Table of Content

15 February 2020, Volume 23 Issue 5

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Monographic Research

The Interpretation of 2019 ESPEN Guideline on Home Enteral Nutrition　

YOU Qian，HU Wen，SHI Lei

2020, 23(5):  505-510.  DOI: 10.12114/j.issn.1007-9572.2019.00.758

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In April 2019，the European Society of Parenteral Nutrition（ESPEN） first published a clinical guideline for home enteral nutrition（HEN）.The ESPEN Guideline on Home Enteral Nutrition aims to let doctors，nurses，nutritionists，pharmacists，nursing workers and other family nutrition related personnel understand the indications，contraindications，clinical implementation and monitoring of HEN.In this paper，the main contents of the guideline are discussed and compared with the existing guidelines or expert consensus，hoping to provide reference for the development and application of HEN in China.


Recent Advances in Uric Acid and Chronic Kidney Disease-mineral and Bone Disorder　

ZHU Xiaoyu，JIANG Lili，WEI Yudan，ZHANG Yangyang，HUANG Xiu，DU Yujun

2020, 23(5):  511-515.  DOI: 10.12114/j.issn.1007-9572.2019.00.266

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With the changes in living standards and dietary structure，the incidence of hyperuricemia is on the rise.Epidemiological studies show that the prevalence of hyperuricemia in adults is 8.4% - 13.3% in China.A large number of studies have shown that hyperuricemia is not only the main cause of gout，but also an independent risk factor for the progression of chronic kidney disease（CKD） and cardiovascular death.It has become one of the metabolic diseases that threaten human health.Mineral and bone disorder are common complications of CKD，including mineral metabolism disorders，bone lesions and extra-osseous calcification，which can lead to increased hospitalization，cardiovascular events and mortality in patients with CKD.Recent studies have found uric acid may be closely related to CKD-mineral and bone disorder （CKD-MBD），but the correlation is still controversial and further researches are needed.This article reviews the pathophysiological function of uric acid，the relationship between uric acid and CKD-MBD and the recent advances of their interaction mechanism.It is suggested that the regulation of uric acid level may be the target of CKD-MBD therapy.


Advances in Research on Evaluation of Cerebral Collateral Circulation　

CHU Bao，ZHANG Jijie，DONG Lipeng，HE Weiliang，LI Litao，WANG Hebo

2020, 23(5):  516-524.  DOI: 10.12114/j.issn.1007-9572.2019.00.305

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Cerebral infarction is the most common type of stroke in China characterized by high incidence and mortality rate.Collateral circulation refers to a network of small arteries that connect adjacent arterial groups.The establishment of collateral circulation is closely related to the prognosis of patients with cerebral infarction.Good collateral circulation is essential for maintaining normal cerebral perfusion and cerebral blood flow after cerebral ischemia，and reducing the size of infarct and ischemic penumbra.There are various methods for evaluating collateral circulation，including transcranial Doppler，computed tomography angiography，computed tomography perfusion，magnetic resonance angiography，fluid-attenuated inversion recovery，arterial spin labeling，permeability imaging，digital subtraction angiography（DSA），etc.In particular，DSA is a recognized gold standard for evaluating collateral circulation.This article reviews the recent research progress of various collateral circulation evaluation methods，and finds that there are advantages and disadvantages in various evaluation methods.Clinical doctors should always consider patients' condition and choose appropriate evaluation tools.


Changes in LL-37 Levels in Children with Recurrent Upper Respiratory Tract Infections after Vitamin D Supplementation　

WANG Boyu，BAI Jinxiu，JIA Hao，ZHAN Yaowu，XU Yuehong

2020, 23(5):  525-529.  DOI: 10.12114/j.issn.1007-9572.2019.00.475

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Background　Epidemiological surveys show that about 1 billion people worldwide suffer from vitamin D deficiency，which is particularly serious in China.Recurrent upper respiratory tract infection （URTI），with vitamin D deficiency a trigger，is a common and frequently-occurring disease in children，seriously affecting their physical and mental health.Vitamin D deficiency is the main reason for the down regulation of LL-37.As an important incentive，vitamin D deficiency has drawn more and more attention.Objective　To explore the changes in LL-37 level in children with recurrent URTI after vitamin D supplementation.Methods　54 children with recurrent URTI and vitamin D deficiency were selected from the outpatient clinic of Affiliated Hospital of Hebei University from May to November 2017.They were equally randomized into the experimental group and control group，receiving regular treatment with vitamin D supplementation，regular treatment with placebo，respectively.All of them were followed up for 12 months.Episodes of URTI before treatment and during the follow-up period，plasma 25-hydroxyvitamin D3 and LL-37 in sputum supernatant before treatment and at the end of the follow-up were measured and recorded.Results　Forty-five cases completed the follow-up （23 in the experimental group，and 22 in the control group）.Before treatment，both groups showed no significant differences in episodes of URTI，plasma 25-hydroxyvitamin D3 and LL-37 in sputum supernatant （P>0.05）.After 12 months of treatment，episodes of URTI were less，and plasma 25-hydroxyvitamin D3 and LL-37 in sputum supernatant were much higher in the experimental group （P<0.05）.Self-controlled comparisons showed that episodes of URTI，plasma 25-hydroxyvitamin D3 and LL-37 in sputum supernatant changed insignificantly in the control group （P>0.05），while episodes of URTI decreased，and plasma 25-hydroxyvitamin D3 and LL-37 in sputum supernatant increased significantly in the experimental group （P<0.05）.Pearson correlation analysis showed that there was a positive correlation between 25-hydroxyvitamin D3 and LL-37 after one-year treatment in the experimental group （r=0.505，P<0.05）.Conclusion　Vitamin D supplementation helps reduce the possibilities of having recurrent URTI，which may be associated with the increase in LL-37 production.


