Chinese General Practice

Suggestions for Domestic Primary Stroke Care Arising from Epidemiological Characteristics，Prevention and Treatment of Stroke in China　

JIANG Bin

2019, 22(30): 3653-3661. DOI: 10.12114/j.issn.1007-9572.2019.00.445

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Stroke is the leading cause of death among Chinese residents，which is a public health problem that endangers health.Stroke is characterized by high morbidity，mortality and disability，which brings heavy burden to patients，families and society.With the development of economy and the change of lifestyle of residents in China，epidemiological characteristics of stroke in the population have changed markedly.Although some progress has been made in stroke prevention and treatment in China，which is far from enough to meet the needs.Community-based strategies for stroke prevention and treatment mean that priority should be given to efforts to strengthen stroke services at the grass-roots level.This paper reviews the epidemiological characteristics，prevention and treatment of stroke in China recently，with a focus on analyzing the needs and problems of stroke prevention and treatment in primary health care in China，hoping to provide evidence-based recommendations for primary stroke care in China.

Dietary Protein Intake and Skeletal Muscle Mass in Elderly People in the Community　

CHEN Yanqiu，ZONG Min，LI Shijie，XIE Hua，WANG Yan，YANG Qing，SUN Jianqin

2019, 22(30): 3662-3666. DOI: 10.12114/j.issn.1007-9572.2019.00.239

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Background　Dietary protein intake and distribution in each meal have received increasing interest.An even distribution of protein intake throughout the day in meals can maximally stimulate muscle protein synthesis to maintain or increase muscle mass.This would be a particularly important strategy for older individuals experiencing sarcopenia and obese individuals losing skeletal muscle mass during energy-restricted diets.Objective　To investigate the correlation of daily dietary protein intake and distribution with skeletal muscle mass in community-dwelling elderly people in Shanghai.Methods　In 2017，a total of 329 elderly people were recruited from four communities（Shimenerlu Community，Chuncheng Community，Lvdi Community and Jiangsulu Community） in Shanghai.General personal characteristics were collected，including sex，age，BMI，skeletal muscle mass，body fat content and history of disease.Three-day food record was used to assess the daily dietary energy，relative daily protein intake，and daily fat intake in three consecutive days.Dietary nutrient intakes were calculated using SY nutrition software developed by Shanghai Clinical Nutrition Quality Control Center & Shanghai Medical College，Fudan University.Results　Among the 329 subjects，116 were males，and 213 were females.The mean age was（69.8±6.4） years.All of them returned effective questionnaires，with a response rate of 100.0%.Compared with women，men had higher average dietary energy，fat intake and carbohydrate intake（P<0.05）．Of the subjects，7.0%（23/329） at least consumed 2 meals of ≥30 g protein/meal，21.6%（71/329） consumed 1 meal of ≥30 g protein/meal，71.4%（235/329） did not consume any meals of ≥30 g protein/meal per day.The frequency of protein consumption（≥30 g/meal） differed significantly by BMI，skeletal muscle mass and body fat content（P<0.05）．Multiple linear regression analysis showed that having 1 meal and ≥2 meals of ≥30 g protein/meal per day instead of having no such meal were independent influencing factors of skeletal muscle mass in the elderly（P<0.05）．Sex-based subgroup analyses showed that having ≥2 meals of ≥30 g protein/meal per day was an independent influencing factor of skeletal muscle mass in elderly men（P<0.05），and having 1 meal and ≥2 meals of ≥30 g protein/meal were independent influencing factors of skeletal muscle mass in elderly women（P<0.05）．Age-based subgroup analysis found that having 1 meal and ≥2 meals of ≥30 g protein/meal per day were independent influencing factors of skeletal muscle mass in 60-79-year-old people（P<0.05）．BMI-based subgroup analysis revealed that having 1 meal and ≥2 meals of ≥30 g protein/meal per day were independent influencing factors for skeletal muscle mass in those with BMI<24 kg/m2，and those with BMI≥24 kg/m2，respectively（P<0.05）．Dose-response analysis demonstrated that when having 1 meal of 40 g protein/meal or at least 2 meals of 35 g protein/meal per day，the skeletal muscle mass tended to be stable.Conclusion　Only a few elderly people in the community consumed at least 1 meal of ≥30 g protein/meal per day.An even distribution of protein across the day in meals（≥30 g/meal） may increase or retain the skeletal muscle mass.Moreover，the consumption of 2 meals with protein content of 30-35 g per meal might be an important strategy for increasing or maintaining skeletal muscle mass in elderly people.

Difference of Myocardial Repolarization Dispersion in Patients with Acute Ischemic and Hemorrhagic Stroke　

LI Minglan，PAN Biyun，CHEN Shiyin，WEN Da，WANG Yanying

2019, 22(30): 3667-3671. DOI: 10.12114/j.issn.1007-9572.2019.00.522

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Background　Patients with acute stroke often have changes in electrocardiogram （ECG） and discrete markers of cardiac repolarization to identify high-risk patients with malignant arrhythmic events.There are studies on the correlation between the two abroad，but few in China.It is of great significance to explore the difference of myocardial repolarization dispersion and its correlation with prognosis in different types of stroke patients.Objective　To evaluate the myocardial repolarization dispersion ndexes of cardiac repolarization in patients with acute ischemic stroke and hemorrhagic stroke and different stroke sites，and to explore the possible correlation between myocardial repolarization dispersion indexes and neurological severity（National Institutes of Health Stroke Scale score，NIHSS score） and disability （Modified?Rankin?Scale score，mRS score）．Methods　The clinical data of 63 patients with acute ischemic and hemorrhagic stroke in the Department of General Practice，Central South University Xiangya School of Medicine Affiliated Haikou Hospital/Haikou People's Hospital from January 1 2017 to December 31 2017 were retrospectively collected and analyzed.Data of myocardial repolarization dispersion indexes were obtained by 12-lead electrocardiogram at admission，including QT dispersion in V5 lead，QTc dispersion，TpTe dispersion and TpTe/QTc，the maximum value of QT，QTc and TpTe in other leads..The differences of cardiac muscle repolarization dispersion between different stroke types and different brain lesions were compared，and the correlation between myocardial repolarization dispersion indexes and NIHSS scores at admission and discharge and mRS scores at discharge were evaluated by Spearman rank correlation method.Results　Among 63 patients，55 were ischemic stroke（ischemic stroke group） and 8 were hemorrhagic stroke（hemorrhagic stroke group）；TpTe/QTc in V5 lead in hemorrhagic stroke group was higher than that in ischemic stroke group （P=0.034）；the maximum value of QT in insular lobe lesion group was higher than that in non-insular lobe lesion group；the maximum value of QT in non-brainstem lesion group was higher than that in brainstem lesion group（P<0.05）．There was no significant difference in myocardial repolarization dispersion between left and right brain lesions（P>0.05）．There was a correlation between the maximum QT at admission and NIHSS and mRS scores at discharge（rs=0.561，0.346；P=0.04，0.02）．Conclusion　Among myocardial repolarization dispersion indices，TpTe/QTc in V5 lead is associated with hemorrhagic stroke，and the maximum value of QT is associated with insular lesion，neuropathy and disability.

