Chinese General Practice

Research Progress on Prognosis Assessment of Community-acquired Pneumonia　

WANG Lina，JIANG Chunyan

2020, 23(14): 1711-1716. DOI: 10.12114/j.issn.1007-9572.2019.00.367

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Community-acquired pneumonia（CAP）is one of the major challenges faced by clinicians.CAP severity grading is the basis for patients to choose appropriate treatment sites and reasonable antibiotic treatment，so it is of great significance to identify and assess comprehensively the severity of CAP at an early stage.Early assessment and active intervention of high-risk patients requiring hospitalization or admission to the intensive care unit（ICU） using clinical scoring systems and/or biomarkers can improve the survival and achieve more effective allocation of medical resources.This article reviews the recent progress in the evaluation of different scoring systems and biomarkers in the prognosis of patients with CAP.

Recent Developments in Research on Anemia and Microvascular Complications in Patients with Type 2 Diabetes Mellitus　

WANG Min，BAN Bo，ZHANG Mei，JI Baolan，SUN Bing

2020, 23(14): 1717-1721. DOI: 10.12114/j.issn.1007-9572.2019.00.560

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Anemia is a common finding in patients with type 2 diabetes mellitus（T2DM）．Many studies have indicated that anemia is a risk factor for diabetic nephropathy and diabetic retinopathy and other diabetes-related microvascular complications.It may be involved in the development and progression of such complications by inducing hypoxia，oxidative stress，and endothelial dysfunction.The article mainly evaluates the pathogenic relationship between anemia and diabetic microvascular diseases，and studies the feasibility of improving the prognosis of microvascular diseases in T2DM patients by treating anemia.
Type 2 diabetes mellitus；Mictovessels；Microvascular complication；Anemia；Review

Research Progress on the Comparison of Lipid Management Mechanism between Atorvastatin and Pitvastatin　

KANG Chenyu，WANG Yixin，FENG Yan，LIU Junmei

2020, 23(14): 1722-1728. DOI: 10.12114/j.issn.1007-9572.2019.00.555

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Dyslipidemia，especially abnormal levels of cholesterol and/or triglycerides（TG），has become an independent risk factor of atherosclerosis and occurrence and development of coronary heart disease.Chinese guidelines for the prevention and treatment of blood lipid insist that lowering the level of low density lipoprotein cholesterol（LDL-C） is the primary intervention target for preventing atherosclerotic cardiovascular disease（ASCVD） and non-high density lipoprotei cholesterol（non-HDL-C） is the secondary intervention target.At present，the preferred drug for lipid regulation in clinical practice is statins，which may differ due to their different structural characteristics and metabolic mechanisms.This paper focused on the chemical structure，dosage，bioavailability，enzyme binding properties，tissue penetration and t1/2，metabolism，elimination，effectiveness and cholesterol regulation（mainly LDL-C），triglycerides and HDL-C mechanism to compare the similarities and differences between atorvastatin and pitavastatin，providing theoretical basis for clinical individualized medication.

Effects of Family Doctor Team Service Model on Fall Prevention among Stroke Patients in Community　

YANG Chunqin，BO Haiyan

2020, 23(14): 1729-1733. DOI: 10.12114/j.issn.1007-9572.2019.00.564

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Background　According to the literature，47% of stroke patients in community have fallen more than once.Falling is considered as a serious complication of cerebrovascular diseases.Therefore，it is urgent to strengthen the fall prevention management of stroke patients in community.Objective　To explore the effects of family doctor team service model on fall prevention of stroke patients in community.Methods　A total of 163 stroke patients registered in Pengpu Xincun Community Health Service Center in Jingan District of Shanghai from January to December 2016 were selected and treated under family doctor team service model for one year.Family doctor team service model was used to intervene in preventing falls among stroke patients and caregivers at home.The cognitive level of fall prevention，scores of fall risk assessment and the incidence of falls among stroke patients and caregivers in 2016 and 2017 were compared at the first-time，six，and 12 months of follow-up.Results　At the first-time，six and 12 months of follow-up，there were significant differences in the cognitive level of fall prevention and scores of fall risk assessment among patients and caregivers（P<0.001）．At six and 12 months，the cognitive level of fall prevention and scores of fall risk assessment among patients and family caregivers were higher than those at first-time follow-up；the cognitive level of fall prevention and scores of fall risk assessment among patients and family caregivers at 12 months were higher than those at six months（P<0.05）．The incidence of falls was 14.9%（24/161） in 2017，which was significantly lower than 32.5%（53/163） in 2016（χ2=13.86，P<0.01）．Conclusion　Family doctor team service model can effectively control the risk factors of falls among community stroke patients，improve the awareness of fall prevention among patients and family caregivers，and reduce the incidence of falls.

Fear of Falling and Self-rated Health among Elderly in Communities　

SUN Yuan，FAN Jie

2020, 23(14): 1733-1739. DOI: 10.12114/j.issn.1007-9572.2019.00.561

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Background　Fear of falling in the elderly is a very common phenomenon，resulting in limited limb function，declining quality of life，increased risk of falls，and increased medical and economic burden.Self-rated health is an important indicator to reflect a person's health status and it is related with mortality.It is simple and easy to use，and can be used for rapid screening and evaluation.Lots of research on the relationship between self-rated health with diseases have been done in developed countries，but few in China.Objective　To investigate the prevalence of fear of falling in a community-based elderly population and explore the relationship between falling and self-assessment life quality in current study.Methods　Using cross section design，the elderly（age≥60 years old） at Niujie Community Health Service Station of Xicheng District，Beijing were selected from March to May 2017，and the data were collected by face-to-face questionnaire survey.The incidence of falls and fear of falls over the past year were investigated.The World Health Organization quality of Life scale（WHOQOL），was used to self-evaluate the overall quality of life，health status satisfaction，sleep satisfaction，daily living ability satisfaction，self-satisfaction，interpersonal relationship satisfaction，friend support satisfaction，place of residence satisfaction，health care satisfaction，traffic satisfaction and negative emotion.Results　A total of 410 questionnaires were sent out，2 people refused to respond and 408 valid questionnaires were collected.Among 408 elderly people in the community，267（65.4%） had fall fear，151（37.0%） had fall in the past year，and among whom 131（86.8%） had fall fear.The incidence of fall fear among elderly who was negative on the overall quality of life，health status，sleep status，ability of daily living，self-satisfaction，interpersonal relationships，friend support，place of residence，health care，traffic self-assessment and self-rated as frequent occurrence of fall was higher than that of contented elderly and patients with occasional occurrence of fall（P<0.05）．The results of multivariate Logistic regression analysis showed that the overall quality of life，health status，sleep status，ability of daily living，self-satisfaction，interpersonal relationship，friend support，place of residence，health care and traffic status were risk factors of fall fear in the elderly（P<0.05），and the occasional occurrence of negative emotional self-evaluation was the protective factor of falls in the elderly（P<0.05）．Conclusion　Fall fear is related to health-related self-evaluation，which is helpful to screen people at high risk of fall fear in order to take corresponding intervention measures to reduce the fear of fall in the elderly and promote the construction of a healthy aging society.