Application of Arteriosclerosis Detection and Correlation Study of Serum Transforming Growth Factor-beta 1 and Connective Tissue Growth Factor in the Elderly

GU Jingyu，WU Xiao，ZHANG Ting，SHA Jiangming，SHAO Rong，ZHENG Ruolong，CUI Junyou，YIN Quanzhong

2020, 23(5):  529-533.  DOI: 10.12114/j.issn.1007-9572.2019.00.582

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Background　Detection of atherosclerosis in the elderly can assess the risk of cardiovascular and cerebrovascular diseases early and monitor the clinical efficacy.Transforming growth factor-beta 1（TGF-β1） and connective tissue growth factor（CTGF） have been identified as key factors of tissue fibrosis.However，there are little research on its correlation with vascular sclerosis in the elderly.Objective　To analyze the relationship between TGF-β1 and CTGF in elderly patients with atherosclerosis，and to explore the feasibility of using TGF-β1，CTGF combined with brachial-ankle pulse wave velocity（BaPWV） and carotid ultrasound as indexes for evaluating arterial vascular pathological changes and monitoring clinical efficacy in the elderly.Methods　A total of 134 elderly patients，who sought medical advice in Department of Geriatrics and Cardiology of Jiangyin People's Hospital from September 2017 to September 2018，were selected and divided into arteriosclerosis group（69 cases） and normal control group（65 cases） according to the standard of BaPWV or carotid ultrasound diagnosis of atherosclerotic plaque.The BMI，blood pressure，levels of total cholesterol（TC），triglyceride（TG），high density lipoprotein cholesterol（HDL-C），low density lipoprotein cholesterol（LDL-C），urea nitrogen（BUN），serum creatinine（Scr） and glycosylated hemoglobin（HbA1c） were compared between the two groups.Serum levels of TGF-β1 and CTGF were detected by enzyme-linked immunosorbent assay（ELISA）．The incidence of hypertension，diabetes mellitus，cerebrovascular disease and coronary heart disease were compared between the two groups.Results　Systolic blood pressure（SBP），mean arterial pressure（MAP），HbA1c and BaPWV in arteriosclerosis group were higher than those in control group（P<0.05）．There was no significant difference in the serum level of TGF-β1 between arteriosclerosis group and control group（Z=-1.499，
P=0.134），while the serum level of CTGF in arteriosclerosis group was significantly higher than that in control group（Z=-3.250，P=0.001）．The morbidities of hypertension，diabetes mellitus and cerebrovascular disease in arteriosclerosis group were significantly higher than those in normal control group（P<0.05），but there was no significant difference in the morbidity of coronary heart disease between the two groups（P>0.05）．Conclusion　The serum level of CTGF in elderly patients with arteriosclerosis increased significantly.Therefore，CTGF combined with BaPWV and carotid ultrasound can be used as indexes for evaluating arterial vascular pathological changes and monitoring clinical efficacy in the elderly.


Nutrients Intake in the Third Trimester and Associated Factors of Delayed Onset of LactogenesisⅡ in Maternal Women　

DING Peipei，ZHAO Mei，ZHANG Fengying，WANG Lulu，YAO Jing，QIU Jie，WANG Xueya，LIU Ling

2020, 23(5):  534-539.  DOI: 10.12114/j.issn.1007-9572.2020.00.105

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Background　WHO advocates exclusive breastfeeding for infants under six months of age.However，global breastfeeding for infants of this age is not satisfactory.Delayed onset of lactogenesisⅡ（DOL） is an important factor affecting breastfeeding.Good maternal nutrition is a key to successful breastfeeding.Maternal nutrition during pregnancy is the ability of mother to provide energies and nutrients for breastfeeding for her baby.And its relationship with DOL has attracted increased attention.Objective　To investigate the nutrients intake during the third trimester and factors associated with DOL for in maternal women.Methods　Puerperas who delivered in the delivery room of the First Affiliated Hospital of Anhui Medical University，the Fourth Affiliated Hospital of Anhui Medical University and Anhui Provincial Hospital（South） were selected from January 2018 to January 2019.An online survey using a questionnaire developed by our research team was conducted in the participants to collect their basic data，nutritional status（including food intake frequency and average food intake per time） and DOL.According to the survey，average daily nutrient intake and nutrient adequacy ratio were calculated.Multivariate Logistic regression analysis was used to analyze the influencing factors of DOL.Results　340 of the 348 participants （97.7%） who returned effective responsive questionnaires were finally enrolled.The prevalence of DOL was 31.5% （107/340），which differed significantly by prepregnancy BMI，prevalence of gestational diabetes mellitus，and delivery times （P<0.05）.During the third trimester，the average ratios of three macronutrients，protein，fat and carbohydrates，to total dietary energy，were 17.3%，22.6%，60.1%，respectively.The adequacy ratio for the intake of energy，protein，carbohydrate intake and vitamin B6 was 1.09，1.26，1.49，and 0.36，respectively.There were significant differences in the intake of energy，protein，fat，carbohydrates，vitamin B2，vitamin B6，vitamin E，iron and selenium between women with and without DOL（P<0.05）.Multivariate Logistic regression analysis showed that gestational diabetes mellitus 〔OR=0.383，95%CI（0.181，0.808）〕 and parity 〔OR=2.275，95%CI（1.307，3.957）〕 were the independent influencing factors of DOL （P<0.05）.Conclusion Higher intake of nutrients during the third trimester is found in maternal women in general.Although the intakes of energy，protein and carbohydrates are too high，vitamin B6 intake is seriously insufficient.Gestational diabetes mellitus and parity are the influencing factors of DOL，so it is necessary to strengthen the related health education in pregnant women.


Effect of EMG Biofeedback Therapy on Post-stroke Shoulder Subluxation with Different Stimulus Parts and Direction of Movement：a Differential Analysis　

