Chinese General Practice

Current status of real world study for advanced non-small cell lung cancer

ZHANG Yushuang, LI Jing

2020, 23(21): 2607-2614. DOI: 10.12114/j.issn.1007-9572.2020.00.350

Asbtract ( )

PDF (1412KB) ( )

References | Related Articles | Metrics

Lung cancer is the malignant tumor with the highest morbidity and mortality，of which non-small cell lung cancer accounts for 80%-85%.Current clinical research on drugs for non-small cell lung cancer is in full swing.Drugs whose effectiveness has been evaluated by randomized controlled trials，the gold standard，still have limitations in clinical use，and their effectiveness can not reach the most "ideal" level in clinical practice generally.In recent years，evidence from real world practice has gradually been adopted by medical products administrative agencies.The purpose of this paper was to explore the differences between the real world study and randomized controlled trials regarding the treatment of advanced non-small cell lung cancer，and put forward relevant suggestions for real world study，so as to provide a reference for clinical evidence-based study of lung cancer.

Research on the construction of rural long-term nursing insurance system

CHEN Mei，MENG Yanchen

2020, 23(21): 2615-2620. DOI: 10.12114/j.issn.1007-9572.2020.00.002

Asbtract ( )

PDF (1415KB) ( )

References | Related Articles | Metrics

As a weak area of China's economic and social development，rural areas should give higher attention to the social security system.The long-term care insurance system can guarantee the quality of life of the elderly in the later years from the perspective of life care and medical care，and resolve the social risks caused by disability and dementia in rural China.This paper starts from the analysis of the necessity of the rural long-term care insurance system，combined with the predicament of the implementation of the rural long-term care insurance system，and puts forward specific proposals for the long-term care insurance system in rural areas，service payment，etc.，aiming to speed up long-term care insurance in rural areas.The journey of system construction.

Analysis of comorbidities in inpatients with osteoporosis

XU Shen，LU Chunyan，WANG Qin，CHEN Decai，LI Jing，YUAN Yanling，WU Chengjie，TIAN Haoming

2020, 23(21): 2621-2630. DOI: 10.12114/j.issn.1007-9572.2019.00.779

Asbtract ( )

PDF (1618KB) ( )

References | Related Articles | Metrics

Background　People with osteoporosis often have multiple coexisting diseases.These comorbidities may further decrease bone mineral density（BMD）and increase fracture risk，eventually putting a greater burden on patients and society.There are very few studies about the relationship between osteoporosis and comorbidities，which gives insufficient support to clinicians to comprehensively understand the comorbidities of osteoporosis.Objective　This study aimed to investigate the characteristics of comorbidities and their impact on osteoporosis in osteoporotic inpatients，improving clinicians' diagnostic and therapeutic levels and reducing the burden of such patients.Methods　From the totaled 37 559 inpatients with osteoporosis in West China Hospital of Sichuan University treated during March 2006 to December 2018，31 362 were enrolled after excluding 6 197.Data about diagnosis and BMD were collected.According to whether the patients have comorbidity，they were divided into comorbidity group and non comorbidity group，and the BMD of lumbar spine，femoral neck and total hip of the two groups were compared；according to whether the patients had fracture，they were divided into fracture group and non fracture group，and the number of comorbidity and the comorbidity rate of various diseases of the two groups were compared.Results　30 698（97.88%）were found with comorbidities，with an average number of comorbidities of（4.0±2.2），and 10 378（33.09%）of them had fractures.The top 3 comorbidities were essential（primary）hypertension（I10），type 2 diabetes（E11）and other intervertebral disc disorders（M51），with a prevalence of 41.41%，18.75%，and 15.88%，respectively.The top 3 coexisting systemic diseases were diseases of the musculoskeletal system and connective tissue（M00-M99），diseases of the circulatory system（I00-I99）and endocrine，nutritional and metabolic diseases（E00-E90），with a prevalence of 42.27%，32.15% and 31.25%，respectively.Among all the 24 comorbidities，there were 14 diseases that subjects complicated with anyone of them had higher lumbar vertebrae BMD than those without（P<0.05）.Those with the highest BMD increase were complicated with type 2 diabetes（E11），essential（primary）hypertension（I10）and gonarthrosis（M17）.There were 3 diseases，that subjects complicated with anyone of them had lower lumbar vertebral BMD than those without（P<0.05），including diseases of the blood and blood-forming organs and certain disorders involving the immune mechanism（D50-D89），chronic obstructive pulmonary disease（J44）and certain infectious and parasitic diseases（A00-B99）.There were 4 diseases that subjects complicated with anyone of them had higher femoral neck BMD than those without（P<0.05）.Those with the highest BMD increase were complicated with gonarthrosis（M17），diseases of the musculoskeletal system and connective tissue（M00-M99）and type 2 diabetes（E11）.There were 12 diseases that subjects complicated with anyone of them had lower femoral neck BMD than those without（P<0.05）.Those with the most BMD decrease were complicated with chronic obstructive pulmonary disease（J44），diseases of the blood and blood-forming organs and certain disorders involving the immune mechanism（D50-D89）and cerebral infarction（I63）.There were 5 diseases that subjects complicated with anyone of them had higher total hip BMD than those without（P<0.05）.Those with the highest BMD increase were complicated with type 2 diabetes mellitus（E11），gonarthrosis（M17）and other intervertebral disc disorders（M51）.There were 9 diseases that subjects complicated with anyone of them had lower total hip BMD than those without（P<0.05）.Those with the most BMD decrease were complicated with chronic obstructive pulmonary disease（J44），diseases of the blood and blood-forming organs and certain disorders involving the immune mechanism（D50-D89）and other respiratory disorders（J98）.Subjects with osteoporotic fracture had more comorbidities than those without（P<0.05）.Subjects with osteoporotic fracture had lower prevalence of coexistence of diseases of the musculoskeletal system and connective tissue（M00-M99），gonarthrosis（M17），injury，poisoning and certain other consequences of external causes（S00-T98），certain infectious and parasitic diseases（A00-B99）and neoplasms（C00-D48）than those without（P<0.05）.Subjects with osteoporotic fracture had higher prevalence of coexistence of essential（primary） hypertension （I10），diseases of the circulatory system（I00-I99），endocrine，nutritional and metabolic diseases（E00-E90），diseases of the genitourinary system（N00-N99），diseases of the digestive system（K00-K93），diseases of the respiratory system（J00-J99），chronic obstructive pulmonary disease（J44），diseases of the nervous system（G00-G99），other respiratory disorders（J98），other diseases of liver（K76），cerebral infarction（I63），chronic ischaemic heart disease（I25），atherosclerosis（I70），diseases of the blood and blood-forming organs and certain disorders involving the immune mechanism（D50-D89），and mental and behavioural disorders（F00-F99）than those without（P<0.05）.Conclusion　In this study，it was found that osteoporosis was often associated with other common chronic diseases in the elderly，and special attention should be paid to the evaluation of BMD and risk of fragility fracture in patients with hypertension，diabetes，chronic obstructive pulmonary disease and nervous system diseases.When DXA underestimates BMD in patients with osteoarthritis and other muscle-joint diseases，a QCT BMD exam or a fracture risk assessment tool such as FRAX may be required for diagnosis.

