Table of Content

15 February 2021, Volume 24 Issue 5

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Monographic Research

Interpretation of Newly Released 2020 Expert Consensus Decision Pathway on Novel Therapies for Cardiovascular Risk Reduction in Patients with Type 2 Diabetes by American College of Cardiology：Not Only Lowering Glucose，But Also Conferring Cardiovascular Benefits　

SU Gong，GAO Mingxi，YANG Hongxia

2021, 24(5):  509-516.  DOI: 10.12114/j.issn.1007-9572.2021.00.111

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Cardiovascular disease remains a leading cause of morbidity and mortality in patients with type 2 diabetes（T2DM）.So the development of treatment strategies to improve cardiovascular outcomes in patients with T2DM remains a major priority.Many sodium-glucose cotransporter 2（SGLT-2）inhibitors and glucagon-like peptide 1 receptor agonists（GLP-1RA）have recently been widely demonstrated to significantly reduce the risk of major adverse cardiovascular events in T2DM patients.Recently，an expert consensus decision pathway on novel therapies for cardiovascular risk reduction in T2DM patients with atherosclerotic cardiovascular disease with data from emerging studies was released by American College of Cardiology.We interpreted this consensus document with a focus on the strategies of using SGLT-2 inhibitors and GLP-1RA，to provide simple and practical guidance for clinicians to optimize clinical strategies when using novel hypoglycemic drugs，achieving the goal of improving the prognosis of T2DM patients.


Is Autokinetic Physical Activity a “Neuroprotectant” for Neurodegenerative Diseases：Evidence from Clinical and Preclinical Studies　

ZHAO Feiyi，GUO Shengnan，XU Yan，LI Aiqun，SONG Hualing，LI Zhimin，FU Qiangqiang

2021, 24(5):  517-525.  DOI: 10.12114/j.issn.1007-9572.2020.00.612

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Continued acceleration of the aging population highlights the seriousness of neurodegenerative diseases （NDD）.With high morbidity，disability and mortality，this global public health problem is becoming one of the biggest social and economic challenges faced by individuals，families and healthcare systems.No specific treatment and prevention approaches are available for NDD.Increasing studies are trying to seek for potential preventive and management strategies from complementary and alternative medicine，including physical activity.Several clinical and preclinical studies currently support that autokinetic physical activity may be a potential 'neuroprotectant' for NDD and other age-related cognitive disorders，although there is a lack of comprehensive review of these evidence.Hence，this article reviews as well as evaluates a large amount of high-quality evidence，and finds regular autokinetic physical activity has shown critical potentials in slowing cognitive decline during normal and pathological aging，and this beneficial effect may be a multi-signaling pathway and interaction of exercise-induced inhibition of systemic- and neuro- inflammation，enhancement of neuroplasticity and neurogenesis，mitigation of oxidative stress damage，repair of endothelial injury and improvement of insulin sensitivity.


Novel Advances in Heart Failure with Mid-range Ejection Fraction　

SHI Fang'e，ZHU Jihong

2021, 24(5):  526-532.  DOI: 10.12114/j.issn.1007-9572.2021.00.005

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Heart failure is the final stage of the development of heart disease.Previous studies classified heart failure into two types based on left ventricular ejection fraction：heart failure with preserved ejection fraction（HFpEF）and heart failure with reduced ejection fraction（HFrEF）.But according to the 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure，heart failure is categorized into HFpEF，HFrEF and heart failure with mid-range ejection fraction（HFmrEF）based on the LVEF.The comparison of epidemiology，clinical characteristics，pathophysiology，treatment and prognosis among the patients with HFrEF，HFmrEF and HFpEF suggests that HFmrEF may be an intermediate phenotype between HFrEF and HFpEF.There are still many diagnosis and treatment strategies for HFmrEF that need to be further explored，such as finding active anti-myocardial ischemia therapies and examining the protective value of ambulatory monitoring of ejection fraction for cardiomyocytes，clinical value of screening for cardiovascular and non-cardiovascular comorbidities in understanding the pathophysiological characteristics of HFmrEF，the diagnostic value of cardiac MRI for pathophysiological changes of HFmrEF，and values of cFGF23 and NPY levels in risk and clinical outcome prediction of HFmrEF.The exploration and research of more relevant information will contribute to improving clinicians' understanding of the pathogenesis and characteristics of HFmrEF to develop effective diagnosis and treatment strategies.


Recent Advances in the Diagnostic Value of New Biochemical Markers of Sepsis-induced Myocardial Injury　

CHEN Fachao，XU Yinchuan，ZHANG Zhaocai

2021, 24(5):  533-538.  DOI: 10.12114/j.issn.1007-9572.2020.00.566

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Sepsis-induced myocardial damage（SIMD）can lead to poor prognosis and high mortality，so early identification and active treatment are essential. As traditional biomarkers such as cardiac troponin and brain natriuretic peptide are not specific for SIMD，we reviewed the advances in biomarkers for this disease，with detailed summary of the history，release mechanism and diagnostic value of several novel biomarkers〔miRNAs，heart-type fatty acid binding protein（H-FABP），pregnancy-associated plasma protein A（PAPP-A），histone，high mobility group protein-1（HMGB-1），soluble triggering receptor expressed on myeloid cell-1（sTREM-1），and neutrophil gelatinase-associated lipocalin（NGAL）〕in SIMD，and found that miRNAs may be a good predictor as well as an improvement parameter for SIMD，and H-FABP，PAPPA，histone，HMGB-1，sTREM-1 and NGAL may be predictors for SIMD，but the combination of multiple biomarkers may have higher predictive value. In view of the fact that patient enrolment using the sepsis 1.0 or 2.0 diagnostic criteria in majority of SIMD-related clinical studies，and there are few studies using the current sepsis 3.0 criteria，in the era of sepsis 3.0，the value of above-mentioned biomarkers for SIMD diagnosis may be challenged，and the power of multi-biomarkers to predict SIMD also needs to be re-evaluated using new clinical evaluation methods.


Recent Advances in Clinical Application of Panax Notoginseng Saponins in Cardiovascular Diseases　

LU Shuli, FENG Yan, GAO Jie, JIN Xianggong, WANG Yixin, CHEN Keji

2021, 24(5):  539-545.  DOI: 10.12114/j.issn.1007-9572.2020.00.623

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Panax notoginseng is a traditional Chinese medicine that has a significant effect on cardiovascular diseases for its effect of promoting blood circulation and removing blood stasis. With the development of techniques for extracting herb drugs， improved purity of Panax notoginseng extract greatly improves its efficacy. In this paper， we reviewed recent literature concerning Panax notoginseng extract 〔 with Panax notoginseng saponins（ PNS） as the main component〕 in the treatment of cardiovascular diseases （ coronary heart disease， hypertension， heart failure， arrhythmia） ， and analyzed and summarized the mechanism of action， clinical effect and possible adverse reactions of PNS， and concluded that PNS and its active ingredients
have definite curative effects on cardiovascular diseases. Moreover， PNS may produce a variety of pharmacodynamic effects on
coronary heart disease， hypertension， heart failure， arrhythmia or coexisting cardiovascular diseases， thereby reducing the
economic and mental pressures and improving quality of life of the patients.

