Chinese General Practice

Individualized and Precision Health Management for Diabetes：Evidence from the Latest Guidelines and Development Prospects in China　

ZENG Zhitong，WANG Zhaoxin，WANG Hui，YU Dehua，HUANG Jiaoling，YU Wenya，ZHOU Liang，LYU Yipeng，JIN Hua，SHI Jianwei

2021, 24(9): 1037-1043. DOI: 10.12114/j.issn.1007-9572.2021.00.158

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The individualized and precision health management level is essentially associated with the preventive and therapeutic results in chronic diseases due to long-term course，complex etiology and multiple complications.Individualized and precision health management for chronic disease has been included in the list of key services of healthcare institutions in developed countries，but in China，there is a lack of sufficient relevant theories，and a complete practice system as well as mature practice skills.Based on the reviewing of the latest guidelines for diabetes，we analyzed the development of individualized and precision health management for diabetes in foreign countries and China，with a view to providing information for promoting its development in China.

Improving the Role of General Practitioners in the Early Diagnosis and Management of Chronic Diseases: a Case Analysis of Chronic Obstructive Pulmonary Disease　

LI Fan，SHENG Chunfeng，WANG Huanying

2021, 24(9): 1044-1050. DOI: 10.12114/j.issn.1007-9572.2020.00.607

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Chronic obstructive pulmonary disease（COPD）is a common and frequently-occurring disease in clinical practice.In China，the number of COPD patients is nearly 100 million，and COPD constitutes another chronic disease with heavy disease burden besides hypertension and diabetes.However，unlike hypertension and diabetes，COPD has not received enough attention from patients，doctors and the government，and its early diagnosis and standardized diagnosis and treatment levels are still relatively low.General practitioners play important roles in the prevention，control and management of COPD，especially in early screening，management of patients in stable phase，as well as pulmonary rehabilitation.And it is imminent to establish a hospital-community-family COPD prevention and control model，conduct the general-specialty care，and develop standardized prevention and control of COPD in primary care.This paper discusses the role of general practitioners in the early diagnosis and management of COPD.

The Influence of Fasting Blood Glucose on Risk of New-onset Upper Gastrointestinal Bleeding：a Prospective Cohort Study　

LI Xingyu，MA Yihan，SHI Xuan，LI Xinran，LIU Yue，YAN Song，ZHANG Yanmin，WU Shouling，ZHANG Chao

2021, 24(9): 1051-1056. DOI: 10.12114/j.issn.1007-9572.2021.00.064

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Background　Upper gastrointestinal bleeding（UGIB）is one of the common and serious clinical diseases，with threatening to life safety and relating to high medical burden；the influence of diabetes on the risk of UGIB has been attracting attention increasingly in recent years，but there is no research about the influence of fasting blood glucose（FBG）on the risk of new-onset UGIB.This study was conducted based on the data of Kailuan Research，which is with relatively fixed queue，large sample size，good follow-up and high reliability.Methods　A total of 100 003 in-service and retired employees of Kailuan Group who received 2006 physical examination were selected based on Kailuan study cohort and divided into normal group（FBG<6.1 mmol/L，n=79 966），pre-diabetes group（6.1 mmol/L≤FBG<7.0 mmol/L，n=7 645）and diabetes group（FBG≥7.0 mmol/L，n=12 392）according to the FBG. Incidence of new-onset UGIB in the three groups was recorded based on annual follow-up with a deadline to December 31，2018；Kaplan-Meier method was used to calculate the cumulative incidence of new-onset UGIB in the three groups and Log-rank test was performed；annual human incidence（incidence density）in the three groups was calculated，and COX proportional hazard regression model analysis and sensitivity analysis were carried out to analyze the influence of FBG on the risk of new-onset UGIB.Results　100 003 cases of physical examination were followed up from 2 days to 15 years，at average of（10.6±1.7）years with a rate of lost to follow-up of 9.96%（9 960/100 003），a total of 942 cases occurred new-onset UGIB with an incidence density of 8.91 per 10 000 person-years，thereinto the number of new-onset UGIB cases in the normal group，pre-diabetic group，and diabetes group were 711，84，and 147，and the incidence density was 8.35，10.45，and 11.67 per 10 000 person-years，respectively. Kaplan-Meier curve showed that cumulative incidence of new-onset UGIB increased with the FBG elevating，and Log-rank test results showed that there is significant difference of cumulative incidence of new-onset UGIB among the three groups（χ2=14.84，P<0.01）. COX proportional hazard regression model analysis results showed that，after adjusting for confounding factors，risk of new-onset UGIB in pre-diabetes group and diabetes group was 1.30 times〔HR=1.30，95%CI（1.02，1.66），P=0.03〕and 1.35 times〔HR=1.35，95%CI（1.09，1.67），P<0.01〕compared with normal group，moreover the results of sensitivity analysis were basically consistent.Conclusion　Cumulative incidence of new-onset UGIB increases with increase of FBG，and FBG≥6.1 mmol/L can increase the risk of new-onset UGIB，moreover pre-diabetes and diabetes are independent risk factors of new-onset UGIB.