Pre-and post-treatment changes in tongue and face diagnosis parameters and their associations with laboratory indices in patients with diabetes

XIE Shengjie，LI Fufeng

2020, 23(21): 2631-2634. DOI: 10.12114/j.issn.1007-9572.2020.00.230

Asbtract ( )

PDF (1273KB) ( )

References | Related Articles | Metrics

Background　The etiology and pathogenesis of diabetes are complex.We intensively studied and summarized TCM-based tongue and face diagnosis techniques to make better use of them to diagnose diabetes conveniently，effectively and reliably.Objective　To investigate pre- and post-treatment changes in tongue and face diagnosis parameters derived from corresponding images and their associations with laboratory indices in patients with type 2 diabetes.Methods　From September 2017 to December 2018，320 diabetic patients' tongue and face diagnosis parameters derived from images（taken by DKF-ⅡFace Digital Detector and DKF-ⅡTongue Digital Detector developed by Shanghai University of Traditional Chinese Medicine），and laboratory indices（plasma blood glucose，glycosylated hemoglobin，cholesterol，triacylglycerol，high-density lipoprotein，low-density lipoprotein，blood urea nitrogen，blood creatinine，blood uric acid） were collected.Canonical correlation analysis was used to analyze the associations of tongue and face diagnosis parameters with laboratory indices.The paired t-test was used to analyze pre- and post-treatment changes in tongue and face diagnosis parameters in 35 of the participants.Results　The canonical correlation coefficient between tongue diagnosis parameters and laboratory parameters was 0.919（P<0.05）.The overall level of tongue diagnosis parameters were mainly influenced by the R value of tongue color，the characteristic value of rotten grease and the characteristic value of thickness of the tongue fur（canonical correlation coefficients were -0.808， -0.791，-0.750，P<0.05）.And the overall level of laboratory indices were mainly influenced by cholesterol，glycosylated hemoglobin and triacylglycerol（canonical correlation coefficients were -0.643，-0.590，-0.569，P<0.05）.The canonical correlation coefficient between the of face diagnosis parameters and laboratory indices was 0.834（P<0.05）.The reference of tongue diagnosis was mainly affected by the Y of face（canonical correlation coefficient was 0.732，P<0.05）.And the laboratory indices were mainly affected by the fasting blood glucose and glycosylated hemoglobin（canonical correlation coefficients were 0.737 and 0.397，P<0.05）.Compared with pre-treatment，the characteristic value of prick and G value of tongue color in 35 diabetic patients decreased after treatment（P<0.05），but other tongue and face diagnosis parameters did not（P>0.05）.Conclusion　 Tongue and face diagnosis parameters may be associated with clinical biochemical indices in type 2 diabetic patients to some extent，indicating that the former two may be used as TCM-based auxiliary predictive parameters for clinical diagnosis and outcome.The pre- and post-treatment changes in tongue and face diagnosis parameters show that tongue diagnosis parameters may be also used as an efficacy evaluation method in these patients.

Daily physical activity in patients living with COPD ：a qualitative study

LUO Yuanrong，CHEN Miaoxia，WU Shaozhu，YU Xueying，QU Fenglei

2020, 23(21): 2635-2641. DOI: 10.12114/j.issn.1007-9572.2020.00.007

Asbtract ( )

PDF (1149KB) ( )

References | Related Articles | Metrics

Background　Physical activity is an excellent index to predict the mortality of patients with chronic obstructive pulmonary disease （COPD）.It is of great significance for COPD patients to obtain a higher level of physical activity in their daily life to reduce the risk of rehospitalization，improve the quality of life and improve the outcome of the disease.Objective　To analyze the experience and associated common facilitators and barriers of physical activity in COPD patients based on the interviews with such patients from a grade A tertiary hospital in Guangzhou，providing strategies for improving the level of daily physical activity，and encouraging long-term adherence to healthy behavior in these patients.Methods　By use of purposive sampling，stable COPD patients from Department of Respiratory Medicine，the Third Affiliated Hospital，Sun Yat-Sen University，were enrolled from October 2017 to April 2018，and were interviewed in a semi-structured way until content and theme saturations were reached.The interview results and non-verbal behavior observation data during the interview of 18 cases were finally included，and were analyzed with thematic analysis.Results　Three themes affecting daily physical activity of COPD patients were extracted：perception and motivation（including value cognition, experience, goal and motivation of physical activity），social support （including medical staff support, family support, peer support） and environmental resources（including seasons, lack of oxygen therapy assistance, community resources）.Conclusion　The physical activity of patients with COPD in Guangzhou is affected by many factors.To improve the level of physical activity，quality of life and outcome in such patients，it is necessary to increase patients and their family members' awareness of physical activity，integrate medical and social support resources，rationally use physical activity facilitators，and effectively solve barriers to physical activity.

Relationship between the changes of intestinal flora and gestational diabetes mellitus

ZHANG Kainan，LIU Xiaoxiao，WANG Hui，ZHANG Zhaoxia

2020, 23(21): 2642-2646. DOI: 10.12114/j.issn.1007-9572.2020.00.239

Asbtract ( )

PDF (1142KB) ( )

References | Related Articles | Metrics

Background　Gestational diabetes mellitus（GDM） accounts for an increasing proportion of gestational diseases in recent years，and its high incidence has brought great harm to maternal and infant health and public health in China．At present，studies suggest that the structural changes of human intestinal flora are closely related to related metabolic diseases．And more and more evidence suggests that changes in the structure and relative proportions of the constituents of intestinal flora may be high risk factors for diseases such as diabetes and obesity．Objective　To explore the relationship between the changes of intestinal Clostridium coccoides and Bacteroides thetaiotaomicron and the occurrence of GDM．Methods　In this study，a nested case-control design was used．A total of 1 034 pregnant women from the First Affiliated Hospital of Xinjiang Medical University were enrolled during March 1，2018 to March 30，2019 ．They were included as an observational cohort at the time of confirming the pregnancy in the first visit，receiving follow-up services once every 4 weeks as well as other antenatal care services from the hospital，till GDM was identified．And those with a definite diagnosis of GDM were included in the case group，who were compared with number-，age-，gestational week- and admission time-matched controls．Comparisons were made between two groups in terms of general data，Clostridium coccoides and Bacteroides thetaiotaomicron levels at admission，20 weeks of gestation，and time of identifying of GDM in the case group．The correlations of fasting blood glucose with Clostridium coccoides and Bacteroides thetaiotaomicron at different times in the case group were analyzed．Results　All the cases in the observational cohort completed the follow-up except for 28 dropouts and 5 missing cases，and the prevalence of GDM in them was 8.99％（90/1 001）.The case and control groups had no significant differences in mean age，education distribution，mean abdominal circumference，prevalence of family history of diabetes，polycystic ovary syndrome and hypertension（P>0.05 ）．There was no significant difference between the two groups in the level of Clostridium coccoides and Bacteroides thetaiotaomicron when they were enrolled in the group（P>0.05）；the level of Clostridium coccoides and Bacteroides thetaiotaomicron in the case group were higher than that in the control group at 20 weeks of gestation and time of identifying of GMD（P<0.05）.At 20 weeks of gestation and time of identifying of GMD，the levels of Clostridium coccoides and Bacteroides thetaiotaomicron in the case group were higher than admission（P<0.05）；Time corresponding to the diagnosis of GDM in case group，the levels of Clostridium coccoides and Bacteroides thetaiotaomicron in the control group were higher than admission and 20 weeks of gestation（P<0.05）．In case group，both Clostridium coccoides and Bacteroides thetaiotaomicron were positively correlated with fasting blood glucose at the time of identifying GDM（r=0.435， P<0.001； r=0.342，P=0.001）．Conclusion　The structural changes of Clostridium coccoides and Bacteroides thetaiotaomicron be one of the causes of GDM.