CHEN Bo，YU Jihua，TANG Yan，ZHANG Chi，CHEN Ruyan，XU Fangyuan

2020, 23(5):  540-546.  DOI: 10.12114/j.issn.1007-9572.2019.00.470

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Background　Shoulder subluxation is a major complication of stroke-induced hemiplegia with high incidence.Among various treatments，EMG biofeedback （EMGBF） has a definite effect.However，in many studies，the stimulation site and direction of motion are not uniform.Objective　To explore the effect of EMGBF on post-stroke shoulder subluxation with different stimulus parts and directions of movement.Methods　A total of 267 patients with post-stroke shoulder subluxation were selected from the Affiliated Hospital of Southwest Medical University from May 2017 to May 2018.They were randomly and equally divided into the flexion group，abduction group and extension group.Subluxation degree detected by finger palpation was classified into gradeⅠ，Ⅱ and Ⅲ.On the basis of routine treatment，all groups were treated with EMGBF.The electrodes were placed in the deltoid muscle anterior bundle，the middle bundle and the posterior bundle，and guidance was given to the patients to perform flexion，abduction and extension movements.Measurements of the electromyographic score （iEMG） before treatment and at the end of the 3rd，6th，9th weeks of treatment，and the scores of Fugl-Meyer upper limb motor function assessment，VAS score，Barthel index，Stroke Specific Quality of Life Scale （SSQOLS） score，interval between the affected acromion and the humeral head （AHI） and the distance between the apex of the bilateral scapula before treatment and at the end of the 9th weeks of treatment were performed.Results　GradeⅠ，Ⅱ and Ⅲ subluxation patients in three groups showed similar pretreatment iEMG and iEMG at the 3rd week of treatment （P>0.05），but significantly different iEMG at the 6th and 9th weeks of treatment （P<0.05），and they obtained significant improvements in iEMG after treatment （P<0.05）．Fugl-Meyer assessment score，VAS score，Barthel index，SSQOLS score，AHI and distance between the apex of the bilateral scapula were similar in gradeⅠ，Ⅱ and Ⅲ subluxation patients in three groups at baseline（P>0.05）．At the end of 9-week treatment，extension group（all patients with different degree of subluxation） showed higher Fugl-Meyer assessment score and lower VAS score than other two groups （P<0.05）．GradeⅠandⅡsubluxation patients in abduction group showed higher Fugl-Meyer assessment score than those in flexion group （P<0.05）．GradeⅠ，Ⅱ and Ⅲ subluxation patients in abduction group showed higher Barthel index than those of other two groups（P<0.05）．GradeⅠ，Ⅱ and Ⅲ subluxation patients in both flexion group and abduction group showed lower AHI than those in extension group （P<0.05）．GradeⅠ，Ⅱsubluxation patients in abduction group showed lower AHI than those in flexion group （P<0.05）．GradeⅠ，Ⅱ and Ⅲ subluxation patients in extension group showed less distance between the apex of the bilateral scapula compared with other two groups （P<0.05）．When the treatment ended，gradeⅠ，Ⅱ and Ⅲ subluxation patients in all groups showed improved Fugl-Meyer assessment score，Barthel index，SSQOLS score，decreased VAS score，and AHI，as well as greater distance between the apex of the bilateral scapula compared with baseline （P<0.05）．Conclusion　The stimulation and abduction of the middle bundle of deltoid muscle are superior to other two schemes in EMGBF.The improvement of the muscle strength of the core bundle can improve the dislocation of shoulder joint，alleviate pain and improve the quality of life.At the same time，it provides a reference for the development of follow-up standardized treatment plan.


Effects of Endoscopic Treatment Combined with Partial Splenic Artery Embolization on the Patients with Hepatic Cirrhosis Combined with Hypersplenism and Esophageal and Gastric Varices Bleeding　

LIN Qiuman，WANG Guiliang，QIU Ping，XU Linfang，GONG Min，HAN Ming，LI Xing，WEN Jianbo

2020, 23(5):  547-552.  DOI: 10.12114/j.issn.1007-9572.2019.00.332

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Background　The patients with hepatic cirrhosis combined with hypersplenism and esophageal and gastric varices bleeding（EGVB） should undergo partial splenic artery embolization（PSE） after emergent endoscopic and medical treatment due to the leukocytopenia，thrombocytopenia，clotting factor reduction，coagulopathy，large volume of bleeding，and high incidence of rebleeding.Objective　To evaluate the effects of endoscopic treatment（ET） combined with PSE on the patients with hepatic cirrhosis combined with hypersplenism and EGVB.Methods　A total of 158 hospitalized patients with hepatic cirrhosis combined with hypersplenism and EGVB in Pingxiang Hospital Affiliated to Southern Medical University from July 2008 to February 2018 were assigned into ET group（78 cases） and ET+PSE group（80 cases） according to the random number table method.The ET group accepted basic treatment and endoscopic treatment，and the ET+PSE group accepted basic treatment，endoscopic treatment and PSE treatment.Ratio of varicose veins disappearance and recurrence and rebleeding were compared between the two groups.White blood cell count，platelet count，liver fibrosis index〔hyaluronic acid（HA），type Ⅲ procollagen peptide（PⅢP），laminin（LN） and type Ⅳ collagen（Ⅳ-C）〕，portal vein diameter，portal vein blood flow velocity，portal venous flow，splenic vein diameter，splenic vein blood flow velocity，splenic venous flow at three time points（before the treatment，four weeks and 12 weeks after the treatment） and incidence of complications in the two groups were analyzed.Results　There was no significant difference between the mortality of patients in two groups（P=1.000）．The ratio of varicose veins disappearance in ET+PSE group was higher than that in ET group，while ratios of varicose veins recurrence and rebleeding in ET+PSE group were significantly lower than those in the ET group at three and six months after the operation（P<0.05）．There were interactions between the treatment and time in white blood cell count，platelet count，HA，PⅢP，LN and Ⅳ-C and its main effects were significant（P<0.001）．The white blood cell count and platelet count in the ET+PSE group at four and 12 weeks after the operation were significantly higher than those at the preoperative time point in the same group and those at the simultaneous time point in the ET group，while HA，PⅢP，LN and Ⅳ-C were significantly lower than those at the preoperative time point in the same group and those at the simultaneous time point in the ET groups（P<0.05）．There were interactions between the treatment and time in portal vein diameter，portal vein blood flow velocity，portal venous flow，splenic vein diameter，splenic vein blood flow velocity and splenic venous flow and its main effects were significant（P<0.001）．The portal and splenic vein diameters in the ET+PSE group were significantly lower than those at the preoperative time point in the same group and those at the simultaneous time point in the ET group at 12 weeks after the operation.The portal vein blood flow velocity，portal venous flow，splenic vein blood flow velocity and splenic venous flow in the ET+PSE group at four and 12 weeks after the operation were significantly higher than those at the preoperative time point in the same group and those at the simultaneous time point in the ET group（P<0.05）．There was no significant difference between the incidences of chest pain in the two groups（P>0.05）．The incidences of fever，abdominal pain and ascites in the ET+PSE group were significantly higher than those in the ET group（P<0.05）．Conclusion　ET can effectively treat the patients with hepatic cirrhosis combined with hypersplenism and EGVB，and PSE can further improve the curative effect.


