Table of Content

20 February 2020, Volume 23 Issue 6

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Monographic Research

Clinical Diagnosis and Treatment Strategy of Children's Bronchial Asthma——Suggestions of Shanghai Pudong New Area / Fengxian District Expert　

YIN Yong，LU Yanming，QIAO Jing，ZHUANG Cheng，LIU Fang，LIU Lixiao，LI Junxia，LI Hengtao，ZHANG Jinping，ZHANG Lei，ZHAO Liebin，ZHAO Yun，YU Jun，XU Jian，GUO Yanfang，SHENG Qiuming，et al

2020, 23(6):  633-643.  DOI: 10.12114/j.issn.1007-9572.2020.00.130

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Asthma is the most common chronic respiratory inflammatory disease in childhood.As long as we grasp the indications of acute and chronic treatment and referral，primary medical and health institutions should be the best platform for asthma prevention and treatment.This suggestions refers to the recent domestic and foreign relevant industry standards，research data and management guidelines，and publishes more specific understanding and interpretation of clinical diagnosis and treatment strategies for children's bronchial asthma，and puts forward more operational requirements and programs for clinical practice.This suggestions is divided into seven parts：early screening of children's asthma，detection of children's asthma pulmonary function，recognition of children's allergic symptoms and detection of allergens，assessment tool of asthma control based on grass-roots hospital，treatment strategy of children's asthma in grass-roots hospital，recommended scheme of children's asthma maintenance period treatment and two-way referral standard and process.Based on the treatment goal of children's asthma，the whole process of diagnosis and treatment is improved combing，focusing on the "key points"，especially according to the "treatment time axis" to develop the corresponding treatment plan，can maximize the standardization and normalization of management，in order to provide a reference for the chronic disease management in primary medical and health institutions.


Recent Advances in Research on Admission Criteria for Hospice Care at Home and Abroad　

ZENG Jie，JIN Lei，SUN Yao，PAN Li，LI Yafang，SHI Baoxin

2020, 23(6):  644-648.  DOI: 10.12114/j.issn.1007-9572.2019.00.404

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Hospice care can improve the life quality of patients in the terminal stage of life and relieve the physical and mental pain of patients and their families.Scientific and reasonable referral criteria for hospice care can help healthcare providers identify patients needing hospice care，so that such patients can receive hospice care in time.Therefore，determination of the referral criteria is the basis for promoting the development of hospice care.This article reviews the development methodology，specific contents，advantages and disadvantages of the referral criteria for hospice care at home and abroad，hoping to provide a reference for the development of referral criteria for hospice care in China.


Hospitalization Cost and Its Structural Variation for Four Kinds of Malignant Tumors in China from 2013 to 2017　

SONG Yannan，YIN Wenqiang，LIU Min，LI Qiusha，LIU Qian，HUANG Yanan，XU Xiaofeng，HUANG Dongmei

2020, 23(6):  649-655.  DOI: 10.12114/j.issn.1007-9572.2019.00.823

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Background　Malignant tumors have brought a heavy medical and economic burden to the family and society，which is easy to cause some families falling into poverty due to illness or giving up treatment.Current studies about tumors mostly focus on single tumor or a region.And hospitalization costs and their structural variation of multiple tumors have been rarely studied at the national level.Objective　To analyze the hospitalization costs of four kinds of malignant tumors in China from 2013 to 2017，as well as the main items and structural changes that affect the hospitalization expenses，so as to provide a reference for controlling the increase of medical expenses and deepening the medical reform.Methods　The data were collected from China's Health and Family Planning Statistical Yearbook（2014—2017）and China Health Statistics Yearbook 2018，involving samples collected from 2013 to 2017.The data of gastric，lung，esophageal and bladder malignant tumors in "30 kinds of diseases per capita hospitalization medical expenses" were counted，in which per capita hospitalization cost includes drug cost，examination fee，treatment cost，operation cost and surgical material cost.Structural variation analysis was performed during April to August 2019 to analyze the structural variation〔value of structural variation（VSV），degree of structural variation（DSV），and contribution rate of DSV to structural variation〕of hospitalization costs of these 4 tumors.Results　From 2013 to 2017，the per capita hospitalization cost for 4 tumors increased year by year，among which the per capita hospitalization cost of gastric malignant tumors was always the highest，and that of lung malignant tumors increased the most.During this period，drug cost accounted for the greatest percentage of the hospitalization cost for these 4 tumors，but decreased year by year in general.Specifically，analyzing the changes of the 5 components of hospitalization cost showed that drug cost increased between 2013 and 2014，but decreased between 2014 and 2017 year by year.After the decline from 2013 to 2014，the cost of examination increased slowly from 2014 to 2017，but the cost of operation and surgical materials increased year by year from 2013 to 2017.In 2013—2017，among the 5 components of hospitalization cost for 4 tumors，drug cost had greatest VSV；the VSV of both drug cost and examination fee showed negative changes，and that of operation cost and surgical material cost showed positive changes，while treatment cost showed no significant changes.From 2013 to 2017，the DSV of hospitalization cost for four kinds of malignant tumors from top to bottom was lung malignant tumor，gastric malignant tumor，esophageal malignant tumor and bladder malignant tumor.During this period，the contribution rate of DSV of drug cost to structural variation of hospitalization cost for these tumors was largest，while that of treatment cost was smallest.The components with the second highest contribution rates of DSV to structural variation of hospitalization cost were operation cost and surgical material cost for gastric and lung malignant tumors，and were operation cost and examination fee for esophageal malignant tumor，and were examination fee and surgical material cost for bladder malignant tumor.Conclusion　Although contribution rate of DSV of operation cost of four kinds of malignant tumors in China from 2013 to 2017 is ideal at present，drug cost and treatment cost are still the key adjustment objects of cost structure.At the same time，the control of surgical material cost and examination fee should be strengthened in order to effectively reduce the per capita hospitalization cost.However，patients with gastric cancer and lung cancer have a serious economic burden of disease，so early prevention and cost control should be strengthened if relief is to be achieved.


