Chinese General Practice

Recommendations guiding compact regional medical consortiums and county-based healthcare networks in the control and prevention of COVID-19 epidemic

Chinese Medical Doctor Association （CMDA）'s General Practitioners Sub-association，Chinese Society of General Practice

2020, 23(8): 889-892. DOI: 10.12114/j.issn.1007-9572.2020.00.309

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Interpretation of 2019 CPS Position Statement：Standards of Diagnostic Assessment for Autism Spectrum Disorder　

LIU Yun，LI Zhibin，XU Kaishou

2020, 23(8): 893-900. DOI: 10.12114/j.issn.1007-9572.2020.00.208

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Autism spectrum disorder （ASD） is a chronic，lifelong neurodevelopmental disorder.Most cases occur in early childhood.With the rising prevalence，ASD has become one of the global public health issues.ASD has serious impacts on lives of children and their families，imposing great economic pressure and heavy spiritual burden on families.Therefore，early detection，and timely diagnosis，as well as early implementation of behavioral intervention and educational intervention，could impact the prognosis of ASD patients and help improve their families' social life.In November 2019，the Canadian Pediatric Socirty （CPS） issued Standards of Diagnostic Assessment for Autism Spectrum Disorder，which is the first ASD diagnosis statement issued by CPS to guiding the community primary healthcare providers.It provides community-based pediatric clinicians with recommendations，tools and resources to perform or assist in the diagnostic evaluation of ASD.This paper interprets this statement and optimizes ASD diagnosis and evaluation strategies，especially to help community pediatric clinicians and primary healthcare providers diagnose ASD as early as possible.

Research Progress and Strategies on Family Intervention of Children with Autism Spectrum Disorder　

ZOU Zhuo，LIU Yun，HUANG Haoyu，LIU Chunming，CAO Xuanlan，ZHANG Yangping

2020, 23(8): 900-907. DOI: 10.12114/j.issn.1007-9572.2019.00.717

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Autism spectrum disorder（ASD）is a group of neurodevelopmental disorders characterized by impaired social interactions，a narrow range of interests and activities，and repetitive and stereotyped behaviors.The incidence of ASD worldwide is about 1%-2%，and it is still increasing year by year.This paper mainly introduces the epidemiological status of ASD and the implementation status of family intervention，and reviews the development status of ASD in China.Previous interventions for children with ASD mainly focused on the recovery of social functions and the increase of social behaviors，and rehabilitation training mainly in rehabilitation institutions，special schools and hospitals.Nowadays，more and more domestic and foreign scholars focused their attention on the parents and families of children with ASD，and gradually realized that the rehabilitation training for children with ASD should not be only limited to institutions，hospitals and special schools，and more rehabilitation treatments should be integrated into the family life.At the same time，the necessity and difficulties of family intervention in China were analyzed，and the thoughts and discussions on family intervention for children with ASD were put forward，so as to enable children with ASD to receive active and relaxing rehabilitation training except the sleep time through family intervention.This paper also focuses on the psychological and emotional state of ASD children's parents and primary caregivers，and points out that medical workers should actively cooperate with relevant psychological，educational and social sectors to design individualized intervention programs to help children with ASD and their parents and families achieve the best possible quality of life.

Application Value of ECG R Wave Pulse Wave Velocity in the Diagnosis of Carotid Atherosclerosis　

ZENG Xianghui，LUO Jianping，LAI Hengli，LI Xiaobo，LIU Weibin

2020, 23(8): 908-912. DOI: 10.12114/j.issn.1007-9572.2019.00.557

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Background　At present，color Doppler ultrasound is the most direct and common method to diagnose atherosclerosis，but its popularization is limited by expensive equipment and technical conditions.Electrocardiogram ( ECG ) R wave-pulse wave velocity ( RWPWV ) can be obtained by ECG monitor, which can reflect the atherosclerosis.The operation is simple and economical.Objective　To investigate the diagnostic value and diagnostic threshold of RWPWV in carotid atherosclerosis.Methods　A total of 1 500 participants who took physical examination were selected by random sampling in Ganzhou Municipal Hospital from July 2016 to December 2018.A total of 986 participants were selected according to inclusion and exclusion criteria.The clinical history of the subjects was collected by interviews with trained personnel using standardized questionnaires.According to the results of color Doppler ultrasound, 675 cases were in the normal group and 311 cases in the carotid atherosclerosis group.The relationship between RWPWV and atherosclerosis was analyzed by binary Logistic regression model.The diagnostic value and diagnostic threshold of RWPWV were calculated by using receiver operating characteristic ( ROC ) curve based on the gold standard of color Doppler ultrasound results.Results　Age, systolic blood pressure ( SBP ), fasting blood sugar, total cholesterol, low density lipoprotein, homocysteine, fatty liver rate and RWPWV in carotid atherosclerosis group were higher than those in normal group ( P<0.05 )．Logistic regression analysis showed that RWPWV was the influencing factor of carotid atherosclerosis〔OR=8.403，95%CI（5.361，13.171），P<0.001〕.The diagnostic value of RWPWV for carotid atherosclerosis by ROC curve analysis showed that when RWPWV truncation value was 4.58 m/s, the sensitivity was 0.698, specificity was 0.637, Youden index was 0.335, area under the maximum ROC curve ( AUC ) was 0.717〔95%CI ( 0.683，0.751 )〕．Compared with the Kappa test ( AUC=0.500 ) , the difference was statistically significant ( P<0.001 )．Conclusion　The increase of RWPWV is a risk factor of carotid atherosclerosis, which has certain diagnostic value for carotid atherosclerosis; the best threshold value of RWPWV for carotid atherosclerosis is 4.58 m/s; RWPWV is a new method for screening carotid atherosclerosis, which is simple, economical and applicable, and worthy of clinical promotion.

