Chinese General Practice

Recent Developments in Long-term Effects of Mild Hypothyroidism During Pregnancy on Offspring Intelligence　

GAO Xue，LONG Yan，LIN Li

2020, 23(15): 1838-1842. DOI: 10.12114/j.issn.1007-9572.2020.00.163

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There are substantial available data showing impaired child intelligence resulting from overt maternal hypothyroidism during pregnancy.This review addresses the effect of mild maternal hypothyroidism on long-term development of intelligence of children.It is concluded that mild maternal hypothyroidism may affect children's mental development.However，the mechanisms that cause this change and how to eliminate these risk factors remain unclear and a large number of clinical and basic experiments are still required to provide evidence for treatment.

Advances in Research on Precision Therapy in Asthma Treatment　

YANG Hongkuan

2020, 23(15): 1843-1848. DOI: 10.12114/j.issn.1007-9572.2019.00.662

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Patients with severe asthma have increased risk of exacerbations and morbidities with more healthcare costs.The glucocorticoid-based therapy in severe asthma is not satisfactory with several side effects.There is an agent need for a new therapy.Asthma is a disease with marked heterogeneity and can be divided into two endotypes depending on the pathological mechanism：T helper 2 Asthma and non-T helper 2 Asthma.Precision therapy is to identify a specific endotype through a complete evaluation of all available biomarkers and make a correct selection of monoclonal antibody targeted specific molecules，which has a promising outlook in the treatment of severe asthma.In this review，we discuss the endotypes and the related precision therapy in severe asthma in order to make a reference for the clinical practice.

Study on the Correlation between Intestinal Flora Imbalance and Cervical Spondylosis　

QIU Yuhang

2020, 23(15): 1848-1852. DOI: 10.12114/j.issn.1007-9572.2019.00.743

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Cervical spondylosis（CS） has been regarded as a degenerative disease of the spine caused by external strain.Most of the studies focus on its structural changes，but few on its immune mechanism.The intestinal flora（IF） has been shown to be widely involved in the immune regulation of various tissues of the human body，and it is also possible to influence the occurrence and development of CS through immunoinflammatory pathways.Through literature review and analysis of the influence of IF imbalance on bone，blood vessels，nerves and muscles，it was suggested that IF imbalance may act on the main tissues of the neck by the gut-brain axis as main stem，causing neck tissue lesions.The chronic low-level immune inflammation caused by IF imbalance，which is the fundamental basis for the formation of CS，can cause damage to the neck tissues of bones，blood vessels，nerves and muscles，while stress strain is only a supplementary factor and the degeneration of neck tissues is only a process or result in this disease.CS is not only a manifestation of the cervical spine aging and disuse，but also more should be regarded as a neck injury caused by intestinal immune disorders.In the clinical treatment of CS，it should pay attention to reasonable diet for protecting intestinal function and maintaining the existing attributes of IF.

Recent Advances in Burden of Multiple Medications in Elderly Patients with Multimorbidity　

WANG Yongli，ZHANG Zhenxiang，FU Bo

2020, 23(15): 1853-1858. DOI: 10.12114/j.issn.1007-9572.2020.00.183

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The burden of multiple medications is a foremost factor associated with medication beliefs，medication behavior and health outcomes in elderly patients with multimorbidity.So paying attention to the multiple medication burden may provide a new perspective for solving medication problems in this group.However，its research development is rarely reviewed.In this study，we gave a clear definition of medication burden，reviewed various studies about medication burden in elderly patients with multimorbidity，and summarized the recent research status，and analyzed general demographic data，complexity of medication regimens，medicine characteristics，patients' medication attitude and medication literacy，and family and social factors associated with medication burden，with a view to providing a scientific reference for reducing the burden of multiple medications in Chinese elderly patients with multimorbidity.
Elderly；Chronic disease；Medication therapy management；Burden of illness；Review

General Practitioners' Coping Strategies for Polypharmacy in Elderly Patients with Multimorbidity　

YAN Wei，CHEN Xue，DING Jing

2020, 23(15): 1859-1863. DOI: 10.12114/j.issn.1007-9572.2020.00.325

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Polypharmacy-induced adverse reactions and hazards are common in elderly patients with multimorbidity.At the same time，the economic burden is increased.We summarized the status and various hazards of polypharmacy in this group，and based on this，proposed that formulating a rational diagnostic and therapeutic regimen should be using Beers Criteria and medication appropriateness index（MAI）after comprehensive patient assessment by the general practice team with at least a pharmacist included.And the regimen should be modified timely according to general practitioner-delivered community-based follow-up results.Moreover，medication safety should be monitored.In addition，to reduce polypharmacy，non-drug interventions such as strengthened medical care and physical therapy can be used，so that the quality of life of the patients may be improved.

Development，Validity and Reliability of the Chinese Version of Living with Medicines Questionnaire in Community-living Elderly Patients with Polypharmacy：a Cross-cultural Adaptation　

WANG Yongli，ZHANG Zhenxiang，LIN Beilei，GUO Yawen，FU Bo

2020, 23(15): 1864-1872. DOI: 10.12114/j.issn.1007-9572.2020.00.234

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Background　Polypharmacy burden is a core factor that affect patients' medication beliefs，medication compliance，and medication safety.By evaluating the patient's medication burden in time，healthcare workers may find out the problems that need to be solved in the process of medicine use，by which a scientific drug intervention plan may be formulated.However，at present，there is a lack of scientific and effective tools to evaluate the patient's polypharmacy burden in China.Objective　To translate the English version of Living with Medicines Questionnaire（LMQ）into Chinese，and test its reliability and validity in community-living elderly patients with polypharmacy，to provide a tool for assessing the medication burden in this group.Methods　The Chinese version of LMQ（initial version）including 8 dimensions and 39 items was formed by using forward translation，proofreading，back translation，expert review，cognitive interview and presurvey.From April to August 2019，convenience sampling was used to select elderly chronic disease patients with polypharmacy from communities served by three community health centers〔Zhengzhou Community Health Center（East 2nd Street），Linshanzhai Community Health Center，Science Avenue Community Health Center of Zhengzhou National High & New Industries Development Zone〕in Zhengzhou as the participants.In the first stage of this study，the data were collected for exploratory factor analysis，and the sample size was 260 cases.In the second stage，the reliability of the initial version of questionnaire was retested 2-4 weeks later in a sample of 30 cases randomly selected from the above-mentioned 260 cases.In the third stage，the data were collected for confirmatory factor analysis，with a sample of 373 cases.The investigation used the General Data Questionnaire and the Chinese version of LMQ（initial version）.The validity and reliability of the final Chinese version of LMQ were evaluated overall.Results　The questionnaire results of effective responders in the first，second，and third stages of this study〔242（93.1%），30（100.0%），and 350（93.8%）〕were included for final analysis.Item analysis showed that the item-total correlation coefficients of the Chinese version of LMQ（initial version）were 0.317-0.658（P<0.01），and the critical value for each item was > 3.0.The results of exploratory factor analysis showed that the KMO value of Chinese version of LMQ（initial version）was 0.875，and the χ2 of Bartlett's test was 8 139.877（P<0.01），which indicated that it was suitable for factor analysis.Eight common factors with eigenvalue > 1.000 were extracted，explaining 76.780% of the total variance，and the loading value of each item on its common factor was > 0.400.The results of confirmatory factor analysis showed that the pre-set model fitting indicators were not ideal，so the model was modified according to the indicator prompts.After adding 8 covariance correlations，the fitting indicators are in the acceptable range.Content validity：the item content validity indices of the Chinese version of LMQ（initial version）were 0.86-1.00，and the scale content validity index was 0.949.Reliability：the scale Cronbach's α coefficient was 0.892，with dimensions' Cronbach's α coefficients ranging from 0.867-0.943； the scale half-reliability was 0.817 with dimensions' half-reliability ranging from 0.841-0.947； the scale retest reliability was 0.904 with dimensions' retest reliability ranging from 0.802-0.875.The final Chinese version of LMQ includes 8 dimensions（39 items）：medication attitude（7 items），practical difficulties（6 items），doctor-patient relationship（5 items），medication effects（5 items），interferences with daily life（6 items），side effects（4 items），medication behavior（3 items），economic burden（3 items）.Conclusion　The Chinese version of LMQ uses simple and easy-to-understand 39 items to assess the patient's medication burden from 8 aspects（medication attitude，practical difficulties，doctor-patient relationship，medication effects，interferences with daily life，side effects，medication behavior，and economic burden），demonstrating good validity and reliability.The assessment is comprehensive and easy to implement，which may effectively assess the burden of medication in community-living elderly patients with polypharmacy，and may provide a measurement tool for healthcare workers to formulate precise drug interventions.