Role of Induced Sputum and Fractional Exhaled Nitric Oxide Test for Assessing Inflammation in Patients with Bronchiectasis　

WANG Xiaosheng，KANG Xiaoling，ZHANG Ying，SUN Baohua

2021, 24(5):  546-550.  DOI: 10.12114/j.issn.1007-9572.2020.00.587

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Background　Bronchiectasis is a common chronic airway inflammatory disease，but varies significantly across individuals.Induced sputum and fractional exhaled nitric oxide（FeNO）have been widely used in the assessment of asthma and chronic obstructive pulmonary disease，but little is known about whether they could be used for evaluating airway inflammation in bronchiectasis.Objective　To evaluate the associations of induced sputum and FeNO with the clinical characteristics and lung function parameters in patients with bronchiectasis，to explore the value of noninvasive airway inflammation tests in stable bronchiectasis.Methods　We enrolled 62 patients with stable bronchiectasis who were treated in Cangzhou Central Hospital from January 2017 to December 2018.Data were collected，including clinical characteristics（gender，age，BMI，smoking history，course of bronchiectasis，number of exacerbations per year，sputum volume，history of hemoptysis，cause of bronchiectasis，colonization of Pseudomonas aeruginosa），results of high-resolution CT（HRCT）of the chest，lung function test parameters（FEV1%pred，FVC%pred，FEV1/FVC ratio，increase in FEV1 after using the bronchodilator），induced sputum test parameters（IL-8，IL-6 and IL-13）and sputum cell classification，and FeNO.Pearson correlation analysis was used to explore the associations of some induced sputum test parameters with FeNO and lung function test parameters.Results　Patients with bronchiectasis can be divided into neutrophilic type （32 cases），eosinophilic type （10 cases）， mixed granulocytic type （6 cases）and paucigranulocytic type（14 cases）according to the cytological classification of induced sputum.The levels of IL-8 and IL-6 in neutrophilic type were higher compared with those of eosinophilic and paucigranulocytic types，while the level of IL-13，FeNO，increase in FEV1 after using the bronchodilator were lower than those of eosinophilic and mixed granulocytic types（P<0.05）.The neutrophilic type had more severe bronchiectasis in HRCT（P<0.05）.The eosinophilic type had lower levels of IL-8 and IL-6 than mixed granulocytic type，greater level of IL-13 and FeNO than paucigranulocytic type，and more increase of FEV1 after using the bronchodilator than mixed granulocytic and paucigranulocytic types（P<0.05）.The increase in FEV1 after using the bronchodilator，levels of IL-8，IL-6，IL-13，and FeNO of mixed granulocytic type were higher than those of paucigranulocytic type（P<0.05）.The level of sputum IL-8 was positively correlated with the score of HRCT（r=0.625）and the percentage of neutrophils（r=0.711），and was negatively correlated with FEV1%pred（r=-0.327），FVC%pred（r=-0.401），FEV1/FVC ratio（r=-0.398），increase in FEV1 after using the bronchodilator（r=-0.312，P<0.05）.IL-6 was positively correlated with the score of HRCT（r=0.342）and the percentage of neutrophils（r=0.221，P<0.05）.The level of IL-13 was correlated with the increase in FEV1 after using the bronchodilator（r=0.439），the percentage of eosinophils（r=0.536），and FeNO（r=0.526，P<0.05）.The percentage of neutrophils was positively correlated with the score of HRCT（r=0.548），and negatively correlated with FEV1%pred（r=-0.372），FVC%pred（r=-0.345），FEV1/FVC ratio（r=-0.253），increase in FEV1 after using the bronchodilator（r=-0.346），the percentage of eosinophils（r=-0.553，P<0.05）.The percentage of eosinophils was positively correlated with the increase in FEV1 after using the bronchodilator（r=0.522）and FeNO（r=0.576，P<0.05）.FeNO was correlated with the increase in FEV1 after using the bronchodilator（r=0.423，P<0.05）.Conclusion　The induced sputum cell classification，IL-8，IL-6，IL-13 levels and FeNO were related with the clinical indicators of patients with bronchiectasis，which may be helpful for the comprehensive evaluation of bronchiectasis.


Clinical Value of Fractional Exhaled Nitric Oxide and Lung Function by Tidal Breathing in Children with Bronchiolitis　

ZHANG Shengxin，YUAN Lin，ZHUO Zhiqiang，LI Mingzhen，TONG Xiubin

2021, 24(5):  551-554.  DOI: 10.12114/j.issn.1007-9572.2020.00.429

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Background　Bronchiolitis is a common lower respiratory disease in children，which may develop into asthma with a relatively high probability when it is poorly controlled.So detecting fractional exhaled nitric oxide（FeNO）and lung function by tidal breathing is of great significance in diagnosing，treating，and evaluating prognosis of bronchiolitis in children.Objective　To explore the clinical value of FeNO and tidal breathing lung function in children with bronchiolitis.Methods　A case control study was conducted in Xiamen Children's Hospital during January 2018 to September 2018 among a random sample of 45 children，including 38 with first diagnosed bronchiolitis（observation group）from Ward 3，and 17 healthy examinees（control group）from the Pediatric Healthcare Department.FeNO and lung function by tidal breathing were tested in the observation group during both acute and convalescent phases of bronchiolitis（before treatment，and before hospital discharge after one or two weeks of standardized treatment）and in the control group，with parameters of FeNO，tidal volume（VT），respiratory rate（RR），inspiratory-to-expiratory time ratio（Ti/Te），ratio of time to reach peak tidal expiratory flow to total expiratory time（TPTEF/TE），and ratio of volume to peak expiratory flow to total expiratory volume（VPEF/VE）were recorded and their interphase and intergroup differences were analyzed.Results　In the observation group，there was no significant difference in the average FeNO level between acute and convalescent phases （P>0.05）.The ratio of TPTEF/TE and ratio of VPEF/VE increased and RR decreased in the convalescent phase compared with the acute phase（P<0.05）.The average FeNO level in the observation group during the acute or convalescent phase was similar to that of the control group（P>0.05）.Compared with the control group，the observation group showed lower average VT，ratio of Ti/Te，ratio of TPTEF/TE，and ratio of VPEF/VE，and higher RR in the acute phase of bronchiolitis（P<0.05）.In the convalescent phase，the observation group still showed lower ratio of TPEF/TE and ratio of VPEF/VE，and higher RR than the control group（P<0.05）.Conclusion　Lung function by tidal breathing may reflect the progression of disease and clinical treatment efficacy，which has certain application value.The FeNO level showed insignificant differences between the acute and convalescent phases of bronchiolitis，and between the suffered children and the healthy children，so the application value of FeNO is limited.


