6.554）〕were factors for aural fullness among medical students（P<0.05）．Conclusion　The hearing status is not optimistic among medical students.The hearing status of the right ear is worse than that of the left ear.Improper usage of earphones and exposure to damaging sound levels at noisy entertainment venue can cause hearing damage.Bad hearing habits have long-term influence on the hearing of medical students.We suggest that qualified schools add PTT to the entrance examination，and strengthen the health education related to hearing.


Blood Glucose Screening and Its Influencing Factors in First Trimester of Pregnant Women at High Risk of Diabetes Mellitus　

PENG Xiaoxiao，WU Kangjie，MA Xuetao，WANG Jingjing，MA Xiuhua

2019, 22(29):  3609-3613.  DOI: 10.12114/j.issn.1007-9572.2019.00.230

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Background　The incidence of gestational diabetes mellitus is increasing，especially among pregnant women at high risk of diabetes mellitus.Early screening and early prevention are very important.However，at present，the methods and diagnostic criteria of early gestational diabetes mellitus screening are still not uniform.Objective　To study the blood glucose of high-risk pregnant women with diabetes mellitus in early pregnancy and to analyze the effect of related high-risk factors on early hyperglycemia.Methods　Collect the data of high-risk pregnant women with diabetes who were enrolled in the maternity clinic of Daxing Teaching Hospital of Capital Medical University from July 2017 to December 2018，and oral glucose tolerance test （OGTT） was used for diabetes screening before 14 weeks of gestation.Results　A total of 596 pregnant women with high-risk diabetes were screened for blood glucose in the first trimester of pregnancy，including 374 cases （62.75%） with normal blood glucose，190 cases （31.88%） with impaired glucose regulation （IGR）and 32 cases （5.37%） with pre-gestational diabetes mellitus （PGDM）．In the IGR group，4 cases （2.11%） only had elevated fasting plasma glucose （FPG） level，177 cases （93.16%） only had higher 2 hours plasma glucose（2 hPG） level，9 cases （4.73%） had elevated FPG and OGTT 2 hPG level.In the PGDM group，6 cases （18.75%） only had elevated FPG，24 cases （75.00%） had only elevated OGTT 2 hPG level，2 cases （6.25%） had elevated FPG and OGTT 2 hPG.There were significant differences in age，height，weight，body mass index （BMI） before pregnancy，number of pregnancy，number of births，neck circumference，waist circumference，proportions of first-degree relatives with diabetes mellitus，previous gestational diabetes mellitus （GDM） history and hypertension among three groups（P<0.05）.The results of multivariate Logistic regression showed that age 〔OR=1.087，95%CI（1.043，1.132）〕，neck circumference 〔OR=1.126，95%CI（1.049，1.207）〕 and first-degree relatives with diabetes 〔OR=1.763，95%CI（1.209，
2.572）〕 were independent influencing factors of IGR （P<0.05）；age 〔OR=1.131，95%CI（1.040，1.230）〕，waist circumference 〔OR=1.063，95%CI（1.030，1.099）〕，GDM history 〔OR=5.260，95%CI（1.641，16.864）〕 and hypertension 〔OR=6.246，95%CI（1.336，29.188）〕 were independent influencing factors of PGDM （P<0.05）．Conclusion　The incidence of IGR and PGDM in the early pregnancy in high-risk diabetic women is high，and glucose screening only with FPG in early pregnancy would lead to a higher rate of missed diagnosis of IGR and PGDM.Advanced age，neck circumference enlargement，and first-degree relatives with diabetes are independent determinants of IGR.Advanced age，waist circumference enlargement，hypertension，and GDM history are independent determinants of PGDM.