Influence Factors of New-onset Hypertension among Kazakh Herdsmen：an Analysis with the Cox Proportional Hazards Model　

WANG Jiawei，FAN Qiongling，LUO Yuanyuan，ZHAN Huaifeng，WANG Hongjun，CHEN Rui，XU Yuezhen，TAO Ning，YOU Shuping

2019, 22(30): 3672-3678. DOI: 10.12114/j.issn.1007-9572.2019.00.358

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Background　The Kazakh herdsmen in Xinjiang are one of the five ethnic groups with the highest prevalence of hypertension in China.Due to long-term living on cold and arid areas of the plateau，unique lifestyle and eating diet，as well as behavior exposure，the prevalence of hypertension and other chronic diseases is increasing，seriously impairs the Kazak herdsmen's physical health.So exploring the incidence rate and predictive factors of new-onset hypertension in this population，can prevent and control hypertension targetedly.Objective　To investigate the prevalence and predictors of new-onset hypertension among Kazakh herdsmen in Xinjiang pastoral area，to provide a reference for prevention and treatment of hypertension in pastoral area.Methods　A prospective cohort study design was used.From the persons undergoing physical examination between January 2008 and December 2010 in Urumqi County Hospital/Health Center，Kazakh herdsmen were selected by use of stratified cluster sampling and the ratio of each subordinate town population to Urumqi County population，and were given a follow-up every two years during 2014 to 2018，and 5 327 cases of them with complete follow-up data were included in the study finally.Baseline information （gender，age，education level，marital status），questionnaire survey results （family history of hypertension，life behaviors such as smoking，alcohol consumption，physical exercise，vegetable intake，salt intake，milk tea intake），physical parameters （height，weight，blood pressure，waistline，hipline，BMI），routine blood test and biochemical parameters〔WBC，hemoglobin，platelet count，serum potassium，serum sodium，total cholesterol（TC），triglyceride（TG），high-density lipoprotein（HDL），low-density lipoprotein（LDL），fasting blood glucose（FBG），ALT，AST〕 were collected.Predictive factors of new-set hypertension were analyzed with univariate and multivariate Cox proportional hazards models.Results　After a follow-up period of 1.1to 8.5 years，a total of 1 985 cases of new-onset hypertension were found，the incidence rate was 11.75 cases per 100 person-years〔 95%CI（11.27，12.24）〕．The incidence rate of new-set hypertension differed significantly by gender，age，smoking，alcohol consumption，salt intake，milk tea intake，family history of hypertension，BMI，and baseline blood pressure status （P<0.05）．Analysis with univariate Cox proportional hazards model showed that gender，age，drinking and smoking habits，daily salt intake，milk tea intake ml/d，family history of hypertension，waist circumference，BMI，TC，TG，HDL ，FBG，prehypertension were associated with new-onset hypertension（P<0.05）.Analysis with multivariate Cox proportional hazards model showed that age，smoking habit，daily salt intake，family history of hypertension，waist circumference，TG，FBG，prehypertension were influence factor of new-onset hypertension in men（P<0.05）.Age，daily salt intake，family history of hypertension，BMI，TG，FBG，prehypertension were influence factor of new-onset hypertension in women（P<0.05）.Conclusion　The incidence rate of hypertension is high among Kazak herdsmen in Xinjiang pastoral areas.Gender，age，drinking and smoking habits，daily salt intake，family history of hypertension，waist circumference，BMI，TC，TG，HDL，FBG，prehypertensionare associated with new-onset hypertension.It is necessary to actively identify and monitor the disease by synthesizing various risk factors，so early prevention and control can be implemented timely，and the incidence of hypertension ca be reduced.

Efficacy of Pemetrexed with Vinorelbine in Recurrent and Metastatic Cervical Cancer after Failure of First-line Chemotherapy　

LU Liang，LIU Aihua，ZHANG Hanqun，CAO Hui，LI Yong，FENG Zhiyu，LI Hang

2019, 22(30): 3679-3682. DOI: 10.12114/j.issn.1007-9572.2019.00.393

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Background　 There are no standardized regimens for recurrent and metastatic cervical cancer patients with disease progression or poor controlled conditions after first-line chemotherapy.Although use of pemetrexed or vinorelbine chemotherapy for such patients has been reported，the clinical efficacy of combination of these two drugs is rarely reported.Objective　To analyze the short-term efficacy and side effects of pemetrexed combined with vinorelbine in the treatment of recurrent and metastatic cervical cancer after failure of first-line chemotherapy.Methods　A retrospective analysis was conducted on 29 cases of recurrent and metastatic cervical cancer after failure of first-line chemotherapy recruited from Guizhou Provincial People's Hospital from January 2014 to December 2017.All of them were treated with pemetrexed plus vinorelbine for 4-6 cycles of treatment（a cycle duration was defined as 21days）．Short-term efficacy and toxic side effects were evaluated.Results　All the cases completed at least 4 cycles of chemotherapy.The rates of complete remission（CR），partial remission（PR），stable disease（SD），progressive disease（PD） were 0，20.7%（6/29），31.0%（9/29），48.3%（14/29），20.7%（6/29），respectively，indicating that a disease control rate of 51.7%（15/29） was achieved.The median progression-free survival（PFS） was 6.5 months（range：2.6-13.7） and the median total survival（OS） was 10.2 months（range：2.6-30.1）．Cervical squamous cell carcinoma and cervical adenocarcinoma patients showed similar overall response rates：PR〔0.8%（5/24） vs 20%（1/5）〕，SD〔33.3%（8/24） vs 20%（1/5）〕 and PD〔45.8%（11/24） vs 60%（3/5）〕（u=0.438，P=0.661）．Moreover，those with cervical cancer spreading to or growing into the walls of the pelvis and those with cervical cancer growing out of the pelvis also showed similar overall response rates：PR〔25.0%（6/24） vs 0〕，SD〔29.1%（7/24） vs 40%（2/5）〕and PD〔45.8%（11/24） vs 60%（3/5）〕（u=0.908，P=0.364）．All the cases demonstrated different degrees of toxic side effects，the most serious（grade 3-4） were leukopenia，neutropenia and thrombocytopenia，followed by nausea and vomiting，anemia，and elevated aspartate aminotransferase，but after corresponding treatment，all of them completed the chemotherapy.Conclusion　Pemetrexed combined with vinorelbine has a good short-term efficacy in the treatment of recurrent and metastatic cervical cancer，with tolerable toxic side effects.But its.long-term efficacy needs to be further studied.