The Application of B-type Natriuretic Peptide Detection in Hospital Level among Inpatients with Heart Failure in China　

CHAI Lin，BAI Xueke，SU Meng，TIAN Lei

2020, 23(5):  553-558.  DOI: 10.12114/j.issn.1007-9572.2019.00.748

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Background　Heart failure，HF for short，has brought heavy social and economic burdens to our country.As an important biomarker of HF，B-type natriuretic peptide has been consistently recommended as class Ⅰ by guidelines in and abroad.However，the application of B-type natriuretic peptide detection in clinical diagnosis and treatment of HF has not been reported in China.Objective　To study the distribution of the capacity and detection rate of B-type natriuretic peptide in hospital level among inpatients with HF in China during 2015.Methods　Two-stage random sampling was used in China PEACE Retrospective Heart Failure Study：in the first stage，the study identified hospitals in five strata by region and location and extracted sample hospitals using simple random sampling；the second stage，the study obtained the database of inpatients with HF from each sample hospital during 2015，and identified cases using a systematic random sampling.The information of hospitals and hospitalized medical record was collected to analyze the distribution of the capacity and detection rate of the B-type natriuretic peptide in hospital level.The hospital with detection rate of B-type natriuretic peptide ≥60% was qualified for B-type natriuretic peptide application.Results　A total of 15 163 HF medical records from 188 hospitals were included in the study.The overall capacity of B-type natriuretic peptide detection in 2015 was 85.1%（160/188），and the difference in distribution among the strata was statistically significant（χ2=34.3，P<0.01）.Multivariate Logistic regression analysis showed that hospitals with independent cardiology department 〔OR=6.40，95%CI（1.78，23.05）〕 or >300 sheets〔OR=4.45，95%CI（1.24，15.95）〕 were more likely to be capable of B-type natriuretic peptide detection（P<0.05），and the capacity of B-type natriuretic peptide detection in western rural areas was lower than that in eastern urban areas〔OR=0.37，95%CI（0.14，0.96），P<0.05〕.The overall detection rate was 63.5%（40.0%，82.3%） from the 159 research hospitals with capacity，and the difference in distribution among the strata was statistically significant（H=13.19，P=0.01）.Multivariate Logistic regression analysis showed that hospitals with independent cardiology department were more likely to pass B-type natriuretic peptide application〔OR=4.91，95%CI（1.53，15.77），P<0.05〕.Conclusion　In 2015，the detection of B-type natriuretic peptide has been basically popularized in hospitals nationwide，but the detection rate among inpatients with HF needs to be improved.Therefore，it is necessary to promote the application of guidelines in clinical practice and resource input in western-rural region especially.


Support for and Satisfaction toward Bidirectional Referral System among Xuzhou's Residents：a Survey　

SUN Hong，MIAO Chunxia，LI Hanhan，ZHUO Lang，JIANG Jinxing，XU Jianqiang，WANG Wenhai，ZHAO Shihong

2020, 23(5):  559-565.  DOI: 10.12114/j.issn.1007-9572.2019.00.421

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Background The 'Healthy China' strategy was proposed at the 19th CPC National Congress, demanding deepening the reform of the pharmaceutical and healthcare system and comprehensively establishing a high-quality and high-efficient medical and health service system.As an important part of the hierarchical medical system, bidirectional referral system is still in its initial development stage.Its further development and improvement needs constant research and exploration.Objective　To investigate residents' support for and satisfaction with the bidirectional referral system, and discuss the influencing factors, providing countermeasures and suggestions for the implementation of the system.Methods By use of multi-stage stratified random sampling, 1 550 residents were selected as the participants from July to August 2016.A self-made questionnaire was used to investigate the participants concerning personal data, support for and satisfaction with bidirectional referral system.Comparisons of support for and satisfaction with bidirectional referral system were made by personal data.Multivariate Logistic regression was used to analyze the influencing factors for level of support and satisfaction for the system.Results　The survey achieved a response rate of 95.0%（1 473/1 550）．The rate of support for bidirectional referral system was 53.8%（793/1 473）．The level of support for bidirectional referral system in the respondents differed significantly by marital status，annual healthcare expenditure，treatment in primary care in the past year，referral experience，approval of compulsory initial consultation in primary care，awareness of hierarchical medical system and support for hierarchical medical system（P<0.05）．Multivariate Logistic regression analysis showed that marital status, annual healthcare expenditure, referral experience, approval of compulsory initial consultation in primary care, and support for hierarchical medical system were associated with the level of support for bidirectional referral system（P<0.05）．Of the 435 respondents with referral experience, 433（99.5%） answered referral satisfaction questions, among whom 133 （ 30.7% ） were satisfied with the referral, 101 （ 23.3% ） were dissatisfied with the referral, and 199（46.0%） gave a neutral evaluation of the referral.Those who approved compulsory initial consultation in primary care showed higher level of satisfaction with bidirectional referral system than those disapproved 〔39.9%（83/208）vs 22.2%（50/225）〕（χ2=15.878，P<0.001）．Those who were in support of hierarchical medical system showed higher level of satisfaction with bidirectional referral system than those who were not〔35.5%（107/301）vs 19.7%（26/132）〕（χ2=10.834，P=0.001）．Those who were in support of bidirectional referral system showed higher level of satisfaction with bidirectional referral system than those who were not〔38.5%（74/192）vs 24.5%（59/241）〕（χ2=9.927，P=0.002）．Complicated procedures, inconvenient reimbursement of medical insurance and lack of information exchange were seen as the inadequacies during the implementation of bidirectional referral system.Conclusion　The levels of support for and satisfaction with bidirectional referral system are low in Xuzhou's residents, which are influenced by insufficient publicity, and inadequate implementation details of the bidirectional referral system as well as the unsatisfactory quality of medical services.In view of this, precise drumbeating of bidirectional referral system should be intensified in both healthcare workers and residents, the referral process should be optimized, and the service capacities of primary care should be improved.


Efficacy and Safety of Virtual Reality for Stroke Rehabilitation：an Overview of Systematic Reviews　

