Table of Content

15 December 2019, Volume 22 Issue 35

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Monographic Research

Misunderstandings of Pancreatic Cystic Neoplasms and How to Avoid Them——Interpretation of 2018 European Evidence-based Guidelines on Pancreatic Cystic Neoplasms　

ZHANG Lixian1，ZHAO Dongqiang

2019, 22(35):  4283-4287.  DOI: 10.12114/j.issn.1007-9572.2019.00.721

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Pancreatic cystic neoplasm（PCN） is a kind of disease with large differences in pathological characteristics，which is divided into benign，malignant and conjunctive malignant neoplasm.Various domestic and international guidelines on how to carry out normative management of PCN have been put forward with corresponding expert consensus with updating and improving constantly.In this paper，the main points of the 2018 European Evidence-based Guidelines on Pancreatic Cystic Neoplasms are interpreted.These guidelines are strategies for diagnosis and treatment and follow-up of PCN firstly based on evidence.This article summarizes and analyzes the core principles of these guidelines in order to provide a reference for improving the diagnosis and management of PCN in China.


Progress in Diagnosis and Treatment of Complex Renal Cystic Lesions Based on Bosniak Classification System　

WANG Yonggang，CHEN Shengjie，LIU Shangying

2019, 22(35):  4288-4292.  DOI: 10.12114/j.issn.1007-9572.2019.00.263

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Renal cystic lesions are very common type of clinical diseases.How to correctly identify the benign and malignant renal cystic lesions and its related further clinical managements are major tests for urologists.The introduction and application of the Bosniak classification system has undoubtedly assisted urologists in the proper treatment of complex renal cystic lesions.With the update and development of the imaging technology，the application field of the Bosniak classification system has also expanded.This paper gives an overview of how to improve the accuracy rate of preoperative diagnosis of benign and malignant renal cystic lesions，and the later clinical intervention based on the characterization of different radiographic Bosniak classification and medical tests like fine needle aspiration of preoperative diagnosis.


Management Progress of Perioperative Pain for Ankle Fracture　

ZHANG Yan，LI Bingbing，KONG Xiangyan

2019, 22(35):  4293-4297.  DOI: 10.12114/j.issn.1007-9572.2019.00.145

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The ankle joint is the largest weight-bearing joint in human bodies and the ankle fracture is the most common infra-articular fracture.Because of the special anatomic structure of ankle joint，the fracture is often accompanied by severe pain and swelling，which brings suffering to patients.This paper analyzed the commonly used pain assessment tools，influencing factors of perioperative pain，perioperative pain management nurses' perception of pain assessment，patients and their families' understanding in pain and analgesic methods，implementation of the pain assessment-intervention-reassessment method，so as to improve the quality of perioperative pain management of ankle fracture by improving the knowledge level of pain in medical staff，popularizing the proper understanding of pain and standardizing the pain management process.


Gender Differences in Plasma Phospholipid Fatty Acids and their Correlation with Blood Pressure in Community Elderly Hypertensive Patients 　

WU Jiajia，ZHANG Yahui，TAO Yao，GUO Yiqiong，WU Yating，YUAN Xiao，GAO Qinghan，TAO Xiujuan，FAN Yanna，YANG Jianjun

2019, 22(35):  4298-4305.  DOI: 10.12114/j.issn.1007-9572.2019.00.238

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Background　Hypertension is one of the risk factors affecting the life quality of the elderly and it is closely related to blood lipid metabolism with gender differences.The blood fatty acid spectrum is an important indicator which reflects the level of blood lipid metabolism, but its correlation with the occurrence and development of hypertension is still controversial.Objective　To investigate the gender differences in plasma phospholipid fatty acids and their correlation with blood pressure in community elderly hypertensive patients of Ningxia.Methods　A total of 2 231 community residents of Ningxia who were examined in Ningxia International Travel Health Care Center in March 2016 were selected through cluster sampling method. According to the inclusion and exclusion criteria of this study, we screened 282 hypertension patients,149 males and 133 females. And their demographic information was collected. Physical examination was conducted to obtain the biochemical indicators and plasma phospholipid fatty acid spectrum.And then Spearman rank correlation analysis was used to analyze the relationship between plasma phospholipid fatty acid content and systolic blood pressure, diastolic blood pressure and pulse pressure difference. Multiple linear regression analysis was adopted to analyze the influencing factors of systolic blood pressure, diastolic blood pressure and pulse pressure difference. Results　The age, education level, marital status, monthly income, smoking, serum creatinine, blood urea（UA）, alanine aminotransferase（ALT）, aspartate aminotransferase（AST）of males were significantly higher than those of the females, while the total cholesterol, high-density lipoprotein cholesterol（HDL-C）and low-density lipoprotein cholesterol（LDL-C）of males were significantly lower than those of the females（P<0.05）．The plasma phospholipid fatty acid C13：0, C22：1, and C24：1, monounsaturated fatty acid（ MUFA）, C18：3n-3, C18：3n-6 and C20：2n-6 of females were higher than those of the males（P<0.05）．Correlation analysis showed that in male patients, plasma phospholipid fatty acids C12：0 and C20：4n-6 were negatively correlated with diastolic blood pressure（P<0.05）, while C21：0, C18：1, C20：5n-3, C18：2n-6, and C20：2n-6 were positively correlated with diastolic blood pressure（P<0.05）, C20：4n-6 were positively correlated with pulse pressure difference and there was negative correlation between C24：0, C18：1, C18:  3n-3, C20：5n-3 and C20：2n-6 and pulse pressure difference（P<0.05）．In female patients, plasma phospholipid fatty acid C10：0 was negatively correlated with systolic blood pressure, while C21：0, C22：0, C18：1T, C18：3n-3, and C18：2TT were positively correlated with systolic blood pressure（P<0.05）, and C22：0 and C14：1 were positively correlated with diastolic blood pressure（P<0.05）, C18：1T and C18：3n-6 were positively correlated with pulse differential pressure（P<0.05）．In hypertensive patients, the plasma phospholipid fatty acids C22：0 and C18：1T were positively correlated with systolic blood pressure, while C23：0 was negatively correlated with systolic blood pressure（P<0.05）, and C12：0 and C20：4n-6 were negatively correlated with diastolic blood pressure, and C15：0, C18：0, C21：0, C22：0, C18：1, C20：5n-3, C18：2n-6, and C20：2n-6 were positively correlated with diastolic blood pressure（P<0.05）, and C18：1T and C20：4n-6 were positively correlated with pulse pressure difference, while C20：5n-3 was negatively correlated with pulse pressure difference（P<0.05）．Multiple linear regression analysis showed that plasma phosphatic fatty acids C21：0〔β=3 312.095, 95%CI（969.916, 5 654.275）, P=0.007〕, C20：5n-3〔β=184.205, 95% CI （16.822, 351.588）, P=0.032〕, and C20：2n-6〔β=-12 371.615, 95%CI（-20 122.194, -4 621.037）, P=0.003〕were the influencing factors of male diastolic blood pressure.C18：3n-6〔β=492.867, 95%CI （77.420, 908.315）, P=0.021〕was the influencing factor of female pulse pressure difference, and C18：1T〔β=113.848, 95% CI （43.906, 183.790）, P=0.002〕and C20：4n-6〔β=31.488, 95% CI （2.431, 60.546）, P=0.034〕were the influencing factors of pulse pressure difference in elderly hypertension patients. Conclusion　The plasma phospholipid fatty acid C13：0, C22：1, and C24：1, MUFA, C18：3n-3, C18：3n-6 and C20：2n-6 of females are higher than those of the males in elderly community hypertensive patients of Ningxia. There are positively correlated between C21:0, C20:5n-3, C20:2n-6 with male diastolic blood pressure, C18:3n-6 with pulse differential pressure, C18:1T, C20:4n-6 with pulse differential pressure.Therefore, we should pay attention to the diet habit and rationally control the intake of fatty acids.