Relationship between Acute-to-chronic Glycemic Ratio and Poor Short-term Prognosis in Patients with Acute Myocardial Infarction　

DU Fawang，LI Ling，WU Qiang，CHEN Dandan，WU Yueting，WANG Jiren，CHEN Baolin

2020, 23(15): 1873-1878. DOI: 10.12114/j.issn.1007-9572.2020.00.232

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Background　Elevated levels of acute glycemia at hospital admission are common among patients with acute myocardial infarction（AMI）.It has been found that in clinical practice，AMI patients are often combined with a variety of complex clinical factors，which may cause acute hyperglycemia.Acute-to-chronic glycemic ratio may be a predictor of poor short-term prognosis in such patients，but relevant studies are still lacking in China.Objective　To study the relationship between acute-to-chronic glycemic ratio and poor short-term prognosis in patients with AMI.Methods　We enrolled 272 inpatients with ST-elevation and non-ST-elevation AMI from CCU，Guizhou Provincial People's Hospital between January 2017 and January 2018.The primary end point of the study was mortality within a 30-day follow-up.Venous plasma glycemia and glycosylated hemoglobin（HbA1c） levels were measured at hospital admission，then the chronic glycemia was estimated based on HbA1c，and acute-to-chronic glycemic ratio was calculated further.Factors associated with poor short-term prognosis were analyzed.The ROC curve of acute-to-chronic glycemic ratio in predicting poor short-term prognosis of AMI was plotted，and the optimal cutoff value was estimated.Kaplan-Meier method was used for survival analysis.The incidence of adverse cardiovascular events was explored by acute-to-chronic glycemic ratio.Results　By the survival status，the patients were divided into the survival group（n=256） and the death group （n=16）.Multivariate Logistic regression analysis showed that Killip classⅡ-Ⅲ，three-vessel coronary artery lesions and elevated acute-to-chronic glycemic ratio were independent risk factors associated with poor short-term prognosis（OR=23.110，0.073，35.885，P<0.05）.Patients were divided into acute-to-chronic glycemic ratio >1.01 group（n=138） and≤1.01 group（n=134）by the cutoff value，and the former group had much lower short-term cumulative survival rate（90.3% vs 97.8%）（χ2=6.932，P=0.008）showed by survival analysis.Further subgroup analysis by diabetes indicated that，those without diabetes and acute-to-chronic glycemic ratio >1.01 had a significantly reduced short-term cumulative survival rate compared with those with diabetes and acute-to-chronic glycemic ratio≤1.01（92.3% vs 97.5%）（χ2=4.465，P=0.035）those with diabetes and acute-to-chronic glycemic ratio >1.01 had a significantly reduced short-term cumulative survival rate compared with those with diabetes and acute-to-chronic glycemic ratio≤1.01（86.0% vs 100.0%）（χ2=5.658，P=0.017）.Acute pulmonary edema，cardiogenic shock，atrial tachycardia，and ventricular tachycardia were significantly increased in acute-to-chronic glycemic ratio >1.01 group （P<0.05）.Conclusion　 Elevated acute-to-chronic glycemic ratio is an independent risk factor for poor short-term prognosis in patients with AMI，and is closely related to adverse cardiovascular events.Elevated acute-to-chronic glycemic ratio is also associated with lower short-term cumulative survival rate and poorer short-term prognosis in AMI patients with or without diabetes.Its value is more valuable to predict the poor short-term prognosis in those with diabetes.Acute-to-chronic glycemic ratio >1.01 may be used as the optimal cutoff value to predict the poor short-term prognosis of patients with AMI.Above this level，cardiovascular adverse events may increase significantly and the short-term prognosis of patients may be poor.

Correlation of Different Blood Pressure with Left Ventricular Hypertrophy in Patients with Essential Hypertension　

TANG Tengteng，XU Xinjuan，ZHANG Junshi，LIU Haiming，LIANG Xiaohui

2020, 23(15): 1879-1883. DOI: 10.12114/j.issn.1007-9572.2020.00.274

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Background　The number of people suffering from cardiovascular disease in China is increasing with the aggravation of aging.Hypertension is the most common cardiovascular disease，often accompanied by damage to target organs such as the heart，brain and kidney.Left ventricular hypertrophy（LVH） is the most common major complication of hypertension，which is closely related to blood pressure levels.Objective　To investigate the correlation of different blood pressure with LVH in patients with essential hypertension.Methods　497 inpatients with hypertension were recruited from the Department of Hypertension，the First Affiliated Hospital of Xinjiang Medical University from January 2012 to December 2018.According to the left ventricular mass index（LVMI），they were divided into non-LVH group（367 cases） and LVH group（130 cases）.The clinical data，indoor blood pressure，central aortic blood pressure related indicators and 24-hour ambulatory blood pressure were collected to analyze their correlations with LVMI，and the influencing factors of LVH.Results　There were statistically significant differences in gender ratio，mean values of age，triglyceride，and admission systolic blood pressure（SBP），diastolic blood pressure（DBP），central aortic SBP，central aortic DBP，24 hSBP，24 hDBP and 24 h pulse pressure（24 hPP） between the two groups（P<0.05）.LVMI was positively correlated with SBP，DBP，central aortic SBP and DBP，central aortic pulse pressure，24 hSBP，24 hDBP，and 24 hPP（P<0.05）.Stepwise multiple linear regression analysis showed that serum cystatin C，central aortic SBP and 24 hSBP were associated with LVH（P<0.05）.Conclusion　LVH is related to indoor blood pressure and central aortic pressure in patients with hypertension.Serum cystatin C，central aortic SBP and 24 hSBP are the influencing factors of LVH.

