Chinese General Practice

Summary of the Cognitive Impairment Screening Recommendations for Community-dwelling Older Adults　

AI Yating，HU Hui

2020, 23(27): 3375-3381. DOI: 10.12114/j.issn.1007-9572.2020.00.425

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The US Preventive Services Task Force updated its 2014 recommendation statement and issued the latest evidence report and systematic review of screening for cognitive impairment in older adults on JAMA，concluding that due to lack of sufficient evidence，the balance of benefits and harms of screening for cognitive impairment （MCI and mild to moderate dementia） of community-dwelling adults aged 65 years and older cannot be determined.More research is needed on the effect of screening and early detection of cognitive impairment.Moreover，a large amount of evidence for long-term follow-up and intervention for cognitive impairment patients and/or their caregivers is needed.In addition，reports on harms of cognitive impairment screening and interventions to participants and reasons for attrition of trial participants should be encouraged.Based on the new recommendation statement and current research status，we overviewed the definition，prevalence，risk and protective factors of cognitive impairment，early cognitive impairment screening instruments and their benefits and harms，and net benefit assessment of screening，treatment and intervention，future research suggestions，as well as the significance of the statement in guiding community-based screening and management of cognitive impairment.

Analysis and Prospect of Hot Topics in Mild Cognitive Impairment Research in China　

XUE Mengting，JIANG Rongrong，HUANG Anle，BU Zihan，LI Qingyun，XU Guihua

2020, 23(27): 3381-3388. DOI: 10.12114/j.issn.1007-9572.2020.00.367

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Background　With the acceleration of population aging，the health problems of the elderly，including dementia，are increasingly prominent.Mild cognitive impairment，the preclinical stage of Alzheimer's disease，has long been a focus of researchers.However，there is a lack of studies concerning the summary or analysis of hot topics of mild cognitive impairment in China.Objective　To analyze the hot topics in mild cognitive impairment research in China from 2008 to 2018，to provide assistance for understanding the current status and development trend of this field.Methods　In June 2019，we searched the CNKI database with the key word "mild cognitive impairment" and subject retrieval as well as source categories limited to SCI and EI source journals，core journals，CSSCI and CSCD for studies about mild cognitive impairment in China during 2008 to 2018.TCM correlation analysis platform-based XMiner software，SPSS 22.0 and Excel-based software were used to perform word frequency and co-word analyses of the key words.Results　Finally，413 studies with 41 high-frequency key words（g=41） were included.Seven hot topics were identified by co-word analysis，including etiology，neuropsychological assessment and screening，diagnosis and classification，intervention，epidemiology，behavioral and psychological symptoms，biomarkers and TCM syndrome of mild cognitive impairment.Conclusion　The hot topics in mild cognitive impairment research in China from 2008 to 2018 are etiology，neuropsychological assessment and screening，diagnosis and classification，intervention，epidemiology，behavioral and psychological symptoms，biomarkers and TCM syndrome of mild cognitive impairment.The results are helpful for healthcare providers to understand the current situation and development trend of this field，with guidance for future research direction.

Value of Hematological Parameters in Predicting Major Adverse Cardiovascular Events after PCI in Patients with Acute STEMI　

CHEN Xinsen，SHAO Meng，ZHANG Tian，ZHANG Hongyan，MENG Youbao，HAI Hua，LI Guihua

2020, 23(27): 3389-3395. DOI: 10.12114/j.issn.1007-9572.2020.00.245

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Background　Monocyte to lymphocyte ratio（MLR），mean platelet volume to lymphocyte ratio（MPVLR），neutrophil to lymphocyte ratio（NLR） are all new markers of inflammatory response，which are related to the adverse outcomes in patients with acute ST segment elevation myocardial infarction（STEMI）.However，few studies at home and abroad have been found to explore the relationship between these hematological parameters，and the clinical value of the combination of them in predicting the prognosis of acute STEMI patients.Objective　To investigate the clinical value of hematological parameters in predicting major adverse cardiovascular events（MACE） after percutaneous coronary intervention（PCI） in patients with acute STEMI.Methods　A total of 524 patients who were diagnosed with acute STEMI and who underwent emergency PCI for the first time at the First Affiliated Hospital，School of Medicine，Shihezi University from August 2017 to February 2019 were enrolled.They were divided into MACE group and non-MACE group according to whether MACE occurred during the follow-up period.Baseline characteristics were collected，including age，proportions of males，smokers，diabetes，hypertension，and hyperlipidemia，Killip class of post-admission acute myocardial infarction-induced heart failure，admission GRACE score，pre-PCI clinical indicators〔fasting blood glucose，creatine kinase isoenzyme（CK-MB） peak，peak troponin T（TnT），total cholesterol，triacylglycerol，low-density lipoprotein，high-density lipoprotein，left ventricular ejection fraction，C-reactive protein（CRP），N-terminal brain natriuretic peptide precursor（NT-proBNP），white blood cell count，neutrophil count，lymphocyte count，hemoglobin，platelet count，monocyte count，MPV，MLR，MPVLR，NLR，red blood cell distribution width，platelet distribution width〕and culprit vessels detected by coronary angiography，number of stents，time from symptom onset to PCI，no-reflow prevalence，and medical treatment.Cox regression analysis was used to investigate the influencing factors of MACE in STEMI patients after PCI.The receiver operating characteristic curve was plotted to evaluate the predictive value of MLR，MPVLR and NLR，alone and in double-combination forms，for MACE after PCI in patients with acute STEMI.Results　In this study，a total of 56 patients developed MACE during the follow-up period，including 23 cases of cardiogenic or all-cause death，15 cases of heart failure，7 cases of recurrent angina pectoris，5 cases of malignant arrhythmia，4 cases of recurrent myocardial infarction and 2 cases of stroke.Compared to those without MACE，MACE patients had greater mean age，higher mean admission GRACE score，peak TnT，CRP，NT-proBNP，neutrophil count，monocyte count，MPV，MLR，MPVLR，and NLR，and also a higher proportion of admission Killip class ≥Ⅱ.Moreover，MACE patients had lower levels of lymphocyte count as well as LVEF（P<0.05）.And they had a higher no-reflow prevalence（P<0.05）.Multivariate Cox regression analysis showed that lymphocyte count〔HR=0.884，95%CI（0.817，0.966），P<0.001〕，monocyte count〔HR=1.169，95%CI（1.104，1.463），P=0.009〕，MPV〔HR=1.333，95%CI（1.005，1.752），P=0.039〕，MLR〔HR=1.701，95%CI（1.332，2.172），P<0.001〕，MPVLR〔HR=1.372，95%CI（1.196，1.443），P<0.001〕and NLR〔HR=1.428，95%CI（1.037，1.576），P=0.015〕were the influencing factors of MACE in acute STEMI patients after PCI.MLR was positively correlated with NLR（rs=0.195，P<0.001） and MPVLR（rs=0.210，P<0.001）.NLR was positively correlated with MPVLR（rs=0.483，P<0.001）.MLR+NLR，MLR+MPVLR，or NLR+MPVLR was better than MLR，NLR，or MPVLR in predicting MACE after PCI in acute STEMI patients（P<0.05）.Conclusion　Hematological parameters such as MLR，MPVLR，and NLR shortly after admission are related to the prognosis of acute STEMI patients.And combined application of these hematological parameters can more effectively identify high-risk patients and predict the occurrence of MACE.