ZHANG Xingxing，DUAN Hongwei，ZHOU Chen，WANG Xiaoxiao，WANG Aihong

2020, 23(5):  566-572.  DOI: 10.12114/j.issn.1007-9572.2019.00.464

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Background　Available surveys show that about 55% to 75% of stroke survivors worldwide have limb dysfunction，which directly affects the motor function and daily living activities，and brings great mental stress and physical pain.Functional rehabilitation after stroke is one method to effectively reduce the disability rate.Virtual reality technology（VR） is one of the most widely used rehabilitation methods in recent years，which is safe，effective and timely responsive.However，clinical evaluation of its effectiveness and safety is not the same.Objective　To systematically overview the systematic reviews（SR）/meta-analyses of the effectiveness and safety of VR for stroke rehabilitation.Methods　Databases of PubMed，EMBase，the Cochrane Library（2018，Issue 6），CNKI，Wanfang Data，CBM and VIP were searched as of June 2018 and the SR/meta analyses based on VR for stroke rehabilitation were collected.Literature screening and data extraction were performed by two reviewers independently.AMSTAR was used to evaluate the methodological quality of the included articles.The GRADE system was used to evaluate the quality of evidence for main outcome indicators reported in the articles.Results　Finally，10 SR/meta analyses were included，involving 7 major outcome indicators.AMSTAR evaluation results showed that only two studies were of high quality and the other eight studies were of medium quality.The major problems of methodological quality assessment were lack of pre-design planning，omission of the status of publications of the included articles，lack of the list of excluded articles and the explaining of the conflicts of interest.Qualities of the evidence for indicators measuring 6 outcomes （the upper limb motor function，limb mobility，functional mobility，balance function，gait speed and the participation） were mainly graded as "medium"，and those for indicators related to stride length were mainly graded as "low".Three studies showed good VR safety and no adverse reactions，and one study showed that a small number of studies reported pain，headache or dizziness，but no serious adverse reactions were found.Conclusion　The methodological quality of included studies is unsatisfied，with a low grade of evidence.VR has good safety and can be used as a short-term clinical assistant rehabilitation for stroke patients.However，there are still some controversies about its long-term effectiveness.A large number of high-quality tests are needed to prove its long-term effectiveness and safety.Clinicians should be cautious when using the evidence for rehabilitation.


Was Conventional Ureteral Stenting Required before Flexible Ureteroscopy？A Meta-analysis　

LIU Junbo，JIANG Guo，CHEN Xiaobin，ZHOU Wenhao，YU Ruichao，WU Tao

2020, 23(5):  573-579.  DOI: 10.12114/j.issn.1007-9572.2019.00.461

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Background　In recent years，with the development of flexible ureteroscopy technology，flexible ureteroscopy technology in urology has a more widespread application.However，whether ureteral stenting is routinely placed in patients before flexible ureteroscopy is still controversial.Objective　To systematically review whether conventional ureteral stenting was required before flexible ureteroscopy.Methods　We searched the Cochrane Library，PubMed，EMBase，VIP，CBM，CNKI and Wanfang Data and the other sources from January 2000 to December 2017.All the randomized controlled trials （RCTs） and case-control studies reporting on patients who received flexible ureteroscopy with or without previous ureteral stenting were included.Two reviewers independently screened literature according to the inclusion and exclusion criteria，extracted data，and assessed the methodological quality of the included studies.Then RevMan 5.3 software was used for meta-analysis.Results　Four RCTs and six case-control studies involving 1 827 patients were finally included.The results of meta-analyses showed that compared with the group without ureteral stenting before flexible ureteroscopy，group with ureteral stenting before flexible ureteroscopy could increase the success rate of operation〔OR=1.55，95%CI（1.14，2.09），P=0.005〕 and the success rate of one-off placement of ureteral access sheath〔OR=14.77，95%CI（5.26，41.43），P<0.000 01〕 and decrease the time of operation〔MD=-1.45，95%CI=（-1.93，-0.96），P<0.000 01〕.There was no significant difference in the time of hospitalization〔MD=1.22，95%CI（-0.39，2.83），P=0.14〕 and occurrence rate of postoperative complications 〔OR=1.38，95%CI（0.93，2.04），P=0.11〕.Conclusion　Ureteral stenting before flexible ureteroscopy could not decrease the time of hospitalization and the postoperative complications rate，but it could increase the success rate of operation and the success rate of one-off placement of ureteral access sheath and decrease the time of operation in a certain extent.


Construction of the Base of Pre-pregnancy Health Care Network:a Community-based Exploration　

LIN Meijuan，QIAN Xiaozhong，CHEN Xiong，NI Hengru，LU Zhiren，YAO Yunfang，SHI Xuehua

2020, 23(5):  580-584.  DOI: 10.12114/j.issn.1007-9572.2020.00.042

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Background　China is a country in which the incidence of birth defects is high，and is increasingly becoming a prominent public health and social issue.To reduce birth defects，Guidelines for Pre-pregnancy and Pregnancy Care has been promulgated and updated by relevant authoritative departments，and free eugenics prenatal testing has been carried out nationally.However，the rate of undergoing this kind of examination is unsatisfied，which may be caused by insufficient propaganda and other reasons.Currently，there is a shortage of pre-pregnancy health education professionals in the community.Objective　To summarize the exploring experience of Baoshan District Songnan Town Community Health Center in the construction of the base of pre-pregnancy health care network.Methods　From March to December 2018，Songnan Town Community Health Center developed a community-based prepregnancy care management network by referring to the effective model for unified management of the integrated health and family planning systems，and a community-based perinatal healthcare network covering health services，family planning guidance and management，and trained a community-based prepregnancy care management team for widely publicizing information about eugenic birth and the national policy of free eugenics prenatal testing，as well as provided hierarchical prenatal services by cooperating with higher level hospitals.Pre- and post-training surveys were conducted in a community-based prepregnancy care management team for evaluating their level of eugenic knowledge.Pre- and post-publicity surveys were conducted in a service population for collecting data concerning history of adverse pregnancy outcomes，awareness levels of national policy of free eugenics prenatal testing，and eugenic birth knowledge，needs of prenatal healthcare，and status of undergoing eugenics prenatal testing.Results　After training，all the members of the community-based prepregnancy care management team showed higher awareness levels of contents of free eugenics prenatal testing，time and reasons of taking folic acid，and suitable time for getting pregnancy after induced abortion（P<0.05）.A total of 438 service people （221 couples，and either one spouse of other 19 couples） received prenatal healthcare education.After receiving education，the prevalence rate of knowing the national policy of free eugenics prenatal testing in these people increased to 100.0% from that〔82.0%（359/438）〕 at baseline.Moreover，the prevalence rates of knowing preparing time for a healthy pregnancy，toxic substances that should not be exposed to before pregnancy，information related to a healthy pregnancy，and start time for taking folic acid also increased significantly（P<0.05）.Furthermore，96 couples（40.0%）underwent eugenics prenatal testing or made an appointment after receiving the education.In 2017，76 couples underwent the free eugenics prenatal testing，which was lower than the goal（83 couples） set by Songnan Town Community Health Center using the original prenatal management，but in 2018，the center used this new prenatal management，95 couples underwent the free eugenics prenatal testing，exceeding the set goal（75 couples）.Conclusion　Our newly developed community-based prepregnancy care management network showed high levels of management and professional performances，with satisfied social publicity and policy implementation capabilities，and enriched prenatal services by providing hierarchical services via cooperating with higher level hospitals.In view of this，it may be has a broad application prospect.