Incidence of Non-diabetic Fetal Macrosomia and Its Influencing Factors　

LI Chun，MA Xiuhua*，CHEN Yi，SONG Fengli，CHANG Hongxia，PENG Xiaoxiao，LIANG Feng

2019, 22(29):  3614-3619.  DOI: 10.12114/j.issn.1007-9572.2019.00.207

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Background　In recent years，with the extensive development and active intervention of screening for gestational diabetes mellitus，the incidence of diabetic macrosomia has gradually decreased.However，the proportion of macrosomia in pregnant women with normal glucose metabolism has increased year by year.Objective　To explore the incidence of non-diabetic fetal macrosomia （NDFMS） and its influencing factors，and to provide relevant evidence for community interventions.Methods　From January 2016 to June 2017，maternity patients who were hospitalized in the Obstetrics and Gynecology Department of Daxing Teaching Hospital of Capital Medical University and the birth weight of whose newborn baby was more than 4 000 g were selected，and 186 women who were excluded from pregnancy with diabetes were selected as the NDFMS group.And 197 women who gave birth to newborns with normal birth weight during the same period were randomly selected as the normal group.General data of maternity women and their spouses，and diet data during pregnancy and exercise-related data were collected in the form of face-to-face interviews within 5 days after delivery.Multivariate Logistic regression was used to analyze the influencing factors of NDFMS.Results　The total delivery volume was 9 942 cases，and 785 cases were fetal macrosomia，including 114 cases of diabetic fetal macrosomia and 671 cases of NDFMS.The incidence rate of diabetic fetal macrosomia was 9.77% （114/1 167），and the incidence rate of NDFMS was 7.65% （671/8 775）．The difference was statistically significant （χ2=6.377，P=0.012）．The proportion of primipara，maternal height，gestational weight gain，spouses' height，daily average staple food intake，daily average sugar intake，and daily average fruit intake in the NDFMS group were higher than those of women in the normal group （P<0.05）．Multivariate Logistic regression analysis showed that the parity 〔OR=0.556，95%CI（0.363，0.882）〕，maternal height 〔OR=1.126，95%CI（1.074，1.181）〕，gestational weight gain 〔OR=1.030，95%CI（1.004，1.056）〕，daily average fruit intake 〔OR=0.998，95%CI（0.997，0.999）〕 was the independent factors affecting NDFMS （P<0.05）．Conclusion　The incidence of NDFMS is the result of multiple factors.The primiparity，maternal height and the gestational weight gain are the high risk factors of NDFMS.Properly increasing the intake of fruit on the basis of reasonable diet may be the protective factor of NDFMS.


Factors Associated with Difficult Mask Ventilation in Emergency Patients　

CHEN Pingxiong，WU Peng，SUN Qiong，QI Yun

2019, 22(29):  3620-3623.  DOI: 10.12114/j.issn.1007-9572.2019.00.268

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Background　Difficult mask ventilation （DMV） leads to oxygenation and ventilatory failure，causing complications，and fatal consequences associated with failed airway management.However，it has rarely been studied as a primary outcome in emergency patients.Objective　To determine the incidence and associated factors of DMV in emergency patients who received tracheal intubation.Methods　Adult patients who received tracheal intubation from November 1，2016 to November 1，2017 in Department of Emergency，Central South University Xiangya School of Medicine Affiliated Haikou Hospital were selected.Potential Risk Factors for Difficult Mask Ventilation Form developed by our research group was used to record and evaluate the potential risk factors of DMV，such as physical and disease characteristics，and history of diseases related to airway anatomy by the consulted physician.Logistic regression analysis was used to determine the risk factors of DMV.Results　A total of 110 cases were included，among whom 51 （46.4%） developed DMV（DMV group），other 59 （53.6%） did not（control group）．DMV group showed higher percentages of having older age，missing teeth，sunken cheeks，a double chin and a short thick neck than the control group（P<0.05）．Multivariate Logistic regression analysis showed that missing teeth 〔OR=3.41，95%CI （1.50，7.76）〕，sunken cheeks 〔OR=1.76，95%CI （1.41，2.18）〕 and double chin 〔OR=24.00，95%CI （11.53，49.90）〕 were risk factors for DMV in emergency patients with tracheal intubation （P<0.05）．The weighted predictive score showed that double chin was the strongest predictor of DMV，with a weighted score of 5，sunken cheeks of 4 and missing teeth of 2.Conclusion　The incidence of DMV is high in emergency patients.Missing teeth，sunken cheeks and double chin are independent risk factors for DMV.


Relationship between Blood Glucose Changes and Hospital Mortality in Patients with Multiple Injuries　