A Phenomenology Study on Medical Delay in Patients with Acute Exacerbation of COPD　

JIANG Zongliang1WANG Haibo，WANG Yuyan，MA Lijun，SUN Naya，ZHANG Weihong

2020, 23(27): 3396-3401. DOI: 10.12114/j.issn.1007-9572.2020.00.104

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Background　Chronic obstructive pulmonary disease（COPD）has high disability and mortality rates，with an increasing annual prevalence.In China，COPD patients have a high possibility of having delayed treatment.Studies have shown that avoiding the occurrence of medical delay can achieve earlier diagnosis and treatment，reduce disability and mortality rates，and relieve medical burden.Objective　To investigate the causes of medical delay in patients with acute exacerbation of COPD，to provide evidence for effective targeted interventions.Methods　This qualitative study was conducted from March 2018 to February 2019 with a phenomenology approach.By purposive sampling based on and the inclusion and exclusion criteria，COPD patients with delayed treatment in three general hospitals（Henan Provincial People's Hospital，the First Affiliated Hospital of Zhengzhou University，People's Hospital of Zhengzhou）and two community aged care centers（Zhengzhou Hangdong Community Health Service Center，Aixin Sunshine City Senior Service Center）in Henan Province were selected.Semi-structured interviews based on the designed outline were conducted with them，each lasting for 30-40 minutes，with possibly appropriate adjustments in duration and contents according to the field observation during the interview.The interviews continued to data saturation，and were analyzed with Colaizzi's seven-step method.Results　Altogether，interviews of 13 cases were included for analysis.Six core themes that can explain delayed healthcare seeking were summarized：low awareness level of COPD，poor self-management of symptoms，misdiagnosis and missed diagnosis in primary medical institutions，lack of effective and continuous nursing care，neglecting symptoms due to ineffective long-term treatment，and increased negative emotions due to lack of support.Conclusion　The factors associated with delayed healthcare seeking in patients with acute exacerbation of COPD are diverse，which mainly include awareness of COPD，continuity of care measures，self-management ability，treatment effectiveness，negative emotions and treatment levels in grassroots medical institutions.To reduce the possibility of delay in healthcare seeking，and improve the quality of life of the patients，person-centered interventions should be delivered according to the factors associated with different stages of seeking healthcare.

Prognostic Value of Pediatric Critical Illness Score in Combination with Glasgow Coma Scale and Video EEG Monitoring in Severe Viral Encephalitis in Children　

JIANG Shaoqing，PAN Xuanren，PANG Zongqin，PANG Jiyan

2020, 23(27): 3402-3407. DOI: 10.12114/j.issn.1007-9572.2020.00.181

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Background　Pediatric Critical Illness Score（PCIS） is widely used in evaluating severe pediatric patients.Glasgow Coma Scale（GCS） is recommended for the evaluation of brain function in critically ill patients.Electroencephalogram（EEG） monitoring is considered to be an important predictive method of brain injury.There are few reports about predicting the prognosis of children with severe viral encephalitis by PCIS in combination with GCS score and video EEG（VEEG） monitoring.Objective　To explore the prognostic value of PCIS combined with GCS score and VEEG monitoring in severe viral encephalitis in children.Methods　A retrospective analysis was conducted on 113 children with severe viral encephalitis treated in the ICU Ward，Yulin Maternal and Child Health Hospital between January 2013 and October 2018，including 37 with good prognosis（4-5 points） and 76 with poor prognosis（1-3 points） evaluated by the Child Glasgow Outcome Scale.The clinical data，CSF examination，PCIS，GCS score and VEEG of the two groups were compared to identify the risk factors for the prognosis of severe viral encephalitis.Values of PCIS，GCS score and VEEG monitoring，alone and in combination in predicting the prognosis of severe viral encephalitis were compared.Results　In good prognosis group，18 cases were cured and 19 had mild sequelae.In contrast，in poor prognosis group，5 died，25 had severe sequelae，and 46 had moderate sequelae.Multivariate Logistic regression analysis showed that adverse prognostic factors for severe viral encephalitis were as follows：PCIS≤80，moderate VEEG abnormalities，and severe VEEG abnormalities（OR=12.626，512.020 and 160.712，P<0.05）.And GCS score > 8 was associated with decreased risk of poor prognosis（OR=0.042，P<0.05）.ROC curve analysis showed that the combination of GCS score，PCIS and VEEG monitoring had a larger AUC than GCS score（0.888 vs 0.615，Z=5.043），PCIS（0.888 vs 0.793，Z=2.834），VEEG monitoring（0.888 vs 0.705，Z=3.484） alone（P<0.05） in predicting the prognosis of severe viral encephalitis.And PCIS showed a greater AUC than GCS score（0.793 vs 0.615，Z=3.248，P=0.001）.Conclusion　In children with severe viral encephalitis，PCIS≤80 as well as moderate and severe VEEG abnormalities increased the risk of poor prognosis，while GCS score > 8 decreased the risk.The combination of PCIS，GCS score and VEEG monitoring showed higher accuracy than each alone in predicting the prognosis.