Glucose Variability and Osteoporosis in Newly Diagnosed Male Patients with Type 2 Diabetes Mellitus　

HU Jing

2021, 24(9): 1057-1060. DOI: 10.12114/j.issn.1007-9572.2020.00.630

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Background　Diabetic patients have high risk of osteoporosis.There have been many reports on the adverse effects of persistent hyperglycemia on bone mineral density（BMD），but there are few reports on the relationship between glucose variability and osteoporosis.Objective　To explore the relationship between glucose variability and osteoporosis in newly diagnosed male T2DM patients.Methods　115 newly diagnosed male T2DM patients were prospectively selected from Department of Endocrinology，People's Hospital of Ningxia Hui Autonomous Region from January 2018 to January 2019.Clinical data were collected，including calculated BMI，fasting plasma glucose，serum calcium，phosphorus，and lipid profile indicators（total cholesterol，triacylglycerol，high-density lipoprotein and low-density lipoprotein） in the sample collected from the median cubital vein in the early morning after fasting for more than 8 hours，and 2-hour postprandial glucose，fasting insulin，fasting C-peptide（FC-P），2-hour postprandial insulin，2-hour postprandial C-peptide（2 hC-P），homeostasis model assessment-insulin resistance（HOMA-IR），and glycosylated hemoglobin（HbA1c），L1-L4 BMD，glucose variability evaluated based on plasma glucose measured at 7 time points（before and after three meals，and at 2：00），and calculated standard deviation of blood glucose（SDBG），postprandial glucose excursion（PPGE），largest amplitude of glycemic excursion（LAGE），coefficient of variation for fasting plasma glucose（CV-FPG），and mean plasma glucose.The above-mentioned indicators were compared between those who were detected with osteoporosis（n=60） and those without（n=55）.Correlation of glucose variability with BMD was analyzed by Pearson correlation analysis.Results　T2DM patients with osteoporosis were found with higher mean HOMA-IR，HbA1c，SDBG，PPGE，LAGE，CV-FPG and mean plasma glucose，and lower mean high-density lipoprotein，FC-P，2 hC-P and BMD compared to those without（P<0.05）.BMD was negatively correlated with age，SDBG，PPGE，LAGE，2 hPG，low-density lipoprotein，HOMA-IR and HbA1c（r=-0.501，-0.325，-0.436，-0.111，-0.603，-0.506，-0.324，-0.712，P<0.05），and positively correlated with serum calcium and 2 hC-P （r=0.029，0.015，P<0.05）.After adjusting for age and BMI，BMD was positively correlated with 2 hC-P（r=0.008，P<0.05） and negatively correlated with HbA1c，SDBG and LAGE（r=0.519，0.285，0.399，P<0.05）.Conclusion　BMD was positively correlated with 2 hC-P and negatively correlated with HbA1c，SDBG and LAGE，indicating that glucose variability may be closely related to BMD in newly diagnosed male patients with T2DM，and controlling glucose variability may have a positive effect on the prevention and treatment of osteoporosis.

Effect of Interventions According to FreeStyle Libre Flash Glucose Monitoring System-measured Glucose on Glucose Variability in Patients with Type 2 Diabetes Mellitus　