Value of Advanced Glycation End-products in Skin Measured Noninvasively in Community-based Screening of Type 2 Diabetes-related Vascular Complications　

XING Meiyan，JIANG Tian，XIA Li，ZHANG Yi，XU Juan，LUO Li，HU Honglin，ZHAO Guangbi，LIU Yong，WANG Yikun，XIA Yingwei，ZHANG Qiu

2020, 23(8): 913-919. DOI: 10.12114/j.issn.1007-9572.2020.00.039

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Background　With the development of living conditions and economy，type 2 diabetes mellitus （T2DM） and T2DM-related chronic complications are increasing year by year.Studies show that advanced glycation end-products（AGEs） in skin are closely associated with diabetes-related vascular complications，but in China there is lack of use of AGEs in skin in large-scale community-based screening of T2DM.Objective　To analyze the value of AGEs in skin measured noninvasively in community-based screening of T2DM-related vascular complications.Methods　From 2 community health centers participating in the medical consortium led by the First Affiliated Hospital of Anhui Medical University after signing a agreement，369 individuals undergoing physical examination during August 2017 to May 2018 were recruited，including 44 with T2DM without complications （pure T2DM group），53 with T2DM and complications （T2DM with complications group），and 272 healthy controls（control group）.Levels of TG，TC，Cr，FBG，HbA1c and AGEs in skin were measured in all participants.Prevalence of lower extremity vascular lesion was determined by ankle brachial index.By the prevalence and severity of peripheral vascular lesion，T2DM patients were stratified into T2DM without peripheral vascular lesion，T2DM with mild and moderate peripheral vascular lesion subgroups.By A/C ratio，T2DM patients were stratified into T2DM without albuminuria，T2DM with microalbuminuria，and macroalbuminuria subgroups.By Neurologic Deficit Score （NDS），T2DM patients were stratified into T2DM with normal neurological function，mild，moderate and severe neurologic deficit subgroups.Results　There was significantly difference in skin AGEs among pure T2DM group，T2DM with complications group and control group （P<0.05）.Specifically，the control group had lower AGEs in skin compared with other two groups （P<0.05）.Compared with pure T2DM group，the level of AGEs in skin was higher in T2DM with complications group （P<0.05）.T2DM patients with complications had higher level of AGEs than those without of the same age group （P<0.05）.The level of skin AGEs increased with the number and severity of T2DM-related complications，such as peripheral vascular lesions，albuminuria，and peripheral neuropathy，and so on （P<0.05）.Multivariate Logistic regression analysis showed that age 〔OR=0.84，95%CI（0.73，0.97）〕 and AGEs in skin〔OR=1.35，95%CI（1.17，1.57）〕 were associated with T2DM with peripheral vascular lesions （P<0.05）.Gender 〔OR=0.14，95%CI（0.03，0.61）〕，FBG 〔OR=1.49，95%CI （1.10，2.02）〕 and AGEs in skin〔OR=1.09，95%CI （1.02，1.16）〕 were associated with T2DM with albuminuria （P<0.05）.Gender 〔OR=0.23，95%CI （0.06，0.86）〕 and HbA1c 〔OR=1.68，95%CI （1.04，2.71）〕 were associated with T2DM with peripheral neuropathy （P<0.05）.The AUC of AGEs in skin in identifying T2DM-related complications was 0.833〔95%CI（0.753，0.914）〕，the optimal cut-off point was 71.5 AU，the sensitivity of diagnosis was 71.7%，and the specificity was 86.4%.Conclusion　AGEs in skin may be used as a predictor of T2DM with peripheral vascular disease and kidney disease，and may be used as a reference for noninvasive measurement of T2DM-related complications in the community.However，the relationship between AGEs in skin and diabetic neuropathy needs to be studied and verified further.

Distribution Characteristics of Pathogenic Bacteria in Different Severity Grades of Recurrent Diabetic Foot Infection　

XIE Shuyong，NIU Min，SHEN Jinfu，LUO Li，ZHANG Qiu

2020, 23(8): 919-922. DOI: 10.12114/j.issn.1007-9572.2019.00.474

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Background　With the application of broad-spectrum antibiotics，the pathogenic bacteria and drug susceptibility spectrum of diabetic foot infections have changed significantly，and studies on the distribution and drug susceptibility of pathogenic bacteria in patients with recurrent diabetic foot infections are rare.Objective　To study the distribution characteristics of pathogenic bacteria in different severity grades of recurrent infection of diabetic foot in patients with diabetes mellitus，and to provide empirical basis for antimicrobial therapy for patients with recurrent infection of diabetic foot.Methods　A total of 52 cases with recurrent diabetic foot infection hospitalized in the Department of Endocrinology，Fuyang People's Hospital from July 2016 to July 2018 were selected.Bacterial culture and drug sensitivity experiments were conducted on their secretions，and the severity of infection was analyzed，and the relationship between the severity of infection and the distribution of pathogenic bacteria was statistically analyzed.Results　Among 52 patients with recurrent diabetic foot infection，there were 19 cases of mild infection，20 cases of moderate infection，and 13 cases of severe infection.Gram-positive coccal infection （14/19） and single infection （17/19） were the main cases of mild infection.Gram-negative bacilli infection （15/28） and mixed infection （6/13） were the main cases of severe infections.A total of 70 pathogenic bacteria strains were cultured from 52 patients with recurrent infection of diabetic foot，including 34 strains（48.6%） of gram-positive cocci，29 strains（41.4%） of gram-negative bacillus，and 7 strains（10.0%） of fungi.Gram-positive cocci，such as staphylococcus aureus，enterococcus faecalis and streptococcus ，were more sensitive to linezolid and vancomycin ，with lower drug resistance，and more serious drug resistance to penicillin and clindamycin.Gram-negative bacteria，such as escherichia coli，proteus and klebsiella pneumoniae，showed low resistance to carbapenems and serious resistance to third-generation cephalosporins.The fungi were more resistant to fluconazole and sensitive to carpofennet and amphotericin B.Conclusion　With the aggravation of recurrent infection of diabetic foot，the infection rate of pathogenic bacteria from Gram-positive cocci decreased，and the infection rate of Gram-negative bacilli increased.The more severe the infection，the higher the chance of having mixed infection.Patients with severe recurrent infection have certain resistance to conventional antibiotics，and the use of antibiotics should be strictly controlled in the clinical treatment of diabetic foot.