Clinical Value of MRI Combined with Mammography in the Diagnosis of Non-tumor Breast Cancer　

DAI Lijuan，SHI Gaofeng，YANG Li，LI Min，ZHOU Yan

2019, 22(30): 3683-3688. DOI: 10.12114/j.issn.1007-9572.2019.00.516

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Background　Non-tumor breast cancer does not have typical characteristics of breast cancer，and the detection rate in its early screening is lower than that in mass-type breast cancer.Objective　To explore the value of MRI combined with mammography in the diagnosis of non-tumor breast cancer.Methods　From January 2015 to July 2016，82 female patients who met the clinical criteria for palpation and mammography in the Fourth Hospital of Hebei Medical University were diagnosed as non-tumor breast lesions，and they were recruited as research subjects and divided into the malignant group and the benign group according to postoperative pathological results as the gold standard.The results of MRI and mammography were compared between the two groups.The sensitivity，specificity and accuracy of MRI and mammography based on BI-RADS classification were analyzed.Then，individual analysis was performed based on the signs and parameters of MRI and mammography.Logistic regression analysis was used to establish a fitted equation for the signs and parameters of MRI combined with mammography in the diagnosis of non-tumor breast cancer.The ROC curve for the diagnosis of non-tumor breast cancer was plotted and the area under the ROC curve（AUC），sensitivity，and specificity were calculated.Results　According to the postoperative pathological results，53 patients were included in the malignant group and 29 patients were included in the benign group.For the MRI examination，the ADC value of the malignant group was lower than that of the benign group，while the outflow type in the time-to-intensity curve（TIC） type and the uneven enhancement ratio in the strengthening mode were higher than those in the benign group（P<0.05）.The malignant group had a higher proportion of clustered microcalcification than the benign group（P<0.05）.Based on the BI-RADS classification criteria，the sensitivity of MRI for the diagnosis of non-tumor breast cancer was 81.13%（43/53），the specificity was 65.52%（19/29），and the accuracy was 75.61%（62/82）.The sensitivity of mammography was 66.04%（35/53），the specificity was 72.41%（21/29），and the accuracy 68.29%（56/82）.In MRI examination，the accuracy of the ADC value，TIC type，and enhancement mode were greater than 70.0%（76.30%，77.80%，and 74.39%，respectively）.In mammography examination signs（focal asymmetric density，clustered microcalcification，gland architectural distortion or disorder，and mixed signs），only the accuracy of clustered microcalcification was greater than 60.0%（70.73%）.The fitted equation of the combined diagnosis model was Logit（P）=-6.369×ADC value+2.580×TIC type+ 1.856×enhancement mode +1.927×clustered microcalcification.The best cut-off value for the combined diagnosis model was 0.708，the AUC value was 0.919，the sensitivity was 84.91%，and the specificity was 93.10%.Conclusion　Both MRI and mammography have different deficiencies in the diagnosis of non-tumor breast cancer.Logistic regression analysis is used to fit the ADC value，enhancement mode and TIC type in MRI and clustered microcalcification in mammography.This combined diagnosis model can significantly improve the diagnostic value of non-tumor breast cancer.

Application of In Vivo Imaging Technique in the Early Detection of NK/T Cell Lymphoma　

LIU Fan，ZHAO Yu，PAN Xinyu，FU Yao，YU Jianbo

2019, 22(30): 3689-3693. DOI: 10.12114/j.issn.1007-9572.2019.00.473

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Background　NK/T-cell lymphoma is a malignant tumor that threatens human health.Its pathogenesis has not yet been clarified.There are few reports on the dynamic monitoring of NK/T-cell lymphoma at the molecular level.Objective　To study the application of In Vivo Imaging Technique （IVIT） in the dynamic monitoring of NK/T cell lymphoma growth.Methods　From October 2015 to October 2016，a total of 3 BALB/C-nu grade SPF mice were taken for experiment（The experiment was repeated three times）．100 μl NK92-Luc cell lymphoma （containing 1×106 cells） was subcutaneously injected into the left hypochondrium of each mouse to establish a nude mouse model of subcutaneous xenograft tumor.Tumor volume was measured and calculated every day after the appearance of tumor，and growth curve was drawn according to the tumor growth.Bioluminescence imaging of tumors was detected by small animal in vivo imaging system on the 5th，8th，and 11th days after injection，and curve was plotted according to tumor luminescence photon number.The mice were sacrificed at the end of the experiment，and tumors and livers were taken out and were then embedded into wax blocks of paraffin，and were stained with HE for observing the histomorphological status.Results　All the mice were successfully inoculated with tumors.The mean tumor size at the 5th，8th，and 11th days after injection was（0.003 8±0.002 3），（0.132 3±0.060 7），（0.423 2±0.069 6） mm3，respectively.Tumor growth curve plotted based on the changes in tumor volume showed that the growth of tumor was not obvious in the first 2 days，but quickened significantly in the 3rd and 5th days，and grew fastest in the 6th and 8th days，but tended to be moderate in the 9th to 11th days.The in vivo imager detected that the measured average photon number of the tumor at the 5th，8th，and 11th days after injection was （53 688 222±25 446 363）ph/s，（2 072 443 366±1 029 688 415）ph/s，（5 559 915 605±708 457 376）ph/s，respectively.The tumor growth curve plotted according to tumor luminescence photon number mapping was consistent with the that based on changes in the tumor volume.Light microscopy revealed that the tumor cells were arranged in a sheet or nest shape，and the tumor cells infiltrated the blood vessels and pathological mitotic figures.Conclusion　IVIT can non-invasively，continuously，quantitatively and dynamically monitor nude mice model of NK/T cell lymphoma stably expressing luciferase，suggesting that it may be used for early detection of NK/T cell lymphoma.