Prognostic value of national early warning score combined with midregional-proadrenomedullin and procalcitonin in patients with sepsis

WANG Huiwen，XING Bo

2020, 23(21): 2647-2652. DOI: 10.12114/j.issn.1007-9572.2020.00.272

Asbtract ( )

PDF (1207KB) ( )

References | Related Articles | Metrics

Background　At present，sepsis still has high morbidity and mortality，and the evaluation method of its prognosis has been a hot topic.In recent years，the national early warning score（NEWS），midregional-proadrenomedullin（MR-proADM）and procalcitonin（PCT）have been widely used to independently evaluate the prognosis in patients with sepsis，but the evaluation efficiency of each of them is moderate.Whether the combination of the three has higher evaluation efficiency is still lack of relevant research.Objective　To explore the prognostic value of NEWS combined with MR-proADM and PCT in patients with sepsis，to provide help for emergency physicians to make an appropriate evaluation of the prognosis of such patients.Methods　A total of 112 patients with sepsis admitted to Department of Emergency，the Second Affiliated Hospital of Hainan Medical University from June 2016 to June 2019 were retrospectively selected.General data，NEWS，MR-proADM and PCT were collected.The patients were divided into the survival group and death group according to 28-day prognosis．The risk factors for 28-day mortality were explored by Logistic regression analysis.And the receiver operating characteristic（ROC）curve analysis was performed to evaluate the value of NEWS，MR-proADM and PCT，alone or in combination，in predicting 28-day mortality.Results　During the 28 days of follow-up，88（78.6%）patients survived（survival group），and 24（21.4%）died（death group）.The mean age，and mean levels of NEWS，MR-proADM and PCT in the death group were greater than those of survival group（P<0.05）.The mortality of patients with NEWS >1-3，>3-5，>5 was higher than that of those with NEWS≤1（P<0.05）.And the mortality of patients with NEWS>5 was higher than that of those with NEWS>1-3（P<0.05）.The mortality of patients with MR-proADM >4.6 nmol/L was higher than that of those with MR-proADM≤1.2 or >1.2-2.5 nmol/L（P<0.05）.The mortality of patients with PCT>3.6 μg/L was higher than that of those with PCT≤ 0.8 or > 0.8-1.4 μg/L（P<0.05）.Multivariate Logistic regression analysis showed that NEWS〔OR=1.321，95%CI（1.070，1.630）〕，MR-proADM〔OR=1.254，95%CI（1.062，1.480）〕 and PCT〔OR=1.179，95%CI（1.049，1.326）〕were independently associated with 28-day mortality（P<0.05）.The area under the ROC curve（AUC）of NEWS combined with MR-proADM and PCT for predicting 28-day mortality was significantly greater than that of each marker alone（Z=2.670，P=0.007；Z=2.104，P=0.043；Z=2.449，P=0.014）.Conclusion　NEWS，MR-proADM and PCT were closely related to the prognosis，and were independently associated with 28-day mortality in patients with sepsis．The combination of the three had higher capability to predict 28-day mortality than each alone．

Safety and outcome in ischemic stroke patients with early intravenous administration of tirofiban following urokinase for thrombosis

LIU Bin，WANG Rong，QU Hongdang，ZHANG Hong，ZHANG Wanlong，ZHANG Shuye，DONG Xiaowan

2020, 23(21): 2653-2658. DOI: 10.12114/j.issn.1007-9572.2020.00.161

Asbtract ( )

PDF (1130KB) ( )

References | Related Articles | Metrics

Background　Acute ischemic stroke is a common and frequently occurring disease in the elderly and is associated with high mortality.But there is no accurate response to intravenous thrombolytic therapy using urokinase in such patients，and the disease is easily to recur.So it is crucial to seek active and effective treatment after intravenous thrombolytic therapy with urokinase.Objective　To investigate the factors associated with the safety and outcome in ischemic stroke patients receiving early administration of tirofiban after urokinase for intravenous thrombolysis，providing a novel perspective for the treatment of this disease.Methods　We conducted a retrospective study on 89 cases of ischemic stroke treated in Suzhou First People's Hospital between February 2017 and February 2019，and classified them into experimental group（early use of tirofiban after urokinase for intravenous thrombolysis） and control group （use of urokinase for intravenous thrombolysis）.We collected their clinical data，including gender，age，prevalence of hypertension，diabetes and atrial fibrillation，admission plasma glucose level，onset-treatment-time，the NIHSS score at admission and 7th day after admission，the number of patients with bleeding，systemic bleedings，hemorrhagic infarction type 1（HI-1），HI-2，parenchymal hematoma type 1（PH-1） or PH-2 in 7 days，and deaths in 3 months after admission，and mRS scores（≤1 was considered a favorable outcome，and ≥2 was considered an unfavorable outcome） at 3 months after treatment.We used propensity score matching to control the confounding factors，and used binary Logistic regression to analyze the factors associated with the outcome.Results　By propensity score matching，26 of the 32 cases in the experimental group and 26 of the 57 cases in the control group were finally included for further analysis， with no significant inter-group differences in sex ratio，mean age，prevalence of hypertension，diabetes，and atrial fibrillation，mean admission plasma glucose level，onset-treatment-time，and admission NIHSS score（P>0.05）.The mean NIHSS score on the 7th day after admission decreased significantly in the control group（Z=-2.321，P<0.05） as well as in the experimental group（Z=-4.121，P<0.05），and it decreased even more significantly in the experimental group（Z=-2.754，P=0.006）.The incidence of bleeding，systemic bleedings，HI-2 and PH-2 within 7 days after admission and mortality rate in 3 months did not differ significantly in two groups（P>0.05）.No HI-1 and PH-1 were found in all patients during the 7 days.The experimental group had a lower mean mRS score，indicating that a better outcome was achieved in general（P<0.05）.Univariate Logistic regression analysis suggested that age〔OR=0.920，95%CI（0.848，1.000），P=0.049〕，NIHSS score at admission〔OR=0.538，95%CI（0.362，0.798），P=0.002〕 and early treatment with tirofiban〔OR=11.271，95%CI（1.833，69.317），P=0.009〕 were associated with the outcome.Conclusion　Intravenous tirofiban immediately after urokinase seems to be safe and potentially more effective in early improvement of neurological functions and 3-month outcome compared with urokinase alone.