Effect of Flexible Fasting on the Improvement of Central Obesity　

LIU Henan，DENG Yingfang，LU Ning，GONG Wenjing，SUN Changqing，ZHANG Chenggang

2020, 23(8): 923-928. DOI: 10.12114/j.issn.1007-9572.2019.00.746

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Background　Significantly improved quality of life and accelerated pace of life have led to a rapid increase in the number of obese people in China.Overweight and obesity are important risk factors for the "big three"（hypertension，hyperlipidemia and diabetes） and other chronic diseases，seriously affecting people's physical and mental health.Therefore，reducing weight may improve people's health and quality of life.Flexible fasting，a weight loss therapy，may significantly reduce the body weight of central obese people，thereby improving obesity-related diseases.Objective　To evaluate the value of flexible fasting in improving obesity and obesity-related symptoms by analyzing the changes in body weight，body mass index（BMI），body circumference，blood pressure and serum homocysteine in central obese people after using this technique.Methods　With the strength of Department of Cardiovascular Diseases，Weihai Maternal and Child Health Hospital，we recruited 32 central obese people who volunteered to participate in the study.After excluding 3 drop-outs，we finally enrolled the remaining 29 cases，and gave them one-week intervention of flexible fasting therapy 〔having a bag of specific prebiotic meal replacement beverage（10 g/bag） for each of the three meals a day〕.We measured their body weight，BMI，body circumference，blood pressure and serum homocysteine before and after the intervention. Results　All participants showed decreased mean body weight 〔（92.2±24.2） kg vs（98.8±25.4） kg〕，BMI 〔（31.3±6.6） kg/m2 vs（33.6±6.6） kg/m2〕，waist circumference 〔（95.9±17.1） cm vs（101.9±18.5） cm〕，upper arm circumference 〔（33.1±3.9） cm vs（35.2±4.3） cm〕，thigh circumference〔（60.8±6.2） cm vs（63.8±6.1） cm〕，chest circumference 〔（104.3±10.8） cm vs（108.7 ± 12.0） cm〕，hip circumference 〔（108.8 ± 9.9） cm vs（113.0 ± 10.4） cm〕，waist-to-hip ratio 〔（0.88 ± 0.08） vs（0.90 ± 0.08）〕，systolic blood pressure 〔（123±16）mm Hg vs （129±19）mm Hg〕，diastolic blood pressure 〔（85±13）mm Hg vs（89±12）mm Hg〕，homocysteine level 〔（9.58±3.38） μmol/ L vs（11.64±3.54） μmol/L〕 compared with before intervention（P<0.05）.Conclusion　Flexible fasting therapy has a certain effect on reducing body weight and waist circumference，and lowering blood pressure，suggesting that it can be used as an adjuvant therapy for improving obesity and obesity-related symptoms.

Efficacy of Montelukast in Treating Symptoms and Recurrent Wheezing after RSV Bronchiolitis in Infants　