Diagnostic Value of Noninvasive Evaluation Model of Liver Fibrosis in Chronic Hepatitis B　

TANG Long，DENG Yongqiong，WANG Hong，ZHANG Zhihong，LI Xiaoming

2020, 23(27): 3408-3415. DOI: 10.12114/j.issn.1007-9572.2020.00.354

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Background　In recent years，intensive studies in chronic hepatitis B have yielded many noninvasive predictive models to substitute liver biopsy for fibrosis assessment and follow-up.However，the biomarkers required in some noninvasive models are limited in clinical use due to challenges in clinical measurement.Meanwhile，the diagnostic value of the models is also lack of large-scale clinical verification.Objective　To compare the values of six noninvasive fibrotic models of APRI，FIB-4，Forns，HB-F，APGA，and Hui in predicting significant hepatic fibrosis and cirrhosis in chronic hepatitis B patients，to acquire a simple feasible model with the highest diagnostic efficacy for clinical popularization.Methods　Two hundred and twenty-one patients with chronic hepatitis B recruited from the Affiliated Hospital of Southwest Medical University during June 2013 to December 2018 were analyzed retrospectively.All of them underwent liver biopsy，and had routine blood，biochemical and prothrombin time tests within four subsequent weeks.According to the Metavir scoring system，the degree of liver fibrosis of the patients was classified into three groups：F01（n=78，Metavir score=0-1），F23（n=98，Metavir score=2-3），and F4（n=45，Metavir score=4）.Significant fibrosis was defined as Metavir score≥2，cirrhosis was defined as Metavir score=4.Then the scores of six models of noninvasive index（APRI，FIB-4，Forns，HB-F，APGA and Hui ） were calculated.The area under the ROC curve（AUC） analyses of these models in diagnosing significant fibrosis and cirrhosis were performed in patients with ALT ≥ 2ULN or ALT< 2ULN，respectively.Results　 There was significant difference in the scores of six models among the three groups（P<0.05）.The scores of all the models were found to be positively with the severity of liver fibrosis（P<0.05）.For patients with ALT ≥ 2ULN，the AUCs of six models to predict significant fibrosis were 0.836 for APRI，0.738 for FIB-4，0.807 for Forns，0.836 for HB-F，0.912 for APGA，and 0.819 for Hui.The AUCs of APRI，FIB-4，Forns，HB-F，APGA and Hui for predicting cirrhosis were 0.732，0.705，0.789，0.784，0.811 and 0.863，respectively.For patients with ALT< 2ULN，the AUCs of APRI，FIB-4，Forns，HB-F，APGA and Hui were 0.790，0.811，0.825，0.768，0.820，0.787，respectively for predicting significant fibrosis，and 0.815，0.872，0.892，0.857，0.863，0.881 for assessing cirrhosis，respectively.The value of APGA in predicting significant fibrosis in patients with ALT ≥2ULN：when the cutoff value was determined as >0.955，39 of the 42 cases with a APGA score >0.955 were identified with significant fibrosis（Metavir score≥2）；when the cutoff value was determined as >1.005，32 cases with a APGA score >1.005 had significant fibrosis（Metavir score≥2）.The value of APGA in predicting cirrhosis in patients with ALT ≥2ULN：when the cutoff value was determined as >0.955，13 of the 42 cases with a APGA score >0.955 were identified with cirrhosis（Metavir score=4）；when the cutoff value was determined as >1.265，6 of the 7 cases with a APGA score >1.265 had cirrhosis（Metavir score=4）.The value of APGA in predicting significant fibrosis in patients with ALT<2ULN：when the cutoff value was determined as >0.815，93 of the 132 cases with a APGA score >0.955 were identified with significant fibrosis（Metavir score≥2）；when the cutoff value was determined as >1.005，45 of the 47 cases with a APGA score >1.005 were identified with significant fibrosis（Metavir score≥2）.The value of APGA in predicting cirrhosis in patients with ALT<2ULN：when the cutoff value was determined as >0.935，28 of the 70 cases with a APGA score >0.935 were identified with cirrhosis（Metavir score=4）；when the cutoff value was determined as >1.155，3 of the 16 cases with a APGA score >1.155 were diagnosed with cirrhosis（Metavir score=4）.Conclusion　The APGA model has a higher efficacy in diagnosing both significant hepatic fibrosis and cirrhosis for chronic hepatitis B patients with ALT ≥ 2ULN or ALT< 2ULN.Moreover，the measurement of APGA is simple and easy，so the model deserves extensive clinical promotion.

Relationship of Abnormal Coagulation with Plasma TF-MPs and P-selectin in Patients with Chronic Mountain Sickness　

WANG Zhuoya1，2，YANG Faman，ZHOU Hongmei，LIU Ji，WANG Yuanjun，LI Xiaoping，JING Zehui

2020, 23(27): 3416-3421. DOI: 10.12114/j.issn.1007-9572.2020.00.238

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Background　Many studies have shown that patients with chronic mountain sickness（CMS） have abnormal coagulation and the mechanism is still unclear．The purpose of this study was to find out new indicators to evaluate the status of abnormal coagulation．Objective　To explore the relationship of abnormal coagulation with plasma TF-MPs and P-selectin in CMS patients．Methods　Participants were Chinese Han males who were enrolled during December 2016 to September 2018，including 20 inpatients with CMS and deep vein thrombosis（CMS+T group），40 inpatients with CMS（CMS group），and 28 physical examinees from plateau regions（plateau control group） from Qinghai University Affiliated Hospital，as well as 40 physical examinees from plain regions from Yuncheng Central Hospital（plain control group）．Hemoglobin（Hb），platelet count（PLT），coagulation parameters 〔prothrombin time（PT），partial prothrombin time（APTT），and D-dimer〕，TF-MPs and P-selectin were routinely detected and compared in all groups．Correlations of PLT，and D-dimer with F-MPs and P-selectin were analyzed．The factors associated with deep vein thrombosis in CMS were identified．Predictive value of D-dimer，TF-MPs and P-selectin for deep vein thrombosis in CMS were explored.Results　Compared with plateau control group，plain control group had lower mean levels of Hb and P-selectin，CMS+T and CMS groups had higher mean levels of Hb，lower mean level of PLT，and longer mean PT and APTT（P<0.05）．The mean D-dimer level in CMS+T group was higher than that in CMS group and plateau control group（P<0.05）．The mean TF-MPs and P-selectin levels in CMS and CMS+T groups were higher than those in plateau control group（P<0.05）．And they were also higher in CMS+T group than those in CMS group（P<0.05）．In CMS patients，TF-MPs was positively correlated with P-selectin（r=0.589，P<0.001），and was negatively correlated with PLT（r=-0.451，P=0.008）．P-selectin was negatively correlated with PLT（r=-0.442，P<0.001）．Multivariate Logistic regression analysis PT〔OR=0.138，95%CI（0.026，0.735），P=0.020〕，TF-MPs〔OR=8.067，95%CI（1.660，39.200），P=0.010〕and P-selectin 〔OR=8.236，95%CI（1.381，49.104），P=0.021〕were associated with deep vein thrombosis in CMS patients．The area under ROC curve of D-dimer，TF-MPs and P-selectin for predicting deep vein thrombosis in CMS patients was 0.939，0.727 and 0.732，respectively，the sensitivity was 85.0%，45.0% and 70.0%，and the specificity was 92.5%，87.5% and 75.0%，respectively．Conclusion　Long-term high altitude exposure may lead to elevated Hb and decreased PLT．In CMS patients，TF-MPs and P-selectin are associated with decreased PLT and deep vein thrombosis．PT，TF-MPs and P-selectin are the influencing factors of deep vein thrombosis．And D-dimer，TF-MPs，and P-selectin all have certain value in predicting deep vein thrombosis.

