Chinese General Practice

Osteoporosis Prevalence and Community-based Diagnosis and Management of Osteoporosis-related Chronic Pain in China　

YUE Jianning

2020, 23(18): 2223-2228. DOI: 10.12114/j.issn.1007-9572.2020.00.334

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The incidence of osteoporosis is very high in Chinese middle-aged and elderly people，but it often fails to gain adequate attentions due to slow development and concealed clinical symptoms.In general，patients with osteoporosis and osteoporosis-related chronic pain may not seek healthcare proactively until developing fractures or other serious complications，but by this point both treatment difficulties and cost probably greatly increase.We outlined the common epidemiological characteristics，prevention and management of osteoporosis in China，narrated the necessity of providing osteoporosis-related trainings for community physicians and nurses，introduced techniques and methods suitable for community-based diagnosis and management of such pains，and put forward that it may be a very efficient way to handle osteoporosis and its related chronic pain in the community.

Repeated Hospitalization in Hypertensive Patients from a Jieshou City in Anhui Province，2016—2018　

XU Shiyu，WANG Xue，WU Yue，SHEN Xingrong，WANG Debin

2020, 23(18): 2229-2234. DOI: 10.12114/j.issn.1007-9572.2020.00.162

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Background　China owns a high hypertension incidence with relatively low control rate and cure rate，as well as long-term course.Hypertension is deemed as a major risk for health，which can lead to a series of complications，often accompanied by diabetes and other risks.Due to these characteristics of hypertension，people suffering from it have a higher risk of rehospitalization.Objective　This article was intended to analyze the prevalence and cost of repeated hospitalization in hypertension patients in Jieshou City of Anhui Province from 2016 to 2018，so as to provide clues for relieving the burden of hypertension.Methods　Data were collected from the Rural Cooperative Medical Scheme （RCMS） reimbursement system and electronic health record（EHS） system of Jieshou City of Anhui Province during February to June 2019.All the hypertensive inpatients obtaining reimbursement registered in the reimbursement system and hypertensive patients recorded in the EHS system between 2016 and 2018 were included and were analyzed to find the eligible inpatients who were also recorded in the EHS system using a computer-based program developed by our research team.The use of hospitalization services was analyzed in detail，including number of hospitalizations based on sex and age，use of local hospitals by level and of out-of-province hospitals based on sex，age，and ordinal number of hospitalizations，average length of stay and cost based on sex，age，local hospitals by level and out-of-province hospitals as well as ordinal number of hospitalizations.Results　The study included 27 092 cases from 18 townships and towns of Jieshou City with 66 008 person-times in total.From 2016 to 2018，12 536 patients （46.27%） were hospitalized once，6 071 （22.41%） were hospitalized twice，and 8 485 （31.98%） were hospitalized at least 3 times.The number of hospitalizations differed significantly by sex and age （P<0.05）.The use of local hospitals by level and of out-of-province hospitals differed significantly by sex，age，and ordinal number of hospitalizations（P<0.05）.The overall average length of stay was （8.5±6.7）d.Males had a longer average length of stay（t=5.10，P<0.05）.The average length of stay differed significantly by age（F=10.49，P<0.05），level of local hospitals and out-of-province hospitals（F= 737.92，P<0.05）.For all of them，the average total cost of hospitalization was （4 790.1±2 587.8） yuan.Among the five items listed in the NRCMS，The percentages of cost of reimbursed drugs （ratio of cost of reimbursed drugs to total hospitalization cost），reimbursed examination fee（ratio of reimbursed examination fee to total hospitalization cost），reimbursed treatment cost（ratio of treatment cost to total hospitalization cost），reimbursed cost of materials（ratio of cost of reimbursed materials to total hospitalization cost），and reimbursed surgery cost （ratio of reimbursed surgery cost to total hospitalization cost） were （29.6±16.7）%，（17.0±11.7）%，（12.9±16.2）%，（7.2±14.2）%，and （3.6±10.8）%，respectively.Males had higher percentages of reimbursed drug cost and examination fee but lower percentage of cost of reimbursed materials than females（P<0.05）.The total hospitalization cost，percentages of OOP，reimbursed drug cost，material cost，examination fee and treatment cost differed significantly by age，use of local hospitals by level and of out-of-province hospitals，as well as ordinal number of hospitalizations（P<0.05）.Conclusion　This group of hypertensive patients showed an increased risk of repeated hospitalization.The risk varied by sex，age and use of local hospitals by level and of out-of-province hospitals.The percentage of cost of reimbursed drug was highest，followed by the percentage of reimbursed examination fee.

Trends in Prevalence，Incidence and Negative Conversion of Hypertension，Fasting Hyperglycemia and Elevated Total Cholesterol in Middle-aged and Elderly Populations from Hangzhou in Even-numbered Years between 2010 and 2018　

YANG Shengyi，DING Xiaoyu，YANG Zhuoqiao，WANG Quan，SUN Ying，MA Haiyan

2020, 23(18): 2235-2241. DOI: 10.12114/j.issn.1007-9572.2020.00.065

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Background　The incidence rates of chronic diseases in middle-aged and elderly people in the community is increasing with the development of society，which aggravate burden of diseases.Objective　To analyze the trends in prevalence，incidence and negative conversion rates of prehypertension，hypertension，fasting hyperglycemia，and increased total cholesterol（TC） in even-numbered years between 2010 and 2018 in residents from Hangzhou，to provide a scientific basis for ensuring the health of residents and implementation of chronic disease management.Methods　The physical examination data of middle-aged and elderly people over 50 years old who underwent free medical examination from January 2010 to December 2018 were obtained from the physical examination database of the Zhalongkou Community Health Service Center，Hangzhou，including physical measurement，history taking，special examination and laboratory examination.Microsoft Excel was used to calculate the overall，sex- and age（50-59，60-69，70-79，80-89）-specific annual prevalence，incidence and negative conversion rates of prehypertension，hypertension，fasting hyperglycemia，and increased TC among the residents in 2010，2012，2014，2016 and 2018.Results　The overall number and distribution of the 50-90-year-old population in Zhalongkou street in 2018 is similar to those of the physical examination population in 2018.Therefore，this group can represent the middle-aged and elderly people in this community.In 2010，2012，2014，2016，and 2018，the number of physical examinees was 9 609，19 727，13 610，13 941，and 10 801，respectively.The mean number for the physical examinees in 2010 and 2012，2012 and 2014，2014 and 2016，and 2016 and 2018 was 5 578，7 185，10 968，and 8 580，respectively.The overall prevalence rates of prehypertension were 39.95%，38.81%，36.96%，34.33%，respectively，in 2012，2014，2016，and 2018.And those of hypertension were 27.04%，41.45%，42.94%，38.85%，respectively.In 2010，2012，2014，2016，and 2018，the overall prevalence rates of fasting hyperglycemia were 22.65%，22.40%，26.99%，23.74%，and 29.01%，respectively.And those of increased TC were 7.96%，13.76%，4.90%，9.64% and 16.05%，respectively.In 2014，2016 and 2018，the overall incidence rates of prehypertension were 37.78%，36.19%，and 10.47%，respectively.And those of hypertension were 29.72%，26.94%，and 23.71%，respectively.In 2012，2014，2016，and 2018，the overall incidence rates of fasting hyperglycemia were 10.84%，13.64%，8.42% and 13.82%，respectively.And those of increased TC were 13.22%，12.27%，17.34% and 11.57%，respectively.In 2014，2016 and 2018，the negative conversion rates of prehypertension were 13.32%，17.83% and 21.69%，respectively，and those of hypertension were 31.25%，31.51% and 38.90%，respectively.In 2010，2012，2014，2016，and 2018，the negative conversion rates of fasting hyperglycemia were 32.87%，26.36%，32.44% and 19.05%，respectively，and those of increased TC were 39.86%，34.61%，39.33% and 36.91%，respectively.Compared with women，men showed higher incidence rates of prehypertension in 2014 and 2018（P<0.05），higher incidence rates of hypertension and fasting hyperglycemia in 2014，2016 and 2018（P<0.05），and higher incidence rates of increased TC in 2012，2014，2016 and 2018（P<0.05）.In 2014，2016 and 2018，the overall incidence rates of prehypertension and hypertension increased annually in age groups of 50-59 and 60-69，but decreased annually in age groups of 70-79 and 80-89.The overall incidence rate of fasting hyperglycemia increased from 6.33% in 2012 to 19.22% in 2018 in age group of 50-59，but decreased from 21.77% to 8.21% in age group of 80-89，and showed little changes in other two age groups.The overall incidence rate of increased TC increased from 6.82% in 2012 to 19.18% in 2018 in age group of 50-59，decreased from 20.34% to 11.62% in age group of 70-79，and demonstrated insignificant changes in other two age groups.Conclusion　The prevalence of prehypertension，hypertension，fasting hyperglycemia，and increased TC in residents in the community in even-numbered years between 2010 and 2018 was not optimistic，showing an overall increasing trend.Although the incidence rate decreased and the conversion rate increased generally during the period，there is still a need to strengthen the monitoring and management of these diseases.