Warning of malignant tumor prevalence detected by physical examination in healthy populations to cancer screening strategies

WU Yanfen，FENG Meijing

2020, 23(21): 2658-2663. DOI: 10.12114/j.issn.1007-9572.2020.00.276

Asbtract ( )

PDF (1110KB) ( )

References | Related Articles | Metrics

Background　The incidence of malignant tumors is on the rise in China.Early detection and treatment are very important to improve the prognosis and even cure malignant tumors.However, how to find a reliable and low-cost tumor screening method in the tumor screening project is worthy of clinical exploration.Objective　To investigate the prevalence and screening methods of malignant tumors in physical examination in healthy populations，providing a reference for bettering tumor screening.Methods　Participants were 185 938 physical examinees（105 204 men and 80 734 women without a history of having malignant tumors，stratified into 5 age groups of≤29，30-44，45-59，60-74，and≥75） from Health Control Department，Aerospace Center Hospital，from January 2016 to December 2018.By retrospectively analyzing their physical examination results，those who had positive results indicating high risk of malignant tumors were screened，and were followed up to explore the subsequent diagnosis，and among them those who were confirmed with a malignant tumor were counted.Results　In our study，153 cases were diagnosed with malignant tumors，and the top five in turn were lung cancer（0.21‰），thyroid cancer（0.12‰），breast cancer（0.11‰），liver cancer（0.09‰），and cervical cancer（0.06‰）.The detection rate of malignant tumor was the highest in the 60-74 age group（2.30‰），followed by≥75 age group（1.75‰），45-59 age group（1.46‰），30-44 age group（0.38‰） and≤29 age group（0.15‰）.Compared with women，men showed higher lung cancer〔0.28‰ vs 0.12‰〕and liver cancer detection rate〔0.13‰ vs 0.02‰〕（χ2=4.318，5.032，P<0.05）.Women had higher detection rates of breast cancer〔0.26‰ vs 0〕and thyroid cancer〔0.22‰ vs 0.05‰〕than men （χ2=27.368，9.989，P<0.01）.The main detection methods used were chest CT or DR，ultrasound，tumor markers and liquid-based cytology test ThinPrep.Lung cancer was mainly detected by lung CT/DR.Ultrasound was the main means of screening pelvic and peritoneal and glandular tumors.Measuring tumor makers was a highly sensitive and specific method for detecting liver cancer，pancreatic cancer，gastric cancer，colorectal cancer and prostate cancer.Conclusion　It is of great significance to conduct early screening for malignant tumors in healthy population，the high incidence age of malignant tumors was 60-74 years old. The main detection methods were chest CT or DR, ultrasound, tumor markers, TCT，especially for malignant tumors with high incidence.Physical examination center should establish a reliable and feasible method of tumor screening.

Community-based diagnosis and treatment moderate-to-severe chronic heart failure patients with reduced ejection fraction down-referred from a tertiary hospital

WANG Zichao，TANG Cunliang，HUANG Guanhua

2020, 23(21): 2664-2668. DOI: 10.12114/j.issn.1007-9572.2019.00.811

Asbtract ( )

PDF (1202KB) ( )

References | Related Articles | Metrics

Background　Heart failure（HF） is a chronic，progressive and spontaneous disease，which is difficult to cure.Medical management can improve the quality of life，prolong life and effectively reduce the consumption of medical resources in patients with moderate-to-severe chronic HF.At present，community-based health care management is the most effective healthcare delivery mode that is recognized internationally.Objective　To investigate the effect of community-based management delivered by community physicians in patients with moderate-to-severe chronic HF with reduced ejection fraction（HF-REF）.Methods　115 moderate-to-severe HF-REF patients（NYHA classⅡ-Ⅳ） recruited from Cardiovascular Department and Emergency Department，the Second Affiliated Hospital of Baotou Medical College，Inner Mongolia University of Science & Technology during January to December 2017，including 52 who were willing to receive contracted healthcare services from community physicians（community group），and 63 who were unwilling to or could not go back to the community to receive such services（out-of-community group）.The community group received community-based management delivered by community physicians and nurses，who had learned Chinese Guidelines for Diagnosis and Treatment of Heart Failure 2014，had the same technique level as the cardiovascular and emergency physicians from the Second Affiliated Hospital of Baotou Medical College，Inner Mongolia University of Science & Technology，and followed the bilateral diagnostic and therapeutic agreement.The out-of-community group only sought healthcare for health problems in higher level medical institutions after discharge.All of them received two telephone-based follow-ups at 6 and 12 months after discharge，respectively，for collecting the following data：general conditions〔aggravation of symptoms，aggravation of signs，increase in dosage，decrease of diet，decrease of exercise，reduction in social activities，change in emotions（irritability/apathy），decrease in sleep〕，adherence to the "golden trigeminy"（ACEIs in combination with beta-blockers and aldosterone receptor antagonists） and HF-related adverse events.Results　Compared with out-of-community group，the community group showed lower aggravation rate of HF symptoms and reduction rate of diet，and higher adherence to beta blockers and aldosterone receptor antagonists at the 6th month after discharge（P<0.05）.Furthermore，the community group showed lower rates of HF symptoms，and reduction in social activities，and decrease in sleep，higher adherence to beta blockers and aldosterone receptor antagonists and lower recurrence rate of acute HF at the 12th month after discharge（P<0.05）.Conclusion　Effective community-based healthcare interventions could slow down the progress of moderate-to-severe HF-REF，improve the medication compliance and the quality of life，as well as reduce the incidence of adverse cardiac events in such patients.

Effects of atorvastatin on bone mass and muscle strength in elderly patients with hypercholesterolemia combined with low bone mass

WANG Xiaodong，DU Yanping，XIAO Feng，ZHANG Min，YU Aihua，WU Rina,CHEN Yu，CHEN Hua，CHENG Qun

2020, 23(21): 2669-2672. DOI: 10.12114/j.issn.1007-9572.2020.00.102

Asbtract ( )

PDF (1110KB) ( )

References | Related Articles | Metrics

Background　Previous studies found that statins can activate osteoblasts and promote bone anabolic effect，thus providing a new perspective for clinical treatment of osteoporosis in the elderly.But it is not clear whether statins can treat osteoporosis in the elderly in the local community.There is also no literature in China about whether statins can retard bone mass loss rate of those with low bone mass.Objective　To study the effects of atorvastatin on bone mass and muscle strength in elderly patients with hypercholesterolemia combined with low bone mass.Methods　401 elderly patients with hypercholesterolemia 〔total cholesterol（TC）>6.99 mmol/L〕and low bone mass（-2.50.05），the bone turnover markers，biochemical markers（except TC），and hand grip strength showed significant differences between the groups（P<0.05）.After two years' intervention，compared with the control group，the experimental group showed greater mean BMD variation of the lumbar vertebrae of 1-4 〔（0.029±0.002） g/cm2 vs （0.007±0.001） g/cm2〕，of femoral neck〔0.024（0.012，0.040）g/cm2 vs 0.009（0.003,0.015）g/cm2〕，and of hip〔（0.026±0.017） g/cm2 vs （0.007±0.006） g/cm2〕（P<0.001）.The experimental group showed lower mean variation of beta-CTX〔（-0.151±0.087） μg/L vs（-0.020±0.017） μg/L〕，and of PINP〔（-17.57±16.89） μg/L vs（-3.48±6.29） μg/L〕（P<0.001）.The mean variation of CK of the experimental group was higher than that of the control group〔0.17（0.11，0.18）U/L vs -0.01（-0.02，0.01） U/L〕（P<0.05），the mean variation of AST of the experimental group was higher than that of the control group〔（1.20±0.31） U/L vs （1.07±0.31） U/L〕（P<0.001），the mean variation of TC of the experimental group was higher than that of the control group〔（-2.68±0.10） mmol/L vs（-0.25±0.00） mmol/L〕（P<0.001）.Moreover，the experimental group also demonstrated higher left-hand grip strength 〔（-1.99±1.34） kg vs（1.18±1.77） kg〕 and higher right-hand grip strength 〔（-2.28±1.26） kg vs（1.10±1.80）kg〕（P<0.001）.After the intervention of statins，there was no linear correlation of CK with the left- or right-hand grip strength within the intervention group（r=0.050，P=0.480；r=-0.105，P=0.141）.But both left- and right-hand grip strength and TC were positively correlated（r=0.302，P<0.001；r=0.462，P<0.001）.Conclusion　Atorvastatin could slow the increase of age-related bone loss，increase BMD，and inhibit bone turnover，but might decrease the muscle strength of the upper limb significantly.Thus，the elderly taking atorvastatin should strengthen muscle strength training.