Development of Community-based Osteoporosis Prevention and Treatment Pathway Based on Bidirectional Referral Patterns　

ZHOU Peng, YANG Lan, XUE Bin, WEI Yangyang, WU Yinghua, WANG Xiaoqin, LIU Haijiao, HU Jiankang, YI Chuntao, GU Wenqin

2020, 23(5):  585-592. 

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Background　Current research on osteoporosis is mostly about the pathogenesis，diagnostic criteria，clinical trials and basic epidemiological investigation，but rarely on the treatment for osteoporosis patients，and prevention and control of osteoporosis in high-risk group and normal residents.Objective　To construct a complete community-based osteoporosis prevention and treatment pathway based on the referral patterns between community-based healthcare institutions and general hospitals，providing a reference for community-based prevention and treatment of osteoporosis in a standardized way.Methods　We developed the procedure and operation rules of community-based osteoporosis prevention and treatment pathway by using tools suitable for community-based screening and diagnosis of osteoporosis selected by reviewing the osteoporosis prevention and treatment tools used at home and abroad during 1999—2019，and by referring to patterns and pilot implementation experience of referrals between Fenglin Community Health Center and Shanghai Sixth People’s Hospital collected by focus group interviews with 5 individuals（including major frontline medical workers offering osteoporosis prevention and treatment services and the head of orthopaedic department） invited from Fenglin Community Health Center.Results　The Osteoporosis Self-Assessment Tool for Asians （OSTA） was selected as the primary tool for community-based osteoporosis risk assessment.The results of dual-energy X-ray absorptiometry （DXA） were determined as the gold standard for community-based diagnosis of osteoporosis.The developed community-based osteoporosis prevention and treatment pathway includes 6 parts:screening，diagnosis，differential diagnosis，prevention and treatment，rehabilitation，and follow-up.Osteoporosis risk assessment（osteoporosis screening），first diagnosis and hierarchical treatment，rehabilitation and follow-up services of osteoporosis were undertaken by the community health center，and differential diagnosis and non-essential services of osteoporosis were delivered by the general hospital，and osteoporosis GPs played a central role in the pathway for delivering services.Conclusion　This pathway may improve the prevention and control level of osteoporosis in healthcare institutions，and may provide a clinical and theoretical basis for national promotion of bidirectional referral patterns in the hierarchical medical treatment of osteoporosis.


Relationships of Hypertension and Diabetes with Cognitive Function among Community-dwelling Middle-aged and Elderly Population　

WANG Yanning，TANG Zhihao，CHEN Jialin

2020, 23(5):  593-597.  DOI: 10.12114/j.issn.1007-9572.2020.00.132

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Background　Chronic disease has a high incidence in middle-aged and aged population.It is closely related to cognitive decline，and is also a major risk factor for cognitive impairment in this group.Objective　To study the relationships of hypertension and diabetes with cognitive function in community-dwelling population in Beijing's Dongcheng District，to provide evidence for the prevention and improvement of cognitive impairment in hypertension and diabetes populations in the community.Methods　A total of 309 middle-aged and elderly people who had physical examination from 2016 to 2018 in Dongcheng District Community Healthcare Center，Beijing were selected，and by the results of physical examination，they were divided into four groups:healthy group（n=97），hypertension group（n=109），diabetes group（n=47） and hypertension and diabetes group（n=56）.MMSE and MoCA were adopted to evaluate overall cognitive functions.Auditory Verbal Learning Test including N1-N3，N4，N5，N1-N5 and R-Odelay was adopted to assess memory capacity.R-Ocopy and CDT were used to assess the visually spatial ability.VFT and BNT were adopted to assess language ability.SDMT，DST（including DSTforward and DSTbackward） were used to evaluate attention ability； Stroop Color-word Test and Trail-Making Test（TMT） were also used to evaluate execution ability.Specifically，Stroop Color-word Test was divided into three parts to record the subjects' reaction time （StroopATime，StroopBTime and StroopCTime） and accuracy （StroopANum，StroopBNum and StroopCNum）.TMT was divided as TMT-A and TMT-B.Results　The mean evaluation scores of MMSE，MoCA，N1-N3，N4，N5，N1-N5，R-Ocopy，R-Odelay，CDT，VFT，BNT，SDMT，DST，DSTforward，DSTbackward，StroopANum，StroopCNum，TMT-A and TMT-B differed significantly across the groups（P<0.05）.The mean MoCA score in healthy group was significantly different from that of other three groups（P<0.05）.The mean evaluation score of N1-N5 differed significantly between hypertension and diabetes group，and between healthy group and hypertension group，and between healthy group and hypertension and diabetes group（P<0.05）.The mean evaluation score of N1-N5 differed significantly between hypertension and diabetes group，and between healthy group and hypertension group，and between healthy group and hypertension and diabetes group（P<0.05）.The mean evaluation score of VFT varied obviously between healthy group and hypertension group，and between healthy group and hypertension and diabetes group（P<0.05）.Significant different differences were found in mean evaluation scores of BNT between healthy group and hypertension group，and between healthy group and hypertension and diabetes group，as well as between hypertension and diabetes group and hypertension group（P<0.05）.The healthy group showed significantly different mean evaluation StroopCNum compared with hypertension group，and hypertension and diabetes group（P<0.05）.The hypertension and diabetes group demonstrated significantly different mean evaluation TMT-B compared with each of other three groups（P<0.05）.Conclusion　Hypertension and diabetes are intimately associated with cognitive impairment in elderly people in the community.Active prevention，diagnosis and management of hypertension and diabetes in the community may slow down the occurrence and development of cognitive impairment.