Mortality and Years of Life Lost of Ischemic Heart Disease among Residents in Pudong New Area of Shanghai between 2002 and 2018　

CHEN Yichen，SUN Lianghong，LI Xiaopan，CHEN Hanyi，ZHANG Ge，QU Xiaobin，CHEN Hua，ZHOU Yi，XIAO Shaotan

2020, 23(18): 2242-2248. DOI: 10.12114/j.issn.1007-9572.2019.00.775

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Background　Ischemic heart disease（IHD） is the leading cause of death on a global scale.At present，the epidemiological data of IHD among residents in Pudong New Area are absent.Objective　To explore the mortality and potential years of life lost in residents with IHD in Pudong New Area of Shanghai from 2002 to 2018，providing a basis for the development of targeted interventions.Methods　This study was performed in March 2019，targeting the registered residents in Pudong New Area.Records of IHD mortality data between January 1，2002 and December 1，2018 were derived from the universal death surveillance database.The data were coded and classified according to International Classification of Disease 10th Revision.Acute myocardial infarction and chronic IHD were encoded as I21 and I25，respectively.The gender- and disease-specific crude mortality rate（CMR），standardized mortality rate（SMR），potential years of life lost（PYLL），potential years of life lost rate（PYLLR），average years of life lost（AYLL），standardized potential years of life lost（SPYLL） and standardized potential years of life lost rate（SPYLLR） were taken as the main outcome measures to analyze the situation of IHD mortality.The tendency of mortality was estimated by annual percent change（APC） Difference decomposition was applied to estimate the contribution of aging to the change of IHD mortality.Results　The CMR and SMR of IHD among these residents between 2002 and 2018 were 101.32/100 000 and 33.98/100 000，respectively，and both of them increased over the years（APCCMR=6.00%，ZCMR=22.051，P<0.001；APCSMR=1.33%，ZSMR=4.755，P<0.001）.Disease classification analysis showed that the CMR of acute myocardial infarction rose year by year during 2002 to 2011（APC=1.83%，Z=2.792，P=0.016），and declined between 2012 and 2018（APC=-2.58%，Z=-2.744，P=0.018）.The SMR declined over the years（APC=-3.62%，Z=-12.457，P<0.001）.Both the CMR and SMR of chronic IHD showed an upward trend during 2002 to 2018（APCCMR=6.96%，ZCMR=22.052，P<0.001；APCSMR=2.22%，ZSMR=6.931，P<0.001）.The CMR of IHD among male residents between 2002 and 2018 was lower than that of female residents（Z=-24.532，P<0.001），but the SMR was higher（Z=-20.197，P<0.001）.Both the CMR and SMR of acute myocardial infarction among males were higher than those of females（ZCMR=7.848，P<0.001；ZSMR=-19.828，P<0.001）.For chronic IHD，the CMR among the males was lower than that of females（Z=-29.929，P<0.001），but the SMR was higher（Z=-13.184，P<0.001）.Both the CMR of IHD among male and female residents rose year by year during 2002 to 2018（APCmale=5.76%，Zmale=19.997，P<0.001，APCfemale=6.19%，Zfemale=20.405，P<0.001），and the SMR among male and female population also showed an upward trend（APCmale=1.15%，Zmale=3.730，P=0.002；APCfemale=1.35%，Zfemale=4.535，P<0.001）.There existed the diversity in the tendency of IHD across different age groups.For the population aged 15 to 59，the age-specific CMR rose over years（APC=3.54%，Z=7.326，P<0.001）.For the population aged 60 to 79，there showed a downward trend（APC=-2.85%，Z=-9.099，P<0.001）.For the population over 80 years old，there showed an upward trend（APC=3.21%，Z=10.550，P<0.001）.The PYLL of IHD was 37 649 years，the PYLL rate was 0.81‰，and the AYLL was 0.80 year per person.The PYLL，PYLLR，AYLL，SPYLL and SPYLLR of IHD among males were all higher than those of females.The PYLL，PYLLR，SPYLL，SPYLLR，due to acute myocardial infarction were lower than those of chronic IHD，but the AYLL was higher.The CMR of IHD in 2018 was higher than that in 2002，demographic and non-demographic factors associated with age contributed to the increase of IHD mortality.The gender-specific analysis showed that both the contributions of demographic and non-demographic factors associated with age to the rise of IHD mortality in males were lower than those of females.The disease classification analysis showed that the demographic factors associated with age enhanced the mortality of acute myocardial infarction，and the non-demographic factors associated with age declined the mortality.But demographic and non-demographic factors associated with age promoted the mortality of chronic IHD.Conclusion　The IHD mortality in Pudong New Area showed an upward tendency during 2002—2018，and caused serious life loss.Both demographic and non-demographic factors associated with age were enhancement factors.More attention should be paid to IHD mortality among males and people of age groups of 15 to 59 and over 80.

Effect of "SMG" Health Management-based Occupational Therapy on Self-efficacy of Stroke Patients with Hemiplegia　

HE Fei，ZHAO Huining，HOU Lihong，LI Bo，ZHANG Chichen

2020, 23(18): 2249-2253. DOI: 10.12114/j.issn.1007-9572.2020.00.016

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Background　Stroke is a common cerebrovascular disease around the world.In China，its prevalence trend and induced economic burden are relatively high.The prevention and control of stroke involve multiple disciplines.To achieve universal health coverage，it is necessary to prevent and control stroke in a combined way.Objective　To evaluate the effectiveness of occupational therapy based on the "SMG" health management model in improving patient self-efficacy and quality of life.Methods　From November 2018 to February 2019，44 inpatients with stroke-induced hemiplegia from Shanxi Rongjun Hospital were enrolled and were ordered according to the admission time，then by using a table of random digits，23 odd-numbered and 21 even-numbered cases were assigned to control group（with routine occupational therapy），and experimental group（with "SMG" health management-based occupational therapy），respectively.The self-efficacy and quality of life were evaluated using the Stroke Self-Efficacy Questionnaire（SSEQ） and the Stroke-specific Quality of Life
（SS-QOL），respectively.Results　After the intervention，the mean scores of SSEQ，daily activities，and self-management of the experimental group were higher than the baseline levels（P<0.05），and were higher than those of the control group（P<0.05）.The post-intervention mean score of SS-QOL in the experimental group showed a significant increase compared to the baseline level（P<0.05），and it was higher than that of the control group （P<0.05）.Conclusion　Occupational therapy based on "SMG" health management is effective in improving the self-efficacy and quality of life of stroke patients with hemiplegia.