Serum Uric Acid Level and Plaque Characteristics Assessed by Intravascular Ultrasound in Elderly Patients with Coronary Heart Disease　

QIN Weibin，HE Guixin，LIN Lin，LIU Pengye，CHEN Yalu，REN Jiayi，CHEN Tianyu

2020, 23(6):  656-661.  DOI: 10.12114/j.issn.1007-9572.2019.00.755

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Background　In recent years，research shows that the prevalence of hyperuricemia is increasing year by year，and the disease has become a major health hazard to the elderly.Current studies have confirmed that hyperuricemia can lead to atherosclerosis and increase the risk of cardiovascular events，while lowering uric acid levels can delay the progression of atherosclerosis.Objective　To analyze the plaque characteristics assessed by intravascular ultrasound（IVUS）in elderly patients with coronary heart disease（CHD）by serum uric acid level，providing a theoretical basis for clinical treatment of CHD.Methods　We enrolled 140 CHD patients with a definite diagnosis of CHD from Department of Cardiovascular，the First Affiliated Hospital of Guangxi University of Chinese Medicine from January 2015 to July 2018.All of them were examined by coronary angiography and IVUS.We collected their general information，uric acid level and IVUS results〔area of extravascular elastic membrane，plaque load，plaque area，plaque cap thickness，eccentricity index，maximum plaque thickness，minimum plaque thickness，plaque calcification type，lipid pool area，remodeling index，mean vessel diameter，left main coronary artery stenosis degree，and stenosis degree and lipid pool area/plaque area of left anterior descending branch（LAD），left circumflex（LCX），and right coronary artery（RCA）〕．According to the level of uric acid during hospitalization，the patients were divided into three groups：low uric acid group（≤199 μmol/L，43 cases），medium uric acid group（200-399 μmol/L，50 cases），high uric acid group（≥400 μmol/L，47 cases）.Results　There were no significant differences in the area of extravascular elastic membrane，plaque load，eccentricity index，minimum thickness of plaque，type of plaque calcification，area of lipid pool，remodeling index，mean vascular diameter，degree of stenosis and area of lipid pool/plaque of LAD，LCX and RCA among high，medium and low uric acid groups（P>0.05）.The plaque area of high uric acid group was larger than that of low and medium uric acid groups（P<0.05）.High uric acid group had less thickness of fibrous cap of plaque，but greater maximum thickness of plaque and degree of stenosis of left main coronary artery than low uric acid group（P<0.05）.Conclusion　The IVUS found that elderly CHD patients with high serum uric acid level mainly had unstable coronary plaques with large plaque area，thin fibrous cap，large maximum plaque thickness，and high degree of stenosis of left main coronary artery.High uric acid can increase the risk of unstable plaque formation of coronary artery.So more attention should be given to the improvement and prevention of unstable plaques in clinical treatment of elderly CHD patients with high uric acid.


Screening Results Analysis of Colorectal Cancer in Diabetic Patients in Communities　

YANG Junhua，ZHANG Wei，YANG Anqing，QIN Zhengwei，LIU Yan，HUA Yun，HUA Hongmei，GUO Xi

2020, 23(6):  662-666.  DOI: 10.12114/j.issn.1007-9572.2019.00.627

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Background　With the changes in modern lifestyles，the incidence of diabetes and colorectal cancer is increasing gradually.The study of the relationship between diabetes and colorectal cancer proves that diabetes is a high risk factor for colorectal cancer，and regular screening for colorectal cancer should be noted.Objective　To analyze the results of patients with diabetes mellitus participating in colorectal cancer screening，and provide more technical references for the management of chronic diseases in community diabetes in the future.Methods　319 diabetic patients who participated in colorectal cancer screening in communities under the jurisdiction of Shanghai Baiyu community health service center from 2016 to 2018 were selected.Two questionnaires were issued at the beginning of the study.One was a health checklist designed by the center based on the requirements of the medical examination.The main purpose was to investigate whether the residents who participated in the screening had a history of diabetes mellitus.Another Shanghai Community Residents Colorectal Cancer Screening Risk Assessment Form prepared for screening for colorectal cancer in Shanghai included basic information（gender，age，marital status，education level，occupation） and risk factors of colorectal cancer（chronic diarrhea，history of chronic constipation，history of mucus and bloody stool，history of chronic appendicitis or appendectomy，history of chronic cholecystitis or cholecystectomy，history of intestinal polyps，history of schistosomiasis，history of cancer，history of first-degree relatives with cancer，history of trauma） and primary screening results（positive occult blood test，positive risk assessment，and any positive results for primary screening）.In the later stage of the study，the questionnaires prepared by the center were distributed，its content included whether to have colonoscopy，colonoscopy results，and recognition related to colonoscopy （fear of colonoscopy，thinking that there will be no problem and worrying about the uncomfortable consequences after the examination，the psychological burden of finding out the problem，the lack of time and interest，and the benefit of colonoscopy）.Results　A total of 319 patients with diabetes were enrolled.The age ranged from 60 to 69 years old（45.8%）.The marital status was mainly married （91.2%）.The education level was mainly secondary specialized school/ secondary school （57.1%）.State-owned enterprise was the mainstay occupation（39.8%）.The risk factors of colorectal cancer were chronic appendicitis or history of appendectomy，history of intestinal polyps，and chronic cholecystitis or history of cholecystectomy，which were 14.7%，13.8%，and 13.5%，respectively.The positive rate of occult blood was 6.6%（21/319），the positive rate of risk assessment was 18.2%（58/319），and the double positive rate was 6.0%（19/319）.There were 79 patients with positive screening and 23 patients underwent colonoscopy.Among them，patients with no lesion accounted for 39.1%，enteritis accounted for 26.1%，and polyps accounted for 21.7%.Of 79 patients who had positive screening results，39 were considered they could benefit from colonoscopy and 22 were afraid of colonoscopy.Conclusion　About 25% of the community diabetes patients with colorectal cancer screening positive， especially pay attention to patients with history of chronic appendicitis or appendectomy， chronic cholecystitis or cholecystectomy， and intestinal polyp..


Effect of Bredinine Combined with Middle Dose Glucocorticoid in the Treatment of IgA Nephropathy　