Association between Serum 25-hydroxy Vitamin D and Microalbuminuria in Overweight or Obese Male Patients with Type 2 Diabetes　

GUO Jiuchang，ZHANG Lin，YANG Dan，YANG Xiaoxia，LI Mingze，LIAO Xin，GAO Lin

2020, 23(15): 1884-1888. DOI: 10.12114/j.issn.1007-9572.2020.00.229

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Background　The associations of vitamin D with obesity，obesity-related complications，diabetes and diabetes-related complications have become a new study field and a hot topic.However，there are few reports on the association of vitamin D with early diabetic kidney disease（EDKD） in overweight or obese populations.Objective　To explore the association between serum 25-hydroxy vitamin D〔25（OH）D〕 level and microalbuminuria（MAU） in overweight or obese male patients with newly diagnosed type 2 diabetes mellitus （T2DM）.Methods　A total of 261 newly diagnosed male T2DM patients from the Affiliated Hospital of Zunyi Medical University were enrolled from January to December 2018.They were divided into DM group（82 with DM），microalbuminuria（MAU） group（47 with normal body weight complicated by MAU），OWB-DM group（65 with overweight or obesity），and OWB-MAU group（67 with overweight or obesity complicated by MAU） according to 24 hour urinary albumin excretion rate（UAER） and body mass index（BMI）.By serum 25（OH）D level，overweight or obese patients were divided into quartiles 1，2，3，4 groups〔Q1 group，serum 25（OH）D<18.13 μg/L，n=33；Q2 group，18.13 μg/L≤serum 25（OH）D<21.22 μg/L，n=33；Q3 group，21.22≤μg/Lserum 25（OH）D<24.32 μg/L，n=32；Q4 group，serum 25（OH）D≥24.32 μg/L，n=34〕.The clinical data of male T2DM patients were collected，the correlation between 24 h UAER and other indicators in overweight or obese male T2DM patients，and the relationship between serum 25（OH）D level and MAU were analyzed.Results　There were significant differences in mean levels of BMI，systolic blood pressure（SBP），diastolic blood pressure（DBP），fasting plasma glucose（FPG），2-hour postprandial blood glucose（2 hPG），glycosylated hemoglobin（HbA1c），total cholesterol （TC），triacylglycerol（TG），high-density lipoprotein cholesterol（HDL-C），low-density lipoprotein cholesterol（LDL-C），homeostasis model assessment of insulin resistance index（HOMA-IR），estimated glomerular filtration rate（eGFR）and serum 25（OH）D among DM，MAU，OWB-DM and OWB-MAU groups （P<0.05）.The mean level of serum 25（OH）D in MAU group〔（20.84±4.12）μg/L〕，OWB-DM group〔（23.46±3.35）μg/L〕 or OWB-MAU group〔（18.00±4.46）μg/L〕 was significantly decreased compared with that of DM group〔（26.14±3.40）μg/L〕（P<0.05）.The mean serum 25（OH）D level in OWB-MAU group was significantly lower than that of MAU and OWB-DM groups（P<0.05）.Q1 group〔72.80（54.70，133.20）mg/24 h〕 had much higher mean 24 hUAER level than Q2〔38.50（18.25，78.85）mg/24 h〕，Q3〔27.90（19.95，69.80）mg/24 h〕，Q4〔20.0（13.20，24.50）mg/24 h〕groups（P<0.05）.The mean 24 hUAER level in Q4 group was much lower than that of Q2 and Q3 groups（P<0.05）.Spearman correlation analysis showed that 24 hUAER was negatively correlated with serum HDL-C and 25（OH）D levels（rs=-0.199，-0.405，P<0.05），and was positively correlated with BMI，SBP，DBP，2 hPG and TG（rs=0.257，0.350，0.282，0.421，0.202，P<0.05） in overweight or obese patients.Binary Logistic regression analysis showed that 25（OH）D，SBP and 2 hPG were independent influencing factors for MAU in overweight or obese male patients（OR=0.717，1.173，1.327，P<0.05）.Conclusion　The level of serum 25（OH）D in overweight or obese T2DM male patients was lower than those with normal weight.24 hUAER was closely related to decreased serum 25（OH）D，disorders of glucose and lipid metabolism，and increased blood pressure.Decreased serum 25（OH）D and increased SBP and 2hPG may be involved in the progression of EDKD in overweight or obese male patients.

Psychological Characteristics and Nicotine Dependence in Smokers in the Community　

MA Hanqiao，LIU Han，JIN Qianying，QIAO Kun，AKBAR Ali，ZHANG Manhua，LI Xingming

2020, 23(15): 1889-1894. DOI: 10.12114/j.issn.1007-9572.2020.00.253

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Background　Psychosocial factors affect nicotine dependence significantly.However，there are few studies on the combined effects of smoking causes and psychosocial factors on nicotine dependence.Objective　To investigate the mental health status and its impact on nicotine dependence in community-living smokers in Beijing.Methods　From 2018 to 2019，a cross-sectional questionnaire study was conducted in a smoking cessation intervention cohort of 407 smokers recruited from 12 communities in Beijing.A self-designed Sociodemographic Questionnaire，the Fagerstrom Test for Nicotine Dependence（FTND），Smoking Abstinence Self-efficacy Questionnaire（SASE），Russell's Reasons for Smoking Questionnaire （RRSQ），Perceived Social Support Scale（PSSS），and Trait Coping Style Questionnaire（TCSQ） were used to collect the corresponding information，respectively.The association of FTND with SASE，RRSQ，PSSS，and TCSQ in terms of score was analyzed by sociodemographic factors and psychological traits，respectively.Multiple linear regression analysis with nicotine dependence as the dependent variable was used to explore the psychological indicators associated with nicotine dependence.Results　 The survey obtained a response rate of 75.9%（309/407）.Nicotine dependence varied significantly by education level and average monthly income （P<0.05）.The scale and subscale（positive/social situation，negative/emotional situation，and habit/addiction situation） scores of SASE differed significantly according to nicotine dependence level（P<0.05）.The scores of the RRSQ subscales（psychological imago，hand and mouth activity，enjoyment，sedation，stimulation，addiction and automatic） differed significantly according to nicotine dependence level（P<0.05）.Spearman correlation analysis showed that education level （rs=-0.224），the scale score of SASE （rs=-0.398），and the scores of its subscale positive/social situation （rs=-0.292），negative/emotional situation （rs=-0.226），and habit/addiction situation （rs=-0.465） were negatively correlated with nicotine dependence level（P<0.05）.The scores of psychological imago（rs=0.120），hand and mouth activity （rs=0.240），enjoyment （rs=0.354），sedation （rs=0.239），stimulation （rs=0.227），addiction （rs=0.426） and automatic （rs=0.298） subscales in the RRSQ were positively correlated with nicotine dependence level（P<0.05）.According to the results of the multiple linear regression equation，education level （t=-3.151），habit/addiction situation subscale score （t=-5.401），enjoyment subscale score （t=2.736） and addiction subscale score （t=3.111） were the influencing factors of nicotine dependence（P<0.05）.Conclusion　The factors influencing the level of nicotine dependence of smokers include education level，self-efficacy of smoking abstinence in habitual/addicted situations，and enjoyment and addiction factors.In view of this，In view of this，it is essential to deliver interventions of smoking cessation based on the psychosocial and addictive factors in the smokers.