Effect of Epstein-Barr Virus Infection on Connective Tissue Disease-associated Interstitial Pneumonia　

XU Yanju，ZHANG Yiling，LU Ping，XU Lin

2020, 23(18): 2254-2258. DOI: 10.12114/j.issn.1007-9572.2020.00.152

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Background　We have clinically found that patients with connective tissue disease-associated interstitial pneumonia often combine with Epstein-Barr（EB） virus infection.However，it is rarely reported that whether EB virus infection is associated with higher risk of bacterial infection，aggravation of inflammatory response，complications and prolongation of treatment time in such patients.Objective　To provide evidence for further study of the impact of EB virus infection on connective tissue-related interstitial lung disease.Methods　113 patients with connective tissue-related interstitial pneumonia admitted to Department of Respiratory and Critical Care Medicine，Guizhou Provincial People's Hospital were prospectively selected from December 2016 to December 2018，and 39 of them with EB virus infection and other 74 without were assigned to infected group and uninfected group，respectively.The general personal data，combined disease，arterial blood gas markers（PaCO2 and PaO2），fraction of inspired oxygen（FiO2），EB virus DNA content，proportion of G- bacteria infection，neutrophil fraction，proportion of drug-resistant bacteria infection，effective treatment time，proportion of transferred cases to the ICU，and inflammatory markers〔serum C- reactive protein（CRP），procalcitonin（PCT），inducible nitric oxide synthase（iNOS），leukocyte count and interleukin（IL）-6，IL-17 and IL-33〕 were compared between the two groups.Relationships of EB virus DNA content with CRP，PCT，iNOS，IL-6，IL-17 and IL-33 in EB virus infected group were analyzed.Results　The mean level of PaO2，prevalence of EB virus DNA content greater than 5×102 copies/ml，proportion of G- bacteria infectiong，mean time of effective treatment and proportion of transferred cases to the ICU differed significantly between the two groups（P<0.05），but general personal data，distribution of combined diseases，mean levels of PaCO2，FiO2，neutrophil fraction，and proportion of drug-resistant bacteria infection did not（P>0.05）.The mean levels of serum CRP，PCT，iNOS，leukocyte count，IL-6，IL-17 and IL-33 in patients with EB virus infection were significantly higher than those without（P<0.05）.In the EB virus infected group，EB virus DNA content was positively correlated with serum CRP，PCT，iNOS，IL-17 and IL-33（r=0.674 5，0.584 3，0.620 4，0.698 9，0.585 1，P<0.05）.There was no linear correlation between IL-6 and EB virus DNA content（r=0.105 2，P>0.05）.Conclusion　Compared with those without EB virus infection，the EB virus-infected patients had aggravated inflammatory response，increased proportion of being infected with drug-resistant bacteria，poorer prognosis，and prolonged hospital stay.The EB virus DNA content in those infected was positively correlated with levels of CRP，PCT，iNOS，IL-17，and IL-33 in the serum.EB virus infection may increase the risk of developing bacterial infection or aggravating the infection.This study shows that EB virus infection may promote the progression and deterioration of patients with connective tissue disease-associated interstitial pneumonia，which provides a certain theoretical basis for clinical research of EB virus infection.

Relationship between Intestinal Flora and Cognitive Emotion Regulation in Patients with First-episode Depression　

WU Yuexia，BAO Xueyan，LI Hongyan，DU Yong，SUN Ting，WANG Ruichen，CHANG Shaohua，FANG Jianqun

2020, 23(18): 2259-2265. DOI: 10.12114/j.issn.1007-9572.2019.00.778

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Background　Recent studies about the relationship of intestinal flora with depression are mostly in animal models，but rarely in humans，and those about intestinal flora and psychological characteristics in humans are even more rare.Objective　To explore the differences in intestinal flora and cognitive emotion regulation between first-episode depression patients and healthy people，and to further explore the relationship of depression with intestinal flora and cognitive emotion regulation strategies.Methods　Participants were enrolled during January to December 2017，including 30 outpatients with first-onset depression（depression group） from Mental Health Center Clinic，Ningxia Medical University General Hospital，and 31 healthy physical examinees（control group） who participated in an epidemiological survey of a major scientific and technological project of Ningxia's 13th Five-Year Plan.Both groups were surveyed with the General Questionnaire，Hamilton Depression Rating Scale（HAMD），and Cognitive Emotion Regulation Questionnaire（CERQ）.High-throughput sequencing and bioinformatics techniques were used to measure the diversity and abundance of microflora in fecal samples of the participants.The relationship of depression with intestinal flora and cognitive emotion regulation was analyzed.Results　Both groups had no significant differences in general conditions（gender ratio，mean age，and BMI，smoking prevalence，education level distribution）（P>0.05）.In this study，the effective sequences of all samples were clustered into Operational Taxonomic Units（OTUs） at a 97% similarity level，and the resulting rarefaction curves tended to be flat，indicating that the amount of sequencing data was reasonable.There was no significant difference in the diversity index of intestinal microflora between these two groups（P>0.05）.Compared to the control group，depression group showed significantly decreased abundance of the Firmicutes，Actinobacteria，and Tenericutes，and significantly increased abundance of the Bacteroidetes（P<0.05） at the level of phylum.At the level of genus，depression group showed lower ratios of Ruminococcus，Subdoligranulum，Enterobacter，Coprococcus，Bifidobacterium，Lactobacillus，and higher ratios of the Klebsiella，Flavonifractor and Bacteroides（P<0.05）.LEfSe analysis showed that the intestinal flora of the depression group mainly consisted of pathogenic bacteria such as Bacteroides，Alcaligenaceae，Burkholderiales，Betaproteobacteria，Erysipelotrichaceae，Helicobacter pylori.In the control group，beneficial bacteria such as Firmicutes，Bifidobacteriales，Subdoligranulum，and Lactobacillales were dominant bacteria.Depression group had higher mean scores of self-blame，rumination，and catastrophizing subscales，and lower mean scores of positive reappraisal，and putting into perspective subscales（P<0.05）.Self-blame subscale score was positively correlated with Enterobacter，and was negatively correlated with Odoribacter and Alistipes（P<0.05）.Rumination subscale score was negatively correlated with Subdoligranulum，Alistipes，Faecalibacterium，and Odoribacter（P<0.05）.Positive refocusing，planning and positive reappaisal subscales scores were positively correlated with Weissella（P<0.05）.Catastrophizing subscale score was negatively correlated with Dialister（P<0.05）.The severity of depression was positively correlated with the relative abundance of Bacteroides and Flavonifractor（P<0.05），and was negatively correlated with Ruminococcus，Subdoligranulum，Coprococcus，Dialister，Odoribacter，Faecalibacterium and Butyricimonas（P<0.05）.Conclusion　There are significant differences in intestinal flora and cognitive emotion regulation strategies between patients with depression and healthy controls.Three emotional regulation strategies（self-blame，rumination，and catastrophizing），increased intestinal pathogens and the reduction of probiotics bacteria and butyrate-producing bacteria are related to depression closely.

Association of Serum Prealbumin Level and Long-term Prognosis in Patients with Acute Heart Failure in the Cardiac Intensive Care Unit　

HAN Kunyuan，ZHENG Yang，ZHU Caizhong，ZHOU Xiaoli，LIN Ruzheng，XIE Pingdong

2020, 23(18): 2266-2269. DOI: 10.12114/j.issn.1007-9572.2020.00.335

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Background　Serum prealbumin is a marker of nutritional and inflammatory status.Low serum prealbumin levels are associated with poor prognosis of coronary heart disease.However，the prognostic value of serum prealbumin levels in patients with acute heart failure （AHF） has not been determined.Objective　To explore the association between serum prealbumin levels at admission and long-term prognosis in patients with AHF in the cardiac intensive care unit.Methods　A retrospective analysis was performed on 186 cases of AHF treated in the Cardiac Intensive Care Unit，Hainan General Hospital from January 2014 to February 2017.By the serum prealbumin level within 24 hours of admission，they were stratified into >14.0 mg/dl（n=119） and≤14.0 mg/dl（n=67） groups，and all received post-discharge follow-up services.The deadline for follow-up was February 2019.The general data and incidence rates of all-cause death and composite endpoints were compared between the two groups.The Kaplan-Meier survival curves of all-cause death and composite endpoints were compared between the two groups.Factors associated with all-cause death and composite endpoints were identified.Results　The incidence rates of all-cause death and composite endpoints in patients with serum prealbumin albumin≤14.0 mg/dl were higher （P<0.05）.There were significant differences in Kaplan-Meier survival curves of all-cause death and composite endpoints between the two groups （P<0.05）.Multivariate Cox regression analysis showed that serum prealbumin≤14.0 mg/dl was associated with all-cause death（P=0.002） and composite endpoints （P<0.001）.Conclusion　Measuring serum prealbumin levels at admission may help to stratify the risk of AHF patients in the acute care setting，and lower serum prealbumin levels may be associated with long-term adverse prognosis.