Correlation between Serum Lipid and Peak Growth Hormone at a Stimulation Test in Children and Adolescents with Short Stature　

CHEN Yun，SHAO Qian，BAN Bo

2019, 22(35):  4306-4311.  DOI: 10.12114/j.issn.1007-9572.2019.00.297

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Background　Short stature is a common problem in children's growth and development，which is caused mainly by growth hormone deficiency （GHD），and its diagnosis depends on the growth hormone（GH） stimulation test.Studies have shown that serum lipid levels may be one of the factors that influence the variability of GH response at a stimulation test.However，similar studies have not been conducted in child population yet.Objective　To investigate the relationship between serum lipids and peak GH at a stimulation test in children and adolescents with short stature，to provide evidence for possible factors influencing the stimulated peak GH in such populations.Methods　A retrospective analysis was performed on 1 009 Chinese children and adolescents with short stature recruited from Department of Endocrinology，Jining Medical University，from 2013 to 2017.Clinical data such as height，body weight，and other anthropometric parameters as well as serum lipid profile，results of GH stimulation test with L-dopa or insulin-induced hypoglycemia test （insulin tolerance test，ITT） were collected.Stratified analysis was performed on two subgroups 〔dwarfism subgroup （n=595） and slightly undersized subgroup （n=414）〕 divided by the third height percentile.Univariate and multiple linear regression analyses were used to explore the correlations of peak GH at a stimulation test with anthropometric parameters and serum lipids.Results　The peak GH value at the stimulation test with L-dopa （PEAK1） was negatively correlated with body weight，BMI，BMI SDS，TG，TC，HDL-C，LDL-C，VLDL-C，and ALT，but positively correlated with IGF-1 （P<0.05）；the peak GH value at the ITT （PEAK2） was negatively correlated with BMI SDS，TC，and HDL-C，but positively correlated with female，age，bone age，height，body weight，Hb and IGF-1 （P<0.05）．Multiple linear regression analysis showed that PEAK1 was negatively correlated with both TG and HDL-C （P<0.05），and PEAK2 was negatively correlated with HDL-C （P<0.05）．In the dwarfism subgroup，PEAK1 showed a negative correlation with HDL-C （P<0.05）．In the slightly undersized subgroup，PEAK1 demonstrated a negative correlation with both TG and HDL-C （P<0.05），and PEAK2 demonstrated a negative correlation with HDL-C （P<0.05）．Conclusion　This study suggests that serum lipids affect the response of GH at the stimulation test.It is suggested that low-fat diet should be adopted before the GH stimulation test，which may improve the accuracy of diagnosis of GHD.


Emotional Cognitive Impairment Regulated by Happy Emotional Induction in People with Subthreshold Depression：an Event-related Potential Study　

ZHANG Jinpeng，LI Xue，TAN Xi，DU Jian，ZHAO Mingyang，YOU Mingyan，ZHANG Yichunzi，KONG Junhui

2019, 22(35):  4312-4317.  DOI: 10.12114/j.issn.1007-9572.2019.00.567

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Background　Subthreshold depression is a sub-health state between health and depression.Because it does not meet the clinical standard，non-drug treatments are more used in practice.The happy emotional induction program developed earlier by our research group can effectively regulate individual emotions，whose mechanism of action may be clarified from the cognitive perspective.Objective　The purpose of this study was to explore whether the people with subthreshold depression have emotional cognitive impairment（ECI） and the regulation results of happy emotional induction program for ECI.Methods　44 undergraduate students of Beijing University of Chinese Medicine were recruited from December 2016 to March 2017 in accordance with the criteria of event-related potential（ERP） for testing different cognitive functions，including 17 healthy individuals（control group） and 27 with subthreshold depression 〔subthreshold depression group，was further randomized into induction subgroup（n=14） and non-intervention subgroup（n=13）〕 by the results assessed by Center for Epidemiological Survey，Depression Scale（CES-D） and 17-item Hamilton Depression Rating Scale（HAMD-17）．All participants performed ERP experiments without pre-test interventions，except those in the induction group received emotional induction according to the happy emotional induction program.A two-factor repeated measure ANOVA was utilized to examine the latencies and amplitudes of N2 and P3 components，with the group（non-intervention subgroup，induction subgroup and healthy controls） as the between-subject factor，and the emotion（positive，negative，and neutral） as the within-subject factor.The Greenhouse-Geisser correction was used to correct repeated measure ANOVA that violated the sphericity assumption，and the Bonferroni correction was applied to all post-hoc pairwise comparisons.Results　Compared with the healthy group，the amplitude of P3 decreased after positive stimulation while the latency of P3 prolonged after neutral stimulation in the non-intervention subgroup（P<0.05）．Compared with the non-intervention subgroup，in the induction subgroup，the positive stimulation increased the amplitude of P3，and prolonged the latency of P3，neutral stimulation decreased the amplitude of N2 and shortened the latency of P3（P<0.05）．Conclusion　There was emotional cognitive impairment in individuals with subthreshold depression.The happy emotional induction program can effectively regulate and improve the cognitive impairment.