WANG Zhiyong，LI Shuqing，QIAN Xiuling

2020, 23(8): 929-934. DOI: 10.12114/j.issn.1007-9572.2019.00.314

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Background　Respiratory syncytial virus（RSV）bronchiolitis is prone to recurrent wheezing，and the concentration of CysLTs in lower respiratory tract secretions is elevated.There are relatively few studies about montelukast，a leukotriene receptor antagonist，in the treatment of symptoms after RSV bronchiolitis.Objective　To explore the effectiveness and safety of montelukast in the treatment of symptoms after RSV bronchiolitis in infants.Methods　Consecutive infant patients with RSV bronchiolitis discharged from Weifang Maternal and Child Health Hospital from June 2015 to June 2017 were enrolled and were randomly divided into treatment group and control group，treated with montelukast oral granules 4 mg，once daily，for 12 weeks，placebo，once daily，for 12 weeks respectively（Ⅰ phase）.Symptom-free days and personal diary about RSV bronchiolitis were evaluated in all infants.Nine-month follow-up（Ⅱ phase）was performed.Number of infants with recurrent wheezing and use of medical resources during Ⅰ + Ⅱphases were analyzed.Data were analyzed by full analysis set（FAS），a classic intention-to-treat analysis.Results　A total of 186 infants were enrolled（92 in the treatment group，and 94 in the control group），179 of them（89 in the treatment group，and 90 in the control group）completed the Ⅰ-phase intervention，and finally 170 completed the interventions in bothⅠ + Ⅱphases（84 in the treatment group，and 86 in the control group）．The average compliance was 97.8%（7 560/7 728）in the treatment group，and 97.4%（7 690/7 896）in the control group，showing no significant difference between the groups（χ2=3.16，P=0.07）．During the study period of Ⅰ phase, there was no significant difference in the number of symptom-free days，symptom-free daytime，symptom-free at night and personal diary about RSV bronchiolitis between the two groups（P>0.05）. During the whole study period（Ⅰ + Ⅱ phases），the number of patients with wheezing after RSV bronchiolitis in the treatment group was less than that in the control group（P<0.05）．In the first nine months of follow-up，the treatment group had lower prevalence rate of recurrent wheezing（χ2=5.14，P=0.02）．The numbers of using medical resources，beta-receptor agonists，and glucocorticoids，and hospitalization during the whole study period in the treatment group was less than that in the control group（P<0.05）．The number of asymptomatic days was significantly different between those with eczema history in the treatment group and those in the control group〔（49.7±20.2）vs（36.3±20.4）〕（t=2.19，P=0.03），and between those with parental asthma history in the treatment group and those in the control group〔（51.3±20.9）vs（37.8±19.3）〕（t=2.24，P=0.03）．During the whole study，no children withdrew from the study because of adverse reactions.There were no significant differences of the rate of gastrointestinal disorders，rash ， elevated transaminase between the two groups（χ2=0.23，P=0.63；χ2=0.03，P=0.86；χ2=0.15，P=0.69）．Conclusion　Although the treatment with montelukast oral granules（4 mg，once daily，for 12 weeks）could not improve the respiratory symptoms after RSV bronchiolitis，it could decrease the recurrence frequency of wheezing.This treatment is safe and effective to some extent.

Genetic Study of Pathogenesis of Graves' Disease　

ZHAO Defa，TENG Weiping，TENG Xiaochun

2020, 23(8): 935-941. DOI: 10.12114/j.issn.1007-9572.2019.00.670

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Background　Graves' Disease（GD） is a common autoimmune disease，but its pathogenesis is not clear.Objective　To find out genes that may related to the pathogenesis of GD by reanalyzing public repository for microarray gene data.Methods　"Graves' Disease" was searched in GEO database and ArrayExpress database，and GSE71956 and E-MEXP-2612 were chosen for further study.The "Limma" package in R language was used to standardize the original data of microarray and to identify the genes with expressions different from those of the normal people.The identified different expression genes were found in CD4 cells in controls compared with those of GD patients（C-GD CD4），in CD8 cells in controls compared with those of GD patients（C-GD CD8），in the thyroid tissue in controls compared with that of patients with short course GD（C-S），in the thyroid tissue in controls compared with that of patients with long course GD（C-L），and in the thyroid tissue in patients with short course GD compared with that of those with long course of GD（S-L）.Then，multiple comparisons and functional annotation analysis of the different expression genes were carried out.Results　Venn diagram showed that KLF9 and RGS1 existed in C-GD CD4，C-GD CD8 and C-L different expression genes simultaneously.Amino acid and steroid metabolism genes may be related to the pathogenesis of GD.FMO2，CALHM6 and C7 exist simultaneously in C-S，C-L and S-L different expression genes.Both long- and short-term GD patients showed higher mean expression level of CALHM6 in thyroid tissue compared with the control group（P<0.05）.The mean expression level of CALHM6 in long-term GD patients was higher than that of short-term GD patients（P<0.05）.Both long- and short-term GD patients demonstrated lower mean expression levels of FMO2 and C7 in thyroid tissue than the control group（P<0.05）.And the mean expression levels of FMO2 and C7 in long-term GD patients were lower than those of short-term GD patients（P<0.05）.Conclusion　The pathogenesis of GD may be related to the abnormal expression of KLF9 and RGS1 and the metabolism of amino acids and steroids.FMO2，CALHM6 and C7 may be related to the course of GD.

A Meta-analysis of Association between Sleep Disturbances and Suicide in Patients with Mental Disorders　

QIN Li，ZHOU Yuqiu，WANG Weiliang

2020, 23(8): 942-948. DOI: 10.12114/j.issn.1007-9572.2020.00.005

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Background　Sleep disturbances are the most prominent and common problem in patients with mental disorders.Some studies have indicated that sleep disturbances may increase the risk of suicide.However，the results of those studies were inconsistent and controversial.Therefore，it is necessary to determine the relationship between sleep disturbances and suicide in patients with mental disorders.Objective　To assess the association between sleep disturbances and suicide in patients with mental disorders by meta-analysis.Methods　PubMed，EMBase，Cochrane Library，Ovid，EBSCO，CNKI，Wanfang Data，VIP and SinoMed were searched for studies about sleep disturbances and suicide in mental disorders patients from inception to April 1，2019.Two researchers independently screened studies according to the inclusion and exclusion criteria，extracted data，and assessed the quality.Meta-analysis was conducted by using Stata 15.1.Results　A total of 21 studies were included，including 17 cross-sectional studies and 4 cohort studies，with a total of 8 118 patients.Meta-analysis showed that sleep disturbances were associated with an increased relative risk of overall suicide either confounding factors were adjusted 〔OR=2.22，95%CI（1.98，2.49），P<0.001〕or not 〔OR=2.17，95%CI（1.92，2.44），P<0.001〕.Subgroup analysis showed that either confounding factors were adjusted or not，general sleep disturbances，nightmares，other sleep problems were associated with an increased relative risk of developing different suicide types（all suicide types，suicidal ideation，attempted suicide，and other types of suicide）（P<0.05），and insomnia was associated with an increased relative risk of all suicide types，suicidal ideation，and attempted suicide（P<0.05）.Meta-analysis showed that after correcting depression symptoms，sleep disturbances were associated with an increased relative risk of overall suicide 〔OR=1.69，95%CI（1.33，2.15），P<0.001〕.Conclusion　Sleep disturbances are associated with suicide in patients with mental disorders.