Effects of Artesunate on Proliferation and Apoptosis of Human Acute Myeloid Leukemia Stem Cell and Its K562 Cell Line　

WANG Meng，JIA Guocun，CHENG Yibing，WANG Haijun，LIU Wei,GUO Yaqiong

2019, 22(30): 3694-3700. DOI: 10.12114/j.issn.1007-9572.2019.00.423

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Background　At present，long-term treatment of acute myeloid leukemia （AML） still faces multiple challenges such as high recurrence rate，treatment-related death risks and chemotherapy-related toxic and side effects.As an new chemical compound （artesunate as its derivative） which has been extracted from compositae plants，artemisia annua for the first time by Chinese scholars，artemisinin has gradually attracted widespread attention in recent years in the treatment of leukemia and cancer.Objective　To explore the effects of artesunate on proliferation and apoptosis of human AML stem cells and K562 cell line.Methods　Density gradient method was performed to separate AML stem cells in bone marrow fluid of 24 children with newly diagnosed or relapsed AML n who met inclusion criteria and were treated in the Department of Hematology，Henan Children's Hospital，from October 2016 to October 2018.The AML K562 cell line was purchased for research.AML stem cells and K562 cell line were equally divided into control group and experimental group （control group 1 and experimental group 1，control group 2 and experimental group 2 in turn）．The control group 1 and control group 2 were not given artesunate for intervention.The experimental group 1 and experimental group 2 were given artesunate solution at a final concentration of 12.5，25.0 and 50.0 μg/ml，respectively （marked as experimental subgroup 1 and experimental subgroup 2 at a final concentration of 12.5，25.0 and 50.0 μg/ml）．The survival of AML stem cells and K562 cells was observed by cell counting method.The growth and inhibition condition were detected by MTT assay.The apoptosis was detected by flow cytometry.Results　At 48 h and 72 h after intervention，survival rate of AML stem cell in experimental subgroup 1 at a final concentration of 12.5，25.0 and 50.0 μg/ml was lower than that in control group 1 （P <0.05）．At 72 h after intervention，survival rate of AML stem cell in experimental subgroup 1 at a final concentration of 25.0 and 50.0 μg/ml was lower than that in experimental subgroup 1 at a final concentration of 12.5 μg/ml （P<0.05）．At 48 h and 72 h after intervention，survival rate of AML K562 cell line in experimental subgroup 2 at a final concentration of 12.5，25.0 and 50.0 μg/ml was lower than that in control group 2 （P<0.05）．At 72 h after intervention，survival rate of AML K562 cell line in experimental subgroup 2 at a final concentration of 25.0 and 50.0 μg/ml was lower than that in experimental subgroup 2 at a final concentration of 12.5 μg/ml （P<0.05）．At 24 h，48 h and 72 h after intervention，growth inhibition rate of AML stem cell in experimental subgroup 1 at a final concentration of 12.5，25.0 and 50.0 μg/ml was higher than that in control group 1 （P<0.05）．At 48 h and 72 h after intervention，growth inhibition rate of AML stem cell in experiment subgroup 1 at a final concentration of 25.0 and 50.0 μg/ml was higher than that in experimental subgroup 1 at a final concentration of 12.5 μg/ml （P<0.05）．At 24 h，48 h and 72 h after intervention，growth inhibition rate of AML stem cell in experimental subgroup 2 at a final concentration of 12.5，25.0 and 50.0 μg/ml was higher than that in control group 2 （P<0.05）．At 48 h and 72 h after intervention，growth inhibition rate of AML stem cell in experiment subgroup 2 at a final concentration of 25.0 and 50.0 μg/ml was higher than that in experimental subgroup 2 at a final concentration of 12.5 μg/ml （P<0.05）．At 48 h after intervention，apoptosis rate of AML stem cells in in experimental subgroup 1 at a final concentration of 12.5，25.0 and 50.0 μg/ml was higher than that in control group 1 （P<0.05）．At 48 h after intervention，apoptosis rate of AML stem cells in experimental subgroup 1 at a final concentration of 25.0 and 50.0 μg/ml was higher than that in experimental subgroup 1 at a final concentration of 12.5 μg/ml （P<0.05）．At 48 h after intervention，apoptosis rate of AML stem cells in experimental subgroup 2 at a final concentration of 12.5，25.0 and 50.0 μg/ml was higher than that in control group 2 （P<0.05）．At 48h after intervention，apoptosis rate of AML stem cells in experimental subgroup 2 at a final concentration of 25.0 and 50.0 μg/ml was higher than that in experimental subgroup 2 at a final concentration of 12.5 μg/ml （P<0.05）．Conclusion　Artesunate can effectively inhibit proliferation of AML stem cells and K562 cell line and induce their apoptosis，which can provide experimental evidence for artemisinin treating AML.

Rational Application of Antipsychotics in Pregnancy　

ZHAI Qian，ZHANG Guofu，LIU Min，WANG Jingjing

2019, 22(30): 3701-3708. DOI: 10.12114/j.issn.1007-9572.2019.00.223

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The effect of medication in pregnancy on maternal health and fetal growth and development has aroused wide concern.However，due to limits of medical ethics and other factors，it is difficult to conduct an in-depth scientific research on medication during pregnancy.Schizophrenia is a chronic mental disease whose prevalence rate is increasing year by year.In particular，it is highly prevalent in those aged 25-35 years old，and women of this age group are in the ‘right' age to have a baby.In addition，treating emotional disorders and other psychiatric disorders associated with pregnancy，also may involve the use of antipsychotics.Antipsychotics can affect the fetus through the placenta，cause perinatal syndrome，even severe fetal malformations，and may also affect long-term neurobehavior.Likewise，untreated mental symptoms also affect the pregnant woman and the fetus.Therefore，the safety and necessity of appropriate use of antipsychotics during pregnancy have become a clinical problem that needs to be solved urgently.This paper mainly discusses the rational application of antipsychotics in pregnancy，in order to provide help for clinicians in formulating medication treatment plan for mental disorders during pregnancy.

Influence of Polypharmacy on Clopidogrel Resistance in Patients with Coronary Heart Disease　