2020, 23(6):  667-671.  DOI: 10.12114/j.issn.1007-9572.2019.00.806

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Background　IgA nephropathy is the most common primary glomerular disease in China，which has a serious impact on the health and quality of life of patients.Glucocorticoid and bredinine are commonly used in the treatment of IgA nephropathy，but there are a few studies on the combination of them.Objective　To study the clinical effect of bredinine combined with middle dose glucocorticoid in the treatment of IgA nephropathy in order to provide basis for clinical treatment.Methods　From April 2015 to April 2017，45 patients with IgA nephropathy in Wuhan Fourth Hospital were selected as the study objects.The patients were randomly divided into three groups：bredinine group，middle dose glucocorticoid group and bredinine combined with middle dose glucocorticoid group，with 15 cases in each group.The patients in bredinine group were treated with bredinine tablets，150 mg/time，once a day.The patients in the middle dose glucocorticoid group were treated with prednisone acetate tablets，40 mg•kg-1•d-1.On the basis of the treatment with prednisone acetate tablets，bredenine tablets were added to the bredenine combined with middle close glucocorticoid group.The dosage and usage were the same as that of bredenine group.The treatment time of the three groups was 6 months.The total efficiency of the three groups was recorded.The levels of serum creatinine，urinary microalbumin，urea nitrogen，24 h urinary protein，IgA and TGF-β1 before and after treatment were measured.And the adverse reactions were calculated.Results　The total effective rate of bredinine combined with middle dose glucocorticoid group was higher than that of bredinine group and middle dose glucocorticoid group（P<0.05）.The level of serum creatinine，urea nitrogen and 24 h urine protein in bredinine combined with middle dose glucocorticoid group were lower than those in bredinine group and middle dose glucocorticoid group，and the level of microalbumin in urine was higher than that in bredinine group and middle dose glucocorticoid group（P<0.05）.The levels of serum creatinine and 24 h urinary protein in three groups were lower than those before treatment，and the levels of urinary microalbumin were higher than those before treatment（P<0.05）.The urea nitrogen level of bredinine group，bredinine combined with middle dose glucocorticoid group after treatment was lower than that before treatment，and that of middle dose glucocorticoid group after treatment was higher than that before treatment（P<0.05）.The levels of IgA and TGF-β1 in bredinine group and middle dose glucocorticoid group were lower than those in bredinine group and middle dose glucocorticoid group（P<0.05）.The levels of IgA and TGF-β1 in three groups were lower than those before treatment（P<0.05）.There was no significant difference in the incidence of adverse reactions among the three groups（P>0.05）.Conclusion　Bredinine combined with glucocorticoid has a significant effect in the treatment of IgA nephropathy.It can improve the renal function，reduce the level of IgA and TGF-β1，and has a high safety.It provides a new treatment idea for IgA nephropathy.


Effect of Electroconvulsive Therapy on Amplitude of Low Frequency Fluctuations and Related Brain Network Changes in Elderly Depressive Patients　

KONG Xiaoming，SUN Yan，ZHU Defa

2020, 23(6):  672-677.  DOI: 10.12114/j.issn.1007-9572.2019.00.624

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Background　Depression is a common psychological disease in the elderly，which seriously impairs the physical and mental health of this group.Its clinical manifestations are different from those of young and middle-aged adults，and the treatment difficulty is significantly increased.Although electroconvulsive therapy（ECT） is relatively good for it，the treatment mechanism is not clear.Although there are many fMRI studies about ECT for depression，elderly depression is rarely explored.So exploration of this treatment for elderly depression is necessary for clarifying the mechanism.Objective　To investigate the impact of ECT on amplitude of low-frequency fluctuations（ALFF） and related brain network changes in elderly depressive patients.Methods　Twelve inpatients with depression aged from 60-80 were recruited from Anhui Mental Health Center during October 2013 to December 2017.All of them received ECT for no more than 12 times.The treatment effects were evaluated by comparing pre- and post-ECT parameters such as scores of the 24-item version of Hamilton Depression-Rating Scale（24-HAMD） and Hamilton Anxiety-Rating Scale（HAMA），rs-fMRI with brain structure scan，ALFF，and whole-brain structural connection network evaluated based the seed points that can be used to delimit functionally distinct cortical areas.Results　Mean scores of 24-HAMD and HAMA after ECT in depressiue patients were all lower than the baseline（P<0.05）．Post-ECT ALFF value in the orbital part of the left inferior frontal gyrus and of the right middle frontal gyrus increased significantly compared with baseline，so these two regions were determined as the ROI，and named as ROI-1（x=-36，y=51，z=-12，radius=6 mm），and ROI-2（x=9，y=66，z=-12，radius=6 mm），respectively.ROI-1-based whole-brain functional connectivity analysis found that compared with baseline，functional connections of a large mass（x=18，y=0，z=6，t=8.61） in the globus pallidus showed significantly improvements after ECT，and the enhancement was especially obvious in the cingulate gyrus，thalamus and globus pallidus.ROI-2-based whole-brain functional connectivity analysis revealed that after the ECT，the functional connections of the left middle frontal gyrus and the opercular part of the right inferior island inferior gyrus.Conclusion　After receiving ECT，ALFF of the left orbital frontal inferior gyrus and the right orbital frontal middle gyrus were significantly increased， and the functional connections between these areas and the brain areas such as the posterior cingulate gyrus， thalamus， pallidus， left frontal middle gyrus and right insular frontal inferior gyrus were enhanced，which may be related to the mechanism of ECT antidepressant treatment.


Predictive Value of Testicular Volume and Reproductive Hormone Levels on the Presence and Absence of Spermatozoa in Testis of Patients with Non-obstructive Azoospermia　

HU Haorui，ZHOU Xiaoming，LIAO Ming，XIE Fanggang，WEI Xing，CHEN Jin，DU Yiqiao

2020, 23(6):  678-681.  DOI: 10.12114/j.issn.1007-9572.2019.00.739

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Background　Testicular sperm aspiration（TESA）is the most commonly used technique for assessing infertility patients at present.However，it is a traumatic procedure that affects patient's bodily functions.Therefore，how to determine the presence of sperm in the testis according to the actual condition of the patient by measuring patient's testicular volume and reproductive hormone levels is very important to determine whether a patient receives TESA and in vitro fertilization（IVF）technology for fertility.Objective　To explore the predictive value of testicular volume and reproductive hormone levels on the presence and absence of spermatozoa in testis of patients with non-obstructive azoospermia（NOA），in order to provide a theoretical basis for clinical non-invasive diagnosis and treatment of NOA.Methods　Seventy-eight patients with NOA admitted to Maternity and Child Health Hospital of Guiyang from February 2014 to March 2018 were retrospectively selected.According to TESA results，patients were divided into spermatozoa group（32 cases）and azoospermia group（46 cases）.The patient's age，testicular volume，reproductive hormone〔prolactin（PRL），follicle stimulating hormone（FSH），luteinizing hormone（LH），estradiol（E2），total testosterone（TT）〕levels were collected.Results　The left testicular volume and right testicular volume were smaller，and LH level and E2 level were lower in the azoospermia group than those in the spermatozoa group，while the PRL level and FSH level were higher（P<0.05）.The left testicular volume（rs=0.837，P<0.001），right testicular volume（rs=0.862，P<0.001），FSH level（rs=-0.218，P=0.026）and E2 level（rs=0.218，P=0.021）were correlated with TESA results in patients with NOA.Multivariate Logistic regression analysis showed that left testicular volume〔OR=0.741，95% CI（0.542，0.860）〕，right testicular volume〔OR=1.047，95% CI（1.008，1.113）〕，and FSH level〔OR=3.168，95% CI（1.216，8.872）〕were influencing factors of azoospermia in NOA patients（P<0.05）.The AUC of the left and right testicular volume to predict the azoospermia of NOA patients were 0.983 and 0.957，and the critical values were 6.3 ml and 6.5 ml with the sensitivity of 65.5% and 92.4% and the specificity of 99.4% and 99.8%.The AUC of the PRL，FSH，LH，E2 and TT levels to predict the azoospermia of NOA patients were 0.537，0.742，0.607，0.628，and 0.568，and the critical values were 9.3 μg/L，12.2 U/L，4.9 U/L，48.5 pmol/L，and 9.9 nmol/L with the sensitivity of 56.7%，69.4%，77.5%，88.4%，and 79.2% and specificity of 89.4%，90.5%，91.3%，91.6%，and 90.4%.Conclusion　The testicular volume and FSH level have a certain predictive effect on the presence or absence of sperm in the testis of patients with NOA，and the accuracy of testicular volume prediction is higher than that of FSH level，which is of certain guiding significance in clinical practice.