YE Jun，WANG Yunsheng，YE Shuai，ZOU Lingling

2021, 24(9): 1061-1065. DOI: 10.12114/j.issn.1007-9572.2020.00.625

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Background　The latest research shows that glucose variability plays a role in the occurrence and development of type 2 diabetes-related chronic complications through a variety of ways.So in order to treat and prevent diabetes，it is essential to take interventions to effectively control glucose variability according to well monitored glucose changes.Objective　To investigate the effect of interventions according to FreeStyle Libre Flash Glucose Monitoring System-measured glucose on glucose variability in type 2 diabetics.Methods　100 type 2 diabetics were selected from the Second People's Hosptial of Hefei from January 2019 to January 2020，and equally randomized into control group and study group，treated with interventions according to the glucose measured by finger-stick glucose monitoring，and FreeStyle Libre Flash Glucose Monitoring System，respectively.The variation coefficient of fasting plasma glucose （CV-FPG），postprandial glucose excursion（PPGE），largest amplitude of glycemic excursions（LAGE），and mean amplitude of glycemic excursions（MAGE） at the end of the 3rd，6th and 9th days of intervention，and number of hypoglycemia attacks as well as the time of reaching the glycemic control objective during the 9-day intervention of both groups were compared.Results　On the 3rd，6th and 9th days of group-specific intervention，the mean CV-FPG，PPGE，LAGE and MAGE of study group were all lower than those of the control group （P<0.05）.Compared with 3-day group-specific intervention，6-day group-specific intervention lowered CV-FPG，LAGE and MAGE more significantly in the control group（P<0.05），and lowered CV-FPG，LAGE，MAGE and PPGE more significantly in the study group（P<0.05）；9-day group-specific intervention lowered CV-FPG，PPGE，LAGE and MAGE more obviously in both groups（P<0.05）；9-day group-specific intervention lowered CV-FPG，PPGE，and LAGE more notably in the study group than 6-day group-specific intervention （P<0.05）.The study group had less number of hypoglycemia attacks and used less time of reaching the glycemic control objective （P<0.001）.Conclusion　Interventions according to the glucose measured by FreeStyle Libre Flash Glucose Monitoring System may reduce the amplitude of glycemic excursion，shorten the time of reaching the glycemic control objective and reduce the incidence of hypoglycemia，which has certain clinical application value.

Sex-specific Risk Factors for Indicators of Atherosclerosis in Patients with Type 2 Diabetes Mellitus　

LIN Zhen，WANG Qi，ZHOU Yanhui，ZHU Ye，WANG Kangming

2021, 24(9): 1066-1070. DOI: 10.12114/j.issn.1007-9572.2021.00.053

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Background　Atherosclerosis is one of common complications in type 2 diabetes，which can cause serious cardiovascular and cerebrovascular events，leading to increased mortality.The risk factors for atherosclerosis in type 2 diabetics may have sexual differences.Objective　To explore the sex-specific risk factors for indicators of atherosclerosis in patients with type 2 diabetes.Methods　166 outpatients with type 2 diabetes were selected from Department of Endocrinology，and Department of General Medicine，Haikou People's Hospital from March 2017 to March 2018.General data including demographics and cardio ankle vascular index（CAVI）and ankle-brachial index（ABI） and so on were collected.Results　Among the 166 patients，113 were males and 53 were females.In male patients，age，smoking，LDL-C/HDL-C ratio，glycosylated hemoglobin，and C-reactive protein were all positively correlated with CAVI，ABI，or the percentage of exercise-induced ABI decrease（P<0.05）.Systolic blood pressure and fasting blood glucose were all negatively correlated with CAVI，ABI or the percentage of exercise-induced ABI decrease（P<0.05）.In female patients，age，LDL-C/HDL-C ratio，glycosylated hemoglobin，and C-reactive protein were positively correlated with CAVI，ABI，or the percentage of exercise-induced ABI decrease（P<0.05）.Systolic blood pressure and fasting blood glucose were all negatively correlated with CAVI，ABI，or the percentage of exercise-induced ABI decrease（P<0.05）.The results of multiple linear regression analysis showed that in men，age and smoking were the influencing factors of CAVI，ABI，and the percentage of exercise-induced ABI decrease（P<0.05），and fasting blood glucose was the influencing factor of CAVI（P<0.05）.Age，fasting blood glucose，and LDL-C/HDL-C ratio were the influencing factors of CAVI，ABI，and the percentage of exercise-induced ABI decrease in women（P<0.05）.Conclusion　Atherosclerosis may appear to be associated with older age and smoking in type 2 male diabetics，and with older age，LDL-C/HDL-C ratio and elevated fasting blood glucose in type 2 female diabetics.

Chain Mediating Effect of Frailty and Sleep Quality on the Relationship between Family Support and Fall Risk of Rural Elderly People　

