Chinese General Practice

Development and Value Evaluation of a Simple Prediction Model of Suicidal Behavior in Depressive Disorder　

LU Heli，TANG Jun，HUANG Zewen，ZOU Qing，GUO Ming，HUANG Xiaoqin，HU Feihu

2020, 23(26): 3247-3252. DOI: 10.12114/j.issn.1007-9572.2020.00.430

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Background　The depression disorder is one of the most common mood disorders，with characteristics of high morbidity，recurrence rate，disability rate and mortality，imposing a huge burden of disease on the patients，even leading to suicide.However，means for rapidly screening of suicidal behavior in patients with depressive disorder are relatively limited.Objective　To develop a simple prediction model for suicidal behavior in patients with depressive disorder using identified associated psychosocial factors of suicidal behavior，offering a reference for the prevention and treatment of suicide behavior in such patients.Methods　By use of cluster sampling，depressive disorder patients treated in the Second Affiliated Hospital of Nanchang University and the First Affiliated Hospital of Nanchang University of Nanchang from January to December 2018 were recruited.The General Information Questionnaire developed by our research group，Zung Self-rating Depression Scale（SDS），Zung Self-Rating Anxiety Scale（SAS）and Landeiman Social Support Scale were used to gather sociodemographic data，prevalence of depression and anxiety and social support information，respectively.Multivariate logistic regression was used to screen the risk factors for suicidal behaviors.Risk scoring measuring the effect of factors on suicidal behaviors was used to develop the prediction model.Results　The survey obtained a response rate of 93.60%（2 090/2 233）.The prevalence of suicide attempt was 6.79%（142/2 090）.Frequent smoking，heavy drinking，having one or more depressive episodes，having one or more hospitalization due to depressive disorder，presence of coexisting anxiety symptoms，psychotic symptoms，and suicidal ideas，family history of mental disorders，antidepressant use，and prevalence of other internal and surgical diseases were associated with a high risk of suicide attempts（P<0.05）.Multivariate Logistic regression analysis showed that the number of previous depressive episodes≥1〔OR=4.308，95%CI（3.547，5.232）〕，coexisting anxiety symptoms〔OR=2.329，95%CI（1.201，4.518）〕，coexisting psychotic symptoms〔OR=2.492，95%CI（1.448，4.287）〕，coexisting suicidal ideas 〔OR=4.044，95%CI（2.305，7.096）〕，and high SAS standard score〔OR=1.036，95%CI（1.003，1.071）〕 were risk factors for suicide attempts（P<0.05），while antidepressant use〔OR=0.110，95%CI（0.057，0.212）〕was associated with decreased risk of suicidal attempts（P<0.05）.The risk score model established based on Logistic regression results is：risk score=40.56×previous depressive episodes+23.50×coexisting anxiety+25.36×coexisting psychotic symptoms+38.81×coexisting suicidal idea-61.25×antidepressant+1.00×SAS standard score.The AUC of the model in predicting suicide was 0.920〔95%CI（0.907，0.931）〕，and when the cut-off value was determined as 193.23，the Youden's index was 0.7，reaching the maximum value，with a sensitivity of 76.8%，and a specificity of 94.2%.Conclusion　The prevalence of suicide attempts in patients with depressive disorder is high，the number of previous depressive episodes≥1，coexisting anxiety symptoms，coexisting psychotic symptoms，coexisting suicidal ideas，and high SAS standard score were risk factors for suicide attempts. The risk score prediction model based on Logistic regression was 76.8% in sensitivity and 94.2% in specificity.

Application of Artificial Intelligence Technologies in Depression and Suicide Management　

YUAN Fan，YU Sihong，YANG Bingxiang，HUANG Zhisheng，RUAN Juan

2020, 23(26): 3253-3257. DOI: 10.12114/j.issn.1007-9572.2020.00.165

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Depression is a common mental disorder characterized by high incidence，high risk for disability and suicide，which brings great harm to individuals，families and society.Moreover，it is relatively difficult to diagnose，treat，monitor and manage for its subtle onset and long course as well as the sufferers' poor help-seeking behaviors.The recently emerged artificial intelligence technologies have become a new way for the management of depression and depression-related suicide.Based on the challenging situations，achievements that have been made in the diagnosis and management of depression，and monitoring and management of depression-related suicide using artificial intelligence technologies were discussed，which could be the reference for further studies about depression.

Rumination and Severity of Depression，Executive Function in Unmedicated Depressed Patients　

ZHOU Jun，XIE Liqin，LI Chunwang，LIAO Aijun，CHEN Xiaogang

2020, 23(26): 3258-3262. DOI: 10.12114/j.issn.1007-9572.2020.00.366

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Background　Cognitive impairment is one of the important causes of incapacitation for work in depressed patients.Some domestic studies have suggested that rumination is related to cognitive function in normal population，but few studies have evaluated the relationship between rumination and executive function，a core component of cognitive function，in depressed patients.Objective　To investigate the relationship between rumination and severity of depression，executive function in unmedicated depressed patients.Methods　116 unmedicated depressed patients from Psychiatric Department，the Second Xiangya Hospital of Central South University were enrolled by convenient sampling method from September 2017 to April 2019.The Chinese version of the Ruminative Response Scale（RRS-C），17-item Hamilton Depression Rating Scale（HDRS）and Wisconsin Card Sorting Test（WCST）were used to measure patients' rumination，executive function and depression，respectively.Pearson correlation analysis was used to explore the correlation of rumination with depression severity and executive function，respectively.Results　The RRS-C score of the patients ranged from 37 to 85 points〔average score：（64.1±12.5）points〕.And the HDRS score ranged from 18 to 36 points〔average score：（23.3±5.1）points）〕.The HDRS score was positively correlated with RRS-C score（r=0.480，P<0.001）， symptom rumination score（r=0.688，P<0.001）， responses administered（r=0.278，P=0.004），total number of errors （r=0.329，P=0.001）and the number of perseverative errors（r=0.311，P=0.001）during the WCST，but was negatively correlated with the categories completed（r=-0.299，P=0.002）.Conclusion　The rumination level of unmedicated depressed patients is higher，which is positively correlated with the severity of depression but negatively correlated with the executive function.