Value of Intra-abdominal Pressure Measurement in Mechanically Ventilated Children with Severe Pneumonia　

WANG Xiaodong，LUO Jiaxin，HUO Ximin，CAO Lijing，XU Meixian，GENG Wenjin，GUO Yanmei，LI Jun'e

2021, 24(5):  555-560.  DOI: 10.12114/j.issn.1007-9572.2021.00.054

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Background　Severe pneumonia in children，which is often accompanied by organ damage，needing mechanical ventilation.Therefore，early and effective intra-abdominal pressure（IAP） monitoring is the key to rescuing children with critical respiratory illness，but there are few reports.Objective　To evaluate the role of IAP under different types of respiratory support in the rescue and prognostic prediction of severe pneumonia in children，providing reliable evidence for organ protection in treating this disease.Methods　150 children with severe pneumonia who were admitted to the ICU，Hebei Children's Hospital from December 2015 to April 2018 were enrolled.Clinical data were collected，including demographic factors（gender，age and so on），blood test parameters 〔procalcitonin（PCT），C-reactive protein（CRP），oxygen saturation（SaO2），arterial partial pressure of oxygen（PaO2），arterial partial pressure of carbon dioxide（PaCO2）〕，symptomatic treatment，and type of respiratory support 〔nasal cannula oxygen therapy（group A，n=50），continuous positive airway pressure（CPAP）（group B，n=50）and mechanical ventilation（group C，n=50）〕，and IAP measured at 24 and 72 hours after admission.Subgroup comparisons of ventilator parameters〔positive end expiratory pressure，peak inspiratory pressure（PIP），fraction of inspired oxygen（FiO2）〕 and incidence of MODS and ACS were performed between those with 72 hours post-admission increased IAP（n=32）and normal IAP（n=18）in group C 〔increased and normal IAP were defined as >10 mm Hg（1 mm Hg=0.133 kPa）and ≤10 mm Hg，respectively〕.Results　Group B had a younger average age than other groups（P<0.05）.Group C had higher average levels of admission CRP，PCT and PaCO2 and lower average levels of admission SaO2 and PaO2 than other groups（P<0.05）.There was no significant difference in average IAP levels among the three groups on admission（P>0.05）.There were significant differences in average IAP levels between the three groups at 24 and 72 hours of respiratory support（P<0.05）.In particular，group C had higher average IAP level at 24 or 72 hours of respiratory support than other groups（P<0.05）.There were significant differences in average IAP levels between groups B and C at different time points（P<0.05）.The average IAP levels in group C measured at admission，24 and 72 hours of respiratory support showed a successive increase trend（P<0.05）.In group C，those with 72 hours post-admission increased IAP had higher average PIP and FiO2 and higher incidence of MODS than those with normal IAP（P<0.05）.Conclusion　IAP may be influenced by the level of airway pressure caused by the three types of respiratory support.PIP and FiO2 under mechanical ventilation may have a significant impact on IAP，which suggests that these two parameters should be lowered as soon as possible in clinical treatment to reduce iatrogenic damage.Dynamic monitoring of IAP in children with pneumonia has a predictive value for the evolution of disease and the degree of organ damage in severely ill children.


Diaphragmatic Mobility Function and Its Correlation with Pulmonary Function in Patients with COPD　

FU Xuming，WANG Jihong，PAN Dianzhu

2021, 24(5):  561-565.  DOI: 10.12114/j.issn.1007-9572.2020.00.329

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Background　Systemic skeletal muscular（including diaphragm）dystrophy and atrophy，are common in chronic obstructive pulmonary disease（COPD）patients.Diaphragmatic fatigue is one of the important pathophysiological bases for disease progression in these patients.But the application of ultrasound combined with pulmonary function in the evaluation of diaphragm function is rarely reported.Objective　To perform a disease severity-based analysis of diaphragm mobility and its correlation with pulmonary function in COPD patients.Methods　From Ansteel Group Hospital during March 2018 to January 2019，81 COPD patients（consisting of mild，moderate and severe patients evaluated by the GOLD criteria），and 30 healthy controls undergoing examination in Pulmonary Function Examination Room were selected.Pulmonary function test was used to examine lung function related parameters.Ultrasound was carried out to measure the diaphragm mobility during quiet breathing at functional residual capacity（FRC）and during forced breathing at total lung capacity（TLC），respectively.The mMRC Dyspnoea Scale was used to assess the status of dyspnea.The height，weight，body mass index (BMI)，mMRC dyspnoea score，FEV1%pred，FVC%pred，FEV1/FVC，FRC，TLC，TLC-FRC，and inspiratory breath were recorded IC%pred，MVV%pred，RV/TLC%pred were compared.Pearson correlation analysis was used to explore the correlation between diaphragmatic mobility and research variables. Multiple linear regression analysis was used to explore the influencing factors of diaphragm mobility.Results　COPD patients had greater average height，weight，and mMRC dyspnoea score，but lower average FEV1%pred，FVC%pred and FEV1/FVC compared with the controls（P<0.05）.The diaphragm mobility in quiet breathing phase，forced breathing phase，and the difference of diaphragm mobility from FRC to TLC were significantly different among mild，moderate and severe COPD patients and controls（P<0.05）.Severe patients had greater average diaphragm mobility at FRC and lower average diaphragm mobility at TLC and difference of diaphragm mobility from FRC to TLC than mild and moderate patients and controls（P<0.05）.Moderate patients showed greater average diaphragm mobility at FRC and lower average diaphragm mobility at TLC and difference of diaphragm mobility from FRC to TLC compared with mild patients and controls（P<0.05）.Mild patients demonstrated lower average difference of diaphragm mobility from FRC to TLC compared with controls（P<0.05）.In COPD group，diaphragm mobility was positively correlated with BMI（r=0.501，P<0.001），FEV1%pred（r=0.697，P<0.001），FVC%pred（r=0.639，P<0.001），FEV1/FVC（r=0.564，P<0.001），IC%pred（r=0.438，P<0.001），MVV%pred（r=0.578，P<0.001），and negatively correlated with mMRC（r=-0.615，P<0.001）and  RV/TLC%pred（r=-0.350，P<0.001）.Multiple linear regression analysis showed that FEV1% pred〔β=0.728，95% CI（0.027，0.042），P=0.001〕was the influencing factor of diaphragm mobility.Conclusion　Diaphragm mobility in COPD patients can be assessed by ultrasound.The degree of diaphragm mobility is related to the level of pulmonary function.