The Value of Umbilical Cord Blood Culture in Premature Infants with Early-onset Sepsis　

YANG Suyan，SUN Fuqiang，DUAN Yang

2020, 23(27): 3422-3426. DOI: 10.12114/j.issn.1007-9572.2020.00.380

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Background　Neonatal sepsis is one of the main causes of premature infant death，especially early-onset sepsis（EOS），so early diagnosis and timely treatment are particularly important.Blood culture is the gold standard in the diagnosis of sepsis，but the peripheral blood volume of newborns is limited.As the earliest blood sample after birth，the umbilical cord blood volume is sufficient and the collection is convenient.Objective　To explore the clinical value of umbilical cord blood culture in preterm infants with EOS，and to observe the changes of inflammatory indexes in infants with positive results of blood culture，in order to provide a basis for the clinical treatment of EOS.Methods　A total of 150 pairs of pregnant women who were suspected or diagnosed with intrauterine infection and their preterm infants（gestational age ≤37 weeks）were selected from the Second Hospital of Tianjin Medical University from June 2018 to June 2019，of which 102 premature infants were diagnosed with EOS.Umbilical cord blood was collected immediately and peripheral venous blood was collected for culture within 24 hours after infants were born.Inflammatory indicators were detected at 0-<24 h，24-<48 h，and 48-72 h after the birth of premature infants，including hypersensitive C-reactive protein（hs-CRP），procalcitonin（PCT），white blood cell count（WBC），and platelet count（PLT）.The inflammatory indexes of premature infants with positive and negative results of cord blood culture were compared at different time periods mentioned above.After positive alarm of cord blood and peripheral blood culture，the bacterial identification was performed.The treatment and outcome of EOS infants with positive cord blood culture were recorded.Results　There was no significant difference in the positive rates of cord blood culture〔19.6%（20/102）〕and peripheral blood culture〔16.7%（17/102）〕in infants with EOS（P>0.05），and the positive rates of cord blood culture and peripheral blood culture in infants without EOS were both 0.EOS infants with positive results of cord blood culture had a higher level of hs-CRP and PCT than those with negative results at 0-<24 h，24-<48 h，and 48-72 h（P<0.05）.EOS infants with positive results of cord blood culture had a lower level of WBC than those with negative results at 0-<24 h（P<0.05）.EOS infants with positive results of cord blood culture had a lower level of PLT than those with negative results at 48-72 h（P<0.05）.A total of 20 pathogenic bacteria were identified in the cord blood culture of infants with EOS，including 15 strains of Gram-positive bacteria（including 10 strains of Staphylococcus，3 strains of Listeria monocytogenes，and 2 strains of Streptococcus lactis），and 5 Gram-negative strains（including 3 strains of Escherichia coli，1 strain of Klebsiella pneumoniae subpneumoniae，and 1 strain of Acinetobacter baumannii）.A total of 17 pathogenic bacteria were identified in peripheral blood culture，of which 15 cases were consistent with the identification results of cord blood culture.Conclusion　The positive rate of cord blood culture is similar to the positive rate of peripheral blood culture in infants with EOS，but cord blood is convenient for blood collection and has sufficient blood retention，which is conducive to the diagnosis of EOS.After the newborn is born，if hs-CRP and PCT increase，WBC and PLT decrease，suggesting that the infant may have EOS and antibiotics can be adjusted as appropriate.The anti-infective therapy，further diagnosis and treatment plan should be formulated after the bacterial culture results come out.

Causes of Cancer Death in Urban Residents of Yingkou from 2013 to 2018　

CHEN Lili，CHENG Xiaoping，BAI Mingyu，LI Ying

2020, 23(27): 3427-3432. DOI: 10.12114/j.issn.1007-9572.2020.00.375

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Background　In the 21st century，the incidence rate and mortality rate of malignant tumors are rising constantly，which imposes both mental and economic burdens on society and individuals.Therefore，the prevention and control of cancer are very important.Objective　To perform a descriptive analysis of cancer death in Yingkou's urban residents from 2013 to 2018，offering a theoretical basis for the prevention and treatment of cancer in this city.Methods　A retrospective design was used.From the mortality information system of Chinese Center for Disease Control and Prevention，death data of Yingkou's urban residents from January 1，2013 to December 31，2018 were obtained，among which cancer death data were extracted by using the ICD-10 code set.Crude mortality，standardized mortality，annual percentage of change （APC），potential years of life lost （PYLL），potential years of life lost rate （PYLLR） and average years of life lost （AYLL） were calculated.Excel 2007，DeathReg 2005，SPSS 17.0，Joinpoint 4.7.0.0 were used to analyze the cancer death and cancer-related loss of life years.A GM grey model was established to predict the cancer mortality in the 2019—2021.Results　From 2013 to 2018，a total of 5 638 people died of cancer in Yingkou，with an average annual crude mortality rate of 210.89/100 000 and a standardized mortality rate of 162.47/100 000.The average annual crude mortality rate for men was 263.78/100 000，and the standardized mortality rate was 209.76/100 000；the average annual crude mortality rate for women was 159.71/100 000，and the standardized mortality rate was 120.23/100 000.The cancer mortality showed a significant upward trend in 16-50 years old （APC=16.42%，P<0.01），and the upward trend of mortality slowed down in over 50 years old （APC=8.03%，P<0.01）.The six leading causes of cancer death were lung cancer，liver cancer，colorectal and anal cancer，gastric cancer，esophageal cancer and breast cancer.During this period，the mortality of colorectal and anal cancer showed an upward trend（APC=8.27%，P<0.01）.PYLL and AYLL caused mainly by cancer were 21 948 person-years，and 10.79 years，respectively.The PYLL caused by lung cancer was the largest （8 327 person-years）.And breast cancer （1 773 person-years） had the second largest impact on women's life expectancy after lung cancer （2 533 person-years）.GM grey model predicted that the cancer mortality in Yingkou was 223.86/100 000 in 2019，227.63/100 000 in 2020 and 231.46/100 000 in 2021.Conclusion　Among Yingkou's urban residents，cancer ranked the second leading cause of death.Men had higher mortality of major cancers than women except breast cancer.Liver cancer and breast cancer tended to be more prevalent in young people.It is predicted that the cancer mortality in Yingkou from 2019 to 2021 would be higher，with an increasing trend.Since cancer has become a serious threat to the health of urban residents in the city，relevant intervention and management should be strengthened.