Association of Serum Ghrelin Level with Type 2 Diabetic Peripheral Neuropathy　

TIAN Luobing，XU Gang，ZHANG Yazhong，DING Yi，TIAN Jinli，WANG Li，FANG Hui

2020, 23(26): 3263-3267. DOI: 10.12114/j.issn.1007-9572.2020.00.424

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Background　Ghrelin is a kind of endogenous gastrointestinal peptide hormones，which may improve diabetic nerve damage.But few human in vivo studies are about the relationship between ghrelin and diabetic peripheral neuropathy （DPN）.DPN has different stages including subclinical and symptomatic DPN with the development of the disease in clinical practice，and the role of ghrelin in each stage of DPN is unclear.Objective　To explore whether serum ghrelin plays a role in each stage of DPN in type 2 diabetics.Methods　Participants were 247 type 2 diabetics who were recruited from Tangshan Gongren Hospital from July 2017 to December 2018，and were divided into non-DPN group （n=129），subclinical DPN group（n=57） and definite DPN group （n=61） according to DPN diagnostic criteria in 2017 Chinese Guidelines for the Prevention and Treatment of Type 2 Diabetes.Serum ghrelin levels in the three groups were compared.Pearson correlation analysis，Spearman rank correlation analysis or partial correlation analysis was used to analyze the relationship of ghrelin level with clinical data.Multivariate Logistic regression was used to identify the influencing factors of abnormal nerve conduction function，subclinical DPN and definite DPN.Results　There were significant differences in average serum ghrelin levels among the three groups （P<0.05）.Non-DPN group showed higher average level of serum ghrelin than other two groups （P<0.05）.The average serum ghrelin level of definite DPN group was decreased than that of subclinical DPN group （P<0.05）.Serum ghrelin decreased with the increase of diabetic duration，BMI and HOMA-IR by Pearson correlation analysis （all P<0.05）.Serum ghrelin was still negatively correlated with BMI and HOMA-IR （all P<0.05），but no longer correlated with diabetic duration （P>0.05） revealed by partial correlation analysis.Increased diabetic duration and HbA1c，as well as decreased serum ghrelin were independent risk factors for abnormal nerve conduction function，subclinical DPN and definite DPN in multivariate Logistic regression analysis （P<0.05）.Conclusion　Decreased serum ghrelin level is significantly associated with subclinical DPN and definite DPN in patients with type 2 diabetes，and is a risk factor for abnormal nerve conduction function，subclinical DPN and definite DPN.

Clinic Research of Early Continuous Renal Replacement Therapy on the Prognosis of Severe Multiple Trauma Patients Complicate with AKI　

PENG Yan，ZOU Xinsen

2020, 23(26): 3268-3273. DOI: 10.12114/j.issn.1007-9572.2020.00.108

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Background　Severe multiple trauma due to systemic inflammatory response syndrome，tissue damage，shock，and even the use of vascular active drugs lead to morbidity of acute kidney injury（AKI）is as high as 18%-26%，which influence with the prognosis of patients，and continuous renal replacement therapy（CRRT） is widely used as prevention and treatment of acute renal injury treatment，but at the moment of intervention time for severe multiple trauma patients complicated with acute kidney injury is still uncertain.Objective　To investigate the effect of continuous renal replacement therapy at different time on the prognosis of severe multiple trauma patients complicated with AKI.Methods　90 patients with severe multiple injuries complicated with AKI admitted to the department of critical care in the first affiliated hospital of chongqing medical university from May 2015 to May 2018 were selected as the research objects.all cases were divided into observation group and control group with using random sampling method，There were 45 cases in each group.The observation group were received 24h CRRT treatment during the RIFLE grading I stage after AKI，and the control group were received 24 h CRRT treatment during the RIFLE grading F stage after AKI.Sodium citrate or heparin-free treatment were given during CRRT 24 h.The general clinical data of the patients after admission，the surgical status and shock status of the patients before CRRT，the use of a large number of vasoactive drugs，the indicators related to systemic inflammatory response syndrome of the patients，and the prognostic indicators of the patients within 10 days after surgery were recorded.Results　Gender，age，serum creatinine，score of trauma severity，and cause of injury are not significantly different between the control group and the observation group（P>0.05）.There is no significant difference in the ratio of head/neck，face，chest，abdomen/pelvic cavity between the two groups（P>0.05），but there is significant difference in the ratio of limbs（P<0.05）.There are no statistically significant difference between the two groups in preoperative CRRT surgery，shock and use of a large number of vasoactive drugs（P>0.05）.There were no statistically significant differences in body temperature，systolic blood pressure，respiratory frequency，pulse，PCO2 and white blood cell count between the two groups before and after treatment（P>0.05）.There were no statistically significant differences in body temperature and systolic blood pressure between the two groups before and after treatment（P>0.05）.there are statistically significant difference in the respiratory frequency，pulse，PCO2 and white blood cell count of the two groups before and after treatment were compared.（P<0.05）.compared to control group，there are statistically significant difference in indexes of patients had complete recovery of renal function underwent CRRT again，developed multiple organ dysfunction syndrome，and died of multi-organ dysfunction syndrome within 10 days inobserve group.（P<0.05）.Conclusion　The patients with severe multiple trauma complicate with AKI were treated with CRRT earlier can effectively promote renal function recovery，prevent MODS and improve prognosis.

Clinical Characteristics of Patients with Cardiovascular Disease and Chronic Pulmonary Disease Complicated with Atrial Fibrillation　

LIU Xiang，XIANG Li，ZHANG Lan，TONG Guangming

2020, 23(26): 3274-3279. DOI: 10.12114/j.issn.1007-9572.2020.00.057

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Background　Atrial fibrillation is an independent risk factor for cerebral infarction.With the introduction of new anticoagulants in recent years，the anticoagulation ratio in patients with cardiovascular disease and atrial fibrillation has gradually increased，and the incidence of cerebral infarction shows the downward trend.However，relatively few reports on the incidence of cerebral infarction and current status of anticoagulant therapy in chronic pulmonary patients with atrial fibrillation are available.Objective　To explore the clinical characteristics of patients with cardiovascular disease and chronic pulmonary disease complicated with atrial fibrillation in the same period of admission and the incidence of long-term cerebral infarction among them，and to evaluate the incidence of cerebral infarction and anticoagulation status in patients with chronic pulmonary disease and atrial fibrillation，in order to provide the early intervention and improve the prognosis.Methods　287 Patients with persistent or permanent atrial fibrillation admitted to the Second Affiliated Hospital of Soochow University were selected prospectively and continuously as the study subjects from June 2012 to May 2013.According to the main complications，the subjects were divided into the cardiovascular disease group（combined with cardiovascular diseases，n=162） and the lung disease group（combined with chronic pulmonary diseases，n=125）.The general data of patients，blood examination results in the early morning of the day after admission，echocardiographic data and CHA2DS2-VASc scores were recorded.The patients were followed up for a period of five years，and the use of anticoagulants and the incidence of cerebral infarction were recorded.Results　The age，proportion of male，resting heart rate，heart failure proportion，right atrial long axis diameter，right atrial short axis diameter，right ventricular diameter（RVD） of basal segment，pulmonary artery pressure，prothrombin time（PT），D-dimer，international normalized ratio（INR），NT-proBNP，CHA2DS2-VASc scores and proportion of CHA2DS2-VASc scores≥4 in the lung disease group were higher than those in the cardiovascular disease group，while the level of thrombin Ⅲ was lower（P<0.05）.There was no significant difference in the use of anticoagulants between the two groups（P=0.208）.The proportion of clopidogrel，ACEI/ARB and amiodarone in the cardiovascular disease group was higher than that in the lung disease group（P<0.05）.During five consecutive years of follow-up，16（9.9%） patients in the cardiovascular disease group and 29（23.2%） patients in the lung disease group suffered from cerebral infarction.The difference between the two groups was statistically significant（χ2=9.477，P=0.002）.Multivariate Logistic regression analysis showed that age，CHA2DS2-VASc scores，right atrial short axis diameter and pulmonary artery pressure were the risk factors of cerebral infarction in patients with atrial fibrillation（P<0.05）.Conclusion　The incidence of long-term cerebral infarction in patients with chronic pulmonary disease and atrial fibrillation is high during the same period of admission，and these patients have high CHA2DS2-VASc scores，right atrial diameter（RAD），RVD and pulmonary artery pressure.For patients with chronic pulmonary disease and atrial fibrillation，anticoagulation indications should be evaluated in time，and corresponding treatment schemes should be strengthened，and the treatment of comorbidities such as heart failure and pneumonia should be emphasized.

