Chinese General Practice

Quality Appraisal of Guidelines/Consensuses on Management of Gastroesophageal Reflux Disease Symptoms　

LI Zimeng，KANG Yannan，LUO Ruzhen，ZHANG Chunmei，JIN Yinghui，LIU Yanhui

2020, 23(33): 4151-4159. DOI: 10.12114/j.issn.1007-9572.2020.00.505

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Background　The incidence of gastroesophageal reflux disease（GERD） is increasing year by year.Interventions such as scientific health education and strengthening symptom management are the key to controlling reflux symptoms，reducing complications and improving quality of life in these patients.So it is necessary to screen，summarize and evaluate relevant high-quality evidence to promote the clinical management of GERD symptoms.Objective　To evaluate the quality of the guidelines/consensuses on the management of GERD symptoms using related evidence-based instruments，to provide a theoretical basis for promoting the translation of evidence into practice.Methods　For retrieving guidelines/consensuses on the management of GERD symptoms published from January 1，2014 to December 31，2019，we searched websites of Guidelines International Network，National Guideline Clearinghouse，New Zealand Guidelines Group，National Institute for Health and Care Excellence （NICE），Registered Nurses' Association of Ontario，Australian Clinical Practice Guideline，and World Health Organization using “gastroesophageal reflux”“GERD”“nonerosive reflux disease”and “reflux esophagitis” in English as search terms，and databases of PubMed and Cochrane Library using medical subject headings and free terms in English including “gastroesophageal reflux/GERD/nonerosive reflux disease/reflux esophagitis”“Guideline/Guidelines as Topic/guideline*/consensus*/routine*/recommendation”，and databases of CNKI，Wanfang Data and VIP using “胃食管反流病/非糜烂性反流病/反流性食管炎/GERD” “指南、规范、指引、共识、建议、指导、规范” in Chinese as search terms.In addition，references of relevant guidelines/consensuses were also retrieved.AGREEⅡ and related quality assessment tools were used to evaluate the quality of the guidelines and consensuses.The recommendations on the management of GERD symptoms were synthesized.Results　A total of 1 593 articles were obtained，and 2 guidelines （published abroad） as well as 6 consensuses （published in China） of them were finally included after gradual exclusion.The average domain scores for the guidelines evaluated by the AGREEⅡwere 80.56% for scope and purpose，73.61% for stakeholder involvement，75.00% for rigour of development，80.56% for clarity of presentation，50.00% for applicability，and 87.50% for editorial independence，with 1 was rated as grade A and another as grade B，respectively.The intra-class correlation coefficient of the 2 guidelines was 0.75，and the inter-rater agreement was high.The items of the 6 consensuses were rated as “included”.The summarized recommendations include eight parts：GERD screening and discrimination，diagnosis of GERD，diagnosis of complications of GERD，appropriate diet，lifestyle interventions，psychological guidance，medication guidance，and treatment guidance.Conclusion　The overall qualities of the included guidelines and consensuses are high，but the process of developing and reporting still needs to be further standardized.The recommendations （consisting of GERD screening and discrimination，diagnosis of GERD，diagnosis of complications of GERD，appropriate diet，lifestyle interventions，psychological guidance，medication guidance，and treatment guidance） summarized after quality appraisal，may be used as evidence for both medical workers and patients in the management of GERD symptoms.

Goal Attainment of Physical Therapy and Metabolic Control among Adult Type 2 Diabetics　

ZHAO Yan，PAN Shasha，SUN Yue，SUN Jing

2020, 23(33): 4160-4166. DOI: 10.12114/j.issn.1007-9572.2020.00.439

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Background　Attaining the goals of physical therapy is an important measure for effective control and prevention of diabetes.Metabolic control parameters can reflect the management level of diabetes.So exploring the status and relationship of goal attainment of physical therapy and metabolic control are of great significance in improving the goal attainment rates of physical therapy and metabolic control in type 2 diabetics.Objective　To explore the status and relationship of attaining the goals of physical therapy and metabolic control in type 2 diabetics from a tertiary hospital in Beijing.Methods　Patients with type 2 diabetes were selected by convenient sampling method from the Department of Endocrinology of Peking University Third Hospital during July 2017 to March 2018.A survey was conducted among them using a self-developed questionnaire named Exercise Status of Type 2 Diabetes Patients for collecting the data concerning demographics and medical history as well as exercise habit，and using the Godin-Shephard Leisure-Time Physical Activity Questionnaire for evaluating exercise intensity and goal attainment of physical therapy.Physiological and biochemical parameters of metabolic control were collected.Results　The survey obtained a response rate of 90.5%（362/400）.Among the 362 respondents，148（40.9%） had attained the goals of physical therapy，but other 214（59.1%） had not.Binary Logistic regression analysis indicated that attaining the goals of physical therapy was associated with the levels of HbA1c，FPG，2 hPBG，TG，and LDL-C（P<0.05）.Education level，occupation，course of type 2 diabetes were associated with HbA1c level（P<0.05）.Occupation and course of type 2 diabetes were associated with 2 hPBG level（P<0.05）.Gender was also associated with TG，LDL-C（P<0.05）.Gender and occupation were associated with SBP level（P<0.05）.Conclusion　Attaining the goals of physical therapy is beneficial to metabolic control of patients with type 2 diabetes.To improve metabolic control in these patients，healthcare workers should play a role in diabetic management to help them to enhance the rate of attaining the goals of physical therapy.

Correlation between C-reactive Protein to Albumin Ratio and Spontaneous Recanalization of Infarct-related Arteries in Patients with Acute ST-segment Elevation Myocardial Infarction　