JIANG Duan，LI Jing

2019, 22(30): 3709-3713. DOI: 10.12114/j.issn.1007-9572.2018.00.440

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Background　Polypharmacy is a major factor that can lead to potentially dangerous drug interactions.Patients with coronary heart disease（CHD） often face problems of polypharmacy.Clopidogrel，a basic drug for secondary prevention of CHD，its antiaggregating activity is easily influenced by drug interactions.However，the influence of polypharmacy on the effect of clopidogrel has been rarely reported.Objective　To analyze the factors associated with clopidogrel resistance（CR） in patients with CHD treated with polypharmacy.Methods　According to the inclusion and exclusion criteria，333 cases of CHD were enrolled from Wuxi People's Hospital，Nanjing Medical University，from September 2015 to March 2018.Through the information system of the hospital，basic information（including sex，age，prevalence of smoking，prevalence of drinking，comorbidity，clinical diagnosis，NYHA functional classification，PCI treatment），physical examination and laboratory results〔including body mass index（BMI），blood pressure，total cholesterol，low-density lipoprotein cholesterol（LDL-C），fasting blood glucose（FBG），serum creatinine，alanine aminotransferase and platelet aggregation rate（PAR）〕，and medication〔including proton pump inhibitors （PPI），diltiazem， statins （atorvastatin and simvastatin）， calcium channel antagonists （CCB），ARB，metoprolol，nitrates，trimetazidine，traditional Chinese medicine containing anti-thrombotic ingredients，low molecular weight heparin〕 were collected.On the basis of the PAR level，132 cases were assigned to the CR group（PAR>50%），and 201 were assigned to the control group（PAR≤50%），respectively.Factors associated with CR were identified by multivariate Logistic regression analyses.Results　The incidence of hypertension，rates of BMI≥25.0 kg/m2，LDL-C≥2.07 mmol/L，FBG，and polypharmacy（≥7）were significantly higher in CR group than those of the control group（P<0.05）．Multivariate Logistic regression analysis showed that FBG（≥6.1 mmol/L）（OR=1.121，P=0.033） and concomitant medications（≥7）（OR=5.224，P=0.003） were associated factors for CR．The combined use rates of traditional Chinese medicine injection containing antithrombotic components and low molecular weight heparin were also obviously higher in the CR group（P<0.05）．Conclusion　FBG and polypharmacy（≥7） are associated with CR.Moreover，combined use of low molecular weight heparin and traditional Chinese medicine injections containing antithrombotic ingredients may also be related to CR.

Precautions for the Treatment of Ulcerative Colitis with Traditional Chinese Medicine Retention Enema　

LI Wei，HU Fenglin，LI Jiyan 3

2019, 22(30): 3714-3716. DOI: 10.12114/j.issn.1007-9572.2019.00.088

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A large number of clinical practice has proved that Chinese medicine retention enema has a significant effect on ulcerative colitis.Current clinical research on the treatment of ulcerative colitis with Chinese medicine retention enema is mainly focused on the components，and compatibility of Chinese medicine，action of mechanism of the therapy，and combined medication.However，to achieve good clinical results，besides good rationality of prescription compatibility，appropriate means by which the drugs can yield increased in vivo efficacy are also needed.On the basis of reviewing related studies，the article discusses the types of Chinese medicine retention enema and related precautions.

Effects of Targeted Traditional Chinese Medicine Permeabilization Therapy in the Treatment of Type Ⅱ Respiratory Failure Associated with Chronic Obstructive Pulmonary Disease　

LI Jie，ZUO Lu，KONG Xinyi，XIONG Ying，LI Juan，LI Jinghong，LIAO Peng

2019, 22(30): 3717-3722. DOI: 10.12114/j.issn.1007-9572.2019.00.309

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Background　Chronic obstructive pulmonary disease（COPD）is a common chronic disease in China，which easily combines with type Ⅱ respiratory failure.COPD with type Ⅱ respiratory failure is treated mainly by antibiotics and hormones，but treatment-related side effects are serious and resistance easily develops.Objective　To evaluate the effects of targeted Traditional Chinese Medicine（TCM）permeabilization therapy in the treatment of type Ⅱ respiratory failure associated with COPD.Methods　One hundred and sixty patients suffering from COPD with type Ⅱ respiratory failure were recruited from Jiangxi Chest Hospital from June 2017 to August 2018 and were randomly divided into two equal groups，therapy group and control group，treated with conventional anti-infective and anti-asthma treatment，and external use of a permeabilized TCM patch，conventional anti-infective and anti-asthma treatment，and external use of a placebo patch （with fuzzy appearance，and the same weight as the permeabilized TCM patch used in the therapy group），respectively，for 2 weeks.PO2，PCO2，FEV1/FVC ratio，serum C-reactive protein（CRP），procalcitonin（PCT）and eosinophils（EOS）levels and six-minute walk test （6MWT）results before and after treatment of both groups were compared.Patients in the therapy group were graded according to GOLD criteria，and CRP，PCT，and EOS were compared before and after treatment in different GOLD subgroups.Results　After excluding 14 dropouts（6 in the control group，and 8 in the therapy group），the remaining 146 cases who completed the trial were finally included（74 in the control group and 72 in the therapy group）．After treatment，PCO2，CRP，PCT and EOS in the therapy group were lower than those in the control group，FEV1/FVC was higher than that in the control group ，6MWT was longer than that in the control group（P<0.05）； there was no significant difference in PO2 between the two groups after treatment （P >0.05）．PO2 ，FEV1/FVC in control group was higher after treatment than before treatment，6MWT was longer than before treatment in the same group，PCO2，CRP，PCT and EOS were lower than before treatment in the same group （P<0.05）； PO2，FEV1/FVC in treatment group were higher than before treatment in the same group，6MWT was longer than before treatment in the same group，PCO2，CRP，PCT and EOS were lower than before treatment in the same group （P<0.05）．The clinical effect of the treatment group was better than that of the control group （Z=-2.191， P<0.05）．Subgroup analysis by GOLD grade showed that，after treatment，mean CRP decreased significantly in all subgroups 〔GOLD A （n=12），GOLD B （n=20），GOLD C （n=22），GOLD D （n=18）〕（value of paired t-test=12.38，53.79，63.38，65.40，P<0.05）；mean CRP decreased significantly in GOLD C and D subgroups（value of paired t-test=3.54，5.83，P<0.05）；mean EOS decreased significantly across GOLD A，B，C and D subgroups （value of paired t-test=4.50，5.56，5.76，7.09，P<0.05）．Conclusion　Targeted TCM permeabilization therapy is a safe，simple and effective treatment for typeⅡ respiratory failure associated with COPD，which can reduce the severity of inflammation，and improve lung functions and the prognosis to some extent.

Theoretical Discussion on the Treatment of Cough Variant Asthma by Harmonizing Yingqi and Weiqi　

WANG Quanlin，WANG Fei

2019, 22(30): 3722-3725.

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Cough variant asthma accounts for up to 1/3 of all chronic cough causes.In this article，we explored the relationships of disharmony of Yingqi and Weiqi with TCM-based physical characteristics，and pathogenesis of allergic reactions caused by immune imbalance at remission stage of cough variant asthma，and TCM-related etiologic factors and morbidity characteristics at the exacerbation stage.And we concluded that the basic pathogenesis of cough variant asthma is disharmony between Yingqi and Weiqi，so harmonizing the relationship between the two is an important therapeutic method for the disease.Finally we expounded the application ways of Guizhi decoction，a treatment regimen，which can be modified in accordance with the individual conditions at both remission and exacerbation stages.