Correlation between Serum Cystatin C Level and Retinal Vascular Diameter in Type 2 Diabetes Mellitus　

WU Zedan，WU Jing，CHEN Linjiang，WANG Hanjing，MA Ming，LIN Lili

2020, 23(15): 1895-1903. DOI: 10.12114/j.issn.1007-9572.2019.00.625

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Background　Diabetic retinopathy（DR） is a common microvascular complication of diabetes.At present，ophthalmoscopy is the major screening method of DR.By contrast，serum Cystatin C（Cys-C），a more sensitive and accurate screening method as it is not affected by physiological factors such as age，race or muscle weight，is becoming popular in the studies of microangiopathy.However，there has been not any publications about the studies on the diameter of microvessels between serum Cys-C and type 2 diabetes mellitus（T2DM）．Objective　To study the effect of serum Cys-C level on retinal artery equivalent（RAE），retinal vein equivalent （RVE） and artery-to-vein ratio（AVR） in patients with T2DM.Methods　The study retrospectively analyzed the clinical baseline data and color fundus photographs of 110 patients screened for T2DM in Nanfang Hospital，Southern Medical University from July 2014 to July 2018.The retinal vessel diameter in the superior temporal 1.0-1.5 PD range of left eye was measured by ImageJ software.The effect of serum Cys-C level on RAE，RVE and AVR，the correlation between serum Cys-C level and clinical baseline data，the influencing factors of serum Cys-C level abnormality and the influence of serum Cys-C level on RAE，RVE and AVR were analyzed.Results　The level of serum Cys-C was positively correlated with the course of diabetes，creatinine（Cr），uric acid（UA） and blood urea nitrogen（BUN）（rs=0.193，0.821，0.501，0.678，P<0.05）．The level of serum Cys-C was negatively correlated with total CO2 and estimated glomerular filtration rate（eGFR）（rs=-0.281，-0.745，P<0.05）．The level of serum Cys-C in T2DM patients with hypertension，diabetic nephropathy，and DR was significantly higher than that in patients without those diseases （P < 0.05）．The levels of serum Cys-C in T2DM patients with non-diabetic retinopathy （NDR），nonproliferative diabetic retinopathy （NPDR），and proliferative diabetic retinopathy （PDR） were （1.07±0.23），（1.31±0.64），and （2.12±1.73） mg/L，respectively，which presented a statistically significant difference（F=7.245，P=0.002）．Binary Logistic analysis showed that uric acid and eGFR were risk factors for abnormal serum Cys-C（P<0.05）．The level of RVE was positively correlated with the level of serum Cys-C（rs=0.236，P<0.05）；AVR was negatively correlated with the level of Cr and serum Cys-C（rs=-0.190，-0.299；P<0.05）．The results of ordered multi-classification Logistic regression analysis showed that smoking，drinking，coronary heart disease，and abnormal serum Cys-C level were the risk factors for the increase of RVE（P<0.05）．The area under the ROC curve for predicting AVR anomalied by serum Cys-C was 0.615〔95%CI（0.508，0.721）〕，while the best critical value for serum Cys-C to predict AVR anomalies was 1.105 mg/L，the Jordan index was 0.26，the sensitivity was 0.673 and the specificity was 0.582.Conclusion　The level of serum Cys-C is affected by UA and eGFR.The increase of serum Cys-C level leads to an aggregation of DR，an enlargement of RVE and a diminution of AVR.Therefore，RVE level is positively correlated with serum Cys-C level，AVR level is negatively correlated with serum Cys-C level，but there is no correlation between RAE and serum Cys-C level.When serum Cys-C≥1.105 mg/L，the AVR is predicted to be less than 2/3.

Clinical Study of Esophageal Motility and Reflux in Patients with Typical and Atypical Symptoms of Gastroesophageal Reflux Disease　

ZHAO Bentian，JIANG Haitao，WANG Ling，LIU Qianshu，WANG Hong

2020, 23(15): 1904-1909. DOI: 10.12114/j.issn.1007-9572.2019.00.663

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Background　Gastroesophageal reflux disease（GERD） is a common digestive system disease with high prevalence，complex and diverse clinical symptoms.Moreover，it shows an increasing trend in annual prevalence.Besides those who are diagnosed with GERD by the chief complaint of typical reflux symptoms，more and more patients are diagnosed by atypical symptoms.To provide guidance for clinical diagnosis and treatment，the differences between GERD patients with typical and atypical symptoms are needed to be further studied.Objective　To compare the differences in reflux characteristics and esophageal motility between GERD patients with typical and atypical symptoms，to fully explore the characteristics of GERD with atypical presentations to improve the understanding of this disease.Methods　We retrospectively enrolled GERD outpatients with typical and atypical presentations from Department of GI Medicine，Affiliated Hospital of Zunyi Medical University during from January 2015 to January 2017.All of them had pathological reflux detected by 24-h multichannel intraluminal impedance-pH monitoring（MII-pH），and had no other organic gastrointestinal disorders determined by high-resolution manometry（HRM） and gastroscopy.According to the main symptoms，the patients were divided into typical presentations group and atypical presentations group.We compared these two groups' baseline data，reflux characteristics〔number of reflux episodes（pH<4），number of reflux episodes > 5 min，percent total time pH<4〕，duration of GERD，esophageal motility parameters〔lower esophageal sphincter resting pressure（LESP），lower esophageal sphincter residual pressure（LESRP），upper esophageal sphincter resting pressure（UESP），upper esophageal sphincter residual pressure（UESRP），contractile front velocity（CFV），distal contractile integral（DCI），lower esophageal sphincter length（LESL）〕.Results　A total of 71 cases were enrolled，including 32 with typical presentations，and 39 with atypical presentations.Both groups showed no significant differences in mean age，sex ratio，mean weight and BMI，as well as gastroscopic findings（P>0.05）.The incidence of nonerosive reflux disease was higher than that of reflux esophagitis in both groups（P<0.05）.Compared with those with atypical presentations，patients with typical presentations had more mean number of reflux episodes（pH<4），greater percent total time pH<4，and shorter duration of GERD（P<0.05），but similar number of reflux episodes >5 min（P>0.05）.Moreover，patients with typical presentations also showed lower mean LESP，DCI and LESL，and higher mean UESP and UESRP（P<0.05），but similar mean LESRP and CFV（P>0.05）.Conclusion　GERD，either with typical or antitypical presentations，more easily occurs in individuals aged 40 to 60 years.The incidence of nonerosive reflux disease is significantly higher than that of reflux esophagitis in these patients.Those with atypical presentations have lower acid reflux degree and more significantly decreased UESP and UESRP，better LESP and esophageal peristalsis function，and longer duration of GERD.