WANG Shunli，TANG Jianmin，WANG Fengyun，SU Dongsheng，ZHU Yinchuan，WANG Tong

2020, 23(33): 4167-4171. DOI: 10.12114/j.issn.1007-9572.2020.00.500

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Background　Multiple studies reported that there is spontaneous recanalization of infarct-related arteries（IRA） in some STEMI patients before emergency PCI，which may be associated with a better outcome.So it is very important to find a simple and effective predicative index for spontaneous recanalization of IRA.At present，there are few studies on the relationship between C-reactive protein/albumin ratio （CAR） and spontaneous recanalization of IRA in patients with acute STEMI at home and abroad.Objective　To investigate the predictive value of CAR for spontaneous recanalization of IRA in patients with acute STEMI.Methods　A retrospective study was conducted.271 acute STEMI patients who underwent emergency PCI in the Second Affiliated Hospital of Zhengzhou University from May 2016 to February 2019 were enrolled，and divided into spontaneous recanalization group （n=56） and non-spontaneous recanalization group（n=215） by the prevalence of spontaneous recanalization of IRA found in the surgery.Clinical baseline data and laboratory results of two groups were compared.Multivariate logistic regression analysis was applied to screen the influential factors of spontaneous recanalization of IRA.The receiver operating characteristic （ROC） curve was used to evaluate the value of CAR in predicting spontaneous recanalization of IRA.Results　The leucocyte count，platelet/lymphocyte ratio （PLR），neutrophil/lymphocyte ratio （NLR），monocyte/high-density lipoprotein cholesterol ratio （MHR），and CAR in the spontaneous recanalization group were all lower than those in the non-spontaneous recanalization group （P<0.05）.Multivariate Logistic regression analysis showed that leucocyte count〔OR=0.856，95%CI（0.753，0.973）〕，NLR〔OR=0.368，95%CI（0.187，0.724）〕，MHR〔OR=0.947，95%CI（0.897，0.999）〕，and CAR〔OR=0.794，95% CI（0.732，0.862）〕 were influencing factors of spontaneous recanalization of IRA.ROC curve analysis showed that the AUC of CAR for predicting spontaneous recanalization of IRA was 0.768〔95%CI（0.705，0.832）〕when the cut-off point was determined as 11.99，with 67.9% sensitivity and 79.1% specificity，respectively.Conclusion　The leucocyte count，NLR，MHR and CAR may independently influence spontaneous recanalization of IRA in patients with acute STEMI，and CAR had certain value in influencing spontaneous recanalization of IRA.

Correlation between Hypertriglyceridemic Waist Phenotype and Thyroid Hormone in Women with Type 2 Diabetes Mellitus　

LIU Yiying，CHENG Xiaoling，DENG Sijie，HAO Xinlin，JIANG Yuefu，WAN Qin

2020, 23(33): 4172-4177. DOI: 10.12114/j.issn.1007-9572.2020.00.506

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Background　Hypertriglyceridemic waist （HTGW） phenotype is a new indicator for the measurement of visceral obesity，which is closely related to cardiovascular and diabetes diseases.However，there are few studies on the relationship between HTGW phenotype and thyroid hormone.Objective　To explore the correlation between HTGW phenotype and thyroid hormone in women with type 2 diabetes（T2DM）.Methods　308 eligible women with T2DM from the Affiliated Hospital of Southwest Medical University were enrolled during May 2017 to May 2019.They were divided into 4 groups by the normal reference range of waistline（<80 cm） and of triacylglycerol（<1.7 mmol/L）：group A（normal waistline and triacylglycerol，n=55），group B（normal waistline but elevated triacylglycerol，n=47），group C（elevated waistline but normal triacylglycerol，n=87），and group D（elevated waistline and triacylglycerol，n=119），and were stratified into 2 groups by the visceral fat area：group Ⅰ（visceral fat area<100 cm2，n=236） and group Ⅱ（visceral fat area≥100 cm2，n=72）.Spearman rank correlation analysis was used to estimate the correlation of thyroid hormone with waist circumference，triacylglycerol and HTGW.Multivariate Logistic regression analysis was used to explore the influencing factors of HTGW in women with T2DM.Results　The median waist circumference，triacylglycerol，thyroid stimulating hormone（TSH），free thyroxine（FT4） and free triiodothyronine（FT3） for the participants were 83.0（13.0） cm，1.80（1.32） mmol/L，2.09（2.07） mmol/L，1.23（0.27） mmol/L and 2.37（0.48） mmol/L，respectively.There were 119 HTGW patients and 189 non-HTGW patients.TSH was positively correlated with waist circumference （rs=0.13，P=0.03） and HTGW （rs=0.14，P=0.01）.FT4 was negatively correlated with HTGW （rs=-0.17，P=0.02）.FT3 was positively correlated with waist circumference （rs=0.13，P=0.02）.Multivariate Logistic regression analysis showed that waist circumference 〔OR=1.236，95%CI（1.139，1.343）〕，triacylglycerol 〔OR=2.501，95%CI（1.365，3.082）〕，low-density lipoprotein〔OR=3.045，95%CI（1.342，6.906）〕，and FT4 〔OR=0.226，95%CI（0.066，0.782）〕were associated with HTGW in women with T2DM（P<0.05）.Conclusion　In women with T2DM，HTGW was negatively correlated with FT4 but positively correlated with TSH.FT4 was an influencing factor for HTGW in women with T2DM.

The Influence of Talking Control before Gastroscopy on the Clarity of Endoscopic Visual Field　

XU Xiuqin，TENG Qifeng，HU Shengjuan，ZHANG Xiaofei，MA Shoucheng，YAN Chenwei，LIU Jun，LI Xingmei，LI Jian，HAN Xi，MA Qi

2020, 23(33): 4178-4182. DOI: 10.12114/j.issn.1007-9572.2020.00.369

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Background　It is clinically found that patients who talk to each other and make phone calls before gastroscopy have poor gastric cleanliness，which easily affects the diagnosis of the disease.At present，the preparation work before gastroscopy in China is mostly on the selection and requirements of medication，and patients are not required to control their own speech and keep quiet.Objective　To investigate the effect of talking control before gastroscopy on the clarity of endoscopic visual field.Methods　A total of 202 patients who met the research criteria for gastroscopy were selected in Ningnan Hospital of People's Hospital of Ningxia Hui Autonomous Region from November 2017 to January 2018.The patients were divided into the observation group （104 cases） and the control group （98 cases） by the random number table method.Before the examination，patients in both groups were given oral dimethicone powder and buccal tetracaine mortar.The patients in the observation group were advised to keep as quiet as possible and not to talk to each other during the waiting period； the patients in the control group were advised to keep quiet without special requirements for speech.The visual field clarity scores，diagnosis results，detection rates of micro lesions，heart rates before and after gastroscopy，and examination time were compared between the two groups.Results　The clarity scores of gastric fundus，upper gastric body，lower gastric body and gastric antrum and the total clarity score of endoscopic visual field in the observation group were lower than those in the control group （P<0.05）.The detection rate of micro lesions in the observation group was 25.0%（26/104），which was higher than that in the control group〔13.2%（13/98）〕（χ2=4.460，P=0.035）.There was no significant difference in heart rates between the two groups before and after gastroscopy（P>0.05）.The examination time in observation group was shorter than that in control group〔（7.1±1.0）min vs.（7.8±1.2）min〕（t=-3.966，P<0.05）.Conclusion　Asking patients to control their own talking before gastroscopy can effectively improve the clarity of visual field in the stomach，shorten the examination time，and improve the detection rate of micro lesions.