Comparison of Medium and Long Term Efficacy and Complications of Different Surgical Methods in the Treatment of Female Stress Urinary Incontinence:a Network Meta-analysis　

LIANG Yunxiao，HE Tianji，WEI Erdong，ZHOU Baotong，GE Bo

2020, 23(8): 949-958. DOI: 10.12114/j.issn.1007-9572.2019.00.579

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Background　Female stress urinary incontinence（SUI） is a common urological disease that causes enormous life and financial burden on female patients.SUI patients usually choose surgical treatment when conservative treatment is not ideal.Since Kelly has been used to treat SUI，a variety of new surgical procedures has achieved significant progress in clinical practice.There is still lack of direct or indirect comparison in terms with medium and long-term efficacy and safety between new surgical procedures.Objective　To compare the efficacy and safety of Burch，tension-free vaginal tape（TVT），outside-in transobturator tape（TOT），inside-out tension-free vaginal tape-obturator（TVT-O），tension-free vaginal tape -sling（TVT-S） and adjustable anchored single-incision mini-slings（Ajust） in the treatment of SUI by using network meta-analysis，and screen out the most optimal surgical approach for SUI.Methods　All studies of randomized controlled trials（RCTs） were searched in the PubMed，the Cochrane Library，Medline，EMBase database to compare the efficacy and safety of Burch，TVT，TOT，TVT-O，TVT-S and Ajust from database building to July 2018.Two researchers evaluated the quality of the included RCT and extracted the data，including the first author，publication time，intervention measures，sample size，age，follow-up time and objective cure rate，subjective cure rate，dysuria，vaginal mucosal perforation，lower urinary tract infection，sling exposure，new emergent symptoms after operation/urgent urinary incontinence，thigh pain/inguinal pain after operation.We used RevMan 5.3 software and Stata 14.0 to analyse the data involved.Results　A total of 42 RCTs and 6，065 patients were included.The network meta-analysis showed that the objective cure rate of TOT was lower than that of TVT 〔OR=0.96，95%CI（0.91，1.00），P<0.05〕.Subjective cure rate of Ajust was higher than Burch，TOT，TVT-O，TVT-S〔OR=1.27，95%CI（1.01，1.61）；OR=1.14，95%CI（1.01，1.27）；OR=1.05，95%CI（1.00，1.10）；OR=1.12，95%CI（1.04，1.22），P<0.05〕，and subjective cure rate of TOT was lower than that of TVT 〔OR=0.93，95%CI（0.86，1.00），P<0.05〕.Dysuria incidence of TVT-O was lower than that of TVT 〔OR=0.57，95%CI（ 0.34，0.95），P<0.05〕.The incidence of vaginal epithelial perforation in TOT was higher than that in TVT 〔OR=4.17，95%CI（1.37，12.74），P<0.05〕，and incidence of vaginal epithelial perforation in TVT-O was lower than that in TOT 〔OR=0.20，95 %CI（0.06，0.66），P<0.05〕.The incidence of urinary tract infection in TOT was lower than that in TVT〔OR=0.62，95%CI（0.42，0.91），P<0.05〕.The incidence of groin or thigh pain in TVT-O was higher than that in Burch 〔OR=12.89，95%CI（1.22，135.66），P<0.05〕；incidence of groin or thigh pain in TOT and TVT-O was higher than that in TVT 〔OR=2.37，95%CI（1.00，5.58）；OR=3.07，95%CI（1.50，6.27），P<0.05〕；incidence of groin or thigh pain in TVT-S and Ajust was lower than that in TVT-O 〔OR=0.25，95%CI（0.10，0.63）；OR=0.18，95%CI（0.04，0.84），P<0.05〕.The surface under the cumulative ranking curves（SUCRA） value ranking results showed that TVT had better objective cure rate，sling exposure and fewer new emergent symptoms/urgent urinary incontinence after operation；Ajust had significantly better subjective cure rate，fewer dysuria and vaginal perforation；TOT had a better superiority in urinary tract infection；Burch had a better superiority in groin or thigh pain.Conclusion　Ajust is probably associated with better efficacy and safety in the medium and long term study of SUI treatment.

The Medical Professionalism Study in America and Its Enlightment to China　

HE Feiying，LIAO Shengwu

2020, 23(8): 959-963. DOI: 10.12114/j.issn.1007-9572.2019.00.653

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The medical professionalism has received more and more attention by all walks of life because of the tension between doctors and patients.Medical professionalism study in Europe and the USA started earlier and rich results have been received in the field of its meaning，measurement，empirical methods and educational studies.This paper summarizes the status of medical professionalism in America，and refines the corresponding enlightenment to China from four aspects，government，industry，hospitals and doctors，respectively.