Correlations of Auditory Function with OSAHS Severity and Triacylglycerol in Patients with Moderate to Severe OSAHS　

LI Li，ZHANG Hao，SHAN Yamin

2021, 24(5):  566-570.  DOI: 10.12114/j.issn.1007-9572.2020.00.201

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Background　Obstructive sleep apnea-hypopnea syndrome（OSAHS）-related pathological changes can lead to dysfunction of the inner ear and auditory system.However，it is not clear whether hyperlipidemia plays a role in this process.Objective　To investigate the correlations of auditory function with OSAHS severity and plasma triacylglycerol（TG）and the possible causes in moderate to severe OSAHS patients.Methods　50 inpatients with moderate to severe OSAHS（consisting of 25 normal and 25 elevated morning fasting plasma TG individuals）were recruited from Department of Otolaryngology，Ruijin Hospital，Shanghai Jiao Tong University School of Medicine from January 2017 to May 2019，and were compared with 20 healthy controls.Pure tone audiometry（PTA）and distortion-product otoacoustic emission（DPOAE）were measured in all participants and hearing threshold and signal-to-noise ratio（SNR）at different frequencies were recorded.Characteristics of auditory function and whether elevated TG was associated with the aggravation of hearing loss in OSAHS patients were analyzed.Pearson correlation analysis was used to explore the correlations of hearing threshold and SNR at different frequencies with characteristics of OSAHS patients.Results　Compared with the controls，OSAHS patients with normal TG had higher average hearing threshold of PTA at 2.00 kHz，4.00 kHz，and 8.00 kHz and overall average hearing threshold but lower average SNR of DPOAE at 4.00 kHz（P<0.05）.The mean SNR of DPOAE at 1.00 kHz，2.00 kHz and 8.00 kHz in OSAHS patients with elevated TG was lower than that of those with normal TG（P<0.05）.The hearing threshold of PTA at 0.50 kHz（r=0.227），1.00 kHz（r=0.362），2.00 kHz（r=0.328），4.00 kHz（r=0.403），and 8.00 kHz（r=0.463），and average hearing threshold（r=0.500）were positively correlated with age.The hearing threshold of 1.00 kHz（r=0.333），2.00 kHz（r=0.372），4.00 kHz（r=0.464），and 8.00 kHz（r=0.330），and average hearing threshold（r=0.399）were positively correlated with AHI.The hearing threshold of 2.00 kHz（r=-0.314）was negatively correlated with the lowest SaO2.The hearing threshold of 1.00 kHz（r=0.378），and 2.00 kHz（r=0.444）was positively correlated with TG.The SNR of DPOAE of 2.00 kHz（r=-0.221），4.00 kHz（r=-0.432）and 8.00 kHz（r=-0.441）was negatively correlated with age，meanwhile the SNR of 4.00 kHz（r=-0.545）and 8.00 kHz（r=-0.241）was negative correlated with AHI.The SNR of 1.00 kHz（r=-0.507）and 2.00 kHz（r=-0.385）was negatively correlated with TG（P<0.05）.Conclusion　Moderate to severe OSAHS patients have different degrees of hearing loss.Moreover，the hearing loss may be aggravated by elevated blood lipids.The severity of OSAHS increased with the aggravation of hearing loss.Moreover，increased age，AHI and TG were associated with aggravated hearing loss in OSAHS.


Application Effect of Invasive to Noninvasive Mechanical Ventilation Step-down Therapy Strategy in Ventilator Dependent Patients with Tracheotomy　

GAO Shenghao，LI Lincan，ZHANG Xiaoju，MA Lijun，HUANG Taibo，HU Xingang，WANG Haibo，WANG Kai，CHENG Jianjian

2021, 24(5):  571-576.  DOI: 10.12114/j.issn.1007-9572.2020.00.511

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Background　As a common complication of clinical mechanical ventilation patients，difficulty weaning could seriously affect patients' prognosis and quality of life. Although corresponding measures have been taken clinically，the weaning strategy for patients with dysfunctional ventilatory weaning response（DVWR）is still unknown.Objective　To explore the application effect of invasive to noninvasive mechanical ventilation step-down therapy strategy in ventilator dependent patients with tracheotomy.Methods　From November 2017 to August 2018，60 patients in the Respiratory Intensive Care Unit，Henan Provincial People's Hospital were selected. All of them received a step-down therapy：the noninvasive positive pressure ventilator was linked with the split humidifier，single breathing tube，the P-V platform valve，the extension tube and the endotracheal tube，and a leaky single breathing loop was formed for conducting invasive-to-noninvasive ventilation. Two patients withdrew for personal reasons. The heart rate，respiratory rate，systolic blood pressure（SBP），diastolic blood pressure（DBP），finger pulse oxygen saturation（SpO2），pH，arterial carbon dioxide partial pressure（PaCO2），arterial oxygen partial pressure（PaO2），bicarbonate ion（HCO3-），base excess（BE），and sputum viscosity 1 hour prior to the step-down therapy and 2，and 24 hours posterior to the therapy were recorded and compared. Post-therapy RICU and outcome were collected and analyzed.Results　Heart rate and respiratory rate increased significantly after 2 hours of the step-down therapy（P<0.05）. Heart rate decreased more significantly after 24 hours of the therapy（P<0.05）. PaCO2 increased significantly after 2 hours of the therapy（P<0.05）. PaO2 showed a significant decrease after 2 hours of the therapy，but demonstrated a more significant increase after 24 hours of the therapy（P<0.05）. The sputum viscosity showed no significant changes during the period of pre- and post-therapy（χ2trend=2.36，P=0.670）. The average post-therapy RICU stay was（15.6±4.3）days. All patients received a 24-week follow-up，during which 28（48.2%）had successful weaning with tracheal extubation and closure of tracheotomy incision，15（25.9%）weaning from MV and switched to warmed humidified oxygen inhalation through the tracheotomy incision，12（20.7%）switched to noninvasive positive pressure ventilation and transferred to the general ward，rehabilitation hospital or home，and 3（5.2%）died in the RICU due to infection. 4 out of the 28 extubated patients（14.3%）underwent tracheotomy again due to sputum problems. 2 out of 15（13.3%）weaning patients from MV with retained oxygen therapy delivered through a tracheostomy were retreated with noninvasive ventilation. By the end of follow-up，no obvious discomfort and intolerance occurred .Conclusion　The invasive to noninvasive mechanical ventilation step-down therapy strategy can improve the successful rates of ventilation withdrawal and the quality of life of DVWR patients with tracheotomy，and can be used as a safe alternative to invasive mechanical ventilation.