Clinical Application of New Software for the Diagnosis and Treatment of Postpartum Hemorrhage　

XU Songyuan，LIANG Shenglian，CAO Lixia，YING Xiaoyan*

2019, 22(30): 3726-3730. DOI: 10.12114/j.issn.1007-9572.2019.00.162

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Background　Postpartum hemorrhage is the leading cause of maternal mortality worldwide accounting for 19.7% of all maternal deaths，which threatens maternal lives seriously.Objective　To explore the clinical application value of the new software for diagnosis and treatment system of postpartum hemorrhage（diagnosis and treatment system）based on fuzzy theory in obstetrics.Methods　A total of 426 patients with postpartum hemorrhage were collected from the Department of Obstetrics and Gynecology of the Second Affiliated Hospital of Nanjing Medical University from 1st May 2015 to 1st May 2017.Their basic information was recorded into the new software to predict the risk of postpartum hemorrhage and its related causes.The predicted results were compared with the actual occurrences，and the actual amount of bleeding was recorded.Results　The risk of postpartum hemorrhage and causes of bleeding predicted by the diagnosis and treatment system software were consistent with the actual occurrences（P>0.05）．The software predicted postpartum hemorrhage with low and medium risks was mainly due to uterine inertia，accounting for 100.0% and 79.3% respectively.The main causes of postpartum hemorrhage with high risk were uterine inertia and placental factors，accounting for 60.5% and 31.4%.Placental factors were the main causes of postpartum hemorrhage with an extremely high risk，accounting for 71.6%.There was a significant difference in the amount of bleeding among patients by diagnosis and treatment system with different postpartum hemorrhage risks（F=241.64，P<0.01）．Among them，the amount of bleeding of patients with medium，high and extremely high risks were more than that of patients with low risk，and as the risk increased，the amount of bleeding increased（P<0.05）．Conclusion　The software for the diagnosis and treatment system of postpartum hemorrhage based on fuzzy theory can accurately assess the risk of postpartum hemorrhage and the causes of bleeding and its predicted results of amount of bleeding with different risks were close to the clinical results，which make it high application value in clinical work.

Diagnostic Value of miR-221 and miR-222 in Ultrasound-guided Fine-needle Aspiration Cytology of Benign and Malignant Thyroid Nodules　

YAN Yongxin，XU Ning，WANG Guofeng

2019, 22(30): 3731-3735. DOI: 10.12114/j.issn.1007-9572.2019.00.520

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Background　Thyroid nodules are a common clinical problem.Although thyroid nodules fine needle aspiration cytology （FNAC） is the gold standard for identifying benign and malignant thyroid nodules，about 15%-30% of thyroid nodules cannot be identified by it.Therefore，there is an urgent need to find molecular markers that can effectively help identify thyroid nodules.Objective　To investigate the expression levels of microRNA-221 and microRNA-222 in thyroid FNAC specimens of patients with benign and malignant thyroid nodules and their diagnostic value for benign and malignant thyroid nodules.Methods　Sixty patients with thyroid nodules who met the research criteria in the First Affiliated Hospital of Kangda College of Nanjing Medical University from March 2015 to December 2017 were selected.All patients were examined by FNAC.The first diagnosis was malignant lesions in 17 cases，benign lesions in 34 cases，suspected malignant and undiagnosed lesions in 5 cases，follicular lesions in 2 cases and follicular tumors in 2 cases.The expression levels of miR-221 and miR-222 in thyroid nodules FNAC specimen of patients with benign and malignant lesions were compared.Take the results of pathological examination after operation as the gold standard，the working characteristic curve （ROC curve） of patients with malignant thyroid nodules diagnosed by miR-221 and miR-222 in thyroid nodules FNAC cytology was drawn，and the area under the ROC curve （AUC），sensitivity and specificity were calculated.The coincidence rates of thyroid nodules FNAC examination results and miR-221 and miR-222 in thyroid nodules FNAC examination specimens for the diagnosis of thyroid nodules were calculated.The expression levels of miR-221 and miR-222 in thyroid nodules FNAC samples of patients with different general data were compared.Results　Pathological examination showed 51 benign nodules and 9 malignant nodules in 60 patients after thyroidectomy.The expression levels of miR-221 and miR-222 in patients with malignant nodules were higher than those in patients with benign nodules （P<0.05）.The AUC of miR-221 in thyroid FNAC specimens for diagnosis of malignant thyroid nodules was 0.774 （0.691， 0.858）. The cut-off value was 2.77， the sensitivity was 80%， the specificity was 60.0%， and the Yoden index was 0.400. The AUC of miR-222 in thyroid FNAC specimens for diagnosis of malignant thyroid nodules was 0.759 （0.672， 0.845）. The cut-off value value was 2.73， the sensitivity was 76.7%， the specificity was 66.7%， and the Yoden index was 0.443. The coincidence rate of thyroid nodules FNAC examination results and thyroid nodules FNAC examination samples in the diagnosis of thyroid nodules by miR-221 and miR-222 was 80.0%.There was no significant difference in the expression levels of miR-221 and miR-222 between patients with different gender，age，maximum diameter of tumors，number of lesions，invasion of capsule，lymph node metastasis and TNM stage （P>0.05）.Conclusion　The expression levels of miR-221 and miR-222 in thyroid nodules FNAC specimen of patients with malignant thyroid gland were significantly increased.The diagnostic value of thyroid nodules FNAC alone in differentiating benign and malignant thyroid nodules was not high，but combined with thyroid nodules FNAC results，it could improve the diagnostic efficiency of benign and malignant thyroid nodules.

Value of Advanced Virtual Monoenergetic Reconstruction Technique in Dual-energy CT for Evaluating TACE Efficacy in Hepatocellular Carcinoma　