Percutaneous Endoscopic Spinal Surgery for Degenerative Lumbar Spinal Stenosis in Elderly Patients at High Risk for General Anesthesia　

GAO Shangju，LI Wenyi，ZHANG Long，WEI Jingchao，CAO Can

2020, 23(27): 3433-3439. DOI: 10.12114/j.issn.1007-9572.2019.00.817

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Background　With the increase of life expectancy，the incidence of degenerative lumbar spinal stenosis（DLSS） in the elderly is increasing.DLSS generally requires surgical decompression.However，elderly patients are often complicated with many medical diseases，and the preoperative anesthesia assessment of spinal decompression for them is usually high risk.Many patients are unable to undergo open surgery under general anesthesia，and their daily life is obviously limited because of the disease.With the development and maturity of endoscopic decompression of spine，percutaneous endoscopic spinal decompression under local anesthesia may be a safe and effective treatment.Objective　To investigate the clinical efficacy of percutaneous spinal endoscopy under local anesthesia for elderly DLSS patients with preoperatively assessed high risk for general anesthesia.Methods　From December 2016 to April 2017，18 elderly patients with DLSS and treated with percutaneous endoscopic spinal decompression from Department of Orthopaedics，Hebei General Hospital were included.All were preoperatively assessed as having a high risk of general anesthesia（ASA P3-P4）.16 cases were operated via a transforaminal approach，and other 2 cases were operated using a translaminar approach.Outcomes were evaluated by follow-up interviews at 6 weeks，6 months，1 year after the surgery.Low back pain and leg pain were measured by Visual Analog Scale（VAS） score.Functional outcomes were assessed by Oswestry Disability Index（ODI）.Results　The operation time was 30-81 minutes〔averaged（49.5±17.0） minutes〕.One patient had neck pain during the operation，but the symptom disappeared after discontinuation of the operation.There were no complications such as postoperative infection，intraspinal hematoma，lumbar instability，and so on.The coexisting medical diseases were stable during the perioperative period.VAS score of low back pain at 6 months and 1 year after operation was significantly lower than that of 6 weeks after operation（P<0.05）.The VAS score of leg pain and ODI at 6 weeks，6 months and 1 year after operation were lower than those before operation（P<0.001）.The ODI at 1 year after operation were lower than that of 6 weeks after operation（P<0.001）.Conclusion　 By relieving the physical pain and improving the functions for daily life，percutaneous spinal endoscopic decompression under local anesthesia has been proved to be effective for elderly DLSS patients at high risk for general anesthesia.

Recent Advances in Multimorbidity Treatment Burden Assessment Tools　

DOU Liyuan，HUANG Juan，GUO Lixiang

2020, 23(27): 3440-3443. DOI: 10.12114/j.issn.1007-9572.2020.00.428

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The patients with multimorbidity are increasing.Compared with those with single chronic condition，they may experience more serious treatment burden due to requirements for visiting physicians of different specialties，multiple treatments and care，and lots of examinations.The treatment burden of these patients has obtained increasing attention，and how to appropriately evaluate it is particularly important.We reviewed the assessment tools for multimorbidity treatment burden，including，Multimorbidity Treatment Burden Questionnaire，Patient Experience with Treatment and Self-management，Treatment Burden Questionnaire，Exercise Therapy Burden Questionnaire，Willingness to Access Life-sustaining Treatment，Living with Medicines Questionnaire，and Health Care Task Difficulty Scale with a concise description of their contents，reliability，validity，strengths and limitations，aiming to provide a scientific reference for medical workers to choose relevant evaluation tools reasonably.

Advances in Sarcopenia Screening Tools in the Elderly　

LU Jinling，XU Qin，HUA Hongxia，XU Xinyi，DING Lingyu

2020, 23(27): 3444-3448. DOI: 10.12114/j.issn.1007-9572.2020.00.423

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In China，the prevalence of sarcopenia is growing along with rapidly increased aging population.Sarcopenia is closely associated with poor health outcomes of the elderly，suggesting that screening of sarcopenia in this group should be strengthened.At present，there are various screening tools for sarcopenia.We reviewed the kinds，application，sensitivity，specificity，area under ROC curve and other indicators of common screening tools for sarcopenia in the elderly，providing a basis for early detection of high-risk population of sarcopenia and timely delivery of relevant interventions.