Effect of Glucocorticoids on Changes of Automatic Nerve Function in Children with Kawasaki Disease and Intravenous Immunoglobulin Resistance　

FU Qiang，HUANG Huali，LI Aimin

2021, 24(5):  577-580.  DOI: 10.12114/j.issn.1007-9572.2020.00.435

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Background　Children with acute kawasaki disease（KD） have reduced parasympathetic nerve function，and mainly treated with aspirin and intravenous immunoglobulin（IVIG） currently.Glucocorticoids are required for ineffective treatment in the early stage，but the conventional view is that glucocorticoids could change the excitability of vagus nerve and promote blood coagulation，increasing the risk of coronary artery tumor formation.Therefore，early application is not recommended.For children with early signs of IVIG resistance，if glucocorticoids are not applied，the disease may be further aggravated.However，there is no report about the relationship between glucocorticoids and the changes of automatic nerve function in KD children at present.Objective　To analyze the effect of glucocorticoids on changes of autonomic nerve function in children with KD and IVIG resistance.Methods　We selected 40 KD children in the Department of Pediatrics of Jingzhou Central Hospital from January 1 in 2017 to June 30 in 2019.According to the presence and absence of the coronary artery lesion（CAL），patients were divided into CAL group（n=14） and non-CAL group（n=26）.Fifteen healthy children admitted to the hospital for physical examination during the same period were selected as the control group.The changes in heart rate variability（HRV） of 24-hour ambulatory electrocardiogram in three groups were observed，including the standard deviation of normal-to-normal intervals（SDNN），standard deviation of the averages of normal-to-normal intervals in 5-minute segments（SDANN），the percentage of successive NN intervals>50 ms（pNN50） and the root-mean square of successive R-R differences as time-domain analysis（RMSSD）.We also assessed the HRV changes of 24-hour dynamic electrocardiogram in KD children with IVIG resistance before and after methylprednisolone treatment when their body temperature stabilized for 48 hours.Results　There was no significant difference in SDANN among three groups（P>0.05）.There were significant differences in SDNN，pNN50，and RMSSD among three groups（P<0.05）.The SDNN，pNN50，and RMSSD in CAL group and non-CAL group were lower than those in the control group，and CAL group had the lowest SDNN，pNN50，and RMSSD（P<0.05）.There were six cases of KD patients with IVIG resistance，all of whom were combined with CAL.There was no significant difference in SDNN，SDANN，pNN50，and RMSSD among KD patients with IVIG resistance before and after the methylprednisolone treatment（P>0.05）.Conclusion　Autonomic dysfunction exists in children with KD in acute phase.Reduced excitability of vagus nerve may be related to coronary artery dilatation.Glucocorticoids have no significant effect on the autonomic nervous function of KD children with IVIG resistance.


Risk Factors Associated with Perinatal Respiratory Complications in Late Preterm Small for Gestational Age Infants　

YUAN Erwei，GUO Huaxian，XU Jinli，ZHAO Wenhui，ZHAO Meilin，WANG Lingling

2021, 24(5):  581-584，602.  DOI: 10.12114/j.issn.1007-9572.2021.00.070

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Background　The physical development of small-for-gestational-age（SGA） infants is poorer than that of appropriate-for-gestational-age（AGA） infants，and they are prone to complications such as respiratory distress syndrome，pulmonary infection，feeding intolerance，cerebral palsy，growth and development retardation.In particular，late preterm SGA infants are more susceptible to respiratory diseases.However，there are relatively few studies on the risk factors of perinatal respiratory complications in late preterm SGA infants.Objective　To investigate the occurrence and risk factors of perinatal respiratory complications in late preterm SGA infants.Methods　A retrospective analysis was conducted on the clinical data of late preterm infants（n=100）admitted to the First Affiliated Hospital of Hebei North University from January 2015 to January 2017 except large-for-gestational-age infants.They were then divided into SGA infants（n=45）and AGA infants（n=55）based on birth weight and were compared in terms of perinatal respiratory complications incidence.Univariate analysis was used to screen maternal and infant-related factors possibly associated with infant respiratory complications by comparing SGA infants with respiratory complications（n=28）and those without（n=17），and the identified high-risk factors were further analyzed with multivariate Logistic regression.Results　The incidence of perinatal respiratory complications in SGA infants was significantly higher than that of AGA infants（62.2% vs. 41.8%，χ2=4.122，P<0.05）.SGA infants with respiratory complications had higher prevalence of maternal-related factors associated with infant respiratory complications，including pregnancy-induced hypertension，multiple pregnancy，umbilical cord abnormalities，intrauterine distress，late pregnancy fever，premature rupture of membranes，history of asphyxia，and placental abruption，and higher prevalence of neonatal sepsis compared with those（P<0.05）.Multivariate Logistic regression analysis showed that pregnancy-induced hypertension，multiple pregnancy，infection during pregnancy，umbilical cord abnormalities，intrauterine distress，late pregnancy fever，premature rupture of fetal membranes，history of asphyxia，and neonatal sepsis were significantly associated with perinatal respiratory complications in late preterm SGA infants（P<0.05）.Conclusion　 Late preterm SGA infants may have higher incidence of perinatal respiratory complications than late preterm AGA infants，which may be closely associated with maternal pregnancy-induced hypertension，multiple pregnancy，infection during pregnancy，umbilical cord abnormalities，intrauterine distress，late pregnancy fever，premature rupture of membranes，history of asphyxia，and neonatal sepsis.


Distribution of Disc Degeneration and Index Level in Patients with Lumbar Degenerative Diseases Undergoing Operation　