Singleton pregnancy outcomes in frozen-thawed embryo transfer in natural cycle and hormone replacement therapy cycle：a comparative study

TIAN Haiqing，MEN Hongqin，ZHANG Meng，LI Xia，LA Xiaolin

2020, 23(21): 2673-2677. DOI: 10.12114/j.issn.1007-9572.2020.00.097

Asbtract ( )

PDF (1130KB) ( )

References | Related Articles | Metrics

Background　Frozen-thawed embryo transfer（FET） has been popularized in assisted reproductive technology（ART）.The natural cycle or hormone replacement therapy cycle is important in FET，whose safety has gained increased attention.Objective　To perform a comparative study of singleton pregnancy outcomes following frozen-thawed embryo transfer in natural cycle and hormone replacement therapy cycle.Methods　This retrospective study was conducted in a cohort of 419 cases with single live birth following successful FET from Reproductive Medicine Centre，the First Affiliated Hospital of Xinjiang Medical University during January 2013 to June 2017.According to the method of endometrial preparation，they were divided into group A（n=175，natural cycle），and group B（n=244，hormone replacement therapy cycle）.General data of two groups were collected，including the age of the couple，maternal BMI，years of infertility，levels of basal FSH，basal luteinizing hormone（LH），anti-Mullerian hormone（AMH），total dose and administration duration of gonadotropins for superovulation cycle，estrogen level on the day of injecting HCG，number of retrieved oocytes，number of oocytes arrested at metaphase of meiosis Ⅱ（MⅡ），number of 2-pronuclear（2PN） zygotes，endometrial thickness on the day of FET，and number of embryos transferred.A follow-up was given to both groups for collecting data about prevalence rates of normal-birth-weight and low-birth-weight infants，preterm infants，preterm and full-term low-birth-weight infants，and macrosomia，sex ratio of newborn birth weight，and gestational age at delivery.Results The number of total natural cycles of group A was 175，and that of hormone replacement therapy cycles for group B was 244.Two groups showed no significant differences in general data （P>0.05）.Compared with group A，group B showed a lower prevalence rate of normal-birth-weight infants（P<0.05）.But two groups showed similar prevalence rates of preterm infants，low-birth-weight infants，preterm and full-term low-birth-weight infants，macrosomia，and male infants，as well as similar mean neonatal birth weight and gestational age at delivery（P>0.05）.Conclusion　Frozen-thawed embryo transfer using endometrial preparation with natural cycle may yield a higher rate of normal-birth-weight infants，and better pregnancy outcomes.

Preliminary application of real-time shear wave elastography in evaluating endometrial receptivity

YU Caicha，SHUI Xujuan，JIAO Yan，LIN Yuanyuan

2020, 23(21): 2678-2681. DOI: 10.12114/j.issn.1007-9572.2020.00.180

Asbtract ( )

PDF (2386KB) ( )

References | Related Articles | Metrics

Background　Endometrial receptivity is a comprehensive condition that makes the endometrium receptive to normal embryo implantation.In recent years，ultrasonic research of endometrial receptivity has become a hot topic，but mainly focuses on endometrial thickness，echo and blood flow.With the development of ultrasonic technology，the tissue elastic properties of endometrium is expected to be a new direction in the study of endometrial receptivity.Objective To explore the value of real-time shear wave elastography（SWE） in evaluating endometrial receptivity by comparatively analyzing the elastic modulus of endometrium in receptive and proliferative phases measured quantitatively with real-time SWE.Methods　 Participants were 80 women who underwent outpatient follicle monitoring for preparing for a healthy pregnancy in Wenzhou People's Hospital during January to December，2018.The mean echo type，thickness，and elastic modulus of receptive endometrium and proliferative endometrium measured with both real-time SWE and two-dimensional ultrasound were analyzed comparatively，and the relationship of mean thickness with elastic modulus was explored with Spearman correlation analysis.Results　The endometrium of 80 women showed three-line sign in proliferative phase and homogenous hyperechoicity in receptive phase.Receptive endometrium had thicker mean endometrial thickness〔11.0（10.0，12.8） mm vs 7.0（6.0，8.0） mm〕 and lower mean elastic modulus〔（9.4±2.7） kPa vs（25.7±4.4） kPa〕 than proliferative endometrium （P<0.05）.There was a negative correlation between the mean value of the endometrial thickness and elastic modulus（rs=-0.849，P<0.05）.The mean elastic modulus varied significantly by echo types（P<0.05）.Conclusion　 Endometrial elasticity，thickness and type of echoes quantitatively measured by real-time SWE may indirectly reflect the temporal phase of endometrial mesenchymal，and may provide a new perspective for evaluating endometrial receptivity in infertility patients.

Effects of moxa-moxibustion on wound healing and PI3K/Akt signaling pathway in rats with pressure ulcer

HAN Chao，YIN Hongna，YANG Xirui，FAN Miaomiao，LI Huihang，WANG Mingzhen，HAN Qichen，SUN Zhongren

2020, 23(21): 2682-2688. DOI: 10.12114/j.issn.1007-9572.2020.00.319

Asbtract ( )

PDF (1922KB) ( )

References | Related Articles | Metrics

Background　In recent years，it has been found that moxa-moxibustion can promote the healing of pressure ulcer（PU），but its mechanism remains unclear.PI3K/Akt signaling pathway plays an important role in the healing process of skin injury by participating in many biological processes such as cell proliferation，differentiation and apoptosis.Objective　To observe the effect of moxa-moxibustion on wound healing and PI3K/Akt pathway in rats with PU，so as to explore the action mechanism of moxa-moxibustion on promoting PU healing.Methods　This study was conducted from March 2018 to February 2019.30 adult female SPF grade SD rats were selected，and 20 of them were modeled with PU according to the principle of ischemia-reperfusion，and were randomly divided into moxa-moxibustion group and model group according to the proportion of 1∶1 after modelling，and the other 10 were assigned to the blank group without modelling.The model group was given iodophor to clean the wound once a day，10 days as a course of treatment.In the moxa-moxibustion group，moxa-moxibustion was used to treat the wound locally，15 minutes a time，once a day，10 days as a course of treatment.On the 1st，3rd，5th，7th and 10th days of the intervention，the wound healing rate，histological state of the healing wound，the protein expression levels of phosphorylated Akts473，phosphorylated Bads136 and phosphorylated Caspase-9s196 were measured and compared.Results　On the 3rd，5th，7th and 10th days of intervention，the wound healing rate of moxa-moxibustion group was higher than that of model group（P<0.05）.Compared with the model group，HE staining tissues of moxa-moxibustion group had less inflammatory cell infiltration and more new granulation tissue and blood vessels formation.On the 1st，3rd，5th，7th and 10th days of intervention，the blank group showed lower mean expression level of phosphorylated Akts473 protein compared with other two groups（P<0.01）.The expression level of phosphorylated Akts473 protein in the moxa-moxibustion group was higher than that in the model group（P<0.05）.The blank group had lower mean expression level of phosphorylated Bads136 protein than other two groups（P<0.01）.The protein expression level of phosphorylated Bads136 in the moxa-moxibustion group was higher than that in the model group（P<0.01）.The mean expression level of phosphorylated Caspase-9s196 in the blank group was lower than that of model group and moxa-moxibustion group（P<0.01）.And it in the moxa-moxibustion group was higher than that in the model group（P<0.01）.Conclusion　Moxa-moxibustion can promote wound healing of PU rats，and its mechanism may be related to the effect of anti-apoptosis of activated PI3K/Akt signal pathway.