Efficacy of Enhanced External Counterpulsation in Patients with Coronary Heart Disease Complicated with Cardiac Dysfunction during the Cardiac Rehabilitation Training　

LIU Miaomiao，FAN Junya，LIU Zhen，ZHANG Zhao，HUANG Xin，ZHANG Hui

2020, 23(18): 2270-2274. DOI: 10.12114/j.issn.1007-9572.2020.00.248

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Background　In recent years，a large number of studies at home and abroad on the enhanced external counterpulsation（EECP），a type of "passive" exercise，have shown that EECP can improve exercise tolerance and cardiac function in patients with stable and unstable angina pectoris and mild to moderate cardiac insufficiency.Yet few reports have covered whether additional gain can be achieved in EECP in combination with active exercises like cardiac rehabilitation training.Objective　To explore the efficacy of EECP in cardiac rehabilitation for patients with coronary heart disease and cardiac dysfunction.Methods　A total of 100 patients with coronary heart disease and cardiac insufficiency who were hospitalized in Cardiovascular Department，the Second Affiliated Hospital of Zhengzhou University from March 2018 to April 2019 were recruited voluntarily.They were randomly and equally divided into two groups，namely，the control group（receiving conventional medication+cardiac rehabilitation training）and the counterpulsation group（receiving conventional medication+cardiac rehabilitation training+EECP）with the adoption of random number tables.Then，the anaerobic threshold（AT），6-minute walking distance（6MWD），left ventricular ejection fraction（LVEF），and serum brain natriuretic peptide（BNP）before and after treatment in the two groups were measured and recorded.Results　The counterpulsation group，after the treatment，had higher mean levels of AT，6MWD and LVEF，and lower mean level of BNP than the control group（P<0.05）.Both groups had significantly increased mean levels of AT，6MWD，and LVEF，as well as significantly lowered mean level of BNP after treatment（P<0.05）.Conclusion　EECP may significantly enhance exercise tolerance，6MWD，heart pump function and heart failure related indices in patients with coronary heart disease and cardiac insufficiency and cardiac rehabilitation training.Its efficacy is better than that of medication treatment or cardiac rehabilitation training alone.Therefore，EECP is highly worthy of clinical promotion.

Associations of Primary Tumor Site and Clinicopathologic Features with TNM-related Survival in Patients with Radical Resection of Colorectal Cancer　

HAN Jing，WANG Guiying，ZHANG Nan，ZHANG Xue，ZHANG Andu，ZHOU Xinliang，FENG Li，WANG Junyan

2020, 23(18): 2275-2283. DOI: 10.12114/j.issn.1007-9572.2020.00.336

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Background　An increasing number of studies have confirmed that tumor site and clinicopathological characteristics are associated with the effectiveness of targeted therapy and survival in advanced colorectal cancer patients.But there is no final conclusion on whether tumor site is associated with the survival in those with radical resection.Objective　To investigate the factors（with focus on tumor site and clinicopathological characteristics） associated with TNM-related survival in patients with radical resection of colorectal cancer.Methods　This retrospective study was conducted in 2 097 eligible patients with radical resection of colorectal cancer from Fourth Hospital of Hebei Medical University from January 2008 to March 2015.Clinicopathological characteristics were collected，including gender，age，pathological type，family history of colorectal cancer，preoperative intestinal obstruction，TNM stage，T stage，N stage，M stage，blood vessel invasion and were compared in those with left-sided colorectal cancer（LSCC）（n=1 711） and right-sided colorectal cancer（RSCC）（n=386），namely，by the side that colorectal cancer originates from splenic flexure.Survival status was followed up by telephone，outpatient follow-up and regular review as of January 31，2016.Cox proportional hazards regression analysis was used to investigate the influencing factors of death.Kaplan-Meier method was used to plot the survival curve.The overall survival（OS） was analyzed by TNM stage，specifically involving the influence of adjuvant chemotherapy in those with stage Ⅱ-Ⅲ.Also，the rate of surviving at least 5 years after resection in those with a 5-year follow-up was compared by tumor site.Results　LSCC and RSCC patients showed significant differences in the distribution of pathological type，TNM stage and T stage，and prevalence of preoperative intestinal obstruction（P<0.05）.Multivariate Cox proportional hazards regression analysis showed that pathological type，family history of colorectal cancer，preoperative intestinal obstruction，N stage，and M stage were independently associated with death（P<0.05）.Stage Ⅰ LSCC was associated with longer average OS（χ2=3.843，P=0.049）.Stage ⅡLSCC and RSCC showed no significantly different average OS（χ2=0.003，P=0.956）.The average OS did not vary significantly between stage ⅡLSCC and RSCC with adjuvant chemotherapy（χ2=0.078，P=0.780） or without（χ2=0.645，P=0.422）.Stage Ⅲ LSCC was associated with longer average OS（χ2=7.612，P=0.006）.StageⅢ LSCC and RSCC without adjuvant chemotherapy demonstrated no significantly different average OS（χ2=0.851，P=0.356）.Stage Ⅲ LSCC with adjuvant chemotherapy was associated with longer average OS（χ2=7.098，P=0.008）.StageⅣ LSCC and RSCC showed no significantly different average OS（χ2=0.504，P=0.478）.Altogether，703 patients completed a 5-year follow-up，including 591 with LSCC〔464 with rectal cancer； 431（72.9%） with a survival period of at least 5 years，and 160（27.1%） without〕 and 112 with RSCC〔68（60.7%） with a survival period of at least 5 years，and 44（39.29%） without〕.The rate of LSCC patients surviving at least 5 years was higher than that of RSCC patients（χ2=6.818，P=0.009）.Conclusion　Pathological type，family history of colorectal cancer，preoperative intestinal obstruction，N stage and M stage were independent survival prognostic factors in patients with radical resection of colorectal cancer.TNM-related survival was affected by tumor location.Stage Ⅰ LSCC was associated with longer OS，so was stage Ⅲ LSCC.But the OS of stage Ⅱcolorectal cancer showed no association with tumor site，so did stageⅣcolorectal cancer.

Relationship of Left Atrial Systolic Strain and Strain Rate Evaluated by Two-dimensional Speckle Tracking in Cardiac Resynchronization Therapy　

YANG Dongmei，HUANG Xiangyang，WANG Yuting，CHEN Kangyu，WANG Qi，XU Jian，YAN Ji

2020, 23(18): 2284-2288. DOI: 10.12114/j.issn.1007-9572.2020.00.142

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Background　Left atrial function is an important component of cardiac function.Studies have shown that left atrial volume can independently affect the efficacy of cardiac resynchronization therapy（CRT）.Objective　In this study，two-dimensional speckle tracking technique was used to quantitatively assess left atrial function and evaluate its effect on the outcome of CRT.The research was meant to evaluate the influence of left atrial strain（Sa） and strain rate（SRa） during atrial contraction on the efficacy of CRT.Methods　A total of 121 patients who underwent CRT implantation in Cardiovascular Department，the First Affiliated Hospital of USTC due to heart failure between May 2015 and January 2018 were selected retrospectively.Two-dimensional speckle-tracing technique was used to evaluate the Sa and SRa of left atrial.CRT response was defined as a reduction of LVESV by at least 15% within six months after surgery.Patients were divided into response group and non-response group by efficacy of CRT.Pre- and post-surgery left atrial Sa and SRa were compared，and relationships of the two with the efficacy of CRT were evaluated.Results　51 patients（42.1%）showed no response to CRT.In other 70 patients（57.9%） with response to CRT，both left atrial Sa and SRa improved significantly at six months after surgery（P<0.05）.The Spearman's rank correlation coefficient between Sa and SRa was -0.770（P<0.001）.Both SRa（OR=5.039，P=0.020） and Sa（OR=1.094，P=0.010）were factors influencing on the efficacy of CRT according to multivariate Logistic regression analysis.Other influencing factors included left bundle branch block（OR=4.913，P=0.002），QRS duration（OR=1.041，P=0.005），E/A ratio（OR=0.309，P=0.008），and pulmonary artery systolic pressure（OR=0.950，P=0.013）.Conclusion　Baseline Sa and SRa were independent predictors of CRT responsiveness.Left atrial systolic function improved significantly in those with response to implantation of CRT.