LIU Lei，WU Jianyun，HUANG Weimin，LI Xinbo，YU Xiuchun

2021, 24(5):  585-591.  DOI: 10.12114/j.issn.1007-9572.2020.00.492

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Background　Disc degeneration is the initiating factor for a series of lumbar degenerative diseases.Previous reports mostly have focused on the epidemiologic and imaging characteristics of lumbar disc degeneration.However，the studies investigating lumbar degenerative diseases with refractory lumbocrural pain that necessitate surgical procedures are sparse.The distribution of the degenerative disc is unknown，along with the index segment（operated segment）.Objective　To study the imaging distribution of disc degeneration and characteristics of the index levels in patients with lumbar degenerative diseases undergoing operation.Methods　503 cases of lumbar degenerative diseases who underwent anteroposterior and lateral radiographs，dynamic radiographs，and sagittal MRI in PLA 960 hospital from January 2012 to February 2016 were enrolled.The distribution of lumbar disc degeneration and index segments was analyzed〔including lumbar instability，Modic changes，high intensity zone（HIZ），and Schmorl's nodes（SN）〕.Disc degeneration was evaluated with the Pfirrmann's staging system，with Ⅰ and Ⅱ designating the normal discs，while Ⅲ-Ⅴ indicating degenerative changes（Ⅳ and Ⅴ implying serious degeneration）.Multi-segment（≥2） disc degenerations used a custom W classification.Results　There were 2 515 degenerative discs in 503 patients，demonstrating a degeneration rate of 74.08% （1 863/2 515），and serious degeneration rate was 36.46%（917/2 515）.The degeneration rate of upper lumbar segments was 56.96%（573/1 006，L1-2 and L2-3），with serious disc degeneration accounting for 34.55%（198/573）.In the lower lumbar segments（L3-4，L4-5，L5-S1），the degeneration rate was 85.49%（1 290/1 509），with the serious disc degeneration rate being 55.74%（719/1 290）.Lower lumbar segments were associated with higher disc degeneration rate and serious degeneration rate（P<0.05）.Female patients of ≥40 years had higher disc degeneration rate（P<0.05）.Female cases ≥40 years showed more instability（P<0.05），but demonstrated no significantly different Modic change，HIZ and SN incidence compared with male cases（P>0.05）.Male patients of <40 years had slightly higher instability than female patients of the same age group（P>0.05），but demonstrated significantly different Modic change，HIZ and SN incidence（P<0.05）.The differences in the incidence of Modic changes and HIZ in males <40 years and ≥40 years were significant（P<0.05）.The differences in the incidence of lumbar spine instability，HIZ and SN in females <40 years and ≥40 years were significant（P<0.05）.There was significant difference in distribution of lumbar instability，Modic changes，SN and HIZ in different degenerated segments（P<0.01）.There were 381 cases of single-segment undergoing operation，102 cases of two-gap，14 cases of three-gap，4 of four-gap，and 2 of five-gap.The degeneration rate of the intervertebral disc in the index level was 99.01%（498/503），and the rate of severe degeneration was 62.82%（316/503）.Conclusion　Lumbar degenerative diseases necessitating surgical interventions had a higher disc degeneration rate，with a female predominance.The degeneration rate increased in lower segments.Female patients were prone to have lumbar instability and Modic changes，whereas showing less serious disc degeneration.The age of 40 years is the watershed for the occurrence of Modic changes and HIZ in male cases，similarly in female patients for lumbar instability，HIZ，and SN.There were disc degeneration in most index segments，representing higher serious degeneration rates.


Comparative Analysis of Postoperative Complications between Age-related Cataract in Patients with and without Diabetes　

CHEN Xuehong，WU Zidong

2021, 24(5):  592-596.  DOI: 10.12114/j.issn.1007-9572.2021.00.084

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Background　The advent of an aging society is seeing an increased incidence rate of age-related cataract（ARC） in China.Cataract is a common complication of diabetes mellitus.In particular，ARC is often found in diabetics clinically，with manifestations similar to those of ARC in non-diabetics except earlier onset and rapider progress.Most diabetic and non-diabetic cases of ARC without surgery contraindications could be treated with cataract extraction despite of causes，but postoperative outcomes may be different.Objective　To investigate the incidence of postoperative complications in diabetic and non-diabetic cases of ARC，to find out possible targeted preventive and therapeutic interventions.Methods　A retrospective design was conducted.Clinical data of 182 cases of ARC（189 eyes） treated with surgery were collected from the Second Affiliated Hospital of Hainan Medical University from January to December 2017，including 51 diabetics（53 eyes） and 131 non-diabetics（136 eyes）.Postoperative complications at 1 week（corneal edema，fibrous exudation，pupil posterior synechia，anterior chamber hemorrhage，macular edema），postoperative visual acuity recovery at 1 week，1 month and 3 months，and prognosis were compared between the two groups.Results　The incidence of 7-day postoperative complications in diabetics 〔56.9% （29/51）〕was higher than that in non-diabetics 〔18.3% （24/131）〕 （P<0.05）.There was no significant difference in corrected visual acuity between the two groups at 1 week，1 month and 3 months after operation（P>0.05）.One month after operation，3 diabetic cases（4 eyes，7.55%，4/53） had poor wound healing，while no non-diabetics occurred.The 30-day postoperative outcome was significantly different between the two groups（P<0.05）.Conclusion　Diabetics with ARC may be more prone to postoperative complications，which should be paid more attention to.To obtain better prognosis for such patients，active measures should be taken to reasonably control blood glucose before operation and choose reasonable operation time to reduce postoperative complications as much as possible.


A Study on the Correlation between pH Changes before and after Hemodialysis and the Death of Maintenance Hemodialysis Patients　

E Jing，KONG Ranran，XIE Liyi，YU Xiaoyang，FENG Jie

2021, 24(5):  597-602.  DOI: 10.12114/j.issn.1007-9572.2021.00.078

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Background　The mortality of maintenance hemodialysis（MHD） patients is significantly higher than that of the general population.Acid-base balance disorder is one of the important factors causing protein energy consumption，inflammation，endocrine disorders and abnormal bone metabolism.Better control and maintenance of acid-base balance in the body is helpful for the survival rate of patients.Current research focuses more on the bicarbonate level before hemodialysis，however，there are relatively few studies on other indicators that affect acid-base balance，such as changes in blood pH before and after dialysis，and its impact on the clinical prognosis of MHD patients.Objective　To investigate the relationship between the blood pH difference between postdialysis and predialysis and the all-cause death and cardiovascular death in MHD patients.Methods　A total of 162 patients with stable MHD who underwent hemodialysis at the Hemodialysis Center of the People's Hospital of Ningxia Hui Autonomous Region from March 2014 to June 2014 were selected as the research subjects.General data of the patients were collected，including gender，age，dialysis age，follow-up time，serum albumin，hemoglobin，fasting blood glucose，high sensitivity C-reactive protein（hs-CRP），blood calcium，blood phosphorus，full parathyroid glands，B-type brain natriuretic peptide，creatinine，urea nitrogen，uric acid，urea clearance index（spKt/V），total cholesterol，triacylglycerol，low density lipoprotein，high density lipoprotein，serum iron，total iron binding capacity，ferritin，systolic blood pressure，diastolic blood pressure，pH before and after dialysis，CO2 before and after dialysis，HCO3- before and after dialysis.According to the median of ΔpH，patients were divided into ΔpH<0.099 5 group and ΔpH≥0.099 5 group.The patients were followed up for a long time，once per 3 months.The end of the follow-up event was the death of the patient （including all-cause death and cardiovascular disease death）.The deadline for follow-up was May 2019.Analyze the relationship between the pH difference of patients and all-cause deaths and deaths from cardiovascular diseases.Results　In the end，142 patients were enrolled，including 39 all-cause deaths and 26 cardiovascular deaths.Compared with patients in ΔpH<0.099 5 group，patients had a higher serum phosphorus，creatinine，urea nitrogen，uric acid，spKt/V and postdialysis pH in ΔpH≥0.099 5 group，but predialysis pH，postdialysis CO2 and predialysis HCO3-，all-cause mortality and cardiovascular mortality were lower.COX regression analysis showed that high sensitive CRP〔HR=3.736，95%CI（1.699，8.213），P=0.001〕，predialysis diastolic pressure〔HR=0.372，95%CI（1.699，0.760），P=0.007〕，and ΔpH〔HR=0.496，95%CI（0.252，0.974），P=0.042〕are independent risk factors for all-cause mortality.Morover，high sensitive CRP〔HR=2.464，95%CI（1.063，5.711），P=0.035〕 and ΔpH〔HR=0.412，95%CI（0.178，0.955），P=0.039〕 are independent risk factors for death from cardiovascular disease in MHD patients.Kaplan-Meier survival analysis showed all-cause deaths and deaths from cardiovascular diseases in the ΔpH≥0.099 5 group were lower than those in the ΔpH<0.099 5 group （P<0.05）.Conclusion　Patients with MHD patients with larger ΔpH have a lower risk of all-cause death and cardiovascular disease death，and more adequate correction of blood pH may help improve the survival rate of MHD patients.