Blood Glucose Change during Hemodialysis in Diabetics Undergoing Regular Hemodialysis：a Multi-center Cross-sectional Study　

CHEN Weixia，JU Changping，CUI Lei，YU Xingxing，YIN Chunhua，LIU Ying，ZHAO Yuanyuan，CHEN Xiang，JIANG Meiyun

2020, 23(33): 4183-4189. DOI: 10.12114/j.issn.1007-9572.2020.00.488

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Background　 As diabetes prevalence is rapid increasingly globally，the prevalence of end-stage diabetics and patients needing hemodialysis in China are also growing.Compared to those without diabetes，increased glycemic changes during hemodialysis may adversely affect the outcome of diabetics.Objective　To analyze the blood glucose changes during hemodialysis in diabetics undergoing regular hemodialysis.Methods　From October 2017 to December 2018，105 diabetics undergoing regular hemodialysis with sugar-free bicarbonate dialysate plus insulin therapy in the blood purification center of three tertiary hospitals in Jiangsu Province（Zhongda Hospital，Southeast University，Lishui Branch and Wuxi Branch of Zhongda Hospital，Southeast University）were selected.After excluding 3 cases with missed blood glucose data during hemodialysis，other 102 were finally enrolled.Blood glucose and the incidence of hypoglycemia and hyperglycemia before hemodialysis，1 hour，2 hours and 3 hours after hemodialysis，and at the end of hemodialysis were collected and analyzed.Results　The average blood glucose for the diabetic participants was（8.4±3.2）mmol/L，which ranged from 1.6 to 27.8 mmol/L.22 cases（30 times）had hypoglycemia，with a hypoglycemia incidence of 21.6%（22/102），moreover 18 of them had asymptomatic hypoglycemia，with an asymptomatic hypoglycemia incidence of 17.6%（18/102）.30 cases（47 times including 26 occurred before hemodialysis）had hyperglycemia，with an incidence of 29.4%（30/102）.The average blood glucose in patients with hypoglycemia was significantly lower than that of those without hypoglycemia before hemodialysis，1 hour，2 hours and 3 hours after hemodialysis，respectively（P<0.05），but there was no significant intergroup difference in the average blood glucose at the end of hemodialysis（P>0.05）.The average blood glucose varied according to the measurement time in patients with and without hypoglycemia（P<0.05）.The average blood glucose in patients with hyperglycemia was significantly higher than that of those without hyperglycemia at each measurement time（P<0.05）.The average blood glucose varied according to the measurement time in patients with hyperglycemia and without（P<0.05）.Compared to those without hypoglycemia，patients with hypoglycemia had much lower proportion of patients stopping insulin therapy or reducing insulin dose on the day of hemodialysis（P<0.05），as well as knowing the definition of hypoglycemia（P<0.05）.The proportion of patients stopping insulin therapy or reducing insulin dose on the day of hemodialysis in patients with hyperglycemia was significantly higher than that of those without hyperglycemia（P<0.05）.Conclusion　Diabetics with regular hemodialysis had a relatively high incidence of hypoglycemia（21.6%），and asymptomatic hypoglycemia was more common.Stopping insulin therapy or reducing insulin dose on the day of hemodialysis and low awareness rate of the definition of hypoglycemia may be related factors of hypoglycemia during hemodialysis.These patients also showed a relatively high incidence of hyperglycemia（29.4%），which often occurred before hemodialysis.Stopping insulin therapy or reducing insulin dose on the day of hemodialysis may be a related factor of hyperglycemia during hemodialysis.

Prevalence and Influencing Factors of Hemorrhoidal Hemorrhage Observed with Fluorescence Microscopy in Hemorrhoidal Disease Patients　

SUN Songpeng，LONG Junhong，ZHANG Shuxin

2020, 23(33): 4190-4195. DOI: 10.12114/j.issn.1007-9572.2020.00.434

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Background　Hemorrhoidal disease（HD） is a common proctologic condition in the general population.There are many studies on exploration of its pathological mechanism，but its clinical manifestations cannot be fully explained and there is no consensus on its common pathological changes.Previous studies have demonstrated that tissue hemorrhage can be observed in pathological examination of hemorrhoids，but the causes of tissue hemorrhage and its important meaning in pathological development and clinical practice were underestimated.Objective　To explore the prevalence and influencing factors of hemorrhoidal hemorrhage observed with fluorescence microscopy in hemorrhoidal disease patients.Methods　From January 2014 to August 2016，the inpatients from Department of Anorectal Surgery，Dongzhimen Hospital，Beijing University of Chinese Medicine，were enrolled consecutively.They were divided into tissue hemorrhage and non-tissue hemorrhage groups according to pathological results.The data were collected retrospectively，including basic profile （sex，age，course of disease，history of anal operation，hypertension，cardiovascular disease，cerebrovascular disease，diabetes，hyperlipidemia），clinical symptoms （prolapse of hemorrhoids，hematochezia，pruritus of anus，dampness of anus，and pain of anus），classification of hemorrhoids，pathologically detected chronic inflammation and thrombosis.Multivariate Logistic regression analysis was performed to analyze the influencing factors of hemorrhoidal hemorrhage.Results　380 patients were finally included，including 302 （79.5%） in tissue hemorrhage group and 78 （20.5%） in non-tissue hemorrhage group.Tissue hemorrhage group showed greater average age and higher prevalence of hypertension，and lower prevalence of anal pain compared with non-tissue hemorrhage group （P<0.05）.The prevalence of non-chronic inflammation was 44.0%（133/302） and 66.7%（52/78） in tissue hemorrhage and non-tissue hemorrhage groups，respectively.The prevalence of chronic inflammation in tissue hemorrhage group was 56.0%（169/302），which was higher than that 〔33.3%（26/78）〕 of non-tissue hemorrhage group（χ2=12.704，P<0.001）.The prevalence of thrombus in tissue hemorrhage group 〔6.3%（19/302）〕 was lower than that〔23.1%（18/78）〕 in non-tissue hemorrhage group（χ2=19.873，P<0.001）.Multivariate Logistic regression analysis showed that hypertension〔OR=3.053，95%CI（1.162，8.020）〕，chronic inflammation〔OR=2.449，95%CI（1.407，4.266）〕，and thrombus〔OR=0.207，95%CI（0.091，0.470）〕 were associated with hemorrhoidal hemorrhage of HD （P<0.05）.Conclusion　Tissue hemorrhage is one of the major pathological changes of hemorrhoids，which is caused by damage to hemorrhoid tissue，and the initial cause may be damage of anal cushion.Age，hypertension，chronic inflammation and thrombus are the influencing factors of tissue hemorrhage of HD.Age and hypertension history may be used as the supplemental basis of surgical decision-making for hemorrhoids patients.