ZHENG Fang，CHEN Changxiang，CUI Zhaoyi

2021, 24(9): 1071-1075. DOI: 10.12114/j.issn.1007-9572.2021.00.051

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Background　The risk of falls increases with age-related gradual decline in physical functions，sleep quality and physical responsiveness as well as increase in frailty，which has become a focus of various scholars.Objective　To explore the chain mediating effect of frailty and sleep quality on the relationship between family support and fall risk of rural elderly people.Methods　From August 2019 to April 2020，the rural elderly in 15 villages of Xiaoji Town，Fengnan District，Tangshan City received a household survey with a questionnaire consisting of parts of self-designed demographics，PSS-Fa，Fried frailty index，PSQI and modified FROP-Com.The questionnaires were handed in immediately after being completed by older people with functional independence or by investigators based on the results of interviews with older people without abilities to complete independently.Pearson correlation analysis and mediation model were used to explore the chain mediating effect of frailty and sleep quality on the relationship between family support and fall risk.Results　The survey obtained a response rate of 96.6%（1 498/1 550）.The average scores of PSS-Fa，Fried frailty index，PSQI and modified FROP-Com were （9.0±2.0）（2.2±1.5）（7.1±4.0）（6.5±5.8），respectively.The average scores of PSS-Fa，Fried frailty index，or modified FROP-Com differed significantly by sex，age and education level as well as marital status （P<0.05）.The average scores of PSQI differed significantly by sex，age and education level（P<0.05）.The score of PSS-Fa was negatively correlated with that of Fried frailty index，PSQI or modified FROP-Com （r=-0.197，-0.113，-0.266，P<0.05）.The scores of Fried frailty index was positively correlated with that of PSQI or modified FROP-Com （r=0.284，0.577，P<0.05）.PSQI score was positively correlated with the score of modified FROP-Com （r=0.319，P<0.05）.Path analysis showed that family support had a negative impact on frailty （β=0.17，P<0.001） and sleep quality （β=0.11，P<0.001）.Good sleep quality had a positive impact on frailty（β=0.27，P<0.001） and risk of falls（β=0.53，P<0.001）.Frailty was associated with increased risk of falls （β=0.53，P<0.001）.Bias-corrected bootstrap revealed that the estimated effect size of frailty in the path of "family support → frailty→ fall risk" was -0.257〔95%CI（-0.340，-0.176）〕，indicating that frailty played a partial medicating role between family support and fall risk.The estimated effect size of sleep quality was -0.055〔95%CI（-0.089，-0.029）〕in the path of "family support → sleep quality → fall risk"，indicating that sleep quality played a partial medicating role between family support and fall risk.The estimated effect size of “sleep quality →frailty” was -0.046〔95%CI（-0.070，-0.020）〕in the path of "family support →sleep quality →frailty→ fall risk"，indicating that sleep quality and frailty played a chain mediating role in the relationship between family support and fall risk.Conclusion　Frailty and sleep quality may have chain mediating effect on the relationship between family support and fall risk in rural elderly people.Therefore，slowing down the process of frailty and improving sleep quality may be conducive to reducing the risk of falls and improving the quality of life.

Association of Sleep Quality，Depressive Symptoms and Their Interaction with Cognitive Frailty in Elderly People　

CUI Guanghui，LI Shaojie，KONG Qingyue，YIN Yongtian，CHEN Lijun，CHEN Lei，LIU Xinyao

2021, 24(9): 1076-1081. DOI: 10.12114/j.issn.1007-9572.2021.00.118

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Background　Disease prevention and treatment，and health management in elderly people are particularly important in the context of accelerated aging and increased healthcare needs of the aging population.As a risk factor of various adverse health outcomes，cognitive frailty has attracted increasing academic attentions，but related research is still in the early stage in China.Objective　To explore the association of sleep quality，depressive symptoms and their interaction with cognitive frailty in the elderly.Methods　In December 2019，by use of random stratified sampling，six communities and 10 administrative villages in Jinan City，China were selected，from which a cluster sample of eligible 1 130 elderly individuals were enrolled，and were invited to attend a questionnaire survey using the General Demographic Questionnaire（development by us），Pittsburgh Sleep Quality Index Scale （used to assess sleep quality），15-item Geriatric Depression Scale（used to assess depressive symptoms），Mini-mental State Examination（used to assess cognitive function） and the Chinese version of Tilburg Frailty Indicator（used to assess frailty）.Cognitive frailty was defined as the presence of both cognitive impairment and frailty.Multivariate Logistic regression analysis was performed to investigate the strength of association of cognitive frailty with sleep quality，depressive symptoms，as well as the interaction between sleep quality and depressive symptoms.Results　In all，1 091 cases（96.6%） who returned responsive questionnaires were included for final analysis.Among the respondents，186（17.0%） had sleep disorders and other 905 （83.0%）did not；180（16.5%） had depressive symptoms and 911（83.5%） did not；89（8.2%）were found with cognitive frailty and other 1 002（91.8%） without.The prevalence of cognitive frailty was varied according to age，education level，sedentary time greater than 5 hours per day，and chronic disease prevalence（P<0.05）.Multivariate Logistic regression analysis showed that sleep disorders 〔OR=3.258，95%CI（1.999，5.309）〕and depressive symptoms〔OR=2.816，95%CI（1.699，4.668）〕 were factors associated with cognitive frailty in the erderly（P<0.05）.The interaction analysis demonstrated that the risk of cognitive frailty in elderly individuals with sleep disorders and depressive symptoms was 10.536 times higher than that in those without〔95%CI（5.395，20.576）〕，RERI=6.998〔95%CI（0.384，13.612）〕，AP=0.664〔95%CI（0.405，0.924）〕，S=3.758〔95%CI（1.407，10.038）〕，indicating that poor sleep quality and depressive symptoms had additive interaction on cognitive frailty.Conclusion　Sleep disorders and depressive symptoms were influencing factors for cognitive frailty among elderly people，and they had an additive interactive effect on cognitive frailty.