Clinical Study of Encapsulated Chinese Medicine Combined with Wax Therapy on Oxaliplatin-induced Mild-to-moderate Cancerous Neuropathic Pain　

LI Mingzhu，WANG Wenping，JIN Shengbo

2020, 23(18): 2289-2293. DOI: 10.12114/j.issn.1007-9572.2019.00.820

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Background　Oxaliplatin-induced cancerous neuropathic pain has a high incidence and long duration.Treatment with western medicine is assessed to be ineffective for it with evident adverse reactions，but traditional Chinese medicine treatment is a research hotspot at present.Objective　To observe and evaluate the clinical efficacy of oxaliplatin-induced mild-to-moderate cancerous neuropathic pain treated by encapsulated Chinese medicine with wax therapy.Methods　65 outpatients and inpatients with oxaliplatin chemotherapy-induced mild-to-moderate cancerous neuropathic pain from Integrated TCM & Western Medicine Department，Liaoning Cancer Hospital were enrolled from February 2018 to February 2019，and were divided into the experimental group（n=32） and control group（n=33） by the order of admission and computer-generated random numbers，receiving encapsulated Chinese medicine，wax therapy and duloxetine hydrochloride enteric-coated tablets，and duloxetine hydrochloride enteric-coated tablets，respectively.The treatment for all cases lasted for 21 days.The treatment outcome was evaluated by pain relief status assessed by NRS score，and VRS score，peripheral neurotoxicity severity assessed by NCI-CTCAE v3.0.2，EMG parameters，TCM symptom score，serum TNF-α and IL-1β levels at the end of treatment.Results　After treatment，compared with the control group，the experimental group showed a lower mean NRS score，better pain relief status，and lower peripheral neurotoxicity grade（P<0.05）.Moreover，the experimental group demonstrated rapider MCV and SCV of tibial nerve and median nerve（P<0.05）.The mean evaluation scores for pain，numbness，aversion to cold，cold extremities，fatigue，and cold-induced exacerbations of symptoms were lower in the experimental group（P<0.05）.The mean TNF-α and IL-1βlevels were also lower in the experimental group（P<0.05）.Conclusion　Encapsulated Chinese medicine with wax therapy showed good effects on oxaliplatin-induced mild-to-moderate cancerous neuropathic pain by relieving pain，improving peripheral neurotoxicity，MCV and SCV of tibial nerve and median nerve，and TNF-α and IL-1β levels，as well as reducing TCM symptoms.Moreover，it also demonstrated good safety.

L-Methionine Attenuates Acute Inflammatory Pain Caused by Formaldehyde Solution by Regulating the Level of DNA Methylation in Spinal Cord　

LUAN Shunlian，LI Yuna，JIN Dan，GAO Yong，WANG Deqiang，SHAO Cuijie

2020, 23(18): 2294-2299. DOI: 10.12114/j.issn.1007-9572.2020.00.249

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Background　Methionine can promote the occurrence of DNA methylation，which is involved in the development and maintenance of pain.Acute inflammatory pain is a common clinical symptom，which will turn into chronic inflammatory pain if it is not controlled in time.Exogenous supplementation of methionine may participate in the regulation of acute inflammatory pain by regulating DNA methylation，so as to improve the pain symptoms of patients.Objective　The aim of this study was to investigate the preemptive analgesic effect and mechanism of L-Methionine（L-MET） on acute inflammatory plantar pain induced by formaldehyde solution in rats.Methods　In this study carried out between July 2017 and December 2018，24 healthy adult cleaning grade male SD rats were randomly and evenly divided into groups A（0.9% sodium chloride solution+0.9% sodium chloride solution group），B（L-MET+0.9% sodium chloride solution group），C（0.9% sodium chloride solution+2 g/L formaldehyde solution group） and D（L-MET+2 g/L formaldehyde solution group）.In the first consecutive three days of intervention，via intraperitoneal injection，L-MET was administered to groups B and D（twice daily，total dosage ≤0.18 mg/kg），and 0.9% sodium chloride solution was administered to groups A and C（twice daily，with the amount equal to that of L-MET），respectively.Then，via subcutaneous injection in the plantar of the rear left foot，20 μl formaldehyde solution（with a concentration of 2 g/L） was administered to groups C and D to induce acute inflammatory pain（a successful model was defined as the foot became swelling with foot lifting and licking behaviors），and 0.9% sodium chloride solution was administered to groups A and B（with the amount equal to that of L-MET），respectively.The number of foot lifting and licking was measured within 60 minutes after the second round of injection，with an overall behavioral monitoring period of 60 minutes（consisting of 20 3-minute observation periods）.Rats were sacrificed after the behavioral examination.The spinal cord lumbar（L4-L6） was taken and the tissue DNA and RNA were extracted.The whole genome DNA methylation，DNMT1，DNMT2，DNMT3a，and DNMT3b were in the tissue were measured.Results　Rats in groups A and B showed no obvious abnormal discomfort reactions.Those in groups C and D were restlessness，and they licked and bit or shook the intervened rear left foot，which was lifted but could not touch the ground，demonstrating typical biphasic pain responses：immediately after the injection，the acute pain appeared and lasted for 3-5 minutes（the first phase），then disappeared for 5-10 minutes，and then the secondary pain appeared and lasted for 0-45 minutes（second phase）.The mean frequency of pain in group C was higher than that of groups A and B at each observation period（P<0.05），and so did group D（P<0.05）.The mean frequency of pain within 6-39 minutes of observation in group D was less than that of group C（P<0.05）.Group B showed higher mean whole genome DNA methylation level than groups A，C and D（P<0.05）.Group D showed higher mean whole genome DNA methylation level than groups A and C（P<0.05）.Group C showed higher mean DNMT3a and DNMT3b RNA levels than groups A and B（P<0.05），and so did group D（P<0.05）.Compared with group C，group D had lower mean DNMT3a RNA level but higher mean DNMT3b RNA level（P<0.05）.Conclusion　L-MET has obvious analgesic effect in a rat model of acute inflammatory pain caused by formaldehyde solution，and the mechanism may be related to the whole genome DNA methylation and the level of DNMT in the spinal cord.

Occurrence and Gene Analysis of Primary Carnitine Deficiency in Li Nationality Newborns in Hainan Province　

WEN Yingmei，ZHAO Zhendong，WANG Jie

2020, 23(18): 2299-2303. DOI: 10.12114/j.issn.1007-9572.2020.00.293

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Background　Primary carnitine deficiency（PCD） is considered as a potentially lethal disease.The loss of carnitine transporter function will lead to the obstruction of fatty acid β oxidation metabolism.Without timely carnitine supplementation，patients with PCD will suffer from acute metabolic decompensation early in life，and bone disease and cardiomyopathy or even sudden death of arrhythmias will occur in the later stages of life.Therefore，PCD screening in neonatal period can prevent sudden death due to acute energy metabolism disorder or acute heart failure and ensure the quality of life and safety of life.Objective　To investigate the incidence of PCD in neonates of Li nationality in Hainan Province，and explore the types of gene mutations in Li nationality population.Methods　Through the Hainan Provincial Newborn Screening Network Platform，22 950 neonates（3 to 28 days after birth） of Li nationality born in Hainan Province from August 1 in 2016 to July 31 in 2019 were collected.The C0 and acylcarnitine（C2，C3，C16，and C18） were screened by tandem mass spectrometry.The suspected neonates（C0<10.0 μmol/L） and mothers were recalled for tandem mass spectrometry.Blood samples of those with low C0 were sent for SLC22A5 gene sequencing.The diagnosis of PCD was based on the detection of SLC22A5 gene mutation.Results　Among the initial screening of 22 950 neonates of Li nationality，the C0 of 14 cases was low，and the abnormal rate was1/1 639（14/22 950） with 7（1/1 710） males and 7（1/1 569） females.There was no significant difference in the abnormal rate of initial screening among Li neonates of different genders（χ2=0.026，P=0.872）.After SLC22A5 gene sequencing，10 neonates were diagnosed with PCD.The incidence of PCD in Li neonates was 1/2 295（10/22 950），of which seven cases had heterozygous mutations and three had homozygous mutations，and 5（1/2 394） cases were males and 5（1/2 196） were females.There was no significant difference in the incidence of PCD among Li neonates of different genders（χ2=0.019，P=0.892）.A total of eight types of gene mutations were detected，c.51C>G，c.760C>T，c.338G>A，c.428C>T，c.1340A>T，c.825G>A，c.4442C>T，and c.1400C>G.Conclusion　The incidence of PCD in Li neonates in Hainan Province is high（1/2 295）.PCD genes have abundant mutations，and c.51C>G and c.760C>T mutations are more common.