Compilation，Validity and Reliability of Questionnaire on Kano Model-based Service Needs among Older People in Integrated Medical and Nursing Institutions　

LIU Xiaochu，GU Li，SUNZI Kejimu，YANG Liangqin，JU Mei

2020, 23(27): 3449-3456. DOI: 10.12114/j.issn.1007-9572.2020.00.427

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Background　At present，integrated medical and nursing institutions are faced with serious problems such as service supply-demand mismatch and idle resources caused by the emphasis on facility construction and ignorance of service needs.Since there still lacks a unified national instrument assessing institutional elderly service demands in China，and available instruments are found to be with properties of incompleteness，strong locality，monotonous factors，and poor applicability，it is imperative to compile a questionnaire which can comprehensively and accurately assess the service demands of older people in integrated medical and nursing institutions.Objective　To compile a questionnaire with favorable validity and reliability that can comprehensively assess the service demand of older people in integrated medical and nursing institutions.Methods　The initial item pool of the questionnaire was developed on the basis of policy literature review and semi-structural interview.Then the items were screened using the boundary value method according to the results of two rounds of consultation using an Email-based Delphi approach with a convenience sample of 23 experts from 5 regions（Beijing，Shanghai，Jiangsu，Sichuan and Guizhou） during November 2018 to January 2019 after experts' positive and authoritative coefficients and Kendall's W were determined as eligible.Then the Questionnaire on Kano Model-based Service Needs among Older People in Integrated Medical and Nursing Institutions was developed using the screened items，with positive and reverse service quality attributes classified according to the Kano model，and its validity and reliability were tested from February to June 2019 in a convenience sample of older people from 27 elderly care institutions in 4 cities （Chengdu，Panzhihua，Luzhou and Zigong） of Sichuan province.Results　The experts' positive and authoritative coefficients and Kendall's W for the first round of consultation were 87.0%，0.910，and 0.309，respectively，and for the second round of consultation were 95.0%，0.927，and 0.349，respectively.After the consultation，the questionnaire was developed，including 5 first-level items （daily care，medical care，health care，psychological and social support，environmental security），and 64 second-level items.The survey for testing its validity and reliability was conducted in 800 participants，received a response rate of 96.6%（773/800）.The overall demand priority of the services stratified by the Kano model was:environmental security>daily care>medical care>psychological and social support>health care.The Cronbach's α coefficient of positive questions was 0.906，and Cronbach's α coefficients for the 5 dimensions，daily care，medical care，health care，psychological and social support，environmental security，were 0.921，0.901，0.937，0.873，and 0.902，respectively.The Cronbach's α coefficient of reverse questions was 0.898，with Cronbach's α coefficients for the above-mentioned 5 dimensions of 0.926，0.881，0.912，0.862，0.894，respectively.The questionnaire had an inter-rater reliability of 0.859，and item-level content validity indices（CVI） ranging from 0.833 to 1.000，S-CVI （S-CVI/UA） of 0.859，and average S-CVI（S-CVI/Ave） of 0.977.Conclusion　Our questionnaire may serve as an instrument assessing the service needs of older people in integrated medical and nursing institutions for its favorable validity and reliability.

TCM Treatment for AECOPD Patients with Drug-resistant Lung Infections　

LENG Jianchun

2020, 23(27): 3457-3459. DOI: 10.12114/j.issn.1007-9572.2020.00.306

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Bacteria are the most common pathogens of pulmonary infections.Due to recently extensive abuse of antibiotics，the rate of drug-resistant bacteria in pulmonary infections has been rising，and new drug-resistant strains have been emerging，which becomes a difficult problem in medical and health care.Drug-resistant bacterial infection is frequently seen in patients with acute exacerbation of chronic obstructive pulmonary disease（AECOPD），often leading to repeated attacks and hospitalization.The disease belongs to the category of "pulmonary distention" and " asthma syndrome" in traditional Chinese medicine（TCM），and its onset is closely related to dysfunctional lung and spleen according to visceral manifestation theory and five-element theory.In this paper，an in-depth analysis is performed on the therapeutic thoughts on TCM treatment of a case of AECOPD with drug-resistant lung infections.

Effects of rTMS Combined with Hyperbaric Oxygen-acupuncture-rehabilitation Therapy on Motor Function，Serum CRP and Plasma Dopamine in Patients with Parkinson's Disease　

SHI Qiang，LUO Qin，GONG Qinping，WANG Gang

2020, 23(27): 3460-3465. DOI: 10.12114/j.issn.1007-9572.2020.00.281

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Background　Along with the increase of population aging，the incidence rate of Parkinson's disease（PD） is gradually increasing.PD is mainly characterized by motor dysfunctions caused by static tremor，increased muscle tone，and muscle rigidity.The gradually decreased motor capacity makes it difficult for the patients to take care of themselves.In recent years，in addition to drug therapy，the main treatment for PD，the study in non-drug therapies has also obtained achievements，such as repetitive transcranial magnetic stimulation（rTMS），acupuncture，hyperbaric oxygen therapy，and rehabilitation function training，but a therapy incorporated with multiple interventions has not been developed.Objective　To explore the effects of rTMS combined with hyperbaric oxygen-acupuncture-rehabilitation therapy on motor function，serum CRP and plasma dopamine（DA） in patients with PD.Methods　90 PD patients hospitalized in Zigong First People's Hospital from April 2017 to February 2019 were selected and equally divided into control group，observation group，and hyperbaric oxygen-acupuncture-rehabilitation group according to a table of randomly generated numbers，receiving routine western medicine treatment，western medicine in combination with rTMS and hyperbaric oxygen-acupuncture-rehabilitation therapy（five-element music therapy，acupuncture and rehabilitation training are performed during a 90-minute hyperbaric oxygen therapy），and hyperbaric oxygen-acupuncture-rehabilitation therapy，respectively.The treatment for three groups lasted for 8 weeks.The outcome was evaluated by the assessment results of Unified Parkinson's Disease Rating Scale-Ⅲ（UPDRS-Ⅲ），Barthel index，Berg Balance Scale（BBS），limit of stability（LOS），clinical response，serum C-reactive protein （CRP），and plasma DA.Results　After treatment，the observation group showed better improvements in UPDRS-Ⅲ，BBS，LOS，CRP，DA and clinical responses than other two groups （P<0.05）.The Barthel index in the observation group was higher than that of the control group（P<0.05），but was similar to that of the hyperbaric oxygen-acupuncture-rehabilitation group（P>0.05）.Conclusion　rTMS combined with hyperbaric oxygen-acupuncture-rehabilitation therapy remarkably improves motor and balance functions，and reduces the expression of inflammatory factors and the loss of DA.In addition，using the therapy，the patients can receive many efficient interventions at the same time，which is time-saving.