Expression of TIP30 in Gastric Cancer and Its Relationship with Prognosis

LIU Qingwei，LI Yong，TAN Bibo，FAN Liqiao，ZHAO Qun，LI Zhaoxing，YANG Peigang

2020, 23(6):  682-687.  DOI: 10.12114/j.issn.1007-9572.2019.00.568

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Background　Gastric cancer is an aggressive cancer with poor prognosis.Identification of effective therapeutic target is important in the treatment of gastric cancer.TIP30，a newly identified tumor suppressor，appears to be involved in multiple functions including tumorigenic suppression，apoptosis induction and diminishing angiogenic properties.At present， there are few reports about TIP30 and gastric cancer at home and abroad. Objective　To explore the expression of TIP30 in gastric cancer and analyze its correlation with gastric cancer prognosis.Methods　Participants were recruited from Fourth Hospital of Hebei Medical University，including 106 cases of gastric cancer receiving surgical treatment during May 2012 to February 2013，and 30 cases of gastric ulcer undergoing gastroscopy in 2017.Immunohistochemistry was used to measure the expression levels of TIP30 and MMP-9 in paraffin-embedded gastric cancer samples of the gastric cancer cases and normal gastric mucosal biopsy specimens of the gastric ulcer cases.Analyses were conducted on abnormal expression of TIP30 and MMP-9 in both gastric cancer and mucosal tissues，expression of TIP30 and MMP-9 in gastric cancer tissues by different clinical features，and correlation of TIP30 and MMP-9 in gastric cancer tissues.The follow-up ended on February 28，2018.The survival curve of gastric cancer cases was drawn with the Kaplan-Meier method.Prognostic factors of gastric cancer cases were analyzed.Results　The prevalence of abnormal expression of TIP30 in gastric cancer tissues was significantly lower than that in normal gastric mucosal tissues 〔41.5%（44/106）vs 86.7%（26/30）〕（χ2=19.089，P<0.001）．TIP30 expression level in gastric cancer tissues differed substantially by depth of infiltration，presence of lymph node metastasis，and TNM stage（P<0.05）．The prevalence of abnormal expression of MMP-9 in gastric cancer tissues was significantly higher than that in normal gastric mucosal tissues 〔82.1%（87/106）vs 23.3%（7/30）〕（χ2=37.800，P<0.001）．MMP-9 expression level in gastric cancer tissues varied significantly by depth of infiltration，presence of lymph node metastasis，and TNM stage（P<0.05）．Spearman rank correlation analysis demonstrated that TIP30 was negatively correlated with MMP-9 in gastric cancer tissues（rs=-0.405，P<0.01）．The median survival time of the gastric cancer patients with TIP30 positive expression and negative expression was 45，and 23 months，respectively.The survive curve of gastric cancer patients changed significantly according to TIP30 expression level（χ2=9.025，P=0.003）．Cox proportional hazards regression analysis demonstrated that lymph node metastasis status〔HR=2.842，95%CI（1.597，5.057）〕 and TIP30 expression〔HR=0.517，95%CI（0.299，0.895）〕 were independent prognostic factors of gastric cancer（both P<0.05）．Conclusion　TIP30 protein is low expressed in gastric cancer，which may play an important role in the invasion and metastasis of gastric cancer，and is closely associated with poor prognosis.


Occurrence and Gene Mutation of Glucose-6-phosphate Dehydrogenase Deficiency in Neonates in Hainan Province　

ZHAO Zhendong，WANG Jie

2020, 23(6):  688-691.  DOI: 10.12114/j.issn.1007-9572.2019.00.612

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Background　Glucose-6-phosphate dehydrogenase （G6PD） deficiency can cause acute hemolytic anemia，which can endanger life in severe cases.Hainan Province is a region with high incidence of G6PD deficiency，and the disease has regional and racial specificity.Through screening and final genetic diagnosis，severe consequences of this disease can be actively and effectively prevented.At present，there is no report of the genetic study of G6PD deficiency in Hainan population.Objective　To find out the incidence and gene mutation characteristics of neonatal G6PD deficiency in Hainan province in 2017.Methods　A total of 130 512 live births from January 1，2017 to December 31，2017 were selected from all deliver units in Hainan Province.Samples of dry blood spot on filter paper were collected from heel blood of newborns who met the inclusion criteria for G6PD gene screening.The suspicious samples were screened for biochemical diagnosis by G6PD/6GPD ratio method.Children with G6PD deficiency confirmed by biochemical examination were divided into different genotypes by dry blood samples.Results　In 2017，the positive rate of G6PD primary screening was 4.00% （5 221/130 512） in Hainan province.A total of 2 993 cases of G6PD/6GPD deficiency were confirmed.All 2 993 cases had G6PD gene mutation detected by gene test.The diagnostic rate of G6PD/6GPD and the mutation rate of G6PD gene were both 2.29% （2 993/130 512） in Hainan province.The incidence of G6PD/6GPD deficiency was 1.80%（1 972/109 590） in Han nationality，5.28% （934/17 698） in Li nationality and 2.70% （87/3 224） in other nationalities.The incidence of G6PD deficiency in Li nationality was higher than that in Han nationality （χ2=826.206，P<0.001）．Ten types of gene mutations were：c.1376G>T of 1 636 cases （54.66%），c.1388G>A of 659 cases （22.02%），c.95A>G of 254 cases （8.49%），c.1024 C>T of 204 cases （6.82%），c.871G>A of 93 cases （3.11%），c.519 C>T of 64 cases （2.14%），c.392G>T of 25 cases （0.84%），c.1360C>T of 22 cases （0.74%），C>T of 19 cases （0.63%），c.592C>T of 11 cases （0.37%），and c.1376G>T combined c.1388G>A mutation of 8 cases （0.27%），c.1376G>T combined c.871G>A mutation of 3 cases（0.10%），and c.1376G>T combined c.517T>C mutation of 3 cases（0.10%）.Five（0.17%） unknown mutations were found，including 1 case of 487G>A，1 case of 1004C>A and 1 case of c.86C>T，which were not reported in Hainan province.Conclusion　The prevalence of G6PD deficiency in neonates in Hainan is high，and the incidence of G6PD deficiency in Li nationality was significantly higher than that in Han nationality.The mutations of G6PD gene are mainly c.1376G>T，c.1388G>A，c.95A>G and c.1024 C>T.Five unknown mutations were found，including c.86C>T，c.487G>A and c.1004C>A.