Utrasonographic Measurement of Hyoid-larynx Approximation in the Evaluation of Dysphagia after Stroke　

HUANG Gelang，YANG Xiyue，HUANG Yan

2020, 23(18): 2304-2308. DOI: 10.12114/j.issn.1007-9572.2019.00.802

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Background　Dysphag ia is common in stroke patients.Accurate assessment of swallowing function is of great significance in rehabilitation treatment of such patients.The use of traditional evaluation methods is limit due to low accuracy and specificity，radiation and complicated operation.As a non-invasive，convenient and highly reproducible method，ultrasound can measure the hyoid-larynx approximation（HLA）accurately，providing a new way to evaluate swallowing function.Objective　To explore the value of utrasonographic measurement of HLA in the evaluation of dysphagia after stroke.Methods　A total of 42 patients with dysphagia after stroke hospitalized in Guigang City People's Hospital from January to December 2018 were enrolled as the study group，and 40 healthy volunteers were selected as the control group.All the subjects in the study group were confirmed to have swallowing dysfunction by videofluoroscopic swallowing study（VFSS）.Two ultrasound physicians separately examined the maximum hyoid-larynx approximation（MHLA） and minimum hyoid-larynx approximation（NHLA） of 5 controls to evaluate the reliability of ultrasound examination.Both groups were examined by pharyngeal ultrasound.The MHLA，NHLA，hyoid-larynx shortening approximation（HLAS） and approximation shortening rate（ASR） were measured or calculated.The differences of ultrasonic values between the two groups were compared，and the correlations between the measured values and the VFSS scores were also calculated.ROC curves were drawn to evaluate the diagnosis ability of NHLA，HLAS and ASR.And the AUC，the optimal cutoff value，sensitivity，specificity and Youden index were determined.Results　The ICC values of MHLA measured by the same operator were 0.975，and 0.949，respectively，and those of NHLA measured by the same operator were 0.924，and 0.957 respectively.The mean NHLA in the study group was significantly larger than that of the control group，while the mean HLAS and ASR were significantly smaller than those of the control group（P<0.05）.VFSS score was correlated negatively with NHLA
（rs=-0.581，P<0.001），while correlated positively with HLAS and ASR（rs=0.575 and 0.778，P<0.001）.The AUC of NHLA，HLAS and ASR in the diagnosis of dysphagia was 0.907〔95%CI（0.822，0.960）〕，0.852〔95%CI（0.757，0.921）〕，and 0.972〔95%CI（0.910，0.996）〕，respectively.ASR had a larger AUC than NHLA（Z=2.012，P=0.044），and HLAS（Z=3.421，P<0.001）.The optimal ASR cutoff value was 40.63%，leading to a sensitivity of 85.71%，a specificity of 100.00%，and a Youden index of 0.857，respectively.Conclusion　The AUC of ASR is larger than that of NHLA and HLAS in diagnosing dysphagia after stroke with high sensitivity and specificity，indicating that ultrasonic measurement of HLA can be used to evaluate the dysphagia after stroke，and ASR is a satisfactory diagnostic indicator.

Screening and Diagnosis Value of Acoustic Radiation Force Impulse Imaging Quantification in Combination with Superb Microvascular Imaging in Early Breast Cancer　

WANG Lei，DENG Kexue，SUI Xiufang，ZHANG Jie，ZHANG Hang

2020, 23(18): 2309-2313. DOI: 10.12114/j.issn.1007-9572.2020.00.095

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Background　Breast cancer is a common malignant tumor in women.The acoustic radiation force impulse imaging（ARFI） and superb microvascular imaging（SMI） are common screening and diagnosis methods of early breast cancer，but each of them has its own advantages and disadvantages.So far，the application of ARFI combined with SMI in the diagnosis of early breast cancer has not been reported.Objective　To investigate the screening and diagnosis value of ARFI in combination with SMI in early breast cancer.Methods　160 cases with breast lump as a primary manifestation visiting Anhui Provincial Hospital Affiliated to Anhui Medical University from January 2017 to December 2018 were enrolled.All of them accepted ARFI quantification，SMI，and pathological examination successively.Consistence of examination result with pathological findings，sensitivity，and specificity were compared between ARFI，SMI，and ARFI in combination with SMI.Results　124 cases of early breast cancer and 36 cases of benign lesions were confirmed by pathological examination，and the diagnosis rate of breast cancer was 72.3%.The consistence of ARFI，SMI，and ARFI in combination with SMI results with pathological results was moderate，moderate and very good，respectively（Kappa=0.569，0.529，0.880，P<0.05）.The mean sensitivity of ARFI，SMI and ARFI with SMI was 79.8%，78.2%，and 95.2%，respectively，showing a significant difference （P<0.05）.And the combination of ARFI and SMI showed a higher mean sensitivity than each alone（P<0.05）.The mean specificity of ARFI，SMI and ARFI with SMI was 88.9%，86.1%，and 97.2%，respectively，demonstrating no obvious difference （P>0.05）.Conclusion　ARFI and SMI are both important examinations in screening and diagnosing early breast cancer.And combined use of the two may increase diagnostic sensitivity，which can be used clinically according to patients' specific conditions.

Diagnostic Value of Desmopressin Stimulation Test Versus High-dose Dexamethasone Suppression Test in Cushing's Disease　

LI Pangmin，CHEN Kang，DU Jin，GU Weijun，BA Jianming，LYU Chaohui，MU Yiming

2020, 23(18): 2314-2317. DOI: 10.12114/j.issn.1007-9572.2020.00.200

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Background　The clinical manifestations of Cushing's syndrome are complex.It is difficult to determine whether Cushing's syndrome is induced by Cushing's disease or ectopic ACTH syndrome.Although bilateral inferior petrosal sinus sampling，a recognized gold standard，can be used to differentiate the two，it can not be implemented in most hospitals.High-dose dexamethasone suppression test（HDDST）is commonly used to diagnose Cushing's disease，but its sensitivity is not satisfactory.Desmopressin has been reported to have the effect similar to corticotropin-releasing hormone，promoting the ACTH-producing pituitary tumor to secrete ACTH.Objective　To explore the diagnostic value of desmopressin stimulation test versus HDDST in Cushing's disease.Methods　72 patients with a clear diagnosis of ACTH-dependent Cushing's syndrome were retrospectively recruited from Chinese PLA General Hospital during January 1st，2015 to August 30th，2018.General data，results of desmopressin stimulation test and HDDST were collected.The sensitivity and specificity of desmopressin stimulation test and HDDST in the diagnosis of Cushing's disease were evaluated.Results　Of the 72 cases，64 were found with Cushing's disease，and 8 with ectopic ACTH syndrome.All of them underwent desmopressin stimulation test except 9 cases of Cushing's disease being excluded.51 had positive test results and other 12 showed negative test results.The desmopressin stimulation test showed a sensitivity of 92.7% and a specificity of 100.0% in diagnosing Cushing's disease.43 had positive results and other 29 had negative results in HDDST.The HDDST demonstrated a sensitivity of 67.2% and a specificity of 100.0% in diagnosing Cushing's disease.38 cases of Cushing's disease had positive results and 9 cases of ectopic ACTH syndrome（8 with ectopic ACTH syndrome）had negative results in both the tests.16 cases had positive results in desmopressin stimulation test but showed negative results in HDDST，and 0 showed negative results in desmopressin stimulation test but showed positive results in HDDST.Among the 55 cases of Cushing's disease undergoing both tests，38 showed positive response and 1 showed negative response to both tests，16 showed positive response to desmopressin stimulation test but showed negative response to HDDST，and 0 showed negative response to desmopressin stimulation test but showed positive response to HDDST.Conclusion　Desmopressin stimulation test has a high diagnostic value for Cushing's disease.It may be used for those with suspected Cushing's disease but show negative response to HDDST，by which the possibility of missed diagnosis of Cushing's disease may be significantly reduced.