Effect of routine language therapy combined with acupoint massage on language function and intelligence in young children with developmental retardation

CUI Jing，DI Weihua，LI Yan，WANG Jinyan，BI Fengli，WANG Wansheng，WANG Deqiang，SHAO Cuijie

2020, 23(21): 2689-2692. DOI: 10.12114/j.issn.1007-9572.2020.00.240

Asbtract ( )

PDF (1109KB) ( )

References | Related Articles | Metrics

Background　Due to the influence of environmental factors，the number of children diagnosed with language delay has increased significantly，which has gradually attracted the attention of parents and medical workers.However，available rehabilitation programs for such patients are homogeneous with slow responses.Although acupuncture and moxibustion therapy，a traditional rehabilitation therapy，has been reported in many articles to be effective in improving language function and intelligence，it is difficult to be accepted by the children and their parents due to its invasion.In contrast，acupoint massage is an effective method without the shortcomings of acupuncture and moxibustion therapy.So we further studied its effect on language function and intelligence in such children.Objective　To explore the effects of routine rehabilitation therapy combined with acupoint massage on language function and intelligence of young children with developmental retardation.Methods　A total of 155 young children diagnosed with developmental retardation in Children's Rehabilitation Clinic，Binzhou Medical University Hospital between January 2018 and January 2019 were included in this study.Using generated random numbers，they were divided into the routine group（n=80） and the intervention group（n=75）.Both groups received routine rehabilitation therapy（consisting of language training and brain circulation therapy with cerebral circulation function therapeutic apparatus），the intervention group additionally received acupoint massage.The Gesell Developmental Schedules were used to assess the mid-term and long-term therapeutic effects in both groups at the end of 3，and 6 courses of treatment，respectively.Results　After 6 courses of treatment，the intervention group showed better language function and intelligence（P<0.05）.Both treatment method and time produced significant main effects on the development quotient of language function and adaptive behavior（P<0.05）.And there was an interaction between treatment method and time on the development quotient of language function and adaptive behavior（P<0.05）.The general mid-term and long-term improvements in the development quotient of language and adaptive behavior in the intervention group were higher than those of the routine group（P<0.05）.Conclusion　For young children with developmental retardation，routine rehabilitation therapy combined with acupoint massage is effective in improving their language function and intelligence.

Systematic perspective of integrating TCM services into family doctor services

FAN Zhuanzhuan，XIANG Leyi，ZHOU Tong，YANG Qian，YAO Dongming

2020, 23(21): 2693-2697. DOI: 10.12114/j.issn.1007-9572.2019.00.660

Asbtract ( )

PDF (1164KB) ( )

References | Related Articles | Metrics

Background　As a unique kind of health resource，traditional Chinese medicine（TCM） plays an irreplaceable role in essential medical care and health care.Therefore，to protect the health of residents，it is indispensable to integrate TCM services into family doctor services.However，TCM services are hardly mentioned and rarely involved in current family doctor services，far from enough to satisfy the healthcare needs of the residents.So，it is urgent to promote the integration of TCM services into family doctor services.Objective　To identify the aspects in family doctor services where TCM services can be integrated on the basis of analyzing the implementation status of China's family doctor services，and to provide corresponding recommendations.Methods　In October 2018，we searched CNKI database for articles about family doctor services published between January 1，2010 and September 15，2018 using advanced search technique with “family doctor services” and “general practitioner services” as the keywords，and “SCI Source Journals，EI Source Journals，Core Journals，CSSCI and CSCD” as source categories.We finally included 83 articles.On the basis of the framework of system theory，we developed the analytical framework for integrating TCM services into family doctor services from the internal aspects（human resources，economic burden，service content and delivery mode） and external aspects（politics，economy，technology and society） of the family doctor services delivery system.Results　Problems in the four dimensions of human resources，economic burden，service content and delivery mode，were reported in 62.7%，12.0%，18.1%，and 6.0% of the 83 articles，respectively.And problems in the four dimensions of politics，economy，technology and society were reported in 43.4%，12.0%，33.7% and 41.0% of the 83 articles，respectively.Conclusion　The integration of TCM services into family doctor services needs to be carried out from the following eight aspects：encouraging TCM doctors to join in the family doctor team，adding TCM service projects to family doctor services，providing contracted integrated TCM and western services，and using TCM techniques appropriately，strengthening financial support，perfecting relevant supporting policies，supplying information technology support and strengthening propaganda and guidance.

Advances in testamentary capacity for elderly patients with dementia

ZHAO Yan，YANG Yeyao，SHEN Xuhui，MAO Dandan，LIAN Haijuan，XU Meiying

2020, 23(21): 2698-2701. DOI: 10.12114/j.issn.1007-9572.2020.00.150

Asbtract ( )

PDF (1100KB) ( )

References | Related Articles | Metrics

Dementia is an irreversible neurodegenerative disease with a progressive course，which primarily impairs the cognitive function of patients.Patients with mild to moderate dementia have certain cognitive and executive functions.Testamentary capacity，a kind of advanced executive ability involving both fields of medicine and law，has attracted extensive attention from scholars.People with dementia have the right to make a will，but the validity of their will is controversial.Studies regarding the assessment criteria and tools for testamentary capacity in dementia patients are increasing gradually in foreign countries，but are relatively less in China.We reviewed the related studies at home and abroad，hoping to provide a basis for the introduction of reasonable and effective testamentary capacity assessment criteria and tools to China，and to provide a reference for protecting the legal rights and interests of dementia patients，safeguarding patients' dignity and reducing family and legal disputes.