Association of Frailty with Sleep Quality and TCM-based Constitution among Elderly People　

CUI Guanghui，LI Shaojie，YIN Yongtian，CHEN Lijun，LIU Xinyao，YU Peilin

2021, 24(9): 1082-1087. DOI: 10.12114/j.issn.1007-9572.2020.00.620

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Background　According to body disease-related theories，TCM-based constitution is closely associated with the initiation，progression，and outcome of diseases，suggesting that TCM-based constitution may play an important role in the development of frailty in the elderly，but there are no relevant studies.Objective　To investigate the effects of sleep quality，body constitution，and their interactions on frailty in the elderly.Methods　In December 2019，by use of random stratified sampling，six communities and 10 administrative villages in Jinan City，China were selected，from which a cluster sample of eligible 1 130 elderly individuals were enrolled，and were invited to attend a questionnaire survey using the General Demographic Questionnaire（developed by our research team），Constitution in Chinese Medicine Questionnaire（CCMQ），Pittsburgh Sleep Quality Index（PSQI）and the Chinese version of Tilburg Frailty Indicator（TFI）.Multivariate Logistic regression analysis was performed to investigate the strength of association of frailty with sleep quality，TCM-based constitution，as well as the interaction between sleep quality and TCM-based constitution.Results　In all，1 091 cases（96.5%） who returned responsive questionnaires were included for final analysis.Among the respondents，186 （17.0%） had sleep disorders and other 905 （83.0%） did not；448 （41.1%） had balanced TCM-based constitution while 643 （58.9%） had unbalanced；373 （34.2%） were frail and 718 （65.8%） were non-frail.Multivariate Logistic regression analysis showed that the presence of sleep disorders〔OR=2.718，95%CI（1.891，3.905）〕and unbalanced TCM-based constitution〔OR=4.782，95%CI（3.410，6.704）〕were factors associated with frailty in the elderly（P<0.05）.Multivariate Logistic regression model-based additive interaction analysis demonstrated that the risk of frailty in elderly individuals with sleep disorders and unbalanced TCM-based constitution was 12.960 times higher than in those without sleep disorders and with balanced TCM-based constitution〔95%CI（8.207，20.465）〕，RERI=6.101〔95%CI（0.579，11.623）〕，AP=0.471〔95%CI（0.181，0.761）〕，S=2.041〔95%CI（1.092，3.817）〕，indicating that sleep quality and TCM-based constitution had additive interaction on frailty.Conclusion　Sleep disorders and unbalanced TCM-based constitution were risk factors for frailty in the elderly，and they also had an additive interactive effect on frailty.

Effect of Pelvic Floor Muscle Training During Pregnancy on the Morphology of Levator Ani Muscle：a Real-world Study　

WANG Jia，LI Tiantian，CHEN Ling，CAI Wenzhi

2021, 24(9): 1088-1094. DOI: 10.12114/j.issn.1007-9572.2021.00.117

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Background　The effects of pelvic floor muscle training（PFMT） during pregnancy have been explored mainly in rigorous randomized controlled trials（RCTs），which may be difficult to be derived from real-world clinical practice.Real-world studies can reveal the treatment status and effect in clinical practice，which further test，expand or supplement the results of RCTs，providing real-world evidence for clinical practice.Objective　To investigate the status of PFMT during pregnancy，and its effect on the morphology of levator ani muscle in real-world clinical settings.Methods　From July 2016 to February 2017，a total of 521 pregnant women in their first or second trimester were enrolled from two hospitals in Shenzhen by convenience sampling.The participants' general information and performance of PFMT were collected by a self-administered questionnaire developed by us.The morphology of levator ani muscle 〔hiatal area at rest （HAR），and at Valsalva maneuver （HAV），difference between HAR and HAV （HAD）〕were examined by three-dimensional transperineal ultrasound.Results　The proportions of women never，occasionally and regularly performing PFMT during pregnancy were 81.38% （424/521），12.28% （64/521） and 6.34%（33/521），respectively.The performance of PFMT showed significant differences in pregnant women by age and abortion history（P<0.05）.A larger HAR，HAV or HAD was found in those with urinary incontinence instead of those without （P<0.05）.Those with abortion history had a larger HAV than those without （P<0.05）.Multiple linear regression analysis showed that there was no significant association between HAR and PFMT during pregnancy 〔occasionally performed （t=-1.565，P=0.118），regularly performed （t=1.022，P=0.307）〕.And HAV had no association with PFMT during pregnancy〔occasionally performed （t=-1.558，P=0.120），regularly performed （t=-0.259，P=0.795）〕.HAD also showed no association with PFMT during pregnancy〔occasionally performed （t=-0.734，P=0.463），regularly performed （t=-1.436，P=0.152）〕.After propensity scoring adjustment，HAR still showed no significant association with PFMT during pregnancy，either performed occasionally（t=-1.514，P=0.131） or regularly（t=1.100，P=0.272）.HAV also still had no significant association with PFMT during pregnancy，either performed occasionally（t=-1.495，P=0.136） or regularly（t=-0.168，P=0.866）.Likewise，HAD demonstrated no significant association with PFMT during pregnancy，either performed occasionally（t=-0.735，P=0.463） or regularly（t=-1.358，P=0.175）.Conclusion　In our study，only 18.61%（97/521）of women performed PFMT during pregnancy，indicating that the implementation of PFMT in this group was not optimistic.Due to low rate of performing PFMT and lack of guarantee of the accuracy of PFMT，no significant effect of PFMT on the morphology of levator ani muscle was found.