Value of Padua Prediction Score with Mean Platelet Volume in the Diagnosis of Venous Thromboembolism in Non-Surgical Inpatients with D-Dimer>500 μg/L　

DONG Lin，LEI Zubao，XU Ping，YANG Wanchun

2020, 23(15): 1910-1915. DOI: 10.12114/j.issn.1007-9572.2019.00.682

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Background　Venous thromboembolism（VTE） is a common underrated vascular disease，but clinical detection methods and risk assessment for it are used insufficiently.Mean platelet volume （MPV） may be one of the important biomarkers for deep venous thrombosis （DVT）.Both Padua prediction score and MPV are easily measured parameters with low cost in primary hospitals，and it is of clinical significance to study their combination predictive value for VTE in non-surgical inpatients with D-dimer >500μg/L.Objective　To evaluate the combination predictive value of Padua prediction score and MPV for VTE in non-surgical inpatients with D-dimer >500 μg/L.Methods　A retrospective analysis was performed on the non-surgical inpatients with highly suspected VTE and D-dimer >500 μg/L selected from the Second People's Hospital of Hefei from February 2017 to April 2019.All of them underwent CT pulmonary angiography or compression ultrasound or venography of the veins in both upper （lower） limbs.Patients were divided into VTE group and non VTE group according to the study criteria.Baseline data were collected，including age，gender，heart rate，D-dimer，Padua prediction score，platelet，MPV，platelet distribution width，platelet thrombocytocrit and mean red blood cell volume.For identifying the risk factors for VTE，baseline parameters were analyzed with univariate Logistic regression initially，then the identified variables with P value less than 0.1 were further analyzed with multivariate Logistic regression.ROC curve analysis was carried out to assess the predictive value of Padua prediction score，MPV，and the combination of the two for VTE.Results　There were statistically significant differences in mean Padua prediction score and MPV between VTE and non-VTE groups （P<0.01）.Multivariate Logistic regression analysis showed that Padua prediction score〔OR=1.930，95%CI（1.326，2.809），P=0.001〕and MPV 〔OR=2.566，95%CI（1.482，4.444），P=0.001〕were the influencing factors for VTE.For predicting VTE，the AUC of Padua prediction score was 0.723 〔95%CI （0.607，0.839）〕，with 4.5 for optimal cut-off value，0.600 for sensitivity，0.815 for specificity，and 0.41 for Youden index.The AUC predicted by MPV was 0.771 〔95%CI （0.661，0.881）〕，with 10.35 fl for optimal cut-off value，0.655 for sensitivity，0.852 for specificity，and 0.51 for Youden index.When Padua prediction score ≥4.5 and MPV ≥10.35 fl，the sensitivity was 0.350，the specificity was 1.000，and the Youden index was 0.35.When Padua prediction score ≥4.5 or MPV ≥10.35 fl，the prediction sensitivity was 0.910，with 0.700 for specificity，and 0.61 for Youden index.Analysis with Z scoring model developed based on the multivariate Logistic regression model using the algorithm of Z=-22+ Padua prediction score+ 2×MPV showed that the AUC of the Z score was 0.851〔95%CI （0.754，0.947）〕，and when Z ≥1.90，the Youden index was 0.63.Conclusion　 Both Padua prediction score and MPV are associated with VTE in non-surgical inpatients with D-dimer >500μg/L，but each has unsatisfactory predictive value.The Z scoring model developed based on the multivariate Logistic regression model proved that the predictive value of the combination of the two may be higher.Padua prediction score ≥4.5 in combination with MPV ≥10.35 fl has high specificity，which may be used as a clinical method for the diagnosis of VTE.

Health Literacy in Young and Middle-aged Gout Patients in Northeastern China：a Qualitative Study　

LIU Xiufang，LIU Li，ZHOU Yuqiu

2020, 23(15): 1916-1920. DOI: 10.12114/j.issn.1007-9572.2019.00.403

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Background　Gout is a metabolic disease，which may induce multi-organ disease，such as kidney and cardiovascular diseases.Influencing factors of gout incidence and prognosis have been revealed，but qualitative studies of the overall gout awareness and health literacy in gout patients are rare.Objective　To explore the health literacy，general perceptions and needed gout-related information in young and middle-aged gout patients in northeastern China，providing theoretical basis for enhancing gout health literacy，self-management ability，and quality of life in such a population in China.Methods　Participants were young and middle-aged patients with a definite diagnosis of gout recruited from Daqing Oil Field General Hospital，Daqing People's Hospital，and Daqing Fifth People's Hospital.13 patients were recruited after information saturation.Data of them were collected by unstructured and semi-structured interviews，and were analyzed with Colaizzi's phenomenological method of data analysis.Results　The themes were refined as follows：self-perceived gout status（perceptions and awareness of gout were poor，severe pain would affect the quality of life of patients with gout，self-perceived causes of gout onset and aggravation were Eating habits and lifestyle，etc），heath-seeking behaviors and experience（including lack of understanding of gout at the initial onset，poor heath-seeking experience，and so on），pharmacological management plan of gout（ low compliance of drug selection，awareness of treatment plan and poor response），non-pharmacological management plan of gout（modification of life style，interactive social resources of gout，and gout information mining and other interactive and critical health literacy of gout）．Conclusion　Due to relatively low health literacy level，very limited ways for gaining gout-related knowledge，one-sided judgment of gout conditions and treatment，young and middle-aged gout patients in northeastern China are inefficient in dealing with gout，which in turn hinders the medical decision-making.To improve the prognosis，it is necessary to enhance the health literacy and understanding of gout of the patients according to their needs and specific weak aspects.