Efficacy and Delay of Recurrence in Cough Variant Asthma Patients Treated with Salmeterol/Fluticasone　

XIN Qingfeng，SUN Youli，KANG Meiqing，LI Chaoyan

2020, 23(26): 3280-3285. DOI: 10.12114/j.issn.1007-9572.2020.00.179

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Background　Cough variant asthma （CVA） is an important cause of chronic cough，and pathophysiological features of the disease appear to be similar to typical asthma.Being recognized as the early stage of asthma，CVA is recommended to be treated with anti-inflammatory agents in combination with bronchodilators as early as possible.However，the effect and mechanism of inhaled corticosteroids and β2 agonists in the treatment of CVA has not been elucidated.Objective　To observe the overall efficacy of salmeterol/fluticasone，and its impact on pulmonary function，airway inflammatory markers〔percentage of peripheral blood eosinophils （BER），serum eosinophil cationic protein（ECP），interleukin 5（IL-5）
and MUC5AC〕 and recurrence rate in CVA patients.Methods　52 patients with CVA in ictal phase treated in The Third Affiliated Hospital of Luohe Medical College during June 2016 to December 2017 were recruited and were equally randomized into the control group（orally administered compound methoxyphenamine capsules） and observation group（inhaled fluticasone propionate/salmeterol xinafoate powder）.Both groups were treated for 8 weeks，and were followed up for 24 weeks （8-week treatment plus subsequent 16 weeks without the above-mentioned treatment）.Main outcome measures for the overall efficacy were changes in daytime and nighttime cough symptom scores，FEV1，peak expiratory flow（PEF），percentage of peripheral blood BER，ECP，IL-5 and MUC5AC at the end of 8th and 24th weeks in comparison with the baseline status.Quality of life was measured by the Mandarin Chinese Version of the Leicester Cough Questionnaire（LCQ-MC） at baseline，and at the end of 8th and 24th weeks of intervention.Adverse reactions during treatment and recurrence rate during follow-up were recorded.Results　Except 2 cases in the control group and 3 cases in the observation group who dropped out of the study or were lost to follow up，the other cases were included for final analysis.At the end of 8-week treatment，the observation group showed a higher overall response rate than the control group〔95.6%（22/23） vs 75.0%（18/24）〕（P=0.047）.The mean daytime and nighttime cough symptom scores of the observation group were all lower than those of the control group at the end of 8th and 24th weeks of intervention（P<0.05）.In both groups，the mean daytime and nighttime cough symptom scores decreased after intervention.Specifically，the mean daytime and nighttime cough symptom scores at the end of the 8th week of intervention were much lower compared with the baseline scores，and compared with the scores at the end of 24 weeks of intervention（P<0.05）.In both groups，mean scores of LCQ-MC and its three physical，psychological and social domains increased after intervention，specifically，mean scores of LCQ-MC and physical，psychological and social domains at the end of the 8th week of intervention were much higher compared with the baseline levels，and compared with the levels at the end of the 24th week of intervention（P<0.05）.The observation group showed higher mean scores of LCQ-MC and physical，psychological and social domains than the control group at the end of 8 and 24 weeks of intervention（P<0.05）.At the end of the 8th and 24th weeks of intervention，the ΔFEV1 in the observation group was greater than that in the control group （P<0.05）.In both groups，mean PEF increased after intervention.Specifically，mean PEF at the end of 8 weeks of intervention was much higher compared with the baseline level，and compared with the level at the end of 24 weeks of intervention（P<0.05）.At the end of the 8th week of intervention，the mean PEF of the observation group was higher than that of the control group（P<0.05）.Compared with the control group，the observation group demonstrated lower mean percentage of peripheral blood BER，ECP，IL-5 and MUC5AC at the 8th week of intervention，and demonstrated lower mean IL-5 at the 24th week of intervention（P<0.05）.In the observation group，the mean percentage of peripheral blood BER，ECP，IL-5 and MUC5AC at the 8th week of intervention were lower than the baseline levels，and were lower than the levels at the 24th week of intervention（P<0.05）.The incidence of adverse reactions in the observation group and control group was 13.0% （3/23） and 8.3% （2/24），respectively，without significant difference （P>0.05）.The recurrence rate of the observation group was 26.1% （6/23），which was lower than that of the control group 〔58.3% （14/24）〕（P<0.05）.Conclusion　Inhaling fluticasone propionate/salmeterol xinafoate powder provides further improvements in cough symptoms，quality of life，pulmonary function and airway inflammation in patients with CVA，and may delay the decline of pulmonary functions，rebound of inflammatory markers as well as CVA recurrence caused by the discontinuation of the therapy.

Evaluation of Safety，Efficacy and Hospitalization Cost of Three Neoadjuvant Chemotherapy Regimens for Advanced Gastric Cancer　

AIKEREMU?Yusufu，ABUDUSHALAMU?Yimiti，ZAIYINUER?Abuduwaili，ROUSIDAN?Tuerdi，PAERHATI?Shayimu，WANG Haijiang

2020, 23(26): 3286-3290. DOI: 10.12114/j.issn.1007-9572.2019.00.774

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Background　Nowadays，the advantages of neoadjuvant chemotherapy（NACT） for advanced gastric cancer（AGC） are widely recognized.The diverse exploratory chemotherapeutic regimens also appeared with different curative effects and optimal choice remains inconclusive.Objective　We are aimed at evaluating the safety，efficacy and cost effect of three NACT regimens and providing a basis for the optimal selection of NACT for AGC.Methods　353 patients with AGC treated in Affiliated Cancer Hospital of Xinjiang Medical University from 2011 to 2016，were enrolled retrospectively and classified into three groups based on different NACT regimens（161 for SOX，111 for TOF and 81 for EOF）.SOX group used oxaliplatin and teggio chemotherapy，TOF group used taxol and oxaliplatin and teggio chemotherapy，EOF group used oxaliplatin and epirubicin and teggio chemotherapy.The operative type，toxicity，overall survival and hospitalization cost of three regimens were analyzed to select the optimum regimen.Results　No statistically significant difference was found in radical resection rate among the three groups（χ2=1.368，P=0.505）.The toxic effects were nausea，vomiting，diarrhea，anorexia and leucopenia for the three groups.There were no statistically significant differences in the incidences of nausea，vomiting，diarrhea，anorexia and leucopenia among the three groups（P>0.05）.The median survival times of patients for SOX，TOF and EOF groups were 63 months，81 months and 67 months，respectively.There was no statistically significant difference in overall survival among the three groups（χ2=4.102，P=0.129）.The difference in hospitalization cost of the three groups was statistically significant（F=7.134，P=0.001）.The hospitalization cost of SOX group occupied 78.3% of that of TOF and 69.9% of that of EOF groups.Conclusion　The curative effect and safety of the SOX，DOF and EOF regimens for AGC patients were similar，and the SOX is the economically optimal regimen.