Latest Developments in the Application of Complementary and Alternative Therapies in Pregnancy-related Low Back Pain　

SHI Zhiyi，LU Ying，LIU Weihua，WANG Zhenzhen，ZHANG Hongmei

2021, 24(9): 1095-1101. DOI: 10.12114/j.issn.1007-9572.2020.00.615

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Pregnancy-related low back pain（PLBP） refers to pain between the twelfth rib and the gluteal fold caused by pregnancy，and the incidence is as high as 50%.PLBP is associated with physical dysfunction，sleep disorders，increased risk of adverse delivery outcomes and postpartum depression.It is of great significance to take tailored interventions to prevent and alleviate PLBP.Due to the restrictions on drug use during pregnancy，complementary and alternative medicine （CAM） plays an important role in the treatment of pregnancy-related diseases.This article reviewed recently published literature on the application of CAM therapies in the prevention and treatment of PLBP，such as exercise，manual，acupuncture，and physical therapies，to provide a reference for the prevention and alleviation of this disease in China.

Correlation between Cervicovaginal Microbiota Variation and Persistent HPV Infection　

BI Qingqing，ZHU Jie，ZHANG Lei，MU Xiaofeng

2021, 24(9): 1102-1106. DOI: 10.12114/j.issn.1007-9572.2020.00.642

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Background　Early differentiation of persistent and transient HPV infection is important in diagnosis and treatment of cervical cancer.It will provide help for the early intervention of cervical cancer，which has important clinical significance.Changes in cervicovaginal microbiota may induce inflammatory microenvironment and persistent chronic inflammation，or may be associated with persistent HPV infection.Objective　To determine the correlation between cervicovaginal microbiota variation and persistent HPV infection.Methods　16s rDNA sequencing was used to determine the cervicovaginal microbiota variation in the samples of women with persistent HPV infection（n=6），transient HPV infection（n=4） and HPV negative（n=5） selected from those undergoing gynecological examination or treatment in Qingdao Central Hospital during January to June 2018.Alpha diversity was applied in analyzing complexity of species diversity.T-test and LEfSe analysis were used to determine the variation of cervicovaginal microbiota among different groups.Results　The structure of cervicovaginal microbiota of healthy and transiently infected individuals was relatively single，Firmicutes occupied the main composition.However，that of those with persistent HPV infection presented a complicated trend and the abundance of Proteobacteria and Bacteroidetes was higher.Bacteria with significant differences between persistent and transient HPV infection included Acinetobacter，Prevotella，Pseudomonas and Sphingomonas.Conclusion　The reproductive tract flora of patients with persistent HPV infection is complex，and Acinetobacter，Prevotella，Pseudomonas and Sphingomonas are related to persistent HPV infection.

High Risk HPV Test Combined with TCT in the Screening of Cervical Intraepithelial Neoplasia　