WU Yi，WANG Deyu，ZHAO Xianggeng

2019, 22(29):  3623-3626.  DOI: 10.12114/j.issn.1007-9572.2019.00.081

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Background　Hyperglycemia with unknown mechanism plays a predictive role in determining the prognosis of patients with multiple trauma.However，the time of blood sugar measurement and the role of blood sugar changes in the monitoring of these patients have not been well reported.Objective　To explore the relationship between the blood sugar level at admission （BS） and the blood sugar level at 3 hours after admission （BS3），the difference between them （ΔBS） and their relationship with in-hospital mortality.Methods　Patients with multiple trauma who came to the Department of Emergency，Central South University Xiangya School of Medicine Affiliated Haikou Hospital from September 2015 to September 2017 were selected.After admission，patients were assessed according to Advanced Traumatic Life Support （ATLS）guidelines，and emergency treatment measures were taken.Gender，age，hospital mortality，injury site，vital signs，injury severity score （ISS） and revised trauma score （RTS） were recorded.Blood samples were sent to the laboratory for emergency examination within 20 minutes after admission.The hemoglobin，hematocrit （HCT），BS，BS3，ΔBS，international normalized ratio （INR），lactic acid and base excess （BE） were recorded.Univariate and multivariate Cox proportional hazard regression model was used to analyze the influencing factors of in-hospital mortality in patients with multiple injuries.Results　There were 963 patients with multiple injuries，683 of whom were excluded and 280 were enrolled in the group.Among them，18 cases （6.4%） died in hospital．Multivariate Cox proportional hazard regression analysis showed that：heart rate 〔HR=4.297，95%CI（1.277，14.458）〕，ΔBS 〔HR=2.910，95%CI（1.477，5.733）〕，INR 〔HR=2.228，95%CI（1.346，3.687）〕 were independent influencing factors of hospital mortality in patients with multiple injuries in emergency department （P<0.05）.Conclusion　For patients with multiple trauma，ΔBS maybe helpful in predicting hospital mortality，but further large sample studies are needed.In addition，tachycardia may and coagulation dysfunction increase hospital mortality.


Model Construction and Analysis of Factors Influencing Life Quality of Community-dwelling Elderly from the Perspective of Personality Theory　

HAO Ran，DONG Huan，SONG Yuanyuan，ZHU Yufang，HU Jie

2019, 22(29):  3627-3633.  DOI: 10.12114/j.issn.1007-9572.2019.00.097

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Background　When facing aging population in China，scholars have paid more attention to quality of life among the elderly，especially their mental health.As is known，mental health is determined by internal factors，of which personality traits plays a very important role.However，there is a lack of research on the effect of personality traits on the life quality of the elderly.Objective　To investigate relevant factors，particularly personality traits，that affect the life quality of community-dwelling elders，so as to provide ideas for exploring new nursing interventions.Methods　A cross-sectional survey was conducted by semi-random method from March to August 2017.First，eight communities in Shijiazhuang were randomly selected by lottery，and then the elderly who met the criteria were selected by convenient sampling as subjects.General Data Questionnaire，36-Item Short Form Health Survey （SF-36），General Well-being Schedule （GWBS），Social Support Rating Scale （SSRS），General Self-Efficacy Scale （GSES） and Eysenck Personality Questionnaire （EPQ） were used to investigate the elderly.The influencing factors and their relationship on the quality of life of the elderly was evaluated by multivariate linear regression and path analysis.Results　A total of 450 questionnaires were issued and 436 valid questionnaires were recovered，with an effective recovery rate of 96.9%.In 436 elderly patients，the SF-36 score was （111.4±30.6），the MCS score was （56.8±16.6），the PCS score was （54.6±16.7），the proportion of good，moderate and poor quality of life was 40.1% （175/436），51.6% （225/436），8.3% （36/436），respectively；the GWBS score was （77.0±12.2），the SSRS score was （39.2±8.2），the GSES score was （24.7±4.0），and the score of sub-scale Extraversion （E） in EPQ was （62.7±12.8），the score of sub-scale Neuroticism （N） was （61.2 ±14.4），and the score of sub-scale Psychoticism （P） was （71.3±22.2）．Multivariate linear regression analysis showed that education level （β=-7.724），current monthly income （β=7.229），GWBS （β=1.143），E score （β=-0.249） were factors influencing the quality of life of the community-dwelling elderly （P<0.05）．The results of path analysis further showed that personality traits with E，N and P as the core can influence the quality of life of the elderly through mediating variables，i.e.general well-being.Conclusion　The quality of life of the elderly in Shijiazhuang communities is at a moderate level，which is closely related to the E of personality characteristics.It is suggested that，based on their personality characteristics，specific care interventions need to be formulated to target social support and general self-efficacy for the elderly in the community，so as to improve overall well-being.