Risk Factors for the Development of Diabetic Kidney Disease in Patients with Type 2 Diabetes　

LI Changyan，LIU Juan，GU Fang，TANG Mingmin，HU Jingjing，OU Santao

2020, 23(26): 3291-3296. DOI: 10.12114/j.issn.1007-9572.2020.00.301

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Background　20% to 40% of patients with diabetes clinically develop diabetic kidney disease（DKD）.The main clinical manifestations of DKD are trace proteinuria and negative changes in renal function.The glomerular filtration rate（GFR） is an indicator of kidney function.In diabetic patients，the relationship of renal function with interventricular septal thickness（IVST） has been confirmed，but its relationship with left ventricular wall thickness（LVWT） is not clear.Objective　To investigate the development of DKD in patients with type 2 diabetes mellitus.Methods　A retrospective analysis was performed on the clinical and laboratory data of patients with type 2 diabetes mellitus who received treatment in 2008 and 120-month follow-up（as of December 31，2018） from Chengdu Fifth People's Hospital.Those with significantly increased albuminuria 〔defined as 24-hour urinary albumin excretion>500 mg/d and GFR<50 ml/min〕 and those without during the study period were assigned to DKD group，and non-DKD group，respectively.Kaplan-Meier method was used for survival analysis.Log-rank test was used to compare the survival status.Multivariate Logistic regression analysis was used to analysis the influencing factors associated with DKD.ROC analysis was conducted to estimate the value of IVST and LVWT in predicting the development of DKD.Results　A total of 178 were included and 48 of them（26.9%） developed DKD.Compared with those without DKD，those with DKD showed similar sex ratio，mean age，BMI，total cholesterol，LDL，BUN，Scr，sUA，hemoglobin，and HbA1c（P>0.05），but had longer mean duration of diabetes，higher mean systolic blood pressure，fasting blood glucose，LVWT and IVST，and mean lower HDL（P<0.05）.The result of multivariate Logistic regression analysis suggested that IVST 〔OR=4.577，95%CI（2.280，9.188）〕，and LVWT 〔OR=3.805，95%CI（1.917，7.553）〕 were independently associated with the occurrence of DKD（P<0.05）.Log-rank test results showed that increased IVST was associated with higher incidence of DKD either in those with hypertension （n=47）or in those without hypertension （n=131）（P<0.05），and so was increased LVWT（P<0.05）.Correlation analysis showed that LVWT and IVST were positively correlated with 24-hour urinary albumin excretion（P<0.001），and were negatively correlated with GFR（P<0.001）.ROC curve analysis showed that the AUC of IVST in the prediction of the development of DKD was 0.824，with 70.00% sensitivity and 73.64% specificity when the optimal cutoff value was determined as 12.5 mm.And the AUC of LVWT was 0.721，with 60.91% sensitivity and 67.27% specificity when the optimal cutoff value was determined as 11.5 mm.Conclusion　Longer duration of diabetes，elevated systolic blood pressure and fasting blood glucose，decreased HDL，increased LVWT and IVST were found to be associated with the development of DKD in type 2 diabetes，among which increased LVWT and IVST may be independent predictors for DKD in type 2 diabetes mellitus.

Clinical Study of Intravenous Administration of Lidocaine in Acute and Subacute Herpes Zoster-related Neuropathic Pain　

XIE Yanhong，CHEN Xiaoquan，SONG Xudong，CHEN Jing，LI Yonglin，YANG Wuzhou，ZOU Cong，HE Yunwu

2020, 23(26): 3297-3302. DOI: 10.12114/j.issn.1007-9572.2019.00.650

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Background　Herpes zoster-related neuropathic pain is a common disease in pain management department，including herpetic neuralgia （HN） and post-herpetic neuralgia （PHN），seriously affecting the quality of life of patients.The pain should be controlled during the acute or subacute phase in order to reduce the occurrence of PHN.Lidocaine is widely used in clinical practice as a local anesthetic.It has been reported that intravenous administration of lidocaine can be used to treat intractable pain.Objective　To investigate the clinical efficacy of intravenous administration of lidocaine in the treatment of HN.Methods　Eighty HN inpatients （40 in the acute phase and 40 in the subacute phase） were enrolled from March to October 2018 from Department of Pain Management，the Second Hospital of University of South China.According to the duration of HN and treatment regimen，the acute group was equally divided into acute routine subgroup （n=18） treated with Foscarnet Sodium Injection + Gabapentin Capsules + Mecobalamin Dispersible Tablets + Alprazolam Tablets，and acute lidocaine subgroup （n=20）treated with the above-mentioned four drugs + 1%W/V Lidocaine Hydrochloride Injection，and the subacute group was also equally divided into subacute routine subgroup （n=15）treated with Gabapentin Capsules + Mecobalamin Dispersible Tablets + Alprazolam Tablets，subacute lidocaine subgroup （n=17）treated with the above-mentioned three drugs + 1% W/V Lidocaine Hydrochloride Injection，respectively.The level of pain was measured with the VAS and sleep quality was assessed with the Sleep Quality Scale （QS） at baseline，and at the end of the 1st，3rd，7th，14th，30th，60th，and 90th days of treatment，respectively，and the level of depression was measured with the Zung Self-Rating Depression Scale （SDS） at baseline，and at the end of the 7th，14th，30th，60th，and 90th days of treatment，respectively.Adverse reactions were observed during treatment and after treatment.Results　Both treatment method and duration had a significant interactive effect as well as obvious main effect on the mean scores of VAS，QS and SDS of acute and subacute patients （P<0.05）．Mean scores of VAS，QS and SDS were similar in both acute routine and acute lidocaine subgroups before treatment （P>0.05），but after treatment，mean scores of VAS and QS decreased more significantly at the end of the 1st，3rd，7th days of treatment，and the mean SDS score decreased more significantly at the end of the 7th day of treatment，in the acute lidocaine subgroup （P<0.05）．Both subacute routine and subacute lidocaine subgroups showed similar mean scores of VAS，QS and SDS before treatment （P>0.05），but after treatment，subacute lidocaine subgroup showed more significantly decreased mean scores of VAS and QS at the end of the 1st，3rd，7th，14th，30th，60th，and 90th days of treatment，and more significantly decreased mean SDS score at the end of the 7th，14th，30th，60th，and 90th days of treatment （P<0.05）．Post-treatment mean scores of VAS，QS and SDS measured at each time decreased significantly in all patients compared with baseline（P<0.05）．There was no significant difference in adverse reactions between acute routine and acute lidocaine subgroups （1/18 vs 2/20）（χ2=0.009，P=0.924） and between subacute routine and subacute lidocaine subgroups （1/15 vs 2/17）（χ2=0.013，P=0.909）．Conclusion　Better efficacy was achieved by routine drug treatment in combination with lidocaine in HN patients，by which the pain level，sleep quality and depression level were all improved without increasing adverse reactions.