LI Tingting，WANG Cuifeng

2021, 24(9): 1106-1110. DOI: 10.12114/j.issn.1007-9572.2021.00.443

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Background　According to global statistics 2018，there are about 560 000 new cases of cervical cancer every year，and the mortality rate of cervical cancer in developing countries is still high.In some underdeveloped regions without appropriate conditions for carrying out comprehensive cervical cancer screening，single screening test for cervical cancer may have a high risk of missed diagnosis.Objective　To explore the value of HPV test with TCT in the screening of cervical intraepithelial neoplasia.Methods　We enrolled 1 620 female patients who underwent cervical screening in the First Affiliated Hospital of Baotou Medical College from January to June 2020.Hybrid capture Ⅲ assay was used to detect 14 types of HPV.TCT test results were interpreted according to the cytologic classification of the Bethesda System.The cervical histopathological diagnosis was used as the gold standard to evaluate the diagnosis accuracies of HPV test，TCT，and HPV test combined with TCT.Results　Among the 1 620 patients，619 were positive for HPV and 1 001 were negative；449 were positive for TCT and 1 171 were negative；205 were positive for HPV combined with TCT and 1 415 were negative；histopathological diagnostic results were positive in 187 cases and negative in 1 433 cases.In diagnosing cervical intraepithelial neoplasia，the HPV test combined with TCT showed higher sensitivity（96.79% vs 81.28%），specificity（98.32% vs 67.41%），positive predictive value（88.29% vs 24.56%） and negative predictive value（99.56% vs 96.50%） than HPV test.And it also demonstrated higher sensitivity（96.79% vs 75.40%），specificity（98.32% vs 78.51%），positive predictive value（88.29% vs 31.40%） and negative predictive value（99.56% vs 96.07%） than TCT.Conclusion　Compared with HPV test or TCT，HPV test combined with TCT showed higher sensitivity，specificity，positive and negative predictive values，thereby reducing the possibilities of rates of missed diagnosis and misdiagnosis，demonstrating higher clinical value.

Effect of Fu's Subcutaneous Needling on Visceral Sensitivity，Gastrointestinal Motility，Intestinal Flora and Intestinal Mucosal Barrier Function in Mild and Moderate Irritable Bowel Syndrome with Diarrhea　

LI Qi，TIAN Fuling，GUO Zhenyu，ZHOU Liwei，ZHU Haosong

2021, 24(9): 1111-1115. DOI: 10.12114/j.issn.1007-9572.2020.00.608

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Background　Irritable bowel syndrome with diarrhea（IBS-D）is a common and frequently-occurring disease of the digestive system，which shows unsatisfactory response to Western medicine treatment，and is easy to recur.Fu's subcutaneous needling has been proved to be effective in treating IBS-D，but the specific mechanism of action is not clear.Objective　To explore the effect of Fu's subcutaneous needling on visceral sensitivity，gastrointestinal motility，intestinal flora and intestinal mucosal barrier function in mild and moderate IBS-D.Methods　A total of 60 outpatients with mild and moderate IBS-D were selected in Gastroenterology Clinic and Acupuncture and Moxibustion Clinic of North China University of Science and Technology from August 2019 to March 2020 and equally divided into control group and observation group by use of a random number table，receiving a 14-day oral administration of compound glutamin entersoluble capsule with routine care，and Fu's subcutaneous needling with routine care，respectively.Pre- and post-treatment Irritable Bowel Syndrome Severity Scoring System（IBS-SSS） score，visceral sensitivity index（VSI）score，indices related to rectal sensitivity to distension，quantity of intestinal flora and biochemical indicators were compared between the two groups.The incidence of treatment-related adverse reactions/complications was recorded.Results　We finally enrolled 29 controls（other one was excluded）and 28 cases（other two were lost to follow up）.After treatment，both groups showed significantly decreased IBS-SSS score，VSI score，serum levels of IL-6，IL-8，IFN-γ，vasoactive intestinal peptide，motilin，D-lactic acid and TNF-α，obviously higher defecation threshold，pain threshold，sensory threshold and serum substance P level，as well as notably increased quantities of bifidobacteria，lactobacilli and bacteroides（P<0.05）.The post-treatment quantity of enteric bacilli in control group was significantly less than that before treatment（P<0.05）.The observation group had significantly less quantity of bifidobacteria，significantly increased quantity of enteric bacilli and obviously higher serum IFN-γ level than the control group after treatment（P<0.05）.No one in the two groups occurred any obvious treatment-related adverse reactions/complications during treatment.Conclusion　In patients with mild and moderate IBS-D，Fu's subcutaneous needling could effectively reduce the severity of symptoms and visceral sensitivity，improve the rectal compliance and enteric dysbacteriosis.Moreover，it may promote the recovery of intestinal mucosal barrier function and secretion of gastrointestinal hormones，and then enhance the immune function of gastrointestinal tract and reduce the stress reaction of gastrointestinal tract possibly by adjusting inflammatory cytokines，gastrointestinal hormones and factors related to intestinal mucosal barrier，with relatively high safety.