Qualitative Research on Somatic Symptoms in Depression　

CHEN Li，JIA Shoumei，LI Ping，LI Yang

2019, 22(29):  3634-3638.  DOI: 10.12114/j.issn.1007-9572.2019.00.023

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Background　It has been found that 65.0% to 98.2% of patients with depression have somatic symptoms，which severely affect the quality of patients' life.To understand patients' experiences can provide better targeted medical services to meet individual needs and improve their quality of life.However，there is a lack of experience and understanding of somatic symptoms in depression at home and abroad.Objective　To understand experience of people with depressive disorder about somatic symptoms.Methods　Fifteen patients with unipolar depression admitted to a psychiatric hospital in Shanghai from October to December 2017 were selected by sampling method，and a semi-structured interview was conducted by descriptive research.MAXQDA10 software was used to organize，encode，classify，induce and extract the topic.Results　Two topics and five sub-topics were extracted，including：（1） descriptions of somatic symptoms in patients，which were mainly in the neuromuscular system，circulatory respiratory system，gastrointestinal system and some symptoms without obvious systemic classification；besides located somatic symptoms，patients also had somatic discomforts that were difficult to explain or could not be accurately located.Physical discomfort experience was more severe than the result of objective examinations；（2） patients' understanding of somatic symptoms，including insufficient understanding of somatic symptoms and the inability to link somatic symptoms to mental disorder.Conclusion　Patients with depression who have various types of somatic symptoms with different degrees can bring adverse effects on patients and reduce their quality of life.Therefore，clinical medical staff should pay more attention to the somatic symptoms of patients with depression.


Value of Game Therapy Combined with Comprehensive Training in Rehabilitation of Children with Spastic Cerebral Palsy　

BAI Yan，WANG Xiuxia，CHEN Haiying

2019, 22(29):  3639-3642.  DOI: 10.12114/j.issn.1007-9572.2019.00.170

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Background　Rehabilitation therapy for children with spastic cerebral palsy is very important，but routine comprehensive training can not achieve ideal benefits.Game therapy can help children release their nature by setting up individualized rehabilitation mode，and stimulating their multiple joints.Objective　To analyze the role and value of game therapy combined with comprehensive training in rehabilitation of children with spastic cerebral palsy.Methods　A total of 260 children with spastic cerebral palsy admitted to the Department of Pediatrics of the Second Hospital of Hebei Medical University from January 2015 to January 2016 were selected as subjects and randomized into training group and combination group，each of 130 cases.Within six months，all children in the training group received comprehensive training，and children in the combination group received comprehensive training combined with game therapy.The changes of fine motor function and fine motor development quotient，the changes of knee flexion angle，and the changes of muscle tension before and after treatment，as well as the rehabilitation benefits were compared between the two groups.Results　After treatment，grasp，visual motor integration scores and fine motor development quotient of the combination group were higher than those of the training group （P<0.05）；of which the two groups were significantly higher than those before treatment（P<0.05）．The knee flexion angle and muscle tension scores of the combination group were lower than those of the training group（P<0.05）；of which the two groups were significantly lower after the treatment （P<0.05）．There was a significant difference in the rehabilitation benefit distribution between the combination group and the training group （Z=15.362，P<0.001），and the excellent and good rate in the combination group was 81.5%（106/130），much higher than that in the control group of 57.7%（75/130）（χ2=17.474，P<0.001）．Conclusion　Game therapy combined with comprehensive training can improve the fine motor function and development quotient，reduce the knee flexion angle and muscle tension in children with spastic cerebral palsy，so as to obtain ideal rehabilitation benefits.


Effect of Early Weight-supported Treadmill Training on Functional Recovery and Bone Tunnel Changes after Anterior Cruciate Ligament Reconstruction　