CHENG Guotao，YANG Tao，KONG Shubing，ZHENG Yi

2019, 22(30): 3736-3741. DOI: 10.12114/j.issn.1007-9572.2019.00.505

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Background　In the evaluation of the efficacy of transarterial chemoembolization （TACE） for hepatocellular carcinoma（HCC），conventional CT examination is prone to producing heavy beam-hardening artifacts in images due to use of iodized oil，but dual-energy CT with advanced virtual monoenergetic reconstruction technique can reduce the beam-hardening artifacts，which is of great significance in accurately evaluating TACE efficacy.Objective　To analyze the clinical value of advanced virtual monoenergetic reconstruction technique in dual-energy CT for evaluating TACE efficacy in HCC to explore the effect of this technique in reducing iodized oil-induced artifacts in images.Methods　The clinical data of 31 patients with HCC who underwent dual-source dual-energy CT examination after TACE in Xianning Central Hospital from September 2015 to October 2017 were retrospectively analyzed.The third generation Flash dual-source CT dual-energy scan was performed.Each patient's linear blending images（M=0.5） and 16 groups of monoenergetic images reconstructed in 10-keV intervals（40，50，60，70，80，90，100，110，120，130，140，150，160，170，180，and 190 keV） were obtained，respectively.CT images influenced most by iodine deposition were selected in which iodized oil-induced artifacts and the normal areas were measured.The objective indices，including image artifact indices，contrast to noise ratio（CNR），the beam-hardening artifacts，image noise，contour of iodized oil deposition，and comprehensive subjective score were compared between the linear blending images and keV images.After comparative analysis，the best monoenergetic keV images with beam-hardening artifacts removed were identified.Results　Iodized oil-induced beam-hardening artifacts：In virtual monoenergetic images，beam-hardening artifacts from iodized oil tended to decrease with the increase of energy levels.Image noise：With the increase of energy，the image noise in the 40-80 keV images decreased gradually，and then increased slowly.Contour of iodized oil deposition：Iodized oil deposits were clearly displayed on 60-80 keV images.There was no significant difference between linear blending images and 70-100 keV images in comprehensive subjective score（P>0.05）.There was no significant difference between linear blending images and 40-50 keV images in artifact indices（P>0.05）.And there was no significant difference between linear blending images and 120-190 keV images in CNR（P>0.05）.Statistical analysis with comprehensive indices indicated that 70 keV and 80 keV were the optimal monoenergetic parameters for dual-energy CT scan with advanced virtual monoenergetic reconstruction technique，which could ensure that the images have appropriate CNR，with reduced beam-hardening artifacts，ideal iodine's contour，and AI and overall quality similar to those of linear blending images.Conclusion　In evaluating TACE efficacy in HCC，using advanced virtual monoenergetic reconstruction technique in dual-energy CT scan can reduce the incidence of iodized oil-induced beam-hardening artifacts in images.Under the conditions of 70 keV and 80 keV，the quality of images are best，the CNR of the images can be guaranteed，beam-hardening artifacts can be reduced，iodine's contour can be displayed well，AI and overall quality similar to those of linear blending images can be achieved.

Oral Healthcare-seeking Behaviors and Utilization of Community Oral Health Service in Residents of Pudong New Area，Shanghai　

SHE Yan，ZHANG Liangnian，ZHANG Shengbing，XU Xianguo

2019, 22(30): 3742-3747. DOI: 10.12114/j.issn.1007-9572.2019.00.235

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Background　Oral health service is an important part of community health services.It is vital to study the demand and utilization of community oral health service，in order to rationally allocate oral health service resources and solve the contradiction between supply and demand of oral health services.Objective　To investigate oral healthcare-seeking behaviors，demands and utilization of oral health services in Pudong New Area residents.Methods　In May 2017，we conducted a face-to-face survey in a convenience sample of permanent residents from 45 communities in Pudong New Area with a self-administered questionnaire consisting of general demographic information，oral healthcare-seeking behaviors（occurrence of oral problems，and corresponding interventions，selected medical institutions for oral diseases，purpose of oral disease treatment），utilization of community oral heath services （reasons for choosing community stomatology department，satisfaction with the community stomatology department，and demanded community stomatology services）．Results　A total of 905 cases participated in the survey.All of them returned responsive questionnaires，obtaining a response rate of 100.0%.Among them，70.5% （638/905） experienced a toothache before，33.3% （301/905） often had at least one of the problems of toothache，gingival bleeding，loose teeth，missing teeth，and misaligned teeth.When having an oral problem，65.1% （585/899） of them visited the doctor，17.2% （155/899） self-medicated，but 16.0% （144/899） did not take any interventions.The way for dealing with oral problems differed significantly by age and medical expense payment form（P<0.05）．In terms of the institutions chosen for oral healthcare，49.7% （447/900） visited community stomatology department，25.9% （233/900） visited stomatological hospital，and 22.4% （202/900） visited stomatology department of a general hospital.The institution selected for oral healthcare varied significantly by age，average monthly income，and medical expense payment form（P<0.05）．83.7% （735/878） of the residents had ever received services from the community stomatology department.The percentage of needing and badly needing oral hygiene health education was highest，reaching 92.0% （833/905）．The demanded community oral health services changed obviously according to age （P<0.05）．Conclusion　Oral healthcare-seeking behaviors in Pudong New Area residents were not good.And the demand for oral health services differed substantially by age，average monthly income and medical expense payment form.Therefore，the supply of community-based oral health services should be demand-oriented，by which the utilization rate of such services can be improved，and a virtuous circle of “need-demand-utilization” can be realized.

Dental Resource Allocation and Service Development Situation in Community Health Centers in Pudong New Area of Shanghai　

ZHANG Liangnian，ZHU Xiqian，CHEN Jieru，YANG Qi，XU Xianguo

2019, 22(30): 3748-3752. DOI: 10.12114/j.issn.1007-9572.2019.00.236

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Background　Community oral health service is one of the most important contents of community health service.Over the last 15 years，a number of different agencies have conducted comprehensive surveys about the situation of oral health service resources allocation and business development in Pudong New Area of Shanghai.However，it has been six years since the last survey.It is necessary to carry out a new round of investigation to allocate the resources of community stomatology accurately and efficiently，and to construct a community oral health service model meeting the current demand.Objective　To investigate the resource allocation and service development situation of the stomatology department in community health centers（CHCs） in Pudong New Area，to provide a reference for the development of community-based oral health care delivery modes.Methods　A questionnaire survey was conducted in 45 stomatology department leaders from 45 CHCs（each was selected from one CHC） in Pudong New Area in May 2017.The questionnaire developed by our research group consists of three parts：（1）general information and 3-year（2014—2016） operation of the stomatology department；（2）general information about dental medical staff in 2014—2016 of the stomatology department；（3） implementation of stomatology services of the stomatology department during 2014—2016.All of them handed in responsive questionnaires，achieving a response rate of 100.0%.Results　All these CHCs have a stomatology department.The average annual outpatient dental visits in all the CHCs during 2014-2016 were 10 105，9 927，9 828，respectively，increasing year by year，but the average annual profit derived from dental services showing a gradual increasing trend（834 483.9 yuan，860 954.1 yuan，929 379.4 yuan in 2014—2016，respectively）．By the end of 2016-12-31，there were 124 dentists and 41 dental nurses in total（14 CHCs had no dental nurses yet）．Of the dentists，69.7% of had a college degree，41.8% had a junior professional and technical title，and 50.0% had an intermediate professional and technical title.Of the dental nurses，57.5% had a junior college degree，50% had a junior professional and technical title，and 50.0% had an intermediate professional and technical title.Primary and secondary prevention of dental diseases were carried out in all the CHCs，and 42 CHCs，respectively.Only 22 CHCs had a good understanding of tertiary prevention of dental diseases.Conclusion　The overall development of oral health services in CHCs in Pudong New Area in the period of 2014—2016 showed a shrinking status.Moreover，the number of dental care providers was insufficient，and the their professional levels were unsatisfied.In addition，primary and secondary prevention services accounted most of the total programs of dental disease prevention care，while tertiary prevention services were relatively insufficient.In views of this，the professional levels of the dental care providers should be enhanced，and hardware support should be strengthened，to comprehensively improve the quality of community-based oral health services.