Prevalence of Hypertension and Its Association with ABO Blood Types in General Health Examinees　

GU Yuncheng，LIU Qing，WANG Suzhen，GE Xinying

2019, 22(35):  4318-4321.  DOI: 10.12114/j.issn.1007-9572.2019.00.565

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Background　Worldwide prevalence of hypertension is increasing gradually.In particular，China owns an ever-larger number of hypertensive patients.Most hypertension prevalence-related research studies are based on the clinical analysis，rarely involves blood groups and other genetic laws.Objective　This study provides a scientific basis for the prevention and treatment of hypertension by analyzing the correlation between the prevalence of hypertension and ABO blood types.Methods　The data stemmed from the electronic health records of Jiangxi residents，involving a sample of 185 633 normal individuals undergoing health screening between 2008 and 2017，including 8 798 who were found with hypertension（hypertension group） and 176 835 without（control group）．Sex，age and blood types of both groups were comparatively analyzed.Sex- and age-specific subgroup analyses were performed to examine the associations of hypertension prevalence with ABO blood types.Results　There were significant differences in sex distribution and age distribution between the two groups（χ2=85.863，P<0.001；χ2=2 765.236，P<0.001）．Both groups also showed significant difference in ABO blood types distribution（χ2=46.102，P<0.001）．Compared with the control group，the percentages of A and B blood types were lower while the percentages of O and AB blood types were higher in hypertension group（RR=0.95，0.93，1.06，1.15，P<0.001）．Sex-specific analysis showed that blood group distribution differed significantly between hypertensive and non-hypertensive men（χ2=25.286，P<0.001），and between hypertensive and non-hypertensive women（χ2=21.271，P<0.001）．Lower percentages of A and B blood types，and higher percentages of O and AB blood types were found in hypertensive men instead of non-hypertensive men（RR=0.95，0.94，1.06，1.16，P<0.001），and were found in hypertensive women instead of non-hypertensive women（RR=0.94，0.93，1.07，1.16，P<0.001）．Age-specific analysis revealed that no significant differences were found in blood group distribution（χ2=2.502，P=0.475），and in the percentages of A，B，O and AB blood types between hypertensive and non-hypertensive adolescent subgroups（0-17 years old）．However，blood group distribution differed significantly between young（18-45 years old） hypertensive and non-hypertensive subgroups（χ2=15.733，P<0.001）．Young hypertensive subgroup showed a lower percentage of blood type B，and higher percentages of blood types O and AB（RR=0.89，1.11，1.20，P<0.05）．Blood group distribution also differed significantly between middle-aged（46-60 years old） hypertensive and non-hypertensive subgroups（χ2=15.982，P<0.001）．Middle-aged hypertensive subgroup showed higher percentages of O and AB blood types（RR=1.07，1.20，P<0.05）．A significant difference in blood group distribution was also found between elderly（> 60 years old） hypertensive and non-hypertensive subgroups（χ2=15.449，P<0.001）．Elderly hypertensive subgroup demonstrated lower percentages of A and B blood types，and higher percentages of O and AB blood types（RR=0.95，0.96，1.05，1.11，P<0.05）．Conclusion　The distribution of blood types differed significantly between hypertensive and non-hypertensive health examinees.Those with blood type O or AB may be more likely to have hypertension.



Values of Serum NSE and Pro-GRP Levels in Evaluating the Response and Outcome Following Chemotherapy in Small Cell Lung Cancer　

XIA Guoqing，HAN Yiping

2019, 22(35):  4322-4326.  DOI: 10.12114/j.issn.1007-9572.2019.00.272

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Background　Small cell lung cancer （SCLC） is highly invasive，characterized by rapid tumor doubling time，early metastasis，easy recurrence，and poor prognosis.At the time of diagnosis，only about 30% of patients are in limited disease.Although SCLC is highly sensitive to radiotherapy and chemotherapy，some patients will develop drug resistance and tumor proliferation after a period of treatment.Therefore，to find out the factors affecting the response and outcome following treatment in SCLC patients will play a certain role in stratified management and prognosis improvement of these patients.Objective　To analyze the serum levels of NSE and Pro-GRP in the evaluation of response and outcome following initial chemotherapy in SCLC patients.Methods　From July 2015 to July 2016，103 patients with SCLC confirmed by pathological examination were recruited from Department of Respiratory Medicine，Changhai Hospital.All of them received initial chemotherapy for 4 to 6 cycles.Serum NSE and Pro-GRP levels were measured before and after chemotherapy.The patients were followed up as of 2017-07-31，and the progression-free survival（PFS） were recorded.Results　Among the 103 patients，7 （6.8%） had complete response （CR），18 （17.5%） had partial response （PR），53 （51.4%） had stable disease （SD），and 25 （24.3%） had disease progression （PD）．Compared with baseline，patients with CR and PR had decreased average serum NSE and Pro-GRP levels after the chemotherapy，so did those with SD（P<0.05）．But there were no significant differences in average pre- and post-chemotherapy NSE and Pro-GRP levels in PD patients （P>0.05）．The average levels of NSE and Pro-GRP in CR+PR，SD，and PD groups were significantly different after chemotherapy （P<0.05）．Spearman rank correlation test revealed that pre-chemotherapy NSE and Pro-GRP levels had no correlations with treatment response （rs=0.019，P=0.845；rs=0.171，P=0.086），but postchemotherapy NSE and Pro-GRP levels did （rs=0.342，P<0.001；rs=0.350，P<0.001）．The distribution of responses to initial chemotherapy differed significantly between those with NSE< upper limit of normal（ULN） and those with NSE≥ULN （P<0.05）．But the distribution of responses to initial chemotherapy did not vary significantly between those with Pro-GRP < ULN and those with Pro-GRP ≥ULN （P<0.05）．The PFS changed obviously according to tumor stage，metastasis status，levels of postchemotherapy NSE and Pro-GRP（P<0.05）．Multivariate survival analysis using Cox's regression model showed that tumor stage 〔HR=2.19，95%CI （1.29，3.72）〕 and postchemotherapy NSE level 〔HR=2.67，95%CI （1.62，4.44）〕 were prognostic factors of SCLC patients （P<0.05）．Conclusion　Postchemotherapy NSE and Pro-GRP levels can well monitor the response to chemotherapy in SCLC patients.In particular，postchemotherapy NSE level may also be used for predicting the outcome.


Smoking Cessation Rate and Factors Influencing Relapse in Postoperative Patients with Colorectal Cancer：an One Year Observation Study　