ZHAO Weiwei，SHAO Chenlan，FU Peng，ZHANG Jianjun

2019, 22(29):  3643-3647.  DOI: 10.12114/j.issn.1007-9572.2019.00.026

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Background　Anterior cruciate ligament （ACL） injury is a common knee injury.Early surgical reconstruction has been a currently recognized treatment，but some patients still have problems such as poor proprioception and decreased walking ability after operation.Body weight-supported treadmill training （BWSTT） is a hotspot in the field of sports rehabilitation in recent years.However，it is mostly used in the walking training of patients with central nervous system injury in clinic.BWSTT has not been widely reported in ACL reconstruction.Objective　To investigate the effect of early BWSTT on functional recovery and bone tunnel changes after ACL reconstruction.Methods　Sixty patients after ACL reconstruction in People's Hospital of Deyang City from May 2017 to May 2018 were selected and randomly divided into observation and control group，each with 30 cases.The control group began progressive lower limb function training one day after operation，while the observation group received early BWSTT one week after operation on the basis of training of the control group，that is，to integrate proprioceptive training into early BWSTT.The recovery of proprioceptive sensation was assessed by electromyography （EMG） at 12 weeks after operation，and the integral electromyogram （iEMG） of electromyography of medial femoral muscle was measured at 12 weeks after operation.Routine MRI at 4 weeks and 12 weeks was used to detect the width of bone marrow canal，signal intensity of graft，and T2 value of tendon and bone node.The motor function was evaluated by 2000 International Knee Documents Committee （IKDC） Subjective Knee Evaluation Scale and Lysholm score.The balance function was evaluated by Fugl-Meyer Balance Scale and Berg Balance Scale （BBS）．Results　The width of bone marrow canal in the observation group at 4 and 12 weeks after operation was narrower than that in the control group，signal intensity of graft and T2 value of tendon and bone node in the observation group at 4 weeks was higher than that in the control group，while the signal intensity of graft and T2 value of tendon and bone node in the observation group at 12 weeks was lower than that in the control group（P<0.05）．The width of bone marrow canal at 12 weeks after operation in both groups was higher than that at 4 weeks after operation，and the signal intensity and T2 value of tendon-bone node were lower than that at 4 weeks after operation （P<0.05）．Reproducibility deviation of passive range of motion （ROM） and iEMG in 0 °-40 °，41 °-80 °，81 °-120 ° in the observation group at 12 weeks after operation were better than those in the control group （P<0.05）．The 2000 IKDC Subjective Knee Evaluation Scale score of the observation group was higher than that of the control group at 12 weeks postoperatively （P<0.05）；the Lysholm score，Fugl-Meyer Balance Scale score and BBS score of the observation group were higher than those of the control group at 4 and 12 weeks after operation （P<0.05）．The 2000 IKDC Subjective Knee Evaluation Scale score，Lysholm score，Fugl-Meyer Balance Scale score and BBS score of the two groups at 12 weeks after operation were higher than those at 4 weeks after operation （P<0.05）．At 12 weeks after operation，the enlargement of bone marrow canal was negatively correlated with Lysholm score and BBS score （r=-0.32，r=-0.35，P<0.05）．Conclusion　Adding proprioceptive training to early walking training can accelerate the recovery of tendon and bone，increase muscle strength and proprioception，and improve motor and balance function.


Clinical Study of Enteral Nutrition Pathway by ‘Sandwich’ Blind Placement of Nasojejunal Tubes　

XIAO Yan，FENG Ping，ZHU Zigui，YAO Hongyi，LIU Wei，HE Chengjian

2019, 22(29):  3648-3652.  DOI: 10.12114/j.issn.1007-9572.2018.00.362

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Background　Early enteral nutritional support therapy for critically ill patients has been widely used in clinical practice.After pyloric feeding through the nasal-jejunal nutrient tube，food reflux in gastric retention，aspiration and other complications can be effectively reduced.However，there is a certain difficulty in placing nasal jejunum nutrient tubes in clinical practice.How to find a quick and easy way to place nasal-jejunal nutrient tube is an urgent problem for clinicians to solve.Objective　To introduce a new method of catherterizing the nasojejunal tube by using "sandwich" method，and to evaluate its safety and clinical value.Methods　In this clinical study，we enrolled 234 patients who needed enteral nutrition therapy in the ICU of Affiliated Nanhua Hospital，University of South China during September 2015 to January 2017.Subjects were divided into endoscope group （51 patients），and “sandwich” group （183 patients）.In endoscope group，we inserted the nasojejunal tube with the assistance of endoscope，and in “sandwich” group，we performed air-nsufflation and wire-guided “sandwich” method.We assessed and compared the catherterizing time，success rate，complication rate and respiratory and cardiac data changes between two groups.Results　The average catheterization time in the “sandwich” group 〔（20±13）min〕 was shorter than that in the endoscope group 〔（24±7）min〕（t=-2.264，P=0.025）.There was no significant difference in the success rate of catheterization between two groups 〔96.7%（177/183） vs 100.0%（51/51），χ2=0.655，P=0.418〕.The complication rate of the “sandwich” group was lower than that of the endoscope group 〔13.1%（24/183） vs 78.4%（40/51），χ2=85.636，P<0.001〕.Heart rate，respiration and systemic pulse oximetry saturation （SpO2） of two groups before catheterization showed no significant difference （P>0.05）.However，the mean arterial pressure （MAP） in the “sandwich” group was higher than that in the endoscope group （P<0.05）.SpO2 of two groups after catheterization showed no significant difference （P>0.05）.However，the heart rate，respiration and MAP in the “sandwich” group were lower than those in the endoscope group （P<0.05）.SpO2 in the endoscope group before and after catheterization showed no significant difference （P>0.05）.However，the heart rate，respiration and MAP in the endoscope group after catheterization were higher than those before catheterization （P<0.05）.There was no statistically significant differences in MAP in the “sandwich” group before and after catheterization（P>0.05）.However，the heart rate，respiration and SpO2 in the “sandwich” group after catheterization were higher than those before catheterization （P<0.05）.Conclusion　The “sandwich” method can shorten the catheterization time，and reduce the occurrence rate of complication.The “sandwich” method is safe，efficient and has less adverse effect on cardiopulmonary function，which is worthy of clinical promotion.