Extra-intestinal Manifestations of Crohn's Disease with Right Lower Abdominal Pain，Facial Swelling and Lung Lesions：a Case Report and Literature Review　

HU Yiting，LI Pingping，LIU Hongna，ZHANG Jian，SU Shaohui，ZHAO Hongwei，WANG Yuzhen，LIU Gaifang

2019, 22(30): 3753-3757. DOI: 10.12114/j.issn.1007-9572.2019.00.303

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Crohn's disease is a chronic granulomatous disease with unknown etiology involving the small intestine and ileocecal region.Some patients had parenteral manifestations.The extraintestinal manifestations of Crohn's disease may involve various systems，but there are no reports of facial swelling.A case of Crohn's disease with parenteral manifestations，including right lower abdominal pain，facial swelling and pulmonary lesions，was reported in this paper.Literature review was also carried out.We suggested that attention should be paid to the differential diagnosis between Melkersson's Rosenthal syndrome and oral-facial granulomatosis，both of which were related to the clinic and pathology of Crohn's disease.Secondly，attention should be paid to pulmonary lesions caused by drugs （mesalazine or sulfasalazine） so as to increase clinicians' understanding of Crohn's disease complicated with parenteral manifestations.

Rapidly Progressive Myasthenia Gravis with Pyramidal Tract Damage and Nystagmus：Clinical Analysis of One Case　

WENG Yinhong，DA Yuwei，XU Min，LU Yan，XU Jiali，QIU Zhandong，JIA Yu，ZHAO Hongmei

2019, 22(30): 3757-3761. DOI: 10.12114/j.issn.1007-9572.2019.00.115

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Objective　To explore the clinical features，diagnosis，treatment and prognosis of rapidly progressive myasthenia gravis（MG） with pyramidal tract damage and nystagmus.Methods　We discussed the clinical manifestations，diagnosis，treatment and prognosis，and pathogenesis of MG with pyramidal tract damage and nystagmus on the basis of analyzing the clinical data of one case who visted Xuanwu Hospital Capital Medical University in March 28，2018 of this disease with rapidly progression treated by us as well as reviewing the related studies.Results　Our patient presented with ptosis and diplopia as the first symptoms.Then her conditions progressed rapidly to fatigable weakness of binocular and limb muscles which were mild in the morning but became severe in the afternoon or evening，with pyramidal tract damage and nystagmus.Further，positive neostigmine test results and decremental responses to low-frequency repetitive nerve stimulation test confirmed that she had MG.After being treated by pyridostigmine，intravenous immunoglobulin pulse therapy，hormone and methotrexate，the patient recovered completely after three months.Conclusion　MG may lead to other systemic damages besides injuries on the neuromuscular junction.So it may be an autoimmune disease related to anti-acetylcholine receptor antibody（AChR-Ab） that can involve the entire nervous system.Its pathogenesis may be associated with the combination of AChR-Ab and AChR in the central and peripheral nervous system.Early immunotherapy can achieve a good prognosis.Clinicians' understanding of this disease should be increased，in order to reduce the possibilities of misdiagnosis or missed diagnosis.

Advances in Diagnosis and Group Psychological Behavioral Therapy for Chronic Insomnia　

XING Jia，DONG Fei，ZHANG Ying，QIN Yuju

2019, 22(30): 3762-3767. DOI: 10.12114/j.issn.1007-9572.2018.00.371

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Chronic insomnia increases the risk of having mental and physical illness，and drug dependence or abuse. This article reviewed the progress in the diagnosis and study of chronic insomnia over recent years，to discuss its definition，diagnosis classification standards at home and abroad and clinical treatment. Present situation and the latest development of cognitive behavioral therapy for chronic insomnia were reviewed in this paper，including the composition and application progress，the setting and treatment methods，and clinical application status for chronic insomnia. We also discussed present situation of group therapy for chronic insomnia，including group cognitive behavioral therapy，dynamic group psychotherapy and group mindfulness cognitive therapy. We found that group cognitive behavioral therapy had a good clinical effect on chronic insomnia，but there is not sufficient clinical evidence，so more clinical treatment and research are needed.

CD36：a New Therapeutic Target for Chronic Kidney Disease　

HOU Yanjuan，WANG Lihua，WANG Qian

2019, 22(30): 3768-3773. DOI: 10.12114/j.issn.1007-9572.2019.00.228

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The transmembrane glycoprotein receptor CD36 binds to ligands participating in various physiological and pathological processes in the body.The recent studies found increased expression of CD36 in chronic kidney disease（CKD）．To introduce the structure，function and expression regulation of CD36，this article described the related mechanism of CD36 in CKD by summarizing the domestic and foreign literatures as well as previous studies.It came to the conclusions that CD36 promoted the progress of CKD in four aspects that included renal lipid deposition，lipid peroxidation，a variety of material endocytosis and intracellular/external cell signal transduction.At the same time，this article pointed out the feasibility of soluble CD36 as a biomarker for detecting the development of CKD，and prospected for drug therapy of CKD in order to provide a new direction for the diagnosis and treatment of CKD.

Early Warning and Its Evaluation Methods of Severe Hand，Foot，and Mouth Disease　

LI Tongzeng，LIANG Lianchun

2019, 22(30): 3774-3778. DOI: 10.12114/j.issn.1007-9572.2019.00.227

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Hand，foot，and mouth disease（HFMD）is an acute infectious disease caused by enterovirus infection，characterized by strong infectivity，high incidence and low mortality.The difficulty in the treatment of HFMD is that its severe cases often progress rapidly.If severe HFMD can be found early，and the early intervention and treatment are available，the goal of reducing the mortality rate of HFMD can be achieved.This paper reviews the early warning and diagnostic indicators for the progress of severe HFMD in recent years，and summarizes the early warning and its evaluation methods for severe HFMD，in order to provide help for the early prevention of HFMD.

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