Prevalence and Associated Factors of Sleeping in the Same Room with the Guardian in Primary School Students　

LI Shuangyan，LIN Yanmei，LIN Lianhong，XIE Likai，ZHANG Bin*

2020, 23(33): 4196-4202. DOI: 10.12114/j.issn.1007-9572.2020.00.433

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Background　Room sharing may affect sleep quality and cause a series of sleep disorders in children.Objective　To explore the prevalence and associated factors of sleeping in the same room with the guardian in primary school students，Guangzhou.Methods　Eligible participants were 2 462 students who were recruited from three key primary schools（including a provincial level，a municipal level and a district level）randomly extracted from the list of registered primary schools of Guangzhou in 2014.The revised Structural Sleep Questionnaire was used to survey the sleep status of these students in the past year，which includes five parts：basic information，family information，parental information，sleep problems and whether usually sleep alone in a room.The questionnaire was distributed to the students，and was completed by the students with their parents at home and was returned within one week.According to the survey results，they were divided into non-cosleeping group and cosleeping group.Results　Altogether，2 345（95.2%）cases〔consisting of 1 218 males and 1 127 females with an average age of（9.5±1.7）years old〕 effectively responded to the survey，including 1 217（51.9%）co-sleepers and 1 128（48.1%）non-co-sleepers.The differences in average age，prevalence of one-year regular medication，single-parent family，sleeping environment，living area and average monthly family income between two groups reached significant level（P<0.05）.The prevalence of sleeping in the same room with the guardian among children aged 7-14 years decreased over years（χ2trend=30.91，P<0.01）.The average maternal age and paternal age of the non-cosleeping group were older than those of the cosleeping group（P<0.05）.The prevalence of maternal difficulties in getting up in the morning had significant intergroup difference（P<0.05）.The intergroup differences in paternal education level，prevalence of paternal dry mouth in the morning，sleep terror，difficulty in getting up in the morning，frequent sweating，drowsiness in daytime，sleeping difficulty，early morning headache，and non-refreshing sleep were significant（P<0.05）.The prevalence of snoring，sleep terror，difficulty in getting up in the morning，frequent sweating，frequent rolling over in sleep，drowsiness in daytime，special prone sleeping position，grinding teeth during sleep，bed-wetting and sleep talking differed significantly between the groups（P<0.05）.Multivariate Logistic regression analysis revealed that age〔OR=0.713，95%CI（0.659，0.772）〕，single-parent family〔OR=1.348，95%CI（1.098，1.655）〕，snoring〔OR=1.115，95%CI（1.020，1.219）〕，living area〔OR=0.908，95%CI（0.826，0.997）〕 were associated with sleeping in the same room with the guardian（P<0.05）.Conclusion　Sleeping in the same room with the guardian is relatively common（51.9%）in primary school students，Guangzhou，which is associated with younger age，single-parent family，snoring，and small living area.

Diagnostic Value of Semi-quantitative Analysis of Microscopic Images of Masson's Trichrome-stained Histological Sections in Renal Interstitial Fibrosis　

WANG Wentao，LI Yan，HUANG Ting，ZHANG Yali

2020, 23(33): 4202-4208. DOI: 10.12114/j.issn.1007-9572.2020.00.394

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Background　Renal interstitial fibrosis（RIF） is a common pathway and the main pathological basis for the development of chronic kidney disease to end-stage renal disease.It is an important factor affecting the prognosis of patients with kidney disease.Early diagnosis and timely treatment are helpful to improve the prognosis.In recent years，many studies have found that RIF can be evaluated by cytokine and other biochemical indices，and ultrasound elastography and other non-invasive tests.However，due to cumbersome operation and high cost，such detections are difficult to be used widely in clinical practice.At present，RIF is manly diagnosed by pathological examination of percutaneous renal biopsy specimens using Masson's trichrome staining or other special staining techniques.But routine pathological diagnosis is made based on the pathologist's electronic microscopic observation of renal interstitial change，which may has subjective error，while diagnosis made using computer aided technology may be an automatic and objective analysis.So we performed a semi-quantitative analysis of microscopic images of the Masson's Trichrome-stained histological sections of RIF.Objective　To assess the diagnostic value of Image-Pro Plus 6.0 in RIF based on this software measured integrated optical density as well as calculated mean optical density （MOD） of Masson's Trichrome-stained histological sections of RIF.Methods　During January to September 2016，from Department of Nephrology，First Affiliated Hospital of Xi'an Jiaotong University，149 cases diagnosed with chronic interstitial nephritis （CIN） and chronic glomerular diseases（RIF group） were enrolled，and by the results of pathological examination of renal biopsy specimens，they were divided into CIN subgroup（including those with a diagnosis of tubulointerstitial nephritis with or without mesangial proliferative glomerulonephritis，n=26） and chronic glomerular disease （CGD） subgroup〔n=123，consisting of IgA nephropathy（n=79）（IgAN Ⅱ-Ⅴby LEE's glomerular grading with 3，35，25，16，respectively）；including IgAN with different degrees of chronic glomerulonephritis hardening（n=44），that is，focal or proliferative sclerosing glomerulonephritis（n=31），or sclerosing glomerulonephritis（n=10），and chronic glomerulonephritis（n=3）〕．They were compared with 27 cases of stageⅠ-Ⅱmembranous nephropathy without RIF confirmed by the same pathological examination in our hospital.Correlations of MOD with clinical indicators 〔serum urea nitrogen （BUN），serum creatinine （Scr），cystatin C，hemoglobin （Hb），and serum and urine β2 microglobulin（β2-MG）〕 were analyzed.ROC analysis of MOD in the diagnosis of RIF was performed，with the optimal cutoff value，sensitivity and specificity were determined.Results　In RIF group，MOD was positively correlated with Scr，serum and urine β2-MG，and was negatively correlated with Hb （P<0.05）.In CGD subgroup，MOD was positively correlated with cystatin C，serum and urine β2-MG，and negatively correlated with Hb （P<0.05）.In the diagnosis of RIF，the AUC of MOD was 0.982〔95%CI（0.961，1.000）〕 when the optimal cutoff value was determined as 0.012 3，with 0.886 sensitivity and 0.963 specificity in RIF group.In CIN subgroup，its AUC was 0.991〔95%CI（0.975，1.000）〕when the optimal cutoff value was determined as 0.011 8，with 1.000 sensitivity and 0.926 specificity.And in CGD subgroup，its AUC was 0.980〔95%CI（0.958，1.000）〕when the optimal cutoff value was determined as 0.008 0，with 0.992 sensitivity and 0.852 specificity.Conclusion　MOD may reflect the degree of RIF，and the estimated optimal cut-off value of diagnosis may be to be 0.012 3.Moreover，it showed high sensitivity and specificity in diagnosing different types of RIF.