Investigation of Adverse Psychological Status of Patients with Lumbar Disc Herniation before Microinvasive Surgery and Its Effects on Prognosis　

LU Qilin，ZHU Yiliang，LI Xugui，XIE Wei，CAI Xianhua，WU Haiyang

2020, 23(14): 1740-1746. DOI: 10.12114/j.issn.1007-9572.2019.00.645

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Background　Percutaneous transforaminal endoscopic spine surgery has gradually become one of the common surgical procedures for the treatment of lumbar disc herniation（LDH）．However，few studies have been conducted to analyze the incidence of adverse psychological state before surgery in patients with LDH and its effects on prognosis.Objective　To investigate the status of anxiety and depression before microinvasive surgery in patients with LDH and analyze its effects on prognosis.Methods　A total of 140 patients with LDH were enrolled in the Department of Orthopedic Surgery of Central Theater Command General Hospital of the Chinese People's Liberation Army from August 2017 to June 2018.The Self-rating Anxiety Scale（SAS） and the Self-rating Depression Scale（SDS） were used to evaluate the anxiety and depression status of patients before surgery.And patients were divided into anxiety group，non-anxiety group，depression group and non-depression according to the scores.All patients underwent percutaneous transforaminal endoscopic spine surgery and were followed up regularly by telephone appointment.The follow-up deadline was January 2019.The scores of SAS，SDS，and Visual Analogue Scale（VAS） and lumbar spine function scores by Japanese Orthopedic Association（JOA） were compared before and after surgery.The effects of preoperative anxiety and depression on postoperative outcomes were analyzed by the modified MacNab evaluation criteria at the last follow-up.Results　A total of 132 patients were included in the final study，including 51（38.6%） patients in the anxiety group，of which patients with mild，moderate and severe anxiety accounted for 15.9%（21/132），17.4%（23/132） and 5.3%（7/132），respectively，31（23.5%） patients in the depression group，of which patients with mild，moderate and severe depression accounted for 12.1%（16/132），9.1%（12/132），and 2.3%（3/132），respectively.Pearson correlation analysis showed that the preoperative JOA scores were negatively correlated with SAS and SDS scores（P<0.001）．The preoperative VAS scores were positively correlated with SAS and SDS scores（P<0.05）．Compared with preoperative scores，the SAS score was significantly lower in the anxiety group at the last follow-up（P<0.001），and the SDS score was significantly lower in the depression group at the last follow-up（P<0.001）．The VAS scores of the anxiety group and non-anxiety group were lower and the JOA scores were higher at the last follow-up than those before surgery（P<0.05）．The improvement of VAS and JOA scores in non-anxiety group and non-depression group was significantly greater than those in anxiety group and depression group（P<0.05）．The VAS scores of the depression group and non-depression group were lower and the JOA scores were higher at the last follow-up than those before surgery than those before surgery（P<0.05）．At the last follow-up，the excellent rate in the non-depression group was significantly higher than that in the depression group〔93.1%（91/101） vs 74.2%（23/31）〕，and the difference was statistically significant（P=0.004）．While there was no significant difference of excellent rate between the non-anxiety group〔90.1%（73/81）〕 and the anxiety group〔86.3%（44/51）〕（P=0.497）．Conclusion　Some patients with LDH have anxiety and depression before surgery and these adverse psychological states can be significantly improved after percutaneous transforaminal endoscopic spine surgery.However，preoperative anxiety and depression may adversely affect the clinical efficacy，especially in combination with depression.Therefore，it is recommended that the abnormal psychological state should be routinely investigated before surgery and psychological intervention should be carried out for such patients.

Value of Cauda Equina Nerve Root Sedimentation Sign in the Diagnosis of Diffrent Kinds of Lumbar Spinal Stenosis　

Asihati?Nuermaimaiti，YANG Yi，Nuerhanati?Shayilanbieke，Hali?Habulihan，JIN Gele

2020, 23(14): 1747-1752. DOI: 10.12114/j.issn.1007-9572.2020.00.139

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Background　Lumbar spinal stenosis（LSS） is a common lumbar spineal degenerative disease with no significant objective signs that is difficult to diagnose.Although many scholars put forward that cauda equina nerve root sedimentation sign（SedS） has no significant value in diagnosing LSS，SedS has been found to be more common in central LSS，and its prevalence is positively associated with the degree of stenosis.However，there are no studies involving the prevalence of SedS in different types and responsible segments of LSS.Objective　To discuss the diagnostic and therapeutic value of SedS in LSS by observing and analyzing its prevalence in different types and responsible segments of LSS.Methods　From 264 cases of LSS receiving treatment in Orthopedic Center，Rehabilitation Department，Acupuncture and Massage Department，the First Affiliated Hospital of Xinjiang Medical University during 2016 to 2017，58 cases were enrolled.A comparative retrospective analysis was performed on their medical records and imaging information between those with SedS in segment of LSS and those without，including sex ratio，mean age，Visual Analogue Score（VAS），Oswestry Dysfunction Index（ODI），body mass index（BMI），duration of low back pain，duration of lower limb pain，and surgical treatment rate.The prevalence of SedS in three types of LSS was analyzed.Inter-observer consistency and repeatability in the assessment of accuracy of SedS in identifying LSS were calculated.Results　There were 133 stenosis segments in the 58 patients，including 61（45.9%） central stenosis segments，34（25.5%） lateral stenosis segments，and 38（28.6%） mixed stenosis segments.The prevalence of SedS in central，lateral and mixed segments was 91.8%（56/61），41.2%（14/34） and 97.4%（37/38），respectively.The prevalence of SedS in responsible segments was 91.9%（34/37），60.0%（6/10） and 96.2%（25/26） in central，lateral and mixed stenosis，respectively.The consistent Kappa value of SedS in diagnosing LSS was 0.84，and the repeatable Kappa value was 0.87.Conclusion　The prevalence rate of SedS is higher in patients with long course of disease，and is higher in central and mixed spinal stenosis segments，and in responsible segments in central and mixed spinal stenosis rather than in the lateral type.SedS had high sensitivity，good consistency and repeatability in the diagnosis of the central and mixed types.