Bioinformatics Analysis of Myelin KLF5 Deficiency Inhibiting Abdominal Aortic Aneurysm Formation in Mice　

CHANG Quan，ZHANG Nana，MA Dong

2020, 23(6):  692-698.  DOI: 10.12114/j.issn.1007-9572.2019.00.754

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Background　Abdominal aortic aneurysm（AAA） is a common cardiovascular disease with high mortality in the elderly.Its pathogenesis remains unclear and there is no special effective pharmacological treatment.Our previous research found increased KLF5 expression in human and mouse AAA tissues，but a detailed network analysis of KLF5 regulating inflammatory gene expression is still unreported.Objective　To investigate the regulating role of KLF5 in AAA by? bioinformatically analyzing the aberrant expressed genes in CaPO4-injured AAA tissues from LyKLF5-/- and WT mice using gene?chip?technology.Methods　Between January 2015 and April 2019，SPF grade KLF5-flox mice and SPF grade LysM-cre mice were cross-bred to produce male mice with LyKLF5-/- and WT C57BL/6，respectively，each group for 3 mice.Extraction of total RNA in CaPO4-injured abdominal aorta from AAA model was used for mRNA microarray screening.The ectopic gene expression was analyzed by functional annotation（GO） and KEGG.Protein interaction network analysis was conducted by STRING.Results　A total of 646 up-regulated genes and 1 410 down-regulated genes were detected（|FC|≥2，P<0.05）.Compared with WT group，the expression of anti-inflammatory genes was significantly increased in LyKLF5-/- group，Bcas3 and Hck genes were obviously up-regulated about 3.96 and 3.14 times，respectively.On the other hand，among the decreased pro-inflammatory genes，Retnla，Olig1 and Tnfrsf11a were obviously down-regulated by 7.68，5.07 and 3.66 times.GO analysis showed that up-regulated genes were mainly enriched in the regulation of polypeptide antigen processing and presentation，the nucleoside diphosphate metabolic process，and the positive regulation of sarcomere organization.Down-regulated genes were enriched in the development and growth，regulation of glucose-stimulated insulin secretion and smooth muscle cell migration.KEGG signal pathway analysis showed that up-regulated differential genes mainly affected osteoclast differentiation，phagosome，biosynthesis of amino acids and other pathways.Down-regulated genes mainly affected vascular smooth muscle contraction，ubiquitin mediated proteolysis and regulation of actin cytoskeleton.Protein interaction network analysis confirmed that the deletion of myeloid KLF5 in mice resulted in up-regulation of Bcas3 and Hck expression and down-regulation of Retnla，Olig1 and Tnfrsf11a expression，the 5 genes playing a role in regulation of vascular inflammation.Conclusion　Bcas3，Hck，Retnla，Olig1 and Tnfrsf11a genes may be important candidates for vascular inflammation and AAA formation.


Reflection on How to Integrate New Technology into Community Information System and Serve Family Doctors to Sign Contracts from the Perspective of First-line General Practitioners　

CAO Zhibin，ZHONG Ling，WU Zebing

2020, 23(6):  699-702.  DOI: 10.12114/j.issn.1007-9572.2019.00.757

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The contracting service of family doctors in China is in full swing.However，when you open the database and search for "Family Doctor Contracts"，you will find that the overwhelming majority of the evaluations，opinions，comments and feedback on family doctor contracts come from management，economics and public health majors，lack of medical staff from one of the main contracting parties.From the perspective of the first-line general practitioners，that is，the practitioners of family doctors' signing services，this paper expounds the current situation of family doctors' signing services in the grass-roots medical information system，and discusses the existing problems and possible solutions.


Development Status and Prospect of County Health Care Unit in Zhejiang Province　

CHEN Yangyang，LIU Ying，ZHU Xiancheng，REN Jingjing

2020, 23(6):  703-706.  DOI: 10.12114/j.issn.1007-9572.2019.00.759

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In order to deeply implement the measure of “two sinking and two improvement ”，some county medical health care units was established in 11 cities of Zhejiang Province in September 2017.After a series of work，a new community-centered health care model was constructed.County medical health care unit is a reconstruction of medical service system carried out by hospitals and primary health institutions through the integration of resources and joint management.It is a kind of reform and innovation faced with the dilemma of medical reform in today's society.After nearly two years' exploration，each unit has achieved certain effectiveness，unified all kinds of resources，reformed the“three medical linkage”，improved the level of medical services，and polished out its own bright spots in the light of their respective actual conditions.The county medical health care unit in Zhejiang Province has made remarkable achievements，but in the process of development，the positioning and division of labor among the members，the construction of the talent team of primary health institutions and the optimization of service level in the county medical health care unit have become problems that cannot be ignored.In this paper，the achievements made after the construction of the county medical health care unit in Zhejiang Province is described to provide the basis for the necessity of its construction，and existing problems are put forward to provide ideas for the development direction of the construction of the county medical health care unit.Only by introducing corresponding measures to solve the problems，the level of medical service can be improved.


Analysis of Risk Factors Related to Type 2 Diabetic Kidney Disease based on Physical Examination　