Advances in Research on the Effects of Regulating Lipid Metabolism Using Astragalus Mongholicus and Pseudo-ginseng on MACE and Analysis of Potential Mechanisms　

LU Jianqi，LIN Hao，ZHU Zhide，PAN Chaoxin1WANG Qinggao，PANG Yan

2020, 23(27): 3466-3473. DOI: 10.12114/j.issn.1007-9572.2020.00.308

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Abnormal fat metabolism is one of the culprit causing and aggravating cardiovascular disease，and even causing MACE.A large number of studies have shown that statins，the major guideline-recommended Western medicines for regulating lipid metabolism，may often cause a series of adverse effects such as liver and kidney dysfunction and myotoxicity in the case of high intensity，large dose，and unreasonable application.It has become a cardiovascular problem that needs to be solved in recent years.Meanwhile，studies about regulating lipid metabolism using Chinese medicine are increasing.For example，Wenxin Granules regulate myocardial fatification and prevents MACE such as ventricular tachycardia after myocardial infarction.We reviewed the pathogenesis of abnormal lipid metabolism，and advances in the research on preventing MACE by regulating lipid metabolism using Wenxin Granules and other proprietary Chinese medicines with astragalus mongholicus and pseudo-ginseng as the main active ingredients，and used network pharmacology to explore the potential mechanisms of astragalus mongholicus and pseudo-ginseng in Wenxin Granules in preventing MACE by regulating lipid metabolism.This may be used as a reference for further exploration and research.

Clinical Analysis of Immunoglobulin Amyloid Light-chain Cardiac Amyloidosis　

WANG Liming，TIAN Ying，ZHAO Lei，YANG Xinchun

2020, 23(27): 3474-3478. DOI: 10.12114/j.issn.1007-9572.2020.00.048

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Background　The immunoglobulin amyloid light-chain cardiac amyloidosis （AL-CA） has a rapid progress and a high mortality rate，but its clinical characteristics are not fully recognized at present.Objective　To summarize the clinical data of immunoglobulin AL-CA patients to improve clinicians' awareness of this disease.Methods　Forty-three inpatients with AL-CA from Beijing Chao-yang Hospital，Capital Medical University were enrolled from January 2012 to December 2016.A retrospective analysis was performed on their general data，clinical symptoms and signs，laboratory examination，12-lead electrocardiogram，echocardiogram，cardiac magnetic resonance imaging，biopsy and therapeutic strategies.Results　（1）The mean onset age was （59±10） years old.Men had a higher prevalence rate〔74.4%（32/43）〕．Type λ was the most prevalent〔69.8% （30/43）〕．25 cases （58.1%） were accompanied with multiple myeloma.（2） Symptoms observed during admission were various.Clinical manifestations mainly consisted of chest tightness and shortness of breath 〔18 cases（41.9%）〕，edema of lower extremity 〔9 cases（20.9%）〕 and tiredness 〔9 cases（20.9%）〕.（3） The increase in BNP〔3 474（1 079，7 040）ng/L〕and cTnI〔0.21（0.06，1.47）μg/L〕 were common in laboratory tests，some of which were accompanied with decreased hemoglobin 〔13 cases（30.2%）〕and elevated serum creatinine〔32 cases（74.4%）〕.The most common manifestations of electrocardiogram were pathologic Q wave 〔12 cases（27.9%）〕，low voltage of the limb leads 〔11 cases（25.6%）〕 and poor R wave progression in precordial leads 〔6 cases（14.0%）〕.Dysrhythmia and conduction block were also be found in some cases.Echocardiography showed atrial enlargement 〔34 cases（79.1%）〕，ventricular wall thickening 〔35 cases（81.4%）〕，myocardial scintillating echo or ground-glass attenuation 〔8 cases（18.6%）〕，restricted diastolic and systolic function 〔21 cases（48.8%）〕，pericardial effusion 〔19 cases（44.2%）〕.Cardiac MRI showed high positive rate （4/4） of late gadolinium enhancement.Among all kinds of biopsies，bone marrow biopsy was the most used〔60.6%（20/33）〕，however，renal biopsy has the highest positive rate（5/6）.（4） Most patients received chemotherapy 〔38 cases（88.4%）〕.The regimens mostly used were BD （bortezomib + dexamethasone） and CyBorD （cyclophosphamide + bortezomib + dexamethasone）.Conclusion　According to the results of this series of cases，the clinical manifestations of patients with AL-CA are very nonspecific.The increase of BNP and cTnI is more common in laboratory tests，electrocardiogram shows low voltage of the limb leads or pathologic Q wave，echocardiography shows concentric left ventricular hypertrophy or myocardial scintillating echo，cardiac MRI shows late gadolinium enhancement.The highest positive results are from renal biopsy among all kinds of biopsies.