Job Satisfaction and Influencing Factors in the First Batch of Community Health Workers Delivered Pilot Family Doctor Services in Guangdong Province　

ZHENG Chanjiao，CHEN Baoxin，HUANG Zhijie，SHEN Huanyu，OU Weilin，ZHANG Dongying，WANG Jiaji，ZHOU Zhiheng

2020, 23(8): 964-968. DOI: 10.12114/j.issn.1007-9572.2020.00.035

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Background　Family doctor teams in primary care safeguard residents' health in a warm way.However，due to insufficient medical construction and other constraints in primary care，it is necessary to find ways to maintain the safeguard.We explored job satisfaction and influencing factors in the first batch of community health workers delivered pilot family doctor services in Guangdong Province，providing a reference for optimizing the delivery of such services.Objective　To investigate job satisfaction and influencing factors in the first batch of community healthcare workers delivered pilot family doctor services in Guangdong Province，offering a basis for the construction of primary healthcare workforce.Methods　From June 2014 to June 2016，a survey was conducted in 3 types of number-matched health workers，managers，health professionals and other workers selected from 36 community health centers delivered pilot family doctor services by stratified sampling using a self-developed questionnaire for collecting demographic data，overall job satisfaction and satisfaction with 21 job-related factors.The job satisfaction and influencing factors were analyzed.Results　Of the 275 cases participating in the survey，251（91.3%） responded effectively，among whom 217（86.5%） were satisfied or very satisfied with the job.The overall job satisfaction score was（3.8±0.7）.Among 21 job-related factors，"colleague relationship" was scored highest〔with an average satisfaction score of （4.1±0.5）〕，and "unit welfare" was scored lowest〔with an average satisfaction score of （2.8±1.1）〕.Age was associated with the significant difference in the satisfaction with "relationship with leaders"（P<0.05）.Education level was associated with the significant differences in the satisfaction with "workload"（P<0.05）.Professional title was associated with the significant difference in the satisfaction with "help from colleagues"（P<0.05）.Multivariate Logistic regression analysis showed that the number and reasonable allocation of workers〔OR=2.118，95% CI （1.072，4.184）〕，personal ability improvement 〔OR=2.220，95%CI （1.181，4.173）〕，unit supervisory management system 〔OR=1.905，95%CI （1.023，3.546）〕，relationship with leaders 〔OR=4.640，95%CI （1.328，16.214）〕 and colleagues relationship 〔OR=5.111，95%CI （1.330，19.644）〕 were the factors affecting overall job satisfaction （P<0.05）.Conclusion　Family doctor based community health technicians are satisfied with their job.The number of workers and the reasonable allocation，personal ability improvement，unit supervisory management system，relationship with leaders and colleagues relationship are the factors affecting overall job satisfaction.

Analysis of the Utilization of Medical Resources in Different Treatments of Acute ST-Segment Elevation Myocardial Infarction Inpatients　

CHEN Aiming，TIAN Lin，QIU Hengjia

2020, 23(8): 969-973. DOI: 10.12114/j.issn.1007-9572.2019.00.329

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Background　In 2012，the World Health Organization announced that ischemic heart disease was the leading cause of death worldwide.In addition，it is also one of the most common causes of death in China.Acute ST-segment elevation myocardial infarction（STEMI） is one of the most common types of ischemic heart disease.Its treatment methods include traditional drug therapy and interventional therapy.However，the quantification of medical resources utilized for both therapy methods has not been elucidated，to some extent，which limits the effective allocation of medical resources.Objective　To investigate the utilization of medical resources of traditional drug therapy and interventional therapy in hospitalized patients with acute STEMI and the related influencing factors.Methods　Patients with acute STEMI admitted for traditional drug therapy or interventional therapy in the Fifth Affiliated Hospital of Sun Yat-Sen University from 10 October，2014 to 31 December，2016 were enrolled by retrospective analysis.The demographic information，disease and treatment characteristics of patients were captured.As traditional drug therapy and interventional therapy were the main predictors，the hospitalization days and the total hospitalization expenses were used as indicators to evaluate the utilization of medical resources and the main influencing factors were analyzed by multivariate linear regression.Results　A total of 315 patients were enrolled，including 67（21.3%） patients in traditional drug therapy group and 248（78.7%） patients in interventional therapy group.There were significant differences between the two groups in age，infarct site，Killip grade，time distribution of SO-to-FMC，admission form，death，CCU or ICU occupancy，total hospitalization expenses，and western charges（P<0.05）．The multifactor linear regression results showed that females（β=4.03），the 50-59 years old（β=3.71），and interventional therapy（β=3.63） were the influencing factors of the increase of length of stay（P<0.05）．Clinical pathway（β=-3.18） and death（β=-4.87） were the influencing factors of the decrease of length of stay（P<0.05）．The 50-59 years old（β=12 483.39），medical insurance（β=7 769.88），interventional therapy（β=36 703.60），and stayed in CCU or ICU before（β=13 539.14） were the influencing factors for the increase of hospitalization expenses，while death（β=-13 347.59） was the influencing factor of the decrease of hospitalization expenses（P<0.05）．Conclusion　The interventional therapy utilizes more medical resources than the traditional drug therapy.Female，the 50-59 years old，and interventional therapy are all correlated to an increased length of stay，while the implementation of clinical pathway can shorten the length of stay.The 50-59 years old，medical insurance and interventional therapy are main influencing factors of the increasing total hospitalization expenses.