ZHENG Shuping，YUAN Hong

2020, 23(6):  707-711.  DOI: 10.12114/j.issn.1007-9572.2019.00.818

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Background　The management of type 2 diabetes played a significant role in decreasing the incidence of diabetic kidney disease within type 2 diabetes mellitus patients.Thus，risk factors analyses of diabetic kidney disease in type 2 diabetes patients could promote patients management for community general practitioners.Objective　To explore the risk factors related to diabetic kidney disease in type 2 diabetes patients，and provide certain theoretical basis for community general practitioners to manage diabetes patients.Methods　Patients diagnosed as type 2 diabetes（n=1 627） between March and August 2018 in Jiangqiao Town Health Service Center，Jiading District were collected，and their physical examination results were gathered.According to the diabetic kidney disease diagnostic criteria in China Clinical Guideline of Diabetic Kidney Disease Treatment and Control，patients were separated into only-type 2 diabetes group 〔eGFR≥60 ml•min-1•（1.732）-1〕 and diabetic kidney disease group 〔eGFR<60 ml•min-1•（1.732）-1〕.General information，including age，gender，smoking history，blood pressure，BMI，waistline，hypertension history，hyperlipidemia history，serum lipid parameters（TC，LDL-C，HDL-C，TG），FPG，HbA1c，SUA，UP，were collected and compared between the two groups.Multivariate Logistic regression analyses were conducted to explore the related risk factors of diabetic kidney disease incidence in type 2 diabetes patients.Results　Among 1 627 diabetes patients，104 were diagnosed as diabetic kidney disease，with a 6.39 percent.Patients in diabetic kidney disease group had higher age，waistline，SBP and BMI than patients in only-type 2 diabetes group；while they had lower DBP than patients in only-type 2 diabetes group；they also had more frequent hypertension history and hyperlipidemia history than patients in only-type 2 diabetes group（P<0.05）.In addition，compared with only-type 2 diabetes group，patients in diabetic kidney disease group had lower LDL-C，HDL-C and higher SUA，UP positive rate（P<0.05）.Age〔OR=1.171，95%CI（1.133，1.211）〕，hypertension history〔OR=1.892，95%CI（1.070，3.344）〕，hyperlipidemia history〔OR=1.719，95%CI（1.077，2.742）〕，SUA〔OR=8.962，95%CI（5.490，14.629）〕，UP〔OR=8.087，95%CI（4.145，15.779）〕，and central obesity 〔OR=2.457，95%CI（1.616，3.736）〕 were the risk factors of diabetic kidney disease incidence in type 2 diabetes patients（P<0.05）.Conclusion　Aging，hypertension history，hyperlipidemia history，SUA，UP and central obesity were independent risk factors for diabetic kidney disease within type 2 diabetes patients，suggesting that community general practitioners should improve the management of aged type 2 diabetes patients.Urinary protein test should be included in surveillance system of type 2 diabetes patients to early detect and treat diabetic kidney disease.


Establishment and Verification of a Risk Prediction Model of Diabetic Retinopathy in Patients with Type 2 Diabetes in the Community　

ZHU Xiayuan，WU Hao，GE Caiying，CHEN Ying，ZHAO Xinying，KONG Min，GAO Wenjuan

2020, 23(6):  712-715.  DOI: 10.12114/j.issn.1007-9572.2020.00.063

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Background　Diabetic retinopathy（DR） has a high incidence and is a leading cause of blindness in adults.Although it is difficult to perform fundus screening in a wide range of population in communities，the risk prediction model of DR can help general practitioners identify high risk population of DR at an early stage.Therefore，carrying out the research on the risk prediction model for DR is particularly important.Objective　To explore the risk factors of DR in type 2 diabetic outpatients in community settings，and use them to establish and verify a risk prediction model for DR，further improving the screening efficiency of DR.Methods　From June 2018 to June 2019，421 type 2 diabetic outpatients from Fangzhuang Community Health Service Center were invited and were divided into model group（336 cases） and verification group（85 cases） by a table of random numbers.Demographic information，blood pressure，fasting blood glucose（FBG），2-h postprandial blood glucose，glycosylated hemoglobin（HbA1c），serum creatinine，urea nitrogen，total cholesterol（TC），triacylglycerol（TG），low-density lipoprotein cholesterol（LDL-C），urine protein，and results of non-mydriatic fundus color photography（NMFCS） of the patients were collected.Univariate Logistic regression analysis was used to identify DR-related factors in model group，and the related factors obtained were discussed with multivariate Logistic regression analysis to explore the risk factors of DR based on which the DR risk prediction model was constructed，and the feasibility of this prediction model was evaluated in the verification group.Results　Altogether，87 patients were found with DR，including 69 in the model group and 18 in the verification group.Multivariate Logistic regression analysis showed that years of having T2DM（β=0.196，OR=1.217，P<0.001），systolic blood pressure（β=0.028，OR=1.028，P=0.038），FBG（β=0.409，OR=1.506，P=0.003），HbA1c（β=0.594，OR=1.811，P=0.001） and LDL-C （β=0.360，OR=1.434，P=0.038） were risk factors of DR in type 2 diabates patients.Therefore，the DR risk prediction model was Y=1/〔1+e-（0.196X1+0.028X2+0.409X3+0.594X4+0.360 x5-16.482）〕，Y refers to the probability of DR，X1 to years of having T2DM，X2 to systolic blood pressure，X3 to FBG，X4 to HbA1c，and X5 to LDL-C.The area under the ROC curve of DR in the model group was 0.884，and the cut-off point was 0.192.The area under the ROC curve was 0.803，the sensitivity was 72.2%，and the specificity was 79.1% in type 2 diabates patients occurred DR in verification group.Conclusion　Years of having T2DM，systolic blood pressure，FBG，HbA1c and LDL-C were significantly correlated with DR.DR risk prediction model has certain prediction value for DR.


Risk Factors for Atherosclerotic Cardiovascular Disease among 45-55-year-old Residents Receiving Outpatient Care：a Survey from a Community in Shanghai's Xuhui District　

SHEN Delei，CHEN Hao，ZHAO Chao，LIANG Huifeng，YI Chuntao

2020, 23(6):  716-720.  DOI: 10.12114/j.issn.1007-9572.2020.00.099

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Background　Atherosclerotic cardiovascular disease（ASCVD） is a leading threat to Chinese resident's health.It is also a primary cause of death，accounting for 41.8% of deaths in urban residents and 44.8% in rural residents，respectively.To early prevent the occurrence and development of ASCVD in community-dwelling middle-aged residents，it is essential for family doctors and family doctor teams to take major responsibility to carry out surveys and evaluations about risk factors associated with ASCVD，and provide targeted interventions and comprehensive management.Objective　To investigate the risk factors of ASCVD among 45-55-year-old residents with outpatient care from Xuhui District Fenglin Community Health Center，Shanghai，providing suggestions for delivering targeted interventions for this group in the community.Methods　Participants were 530 outpatient patients recruited from Xuhui District Fenglin Community Health Center during January to May 2019.From the information database and physical examination department of this health center，their correct personal information（sex，age and telephone number），and physiological and biochemical data〔height，weight，BMI，blood pressure，serum total cholesterol（TC），triacylglycerol （TG），high-density lipoprotein cholesterol（HDL-C），low density lipoprotein cholesterol（LDL-C），and fasting plasma glucose（FPG） 〕 were collected.They were invited to participate in a telephone-based questionnaire survey or a fact-to-face questionnaire survey for assessing overall cardiovascular risks.The risk of ASCVD was classified according to the chapter "Overall cardiovascular risk assessment" in 2016 Chinese Guidelines for the Management of Dyslipidemia in Adults.According to the conditions of the community that the participants came from，those were evaluated with low and medium risks were assigned to low-risk group and those with high and extremely high risk were assigned to high-risk group.Stepwise Logistic regression analysis was used to identify the factors associated with levels of ASCVD risks.Results　530 questionnaires were sent out and 502 effective questionnaires were recovered. The effective recovery rate was 64.7%. There were 38 cases in ASCVD low risk group and 464 cases in ASCVD high risk group.High-risk group showed greater mean age，higher mean levels of TG and FPG，male ratio，prevalence rates of cardiovascular disease，diabetes，hypertension，and rates of oral administration of antihypertensive agents，and lipid-lowering drugs compared with low-risk group（P<0.05）.High-risk group showed greater mean age，higher mean levels of TG and FPG，male ratio，prevalence rates of cardiovascular disease，diabetes，hypertension，and rates of oral administration of antihypertensive agents，and lipid-lowering drugs compared with low-risk group（P<0.05）.Stepwise multiple Logistic regression analysis found that≥50 years old，TG≥1.5 mmol/L and FPG≥6.1 mmol/L，male were associated with increased risk of ASCVD（P<0.05），while oral administration of lipid-lowering drugs was associated with decreased risk of ASCVD（P<0.05）.Conclusion　In this group，the controllable risk factors for ASCVD mainly are abnormal blood lipids（TG） and FPG，and the uncontrollable risk factors are age and sex.So more attention should be paid to ASCVD risks in elderly，men，and those with dyslipidemia，and give them interventions for changing unhealthy lifestyles，as well as guidance for standard use of lipid-lowering drugs.Community-based evaluation and management of multiple risk factors of ASCVD are very important for early screening，intervening and treating ASCVD，and may offer assistance for family doctors and family doctor teams in carrying out primary and secondary prevention of ASCVD.