Relationships of Serum CTRP3 with Diabetic Nephropathy Associated Metabolic Parameters and Its Diagnostic Value 　

AN Chao，LU Yanmin，ZHANG Ying，YANG Yang

2020, 23(26): 3303-3310. DOI: 10.12114/j.issn.1007-9572.2020.00.323

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Background　Diabetic nephropathy（DN）is one of the serious complications of type 2 diabetes mellitus（T2DM）.Previous studies have suggested that C1q/TNF-related protein-3（CTRP3）may play a role in the development of DN.However，the relationship between CTRP3 and DN remains unclear.Objective　To investigate the relationships of serum CTRP3 with DN and associated metabolic parameters.Methods　Fifty-four patients with T2DM（T2DM group），55 with type 2 diabetic nephropathy（DN group） from Binzhou Medical University Hospital，and 55 healthy people （control group） were enrolled from July 2017 to June 2018.The three groups were tested for metabolic parameters.Moreover，ELISA was adopted to detect the concentrations of CTRP3，interleukin 6（IL-6），tumor necrosis factor-α（TNF-α），and adiponectin（APN）.Pearson correlation test was used for correlation analysis.Multiple linear regression was used to analyze the influencing factors of CTRP3 in each group.And receiver operating characteristic curve （ROC）was plotted to analyze the ability of CTRP3 in distinguishing disease status.And receiver operating characteristic curve （ROC）was plotted to analyze the ability of CTRP3 in distinguishing DN and T2DM.Results　Compared with the control group，serum IL-6 and TNF-α were significantly increased in T2DM and DN groups，whereas APN and CTRP3 levels were notably decreased（P<0.05）.DN group showed higher average IL-6 level but lower average CTRP3 levels than T2DM group（P<0.05）.Female and overweight/obesity were associated with higher serum CTRP3 level（P<0.05）.Multiple Logistic regression analysis results showed that CTRP3 was independently associated with the risks of T2DM 〔OR=0.804，95%CI（0.731，0.883），P<0.001〕 and DN 〔OR=0.730，95%CI（0.654，0.814），P<0.001〕.Pearson correlation analysis showed that in the control group，CTRP3 was negatively correlated with insulin（r=-0.415）and insulin resistance index（HOMA-IR）（r=-0.438）（P<0.05）.CTRP3 was negatively correlated with insulin，HOMA-IR，HbA1c，IL-6 and TNF-α in T2DM group （r=-0.312，-0.327，-0.286，-0.342，-0.359） and in DN group（r=-0.407，-0.436，-0.287，-0.386，-0.365）（P<0.05）.CTRP3 also showed a negative correlation with Cr（r=-0.389）in DN group（P<0.05）.Moreover，it was positively correlated with eGFR and APN in T2DM group（r=0.274，0.436） and in DN group（r=0.428，0.273）（P<0.05）.Besides，multiple linear regression analysis indicated that HOMA-IR
〔β=-64.330，95%CI（-92.067，-9.537）〕 and APN 〔β=9.210，95%CI（4.510，16.627）〕 were independently associated with CTRP3 in T2DM group（P<0.05）.And HOMA-IR 〔β=-62.773，95%CI（-122.250，-13.348）〕and eGFR 〔β=0.953，95%CI（0.327，2.442）〕were independently associated with CTRP3 in DN group（P<0.05）.The AUC for CTRP3 in the diagnosis of DN was 0.881〔95%CI（0.820，0.943）〕，the sensitivity was 76.36%，and the specificity was 90.91%.Conclusion　CTRP3 was significantly reduced in patients with T2DM and DN，and was independently associated with the risks of T2DM and DN，and showed high sensitivity and specificity in the diagnosis of DN，indicating that it may play a role in the pathogenesis of DN and may be used as a potential biomarker for DN.

Network Meta-analysis of Eight Kinds of Traditional Chinese Medicine Injections Combined with Paclitaxel and Cisplatin Chemotherapy in the Treatment of Non-small-cell Lung Cancer　