First-contact Care and Influencing Factors in Community Health Institutions among Elderly Patients：a Survey from Wuxi Implementing the "Upgraded" Family Doctor System　

SHI Huawei，LI Juan，LIANG Yahao

2020, 23(18): 2318-2323. DOI: 10.12114/j.issn.1007-9572.2020.00.100

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Background　To deepen the medical reform，and to provide precise heath services to satisfy residents' healthcare needs via the implementation of family doctor system，Wuxi City started to implement the "upgraded" family doctor system to provide contracted services for local permanent residents in 2018.Objective　To investigate the choice of medical institutions for first-contact care and influencing factors in elderly people in Wuxi after the implementation of the "upgraded" family doctor system，to discuss community-based healthcare needs in this group，offering feasible suggestions for the improvement and promotion of this kind of system.Methods　From January to February 2019，by use of multistage stratified random sampling，we enrolled 879 elderly people from Wuxi and surveyed them using a structured self-administered questionnaire designed by our research team for investigating the prevalence of choosing of community healthcare institutions for first-contact care during the implementation of the "upgraded" family doctor system in Wuxi，and their community-based healthcare needs.Results　The survey won a response rate of 95.3%（838/879）.429 of the respondents chose community healthcare institutions for initial consultation.Single factor analysis revealed that the choice of community healthcare institutions for first-contact care differed significantly by personal conditions，mean monthly income in the past year，prevalence of receiving home services provided by social workers，and receiving long-term repeated dynamic health management，time required to walk to the community healthcare institution nearest to home，medical costs in the past year，awareness levels of the hierarchical medical system and the family doctor system（P<0.05）.Multivariate Logistic regression analysis showed that the physical condition（often getting sick：OR=2.223，P<0.05；general disease：OR=1.449，P<0.05），high medical costs in the past year （2 000-3 000 yuan：OR=1.153，P<0.05；>3 000-4 000 yuan：OR=1.138，P<0.05；>4 000 yuan：OR=2.367，P<0.05），short time required to walk to the community healthcare institution nearest to home（15-30 min：OR=1.145，P<0.05；<15 min：OR=1.438，P<0.05），awareness of the hierarchical medical system（OR=1.367，P<0.05） and awareness of the contracted family doctor system（OR=1.573，P<0.05）were the influencing factor of choosing community healthcare institutions for first-contact care.The top three healthcare needs were professional guidance on medication〔75.8%（635/838）〕，scientific guidance on health promotion〔73.1%（612/838）〕，and scientific guidance on health protection〔72.6%（608/838）〕.Conclusion　The rate of choosing community healthcare institutions for first-contact care in elderly people in Wuxi needs to be improved，which is associated mainly with personal conditions，medical costs in the past year，time required to walk to the community healthcare institution nearest to home，awareness levels of the hierarchical medical system and the family doctor system.It is suggested that during the promotion of the "upgraded" family doctor system，more attention should be paid to individual healthcare needs，by which the implementation of the system may become an effective tool for relieving the doctor-patient contradiction in the aging society，and improving medical resources utilization efficiency and ensuring the caring efficiency for the elderly.

Effectiveness of Family Doctor-led Team-based Early Kidney Disease Management in Elderly People with Chronic Kidney Disease　

CHEN Liang，ZHANG Weiwei，LI Qiang

2020, 23(18): 2324-2327. DOI: 10.12114/j.issn.1007-9572.2020.00.044

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Background　At present，chronic kidney disease （CKD） has become one of the diseases that seriously threaten human health.Early detection，diagnosis and treatment of CKD，prevention and treatment of various reversible factors and delay of progression of kidney disease，are the problems that medical workers must face.Objective　To explore the effect of family doctor-led team-based early kidney disease management in elderly CKD patients.Methods　From November to December 2017，by the lottery number drawn subjectively，400 eligible patients with confirmed early CKD were selected from Huangdu Community Health Center，and were equally divided into control group（routine examination） and intervention group（family doctor-led team-based early kidney disease management，including health education，health management，individualized drug treatment and regular examination） by tossing a coin.The intervention for both groups lasted for 18 months.Comparisons were made between pre- and post-intervention anthropometry indices 〔body mass index （BMI），systolic blood pressure （SBP），diastolic blood pressure （DBP）〕 and blood biochemical indicators 〔（fasting blood glucose （FPG），glycosylated hemoglobin （HbA1c），serum creatinine （Scr），blood urea nitrogen （BUN），serum uric acid （SUA），estimated glomerular filtration rate （GFR），urine albumin（ALB），urine creatinine （Ucr），total cholesterol （TC），triglyceride （TG），high-density lipoprotein （HDL），and low-density lipoprotein （LDL）〕.End of June 2019，the end-point events （including all-cause death，all-cause hospitalization and dialysis） of patients were recorded.Results　Except that，1 case in the intervention group and 2 cases in the control group were lost to follow up，other cases were included in the final analysis.After intervention，the intervention group showed lower mean levels of BMI，SBP，DBP，FPG，HbA1c，Scr，BUN，SUA，ALB，Ucr，TC，TG，and LDL，and higher mean levels of GFR and HDL than the control group （P<0.05）.Mean levels of BMI，SBP，DBP，FPG，HbA1c，Scr，BUN，SUA，ALB，Ucr，TC，TG，and LDL decreased significantly and mean levels of GFR and HDL increased significantly in the intervention group compared with baseline levels（P<0.05）.By the end of June 2019，37 patients（9.3%） had end-point events，including 4 all-cause deaths （1 due to respiratory failure and 3 due to heart failure）.20 patients were hospitalized for all causes，mainly due to the deterioration of basic diseases，poor blood pressure and blood glucose control，and the onset of cardiovascular diseases.Dialysis was performed in 13 patients.The intervention group had higher all-cause hospitalization rate，but lower all-cause mortality rate and dialysis rate than the control group （P<0.05）.Conclusion　Family doctor-led team-based early kidney disease management has a good effect in elderly CKD patients，which is manifested as improving the blood biochemical indices，reducing the all-cause mortality and dialysis rate，and enhancing the quality of life.