Effect of Healthy Eating Plate on Blood Glucose Control in Diabetic Patients in the Community　

LI Peng，FANG Yuewei，CHEN Jufei，TONG Zhendong，WU Jingya

2020, 23(6):  721-725.  DOI: 10.12114/j.issn.1007-9572.2020.00.003

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Background　China has a high incidence of diabetes，which is a major public health issue.There is no cure for diabetes，and dietary therapy is the most basic treatment for diabetes.Diabetes can not be cured currently，and is treated essentially by dietary therapy.However，although there are abundant theories about dietary therapy，it is difficult for patients to implement due to lack of implementation techniques.Objective　To study the effect of healthy eating plate on glycemic control in diabetic patients，to provide a scientific basis for further promoting its application.Methods　Participants were 117 community-dwelling diabetic patients who were registered and were managed for more than one year at 6 community health stations with similar management level in service areas of Newcity Community Health Center in Zhoushan City selected by purposive sampling from May 2018 to May 2019.By the lottery number drawn subjectively，they were divided into experimental（59 cases）and control（58 cases）groups.Both groups received the same education concerning dietary therapy and normal dietary guidance，but the control group used common eating utensils，the experimental group used healthy eating plates for providing detailed guidance for eating.The general data，anthropometric indices（BMI，BP，and WC）and biochemical indices（FPG，HbA1c，TC，TG，LDL-C，HDL-C）of the two groups were analyzed comparatively before and after the intervention.Anthropometric and biochemical indices were further compared between those who failed to reach glycemic targets in the two groups（22 in the experimental group and 20 in the control group）.Results　There were no statistically significant differences between the two groups in gender ratio，mean age，occupation，education level，exercise and regular drug use（P>0.05）.Before intervention and at 1 year after intervention，there were no statistically significant differences in mean BMI，BP，WC，FPG，HbA1c，TC，TG，LDL-C and LDL-C between the two groups（P>0.05）.After 1 year intervention，mean BMI，BP，WC，FPG，HbA1c，TC，TG，LDL-C，and HDL-C showed no significant changes in the control group compared with those before intervention（P>0.05），and they also changed insignificantly in the experimental group（P>0.05） except that HbA1c showed a significant reduction（P<0.05）.Patients who failed to reach glycemic targets the experimental group had similar mean levels of BMI，BP，WC，FPG，TC，TG and LDL-C（P>0.05），but lower mean levels of HbA1c and HDL-C compared to those in the control group before intervention and at one year after intervention（P<0.05）.The mean level of HbA1c decreased significantly in both groups compared to the baseline level（P<0.05）.Conclusion　The application of healthy eating plate combined with nutrition education can effectively control the blood glucose level，which is worthy to be popularized in community-dwelling diabetic patients.


Development of a Structured Treatment and Education Program for Hypertension　

LI Lin，AN Yanling，LIU Keke，LI Jun，JIANG Hua，LI Mingzi

2020, 23(6):  726-732.  DOI: 10.12114/j.issn.1007-9572.2019.00.571

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Patient education is the basis of the control of hypertension，and structured education is widely used for patients with chronic diseases in the world.This paper introduced the development principle of Structured Treatment and Education Program for Hypertension，from analysis，design，teaching strategies，curriculum implementation，to curriculum evaluation，to describe the process of curriculum development.Finally we chose 15 patients with hypertension in the tertiary hospital in Beijing where the researchers worked，and made a teaching demonstration.Analysis showed that the curriculum was feasible，and the curriculum could regulate health management，enhance the capacity of grassroots innovation of beneficial exploration on the education model，which is worth further validation in clinical practice.


Changes in Medical Labels：Emotional Experience of Patients with Mild Cognitive Impairment　

ZHANG Xiuxiu，SUN Huimin，WANG Jinbo，HUANG Rongrong

2020, 23(6):  733-736.  DOI: 10.12114/j.issn.1007-9572.2019.00.531

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As the incidence of dementia increases year by year，mild cognitive impairment（MCI） occurs as pre-dementia in the medical diagnosis with non-ignorable psychosocial impact.This paper reviews the relevant literatures at home and abroad and summarizes different emotional experience of patients with MCI at and after diagnosis.We reflect the negative impacts of changes in medical labels，in order to provide the direction for the establishment of individualized health support and service system for MCI.


Research Progress of Mechanism of Type D Personality on the Development of Coronary Heart Disease　

YI Huijie，LIN Ping，LI Ling，WANG Yini

2020, 23(6):  737-741.  DOI: 10.12114/j.issn.1007-9572.2019.00.735

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As an important early warning indicator of coronary heart disease，more and more studies begin to pay attention to the mechanism and pathway between type D personality and the development of coronary heart disease.However，previous studies have only expounded the mechanism of type D personality on coronary heart disease from a single biomedical or behavioral psychology perspective，and no studies have clarified the mechanism from a complete perspective of biology and behavioral psychology.By summarizing the latest research evidence，this paper analyzes the relationship between type D personality and the occurrence，development and prognosis of coronary heart disease，and further explores the potential pathways between type D personality and coronary heart disease from the perspectives of biology and behavioral psychology to provide theoretical basis for clarifying the mechanism of type D personality on coronary heart disease.It provides new intervention targets for improving the clinical outcomes of patients with coronary heart disease and type D personality，so as to continuously improve the prognosis of patients with coronary heart disease，and prevent and reduce the occurrence of cardiac adverse events.