Management and treatment of severe mental disorders in Henan Province

YAO Fengju，ZHANG Weiping，ZHANG Ruiling，LIU Changjun，WANG Hailing，GUO Zhengjun，WANG Yujie

2020, 23(21): 2702-2708. DOI: 10.12114/j.issn.1007-9572.2020.00.206

Asbtract ( )

PDF (1174KB) ( )

References | Related Articles | Metrics

Background　As a major public health problem and a prominent social problem，the management and treatment of severe mental disorders emphasizes the comprehensive management of multiple departments and the integrated whole-process treatment of hospital and community.Studying the management and treatment status of registered patients with severe mental disorders may facilitate the improvement of healthcare delivery system，and may provide a basis for the recovery of patients' social function and reduction of disease burden.Objective　To analyze the management and treatment status of patients with severe mental disorders in Henan Province from 2014 to 2018，to provide supports for government departments to improve mental healthcare delivery system，develop treatment- and aid-related policies，and for the promotion of community rehabilitation services.Methods　The number of permanent residents in provincial cities，and counties（cities）directly administered by Henan provincial government stemmed from the data published by Chinese Center for Disease Control and Prevention.All patients with severe mental disorders in Henan Province registered in the information system between January 2014 and December 2018 were selected during January to April 2019.The usage of information system（coverage rate and the number of users），general information of registered patients，the registration，management and treatment of patients in 2018（ the number of permanent residents，registered patients，patients with standardized management，patients taking medicine regularly，stable patients，home-based management patients，reported prevalence，rates of standard management，regular medication and stability）were recorded.Prevalence rates of severe mental disorders，standard management，regular medication and stability in 2014 and 2018 were compared.The mean untreated period，mean course of disease and policy utilization of registered patients from 2014 to 2018 were analyzed.Results　By the end of 2018，174 counties / districts in Henan Province had opened user accounts of national information system，and input the information of the patients and provided follow-up services for them.The coverage rate of the system was 100.00% and the registered users numbered 3 429 in total.There were 413 240 registered patients in 2018，which increased by 66.54% compared with that（248 128）of 2014.In 2018，the reported prevalence rate of severe mental disorders was 4.34‰ for the whole province.The top three provincial cities with highest prevalence rate were Shangqiu（5.23‰），Zhoukou（5.23‰）and Zhumadian（5.23‰），and the top three counties（cities）directly administered by the provincial government with highest prevalence rate were Xincai（5.68‰），Lankao（5.17‰）and Huaxian（5.12‰）.In 2018，the rate of standard management of severe mental disorders was 72.99% for the whole province.The top one provincial city with highest rate of standard management was Luohe（87.96%），and the top one city（county）directly administered by the provincial government with highest rate of standard management was Lankao（96.08%）.The province owned a rate of regular medication of 30.31% in severe mental disorders patients in 2018.The top one provincial city and top one city（county）directly administered by the provincial government owning highest rate of regular medication were Luoyang（51.15%）and Dengzhou（74.95%），respectively.The province had a rate of stability of severe mental disorders of 81.43%.Jiyuan（97.76%）was the top one provincial city and Lankao（98.46%）was the top one city（county）directly administered by the provincial government owning highest rate of stability.Compared with 2014，in 2018，the province had higher reported prevalence rate of severe mental disorders，and higher rates of standard management，regular medication and stability，with growth rates of 66.92%，115.31%，80.10% and 62.44%，respectively（P<0.05）.The mean untreated period of patients with schizophrenia in the province showed a gradually shortened trend year by year from 2014 to 2018.In those with bipolar disorder and mental retardation（accompanied with mental disorders），the mean untreated period in 2015 was longer than that of 2014，then decreased annually during 2016—2018.For those with paranoid mental disorder associated with epilepsy，the mean untreated period decreased from 2014 to 2016，and then it was prolonged first and then shortened in the next two years.The mean untreated period of patients with schizoaffective disorder showed a gradually shortened trend year by year from 2014 to 2017，but the mean length of period in 2018 was consistent with that of 2017.For those with mental disorders associated with epilepsy，the mean untreated period decreased from 2014 to 2017，but the mean length of period in 2018 was slightly longer than that of 2017.The mean course for severe mental disorders（calculated based on the data of schizophrenia，which was selected as a representative disease）in the province from 2014 to 2018 was 13.45，12.12，10.66，10.50 and 10.10 years，respectively，with a trend of gradual decrease.Among the 2 500 cases receiving outpatient medical aids，1 629（65.16%）had subsistence allowance，631（25.24%）had benefits gained from the local federation of disabled persons，304（12.16%）had assistance from the local civil affairs departments，966（38.64%）had reimbursement for outpatient treatment of chronic diseases，and 346（13.84%）had at least 3 kinds of assistance derived from related policies.Conclusion　In Henan from 2014 to 2018，the number of registered patients with severe mental disorders increased gradually，the management and treatment status improved，and the untreated period shortened，with significant inter-area differences.The rate of regular medication needs to be improved further.

Effect of psychological correction in heroin addicts with methadone maintenance therapy

SU Yaling，JIANG Zhendong，ZHANG Aijun，XU Yanjin，TANG Yanxia，XIAO Zedan

2020, 23(21): 2709-2713. DOI: 10.12114/j.issn.1007-9572.2020.00.244

Asbtract ( )

PDF (1272KB) ( )

References | Related Articles | Metrics

Background　Long-term use of heroin can cause a series of physical，mental and emotional problems.At present，methadone maintenance therapy（MMT） is the most effective treatment for heroin-dependent patients.Many drug addicts have psychological problems，but the psychological correction for drug addicts in China is still in its infancy.Objective　To investigate the effect of psychological correction on heroin-dependent patients receiving MMT.Methods　From January to June 2018，from 5 most representative clinics treating heroin addicts with MMT randomly selected from 4 districts of Wuhan，400 such patients with a consecutive treatment for at least 2 years were enrolled and were divided into individual correction group（n=86，each was intervened with MMT combined with correction services delivered by professional counseling workers with intermediate national psychological consultant qualification for 24 times，once a week，0.5 hour each time），group correction group（n=120，intervened with MMT combined with correction services delivered by professional counseling workers with intermediate national psychological consultant qualification in subgroups of 10-15 individuals for 24 times，once a week，1.5 hours each time），peer correction group（n=115，intervened with MMT combined with the positive stress influence from peers during the group cooperative learning），and control group（n=79，only intervened with MMT with strict adherence to the stipulated dosage and the medication procedure，with medication-related precautions informed by outpatient medical workers）by random number table method.The self-made General Situation Questionnaire was used to collect the demographic data.The Social Support Rating Scale（SSRS），8-item Morisky Medication Adherence Scale（MMAS-8），and SCL-90 were used to evaluate the treatment effect.Results　73 cases（84.9%），99 cases（82.5%），92 cases（80.0%），and 61 cases（77.2%） in the individual correction group，group correction group，peer correction group，and control group completed the follow-up.The control group had lower mean scores of MMAS-8 and SSRS，and higher mean SCL-90 score after intervention compared with other groups（P<0.05）.The peer correction group showed lower mean scores of MMAS-8 and SSRS，and higher mean SCL-90 score after intervention compared with other two correction groups（P<0.05）.Individual correction group demonstrated higher mean scores of MMAS-8 and SSRS，and lower mean SCL-90 score after intervention compared with group correction group（P<0.05）.Conclusion　Psychological correction has a good effect on drug addicts with MMT.There are differences in the effects between three correction methods，which can be selected according to the specific situation of the patient.