Hypertonic Glucose Versus Lauromacrogol with Cyanoacrylate Sandwich Therapy for Gastroesophageal Variceal Hemorrhage：a Cost-effectiveness Analysis　

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

2020, 23(8): 974-979. DOI: 10.12114/j.issn.1007-9572.2019.00.330

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Background　Gastroesophageal variceal hemorrhage is a most serious complication of hepatic cirrhosis，a chronic and diffuse liver disease.Endoscopic ligation and cyanoacrylate injection are used as the key treatments.To achieve better effectiveness of cyanoacrylate injection，sandwich therapy of cyanoacrylate in combination with hypertonic glucose（hypertonic glucose-cyanoacrylate-hypertonic glucose，HCH） or lauromacrogol（lauromacrogol-cyanoacrylate-lauromacrogol，LCL） are often used.Objective　To perform a cost-effectiveness analysis of HCH versus LCL sandwich therapy in the treatment of gastroesophageal variceal hemorrhage.Methods　A total of 164 patients with gastroesophageal variceal hemorrhage were recruited from Southern Medical University Affiliated Pingxiang Hospital from July 2013 to July 2017 and were randominzed into HCH group（n=70） and LCL group（n=94），treated with HCH，LCL sandwich therapy，respectively.Improvement in hemostasis rate，rebleeding rate and varices between the groups were compared.According to the numbers and diameter，the gastric varices were assigned into 2 groups：number×diameter < 2 （ones ? cm） group （36 cases in HCH group and 49 cases in LCL group）；number×diameter ≥ 2 （ones ? cm） group （34 cases in HCH group and 45 cases in LCL group）．The cost and cost-effectiveness ratios of the 2 groups，treatment-related complications and adverse reactions were analyzed.Results　The immediate hemostasis ratios of both groups were 100.0%.There were no significant differences between the hemostasis ratios at 1 week，1 month，and 2 months after treatment between the 2 groups （P>0.05）．There were no significant differences between the rebleeding ratios at 3 months，6 months，and 1 year after treatment between the 2 groups （P>0.05）．There were no significant difference between the improvement ratios of the varicose veins at 1，3，and 6 months after treatment between the 2 groups （P>0.05）．For the treatment of gastric varices with diameter < 2（number×diameter，ones ? cm），there were no significances between the groups in terms of injection times，the injection points，the total amount of cyanoacrylate，cost，immediate cost-effectiveness ratio，1-week hemostasis rate，1-week cost-effectiveness ratio，1-month hemostasis rate，1-month cost-effectiveness ratio，2-month hemostasis ratio and 2-month cost-effectiveness ratio （P>0.05）；for treating gastric varices with diameter ≥ 2（number×diameter，ones ? cm），LCL group showed less injection times，injection points，total cyanoacrylate，cost，immediate cost-effectiveness ratio，1-week cost-effectiveness ratio，1-month cost-effectiveness ratio and 2-month cost-effectiveness ratio （P<0.05）．There were no significant differences between the incidence rates of postoperative fever，and chest and abdomen pain between the 2 groups （P>0.05）．The incidence rates of local ulcer and ectopic embolism in LCL group were lower than those of the HCH group （P<0.05）．Conclusion　Both therapies are efficient for gastroesophageal variceal hemorrhage，and can achieve similar effectiveness.Cost-effectiveness anlaysis of the treatment by number×diameter < 2 （ones ? cm） of gastric varices shows that both therapies have similar cost and effectiveness，and either of them can be selected.Further anlaysis of the treatment by the number×diameter ≥ 2 （ones ? cm） of gastric varices indicates that both of them have nearly equal effectiveness，but LCL sandwich therapy has lower cost and fewer adverse reactions，suggesting that LCL sandwich therapy is better.

The Economic Evaluation of Antibiotics in the Treatment of Pulmonary Infection with Acinetobacter Baumannii Based on Decision Tree Model　

SHI Falin，DING Lili，YAO Xinbao，WANG Chunxiang，LEI Jun，HE Wenying

2020, 23(8): 980-984. DOI: 10.12114/j.issn.1007-9572.2019.00.466

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Background　With the rapid development of medical standards，under the premise of ensuring the safety and effectiveness of medication，reducing medical costs as much as possible has become an urgent problem for medical institutions.Therefore，using the principles of pharmacoeconomics to evaluate the costs and corresponding effects of drug treatment as well as the relationship between them has important guiding significance for the selection and formulation of optimal drug regimens.Objective　To carry out the pharmacoeconomic evaluation of cefoperazone/sulbactam and piperacillin/tazobactam in the treatment of pulmonary infection with Acinetobacter Baumannii in order to provide a reference for clinical rational drug use.Methods　A retrospective investigation of 288 patients of pulmonary infection with Acinetobacter Baumannii in the First Affiliated Hospital，School of Medicine，Shihezi University was carried out from 2015 to 2017.According to the antibacterial treatment regime，the cefoperazone/sulbactam group（group A） had 153 patients and the piperacillin/tazobactam group （group B） had 135 patients.The therapeutic effects of the two groups were compared and a decision tree model was constructed for cost-effectiveness analysis.Results　There were no significant differences in white blood cell count （WBC），C-reactive protein （CRP） and procalcitonin （PCT） between the two groups before and after treatment （P>0.05）．The levels of WBC，CRP and PCT in the two groups after treatment were lower than those before treatment （P<0.05）．There were no significant differences in the time for body temperature returned to normal，improvement time for cough and expectoration，and improvement time for chest tightness and shortness of breath between the two groups （P>0.05）．There was no significant difference in the incidence of adverse reactions between the two groups 〔2.0%（3/153）vs 2.2%（3/135），χ2=0.07，P=0.80〕.There was no significant difference in the effective rates of drugs between the two groups 〔group A=83.7%（128/153），group B=82.2%（111/135），χ2=0.11，P=0.75〕.The expected costs of the two groups were 487 564 yuan and 438 737 yuan，and the cost-effectiveness ratio was 5 825 and 5 337.The cost of cefoperazone/sulbactam for each unit of clinical effect was 32 551 yuan more than piperacillin/tazobactam.Conclusion　There is no difference in the efficacy and incidence of adverse reactions of cefoperazone/sulbactam and piperacillin/tazobactam in the treatment of pulmonary infection with Acinetobacter Baumannii，but piperacillin/tazobactam has economic advantages.