Value of Bacteria Culture of Renal Pelvis Urine and Calculi and Drug Sensitivity Test in the Prevention of Urosepsis after Percutaneous Nephrolithotomy　

CHEN Zhongjun，ZHOU Jiajie，SHEN Hao

2020, 23(14): 1753-1759. DOI: 10.12114/j.issn.1007-9572.2019.00.647

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Background　Percutaneous nephrolithotomy（PCNL） is the main method for the treatment of upper urinary calculi，and urinary infection caused by this operation is the most common postoperative complication.In recent years，the drug resistance rate of bacteria has increased year by year，and unreasonable use of drugs after surgery is common.Therefore，how to reduce the incidence of postoperative urinary sepsis，and rational and effective use of antibiotics have important clinical significance.Objective　To explore the value of bacteria culture and drug sensitivity analysis of renal pelvis urine and calculi in the prevention of urosepsis after PCNL.Methods　A total of 940 patients who were carried out PCNL in Jingzhou Central Hospital were collected for the results of bacterial culture and drug sensitivity test of preoperative midstream urine，intraoperative renal pelvis urine and calculi，and the bacterial species distribution and drug susceptibility test results of the three samples were analyzed from October 2016 to October 2018.According to the drug sensitivity test results of renal pelvis urine and calculi，three non-carbapenems antibiotics with the highest sensitivity were selected.A total of 100 patients with upper urinary calculi with escherichia coli or klebsiella pneumoniae who underwent PCNL surgery in Jingzhou Central Hospital from October 2018 to December 2018 were collected.According to whether antibiotics sensitive to bacteria in renal pelvis urine and calculi were used intraoperatively or postoperatively，the patients were divided into control group and experimental group with 50 patients in each group.The patients in control group were treated with sensitive non-carbapenem antibiotics indicated by mid-stage urine culture and drug sensitivity before and after operation，and the patients in experimental group treated with sensitive antibiotics by midstream urine culture + drug sensitivity test in preoperative period，and non-carbapenems antibiotics sensitive to renal pelvis urine and calculi culture in intraoperative/postoperative period.The incidence of urosepsis after one week of PCNL was observed in the two groups.Results　Among 940 patients，171 cases had positive culture result in the preoperative midstream urine，210 cases had positive culture result in the intraoperative renal pelvis urine，and 182 cases had positive culture result in the intraoperative calculi.Escherichia coli and klebsiella pneumoniae were the main bacterial species cultured from midstream urine，renal pelvis urine and calculi.Among the drug sensitivity test results of escherichia coli cultured in preoperative midstream urine，Ceftazidine，Cefoxitin and Minocycline were the most sensitive antibiotics of non-carbapenems，and among the drug sensitivity test results of escherichia coli cultured in intraoperative renal pelvis urine and calculi，Piperacillin/Tazobatam，Cefoperazone/Sulbactam and Amikacin were the most sensitive antibiotics of non-carbapenems.Among the drug sensitivity test results of klebsiella pneumoniae cultured in preoperative midstream urine，Levofloxacin，Cefoxitin and Sulfamethoxazole were the most sensitive antibiotics of non-carbapenems，and among the drug sensitivity test results of klebsiella pneumoniae cultured in intraoperative renal pelvis urine and calculi，Piperacillin/Tazobatam，Cefoperazone/Sulbactam and Amikacin were the most sensitive antibiotics of non-carbapenems.There were statistically significant differences in the sensitivity rates of escherichia coli to Ceftazidime，Cefoxitin and Minocycline in preoperative midstream urine，intraoperative renal pelvis urine and calculi（P<0.01）．Among them，the sensitivity rate of escherichia coli to Ceftazidime，Cefoxitin and Minocycline in intraoperative renal pelvis urine and calculi was lower than that in preoperative midstream urine（P<0.01），but there was no statistically significant difference in the sensitivity of escherichia coli to Ceftazidime，Cefoxitin and Minocycline in intraoperative renal pelvis urine and calculi（P>0.01）．There were statistically significant differences in the sensitivity rates of klebsiella pneumoniae to Levofloxacin，Cefoxitin and Sulfamethoxazole in preoperative midstream urine，intraoperative renal pelvis urine and calculi（P<0.05）．Among them，the sensitivity rate of klebsiella pneumoniae to Levofloxacin，Cefoxitin and Sulfamethoxazole in intraoperative renal pelvis urine and calculi was lower than that in preoperative midstream urine（P<0.01），but there was no statistically significant difference in the sensitivity of klebsiella pneumoniae to Levofloxacin，Cefoxitin and Sulfamethoxazole in intraoperative renal pelvis urine and calculi（P>0.01）．The incidence of urosepsis 1 week after PCNL was 26.0%（13/50） in the control group and 10.0%（5/50） in the experimental group.The risk of urosepsis 1 week after PCNL was higher in the control group than that in the experimental group〔RR=2.600，95%CI（1.002，6.750），P<0.05〕.Conclusion　The use of antibiotics sensitive to bacteria in intraoperative pyelolithiasis and calculi can reduce the incidence of urinary sepsis after PCNL.In PCNL，the bacterial culture and drug sensitivity test of renal pelvis urine and calculi should be performed routinely.