The Prevalence of Cerebral Palsy in Children Aged 0-6 Years in China：a Meta-analysis　

FENG Yuxia, PANG Wei, LI Xin, YANG Shunbo, LIU Shiyu, LU Shuqing

2021, 24(5):  603-607.  DOI: 10.12114/j.issn.1007-9572.2021.00.072

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Background As one of the main causes of children's disability， cerebral palsy（ hereinafter referred to as CP） affects the improvement of our population quality.At present， the results of researches on the prevalence of children suffering from CP inour country are quite different， and there is a lack of epidemiological studies based on larger sample sizes and the current prevalence of CP.Objective To learn about the prevalence of CP in children aged 0-6 in China.Methods Literatures on the prevalence of CP in children aged 0-6 in China were retrievaled through computer in PubMed， Web of Science， The Cochrane Library， China National Knowledge Infrastructure（ CNKI） ， Wanfang Data Knowledge Service System， VIP Database（ VIP） ， and China Biology Medicine disc（ CBM） ， and the publication date limited from January 1st to January 1st， 2020.Based on established inclusion criteria， literatures were screened.Meta-analysis was performed on the included literatures with Stata 12.0 software， the prevalence was quantitatively combined， and subgroup analysis was carried out on classification indicators， such as gender and age.Results This study finally included 8 papers of medium or above quality，with a total of 527 758 people， including 1 022 CP children.The results of Meta-analysis proved that the overall prevalence of CP among children aged 0 to 6 in China was 0.23%〔 95%CI（ 0.17%， 0.29%）〕 .The subgroup analysis results revealed that the prevalence of boys was 0.22%〔 95%CI（ 0.14%， 0.29%） 〕 ， the prevalence of girls was 0.12%〔 95%CI（ 0.06%， 0.19%） 〕 . The prevalence of CP among children at the ages of below one years， one years， two years， three years， four years， five years， and six years was 0.21%〔 95%CI （ 0.02%， 0.40%）〕， 0.20%〔 95%CI （ 0.10%， 0.30%）〕， 0.19%〔 95%CI （ 0.08%， 0.30%）〕，0.21%〔 95%CI（ 0.09%， 0.32%） 〕 ， 0.13%〔 95%CI（ 0.02%， 0.24%） 〕 ， 0.20%〔 95%CI（ 0.09%， 0.32%） 〕 ， 0.32%〔 95%CI （ 0.14%， 0.50%）〕， respectively.Conclusion The prevalence of CP in children aged 0 to 6 in China was 0.23%， and the prevalence of gender and age was different， guiding significance for policy formulation and clinical intervention.It is recommended to conduct more cross-sectional investigations based on the new classification of CP.

Anxiety and Depression Prevalence in Chinese Patients with Gastroesophageal Reflux Disease：a Meta-analysis　

ZHOU Jinchi, DOU Weijia, WEI Yan, ZHAO Shuguang, HAN Wei, CHENG Hao, LIU Zhenxiong

2021, 24(5):  608-613.  DOI: 10.12114/j.issn.1007-9572.2021.00.080

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Development，Reliability and Validity of Chinese Medical Students' Doctor-patient Communication Skills Scale Evaluated by Inpatients　

LIU Jianghua，LI Jiaoyang，FENG Tiantian，WEN Lan，TANG Yan，SU Ling，CHEN Guodong

2021, 24(5):  614-618.  DOI: 10.12114/j.issn.1007-9572.2021.00.076

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Background　At present，domestic studies about Chinese medical students' doctor-patient communication skills are rare and have many limitations，which are hard to offer medical students an objective and accurate assessment，as well as to provide a feedback in time.Objective　To develop a Chinese medical students' doctor-patient communication skills scale evaluated by inpatients，and to test its reliability as well as validity.Methods　During October to November，2018，448 resident doctors who underwent standardized training and took after-department examination in the First Affiliated Hospital of University of South China were selected through cluster sampling.The beta scale was built through literature review，panel discussion，expert argumentations and preliminary tests，during the simulated process from inpatients' hospitalization to hospital discharge，and inpatients were invited to assess resident doctors' doctor-patient communication skills.Then，items were screened through calculating the critical ratio，correlation coefficient，and Cronbach's α and exploratory factor analysis to develop the formal scale.We also assessed homogeneity reliability，split-half reliability，composite reliability，concurrent validity，construct validity，tested the structure rationality by confirmatory factor analysis of RMSEA，GFI，NFI，CFI，and RFI.Results　395 out of 448 samples were valid（176 were collected in October and the rest 219 in November）.Through item selections and exploratory factory analysis，the formal scale concluded 6 dimensions（communication attitude，understanding of diseases，disease informing，communication effectiveness，obtaining medical histories，diagnosis and treatment explanation）and 24 items.Cronbach's α coefficient of the formal scale was 0.863，split-half reliability was 0.716，and composite reliability of the 6 dimensions were within 0.766-0.837，the correlation coefficients between the 6 dimensions and the total scale were within 0.639
-0.791.The results of the confirmatory factor analysis showed：RMSEA was 0.050，GFI was 0.837，NFI was 0.872，CFI was 0.835，and RFI was 0.819.Conclusion　The inpatient-evaluation scale of Chinese medical students' doctor-patient communication skills has been proved to be reliable and valid and is worthy of popularization and application.