Preference and Influencing Factors of Community Home-based Elderly Care in Community-living Elderly People in Nanning　

XU Mingjiang，ZHAO Yunxian，YOU Jianpeng，WANG Biyan，LI Zhao

2020, 23(18): 2328-2334. DOI: 10.12114/j.issn.1007-9572.2020.00.255

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Background　Community home-based elderly care is expected to become the most appropriate choice for the elderly because it makes up for the shortage of institute-based elderly care.Accurate identification of the needs of community home-based elderly care may help the government to provide targeted and focused elderly services for special groups.Objective　To explore the demand of community home-based care and influencing factors in Nanning based on the demand-side perspective.Methods　From March to May 2019，a cross-sectional survey was conducted in Nanning City among a convenience sample of 505 community-dwelling elderly individuals（≥60 years old） who were eligible for the study.A self-made questionnaire consisting of 3 major aspects〔demographic data，demands for community home-based elderly care，choice of elderly care（home-based elderly care，community home-based elderly care，and institution-based elderly care）〕 was used in the survey，and was completed by the participants with the assistance of the investigators using a question-and-answer approach.For ease of exploring the influencing factors of the intention of choosing community home-based elderly care，home-based care was included into community home-based elderly care.Results　A total of 505 sets of questionnaires were distributed，and 486 responsive ones were collected，with a response rate of 96.2%.Among the 486 respondents，91.3%（444/486） did not know whether there was a home-based elderly care center or day-care center in their own community，53.1%（258/486） knew whether there was a community health center in their own community，54.7%（266/486） were not aware of the daily care services provided by the community health center in their own community，34.0%（165/486） knew that the community health center could provide diagnostic and therapeutic services.41.3%（201/486） expected to be provided with expanded activity venues and increased elderly care services，and 39.3%（191/486） did not need any community-based daily care services，66.7%（324/486） expected to be provided with community-based medical examination，rehabilitation，and elderly care services，60.0%（292/486） expected to be provided with community-based health counseling and health guidance，48.0%（233/486） expected to be provided with home-based medical care and medication care.60.9%（296/486） of the elderly chose home-based elderly care，followed by community home-based elderly care，accounting for 20.0%（97/486），and 19.1%（93/486） of the elderly chose institutional pension.Those chose institution-based elderly care accounted for the least〔19.1%（93/486）〕.Education level 〔high school or special（or technical） secondary school：OR=3.379，95% CI（1.307，9.802），second- or three-year college and above level：OR=3.955，95% CI（1.508，10.371）〕，occupation before retirement〔OR=5.097，95% CI（2.382，10.908）〕，number of children 〔 two：OR=8.198，95% CI（2.982，22.537），more than three：OR=3.607，95% CI（1.521，8.552）〕，self-care situation 〔complete dependence：OR=4.165，95% CI（1.570，11.050）〕 and care situation 〔nanny care：OR=0.046，95% CI（0.010，0.209）〕 were the influencing factors associated with the choice of community home-based elderly care（P<0.05）.Conclusion　In Nanning，home-based elderly care is still the first choice for urban elderly people and those choosing community home-based elderly care is increasing，and it seemed that community home-based elderly care may become a major elderly care form.Good economic conditions（high education and having an occupation before retirement），good family support conditions（living with the spouse and having multiple children），and poor health status are associated with the choice of community home-based elderly care.

Prevalence and General Practice-based Interventions of Hypertension：a Community-based Study in Haikou　

ZENG Wangyuan，ZHOU Suyun，GU Shenhong

2020, 23(18): 2335-2341. DOI: 10.12114/j.issn.1007-9572.2020.00.328

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Background　In China，hypertension prevalence is increasing，and hypertension-related cardiovascular and cerebrovascular diseases have become the leading causes of death.However，the rates of hypertension awareness，treatment and control are relatively low in residents.Moreover，hypertension problems have imposed great burden on the government and residents.So it is necessary to carry out efficient and inexpensive hypertension-related prevention and treatment interventions.Objective　To analyze hypertension control，antihypertensive medication status，and responses to general practice care in hypertensive patients from Haikou communities based on analyzing hypertension management data of community health centers in Haikou，providing a theoretical basis for promoting community-based prevention and treatment of hypertension in this area.Methods　Data were collected from 4 community health centers（Dayuan Community Health Center，Jinpan Community Health Center，Binhai Community Health Center，and Jinmao Community Health Center） in Haikou.And from he health records system of these centers，a simple random sample of 200 cases were selected（50 from each center） out of those who lived in the communities within the serving areas of the above-mentioned health centers during August 2017 to January 2018，with health records documenting，hypertension management and follow-up data，and without interventions from hypertension trials.They were equally randomized into test group and control group，treated with 6-month general practice-based interventions and self-management interventions，respectively.Demographic characteristics （including gender，age，education level，family history of hypertension，cardiovascular and cerebrovascular complications，medications，and approaches for medications），hypertension control，and medication type and regimen were collected.Post-intervention effect was evaluated by hypertension control，BMI，medication compliance，correction of unhealthy life habits，and satisfaction with general practice care.Results　Hypertension control status differed significantly by family history of hypertension，cardiovascular and cerebrovascular complications，medication，and administration method（P<0.05）.The most commonly used antihypertensive monotherapy was calcium channel blockers，followed by β-receptor blockers，angiotensin Ⅱreceptor blockers，compound preparations，angiotensin converting enzyme inhibitors and diuretics.For combined use，β-receptor blockers + calcium channel blockers were the primary combination，followed by angiotensin Ⅱ receptor blockers + calcium channel blockers，calcium channel blockers + angiotensin converting enzyme inhibitors.After intervention，compared with the control group，test group had higher hypertension control rate（P<0.05），lower average BMI（P=0.004），and greater improvements in correcting unhealthy habits such as heavy drinking，little exercise and high-salt diet（P<0.05）.Moreover，test group showed higher average level of satisfaction with general practice care（P<0.05），because they spent sufficient time on communicating with the physicians，based on which the physicians provided comprehensive preventive，diagnostic and/or therapeutic services（including the explanation of the purposes of examination and treatment），and were willing to listen to patients' opinions about their own regimens.Conclusion　The control rate of hypertension in the communities in Hainan is still not ideal.Rational use of antihypertensive drugs should be improved.General practice-based interventions are beneficial to controlling hypertension.

Outpatient Consultation Skills in General Practices in the UK　

YAN Hongmei，JIANG Yue，LI Tianzi

2020, 23(18): 2342-2345. DOI: 10.12114/j.issn.1007-9572.2020.00.297

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Outpatient consultation is the most important part of a diagnostic and therapeutic process in general practice，whose quality reflects the professional ability of the general practitioner.It is also an important aspect of research in general practice.We analyzed the dialogue in a demonstrated outpatient consultation and the whole process in a general practice in the UK using a step-by-step approach，and summarized the results，concluding that the consultation is patient-centered，complete and efficient，and it also reflects the high quality of the general practitioner.

Granulomatosis Polyangiitis with Diffuse Alveolar Hemorrhage：a Case Report and Literature Review　

LU Cui，SU Yutong，TENG Jialin，YANG Chengde，YE Junna

2020, 23(18): 2346-2350. DOI: 10.12114/j.issn.1007-9572.2019.00.753

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Background　Granulomatous polyangiitis（GPA）is a rare systematic disease that mainly affects the upper respiratory tract，lung and kidney.Diffuse alveolar hemorrhage（DAH）is a rare manifestation of the disease.Once it occurs，the situation is critical with a high mortality rate.Objective　To investigate the clinical manifestations，laboratory and imaging features，diagnosis and treatment as well as prognosis of GPA with DAH，enhancing clinicians' understanding of this disease to perform a diagnosis and deliver appropriate treatment early to improve the patient prognosis.Methods　The clinical data of a GPA patient with DAH admitted to Department of Rhrumatology and Immunology，Ruijin Hospital，Shanghai Jiao Tong University School of Medicine，was reviewed and analyzed.Besides，publicly published reports on GPA or GPA with DAH during January 1980 to February 2019 were retrieved from electronic databases of Wanfang Data Knowledge Service Platform，CNKI，and PubMed using "Wegener，vasculitis，granulomatous polyangiitis，pneumorrhagia，and alveolar hemorrhage" as keywords.Results　12 cases were reported，combined with our case，there were 13 cases of GPA with DAH，including 7 males and 6 females，with an average age of（38.6±19.3）years，and an average duration of（72.1±62.7）days.Most of them were treated with high-dose intravenous corticosteroid pulse therapy combined with cyclophosphamide.The rate of mortality was 23.1%（3/13）.Commonly seen clinical manifestations were cough（83.3%），dyspnea（83.3%），and hemoptysis（42.7%）.Chest X-rays or CT scans showed multiple patches，ground-glass opacities or bilateral diffuse alveolar infiltrates and consolidations.Bronchoscopy may show airway hemorrhage，and elevated number of hemosiderin-laden macrophages could be found in bronchoalveolar lavage fluid.Conclusion　DAH is a rare manifestation of GPA，characterized mainly by dyspnea，cough，hemoptysis，rapid progress，and high mortality rate.Early treatment may improve the prognosis.

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