Etiological Factors of Recurrent Spontaneous Abortion　

ZHANG Qinghua，PAN Jing，YAO Liyan

2020, 23(14): 1760-1764. DOI: 10.12114/j.issn.1007-9572.2019.00.738

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Background　The incidence of recurrent spontaneous abortion（RSA） is increasing year by year，which seriously affects women's physical and mental health.However，the etiology and pathogenesis of RSA in modern medicine are not completely clear.Objective　To investigate the etiology distribution of RSA，and its association with the gestational age of abortion and number of abortions.Methods　198 cases of RSA were recruited from the Second Affiliated Hospital of Xinjiang Medical University in 2018.Retrospective analyses were performed on general information such as age，number of abortions，and gestational age of abortion，and etiological factors of abortion，such as chromosomal abnormalities in the couple，anatomic abnormality of the female reproductive tract，autoimmune abnormality，infections of the female reproductive tract，and female endocrine abnormality.They were stratified into early RSA group（<12 weeks，n=155） and late RSA group（≥12 weeks，n=43） by gestational age of abortion，and were stratified into 2 times group（n=123），and more than 2 times group（n=75） by the number of abortions.The distribution of various etiological factors for RSA was analyzed in all patients，and was further analyzed by the gestational age of abortion，and number of abortions.Results　Of the 198 cases，the prevalence of chromosomal abnormalities in the couple，anatomic abnormality of the female reproductive tract，female autoimmune abnormality，female reproductive tract infections，female endocrine abnormality，and unknown causes was 4.55%（n=9），5.56%（n=11），18.18%（n=36），7.07%（n=14），15.15%（n=30），and 49.49%（n=98），respectively.Late RSA group showed higher prevalence of anatomic abnormality of the female reproductive tract，and lower prevalence of unknown causes compared with early RSA group（P<0.05），but the prevalence of other etiological factors for RSA was similar in both groups（P>0.05）.The prevalence of such etiological factors for RSA was not associated with the number of abortions，either 2 times or more（P>0.05）.Conclusion　There are many factors leading to RSA，such as chromosomal abnormalities in the couple，anatomic abnormality and infections of the female reproductive tract，female endocrine and autoimmune abnormalities and unknown causes.Among them，unknown causes account for the majority.The third trimester of pregnancy is influenced more by anatomic abnormality of the female reproductive tract than the first trimester of pregnancy.

Clinical Significance of Serum a Proliferation-inducing Ligand in Patients with Idiopathic Membranous Nephropathy　

ZHAI Yaling，GAO Jingge，LONG Xiaoqing，LI Ruman，DOU Yanna，LIU Dong，XIAO Jing，ZHAO Zhanzheng，LIU Zhangsuo，CHENG Genyang

2020, 23(14): 1764-1768. DOI: 10.12114/j.issn.1007-9572.2019.00.646

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Background　Membranous nephropathy，a common cause of nephrotic syndrome in adults，is considered to be an antibody-mediated autoimmune disease.Serum a proliferation-inducing ligand（APRIL） has been shown to be involved in the pathogenesis of a variety of autoimmune diseases，but whether it plays a role in the pathogenesis of idiopathic membranous nephropathy（IMN） is unknown.Objective　To examine the relationships of APRIL level with clinicopathological manifestations，and treatment effect in patients with IMN.Methods　Participants were recruited from The First Affiliated Hospital of Zhengzhou University between February 2015 and February 2016，including 108 with IMN from Department of Nephrology，and 20 sex- and age-matched health examinees from Physical Examination Center.10 ml whole blood sample was collected from IMN patients on the day of undergoing nephrocentesis，and from the controls on the same day.ELISA was used to measure serum APRIL level.By the median APRIL level，IMN patients were stratified into high APRIL expression group（n=54） and low APRIL expression group（n=54）．Clinical and pathological data of IMN patients were collected.A 6-month follow-up was given to the patients，and at the end of which，urinary protein outcome was measured and was used to stratify the patients into responsive and nonresponsive groups.Mean serum APRIL level was compared between IMN and control groups，between high and low APRIL expression groups，and between responsive and nonresponsive groups.Results　The mean serum APRIL level was significantly higher in IMN group compared with that of healthy controls〔（14.3±4.1） μg/L vs（7.7±4.8）μg/L，t=6.383，P<0.001〕.High APRIL expression group showed higher mean serum levels of BUN，Scr，and UA than low APRIL expression group（P<0.05）．What is more，the intensity of IgG deposition in renal specimen significantly increased in high APRIL expression group compared with low APRIL expression group（P<0.05）．Among the 54 patients who completed the follow-up，29 were responsive to the treatment，and other 25 were nonresponsive.However，there was no difference in mean APRIL level between these two groups〔15.7（13.0，17.9）μg/L vs 14.4（11.5，16.5）μg/L，Z=0.950，P=0.327〕.Conclusion　Serum APRIL level was closely associated with the severity of IMN，and was positively correlated with the intensity of deposited IgG in the renal specimen，indicating APRIL may participate in the pathogenesis of IMN.

Effect of Cycling on Exercise Capacity and Circulatory State in Maintenance Hemodialysis Patients：a Meta-analysis　