Autologous Arteriovenous Fistula Aneurysm Hyaline Degeneration Is the Main Pathological Basis of Vascular Dilation and Recurrence after Partial Aneurysmectomy　

LI Hong，BAI Yafei，AN Na，XU Mingzhi，CHEN Ruman，LI Xinnian

2020, 23(33): 4209-4213. DOI: 10.12114/j.issn.1007-9572.2020.00.504

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Background　By 2019，there have been 600 000 patients with maintenance hemodialysis （MHD） registered in China，and more than 80% of them had autologous arteriovenous fistula （AVF）.As aterial-venouse fistula aneurysm （AVFA） is one of the most common complications of AVF，the study of AVFAs is helpful for its prevention and control.Objective　To track the AVFAs recurrence in AVF patients and to explore its association with AVFAs histopathology based on studying the histology of the diseased blood vessels removed during partial aneurysmectomy of AVFAs，to formulate corresponding feasible prevention and control measures.Methods　A total of 13 cases of complex AVFAs were reconstructed with partial aneurysmectomy from April 2016 to October 2019 in Hainan Genenral Hospital.The resected vascular tissue 〔with a size of （5-10） mm×（5-10） mm〕 was used for pathological analysis.The changes of the AVFAs were followed up.Results　The surgeries were successful for all 13 patients.During the follow-up of 3-39 〔average （22.4±11.9）〕 months，seven were found with AVFAs relapse within 3-6 months after surgery，but 12 had a patent fistula.Pathology results:vascular endothelial cells were significantly reduced or absent；fibroblasts and collagen tissue of the vascular intima and media showed proliferation and were disordered，the inner and outer elastic layers were incomplete or absent，and few reticular and elastic fibers were present；and few or no smooth muscle cells were present.The aneurysm wall showed large-scale hyaline degeneration in all 13 patients，which has never been reported before.In particular，the whole section of the vascular wall was involved in 10 patients，with scattered mucoid degeneration and focal calcification mixed or alone.AVFAs recurred during follow-up in 6 patients with hyaline degeneration involving the entire cross section of the resected blood vessel.Conclusion　Partial aneurysmectomy for AVFAs is effective at preventing vascular rupture and preserving vascular resources.Diverse degeneration patterns，including severe hyaline degeneration，mucoid degeneration，and focal calcification of intraoperative use of AVF vessels，especially continued cannulation in the reconstructed area，may easily induce AVFAs to relapse.Buttonhole cannulation may reduce the incidence of AVFAs and reccurence ratio after partial aneurysmectomy.Early local compression of the aneurysm can delay the development of AVFAs and reduce the need for invasive surgery.Larger-scale studies of AVFAs histology，comparison studies of the effects of different AVF cannulation methods on the incidence of AVFAs，and studies on the profile of AVFAs disease-related genes are needed.

Short-term Curative and Plasma Angiogenic Responses to Fuhe Beihua Decoction with Transcatheter Arterial Chemoembolization in Primary Liver Cancer Patients with Liver Depression and Spleen Deficiency Syndrome　

JIANG Ruiyuan，WANG Tongbiao，MAN Tingting，QIN Yanchun，HONG Xiaohua，RONG Zhen，MO Chunmei

2020, 23(33): 4214-4221. DOI: 10.12114/j.issn.1007-9572.2020.00.489

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Background　Although transcatheter arterial chemoembolization（TACE）is the preferred local treatment for inoperable intermediate and advanced primary liver cancer at present，there are many problems which demands prompt solution after TACE.To improve the treatment benefits from TACE，TCM treatment may be used as an appropriate adjuvant therapy.Objective　To investigate the short-term curative and plasma angiogenic responses to Fuhe Beihua Decoction with TACE in primary liver cancer patients with liver depression and spleen deficiency syndrome.Methods　From January to June 2018，90 primary liver cancer patients with liver depression and spleen deficiency syndrome were selected from Oncology Department and Liver Disease Department，the First Affiliated Hospital of Guangxi University of Chinese Medicine，and were equally divided into control group and treatment group by random number table method.Both groups underwent TACE at the distal portion of the subsegmental hepatic artery plus routine symptomatic and supportive therapies.The treatment group additionally received Fuhe Beihua Decoction for 12 consecutive weeks（started on the completion day of TACE）.Short-term（12 weeks after treatment）curative response，progression-free survival（PFS），pre- and post-treatment serum alpha-fetoprotein（AFP）level，Karnofsky（KPS）score，TCM syndrome score，plasma angiogenesis factors〔including vascular endothelial growth factor（VEGF），basic fibroblast growth factor（bFGF），platelet-derived growth factor（PDGF）〕were compared between the two groups.Toxic and side effects and/or complications occurred in both groups were also compared.Patients in the two groups were followed up by telephone after TACE until to the occurrence of progress of disease or the end of course of treatment（12 weeks）.Results　All the patients completed the whole course of treatment and follow-up with complete data.The overall response rate and disease control rate were not significantly different between the two groups（P>0.05）.At average of （207.5±28.4）d of follow-up，Kaplan-Meier analysis revealed that PFS differed significantly between the groups（P<0.05）.Compared to control group，post-treatment serum AFP level，score of abdominal pain and distention，inappetence，depression，nausea and vomiting，fatigue，bitter mouth and dry throat，TCM syndrome score，as well as plasma levels of VEGF，bFGF and PDGF were significantly lowered in treatment group，but KPS score increased（P<0.05）.The incidence of toxic and side effects and/or complications was not significantly different between the groups（P>0.05）.Conclusion　In primary liver cancer patients with liver depression and spleen deficiency syndrome，Fuhe Beihua Decoction combined with TACE may improve prolong the PFS to some extent，relieve the clinical symptoms，improve the tumor vascular microenvironment，and reduce the levels of serum tumor markers and plasma angiogenic factors，which is helpful to improve the patients' quality of life with relatively high safety.