Influencing Factors of Frailty Syndrome in Elderly People in the Community　

QIN Li，LIANG Zhenzhen，GE Libin，CHEN Liang，HUO Yongyan，LI Qiang

2020, 23(5):  598-603.  DOI: 10.12114/j.issn.1007-9572.2020.00.060

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Background　In China，the prevalence of frailty syndrome in increased aging population has caused increasingly prominent social and economic problems.Frailty syndrome can lead to adverse events such as falls，disability，and hospitalization.But there are few epidemiological data on frailty syndrome in China.Objective　To investigate the prevalence and influencing factors of frailty syndrome in community-dwelling elderly people.Methods From April to September 2018，a survey was conducted in a random sample of 408 elderly people recruited from Jiading District Anting Town Huangdu Community Health Service Center，Shanghai.Two self-developed questionaires（named General Information Questionaire and Underlying Chronic Disease Questionaire） were used in the survey and were filled by unifiedly trained investigators after interviewing the participants and extracting data from the physical exmination database of elderly people of the service center.The Fried Frailty Phenotype was also used in the survey for asessing the prevelence of frailty and was completed by the participants with the guidance of investigators.Multivariate ordered Logistic regression was used to analyze underlying chronic diseases and frailty syndrome.Results　The participants were found to consist of nonfrail group （n=184），prefrail group （n=201） and frail group（n=23）.The three groups showed significant differences in gender, age, height, 2017 BMI, 2018 BMI, marital status, educational level, living status, eating habits, smoking history（P<0.05）.The top 6 highly prevalent underlying chronic diseases were hypertension，cerebral infarction，osteoporosis，coronary heart disease，chronic obstructive pulmonary disease and diabetes.The prevalence rates of chronic obstructive pulmonary disease，cerebral infarction，chronic liver disease，chronic kidney disease，hyperlipidemia and osteoporosis differed significantly across the groups （P<0.05）.Multivariate ordered Logistic regression found that chronic obstructive pulmonary disease〔OR=4.339，95%CI（1.580，11.911）〕，cerebral infarction〔OR=-4.176，95%CI（-0.372，-0.134）〕 and osteoporosis〔OR=-2.044，95%CI（-0.311，-0.006）〕 were associated with frailty syndrome（P<0.05）.Conclusion Chronic obstructive plumonary disease，cerebral infarction and osteoporosis are the influencing factors of frailty syndrome.To timely predict adverse events associated with frailty syndrome，frailty syndrome should be screened regularly by primary care physicians to identify those at high risk of frailty syndrome，especially those with chronic obstructive plumonary disease，cerebral infarction and osteoporosis.Moreover，to improve the quality of life of the elderly，guidance should be given to frailty syndrome patients and their family members to increase their attention to patient health.


Prevalence and Influencing Factors of Hyperuricemia in Aged Physical Examination Population　

CHEN Jianfeng，MA Bin

2020, 23(5):  604-610.  DOI: 10.12114/j.issn.1007-9572.2020.00.004

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Background　Hyperuricemia（HUA） is closely associated with many chronic diseases，and it is recognized as the "fourth hyper" after hypertension，hyperglycemia and hyperlipidemia.The population aging in Shanghai Pudong New Area Gaodong Community is serious，but the prevalence of HUA in elderly group in this community is still unclear.Objective　To investigate the prevalence and possible risk factors of HUA among elderly people in Gaodong Community of Shanghai，so as to provide evidence for the prevention，control and community-based management of HUA and HUA-related chronic diseases.Methods　The survey was based on the physical examination program of the elderly over 60 years old carried out by Gaodong Community Health Center from March to May 2018，which mainly included health records information，and results of physical examination and laboratory tests.The prevalence and population distribution of HUA were analyzed，and the possible influencing factors of HUA were screened by unconditional Logistic regression model.Results　The crude and standardized prevalence rates of HUA in 8 600 physical examination subjects were 21.76%（male：24.15%，female：19.66%） and 24.10%（male：24.21%，female：20.58%），respectively.The crude prevalence rate of HUA in males was higher than that in females（χ2=25.312，P<0.001）.In 60-69 age group，the crude prevalence rate of HUA in males was higher than that in females（χ2=51.121，P<0.001），but there were no significant differences in sex-specific crude prevalence rate of HUA in both age groups of 70-79 and ≥80（P>0.05）.The overall crude prevalence rate of HUA increased with age（P<0.001）.The sex-specific crude prevalence rate of HUA also increased with age（P<0.001）.There were statistically significant differences in gender，age，occupation before retirement，education level，smoking，drinking，exercise，and the prevalence of hypertension，central obesity，obesity，chronic kidney disease（CKD），coronary heart disease，hyperlipidemia and gout，white blood cell count，total protein，serum albumin and alanine aminotransferase between the HUA group and the non-HUA group（P<0.05）.Multivariate Logistic stepwise regression analysis showed that gender 〔OR=1.27，95%CI（1.11，1.45）〕，age 〔OR=1.01，95%CI（1.00，1.02）〕，drinking 〔regular drinking vs never drinking OR=1.43，95%CI（1.19，1.70）〕，exercise 〔regular exercise vs never exercise OR=0.84，95%CI（0.73，0.98）〕，hypertension 〔OR=1.47，95%CI（1.30，1.66）〕，diabetes 〔yes，and poor glycemic control vs no OR=0.76，95%CI（0.65，0.88）〕，central obesity 〔OR=1.29，95%CI（1.13，1.48）〕，obesity 〔OR=1.43，95%CI（1.23，1.66）〕，CKD 〔OR=4.59，95%CI（3.91，5.38）〕，gout 〔OR=5.07，95%CI（3.54，7.28）〕，white blood cell count 〔OR=1.08，95%CI（1.04，1.11）〕，total protein 〔OR=1.04，95%CI（1.03，1.06）〕，serum albumin 〔OR=1.03，95%CI（1.01，1.05）〕and alanine aminotransferase 〔OR=1.01，95%CI（1.00，1.01）〕 had regression relationship with the prevalence of HUA in aged physical examination population in the community（P<0.05）.Conclusion　The prevalence of HUA in aged physical examination population in Shanghai Gaodong community is high，and it is associated with many adverse clinical indicators.It is necessary to strengthen the prevention and treatment of hyperuricemia in community residents.