ZHAO Ping，HUANG Yanlin，HE Li，YANG Zhen，LU Haizhen

2020, 23(14): 1769-1777. DOI: 10.12114/j.issn.1007-9572.2019.00.730

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Background　Hemodialysis is one of the alternative therapies for end-stage renal disease，but it may cause complications such as dialysis disequilibrium syndrome，decreased motor ability，vascular access-related infections，etc.Exercise therapy is widely used to prevent and treat the aforementioned complications，but there are still different opinions on whether cycling can significantly improve the exercise ability and circulation status of patients with maintenance hemodialysis（MHD）.Objective　To systematically evaluate the clinical effects of cycling on exercise capacity and circulatory state of MHD patients.Methods　Electronic databases，including PubMed，Web of Science，ScienceDirect，CINAHL，Physiotherapy Evidence Database（PEDro），Wily Online Library，CNKI，Wanfang Data Knowledge Service Platform，VIP，and CMB were systematically searched for randomized controlled trials（RCTs） of MHD patients using cycling interventions included from January 2000 to April 2019.Quality assessment and data extraction were performed.And meta-analysis was carried out on outcome indicators of six-minute walking test，VO2 peak，hand grip strength，pulse wave velocity，systolic blood pressure（SBP），diastolic blood pressure（DBP），heart rate（HR），physical component score（PCS），and mental component score（MCS）.Results　Twenty-two RCTs with 710 participants were included.The quality of all of them was evaluated as "B".The results of meta-analyses showed that cycling could improve the exercise capacity of MHD patients〔SMD=62.31，95%CI（48.43，76.19），P<0.001〕，increase their VO2 peak 〔SMD=3.06，95%CI（1.70，4.41），P<0.001〕，and improve their hand grip strength〔SMD=6.30，95%CI（3.64，8.95），P<0.001〕，SBP〔SMD=-5.65，95%CI（-9.52，-1.78），P=0.004〕，DBP〔SMD=-3.76，95%CI（-5.95，-1.58），P=0.000 7〕，HR〔SMD=-4.86，95%CI（-8.82，-0.89），P=0.020〕，and PCS〔SMD=4.12，95%CI（1.19，7.05），P=0.006〕.Conclusion　Aerobic exercise with cycling as the main form in MHD patients during hemodialysis interval can effectively improve exercise capacity，circulatory state and quality of life.

Meta-analysis of the Efficacy and Safety of Polyethylene Glycol Electrolytes Powder with Mosapride as Bowel Preparation before Colonoscopy　

DAI Qiuying，ZHANG Shuxin，LIU Zihao，JI Huiru，CAO Minran，LI Shiying，QU Ying，FU Liyuan，LU Yu，LIU Na，DONG Yan，LI Huiying

2020, 23(14): 1778-1784. DOI: 10.12114/j.issn.1007-9572.2019.00.731

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Background　Bowel preparations are of great importance to the accuracy and safety of colonoscopy.Some clinical randomized controlled trials（RCTs） suggest that polyethylene glycol electrolytes powder（PEG-EP） combined with mosapride could improve the cleaning effect and safety of bowel preparation before colonoscopy.However，the results of such studies are inconsistent and controversial.So it is necessary to perform a systematic evaluation of these studies.Objective　 To systematically evaluate the efficacy and safety of PEG-EP with mosapride versus single administration of PEG-EP as bowel preparation before colonoscopy.Methods　All RCTs about PEG-EP with mosapride used for bowel preparation before colonoscopy were searched from databases of CNKI，Wanfang Data，VIP，CBM，PubMed，Cochrane Library，and EMBase from inception to June 2018.The review，screening based on the inclusion and exclusion criteria of this study and data extraction were performed by two researchers separately.RevMan 5.3 was used to conduct the Meta-analysis.GRADE profiler 3.6 was used to classify the outcome of Meta-analysis.Results　A total of 14 RCTs were included.The results of Meta-analysis showed that the rate of effective bowel preparation in the control group was lower than that of two subgroups of the observed group 〔RR=1.15，95%CI（1.06，1.25），P=0.000 8；RR=1.03，95%CI（1.01，1.06），P=0.02〕.In terms of safety，the incidence rates of total adverse reactions 〔RR=0.54，95%CI（0.44，0.67），P<0.000 01〕，nausea 〔RR=0.48，95%CI（0.39，0.60），P<0.000 01〕，vomiting 〔RR=0.46，95%CI（0.32，0.65），P<0.000 1〕，and abdominal distention 〔RR=0.36，95%CI（0.26，0.50），P<0.000 01〕 in observed group were lower than those of the control group.There were no significant differences in the incidence of abdominal pain and the detection rate of polyps between the two groups 〔RR=0.79，95%CI（0.58，1.08），P=0.14；RR=0.90，95%CI（0.74，1.10），P=0.32〕.Conclusion　The efficacy and safety of PEG-EP combined with mosapride are better than those of PEG-EP alone for bowel preparation.However，high-quality studies are needed to confirm the results of this study.

Executive Dysfunction in Schizophrenics　

ZHAI Qian，FENG Lei，ZHANG Guofu

2020, 23(14): 1785-1789. DOI: 10.12114/j.issn.1007-9572.2019.00.742

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Background　Schizophrenia is a serious mental disorder with high morbidity and mortality.Cognitive dysfunction，as one of its core symptoms，can run through the entire course of the disease and even as a residual symptom for a long time，significantly impacting the patient's social functioning.Executive dysfunction is one of the behavioral manifestations of cognitive impairment，which influences the patient's daily life and prognosis greatly.Objective　To discuss the prevalence of executive dysfunction in schizophrenia and its relationship with the severity of schizophrenia.Methods　This study was carried out following a case-control design.Participants were recruited from Psychiatric Disorders，Beijing Biobank of Clinical Resources，including 88 cases of schizophrenia，and 120 normal controls during January 2014 and January 2018.Executive dysfunction was screened in all participants by the time used to complete part A and part B of the trail making test（TMT） and errors made during the process.The association of executive dysfunction with the severity of schizophrenia was examined by comparing the TMT results between schizophrenia patients with PANSS score <70（n=44） and those with PANSS score ≥70（n=44）.Results　Compared with the controls，schizophrenia patients used more time to complete both part A and part B of the TMT，and they made more errors in performing either part A or part B（P<0.05）.Schizophrenia patients with PANSS≥70 used more time to finish both part A and part B of the TMT，and they made more errors in performing either part A or part B than those with PANSS<70（P<0.05）.Conclusion　Impaired executive functioning is found in schizophrenia patients，and the degree of impairment is positively associated with the severity of schizophrenia.