Clinical Manifestations and Gene Mutations of Children with Glycogen Storage Disease　

LI Yuan，TIAN Yunfen

2020, 23(15): 1921-1927. DOI: 10.12114/j.issn.1007-9572.2019.00.666

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Background　Hepatic glycogen storage disease（HGSD） is a rare group of hereditary glycometabolism disorders involving the liver.All types of HGSD have similar clinical manifestations.Gene detection has replaced enzymatic diagnosis requiring liver biopsy，provides a reliable basis for the diagnosis，classification and treatment of HGSD.Objective　To study the clinical characteristics and gene mutation in children with HGSD.Methods　Six children diagnosed with HGSD on the basis of clinical manifestations and laboratory examinations were recruited from Department of Pediatrics，the First People's Hospital of Yunnan Province from 2015 to 2018.Next generation sequencing was used to directly sequence the exons of related genes of HGSD and to compare them with the reference sequences to find possible gene mutations.The clinical manifestations，signs，laboratory results，gene test results，treatment and prognosis of the children were summarized.Results　Hepatomegaly，hypoglycemia，and increased ALT，triacylglyceroll and actic acid were found in all cases，elevated uric acid in 4 cases，and elevated cholesterol in 2 cases.Urinary protein was found in 4 cases.Positive urine ketones and suspected positive urine ketones were found in 4 cases，1 case，respectively.Four cases had short stature.Three cases were found with G6PC mutations，and 2 of them had c.648G>T homozygous mutations，the other 1 had c.262 delG/ c.648 G>T compound heterozygous mutations，but all of them were diagnosed with HGSD type Ⅰa.One case did not undergo the gene testing due to death，but her parents were detected with a heterozygous mutation of G6PC gene，c.49delCinsGTA and c.262delG，respectively，suggesting that she had HGSD type Ⅰa.One case was detected with SLC37A4 gene compound heterozygous mutations：c.1109G>A/c.572C>T，and was diagnosed with HGSD type Ⅰb.Homozygous mutation of c.579delC in AGL gene was detected in 1 case and confirmed as HGSD typeⅢ.Conclusion　This group of HGSD patients had hepatomegaly，hypoglycemia，hyperlipidemia and elevated ALT，generally accompanied by high lactic academia，hyperuricemia，positive urinary ketones and short stature.HGSD type Ⅰa was the most common type（4 cases），and the G6PC mutation type was c.648G > T，c.262delG mutation；1 case was GSD typeⅠb.SLC37A4 c.572C > T mutation is a common mutation in Chinese，but c.1109G > A mutation is newly discovered.One case had HGSD type Ⅲ，with c.579delC mutation of AGL gene as a known pathogenic mutation.

Effect of National Metabolic Management Center in the Management of Diabetes　

YIN Huihui，DU Jianling，WANG Aihong，MEN Lili，CHEN Zhengnyu，AN Li

2020, 23(15): 1928-1932. DOI: 10.12114/j.issn.1007-9572.2019.00.741

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Background　The incidence of diabetes in China is growing rapidly，and is increasingly occurring in young people.Diabetes and diabetes-related complications impair patients' quality of life，and impose great economic burden on patients' families and society.Scientific management is essential to the prevention，and control of diabetes-related complications incidence and development.The national metabolic management center（MMC），a new management mode developed recently，can effectively management diabetic patients.Objective　To evaluate the management effect of MMC in patients with diabetes.Methods　By use of convenience sampling，140 diabetic inpatients were recruited from Department of Endocrinology，the First Affiliated Hospital of Dalian Medical University from July 2017 to January 2019，and were stratified into the control group（n=70），and experimental group（n=70）.Both groups received routine comprehensive assessment after admission and routine post-discharge individual guidance，and the experimental group additionally received MMC during the post-discharge follow-up period.Intervention results were evaluated by self-management level assessed by the Summary of Diabetes Self-Care Activities（SDSCA） measure at the end of 1-year intervention，and 3 glycemic parameters〔fasting plasma glucose（FPG），2-hour postprandial glucose（2 hPG），glycosylated hemoglobin（HbA1c）〕，and 4 lipid parameters〔triacylglycerol（TG），total cholesterol（TC），high-density lipoprotein cholesterol（HDL-C） and low-density lipoprotein cholesterol（LDL-C）〕 measured at the end of 6-month and 1-year intervention.Results　After excluding 9 cases who lost to follow up，the remaining 131 cases（66 in the experimental group and 65 in the control group） were included in the analysis.After 1 year of intervention，the experimental group obtained much better results in terms of diet control，exercise，blood glucose monitoring，foot care，drug compliance and SCSCA scale score（P<0.05）.The main effects of the period and mode of intervention on FPG，2 hPG and HbA1c were significant（P<0.05）.And there was interaction between the period and mode of intervention on FPG，2 hPG and HbA1c（P<0.05）.After 1 year of intervention，TG and LDL-C levels in the experimental group were more lower（P<0.05），but TC and HDL-C levels were similar in both groups（P>0.05）.Conclusion　 Routine management plus MMC enhances the self-management level，reduces the levels of FPG，2 hPG and HbA1c，and improves TG and LDL-C levels in diabetic patients.

Effects of Community-based Interventions in Mixed Hyperlipidemia　

TU Hongliang

2020, 23(15): 1932-1935. DOI: 10.12114/j.issn.1007-9572.2020.00.254

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Background　Combined hyperlipidemia is the most common type of abnormal lipoprotein metabolism or transport in the general population with dyslipidemia in China.A series of clinical studies at home and abroad have confirmed that mixed hyperlipidemia is an important cause of atherosclerotic cardiovascular disease（ASCVD），such as coronary heart disease，stroke and peripheral vascular disease.To prevent and control chronic disease at primary care level，it is essential for community general practitioners（GPs） to conduct comprehensive interventions including lifestyle intervention and medication selection according to related guidelines.Objective　To explore the effects of community-based interventions in mixed hyperlipidemia.Methods　329 eligible patients with mixed hyperlipidemia were recruited from Fangshan Community Health Center during March 2014 to September 2018，including healthcare seekers and physical examinees，as well as downward referrals from specialty hospitals.They were divided into low-to-medium risk group（n=204），high risk group（n=93） and extremely high risk group（n=32） by the baseline plasma lipid level according to the criteria defined in Chinese Guidelines on Prevention and Treatment of Dyslipidemia in Adults（2016 Revision）.All participants received multiple comprehensive interventions from community GPs，such as diet regulation，appropriate exercise，drug treatment，health education and so on.The patients were followed up for 12 months to observe the improvement of adherence to treatment，plasma lipid indices（TC，LDL-C，HDL-C，and TG） and BMI.Results　The adherence to treatment in all participants after intervention was better than before（Z=256.206，P<0.05）.The mean levels of post-intervention TC，LDL-C and TG were all lower than the baseline levels（P<0.05）.However，there was no significant difference between mean pre-and post-intervention HDL-C levels（P>0.05）.The mean BMI in extremely high risk，high risk and low-to-medium risk groups after intervention improved significantly after intervention（Z=30.019，230.882 and 184.877，respectively，P<0.01）.Conclusion　Through comprehensive interventions，such as community health education，scientific lifestyle intervention and rational selection of lipid-lowering drug treatment，the adherence to treatment，plasma lipid indices and BMI in people with mixed hyperlipidemia were effectively improved.The interventions are worthy of community promotion.