Fever，Variable Rashes，and Gastrointestinal Hemorrhage：a Case Analysis　

SHU Jing，HE Qiang，CHEN Fang，MO Xin

2020, 23(8): 985-988. DOI: 10.12114/j.issn.1007-9572.2019.00.463

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Behcet's disease is a systemic disease involving multiple systems and organs.The basic pathological manifestations are vasculitis mediated by the immune complex，which can involve any size and types of blood vessels with diverse and complicated clinical manifestations.The disease is characterized by an alternating process of repeated attacks and remission，while the laboratory results are non-specific and its early diagnosis is extremely difficult.Early clinical symptoms of Behcet's disease in children are atypical and heterogeneous，and the disease can progress rapidly in a short period of time.In this study，we retrospectively analyzed the evolution of a case of Behcet's disease and the process of its diagnosis and treatment，and reviewed the relevant literature，so that clinicians can further understand the disease and diagnose it correctly as soon as possible，so as to carry out early disease management and prevent critical illness.

Interstitial Pneumonia Caused by Cladribine in the Treatment of Classic Hairy Cell Leukemia：a Case Report and Literature Review　

FU Leihua，GE Guoxing，FU Jiaping，ZHANG Zhijian，HONG Pan，FENG Weiying

2020, 23(8): 989-992. DOI: 10.12114/j.issn.1007-9572.2019.00.584

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Hairy cell leukemia（HCL） is a rare B-cell chronic lymphoproliferative disorder characterised by splenomegaly，pancytopenia and bone marrow involvement with fibrosis.Cladribine，as the first-line treatment for HCL，obtains a high complete remission rate.We reported herein a patient with classic HCL admitted by Shaoxing People's Hospital on September 4, 2017 who had received Cladribine treatment，underwent agranulocytosis with fever and complicated with systemic rash and interstitial pneumonia，and finally recovered after the administration of high dose of glucocorticoids.The diagnosis and treatment of HCL were reviewed with literatures retrospectively，and we summarized and analyzed the rare complication of interstitial pneumonia after Cladribine treatment，in order to improve clinicians' understanding of the adverse reaction and provide reference for clinical work.
Hairy cell leukemia；Cladribine；Interstitial pneumonia；Case report

Advances in Geriatric Syndrome and the Application of Comprehensive Geriatric Assessment　

LI Huifang，YANG Guirong，YANG Changchun

2020, 23(8): 993-998. DOI: 10.12114/j.issn.1007-9572.2019.00.716

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Geriatric syndrome is a worldwide health problem in the elderly.This paper introduces the important method and screening of geriatric syndrome - comprehensive geriatric assessment，which expounds the concept，characteristics，evaluation object and timing，details and purpose of the comprehensive evaluation.This paper briefly introduces the comprehensive evaluation tools for the elderly at home and abroad，points out their application value and significance，and puts forward that the comprehensive geriatric assessment can protect and maintain the function of the patients with geriatric syndrome to the greatest extent.It is necessary to develop comprehensive assessment tools suitable for the elderly considering the actual situation of our country to carry out effective and continuous management of the elderly in order to actively deal with the aging problem in China.

Recent Advances in Correlation Studies of RDW and Acute Pancreatitis　

WANG Wenmei，ZHANG Jingli，ZHANG Hairong

2020, 23(8): 998-1002. DOI: 10.12114/j.issn.1007-9572.2019.00.179

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Acute pancreatitis（AP） is a common emergency in gastroenterology whose incidence is rising year by year.Severe AP（SAP） has been reported to have a mortality as high as 30% to 50%，seriously affecting the quality of life of the patients.Therefore，early identification of SAP is crucial to improve prognosis through a timely and effective treatment.Increasing evidence show that red cell distribution width（RDW） has a certain correlation with AP，which can be used as a predictor of severity and prognosis of AP.The article reviews recent advances in the correlation between RDW and AP.

Research Progress on Biomarkers in Early Diagnosis of Pediatric Cerebral Palsy

WANG Jing，LIU Yun，DENG Xiaoli，ZHANG Yangping

2020, 23(8): 1003-1008. DOI: 10.12114/j.issn.1007-9572.2019.00.513

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Pediatric cerebral palsy is a non-progressive brain injury syndrome，which generally occurs in the brain development stage from prenatal period to postnatal period and presents a group of syndromes mainly involving postural and motor dysfunction.Cerebral palsy is characterized by high morbidity，mortality and disability rate.It has become an urgent child health problem which seriously threatens the growth and development of children with a huge burden to families and society and needs to be solved in recent years.Therefore，the early identification and diagnosis of pediatric cerebral palsy plays an important role in its early rehabilitation intervention and effect and the reduction of disability in children with cerebral palsy.This paper reviews the research progress of biomarkers related to the early diagnosis of pediatric cerebral palsy in order to provide a reference for the early diagnosis of cerebral palsy in children.

Research Progress on Sleep Physiology and Sleep Disorders During Pregnancy　

BAI Lijuan，WU Jianjie，ZHANG Yutao，WU Kewen

2020, 23(8): 1008-1016. DOI: 10.12114/j.issn.1007-9572.2019.00.139

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Sleep and pregnancy is a dynamic process with unique physiological basis，and sleep problems are very common during pregnancy.The existing hypothesis regards sleep as a metabolic process that is important for cell and tissue regeneration.This review introduced the physiological basis of sleep changes during pregnancy，and summarized the epidemiology，diagnosis and treatment of obstructive sleep apnea（OSA）and restless leg syndrome（RLS）caused by changes in physiological basis in order to help doctors better understand the sleep problems during pregnancy.

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