Therapeutic Effect of Pressing Shenmen-associated Acupoints with Seeds in Stage 1 Essential Hypertension Patients with Liver-yang Hyperactivity Syndrome　

GONG Yuhong，GE Lingyu，CHEN Run，CAI Yisheng，JIN Lisha，ZHANG Zhe

2020, 23(33): 4222-4226. DOI: 10.12114/j.issn.1007-9572.2020.00.490

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Background　Our research group sorted out the core components of pressing Shenmen-associated acupoints with seeds for essential hypertension through literature review and complex system entropy clustering method in 2018，but its curative effect was not satisfactory in some clinically treated patients.After adjusting the time of pressing acupoints，the curative effect has revealed.Objective　To analyze the therapeutic effect of pressing Shenmen-associated acupoints with seeds in stage 1 essential hypertension patients with liver-yang hyperactivity syndrome.Methods　Participants were 150 patients with stage 1 essential hypertension with liver-yang hyperactivity syndrome who were treated in Shanghai Jiading District Nanxiang Community Health Center during May to August 2019.They were equally divided into control group，regular pressing group，and irregular pressing group according to random number table method.All groups continued to use the originally prescribed Western medicine therapy，but regular and irregular pressing groups were additionally treated with pressing Shenmen-associated acupoints with seeds regularly and irregularly，respectively.Efficacies of the three regimens were evaluated at the end of a consecutive 3-month treatment by comparing pre- and post-treatment SBP，DBP and TCM syndrome score，and safety of the regimens was evaluated by incidence of adverse reactions or discomfort during treatment.Results　All the participants were included in the final analysis since no one dropped out or was excluded.The control group showed lower treatment response than the other two groups，however regular pressing group had higher treatment response than irregular pressing group（P<0.05）.The average post-treatment SBP and DBP in control group were significantly higher than those in the other two groups（P<0.05）.Regular and irregular pressing groups had no significant differences in average post-treatment SBP and DBP（P>0.05）.The average post-treatment TCM syndrome score in control group was significantly higher than that in the other groups，respectively（P<0.05）.The average post-treatment TCM syndrome score in regular pressing group was significantly lower than that in irregular pressing group（P<0.05）.No adverse reactions or discomfort occurred in all groups during treatment.Conclusion　Routine Western medicine therapy plus pressing Shenmen-associated acupoints with seeds is highly safe，which can achieve obvious efficacies such as good antihypertensive effect and symptom relief.Furthermore，regular pressing may achieve better symptom relief than irregular pressing.

TCM Syndrome-based External Treatment of Otitis Media Effusion in Children Using Sun's Sequential Therapy　

CHEN Qifeng，SUN Shuchen，LIU Rui，LU Ye

2020, 23(33): 4227-4235. DOI: 10.12114/j.issn.1007-9572.2020.00.498

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Background　Otitis media with effusion（OME） is a kind of self-limited disease commonly found in children，which often occurs with adenoid hypertrophy，and may manifest as hearing loss，ear pain，nasal congestion，and runny nose.External use of Sun's sequential therapy （SST） is a TCM treatment including fumigating nose during preparing the decoction，and dropping nose using the distilled vapor of the decoction after cooling，which can avoid the trouble caused by oral administration of the decoction to children，contributing to good compliance in them.However，there are no studies on the efficacy of TCM syndrome-based external use of SST in OME children with different symptoms and adenoid hypertrophy.Objective　To explore the therapeutic effect of TCM syndrome-based external use of SST in OME children with different symptoms and different levels of adenoid hypertrophy.Methods　From September 2018 to December 2019，45 eligible children （64 ears） with a chief complaint of nasal or ear discomfort were selected from ENT Clinic，Guang'anmen Hospital，China Academy of Chinese Medical Sciences.The symptoms of the children at the first visit were collected，including hearing loss，earache，nasal congestion，runny nose，and so on，and all received TCM syndrome-based external treatment using SST.The overall response rates at the end of the 2nd and 16th weeks of treatment were evaluated by the number of ears with improvement in hearing loss and earache，and were evaluated by the prevalence of improvement in nasal congestion，runny nose，adenoid hypertrophy （diagnosed by nasal endoscopy），and TCM syndrome.The overall and complete response rates of affected ears at the end of the 2nd，4th，6th，8th，10th，12th，14th and 16th weeks of treatment were recorded.Results　The symptom distribution in the 45 children at the first visit：43（95.6%） with nasal congestion，35（77.8%） with runny nose，25（55.6%） with hearing loss，and 14（31.1%） with earache.Among the 64 ears，there were 38 ears with hearing loss and 26 ears without；21 ears with earache and 43 ears.There were 2 without nasal congestion，4 with mild nasal congestion，28 with moderate nasal congestion，and 11 with severe nasal congestion.35 had runny nose and 10 did not.39 had adenoid hypertrophy （including 32 diagnosed by nasal endoscopy）：4 with grade 2，15 with grade 3，and 13 with grade 4.20 had a syndrome of pathogenic wind attacking the superficies，and 25 had pathogenic toxin retention.The overall response rates were 46.9%（30/64）and 93.8%（60/64）at the end of the 2nd and 16th weeks of treatment，respectively.The overall response rate of affected ears with hearing loss and earache was lower than those without at the end of the 2nd week of treatment （P<0.05），whereas the intergroup difference became insignificant at the end of the 16th week of treatment （P>0.05）.The overall response rate did not differ significantly by the prevalence of nasal congestion，runny nose and adenoid hypertrophy at the end of the 2nd and 16th weeks of treatment （P>0.05）.Those with pathogenic wind attacking the superficies showed higher overall response rate than those with pathogenic toxin retention at the end of the 2nd week of treatment （P<0.05），but the intergroup difference became insignificant at the end of the 16th week of treatment （P>0.05）.The overall response rate of affected ears increased with the prolongation of treatment time（χ2trend=5.307，P<0.05），so did the complete response rate（χ2trend=6.583，P<0.05）.Conclusion　External treatment of OME in children using TCM syndrome-based SST has been proved to have a good therapeutic effect.Its short-term efficacy may be even more significant in those without hearing loss and earache or those with a syndrome of pathogenic wind attacking the superficies.On the whole，the therapeutic effect of this therapy may increase with time，so the long-term efficacy may also be good.So this therapy is worthy of clinical use.