HONG Xiaohua，WANG Guangyao，LIU Tiqin，FU Fang，MO Chunmei，RONG Zhen

2020, 23(26): 3311-3323. DOI: 10.12114/j.issn.1007-9572.2019.00.821

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Background　Non-small-cell lung cancer（NSCLC） is a common lethal malignancy that places great stress and burden on society and patients.Chinese medicine injection（CMI） combined with paclitaxel and cisplatin chemotherapy has been widely used in the treatment of NSCLC，and has made great progress in synergistic and attenuating，but there is still a lack of direct or indirect comparison between proprietary Chinese medicines.Objective　To systematically evaluate the efficacy and safety of CMI-assisted paclitaxel and cisplatin chemotherapy in the treatment of NSCLC.Methods　The PubMed，Cochrane Library，CNKI，CBM，Wanfang Data Knowledge Service Platform and VIP databases were searched from inception to March 2019 for RCTs about paclitaxel and cisplatin chemotherapy assisted by 8 kinds of CMIs commonly used in clinical practice（Brucea Javanica Oil Emulsion Injection，Aidi Injection，Matrine Injection，Cinobufacini Injection，Delisheng Injection，Xiaoaiping Injection，Kang'ai Injection，Shenqi Fuzheng Injection） in the treatment of NSCLC.Quality evaluation and data extraction were performed on the included RCTs.Mesh analysis was performed using the GeMTC and Stata 14.Results　Finally，10 RCTs and 49 semi-RCTs were included.Network meta-analysis showed that by directly comparing，the case groups treated with either of 5 CMIs（Aidi Injection，Matrine Injection，Xiaoaiping Injection，Kang'ai Injection，and Shenqi Fuzheng Injection） showed better short-term efficacy than the controls（P<0.05）.Moreover，the case groups treated with either of 8 CMIs demonstrated lower incidence of leukopenia（P<0.05）.By indirectly comparing，the case groups treated with either of the CMIs except Brucea Javanica Oil Emulsion Injection and Xiaoaiping Injection showed lower incidence of nausea and vomiting（P<0.05）.And the quality of life impaired by chemotherapy improved more significantly in all CMI-treated groups（P<0.05）.In terms of the probability of improving the short-term effect of chemotherapy，Cinobufacini Injection had highest probability，followed by Xiaoaiping Injection，Kang'ai Injection，Aidi Injection，Shenqi Fuzheng Injection，Matrine Injection，Delisheng Injection，and Brucea Javanica Oil Emulsion Injection.In terms of reducing the possibility of developing chemotherapy-induced leucopenia，Cinobufacini Injection also showed highest probability，followed by Xiaoaiping Injection，Shenqi Fuzheng Injection，Delisheng Injection，Aidi Injection，Brucea Javanica Oil Emulsion Injection，Matrine Injection，and Kang'ai Injection.With regards to reducing the possibility of developing chemotherapy-induced nausea and vomiting，Shenqi Fuzheng Injection demonstrated highest possibility，followed by Delisheng Injection，Xiaoaiping Injection，Cinobufacini Injection，Matrine Injection，Brucea Javanica Oil Emulsion Injection，Kang'ai Injection，and Aidi Injection.In respect of the possibility of improving health-related quality of life impaired by chemotherapy，Kang'ai Injection showed highest possibility，followed by Brucea Javanica Oil Emulsion Injection，Xiaoaiping Injection，Delisheng Injection，Cinobufacini Injection，Aidi Injection，Shenqi Fuzheng Injection，and Matrine Injection.Conclusion　This analysis shows that，in enhancing the clinical effect of anticancer，Cinobufacini Injection and Kang'ai Injection are more effective；Shenqi Fuzheng Injection and Cinobufacini Injection show better effects on reducing the toxic side effects of chemotherapy.And Cinobufacini Injection is recommended as the first choice for adjuvant therapy for paclitaxel and cisplatin chemotherapy for NSCLC for all concerned.

Effectiveness of Perioperative Exercise in Patients with Non-small Cell Lung Cancer：an Overview of Systematic Reviews　

ZHANG Xiaomin，ZHANG Xinqiong，HAN Shiyu，KONG Haiyan，WANG Tingting

2020, 23(26): 3324-3329. DOI: 10.12114/j.issn.1007-9572.2020.00.040

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Background　Appropriate physical exercise is beneficial for patients with non-small cell lung cancer （NSCLC）.However，due to controversial results and uneven methodological quality of current studies about this，the transformation of practical results and application of clinical decisions are hindered.Objective　To conduct an overview of systematical reviews of the effectiveness of perioperative exercise in patients with NSCLC.Methods　Databases of CNKI，CBM，WanFang Data，VIP，PubMed，The Cochrane Library，CINAHL，EBSCO，Ovid，Web of Science，EMBase and Elsevier ScienceDirect were searched to collect systematic reviews of the effectiveness of perioperative exercise in NSCLC patients included from inception to May 1，2019.AMSTAR 2 and PRISMA statement were used to assess the methodological quality and the reporting quality of included studies，respectively.Results　A total of 9 systematic reviews were included.Analysis showed that the methodological quality of 2，3，and 4 reviews were moderate，low，and critically low，respectively〔items 3，7 and 10 evaluation results were missing （report rate <50%）〕.The evaluation results of PRISMA statement showed that the reporting rates of items 2，4，11，22，24，and 27 were low.All the reviews concluded that preoperative exercise may improve the exercise capacity，reduce the risk of postoperative complications，shorten the length of hospitalization，and duration of postoperative thoracic/intercostal chest tube drainage.However，they had controversies on the degree of improvement in exercise capacity，lung functions，and health-related quality of life.Conclusion　The methodological quality and reporting quality of the systemic reviews of perioperative exercise effectiveness in NSCLC patients need to be improved.The results of this study can provide a reference for topic selection，research design and achievement reports of future research.

Changes in Trends of Toxic Side Effects of Radiotherapy in Discharged Patients with Nasopharyngeal Carcinoma 　

LIAO Tingting，YANG Li，QIU Liyan1HUANG Yuping，LI Lin，SUN Xihui

2020, 23(26): 3330-3336. DOI: 10.12114/j.issn.1007-9572.2020.00.182

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Background　Radiotherapy is the most appropriate treatment for patients with nasopharyngeal carcinoma（NPC）currently，but the damage of radiotherapy to tissues or organs in the radiation area is extensive and long-lasting.However，most related studies only summarize the types and frequencies of toxic side effects of NPC，and less involve the specific change trend of such effects over time.Objective　To analyze the frequency，severity and development trend of toxic side effects of radiotherapy in discharged NPC patients.Methods　From December 2018 to March 2019，322 NPC patients were selected by convenient sampling，who were discharged from the First Affiliated Hospital of Guangxi Medical University after radiotherapy and chemotherapy and passed the outpatient reexamination.They were divided into 5 groups according to the duration from the ending time of radiotherapy to the starting time of this study：≤ 6 months，> 6-12 months，> 1-3 years，> 3-5 years，and > 5 years.The incidence and level of toxic side effects of radiotherapy such as dry mouth，nasal congestion，tinnitus，hearing loss，trismus，neck fibrosis，radiation dental caries，dizziness and headache，oral ulcers，and radiation dermatitis in each group were collected，and the development trend of each side effect was analyzed by Spearman rank correlation analysis.Results　The incidence of the common advanced toxic side effects of dry mouth，nasal congestion，tinnitus，hearing loss，trismus，neck fibrosis，radiation dental caries，dizziness and headache，oral ulcers，and radiation dermatitis was collected as 95.3%（307/322），43.8%（141/322），45.7%（147/322），44.7%（144/322），17.4%（56/322），14.3%（46/322），44.7%（144/322），20.5%（66/322），2.8%（9/322），and 2.2%（7/322），respectively.With the prolongation of discharged time，the incidence of nasal congestion decreased，but the incidence of trismus，fibrosis of the neck，and dizziness and headache increased（P<0.05）.Oral ulcers（9 cases，10.6%）and radiation dermatitis（7 cases，8.1%）were only found in the ≤6 months group.Spearman rank correlation analysis showed that the severity levels of dry mouth（rs=-0.393，P<0.001）and nasal congestion（rs=-0.314，P<0.001）decreased，but those of trismus（rs=0.133，P=0.017）and radiation dental caries（rs=0.112，P=0.044）increased by the time of discharge.Neck fibrosis occurred in 46 cases was all evaluated as level 1.Conclusion　With the prolongation of discharged time，the incidence of dry mouth，tinnitus，and hearing loss remained high，the severity levels of radiation dental caries and trismus increased while those of dry mouth and nasal congestion decreased.