Study on Related Factors for Male Psychiatric Patients with Violent Behavior　

ZHEN Wenfeng，MA Xin，LIN Xiangji，WANG Hongxing

2020, 23(14): 1790-1795. DOI: 10.12114/j.issn.1007-9572.2019.00.812

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Background　Some psychiatric patients，mainly male patients，may have violent behavior，often causing accidents and misconduct，but there is a lack of analytical research on the factors on related factors of violent behavior in this type of patients.Objective　To explore the related factors of violent behavior of male psychiatric patients，and help to prevent the occurrence of violent behavior.Methods　From March 2014 to January 2016，96 male patients who were judged by the Judicial Appraisal Center of Beijing Ankang Hospital and met the criteria were included in the study group，and 65 patients with mental illness admitted to Beijing Anding Hospital were included in the control group.This study was a case-control study.we used a self-made questionnaire to investigate the patient's general information，including age，years of schooling，marital status，ethnicity，education，place of residence，occupation；history of the disease，including the age of first onset，treatment，history of craniocerebral disease，history of alcohol consumption，history of smoking and suicide，number of past hospitalizations；overview of personal growth history，including whether you lived in poor family environment in childhood，whether you were abused by parents，whether you were abandoned by parents，parental health status，parental marriage status，mental illness hospitalization records，whether your parents had a criminal record，whether your parents had alcohol or substance abuse history，the way of living，whether the family was harmonious，and family monthly income；family history，including family crime history，family psychosis history.The Psychological Correction Scale Revision（PCL-R） was used to evaluate the personality characteristics of patients.The Concise Psychiatric Rating Scale（BPRS） was used to evaluate the psychiatric symptoms of patients.The Modified Explicit Attack Behavior Scale（MOAS） was used to evaluate patient's attacks behavior.The questionnaire was filled out after two investigators who were trained in the consistency of the questionnaire asked the patients who was identified or on the day of admission or their family members.Results　Judicial identification results showed that most of the psychiatric patients with violent behaviors were schizophrenia（82 cases，accounting for 85.4%）.The study group and the control group had statistically significant in education level，place of residence，occupation，treatment status，number of previous hospitalizations，and monthly household income per capita（P<0.05）.Compared with the control group，the study group had higher anti-social factor score of PCL-R，higher thinking disorder score，hostile factor score and the total score of BPRS，and property attack weighted score，physical attack weighted score and total weighted score of MOAS（P<0.05）.Multivariate Logistic regression analysis showed that the educational level 〔OR=8.732，95%CI（1.268，60.123）〕，treatment 〔OR=45.846，95%CI（4.254，494.149）〕，property attack weighted score 〔OR=0.044，95%CI（0.006，0.321）〕，physical attack weighted score 〔OR=0.035，95%CI（0.005，0.246）〕 was the influencing factor of the occurrence of violent behaviors in male psychiatric patients（P<0.05）.Conclusion　Male psychiatric patients with violent behaviors were mostly schizophrenia patients.Low levels of education，lack of active treatment，property attacks tendency，and physical attack tendency are the risk factors for the occurrence of violent behaviors in male psychiatric patients.To strengthen cultural education and active treatments may help to reduce the occurrence of accidents in such patients.

Effect of Meridian-following Meditation on Depression in College Students　

WU Yan，SUN Jing，GU Ruimeng，LI Jianzhong

2020, 23(14): 1796-1799. DOI: 10.12114/j.issn.1007-9572.2019.00.359

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Background　Available studies show that depression is one of the important factors affecting college students' mental health.Therefore，it is necessary to conduct effective interventions for college students with depression.Objective　To investigate the effect of meridian-following meditation on depression in college students.Methods　In April 2018，60 cases were selected by the survey results with the Zung Self-rating Depression Scale（SDS）from the undergraduates of a university who voluntarily participated in the study of our meridian-following meditation group.According to the sex ratio，they were randomly divided into meridian-following meditation group and resting training group by the method of random number table，receiving 4-week meridian-following meditation intervention，and 4-week resting training intervention，respectively.All of them completed the SDS before and after the intervention，and the E-prime emotional pictures task.Pre- and post-intervention measured parameters and differences between pre-and post-intervention measured parameters were obtained.Results　Pre- and post-intervention emotional valences evoked by watching positive，neutral and negative pictures in both groups showed no significant differences（P>0.05）．Differences between pre- and post-intervention emotional valences evoked by watching positive，neutral and negative pictures in both groups were not significant（P>0.05）．Compared with baseline，post-intervention emotional valences evoked by watching positive，neutral and negative pictures showed insignificant changes in resting training group（P>0.05），but emotional valence evoked by watching positive pictures decreased，and that evoked by watching negative pictures increased in the meridian-following meditation group（P<0.05）．There was no significant difference in pre-intervention SDS score between the two groups（P>0.05）．Meridian-following meditation group showed lower post-intervention SDS score and greater differences between pre- and post-intervention SDS scores than the resting training group（P<0.05）．SDS scores decreased significantly after intervention in both groups（P<0.05）．Conclusion　Meridian-following meditation can reduce the depression level in college students，possibly because it can change people's emotional cognition and sleep quality，and make people become peaceful.

Superficial Siderosis of the Central Nervous System with Acute Cerebral Infarction：a Case Analysis and Literature Review　

CHEN Jinghong，ZHAO Jingru，SUN Sujuan，LI Rui，LI Na

2020, 23(14): 1800-1803. DOI: 10.12114/j.issn.1007-9572.2019.00.467

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A patient with the superficial siderosis of the central nervous system（SSCNS） who had been followed up for many years suddenly presented acute cerebral infarction and was admitted to the Department of Neurology in Hebei General Hospital.The images of this patient in previous years were analyzed and the literature was reviewed.The results showed that the SSCNS may be the cause of acute cerebral infarction in this patient.The SSCNS may be the cause of ischemic stroke，which provides a basis for the etiologic classification of ischemic stroke.