Reliability，Validity and Applicability of the Chinese Version of the Psychological Need Satisfaction in Exercise Scale for the Elderly　

LIU Lei，LIU Huaping，GUO Hong，SUN Zhe，ZHONG Lili，LI Xiaoxue

2021, 24(5):  619-624.  DOI: 10.12114/j.issn.1007-9572.2020.00.459

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Background　As an important variable in the framework of self-determination theory，the measurement of basic psychological needs in excise helps to understand the satisfaction of three needs for autonomy，competence and relatedness，influences and the formation of self-determination motivation，it can also provide a basis for exercise intervention.However，there is no scale to measure the psychological needs in exercise of the elderly in China.Objective　To chinesize the Psychological Need Satisfaction in Exercise Scale（PNSE），and evaluate its reliability and validity and applicability in Chinese older adults receiving nursing home care，to provide an effective psychological need assessment instrument for nursing home residents.Methods　We chinesized the PNSE to form a Chinese version of PNSE，and tested its reliability and validity in a convenience sample of 800 older adults from 102 nursing homes in Shenyang from February 4 to March 6，2017.Then we conducted two rounds of surveys among the participants，one for evaluating the contents and item analysis and exploratory factor analysis of the scale using a self-developed Demographic Data Questionnaire and the scale，and another for confirmatory factor analysis and reliability analysis of the scale，with response rates achieved as high as 88.50%（389 out of the 400 completed，and 354 responded effectively），and 88.75%（376 out of the 400 completed，and 355 responded effectively），respectively.Item analysis method was used to testify item relevancy during which the independent-sample t test was used to compare the average scores of high and low score groups（those ranked among the top 27% and bottom 27% in terms of the total scale score） with critical ratio（CR value，that is，t value）> 3.000 as the criterion of item selection.Inter-rater reliability（IR），item-content validity index（I-CVI），scale-content validity index（S-CVI），universal agreement S-CVI（S-CVI/UA），average S-CVI（ S-CVI /Ave）and Kappa value were used to evaluate the content validity of the scale.Bartlett's test of sphericity of χ2 value and KMO value were used to determine whether this scale was suitable for exploratory factor analysis.The maximum likelihood estimation was used for the model adaptation analysis in which the comparative fit index（CFI），standardized root mean square residual（SRMR），and root mean square error of approximation（RMSEA） were estimated.The internal consistency and stability of the scale were estimated by using the Cronbach's α coefficient and retest reliability.Results　The CR value of all items was >3.000.The differences in the average score for each item between the high and low score groups were significant（P<0.05）.The values of parameters for content validity of the scale were：IR=1.00，I-CVI >0.78，Kappa value>0.74，S-CVI/UA=0.89，S-CVI/Ave=0.98，and KMO value=0.93.Principal component analysis revealed that，the factor loading of items ranged from 0.659-0.860，with the communality of 0.479-0.790，with 3 factors of eigenvalue >1，which could explain 73.021% of the total variance.In the confirmatory factor analysis，the factor loading of the 18 items was from 0.60 to 0.88.Bartlett's test of sphericity of χ2 value of the scale was 229.62，the CFI being 0.977，SRMR being 0.03，and the RMESA being 0.05.The Cronbach's α coefficient for the scale was 0.914，and for the subscales of autonomy，competence，and relatedness was 0.916，0.916 and 0.899，respectively.The retest reliability of the scale was 0.883，and that of competence，autonomy and relatedness subscales was 0.876，0.829 and 0.860，respectively.Conclusion　The factor structure and composition of the Chinese version of PNSE conforms to the model of psychological need satisfaction in exercise.Each item of this model is suitable for measuring the potential structure，so it can be used to measure the psychological need in exercise among the nursing home residents in China.


Diagnosis and Treatment Process and Literature Review of a Patient with Variant Angina Pectoris without Coronary Artery Obstruction　

WANG Lida，QI Zhen，ZHU Ning，WANG Jiwen

2021, 24(5):  625-629.  DOI: 10.12114/j.issn.1007-9572.2020.00.508

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Variant angina is not uncommon，but variant angina without coronary artery occlusion is rare.Following the publication of the management guidelines by the European Society Cardiology in 2018，the American Heart Association announced the recommendations for the diagnosis and management of patients with myocardial infarction in the absence of obstructive coronary artery disease in 2019，which reflect that these diseases have attracted more and more attention.Most of the symptoms of patients with variant angina without coronary artery occlusion can be controlled after adding diltiazem and nicorandil，but the treatment for some patients is still very difficult due to unclear cause and pathogenesis of the disease.We reported the diagnostic and therapeutic procedure of a case of severe variant angina with allergic rhinitis without coronary stenosis and slow coronary flow，who was ever diagnosed with cardiac neurosis.Moreover，a literature review was made.The points for attention derived from this study are： Do not make a diagnosis hastily when there is no stenosis in coronary angiography，especially the patient is found to be with right coronal lesion（which is prone to spasm），it is essential to continue to identify clues for a definite diagnosis.And when exploring the causes of coronary artery spasm，allergic constitution and hormone application should be considered.


Lung Cancer with Dizziness as the Initial Symptom：a Case Report and Literature Review　

LI Jiarong，LIAO Yu，LI Jianwei，LIU Feiqi

2021, 24(5):  630-632，636.  DOI: 10.12114/j.issn.1007-9572.2020.00.318

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Dizziness is an undifferentiated disease commonly encountered in outpatient settings，which is difficult to diagnose and treat due to complex and diverse causes.Presently，patients with small-cell lung cancer with dizziness as the initial symptom are very rare.They may be missed if having no typical symptoms of lung caner as specialists may tend to pay attention to dizziness，and neglect important laboratory examinations of abnormalities.In this article，a patient who hospitalized in Department of General Medicine，Xiangtan Central Hospital on September 25，2019 was retrospectively reported.She was diagnosed with lung cancer although dizziness was the chief complaint.The diagnostic and therapeutic process of this case indicates that，if a dizziness patient with laboratory-detected hyponatremia shows poor response to symptomatic treatment，whether he has small-cell lung cancer manifested by syndrome of inappropriate antidiuretic hormone secretion（SIADH） should be carefully considered.It is hoped that this study can provide help for reducing the possibilities of missed diagnosis and misdiagnosis of atypical lung cancer patients，so that they may obtain early diagnosis and treatment，which is beneficial to their prognosis.


Clinical Diagnostic and Therapeutic Perspectives in Primary Care Practice：a Case Study of Mouth Deviation　

HUANG Susu，WANG Jing

2021, 24(5):  633-636.  DOI: 10.12114/j.issn.1007-9572.2020.00.520

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When encountering a case of mouth deviation，we mainly used John Murtagh's safe diagnostic strategy from a general medical perspective，which consists of five clinical questions:（1） What common diseases could cause mouth deviation？（2）What severe disorders must not be overlooked？（3） Could the patient have a concealed illness？（4）What conditions are often missed？（5）Is the patient's family member trying to say something？The case was diagnosed with idiopathic facial paralysis based on detailed consultation，careful physical examination and auxiliary examination.The significance of this diagnostic procedure is：（1）The patient should be transferred to a specialist immediately if he has other neurological symptoms and signs and acute critical condition observed carefully during the consultation.（2）Although facial paralysis is a physical dysfunction，it has a great impact on the patient's emotions.To analyze mouth deviation，and explain the patient's thoughts，worries and expectations，we additionally adopted RICE（Reason-Idea-Concern-Expectation）skills during the consultation，using a patient-centered perspective with empathy，achieving a somatopsychic therapeutic effect.