Applying the Wagner Chronic Care Model in Diabetes Management：Australian Experience and Implications to China　

OUYANG Ling，LI Baoqi，YANG Hui

2020, 23(33): 4236-4240. DOI: 10.12114/j.issn.1007-9572.2020.00.443

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It is a critical component of the development of the modern health care system to efficiently manage chronic diseases.The Wagner Chronic Care Model（CCM）widely used internationally provides a strong theoretical basis and practical framework for guiding chronic disease services.Australia has developed a more mature and effective management of chronic diseases under its universal health insurance system（Medicare），while China's chronic disease management is still at a stage of continuous exploration and innovation.We analysed the specific connotation of the six elements of Wagner CCM used in diabetes management.Then，based on the relevant experience of Australia using the model in diabetes management，we put forward practical suggestions to improve and promote the quality and results of diabetes management in China aiming at domestic current situation（including problems） of chronic disease management represented by diabetes.

Dynamic Pain Assessment in Pain Management of Hemiplegic Shoulder Pain among Stroke Patients　

WU Kangshun，YU Weihua，GE Qian，XU Kecai

2020, 23(33): 4241-4246. DOI: 10.12114/j.issn.1007-9572.2020.00.448

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Background　As one of the most common complications of stroke，hemiplegic shoulder pain is easily ignored due to being hidden by hemiplegic symptoms.Related studies are mainly about the modulation and adaptation of hemiplegic shoulder pain，but rarely involve the functional motion in such patients.Objective　To evaluate the application effects of dynamic pain assessment for hemiplegic shoulder pain among stroke patients.Methods　76 stroke patients with hemiplegic shoulder pain were selected from rehabilitation department of Hefei First People's Hospital and Hefei Binhu Hospital from June 2018 to September 2019，and were randomized into the intervention group and control group with 38 cases in each.The control group received guidance on pain relief and rehabilitation exercise with range of motion dependent on the pain severity measured using the VAS in resting state at 7:00 and 16:00 o'clock every day.The intervention group received the same guidance on pain relief，and the same pain severity measurement by the VAS，but during which they also underwent Bobath handshake，and received rehabilitation exercise with range of motion dependent on the Functional Activity Score（FAS）.At group admission and discharge，the pain severity was measured by the VAS and Brief Pain Inventory（BPI），and shoulder passive range of motion （PROM） was evaluated in both groups.Results　There were no significant differences in the average pre-intervention VAS score between the two groups （P>0.05）.After the intervention，although the average VAS score decreased significantly in both groups（P<0.05），there was still no significant intergroup difference（P>0.05）.Before the intervention，the average scores of general activity，mood，walking ability，normal work，relations with other people，sleep，and enjoyment of life were similar between the two groups （P> 0.05），but after the intervention，they decreased more significantly in the intervention group（P<0.05） except the average sleep score was still similar in both groups （P>0.05）.Before intervention，the forward flexion，abduction，outward rotation，inward rotation，and backward extension of PROM were similar in both groups （P>0.05），but they improved more significantly in the intervention group after the intervention （P<0.05）.Conclusion　Dynamic pain assessment may effectively promote the pain management level in hemiplegic shoulder pain.

Prevalence and Associated Factors of Depression and Anxiety in Elderly Patients with Mild Cognitive Impairment in Community：a Cross-sectional Study MA

Jia，ZHANG Shaowei，LIU Wenbin，CHEN Shen，YU Dehua，QIAN Jie，LI Chunbo，LU Yuan

2020, 23(33): 4246-4251. DOI: 10.12114/j.issn.1007-9572.2019.00.617

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Background　Mild cognitive impairment(MCI) is a clinical state between normal age-related cognitive decline and dementia.Depression and anxiety are the most common neuropsychiatric symptoms in patients with MCI.They are risk factors for MCI，and for the progression of MCI to dementia.Objective　To investigate the prevalence and associated factors of depression and anxiety in elderly patients with MCI from a community of Yangpu District，Shanghai.Methods　This cross-sectional survey was conducted between April and July，2018.By use of cluster sampling，1 587 elderly people aged 60 years or over were selected from the neighborhood committees of Dinghai Subdistrict，Yangpu District，Shanghai.Among them，those with MCI were screened out using the Montreal Cognitive Assessment-Basic(MoCA-B) and the clinical diagnostic criteria.MCI participants were further assessed by the Geriatric Depression Scale(GDS) and Hamilton Anxiety Rating Scale(HAMA) ．The factors affecting depression and anxiety in patients with MCI were estimated using a stepwise binary Logistic regression model.Results　A total of 342 cases(21.55%) were diagnosed with MCI，and among them，the prevalence of depression and anxiety was 38.9%(133/342) and 34.2%(117/342) ，respectively.Univariate analysis showed that the prevalence of depression differed significantly by age，mean monthly income，income satisfaction，alcohol consumption，sleep quality and MoCA-B score(P<0.05) ．The prevalence of anxiety varied obviously by mean monthly income，income satisfaction，smoking consumption，alcohol consumption，sleep quality and number of chronic illnesses(P<0.05) ．Further stepwise binary Logistic regression analysis revealed that in elderly MCI patients，age，mean monthly income，income satisfaction，alcohol consumption，sleep quality and MoCA-B score were associated with depression(P<0.05) ，and mean monthly income，alcohol consumption and sleep quality were associated with anxiety(P<0.05) ．Conclusion　The prevalence of symptoms of depression and anxiety is high in this group，which is associated with multiple factors.To reduce the prevalence，it is recommended to conduct cohort or intervention studies to further explore the risk factor management for MCI.