Castleman's Disease-related Hemophagocytic Syndrome：a Case Report and Literature Review　

CHEN Chunjiang

2020, 23(14): 1804-1807. DOI: 10.12114/j.issn.1007-9572.2019.00.658

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Background　Castleman's disease（CD） and hemophagocytic syndrome（HPS） are rare lymphoid hyperplasia diseases with high mortality rate and no standard treatment currently.Objective　To improve clinicians' understanding，diagnostic and therapeutic levels of CD-related HPS.Methods　A case of CD-related HPS admitted to Qian Xi Nan People's Hospital on August 22，2017 was reported.His diagnosis and treatment were summarized with literature review.Results　This patient with recurrent fever，hepatosplenomegaly，lymphadenectasis and systemic edema was ever misdiagnosed as septicemia，infectious mononucleosis and lymphoma，and treated with pulse therapies including repeated anti-infective agents，high-dose hormones and gamma globulin，but no curative effects were achieved.Results of PET-CT scan and cervical lymph node biopsy indicated multicentric CD involving multiple lymph nodes.Bone marrow cytology showed increased hemophagocytosis.Altogether，CD-related HPS was considered.The patient was treated with IL-6 targeted therapy and continued remission was achieved.Conclusion　CD is a rare disease with rapid progression and poor prognosis.Histopathological examination is necessary for clear diagnosis.For treatment，IL-6 pathway targeted therapies may become an effective therapy for CD patients.

Experience in Diagnosis and Treatment of a Refractory Diabetic Foot Ulcer　

CHEN Cunren，LIN Lu，WEI Weiping，ZHANG Yan，CHEN Kaining

2020, 23(14): 1807-1811. DOI: 10.12114/j.issn.1007-9572.2019.00.585

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A case of a 54-year-old patient with diabetic foot ulcer and a large area of heel ulceration admitted by Hainan General Hospital on October 6，2017 was reported.Debridement was performed by controlling blood sugar，giving anti-infection therapy and improving the nutritional status of the whole body.The patient was successfully cured by vacuum sealing drainage，autologous platelet-rich gel and micro-dynamic vacuum pack dressings.Diabetic foot ulcer，as a special chronic wound，is easy to be infected and difficult to heal in clinical treatment.Among them，ulcerations involving the heel are often more difficult to treat.Our experience was to do a good job firstly in the assessment of the overall situation of the patient because the improvement of the overall nutritional status and debridement were carried out simultaneously.Secondly，the most important thing was to select the appropriate treatment methods according to different needs of wound healing in different treatment periods to achieve the best therapeutic effect.

Reliability and Validity of the Chinese Version of the Glucose Monitoring Satisfaction Survey　

LU Huiya，LU Xiaolin，GAO Hongkai，GAO Yanhong

2020, 23(14): 1812-1818. DOI: 10.12114/j.issn.1007-9572.2019.00.809

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Background　To satisfy the needs of increased diabetic population，blood glucose monitoring equipments are becoming increasingly diverse.Accurately quantifying the level of diabetic patients' satisfaction with such equipments is of great significance in motivating their enthusiasm in glycemic management.The Glucose Monitoring Satisfaction Survey（GMSS），a scale has been proved to have good reliability and validity in countries such as the United States，Denmark and so on，but its applicability to China has not been tested.Objective　To test the reliability and validity of the Chinese version of GMSS in China's diabetic population.Methods　After obtaining the consent of the authors of the GMSS，we developed the initial Chinese version of the GMSS（consisting of GMSS-T1DM and GMSS-T2DM） on the basis of forward translation and back-translation with the help of two bilingual scholars，then developed the final version after two times of revision based on two rounds of 8 diabetes expertsd consultation（the first revision was performed according to the experts' evaluation of the content validity and cross-cultural adaptation of the initial version and corresponding suggestions，and their evaluation scores for the association of each item with the satisfaction with the monitoring system，and then this revised version was evaluated again by the experts，and the second revision was based on the experts' second evaluation scores） and calculating the content validity of the revised version.By use of convenience sampling，475 eligible patients with type 1 or type 2 diabetes were recruited from 3 communities in Beijing（Yijiefang Community，Erjiefangdong Community and Tiancunlu Subdistrict Community） from June to October 2018，and were surveyed with the General Data Questionnaire，Chinese version of GMSS，5-item World Health Organization Well-Being Index（WHO-5），Blood Glucose Monitoring System Rating Questionnaire（BGMSRQ），and Diabetes Distress Scale（DDS）.The general data of the patients were analyzed.Pearson correlation coefficients of the scale and subscale scores of the Chinese version of GMSS-T1DM and GMSS-T2DM with the scores of the WHO-5，BGMSRQ and DDS were calculated to evaluate the criterion validity of the Chinese version of GMSS.And the structural validity and internal consistency reliability of the Chinese version of GMSS were evaluated by using exploratory factor analysis and calculating the Cronbach's α coefficient，respectively.Two weeks later，the Chinese version of GMSS was retested for evaluating its test-retest reliability in 30 of the respondents of the first survey randomly selected in accordance with the proportion of sample size of each community.Results　Altogether，463（97.47%） responded effectively to the first survey，including 256 with T1DM，and 207 with T2DM.The average CVI values for the Chinese version of GMSS-T1DM and GMSS-T2DM were 0.910，0.925，respectively.The scale score of the Chinese version of GMSS-T1DM，and the scores of two subscales，openness and trust，were positively associated with the scale scores of WHO-5 and BGMSRQ，and negatively associated with the scale score of DDS-T1DM，while the scores of emotional burden and behavioral burden subscales were negatively associated with the scale scores of WHO-5 and BGMSRQ，and positively associated with the scale score of DDS-T1DM（P<0.05）.The scale score of the Chinese version of GMSS-T2DM，and the score of openness subscale were positively associated with the scale scores of WHO-5 and BGMSRQ，and negatively associated with the scale score of DDS-T2DM，the scores of emotional burden and behavioral burden subscales were negatively associated with the scale scores of WHO-5 and BGMSRQ，and positively associated with the scale score of DDS-T2DM，and the score of worthwhileness subscale was positively associated with the scale scores of WHO-5，BGMSRQ and DDS-T2DM（P<0.05）.By exploratory factor analysis，four common factors were extracted from each of the Chinese version of GMSS-T1DM and GMSS-T2DM，with loading ranged from 0.612 to 0.913，explaining 66.500% of the total variance of the former，and 67.650% of the total variance of the latter，respectively.The Cronbach's α coefficients for the Chinese version of GMSS-T1DM，and its openness，emotional burden，behavioral burden and trust subscales were 0.87，0.82，0.83，0.81 and 0.83，respectively.The Cronbach's α coefficients for the Chinese version of GMSS-T2DM，and its openness，emotional burden，behavioral burden，and worthwhileness subscales were 0.90，0.81，0.80，0.84 and 0.85，respectively.The test-retest reliability and split-half reliability were 0.86，0.89，respectively for the Chinese version of GMSS-T1DM，and were 0.91 and 0.90，respectively for the Chinese version of GMSS-T2DM.Conclusion　Both the Chinese version of GMSS-T1DM and GMSS-T2DM have good content validity，criterion validity，structural validity and internal consistency reliability，so they can be used for evaluating diabetic patients' satisfaction with the blood glucose monitoring system.