An Obesity Epidemic among Primary and Middle School Students in Minhang District，Shanghai：a Survey of Body Mass Index and Distribution Characteristics　

TAN Linglin，YU Feng，ZHANG Zhiruo，CHEN Qian，HU Xingyu，ZHANG Jing

2020, 23(15): 1936-1941. DOI: 10.12114/j.issn.1007-9572.2019.00.822

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Background　As Shanghai experiences a rapid economic development，it is also facing an obesity epidemic among students.Therefore，understanding the distribution of body mass index（BMI） and the prevalence of obesity among students in Shanghai is of great importance for revising China's standard definition for child obesity and delivering precise interventions for obesity children.Objective　To analyze BMI distribution characteristics and obesity epidemic in students from Shanghai's Minhang District，providing scientific evidence for the development of health policies concerning obesity control in primary and middle school students in China.Methods　Participants were 95 360 primary and middle school students（49 926 boys and 45 434 girls） selected from those undergoing physical examination in Minhang District in 2016.All of them had a complete record of demographic，height and weight data，and aged 84 months（7 years） and over but younger than 216 months（18 years）.The fitted growth curve of BMI percentiles was graphed by the generalized additive modelling of location，scale，and shape technique，and was compared with the fitted BMI percentile curves from nine cities' data obtained in 2005（the nine cities being Beijing，Harbin，Xi'an，Shanghai，Nanjing，Wuhan，Guangzhou，Fuzhou and Kunming which were censored for the 2005 Chinese Students' Physique and Health Survey conducted by the Ministry of Education）.The rates of standardized overweight，obesity and overweight-obesity were calculated by the norm levels of the 7-18-year-old population in the 2010 Chinese Census，and were compared with those of both 7-18-year-old girls and boys in cities with a majority of Han population obtained in 2014（the sample data taken from the 2014 Chinese Students' Physique and Health Survey conducted by the Ministry of Education）.Results　The BMI percentile curves of both boys and girls showed a rising trend with age.In the same percentiles，boys' BMI curves were all higher than those of girls without cross.Compared with the fitted BMI percentile curves from nine cities' data obtained in 2005，the same trend was observed that the BMI rose with the increase of age for both boys and girls.However，at the same age，the BMI of these students in Minhang District were all higher than those from the nine cities' data.The standardized overweight rates，obesity rates，and overweight-obesity rates of male students in Minhang District were 15.9%，20.6%，and 36.5% respectively，while those of female students were 7.8%，12.8 %，and 20.6%，respectively；both were higher than the average level in cities with a majority of Han population in 2014.At the primary school level（age group of 7–11 years），the standardized overweight-obesity rates in boys were higher in public schools and category Ⅰ private schools than in category Ⅱ private schools（χ2=124.36，39.88，respectively，both P<0.001）.The standardized overweight-obesity rates in girls were higher in public schools than in category Ⅰ and category Ⅱ private schools（χ2=12.87，43.78，respectively，both P<0.05）.At the middle school level（age group of 12-18 years），standardized overweight and obesity rates for boys were significantly higher in categoryⅠ private schools than they were in public schools（χ2=15.08，P<0.05）.However，no difference was observed among girls across categoryⅠ private schools and public schools（χ2=1.91，P=0.17）.Conclusion　Based on the data from the primary and middle school students in Minhang District，Shanghai，the BMI percentile curve rose as age increased for both genders.The BMI curves for boys were higher than those for girls in the same percentile.In addition，the overweight and obesity rates were higher in boys.Corresponding community-school-family linked interventions should be carried out as soon as possible to lay an early and solid foundation for reducing the prevalence of chronic diseases in adults in China.

Prevalence and Influencing Factors of Pulmonary Tuberculosis in Maintenance Hemodialysis Patients in Hainan Province，2017　

CHEN Ruman，AN Na，XU Mingzhi，FENG Haihuan，LI Hong

2020, 23(15): 1942-1949. DOI: 10.12114/j.issn.1007-9572.2020.00.147

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Background　Chronic kidney disease（CKD） patients are a major population prone to pulmonary tuberculosis due to decreased cellular and humoral immunity caused by pre-uremia immunosuppressive treatment and multiple factors in uremia.Hainan Province is a high incidence area of pulmonary tuberculosis in China，but there is lack of long-term pulmonary tuberculosis prevalence data among hemodialysis patients in this region.Objective　To investigate the epidemiological status and influencing factors of pulmonary tuberculosis in maintenance hemodialysis （MHD） patients in Hainan Province in 2017，to find a breakthrough in further tuberculosis prevention and control.Methods　Participants were 2 385 patients undergoing MHD in the blood purification center / room of 33 secondary and tertiary hospitals in Hainan during January 1 to December 30，2017.They were invited to attend a survey conducted by well-trained medical quality controllers from the blood purification center / room of the above-mentioned hospitals using a self-administered questionnaire developed by Hainan Provincial Blood Purification Quality Control Center for investigating their demographic and clinical as well as imaging data.The survey results were registered by the controllers.Results　A total of 1 917 responsive questionnaires were collected，obtaining a return rate of 80.37%.Of the 1 917 respondents，by chest CT scan，457 （23.84%） were detected with negative findings，336（17.53%） with inactive tuberculosis，1 045（54.51%） with suspected pulmonary tuberculosis，and 79（4.12%） with pulmonary tuberculosis.The results of chest CT scan varied significantly by sex，age，type of medical insurance，primary renal disease and geographical distribution （P<0.05）.The results of chest CT scan in age group of ≤44 years were significantly different from those of age groups of 45-59，60-74，and 75-89（P<0.05）.The results of chest CT scan showed a significant difference between age groups of 45-59 and 75-89（P<0.05）.The results of chest CT scan also demonstrated a significant difference between those with urban resident basic medical insurance and those with basic medical insurance for employees（P<0.05）.Those with primary glomerulonephritis-induced uremia showed significantly different results of chest CT scan compared with those with diabetic nephropathy-induced uremia（P<0.05）.Significantly different results of chest CT scan were found between patients from northern Hainan and those from eastern，southern and central Hainan（P<0.05），and between patients from eastern Hainan and those from southern and western Hainan（P<0.05），and between patients from southern Hainan and those from central Hainan（P<0.05），as well as between patients from western Hainan and central Hainan（P<0.05）.Age 〔OR=1.492，95%CI （1.303，1.709）〕，geographical distribution 〔northern Hainan：OR=5.299，95%CI （3.493，8.038）；southern Hainan：OR=2.320，95%CI （1.469，3.663）；western Hainan：OR=3.817，95%CI （2.454，5.937）〕were factors associated with suspected pulmonary tuberculosis（P<0.05）.Age〔OR=1.373，95%CI （1.160，1.625）〕，geographical distribution 〔northern Hainan：OR=3.739，95%CI （2.219，3.299）；southern Hainan：OR=1.929，95%CI （1.079，3.448）；western Hainan：OR=2.332，95%CI （1.327，4.100）〕 were factors associated with inactive pulmonary tuberculosis （P<0.05）.Gender〔OR=2.073，95%CI （1.172，3.665）〕，age〔OR=1.944，95%CI （1.466，2.578）〕，geographical distribution〔northern Hainan：OR=5.103，95%CI （1.710，15.224）〕；southern Hainan：OR=4.650，95%CI（1.458，14.828）；western Hainan：OR=3.260，95%CI （1.004，10.579）〕were factors associated with pulmonary tuberculosis （P<0.05）.Conclusion　Chest CT scan showed that in Hainan in 2017，the prevalence of pulmonary tuberculosis was 4.12% in MHD patients.And MHD patients with suspected and confirmed pulmonary tuberculosis accounted for 56.83% of the total tuberculosis cases in the province.Oder age，male，and having medial insurance were associated with higher prevalence of pulmonary tuberculosis.Nephropathy-induced uremia increased the risk of having pulmonary tuberculosis compared with primary glomerulonephritis-induced uremia.Central Hainan was associated with lower risk of having pulmonary tuberculosis and suspected pulmonary tuberculosis.Age and geographical distribution were associated with suspected，and inactive as well as confirmed pulmonary tuberculosis.Moreover，sex was also associated with pulmonary tuberculosis，which also should be paid attention to.