SU Chang，CAO Yiou，XIAO Lijun，LIU Shaoqun，LEI Ming，CHEN Yi

2019, 22(35):  4327-4331.  DOI: 10.12114/j.issn.1007-9572.2019.00.468

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Background　Smoking is one of the risk factors for colorectal cancer，and is closely associated with the recurrence and metastasis of colorectal cancer after operation.The harm of smoking to patients with colorectal cancer has not achieved sufficient clinical attention，and the research on smoking cessation rate and factors influencing relapse in such patients is rare.Objective　To investigate smoking cessation rate and factors influencing relapse in colorectal cancer patients who had smoking habit at admission within one year after operation.Methods　From January 2014 to January 2017，117 patients who had not quit smoking when diagnosed with colorectal cancer by colonoscopy and pathology at Minhang Hospital，Fudan University were enrolled.They received radical colorectal cancer surgery （laparotomy or laparoscopic minimally invasive surgery） 1 to 2 weeks after routine cessation of smoking.The patients stopped smoking for 3-4 weeks and received regular health education before discharge.The general condition of the patients were recorded，the information of factors that may influence the relapse were obtained through a questionnaire survey，and the situation of relapse was observed through one-year out-patient follow-up.The smoking cessation rate and independent factors influencing relapse were analyzed with multivariate Logistic regression.Results　A total of 117 cases were included，and all of them completed one-year follow-up.Smoking cessation rate was 59.8%（70/117），and smoking relapse rate was 40.2%（47/117）．Sex，education level，monthly household income，age of starting to smoke，smoking age，daily cigarette consumption，having the first cigarette within 5 minutes of waking up in the morning，understanding level of the dangers of smoking，understanding level of the relationship between smoking and respiratory diseases，and receiving regular postoperative chemotherapy were not associated with postoperative one-year smoking relapse rate （P>0.05）．Age >55 years old，not living alone，family members and friends opposing smoking，understanding the relationship between smoking and colorectal cancer，undergoing laparotomy，and having a permanent colostomy were associated with a lower smoking relapse rate （P<0.05）．Multivariate Logistic regression analysis showed that age 〔OR=0.276，95%CI（0.104，0.729）〕，living alone 〔OR=0.190，95%CI（0.044，0.816）〕，attitudes of family and friends towards smoking 〔OR=0.279，95%CI（0.108，0.719）〕and whether having a permanent colostomy 〔OR=0.162，95%CI（0.032，0.810）〕 were independent influencing factors for postoperative one-year smoking relapse in colorectal cancer patients （P<0.05）．Conclusion　Postoperative one-year smoking cessation rate in patients with colorectal cancer is less than desirable.Age，living alone or not，family members and friends' attitudes toward smoking are the main factors that affect patients smoking cessation.Tobacco control should be strengthened especially for those undergoing minimally invasive surgery without colostomy.


Effect of Tidal Volume on Stroke Volume Variability and Patient Capacity Evaluation in Open Gastrointestinal Surgery　

WANG Weizhi，ZHONG Yuqi，ZHAO Yajuan，WANG Binbin，ZHAO Maohong

2019, 22(35):  4332-4336.  DOI: 10.12114/j.issn.1007-9572.2019.00.732

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Background　Available studies have shown that in the monitoring of patient volume status and volume responsiveness by the FloTrac/Vigileo system，stroke volume variation（SVV） ≥ 13% indicates the patient capacity is insufficient，otherwise it is relatively sufficient，and when the tidal volume（VT） ≤ 5 ml/kg，SVV can not accurately reflect patient volume status and volume responsiveness.However，there is no clear conclusion about the specific relationship between VT and SVV.Objective　To investigate the effects of different VT on SVV in open gastrointestinal surgery，and to analyze the feasibility and accuracy of using SVV to evaluate patient volume responsiveness under different VT.Methods　Sixty patients undergoing elective open gastrointestinal surgery in Weifang People's Hospital from October 2018 to June 2019 were selected.After mechanical ventilation，the VT was adjusted to 6，8，10 and 12 ml/kg，respectively，and the mean arterial pressure（MAP），heart rate（HR），SVV and CI values were recorded.When the SVV measured at VT of 8 ml/kg was ≥13%，then rapid intravenous rehydration of 500 ml 6% hydroxyethyl starch 130/0.4 in 0.9% sodium chloride injection was performed.Then the MAP，HR，SVV and the CI under four VT conditions were measured and recorded again.Results　Before rapid intravenous rehydration therapy，MAP and HR were similar under four different VT conditions（P>0.05），while SVV differed significantly（P<0.05）.The SVV under four different VT conditions increased with the increase VT，to be specific，SVV at VT=8 ml/kg was higher than that at VT=6 ml/kg，SVV at VT=10 ml/kg was higher than that at VT=6 ml/k and VT=8 ml/kg，and SVV at VT=12 ml/kg was higher than that at VT=6 ml/k，VT=8 ml/kg and VT=10 ml/kg（P<0.05）.After rapid rehydration therapy，MAP and HR were still similar under four different VT conditions（P>0.05），while SVV still differed significantly（P<0.05）.When the ΔCI（the difference of CI before and after rapid rehydration therapy） ≥15% was defined as having response to rehydration therapy，the AUC of SVV in determining the volume responsiveness at VT=6 ml/kg，8 ml/kg，10 ml/kg and 12 ml/kg，was 0.625，0.884，0.873，and 0.856，respectively，and the corresponding diagnostic threshold was 10%，13%，16%，and 19%，respectively.Conclusion　VT has an effect on SVV.The greater the VT，the larger the measured SVV value.The SVV monitored under VT of 6-12 ml/kg can determine the blood volume status of the patient.But compared with at VT of 6 ml/kg，the SVV measured at VT=8，10，12 ml/kg can more accurately determine the capacity status and volume responsiveness of the patient under mechanical ventilation.The critical values of SVV under different VT are different.The critical values of SVV are 10%，13%，16%，and 19%，respectively，when VT=6，8，10，12 ml/kg.


Peripheral Neuropathy in Elderly Patients with Colorectal Cancer Treated with Oxaliplatin-assisted Chemotherapy　