Clinical Features of 17 Patients with Sporadic Creutzfeldt-Jakob Disease　

LIANG Na，WANG Liang，LIU Yaling，ZHANG Haibo，ZHAO Wenyan，REN Bowen

2020, 23(27): 3479-3483. DOI: 10.12114/j.issn.1007-9572.2020.00.038

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Background　Sporadic Creutzfeldt-Jakob disease（sCJD）is a rare disease characterized by various clinical manifestations in the early stage，which is difficult to diagnose，requiring the assistance of an auxiliary examination.Objective　To analyze the clinical features and auxiliary examinations of 17 patients with clinically possible or probable sCJD，providing implications for early diagnosis of sCJD.Methods　By searching the records of patients with a discharge diagnosis of clinically possible or probable sCJD in Department of Medical Records，the Second Hospital of Hebei Medical University from November 2014 to August 2018，we collected their general information（gender，age，ethnic group，discharge diagnosis，first symptoms and major clinical manifestations），auxiliary examinations 〔brain MRI，EEG，CSF 14-3-3 protein，serum PRNP gene，autoimmune related antibodies of rapidly progressive dementia in serum and cerebrospinal fluid（ antibodies related to non-para-tumor autoimmune encephalitis，antibodies associated with para-tumor autoimmune encephalitis）〕.And by a telephone-based follow-up survey，we collected the data about morality and total duration of course.Results　Seventeen patients were enrolled，with an average age of（61.8±6.2）years，all of them were Han nationality.Sixteen of them were diagnosed with probable sCJD（94.1%）and other 1 with possible sCJD（5.9%）.The first symptoms mainly were memory decline（41.2%），dizziness（29.4%）and psychobehavioral abnormalities（17.6%）.The main clinical manifestations were cognitive decline（82.4%）and conical/extrapyramidal impairment（47.1%）.Diffusion-weighted imaging（DWI）of the brain performed in 16 cases showed that patients showed abnormally high signal intensity in cortex and/or basal ganglia，and correspondingly low signal intensity in apparent diffusion coefficient（ADC）.At least 2 lobes in the cortex showed abnormal high signals of gyrus along the surface of the brain，presenting "lace sign" or "ribbon sign".Basal ganglia included single/bilateral caudate nucleus，putamina，etc showed abnormal high signals in DWI.1 patient was examined by magnetic resonance spectroscopy（MRS），which revealed decreased peak of NAA.EEG was performed in 16 patients，the result includes 15 with slow basic rhythm，4 with PSWCs，5 with triphasic wave，and 4 with aperiodic epileptic discharge in the background with slow basic rhythm.CSF 14-3-3 protein test was performed in 8 patients，and 3 were positive.PRNP examination was performed in 8 patients，all showed：（1）no mutation in the sequence compared with the standard sequence（standard sequence number NCBI：NM-183079.1）；（2）polymorphism of amino acids at position 129 was M/M type；（3）amino acid polymorphism at position 219 was E/E type.Eleven patients were negative in serum and CSF non-para-tumor autoimmune encephalitis antibody tests.Nine patients were negative in serum and CSF para-tumor related antibodies test.All 17 patients were followed up by telephone，and 11 of them had died at the time of follow-up，with a total course of disease ranging from 1.5 to 16.0 months and an average of（7.4±4.7）months.The 1-year mortality rate was 81.8%（9/11）.Telephone contact failed in 2 patients.Family members of 2 patients refused to be followed up.The family members of one patient did not cooperate with the follow-up，and the patient died，the time of death was unknown，but the total course of disease was less than 14.0 months.One patient survived until 2019-02-01，the course of disease was 14 months.Among the 11 patients who died，9 patients developed into akinetic mutism，and 2 died due to bedsore infection.Brain DWI examination was performed in 10 cases（7 had abnormal signals in basal ganglia and cortex and the median course of the disease was 11.0 months，3 had abnormally high signal only in the cerebral cortex and the median course of disease was 4.0 months）.Conclusion　sCJD is a rapidly progressive and fatal neurodegenerative disease caused by prion protein infection.When the clinical manifestations are memory loss，visual abnormalities，etc，EEG，brain MRI，CSF 14-3-3 protein，RT-QuIC examination should be performed to clarify the clinical diagnosis.The disease progression may be faster when the isolated cortex is involved showed by the brain MRI and 14-3-3 protein is positive.The presence of aperiodic epileptiform discharges，characteristic triphasic waves，and PSWCs in EEG should be closely monitored for disease progression.

Angionecrosis at the Injection Site Accompanied by Adjacent Skin Ulceration due to Intravenous Drip of Aciclovir in Infants　

OUYANG Yan，ZENG Xinhua，LI Ting，ZHU Huifang，LUO Kaiyuan

2020, 23(27): 3484-3487. DOI: 10.12114/j.issn.1007-9572.2020.00.361

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Viral encephalitis is an acute inflammation of the brain parenchyma usually caused by various viral infections，which is an infectious disease of the central nervous system commonly seen in the pediatric intensive care unit.Acyclovir （ACV），a high-efficiency broad-spectrum antiviral drug，is used as the first choice for clinically treating viral encephalitis in children.It can significantly improve the patients' clinical symptoms，and reduce the incidence of complications.But during the treatment，ACV may also lead to some different adverse reactions depending on individual response，such as kidney damage，gastrointestinal reactions，allergic reactions，as well as venous inflammation.In this study，we reported two viral encephalitis infants with angionecrosis at the injection site accompanied by adjacent skin ulceration，rare adverse reactions induced by intravenous drip of ACV，in which the potent mechanisms accounted for the adverse reactions were analyzed and summarized，offering clinical care experience to deal with similar adverse reactions to improve the prognosis of the patients.

Recent Advances in Parenteral Nutrition-associated Metabolic Bone Disease　

HU Jing，LI Mei

2020, 23(27): 3488-3491. DOI: 10.12114/j.issn.1007-9572.2020.00.242

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Chinese Academy of Medical Science /Peking Union Medical College/Department of Endocrinology，Peking Union Medical College Hospital/Key Laboratory of Metabolic bone diseases are quite common in patients receiving long-term parenteral nutrition （PN），which significantly impair their life quality.Many risk factors are correlated with PN-associated metabolic bone disease，such as micronutrient deficiencies，vitamin D deficiency，secondary hyperparathyroidism，imbalanced bone turnover and underlying diseases.Because most of the patients are asymptomatic in the early stage，it is essential to regularly monitor bone biochemical markers and evaluate bone mineral density.For those with higher risk of metabolic bone diseases，primary interventions consist in removing risk factors and improving nutrition，and initiating pharmacological therapies if necessary，should be delivered early.

Research Progress of Neutrophil Gelatinase-associated Lipocalin in Coronary Heart Disease　

CUI Xiaohao，YANG Zhiming

2020, 23(27): 3492-3495. DOI: 10.12114/j.issn.1007-9572.2020.00.096

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In recent years，the rapid development of cardiac markers has improved the overall level of cardiovascular disease's diagnosis.Research findings have shown that neutrophil gelatinase-associated lipocalin（NGAL），as a marker of acute renal injury（AKI），is closely related to the severity of coronary heart disease，adverse prognosis and the occurrence of future cardiovascular events.NGAL is also a potential marker in coronary heart disease.The purpose of this review is to elucidate the origin and nature of NGAL and the relationship between NGAL and the severity of coronary artery disease，stable coronary heart disease，acute coronary syndrome（ACS）and future coronary heart disease events.And it aims to provide a promising reference direction for the researches of biomarkers in coronary heart disease.

Clinical Diagnosis and Treatment of Perianal Paget's Disease　

YAN Guilin，DU Yuanfang，PU Yongping，LIU Li，YANG Xiangdong

2020, 23(27): 3496-3502. DOI: 10.12114/j.issn.1007-9572.2020.00.050

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Perianal Paget's disease is a rare malignant disease.Due to its atypical clinical manifestations，the disease is easily confused with chronic perianal eczema，abalone and other diseases，and there is no unified standard and consensus in clinical diagnosis，treatment，recurrence factors and prognosis judgment，so the misdiagnosis rate in clinical practice is high.Therefore，this paper will make a review of perianal Paget's disease from the aspects of epidemiology，classification，pathological features，clinical manifestations，differential diagnosis，treatment，recurrence and prognosis，so as to improve the clinicians' understanding of this disease.

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