Prevalence and Influencing Factors of Metabolic Syndrome among Kazakh Herdsmen in Xinjiang Pastoral Area　

WANG Jiawei，FAN Qiongling，LUO Yuanyuan，ZHAN Huaifeng，WANG Hongjun，CHEN Rui，XU Yuezhen，TAO Ning，YOU Shuping

2020, 23(15): 1950-1955. DOI: 10.12114/j.issn.1007-9572.2020.00.098

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Background　It is estimated that increasing prevalence of metabolic syndrome （MS） will cause a heavy disease burden in the future.Studies have shown that the incidence of cardiovascular events in patients with metabolic syndrome is 5.5 times higher than that in those without MS during a 5-year follow-up.Therefore，intensive studying the risk factors of MS in a given area is conducive to improving the overall quality of life of the area.Objective　To explore the prevalence and influencing factors of MS among Kazakh herdsmen in Xinjiang pastoral area.Methods　In this cross-sectional study，by use of multistage clustered and stratified random sampling，7 453（≥18 years old） Kazakh herdsmen in Xinjiang pastoral area were recruited during January to October 2018.They received a questionnaire survey，a physical examination and a laboratory test.The age-specific prevalence of MS in this group was standardized in accordance with that of age-matched norm population collected from China's Sixth National Population Census held in 2010，influencing factors of MS among Kazakh herdsmen in Xinjiang pastoral area were discussed.Results　Among the participants，the prevalence rate of MS was 35.11% and the standardized prevalence rate was 33.46%.The trend chi-square test showed that the prevalence of MS increased with BMI increasing （χ2ttrend=1 485 436，P<0.05）.By fitting regression curves for age and the number of MS components，we found that the number of MS components also increased with age increasing，so the derived fitting equation was：y=0.333+0.029x，R2=0.61.After adjusting 3 confounding factors including age，BMI，and education level，multivariate unconditional logistic regression analysis showed that female，meat-rich diet，salt tooth，fatty tooth，smoking，frequent drinking，daily drinking，occasional exercise，no exercise，familial history of hypertension and familial history of coronary heart disease were influencing factors for MS（P<0.05）.Conclusion　The prevalence of MS was high among Kazakh herdsmen in Xinjiang pastoral area，which was mainly influenced by gender，meat and vegetable collocation，salt tooth，fatty tooth，smoking，drinking，physical exercise，familial history of hypertension and familial history of coronary heart disease.

Thoracoscopic Diagnosis and Treatment Procedure for Multiple Ground-glass Nodules in the Lung　

LIU Guangjie，JIA Yuxuan，XU Wenhua，LI Bing，SUN Pengli，LI Lizhe，HAN Yaqing，LIU Qingyi

2020, 23(15): 1956-1960. DOI: 10.12114/j.issn.1007-9572.2020.00.109

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Background　 The detection rate of multiple ground-glass nodules（GGNs） in the lung is increasing with the widening application of spiral CT in lung disease screening and people's increased awareness and participation in physical examination.The management of single ground-glass nodule in the lung can follow the guidelines published by the Fleischner Society and NCCN，but there is no reference for the management of multiple GGNs in the lung.Objective To develop a diagnosis and treatment procedure for multiple GGNs in the lung based on analyzing clinical imaging data and results of CT-guided puncture biopsy of such patients，providing a reference for clinical practice.Methods In this study we summarized the data of 54 patients with multiple GGNs in the lung recruited from Department of Thoracic Surgery，the 4th Hospital of HeBei Medical University from May 2015 to December 2018.All the patients underwent thin-slice chest CT scan and all the GGNs were marked and the dominant lesions were figured out by characteristics of the lesions，including shape，density，diameter and proportion of solid components.Afterwards，CT guided puncture biopsy was performed according to the location and characteristics of the GGNs，and treatment strategies were formed accordingly.Results A total of 140 GGNs lesions were detected in the 54 patients，including 58 dominant lesions and 82 non-dominant lesions.CT-guided puncture was performed in 15 unilateral cases and 10 bilateral cases.Puncture pathology results proved that there were 20 cases of adenocarcinoma，12 cases of lepidicpredominant tumor，and 3 cases of benign tumor.Seven cases did not undergo surgery（including 2 receiving targeted drug therapy，3 with benign lesions found by biopsy，and 2 receiving radiofrequency ablation），other 47 underwent thoracic surgery，but all of them were discharged after successful treatment.A total of 50（86.2%） dominant lesions and 35（42.7%） non-dominant lesions were resected.Finally，19 cases of synchronous multiple primary lung cancer，26 cases of primary lung cancer，1 case of atypical epithelioid nodule and 1 case of atypical adenomatous hyperplasia（AAH） were diagnosed.At the same time，there were other 55 GGNs were followed up.All patients were followed up from 2 to 43 months and were all in good health.Conclusion According to the imaging data and the pathological results of CT guided puncture，appropriate surgical strategy can be worked out for multiple GGNs before surgery，so that reasonable diagnosis and treatment be made up to avoid unnecessary surgery.

Clinical Features and Diagnosis and Treatment of Ectopic Hydatidiform Mole in Early Pregnancy：Report of Two Cases　

LI Chanjuan，ZHOU Caiyun

2020, 23(15): 1961-1965. DOI: 10.12114/j.issn.1007-9572.2019.00.681

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Ectopic hydatidiform mole can cause serious complications in clinical practice.Its incidence is extremely low，and it is easily to be missed and misdiagnosed.This article reports the clinical manifestations and pathological findings of two cases with ectopic hydatidiform mole.The first case was partial hydatidiform mole，and the second case was complete hydatidiform mole with cervical malignant tumor.Both cases were clinically characterized and firstly treated as ectopic pregnancy，resulting in misdiagnosis and therapeutic error.Both cases were treated by operation，and hydatidiform mole was diagnosed by pathological examination after the operation.After the follow-up and additional treatment，both cases were cured.Both the diagnosis and treatment of two cases were insufficient.Combined with relevant literature，this paper analyzes and summarizes medical records to expound typical clinical manifestations and the latest treatment progress of ectopic hydatidiform mole，in order to arouse the attention of clinicians and provide support for its early diagnosis and treatment.

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