Related Factors for Sarcopenia in Elderly Hospitalized Patients with Chronic Diseases　

WANG Nan，WEI Yanan，LIU Jie，WANG Jingtong

2020, 23(5):  611-616.  DOI: 10.12114/j.issn.1007-9572.2020.00.006

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Background　Sarcopenia，an age-related progressive decline in total body skeletal muscle mass and/or decreased muscle strength or decreased muscle physiological function，is associated with health problems，and high social and medical expenditure.Objective　To investigate the prevalence and associated factors of sarcopenia in elderly hospitalized patients with chronic diseases，facilitating early detection and prevention of sarcopenia.Methods　236 inpatients（≥60 years old） with chronic diseases from Department of Geriatrics，Peking University People's Hospital were enrolled during November 2017 to November 2018.Their demographic data and clinical data including prevalence of chronic disease，medication in the past 3 months，laboratory parameters，and prevalence of depression assessed by the 30-item Geriatric Depression Scale（GDS-30），and nutrition status assessed by Mini-Nutritional Assessment Scale-Short Form（MNA-SF） were collected，and were compared between those who were diagnosed with sarcopenia（n=63） and those without sarcopenia（n=173） by the guidelines by Asian Working Group for Sarcopenia.Multivariate Logistic regression analysis was performed to identify the factors associated with sarcopenia.Results Patients with sarcopenia ands those without showed significant differences in sex ratio，mean age，BMI，osteoporosis incidence，mean levels of hemoglobin，albumin，urea nitrogen，total cholesterol，triglyceride（TG） / high-density lipoprotein cholesterol（HDL-C） ratio，estimated glomerular filtration rate，prevalence and risk factors of malnutrition，appendicular skeletal muscle mass index（ASMI），grip strength，and gait speed（P<0.05）.Multivariate Logistic regression analysis showed that，age 〔OR=1.052，95%CI（1.007，1.099）〕，BMI 〔OR=0.885，95%CI（0.793，0.988）〕，osteoporosis 〔OR=2.217，95%CI（1.100，4.467）〕，hemoglobin 〔OR=0.936，95%CI（0.909，0.964）〕，TG/HDL-C ratio 〔OR=1.501，95%CI（1.074，2.099）〕 were independently associated with sarcopenia（P<0.05）.The incidence of sarcopenia differed significantly across BMI quartile groups（P<0.05）.In particular，the prevalence of sarcopenia in BMI 24.7-27.0 kg/m2 group was significantly lower than that in BMI ≤ 22.4 kg/m2 group（χ2=12.844，P<0.001）.There was no significant difference in the prevalence of sarcopenia across TG/HDL-C ratio quartile groups（P>0.05）.Conclusion　Older age，osteoporosis，decreased hemoglobin and increased TG/HDL ratio are associated with an increased risk of sarcopenia.The relationship between BMI level and sarcopenia tends to be U-shaped.


The Scope of General Practice Viewing from Removal of Ear Wax，Fishbone in the Throat and Foreign Body in the Eyes are Commonly done by General Practitioners，etc　

PEI Linxi，WU Hanji，WEI Xinping

2020, 23(5):  617-619.  DOI: 10.12114/j.issn.1007-9572.2019.00.771

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After nearly a decade of "medical and health reform"，medical services led by large hospitals，large institutions，and government community health service centers，the level of "general practice" has not been significantly increased to the service standards of developed countries，although developments in the provision of general medical services in China has made significant progress.In this paper，we reviewed the operation of "specialties and sub-specialties" in the Chinese mainland and the historical development of general practice and the specialties through three cases，including removal of ear wax，fishbone in the throat and foreign body in the eyes are commonly done by general practitioners，as comparison of differences in diagnosis and treatment at home and abroad.To explore "what is the scope of general practice" in China with the concept of WONCA and learn from experience of developed countries to understand the content and scope of general practice within the wider scope of general medical services.


4P Model-based Consultation Pattern in Whole-person Care by the General Practitioner：Analysis of One Case of Generalized Muscle Beating　

LIU Ruihong，CHEN Zhiyuan，HUANG Zhiwei

2020, 23(5):  620-622.  DOI: 10.12114/j.issn.1007-9572.2020.00.045

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In clinical practice，general practitioners frequently encounter patients with medically unexplained symptoms （MUS），which evoke a great challenge for both diagnosis and management.In this paper，we presented a case of generalized involuntary muscle beating over a duration of 2 months admitted to Department of Family Medicine，the University of Hong Kong-Shenzhen Hospital on July 13，2019.The diagnostic and therapeutic process of this case demonstrated routine application of biopsychosocial model in primary care，and a systematic approach incorporating the 4P model（namely，predisposing，precipitating，perpetuating and protective factors）to history taking，finding the clues and collecting the evidence that helps to explain the symptoms to the patient in an assuring way，facilitate active management，improve clinical outcome，and ultimately deliver whole-person care.


Postoperative Diagnosis and Treatment of One Case of Thyroid Cancer：a Biopsychosocial Perspective　

XIE Xingwei，LIU Chunmei，LIU Shuxian，SHEN Hang，ZHANG Daolong，ZHONG Liping，KONG Lingwei

2020, 23(5):  623-628.  DOI: 10.12114/j.issn.1007-9572.2020.00.014

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The patient-centered medical home （PCMH） is an optimized model used for delivering general care from biological，psychological and social perspectives by the healthcare team consisting of professionals in various fields.How to appropriately use this kind of biopsychosocial approach to treat patients is a great challenge to general practitioners （GPs）.We reported a 31-year-old female patient who was admitted to the PCMH，Beijing Jiaotong University Community Health Center on December 7，2018，and was given treatment using a biopsychosocial approach.This case mainly complained of 13-year irregular menstruation，six months after thyroid cancer surgery，and requiring comprehensive treatment.Moreover，she was found with polycystic ovary syndrome，type 2 diabetes，temperaments of pursuing perfection and high self-esteem，and fertility needs.Instead of treating patients by some specialists only from the biological perspective，GPs should systematically and comprehensively analyze the patients' complex conditions，and recognize that the patient needed biological treatment，psychological counseling，and support from her family and work unit，and then develop treatment regimen using a biopsychosocial approach.


Diagnosis and Treatment of a Patient with Liver Abscess—to Identify the Cause of Fever with General Practice Diagnosis Strategy　

CHEN Li，LU Gang，ZHOU Ping，LIN Chengbiao，LU Jingjie，ZHU Yanyan

2020, 23(5):  629-632.  DOI: 10.12114/j.issn.1007-9572.2019.00.808.

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Liver abscess is a common liver system infectious disease，which can threaten the lives of patients in severe cases.So it must be discovered and treated early.However，the symptoms of patients with liver abscess are generally not typical，lack of specificity and are misdiagnosed easily.The process of diagnosis and treatment for a case of patient with liver abscess mainly presented as fever was reported in this manuscript.The patient-centered thinking model was applied to analyze the patient with atypical liver abscess from the perspective of multi-system and multi-organ by general practitioner，so as to make a clear diagnosis and gain precious time for the patient to receive timely treatment.It is hoped that through sharing this case，the best thinking mode of general practice can be builted，the thinking conscious of general practice can be increased，and misdiagnosis and missed diagnosis can be reduced.