WANG Zhenfen，CAI Guohao，ZHANG Weitong，HUANG Ping，FU Yong，YE Mulin

2019, 22(35):  4337-4341.  DOI: 10.12114/j.issn.1007-9572.2019.00.476

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Background　The addition of oxaliplatin to adjuvant chemotherapy for colorectal cancer has been shown to improve overall survival at the expense of increased toxicity.The incidence and severity of toxicity might be greater among older patients who might also derive less benefit from oxaliplatin.Objective　To evaluate the association between oxaliplatin-assisted chemotherapy and peripheral neuropathy in elderly patients with colorectal cancer.Methods　This study was a retrospective cohort study.A total of 38 085 patients aged 66 or above who underwent surgery for colorectal malignancies in the Department of Gastrointestinal Surgery of Hainan General Hospital and the Second Affiliated Hospital of Hainan Medical University from 2012 to 2015 were included in the study.Among 3 607 stage Ⅱ and Ⅲ patients receiving adjuvant chemotherapy，1 541 （42.72%） patients received oxaliplatin-assisted chemotherapy and 2 066 （57.28%） patients received fluorouracil chemotherapy alone.According to age，patients were divided into 66-69 years old group（n=987） and ≥70 years old group（n=2 620）.The clinical data were collected in the three-year follow up.As of 1 February 2018，the incidence of peripheral neuropathy，drug use rate of neuropathic pain and mortality rate were recorded.A multi-variable hazard modelling was constructed by the incidence of peripheral neuropathy and drug use rate of neuropathic pain.The cumulative incidence function was used to estimate the incidence of peripheral neuropathy，drug use rate of neuropathic pain，and mortality rate.Results　There were significant differences in gender，pathological stages，complication rate of dementia and stroke，Charlson's complications index （CCI） between two groups （P<0.05）.The proportion of pathological stageⅢ and colon cancer in patients aged 66-69 with oxaliplatin-assisted chemotherapy was higher than those without oxaliplatin-assisted chemotherapy，while the complication rate of diabetes mellitus and CCI were lower （P<0.05）.The proportion of male，pathological stageⅢ and colon cancer in patients aged 70 or above with oxaliplatin-assisted chemotherapy was higher than those without oxaliplatin-assisted chemotherapy，while the age，complication rate of dementia and CCI were lower （P<0.05）.Oxaliplatin-assisted chemotherapy was associated with an increased risk of peripheral neuropathy in all patients （P<0.05）.Oxaliplatin-assisted chemotherapy was not associated with an increased risk of peripheral neuropathy in patients aged 66-69 （P<0.05）.Oxaliplatin-assisted chemotherapy was associated with an increased risk of peripheral neuropathy in patients aged 70 or above（P<0.05）.Oxaliplatin-assisted chemotherapy was associated with increased use of gabapentin，tricyclic antidepressants and duloxetine in all patients （P<0.05）.Oxaliplatin-assisted chemotherapy was associated with increased use of tricyclic antidepressants in patients aged 66-69（P>0.05）.Oxaliplatin-assisted chemotherapy was associated with increased use of gabapentin and tricyclic antidepressants in patients aged 70 or above （P<0.05）.The incidence of peripheral neuropathy was 6.63% 〔95%CI（5.44%，7.97%）〕，the drug use rate of neuropathic pain was 15.43% 〔95%CI（13.61%，17.37%）〕 and the mortality rate was 14.72% 〔95%CI（13.04%，16.67%）〕 in patients receiving oxaliplatin-assisted chemotherapy for three years.Conclusion　Oxaliplatin-assisted chemotherapy in elderly patients with colorectal cancer can lead to peripheral neuropathy，especially in patients aged 70 and above who have a higher risk of peripheral neuropathy and drug use of neuropathic pain.Therefore，for adjuvant chemotherapy in elderly patients with colorectal cancer，it is necessary to fully consider the peripheral neuropathy.


Analysis of Gene Diagnosis of Thalassemia in Dali Bai Autonomous Prefecture of Yunnan　

YANG Xitong，YANG Zongmei，MA Rong，XU Hongyang，ZHAO Caihong，WANG Guangming

2019, 22(35):  4342-4345.  DOI: 10.12114/j.issn.1007-9572.2019.00.254

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Background　Thalaseemia is an autosomal inherited disease, and patients with mild thalassemia may only have the corresponding symptoms of anemia, but severe thalassemia which requires regular blood transfusions or bone marrow transplants brings pain and burden to patients' lives. Couples with thalassemia may pass it to their newborn.Therefore, a systematic analysis of thalassemia through genetic diagnosis can reduce the birth rate of children with thalassemia, improve the quality of life and reduce family burden. Objective　To explore epidemiology and phenotypic characteristics of thalaseemia in Dali, Yunnan.Methods　A total of 6 120 cases who undergone thalassemia genotype genetic diagnosis from the First Affiliated Hospital of Dali University and Dali Bai Autonomous Prefecture People's Hospital were selected between August 2014 to May 2018. 5 ml of venous blood was collected with EDTA - K2 anticoagulant tube and 23 thalassemia gene mutation types ( alpha-thalassemia: 3 deletion forms, 3 mutant forms; beta-thalassemia: 17 mutant forms) were detected through the technique combined with the first generation of sequencing, real-time fluorescent quantitative polymerase chain reaction ( PCR ), PCR-reverse dot hybridization method and Gap-PCR method. Results　Of the 6 120 cases, 1 220 were diagnosed as thalassemia（19.93%）, 560（45.90%） of who had α-thalassemia, with 520 cases of deletion form and 40 cases of mutant form, and 660 （54.10%）of who had β thalassemia -α3.7 mutation 〔69.23%（360/520）〕had the highest frequency of α thalassemia deletion form, the highest in mutant form was αCSα〔75.00%（30/40）〕 and Be（GAG>AAG）〔53.03%（350/660）〕 mutation had the highest frequency of β thalassemia mutant form．Conclusion　The frequency of β thalassemia is higher than that of α thalassemia in Dali, Yunnan.The frequency of deletion form is higher than that of mutant form in α thalassemia, with -α3.7 deletion form in majority. And αQSα mutation form is not detected in α thalassemia mutation.


Advances in Diagnosis and Treatment of Heart Failure by Intestinal Microbiota　

CHEN Zijun，ZHU Bin，YANG Chun，YANG Ling

2019, 22(35):  4346-4352.  DOI: 10.12114/j.issn.1007-9572.2019.00.306

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The physiological role of intestinal microbiota in non-gastrointestinal diseases has attracted growing attention of researchers, which has also been shown to be an important factor in the pathogenesis and development of heart failure.There are characteristic changes in intestinal microbiota composition in patients with heart failure, such as the increase of harmful microbiota and their metabolites, for example trimethylamine oxide（TMAO）, and the decrease of protective microbiota and their metabolites, for example short-chain fatty acids. Meanwhile, heart failure can also induce intestinal congestion, edema, and heightened permeability, allowing harmful microbiota and their toxic metabolites such as endotoxin into the circulation through the intestinal wall, which triggers cytokine generation and activates signal pathway, thereby contributing to further impairment in cardiac function. Given the importance of intestinal microbiota in the development of heart failure, it is expected that regulating intestinal microbiota and interfering with its metabolites will be a new target for the diagnosis and treatment of heart failure. The article aims to review the changes of intestinal microbial composition, the mechanism of their toxic metabolites in heart failure and the research progress in interventional intestinal microbiota in the treatment of heart failure.


Correlation between Chronic Obstructive Pulmonary Disease and Gut and Lung Microbiota　

LI Xiaojun，LI Ya，LI Suyun

2019, 22(35):  4353-4357.  DOI: 10.12114/j.issn.1007-9572.2019.00.575

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According to the latest literature，this paper introduced the pathogenesis of chronic obstructive pulmonary disease（COPD），expounded the relationship among lung microbiota，gut microbiota and the body，and analyzed the correlation between the imbalance between the lung and gut microbiota to COPD and its acute aggravation events.In the absence of longitudinal or interventional studies，it is difficult to determine whether changes in the gut or lung microbiota are related to the development of COPD causally.The research on the changes of the pulmonary and gut microbiota in acute aggravation and stabilization period would reveal the dynamic change of COPD and propose new strategies for its treatment.
Pulmonary disease，chronic obstructive；Microbiota；Gut；Lung；Review


Comprehensive Evaluation for Hubei Health Management Service Based on Weighted Rank Sum Ration Model　