A Study on the Relationship between Diabetes Mellitus and Cognitive Impairment Based on Comprehensive Health Assessment of the Elderly　

CAO Ying，WANG Yijun，HE Qingyue，YU Guo，LYU Lixia，GAO Ming，XU Xiaohui

2020, 23(33): 4252-4255. DOI: 10.12114/j.issn.1007-9572.2020.00.122

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Background　There are no available treatments targeting cognitive dysfunction in elderly patients with diabetes.And no effective treatments have been found to reverse the development of dementia.Therefore，actively identifying risk factors for dementia，and preventing and control its development is an effective way to improve the passive diagnosis and treatment of dementia.Objective　To explore the correlation between diabetes and cognitive dysfunction in elderly inpatients.Methods　Elderly inpatients with an experience of completing comprehensive health assessment from Department of Geriatrics，Chengdu First People's Hospital were enrolled during September 2017 to February 2019.A survey using Mini-Mental State Examination（MMSE），Clinical Dementia Rating （ CDR ） Scale，and Activities of Daily Living Scale （ADL） was conducted to collect prevalence of cognitive impairment and dementia，and level of independent living skills，respectively.According to the diagnostic criteria of type 2 diabetes，the patients were divided into normal group and diabetic group.Binary Logistic regression analysis was used to explore the correlation of diabetes and cognitive impairment in elderly inpatients.Results　A total of 610 questionnaires were distributed and 606 valid questionnaires were recovered, with an effective recovery rate of 99.3%.Of the 606 cases enrolled，428 were found without diabetes，including 180 men（42.1%），and 248 women（57.9%），with an average age of （71.4±7.6） years，other 178 with diabetes，including 82 men（46.1%），and 96 women（53.9%），with an average age of （72.3±6.4） years.There were significant differences in mean scores of MMSE，CDR，ADL，as well as cognition between the two groups （P<0.05）.The results of binary Logistic regression analysis showed that there was a correlation between diabetes and cognitive dysfunction（P<0.05）．Conclusion　There is a close relationship between diabetes mellitus and cognitive dysfunction.We should pay close attention to the common risk and influencing factors of the two in clinical practice，and also to the screening of cognitive function in elderly diabetic patients to find out cognitive dysfunction in time and deliver effective intervention.

PET/CT Diagnosis of Vasculitis：Three Cases and Literature Review　

REN Qijie，GU Bingjie，WANG Xiaoqin，CHEN Xingguo，SU Dinglei，YUAN Hai，YANG Leilei，SHEN Minning

2020, 23(33): 4256-4258. DOI: 10.12114/j.issn.1007-9572.2020.00.101

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Large-vessel vasculitis is a chronic inflammatory disease involving the aorta and its main branches.Its clinical manifestations are atypical and lack of specific laboratory indicators，which often leads to missed diagnosis and misdiagnosis.In recent years，PET/CT has been widely used in the diagnosis of large-vessel vasculitis，greatly improving the diagnostic efficiency.This paper summarizes three cases of large-vessel vasculitis diagnosed by 18F-FDG PET/CT in Nanjing First Hospital，and analyzed the role of 18F-FDG PET/CT in the diagnosis and monitoring of large-vessel vasculitis combined with the relevant literature at home and abroad.

Sporadic Creutzfeldt-Jakob Disease：Report of 3 Misdiagnosed Cases and Literature Review　

WANG Qian，XIAO Xinguang，GU Meilan，REN Cuiping

2020, 23(33): 4259-4263. DOI: 10.12114/j.issn.1007-9572.2020.00.384

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Creutzfeldt-Jakob disease（CJD） is a rare neurodegenerative disease caused by mutated prion protein（PrP），often presenting with a subacute or chronic onset，and rapid progressive dementia as the major clinical symptom.The disease is infectious and always fatal.Due to lack of specific initial symptoms，CJD is easily misdiagnosed as other neurological diseases.We reported 3 CJD patients with different clinical manifestations who were misdiagnosed as other diseases at admission，with a summary of their clinical，MRI imaging，EEG，and cerebrospinal fluid characteristics，and conducted a literature review，with a view to improving clinicians' understanding of the disease，thereby reducing the possibilities of misdiagnosis.

Addison's Disease with Refractory Hyponatremia as the First Manifestation：Report of One Case and Diagnostic Procedure Analysis　

RUAN Hang，WU Yanfei，ZHENG Yulan

2020, 23(33): 4264-4266. DOI: 10.12114/j.issn.1007-9572.2020.00.444

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Addison's disease is a disorder in which the adrenal glands fail to produce the required amount of adrenaline due to hypofunction.Patients with Addison's disease may present an enormous variety of clinical symptoms due to different degrees of adrenal hormone deficiency，bringing challenges to clinical diagnosis.We reported a case of Addison's disease with refractory hyponatremia as the first manifestation，in which the procedure leading to the final diagnosis was analyzed in detail，providing a reference for clinical correct diagnosis of the disease.

Recent Advances in Male Type 2 Diabetics with Erectile Dysfunction　

NIE Li，LI Yanhua，LI Junwei

2020, 23(33): 4267-4273. DOI: 10.12114/j.issn.1007-9572.2020.00.499

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Erectile dysfunction is a microvascular complication of type 2 diabetes，a common chronic disease with global prevalence，but is often neglected.Erectile dysfunction prevalence is increasing，which seriously affects life quality，marital stability and family harmony of the patients.We reviewed the epidemiology，risk factors，pathogenesis，and treatment of erectile dysfunction in type 2 diabetics，aiming to improve the public awareness of this disease，and enhance the life quality of these patients by providing them with theoretical treatment guidance.

Recent Progress in Ultrasonic Diagnosis of Muscle and Tendon Injuries Caused by Various Causes　

CAO Dongming

2020, 23(33): 4274-4278. DOI: 10.12114/j.issn.1007-9572.2020.00.491

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CT，MRI and ultrasonography are common clinical diagnostic imaging techniques，which can be used for the diagnosis of musculoskeletal diseases.Among them，CT and MRI have certain advantages in the diagnosis of muscle and tendon and other soft tissue diseases，but their clinical application is limited due to external factors such as hospital equipment，the operator's professional level and patients' economic conditions.Moreover，indications for the two examinations are also strictly specified.Ultrasonography，by contrast，can be used to diagnose lesions involving muscle，tendon and soft tissues，and joint and other skeletal system diseases，as well as the superficial soft tissue injury，and even the pathological changes of deep muscle.Furthermore，ultrasonography may has more advantages in clinical application because of a wider range of use，easy and quick to operate，and dynamic observation of conditions of muscle and tendon injury in real time during the whole process or at each stage of injury and convalescence.Ultrasonography use in musculoskeletal diseases has been gradually expanded by recent rapid advances in related imaging technologies，such as the emergence of contrast-enhanced ultrasound and interventional ultrasound.This study reviews recent clinical application of ultrasonography in the diagnosis and treatment of muscle and tendon injury caused by various reasons，aiming to provide reference data for the summary of relevant clinical-stage development.

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