Evidence Summary for Arteriovenous Fistula Protection in Maintenance Hemodialysis Patients　

NIE Yulu，SHI Yuexian，HOU Jiaohui，MA Li4

2020, 23(6):  742-746.  DOI: 10.12114/j.issn.1007-9572.2019.00.573

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Background　Arteriovenous fistula is the most common vascular access in maintenance hemodialysis patients.The use time of arteriovenous fistula depends largely on the correct protection.At present，China lacks the best evidence for the maintenance of arteriovenous fistula.Objective　To retrieve and analyze the relevant evidence on protection of arteriovenous fistula in maintenance hemodialysis patients，and to summarize the best evidence.Methods　We performed a systematic search of evidence from computerized databases：British Medical Journal（BMJ） Best Practice，Uptodata，Cochrane Library，Joanna Briggs Institute（JBI） Library，National Institute for Health and Clinical Excellence（NICE），Registered Nurses' Association of Ontario，Canada（RNAO），Scottish Intercollegiate Guidelines Network（SIGN），National Guideline Clearinghouse（NGC），Guideline International Network（GIN），American Center for Disease Control and Prevention（CDC），PubMed and China National Knowledge Infrastructure（CNKI） from October 2017 to September 2018.Results A total of 10 literatures were selected，including one clinical decision support，six clinical practice guidelines，one expert consensus and two systematic reviews.Finally，12 items of best evidence were summarized，which included 10 A-level recommendations and 2 B-level recommendations.The contents covered the 4 aspects：the selection of the time of using arteriovenous fistula，preparation before use arteriovenous fistula，methods of puncture and needle insertion，education and training for patients and nurses.Conclusion　This study summarized the best evidence for protecting arteriovenous fistula in maintenance hemodialysis patients.It is convenient for nurses in hemodialysis room to use and protect the arteriovenous fistula according to the best evidence，and instruct patients to learn how to self-protect the internal arteriovenous fistula，so as to prolong its service life.


Bibliometric Analysis of Deprescribing on Web of Science　

PAN Jianjiang，XU Zhijie，ZHU Yue，FANG Lizheng

2020, 23(6):  747-754.  DOI: 10.12114/j.issn.1007-9572.2019.00.400

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Background　Inappropriate polypharmacy，especially in older people，imposes substantial burden of adverse drug events，illness，disability，hospitalization and even death.Deprescribing is the process of tapering or stopping drugs，aimed at minimizing polypharmacy and improving patient outcomes.Objective　To search and analyze theoriginal researches on deprescribing from 2013 to 2018 in Web of Science，and to explore the literature distribution and research focus.Methods　The retrieval date was October 10，2018.We searched medical subject headings in Web of Science Core Collection Databases，set the date ranged from 2003 to 2018 and the search formula was as follows：subject=（"deprescribing"） OR topic=（"deprescribe"）．Firstly，the retrieved literature were screened according to the inclusion criteria.Then the included literature were analyzed by bibliometric through EndNote 8.0 and the analysis and retrieval tools in Web of Science.Results　A total of 70 original research papers were included in the study.From 2012 to 2014，two articles about deprescribing were published（accounting for 2.9%）．The number of published articles began to increase and 5 articles（accounting for 7.1%） were published in 2015.From January 2016 to October 2018，the number of published articles increased rapidly 〔a total of 63 articles（accounting for 90.0%）〕.BMJ Open and European Journal of Hospital Pharmacy Science and Practice published the largest number of papers（each with 5 papers），and seven SCI journals published three or more papers each.In addition，BMC Medicine had the highest influence factor（IF=9.08）．There were 21 highly cited papers（citation≥7）．The included literature were from 17 countries and regions，among which Canada，Australia and the United States were the three countries with the largest number of publications.The average author cooperation degree of the literature was 5.4，that is，each paper has an average of 5-6 authors.And the average institutional cooperation degree was 3.0，that is，an average of three institutions participated in the research of each paper.The analysis of the occupational distribution of the first authors showed that most of them were clinical pharmacists，public health scholars and general practitioners.And the research disciplines of the included literature were mainly pharmacy and internal medicine，followed by geriatrics.Conclusion　Although research on deprescribing is still at an early stage，it has become a research focus.The number of published literature has increased rapidly since 2016 and Canadian，Australian and American scholars have published the most number of papers.The first authors of published literature were mainly pharmacists，public health researchers and general practitioners.


Quantitative Analysis of Literature Research of General Practitioners in China from 2014 to 2018　

ZHANG Zhaochun，HU Haiyuan，LI Chuangwei，ZHANG Yili

2020, 23(6):  755-760.  DOI: 10.12114/j.issn.1007-9572.2019.00.537

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Background　In recent years，Chinese government attaches great importance to the construction and development of general practitioners，and there are still some problems in the process of its rapid development.By studying the relevant literature of general practitioners in China from 2014 to 2018，we deeply understand the present situation and development trend of general practitioners in China.Objective　To collect and analyze the literature of general practitioners in China from 2014 to 2018，to reveal the present situation and characteristics of general practitioners' research in China，and to provide reference for the related research of general practitioners in China in the future.Methods　In January 8 2019，the literature of general practitioners in China from 2014 to 2018 was searched by CNKI database system.“General practitioners，general physicians or team of general practitioners” were used as search words，and taking the academic literature of related research journals of general practitioners retrieved from the CNKI as the research object.The inductive method，comparative analysis method and bibliometric analysis method were used to sort out and analyze the searched literature.Results　A total of 1 508 articles of general practitioners were published in China from 2014 to 2018，and the number of research documents has increased since 2014.The literature of general practitioners in China was mainly the journal（90.52%）.The subject with the largest number of published literature was medical and health discipline（45.23%）.The main research methods were investigation，description and exploratory methods（46.75%）.Hospitals，colleges and universities and community health service centers were the main forces of general practitioner research in China，and their number of papers accounted for 91.98% of the total literature.The research content mainly involved training，education and training research（46.22%）.Conclusion　China attaches importance to the research and development of general practitioners.The number of literature continues to increase，many of which are research-funded projects，and the related research of general practitioners is in the stage of rapid development.The research of general practitioners in China has not formed a high influence core author group，and the research area is mainly distributed in the eastern coastal economically developed cities，involving a wide range of disciplines，with diverse research methods.“Laws and regulations，service quality evaluation，Internet+，satisfaction research，performance appraisal，salary payment，evaluation index system construction”of general practitioners are the new research directions in the future.