Rapid emergency diagnostic analysis of atypical acute aortic dissection

JIANG Youjin，LI Juan，ZHANG Zhengfang，ZHU Bing

2020, 23(21): 2714-2718. DOI: 10.12114/j.issn.1007-9572.2020.00.148

Asbtract ( )

PDF (1135KB) ( )

References | Related Articles | Metrics

Background　Acute aortic dissection （AAD） is a rare but fatal aortic disease if left untreated.Patients with continuous severe chest and back pain，high risk factors and obvious physical findings are hardly misdiagnosed or have a missed diagnosis，but those with atypical symptoms are difficult to be diagnosed timely.Therefore，it is urgent to formulate diagnostic framework for atypical AAD.Objective　To summarize a rapid emergency diagnostic and therapeutic procedure for atypical AAD，and to analyze the improvement in waiting time for a confirmed diagnosis and retention time in emergency department.Methods　We collected the clinical data of 91 AAD patients who had been diagnosed and misdiagnosed by Department of Emergency，Maanshan People's Hospital from January 2012 to December 2018，and divided them into typical AAD group（n=51） and atypical AAD group（n=40）according to clinical manifestations and final diagnostic results，then further divided atypical AAD patients into control subgroup （n=24，admitted from January 2012 to December 2015），and observation subgroup （n=16，admitted from January 2016 to December 2018） according to the admission time.We used two diagnostic procedures although efforts have been made to explore and improve the procedure since the first atypical patient had been found in our hospital in 2012.Before 2016，due to insufficient understanding of AAD，we diagnosed suspected AAD patients without performing examinations such as routine blood test，measurement of serum C-reactive protein，electrolytes，and amylase，ECG，liver and kidney functions，urine amylase，PT，APTT，TT and FIB，myocardial enzyme and CTnI，and D-Dimer，as well as CT scan when necessary.Since 2016，we used a different diagnostic procedure revised based on gradually improved understanding of atypical AAD gained by years of summary and learning of aortic disease-related knowledge and literature review，and the suspected AAD patients are diagnosed based on data including the aforementioned examinations，for those highly suspected，if the aforementioned examinations are not sufficient to make a confirmed diagnosis，aortic angiography was performed additionally.We compared the demographic data，missed diagnosis，misdiagnosis，time of confirmed diagnosis，retention time in emergency department，and outcome across the typical patients，control and observation atypical patients.Results　Sex ratio （χ2=0.024，P=0.989） and mean age （F=2.594，P=0.080） showed no significant differences across typical AAD group，control and observation atypical AAD subgroups.One observation atypical patient and 1 control atypical patient as well as 5 typical patients were misdiagnosed.The mean time for making a diagnosis for those with correct diagnosis in typical AAD group，control atypical AAD subgroup and observation atypical AAD subgroup was （27.6±16.8） min，（38.8±21.6） min，and （19.1±7.4） min，respectively，showing a significant difference（F=6.180，P=0.003）.The mean retention time in emergency department for typical AAD group，control and observation atypical AAD subgroups was 0，3.4（8.9） hours，and 1.5（1.0） hours，respectively.The control atypical AAD subgroup had a longer mean retention time in emergency department than observation atypical AAD subgroup （Z=-3.875，P<0.001）.77 patients were transferred to higher level hospitals，the other 12 patients were treated in our hospital，11 of whom received pharmacological treatment，and the other 1 received stent implantation.Two typical AAD patients died within 1 hour after diagnosis.Conclusion　To improve the diagnostic accuracy of atypical AAD to save time for further treatment，measurement of D-Dimer and CT scan or together with CTA when necessary should be performed for suspected atypical AAD patients during the initial examination as far as possible.In addition，learning of clinical symptoms and imaging features of atypical AAD should be strengthened in front-line clinicians and emergency diagnostic and therapeutic procedure for atypical AAD should be standardized.

Electrocardiograms with de Winter syndrome of acute ST-segment elevation myocardial infarction during the whole period of treatment

CHU Qingmin，TANG Na，JIN Zheng，LI Rong

2020, 23(21): 2719-2723. DOI: 10.12114/j.issn.1007-9572.2020.00.362

Asbtract ( )

PDF (3367KB) ( )

References | Related Articles | Metrics

The de Winter electrocardiogram（ECG） pattern is considered as the ECG manifestation for acute ST-segment elevation myocardial infarction （STEMI），based on the evidence of clinical coronary angiography suggested severe proximal stenosis or complete occlusion of the anterior descending branch，and its intrinsic relationship with the typical four-stage ECG findings of STEMI is not clear.In this paper，we analyzed the changes on the ECGs with de Winter pattern of a case of acute STEMI during the whole period of treatment，and reviewed relevant studies，then assessed the relationship between acute STEMI and de Winter ECG，in order to provide new ideas for the further understanding of de Winter ECG.

Acute bilateral fornix column infarction：clinical analysis and literature review

LIANG Na，WANG Shan，JI Guang，ZHI Guiqin，LIU Yaling

2020, 23(21): 2724-2726. DOI: 10.12114/j.issn.1007-9572.2020.00.198

Asbtract ( )

PDF (1162KB) ( )

References | Related Articles | Metrics

Cerebral infarction may present various symptoms of nervous system damage，but rarely manifests only as memory impairment，and infarction of the fornix column is more rare.Due to special anatomical characteristics，fornix column uncommonly becomes a site of infarction，which leads to highly increased possibilities of being ignored and misdiagnosed clinically.This article reports a case of bilateral fornix column infarction，and reviews related case reports，in which the anatomy，function，and causes of infarction of fornix column as well as infarction-induced cognitive impairment and prognosis are analyzed and summarized，to increase clinicians' knowledge to identify this disease and give appropriate treatment as early as possible.

Lymphoma with thrombotic thrombocytopenic purpura as the first symptom：report of two cases and literature review

ZHAO Tongde，XU Yamei

2020, 23(21): 2727-2730. DOI: 10.12114/j.issn.1007-9572.2020.00.233

Asbtract ( )

PDF (1850KB) ( )

References | Related Articles | Metrics

Diffuse large B-cell lymphoma（DLBCL）is the most common type of lymphoma，with various forms of onset.Thrombotic thrombocytopenic purpura（TTP）is a rare and life-threatening thrombotic microangiopathy.DLBCL patients with TTP as the first symptom are rare.We introduced two cases of DLBCL with TTP as the first symptom，summarized the clinical characteristics that easily cause missed diagnosis and misdiagnosis，some highly heterogeneous clinical manifestations，and the treatment and outcome.Moreover，we also discussed the epidemiological characteristics，diagnostic and therapeutic perspectives of TTP based on the review of relevant literature，and concluded that the key to remission is to recognize TTP as early as possible and control DLBCL in time.

Nephrogenic diabetes insipidus without gene mutation：a case report

HAN Xiudan，WANG Jiao，ZHU Lingyan，XU Jixiong

2020, 23(21): 2731-2734. DOI: 10.12114/j.issn.1007-9572.2020.00.010

Asbtract ( )

PDF (1284KB) ( )

References | Related Articles | Metrics

Nephrogenic diabetes insipidus is a typical rare disease，and the diagnosis of hereditary nephrogenic diabetes insipidus mainly depends on clinical manifestations and genetic testing.Up to now，nephrogenic diabetes insipidus has not attracted the attention of patients.Although the genetic testing methods used to diagnose nephrogenic diabetes insipidus are becoming more and more popular，there are still cases that are ignored，leading to the emergence of corresponding complications.Therefore，we report a case of nephrogenic diabetes insipidus with high clinical suspicion in the First Affiliated Hospital of Nanchang University，and sequenced the whole exon gene of arginine vasopressin type 2 receptor（AVPR2）gene and aquaporin 2（AQP2）in patients and their parents，but found no meaningful mutations.After oral administration of hydrochlorothiazide，the patient's symptoms improved significantly，which is worthy of clinical attention.

Table of Content