GAO Xudong，TAN Xiaodong，WANG Zhenkun，KONG Chan

2019, 22(35):  4358-4361.  DOI: 10.12114/j.issn.1007-9572.2018.00.334

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Background　Hubei Province launched a pilot project of health management in 2013. After four years of implementation, it has achieved good results and has been popularized throughout the Province. However, there is no systematic evaluation standard for health management in Hubei Province. Objective　To establish and apply an evaluation system for health management service in Hubei Province.Methods　Literature review and expert consultation methods were used to establish the evaluation system of Hubei health management services from 2014 to 2016.Based on analytic hierarchy process （AHP），index weight coefficients were established.From the data of pilot areas in four functional zones in Huangpi of Wuhan，namely，Airport Economic Zone，North Hankou Commercial Zone，Mulan Tourism Zone and Metropolitan Agricultural Zone，the weighted rank sum ratio （WRSR） model was used to classify and rank the service.Results　The final established health management service evaluation system included 6 first-level indexes，21 second-level indexes and 38 third-level indexes.The WRSR values of North Hankou Commercial Zone，Metropolitan Agriculture Zone，Mulan Tourism Zone and Airport Economic Zone were 0.702 6，0.680 3，0.618 5，0.498 7，respectively.Conclusion　The WRSR model can be used to evaluate the quality of health management service in Hubei Province，which proves that the overall service is generally good.


Theory of Planned Behavior-based Structural Equation Model Analysis of Behavioral Intention for Young and Middle-aged Patients with Obesity-related Nonalcoholic Fatty Liver Disease in TCM Health Management　

GAO Xiaolian，ZHENG Wenqing，XIAO Mingzhong，TAO Junxiu，ZENG Dan，AI Yating

2019, 22(35):  4362-4369.  DOI: 10.12114/j.issn.1007-9572.2019.00.576

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Background　The incidence of obesity-related nonalcoholic fatty liver disease（NAFLD） in obese young and middle-aged people is gradually increasing，but the practice of Traditional Chinese Medicine health management（TCM-HM） is unsatisfied.The problems such as low motivation，poor compliance，and low utilization of TCM resources still exist.Patients are the key to health management.However，there are rare studies seeking patients' awareness of disease and TCM-HM based on the social behavioral theory.Objective　To explore the influencing factors of young and middle-aged people with obesity-related NAFLD participating in TCM-HM based on the theory of planned behavior（TPB）．Methods　Participants were volunteers who underwent physical examination in the Hepatology Research clinic of Hubei Provincial Hospital of TCM and enrolled into the biological sample database of overweight/obesity from October to December 2016.A total of 552 questionnaires were issued，552 were collected，and 432 were valid，with an effective recovery rate of 78.26%.The questionnaire pool was established by in-depth interviews and literature method.An initial questionnaire was formed through expert consultation and multiple rounds of revision by the research group.After preliminary investigation，it was revised and adjusted for several times.The formal questionnaire was produced named the survey of behavioral intention for young，middle-aged patients with obesity-related NAFLD participating in TCM-HM.Exploratory factor analysis（EFA） was used to catch potential factors.The Structural Equation Model（SEM） for behavioral intention of TCM-HM for the young and middle-aged patients with obesity-related NAFLD was constructed，and confirmatory factor analysis（CFA） was performed.Results　EFA identified seven potential factors including subjective norm，self-efficacy，negative attitude，health perception，perceived behavior control，TCM-HM intention and actual behavior in 65 measurements；CFA confirmed the correlation between the seven potential factors mentioned，and the SEM had a good fitting evaluation〔comparative fit index（CFI）=0.949，Bentler-Bonett normed fix index（NFI）=0.977，Tucker-Lewis index（TLI）=0.932，goodness-of-fit index（GFI）=0.868，χ2/df=2.436，root-mean-square error of approximation（RMSEA）=0.065〕；the hypothesis test results showed that positive correlation initiated between subjective norm，perceived behavioral control and TCM-HM intention（path coefficient were 0.144，0.098，respectively，P<0.001）；negative attitude remained negative correlation with health perception and TCM-HM intention（path coefficient were -0.097 and -0.168，respectively，P<0.001）；there was no correlation between self-efficacy and TCM - HM intention（the path coefficient was -0.023，P=0.471）．From the perspective of the behavior，behavior was verified with no correlation among subjective norm，self-efficacy，health perception（path coefficient were -0.038，0，0.095，respectively，P values were 0.457，0.991，0.083，respectively），and perceived behavior control and actual behavior had a positive correlation（path coefficient was 0.093，P<0.001），while negative attitude and actual behavior had a negative correlation（path coefficient was -0.110，P<0.001）．TCM-HM intention had no correlation with actual behavior（path coefficient was -0.091，P=0.074）．Conclusion　TPB-based model construction is applicable to explain the intention of TCM-HM in young and middle-aged people with obesity-related NAFLD.Subjective norm，negative attitude，health perception and perceived behavior control can affect TCM-HM intention，but the gap still exists between TCM-HM intention and actual behavior.When NAFLD TCM-HM model is established，TCM resources must be optimized to guarantee the quality，especially strengthen the availability and feasibility of resources.At the same time，it is important to standardize TCM information and improve the patients knowledge of fatty liver disease.Further，it is beneficial to analyze the patients' personality and behavioral pattern in order to formulate personalized TCM-HM plan.


Testing of Reliability and Validity of the Chinese Version of Family Satisfaction with Advanced Cancer Care-2　

JIN Lei，ZENG Jie，QUAN Manman，LI Qian，WU Wenjing，SHI Baoxin

2019, 22(35):  4370-4374.  DOI: 10.12114/j.issn.1007-9572.2019.00.554

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Background　Satisfaction is one of the important indicators in the quality assessment system of hospice care.Timely and accurate assessment for satisfaction has great significance for understanding and improving the development level of hospice care in China.Objective　To translate Family Satisfaction with Advanced Cancer Care-2 （FAMCARE-2） from English to Chinese and evaluate its reliability and validity.Methods　Brislin translation model was applied for translation and back translation，and cultural adjustment was performed through expert committee discussions and pre-tests.Convenience sampling method was used to select 206 family caregivers of advanced cancer patients who received hospice care services in the Department of Integrated Chinese and Western Medicine in Tianjin Medical University Cancer Institute and Hospital from September to December in 2018.General information questionnaire and the Chinese version of FAMCARE-2 were used，and 30 family caregivers were retested after one week.Item analysis，reliability analysis and validity analysis of the Chinese version of FAMCARE-2 were tested.Results　The Chinese version of FAMCARE-2 included 17 items in four dimensions，managements of physical symptoms and comfort，provision of information，family support，and patient psychological care.The results of the item analysis showed that the critical ratio （CR） of 17 items was 13.463-20.324，and each item was positively correlated with the total score（r=0.763-0.925）．The Cronbach's α coefficient of the scale after deleting each item was 0.972-0.975.Confirmatory factor analysis results showed that CMIN/DF was 2.045； GFI was 0.903； NFI was 0.949； RFI was 0.929； RMR was 0.011 and RMSEA was 0.071.The I-CVI and S-CVI of the scale were 0.857-1.000 and 0.958，respectively.Cronbach's coefficient of the scale was 0.975，and 0.922，0.903，0.908，and 0.924 for each dimension，respectively.The test-retest reliability of the scale was 0.837.The split-half reliability was 0.947.Conclusion　The Chinese version of FAMCARE-2 has good reliability and validity，and is suitable for the evaluation of the satisfaction of family caregivers of patients with hospice care in China.