Establishment and Application of Postoperative Fatigue Risk Screening Scale for Gastrointestinal Tumor Patients Based on Predictive Model　

XU Xinyi1，XU Qin，HUA Hongxia，CHEN Li，LI Fang

2020, 23(14): 1819-1826. DOI: 10.12114/j.issn.1007-9572.2019.00.793

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Background　The incidence of postoperative fatigue（POF） after gastrointestinal tumor surgery is high，which brings negative effects on patients' prognosis and quality of life.However，available studies about factors associated with POF are limited to physiological and psychological aspects，and predicting POF preoperatively and screening POF in high-risk patients have not been achieved.Objective　To establish a risk screening scale based on predictive model for POF after gastrointestinal tumor surgery，to provide a basis for early identification and delivering interventions for high-risk patients.Methods　360 patients who underwent gastrointestinal tumor surgery in the First Affiliated Hospital with Nanjing Medical University from January to June 2018 were included for prospective analysis.Physiological，psychological，and sociological data were collected before surgery，and POF was measured after surgery.The independent risk factors of POF were screened by univariate and multivariate analyses，and were substituted into the binary logistic regression model，BP neural network model and decision tree model，respectively.The AUC and generalization ability of the model tester were compared to select the optimal model.On this basis，POF Risk Screening Scale was formed，then its reliability and validity were analyzed and the cut-off value was determined.Finally，105 patients with gastrointestinal tumor surgery fro the same hospital were included to test the scale.Results　The AUC for the binary logistic regression model，BP neural network model and decision tree model was 0.857，0.894，0.774，respectively，indicating that all of them had a good generalization ability，but BP neural network model was the optimal，with tumor stage，education level，personal monthly income，subjective support，age，preoperative anxiety and depression，and preoperative albumin included.The risk screening scale scored 0 to 15 points.The CVI for the scale was 0.90，and ranged from 0.80 to 1.00 for its items.Exploratory factor analysis indicated that the scale consisted of 3 factors which explained 66.04% of the total variance，and factor loading of all items ranged from 0.552 to 0.751.The Cronbach's α coefficients for the scale，and its 3 factors were 0.730，0.839，0.763，and 0.637，respectively.The AUC of the scale in predicting POF was 0.839，and the cut-off value was 8.In the stage of verification，the scale showed an accuracy of 90.49% in predicting POF.Conclusion　The POF Risk Screening Scale for Gastrointestinal Tumor Patients based on BP neural network model has good reliability and validity，which can be used to effectively predict POF，providing guidance for POF risk screening and delivery of targeted interventions.

Development of a 'No Omissions and No Waiting Minimalist Management System' for Smart Delivery of Community-based Health Services: a Practical Exploration　

WANG Junqi，TAO Haiqi，SHU Dandan，WU Qinghai

2020, 23(14): 1827-1832. DOI: 10.12114/j.issn.1007-9572.2020.00.049

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Background　The current community health service management system fails to stipulate the management object，service contents，service process，and service resource allocation to all residents directly.Objective　To attempt to improve two representative service lines of the community health center（CHC） to observe the feasibility，results and promotion value of their smart operation based on the assertion of the management of community-based health services can be smart concluded from intensively analyzing the delivery features of such services.Methods　By analyzing the causes of the omission of healthcare tasks and inappropriate queue management observed in a first-hand opportunity in the newly established Jingan District Pengpu Town Second Community Health Center，we put forward countermeasures，and developed a minimalist task reminder and queue management system named as "no omissions and no waiting minimalist management system"，and informationized it during December 2016 and June 2019.Then the informationized system was used in two essential service modules of community-based maternal and child health care clinic and TCM bone injury clinic to test it effectiveness.Results　The operation results showed that the system led to improved efficiency of community health service management in four indicators:omission prevention and control，total service load，waiting time for consultation，and idling time reduction of resources.Conclusion　Our system，aiming at addressing the problems of omission of healthcare tasks and inappropriate queue management in the CHC，may be useful in improving the service lines of community healthcare，by which residents' experience of receiving community health services，and the core competitiveness of the CHCs may be enhanced comprehensively.

Analysis of Problems in the Family Doctor System Based on the Chronic Care Model　

LUO Qin，LIANG Hailun

2020, 23(14): 1833-1838. DOI: 10.12114/j.issn.1007-9572.2019.00.208

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To optimize the allocation of medical resources，local governments have successively explored the implementation of the family doctor system in practice in recent years.Although the family doctor system has achieved certain success in some cities，such as Beijing，Shanghai，Chengdu and so on，there are still many problems which restrict the development of family doctor system.Although some literature has pointed out problems in one or several aspects of the family doctor system，it lacks a unified analytical framework.The chronic care model（CCM） has achieved good practical results abroad in which the nurses mainly undertake the tasks of the medical team while the family doctor system in China is based on general practitioners.Both of them are implemented in primary health care institutions，so the effective working mechanism and process design of CCM can provide guidance for improving the family doctor system.Under the framework of the CCM and through theoretical research，this paper finds there are still some shortcomings of the family doctor system in the personnel and process of the service delivery system，the coordination of medical service organizations，the self-management support for patients，the construction of medical information system，decision support，resource allocation，and policy support that impede the advancement of the family doctor system.On the basis of the CCM，this paper proposes some suggestions combined with the practice of the family doctor system in several cities for its future development and improvement，including improving the medical service process with an efficient team，promoting hierarchical diagnosis and treatment system to strengthen the coordination of the medical service organizations，educating patients and paying attention to their self-management，using internet technology to improve the medical information system，increasing policy support to promote the allocation of medical resources.

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