Repeated Use of Antibiotics for Allergic Diseases in Inner Mongolia's Grassland Region：a Survey　

CHEN Yanlei，MA Tingting，WANG Xueyan

2020, 23(26): 3337-3341. DOI: 10.12114/j.issn.1007-9572.2020.00.349

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Background　Prevalence of allergic diseases including allergic rhinitis increases gradually nowadays.Allergic rhinitis is often mistaken for common cold caused by bacteria，and due to this，there may be inappropriate use of antibiotics for treatment.The misuse or abuse of antibiotics is the main cause of bacterial resistance.Objective　To investigate the repeated use of antibiotics for treating three common allergic diseases（allergic rhinitis，allergic conjunctivitis and allergic asthma） in Inner Mongolia's grassland region.Methods　A survey was conducted among a stratified multistage sample from Erenhot City，Xilinhot City，Duolun County，Jarud Banner，Kailu County，and Tongliao City in grassland region of Inner Mongolia during May to August 2015 using an interview-based questionnaire to collect the demographic data（gender，age，ethnicity，residence，and so on），repeated use of antibiotics in the past two years，prevalence of allergic rhinitis，conjunctivitis and asthma（symptoms，disease duration，medication，and so on），and family history of atopy.Results　A total of 5 944 questionnaires were sent out and 5 787 valid questionnaires were returned，with valid response rate of 97.36%.Among the subjects，1 079（18.65%） used antibiotics repeatedly，while 4 708（81.35%） did not.The prevalence of allergic rhinitis，conjunctivitis，asthma，rhinoconjunctivitis，allergic asthma with rhinitis or conjunctivitis，allergic rhinoconjunctivitis with asthma was 12.74%（737/5 787），8.85%（512/5 787），and 1.80%（104/5 787），15.91%（921/5 787），1.73%（100/5 787），and 2.94%（170/5 787），respectively.2 544（43.96%） were found to have at least one of these three common diseases（allergic rhinitis，conjunctivitis，and asthma） while other 3 243（56.04%） were not.Those with allergic rhinitis，conjunctivitis，and asthma had higher rate of repeated use of antibiotics than those without，regardless of sex（male and female），ethnic group（Han，Mongol ethnic minority or other ethnic groups），and residence（urban or rural areas）（P<0.05）.Moreover，those of age groups of 2-17 and 18-80 with allergic rhinitis，conjunctivitis，and asthma were found with higher rate of repeated use of antibiotics（P<0.05）.The prevalence of repeated use of antibiotics was higher in those with allergic rhinitis，conjunctivitis，asthma than that of those without（P<0.01），exceeding by a factor of 1.5 〔95%CI（1.33，1.76），P<0.01〕，1.33〔95%CI（1.15，1.53），P<0.01〕，and 2.12〔95%CI（1.68，2.67），P<0.01〕，respectively.Among those with allergic rhinitis，conjunctivitis and asthma，the prevalence of repeated use of antibiotics was significantly higher in those with positive family history of atopy，compared with those with negative or unknown family history（P<0.01）.Conclusion　The prevalence of the three common diseases was high in this sample.And the prevalence of repeated use of antibiotics was higher compared with that of the normal healthy population.Repeated use of antibiotics，as a synergistic factor，increased the risk of having allergic rhinitis，conjunctivitis and asthma in those with family history of atopy.This survey provides support for rational use and management of antibiotics and the prevention and treatment of allergy diseases.

Development，Reliability and Validity of the Chinese Version of Nutrition Literacy Assessment Instrument in Patients with Diabetes Based on CTT and Rasch Model　

CHEN Yuanyuan，YANG Chunjun，WANG Dongmei，SONG Ying

2020, 23(26): 3342-3347. DOI: 10.12114/j.issn.1007-9572.2020.00.009

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Background　Diabetes is a nutrition-related chronic disease with high prevalence and disability.Therefore，the ability of patients to master and apply nutritional knowledge（i.e.，nutritional literacy） is essential for the prevention and control of diseases.However，no effective evaluation tool has been found in China.Objective　To translate the English version of the Nutrition Literacy Assessment Instrument（Nlit） into Chinese and test its reliability and validity based on CTT and Rasch model.Methods　A total of 325 diabetic inpatients from Department of Endocrinology，Tianjin Medical University General Hospital from November 2018 to May 2019 were selected by convenience sampling，and were surveyed with the revised Chinese version of Nlit（CHI-NLit）.CTT and Rasch-based approaches were used to divide the dimension of the CHI-NLit，and to evaluate its internal consistency，content validity，structural validity and validity.Results　Principal component analysis of residuals showed that the CHI-NLit was not a unidimensional test，and the six subscales met the unidimensional criteria，so the six dimensions of the original scale were retained.After the fitting degree and difficulty analysis of Rasch model，items 26，29，31，32 that were not up to standard were removed，and a total of 38 items were retained to form the CHI-NLit.The item reliability and sample reliability of CHI-NLit were 0.919 and 0.838，respectively.The item reliability and personal reliability of the subscales were 0.928/0.681，0.902/0.690，0.948/0.679，0.932/0.651，0.960/0.601，0.928/0.683，respectively.The KR-21 reliability coefficients of the scale and subscales were 0.860，0.702，0.718，0.719，0.684，0.721，respectively.The test-retest reliability of total scale and subscales were 0.936，0.895，0.915，0.906，0.931，0.923，and 0.904，respectively.In terms of validity，the content validity index（CVI） of the scale was 0.905，and the item-level CVI（I-CVI） was 0.8-1.0.The fit of each item was in line with the Rasch model，with moderate difficulty and good structural validity.The Pearson correlation coefficient of criterion validity was 0.784.There was a linear positive correlation between the score of each subscale of NLit and the score of NVS.Analysis of ROC curve of CHI-NLit to predict nutritional literacy level showed that the area under the curve（AUC） was 0.885〔95%CI（0.846，0.924）〕.When the cut-off value was 21.5 points，the Youden index was greatest（0.623）.Conclusion　CHI-NLit has good reliability and validity，which may be used as an auxiliary tool for the measurement of nutritional literacy of diabetic patients.