Development，Reliability and Validity of the Questionnaire of Home Care Service Needs in Cancer Patients in Nanjing Using the Delphi Method　

PU Yalou，MENG Aifeng，ZHI Xiaoxu，DONG Gaoyue，LIU Yan，WANG Pengcheng，LU Lijing，TANG Lin

2019, 22(35):  4375-4380.  DOI: 10.12114/j.issn.1007-9572.2019.00.577

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Background　During the vigorous implementation of the facilitation strategies for achieving goals towards building a healthy China，it has become an inevitable trend to improve the quality of whole life health in cancer patients.It is of great realistic significance to focus on the development of home care services for these patients.However，there is no suitable tool for assessing home care service needs in such patients.Objective　To develop a questionnaire of home care service needs in cancer patients in Nanjing，and to test its reliability and validity.Methods　On the basis of literature review，qualitative interviews with cancer patients and group discussions with experts，a questionnaire item pool was compiled.Then the items were revised according to the results of two rounds of mail-based Delphi surveys conducted in January 2019 in a convenience sample of 25 experts in the field of providing home care services for cancer patients from tertiary grade A hospitals，community hospitals，and medical colleges，Nanjing.The response coefficient，authority coefficient，and collaborative degree of experts were counted and analyzed.In February 2019，the initial version of Home Care Service Needs in Cancer Patients in Nanjing Questionnaire were pretested in a convenience sample of 35 cancer patients from Day-care Ward，Jiangsu Cancer Hospital，and its reliability and validity were tested.Results　The response coefficient and Kendall's W for the first round of Delphi survey were 92.0%，0.236，respectively，and for the second round were 100.0%，0.056，respectively.The Cr of Delphi surveys was 0.884.The CVI and Cronbach's αcoefficient of the questionnaire were 0.903，and 0.761，respectively.The final questionnaire includes 7 dimensions，including educational guidance，auxiliary monitoring，life care，professional care，psychological counseling，diet and nutrition，and hospice care，with a total of 43 items.Conclusion　The questionnaire compiled in this study has high reliability and validity，and can be used as a tool to investigate the needs of home care services in cancer patients.


Comparison of the Performance of Three Versions of Constitution of Chinese Medicine Questionnaire for Healthy Populations　

ZHU Yanbo， SHI Huimei， YU Xiaohan

2019, 22(35):  4381-4387.  DOI: 10.12114/j.issn.1007-9572.2018.00.320

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Background　There were three Constitution of Chinese Medicine Questionnaire（CCMQ） with 60-item, 41-item, and 30-item. But, their performance hadn't been evaluated in the healthy population. Besides, targets of the three CCMQ were different. Then their performance should be evaluated and compared by the same sample, so that researchers can choose the suitable one according to their actual situation. Objective　To compare the performance of 60-item CCMQ， 41-item CCMQ， and 30-item CCMQ in healthy populations. Methods　This cross-sectional study was conducted from 2015 to 2016. The 1 295 participants were all with a history of donating whole blood voluntarily without payment，who were recruited at Beijing Red Cross Blood Center huts and cars received a field survey，for collecting the data concerning general demographic characteristics， constitution evaluated by 60-item CCMQ. According to the whole-blood donation times calculated by the donated blood volume， the participants were divided into three groups： 1-4 times group （n=692）， 5-9 times group （n=311） and ≥10 times group （n=292）． The reliability， construct validity， and discrimination validity of these 3 versions of CCMQ were analyzed with Cronbach's α， factor analysis， and method of least squares， respectively. Results　The Cronbach's α were 0.70-0.80 for 60-item CCMQ， 0.61-0.80 for 41-item CCMQ， 0.49-0.73 for 30-item CCMQ. By factor analysis， 8 common factors with an eigenvalue greater than 1 were extracted from 60-item CCMQ， and 41-item CCMQ， respectively， explaining 48.08%， 52.86% of the total variance， respectively. For the 8 common factors extracted from 30-item CCMQ， the first 6 ones had an eigenvalue greater than 1， while factor 7 and factor 8 had an eigenvalue of 0.96， 0.90， respectively， explaining 57.13% of the total variance. 1-4 times group， 5-9 times group and ≥10 times group showed significant differences in the mean scores of gentleness， qi-deficiency， yang-deficiency， yin-deficiency， phlegm dampness， dampness-heat， blood-stasis， qi-depression， and special diathesis of both 60-item and 41-item CCMQ， and in the mean scores of gentleness， qi-deficiency， yang-deficiency， yin-deficiency， dampness-heat， blood-stasis， and qi-depression of the 30-item CCMQ （P<0.05）． Conclusion　For the assessment of constitution of healthy populations， all these 3 versions of CCMQ have good reliability and validity. Researchers can select one of them according to the purpose of study and the properties of the participants.


VSD-based Closed Irrigation Technique Applied in the Treatment of Infections Involving Lumbar Intervertebral Disc Space and Lumbar Deep Soft Tissues　

GAO Mingyong，TAO Haiying，GUO Weichun，JIN Wenyi

2019, 22(35):  4388-4391.  DOI: 10.12114/j.issn.1007-9572.2019.00.736

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Background　Sealed negative pressure sealing dressing and drainage techniques developed using new biomaterials bring new hope to the prevention and treatment of intervertebral space infection and its related serious complications.It is a new progress in the treatment of deep soft tissue infection including bone tissue infection at home and abroad.Objective　To investigate the medical efficacy of VSD-based closed irrigation technique in the treatment of infections of lumbar deep soft tissues and infections after posterior lumbar interbody fusion with internal fixation.Methods　A retrospective study was conducted with 21 patients suffering from infections of lumbar deep soft tissues from Department of Orthopedics，Renmin Hospital of Wuhan University from January 2012 to January 2017.All patient subjects were initially treated with sensitivity antibiotics based on the results of microorganism culture，and early exhaustive debridement before implantation with VSD-based closed irrigation system.The replacement or removal of VSD irrigation and drainage system was determined by the conditions including repair outcome of infected soft tissue，negative conversion of infectious markers and outcome of germiculture result after treatments which lasted till infections were cured and wounds were healed.Results　The VSD drainage systems were removed after an average of（17.2±1.3） days（range:11-27 days） of treatment.The levels of CRP and ESR decreased to normal levels after an average of（15.6±1.7） and of（34.3±2.4） days，respectively.The average hospital stay was（22.6±3.1） days with all the infections being cured completely.There was no recurrence of infection at the 6-48 months follow-up.Conclusion　VSD-based closed irrigation technique emerged as an effective treatment for infections involving lumbar intervertebral disc space and lumbar deep soft tissues.


Clinical Observation on Auricular Acupressure Therapy Combined with Three-step Analgesic Ladder Therapy for Moderate to Severe Cancer Pain　

SHI Junjing，JIANG Hua，LIU Ronghui，XU Gaojie，DING Chunmei，HUANG Jinwei，QIN Jin，WANG Zhaoxin

2019, 22(35):  4392-4396.  DOI: 10.12114/j.issn.1007-9572.2019.00.712

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Background　A large number of patients with moderate to severe cancer pain have intolerable adverse reactions during the analgesic treatment with commonly used western medicine.The therapeutic effect of auricular acupressure therapy combined with traditional Chinese medicine is worth exploring.Objective　To explore the clinical effects of auricular acupressure therapy combined with three-step analgesic ladder therapy for moderate to severe cancer pain.Methods　A total of 60 advanced cancer patients with moderate to severe cancer pain were selected from the Hospice Care Ward of Yingbo Community Health Service Center in Pudong New Area in Shanghai from 2017 to 2018.They were divided into the control group and the treatment group by random number table method by 30 in each.The patients in control group were given the three-step analgesic ladder therapy，while the patients in treatment group were given auricular acupressure therapy on the basis of the control group.The analgesic effect，medication（Oxycontin） dosage，the incidence of nausea，vomiting and constipation along with the improvement of depression were observed after one-week treatment.Numerical Rating Scale（NRS） was used to assess the degree of pain，and Hamilton Depression Scale（HAMD） was used to assess the state of depression.Results　There was no significant difference in NRS pain scores between the two groups（Z=0.106，P=0.916）.The dosage of Oxycontin used in the treatment group was 40（20，60）mg/24 h，which was lower than that in the control group〔40（40，60）mg/24 h〕（Z=2.067，P=0.039） after one-week titration.The severity of nausea and vomiting in the treatment group was lighter than that in the control group（Z=2.395，P=0.017）.The incidence of constipation in the treatment group was 16.7%（5/30），which was lower than 43.3%（13/30） in the control group（χ2=5.079，P=0.024）.The HAMD score of the treatment group was lower than that of the control group after one-week treatment（P<0.05）.Conclusion　Auricular acupressure therapy combined with three-step analgesic ladder therapy can effectively reduce the dosage of analgesics，alleviate adverse reactions of the digestive system，and improve the depression of patients with moderate to severe cancer pain，which has the certain clinical application value and thus deserving popularization.


Application of Oscillographic Method for Blood Pressure Measurement in Lower Extremity Arterial Diseases　

LIU Songtao，SU Hai，LI Ping

2019, 22(35):  4397-4400.  DOI: 10.12114/j.issn.1007-9572.2019.00.181

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Background　At present，the prevalence of lower extremity arterial disease（LEAD）is gradually rising.In addition，many studies have proved that LEAD is associated with cardiovascular and cerebrovascular diseases and all-cause mortality.Previously，most patients were identified via abnormal ankle-brachial index （ABI of ≤0.90），by Doppler method.In recent years，oscillometric method has become a simple method for not only four-limb blood pressure measurement （OS-ABI）．but inter-arm difference （IAD） in blood pressure （BP） and inter-ankle BP difference （IAND）．Objective　To evaluate the screening value of OS-ABI and IAND detected by oscillometric method for LEAD.Methods　A total of 206 patients underwent vascular surgery were selected from October 2017 to April 2018 in the Second Affiliated Hospital of Nanchang University.Oscillographic method for blood pressure measurement was used to measure the blood pressure of limbs.OS-ABI and IAND were obtained.OS-ABI≤0.9 or IAND≥15 mm Hg were used as the diagnostic criteria for LEAD.Patients also needed to perform computed tomography angiography （CTA），with the results of CTA as the gold standard.Results　Among the 206 patients，182 cases （88.3%） were diagnosed as LEAD；169（82.0%）had ABI≤0.9 and 106 （51.5%） had IAND≥15 mm Hg.The sensitivity，specificity and accuracy of IAND≥15 mm Hg in the diagnosis of LEAD were 55.5%，79.2% and 58.3%，respectively.When OS-ABI ≤0.9 combined with IAND≥15 mm Hg，the sensitivity，specificity and accuracy of LEAD diagnosis were increased to 96.2%，70.8% and 93.2% respectively.Conclusion　OS-ABI is an effective index for LEAD screening.Combination of IAND and OS-ABI can improve the value of LEAD screening，which is worth popularizing in clinic.


Autoimmune Polyendocrinopathy Syndrome Type Ⅱ：a Case Report and Literature Review　

XIANG Pingping，SU Xiaohui，DI Hongjie，LIU Chao，CAO Wen

2019, 22(35):  4401-4405.  DOI: 10.12114/j.issn.1007-9572.2019.00.294

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Autoimmune polyendocrinopathy syndrome （APS） refers to a group of syndromes comprising two or more kinds of endocrine autoimmune diseases.We reported a case with APS type Ⅱ combined with Graves disease and type 1 diabetes who admitted to Affiliated Hospital of Integrated Traditional Chinese and Western Medicine，Nanjing University of Chinese Medicine on 10 July 2018.A 12-year-old girl had enlarged neck mass and exorbitsm for 6 years.Antithyroid drugs had poor therapeutic effects，and type 1 diabetes was confirmed in the course of disease.Thyroidectomy and insulin control of type 1 diabetes mellitus can control hyperthyroidism，thyroid-associated ophthalmopathy and type 1 diabetes mellitus.
Hyperthyroidism；Graves ophthalmopathy；Diabetes mellitus，type 1；Polyendocrinopathies，autoimmune；Case reports


Antiphospholipid Antibody Syndrome with Fahr's Syndrome Secondary to Systemic Lupus Erythematosus：a Case Report and Literature Review　

DU Yumei，QIN Ting，GAO Wei，TANG Huan，MA Xin，LIU Jianping

2019, 22(35):  4406-4408.  DOI: 10.12114/j.issn.1007-9572.2019.00.095

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In systemic lupus erythematosus （SLE） patients，about 20% have secondary antiphospholipid antibody syndrome（AAS），but it is rare for them with secondary Fahr's syndrome at the same time.We reported a case of AAS with Fahr's syndrome secondary to SLE，and reviewed the related literature.Moreover，we discussed the pathogenesis and treatment of extensive intracranial calcifications，and the role of antiphospholipid antibody in the development of Fahr's syndrome secondary to SLE.It is suggested that it is necessary for clinicians to diagnose AAS secondary to SLE at an early stage，and to give personalized anticoagulant therapy timely.