The Construction of an Index System for Health-related Fitness Evaluation　

JIANG Lijie，XU Jun，HUANG Chen，FENG Yefang，XU Mengyao1WU Chengkai，LI Wenyuan，ZHANG Jinhua，WU Weixuan

2020, 23(26): 3348-3354. DOI: 10.12114/j.issn.1007-9572.2020.00.392

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Background　With the continuous deepening of people's understanding of health-related fitness concepts，the individual fitness assessment should not only be limited to one aspect of physical（physiological） fitness，but also include the aspects of mental fitness and social fitness.Therefore，to enrich and improve the connotation and extension of health-related fitness，as well as construct an index system for health-related fitness assessment from various aspects of physical，mental and social fitness has become a research hotspot in academia.Objective　To reevaluate the health-related fitness assessment indicators previously selected by Delphi expert consultation，in order to guarantee the scientificity，reliability and representativeness of the indicators.Methods　An Healthy Fitness Measurement Scale was designed and used to conduct an epidemiological survey in Guangzhou from July to August in 2019 using the convenience sampling method.The item analysis method（critical ratio method），item selection method〔coefficient of variation method，correlation coefficient method between indicators（index collinearity analysis），correlation coefficient method between indicators and dimensions，factor analysis，principal component analysis and internal consistency coefficient method（Cronbach's α coefficient method）〕were applied to analyze and reevaluate the health-related fitness indicators.Results　Of the 600 distributed questionnaires，581 questionnaires were collected totally，and 553 valid questionnaires were received with an effective recovery rate of 92.2%.The item analysis method indicated that there were significant differences between items in high score group and low score group in the scale，and all items were retained.According to the item selection method，14，11 and 9 items were selected for three sub-scales of physical，mental，and social fitness，respectively.Together with 4 overall assessment items，a total of 38 items constituted the health-related fitness assessment index system.Conclusion　This study has initially constructed a health-related fitness assessment index system involving physical，mental and social fitness，which reflects the true connotation and extension of health-related fitness comprehensively，accurately and specifically.The comprehensive analysis and reevaluation of the health-related fitness assessment indicators using a variety of methods effectively guarantees the scientificity，reliability and representativeness of the indicators，and provides a scientific basis for the compilation of Healthy Fitness Measurement Scale.

Reliability and Validity of the Chinese Version of Depression Prevention and Management Survey in Community Residents　

HUANG Run，YANG Bingxiang，LI Xiaoyun，YANG Fang，WANG Xiaoqin，FANG Shu

2020, 23(26): 3355-3362. DOI: 10.12114/j.issn.1007-9572.2020.00.258

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Background　Prevention and management of depression is essential for relapse and recurrence and rehabilitation in depression.Good prevention and management of depression are helpful for effectively reducing the morbidity，rates of relapse and recurrence.Personalized and stage-based interventions and management evaluations are important facilitators for the rehabilitation and reduction of relapse and recurrence.However，there is a lack of effective tools to evaluate the process of depression prevention and management.Objective　To sinicize the English version of Depression Prevention & Management Survey（DPMS） and test the validity and reliability of the Chinese version.Methods　Data were collected in 2017.Stratified multistage sampling with the Center for Epidemiological Studies Depression Scale（CES-D） was used to select 429 residents with depressive symptoms（CES-D score ≥16 or with a previous diagnosis of depression） from 2 000 residents randomly selected from 40 communities in 5 administrative divisions（8 communities were selected from each division，and 50 residents from each community） in 7 central urban areas of Wuhan.The Chinese version of DPMS was developed via translating the English version，and was used to survey the 429 cases，then based on the survey results，its validity was explored via content validity analysis，exploratory factor analysis and confirmatory factor analysis，and its reliability was tested using internal consistency coefficient and Pearson correlation analysis.Two weeks later，the test-retest reliability of the scale was evaluated in a convenience sample of 30 cases selected from the initial sample.Results　The Chinese version of the DPMS retained 45 items and 4 subscales of the original scale.The inter-subscale correlation coefficients of the Chinese version of DPMS ranged -0.001-0.410.Except that the change stage was not related to decisional obstacles，the correlation coefficients of other subscales were statistically different（P<0.05）.The content validity index for the scale was 0.85，and for the items ranged 0.67-0.87.Exploratory factor analysis of the decision equilibrium subscale yielded two common factors，which were named perceptual benefits and perceptual obstacles，respectively，accounting for 61.89% of the cumulative variance，and confirmatory factor analysis showed that NFI=0.97，CFI=0.99.Exploratory factor analysis of the change process produced 4 common factors named personal cognition，knowledge and social support，public environment，and positive feedback，respectively，accounting for 61.98% of the cumulative variance，and confirmatory factor analysis showed that NFI=0.83，CFI=0.91.A common factor was obtained through exploratory factor analysis for self-efficacy subscale，which was named as self-efficacy，accounting for 68.62% of the cumulative variance，and confirmatory factor analysis showed that NFI=0.98 and CFI=0.99.The Cronbach's α coefficient for the scale was 0.95，and for the subscales ranged 0.68-0.95.The test-retest reliability coefficient for the scale was 0.75，and 0.85（P<0.01） for change stage subscale，0.64（P<0.05） for decision equilibrium subscale，0.53（P>0.05） for change process subscale，and 0.94（P<0.01） for self-efficacy subscale，respectively.Conclusion　The Chinese version of DPMS showed good validity and reliability in our survey，which may be useful in evaluating behavioral changes in depression prevention and management.

New Advances in Seasonal Affective Disorder and Bright Light Therapy　

ZHAI Qian，FENG Lei，ZHANG Guofu，LIU Min，WANG Jingjing

2020, 23(26): 3363-3368. DOI: 10.12114/j.issn.1007-9572.2019.00.680

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Seasonal affective disorder， also known as "winter blues"， refers to an emotional disorder caused by climate change. With a unique pathogenesis， the key to diagnosis is obvious seasonal onset and spontaneous symptom relief. Seasonal affective disorder has a significant impact on people's lives. Medical workers should accurately recognize the characteristics of symptoms of this disease， and timely deliver treatment and interventions， as well as guidance on healthy lifestyle， to minimize the impact of the disease. Bright light therapy， a unique treatment， plays an important role in the treatment of seasonal affective disorder. In this paper， major symptoms， susceptible populations， pathogenesis， treatments and preventions for the disease are discussed in detail.
Seasonal affective disorder；Winter blues；Climate change；Mood disorders；Bright light therapy；Review

Relationship Between Irritable Bowel Syndrome and Regulatory Abnormalities of Neuro-endocrine-immune Network　

XU Xintian，XU Danhua，LU Weimin

2020, 23(26): 3369-3374. DOI: 10.12114/j.issn.1007-9572.2019.00.727

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Irritable bowel syndrome （IBS） is one of the most common functional gastrointestinal disorders （FGIDs）clinically， and its pathophysiological changes have not been fully explained.Underlying mechanisms that could lead to IBS include genetic factors， post-infectious changes， chronic infections and disturbances in the intestinal microbiota， low-grade mucosal inflammation， immune activation， and altered intestinal permeability， disordered bile salt metabolism， and abnormalities in serotonin metabolism. Rome Ⅳ has emphasized the significance of correlation between the occurrence of IBS and abnormalities of neuro-gastroenterology and brain-gut interactions， with complex neuro-endocrine-immune （NEI） factors involved， featuring the heterogeneity of IBS clinical manifestations. Based on domestic and overseas research achievement， this article explores the relevance between the altered NEI signals and pathogenesis of IBS， which includes neural factors mainly focusing on autonomic nervous dysfunction and visceral hypersensitivity in brain-gut and gut-brain interactions， endocrine factors of corticotropin-releasing factor（CRF）， corticosteroids and glucagon-like peptide 1（GLP-1）， and immune factors of infections and dysbacteriosis， inflammation and immune activation.

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