Clinical Effect of Hewei-acupuncture Manipulation as an Adjuvant Therapy for Sleep Disorder in Children with Cerebral Palsy　

XU Xia，CONG Yan，HE Kelin，MA Ruijie

2021, 24(9): 1116-1120. DOI: 10.12114/j.issn.1007-9572.2021.00.081

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Background　Acupuncture，a therapy of traditional Chinese medicine，has unique advantages on sleep disorder in children with cerebral palsy，but there is no clinical study about Hewei-acupuncture manipulation in treating this disease.Objective　To explore the clinical effect of Hewei-acupuncture manipulation as an adjuvant therapy for sleep disorder in children with cerebral palsy.Methods　A total of 80 cerebral palsy children with sleep disorders were selected from Child Rehabilitation Department of Yiwu Maternity and Children Hospital from January to December 2019 and equally divided into conventional treatment group and Hewei-acupuncture manipulation group using a computer-based random allocation algorithm，receiving scalp acupuncture，and scalp acupuncture with Hewei-acupuncture manipulation，respectively，once daily，for a total of 30 times（a course of treatment）in addition to the conventional rehabilitation treatment.Sleep status was assessed by the Children's Sleep Habits Questionnaire（CSHQ）before，during and after one month of treatment.Responses to the treatment were assessed at the end of treatment.The incidence of acupuncture-related complications was recorded.Results　Eight dropouts in each group were excluded，the remaining 32 cases were finally included.The average scale and factor scores of CSHQ were similar in both groups at baseline（P>0.05）.They decreased significantly during and at the end of one month of treatment in both groups（P<0.01），but demonstrated no obvious intergroup differences（P>0.05）.The Hewei-acupuncture manipulation group had a much higher rate of response to treatment〔87.5%（28/32）vs 65.6%（21/32），P<0.05 〕.No acupuncture-related complications occurred in both groups.Conclusion　Hewei-acupuncture manipulation has partial clinical effects and advantages in cerebral palsy children with sleep disorder，which may effectively improve the sleep habits and quality，and thus provide a new idea for acupuncture and moxibustion therapy and acupoint selection in treating this disease.

Clinical Efficacy of Smoking versus Smokeless Moxibustion and the Role of Products of Mugwort Somke in Antipruritic Effect in Treating Anal Pruritus　

XU Li，CHEN Chunhua，HE Xiaokang，LI Min

2021, 24(9): 1120-1124. DOI: 10.12114/j.issn.1007-9572.2020.00.592

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Background　It is one of the disputed questions that which is the critical factor for the action of moxibustion therapy in products of mugwort smoke，photoradiation effect and warm-heat effect in recent years.However，there are few reports about the role of products of mugwort smoke in antipruritic effect of moxibustion therapy so far.Objective　To explore the clinical efficacy of smoking versus smokeless moxibustion，and the role of products of mugwort smoke in antipruritic effect in treating anal pruritus.Methods　From June 2017 to June 2019，62 patients with anal pruritus admitted to Department of Anus and Intestine Surgery，the First Affiliated Hospital of Zhejiang Chinese Medical University，were selected and divided into groups A（n=30）and B（n=32）by a table of random numbers.Patients in the two groups received warming moxibustion of Point GV1（Changqiang），thereinto patients in group A used smokeless moxa stick，while those in group B used smoking moxa stick.Both groups were treated for 2 consecutive courses（2 weeks as a course）.Intergroup comparisons were performed regarding pre- and post-treatment pruritus degree，pruritus frequency，qualtiy of life evaluated by the Dermatology Life Quality Index（DLQI）before treatment and at the end of one and two courses of treatment，and tolerance to moxibustion and incidence of discomfort/complications during treatment.Results　Post-treatment Visual Analogue Scale（VAS）/Numeric Rating Scale（NRS）ratio and pruritus frequency in both groups were significantly lower than those before treatment，and they were more significantly lower in group B（P<0.05）.There was significant interaction on total score of DLQI between treatment method and time（P<0.05）.Main effects of treatment method and time were both significant on total score of DLQI（P<0.05）.In both groups，each of the total score of DLQI measured after treatment was lower than the baseline score（P<0.05），and the second measured score was lower than the first measured（P<0.05）.Each of the total score of DLQI measured after treatment in group B was lower than that of group A（P<0.05）.Patients in the two groups were tolerant to moxibustion therapy，and no one occurred any discomfort/complications.Conclusion　Smoking moxibustion has better effect on lowing pruritus degree，reducing pruritus frequency and improving quality of life，and products of mugwort smoke play an important role in the antipruritic effect of moxibustion therapy.

Mental Health Case Studies: Counseling and Treatment for Panic Disorder　

CHEN Dongyang，LI Jianzhong，WANG Yong，YANG Cuiru，BAO Youyuan

2021, 24(9): 1125-1130. DOI: 10.12114/j.issn.1007-9572.2020.00.410

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Panic disorder is a kind of anxiety disorder characterized by repeated unexpected panic attacks，often accompanied by strong fear，palpitation，sweating，tremor，asphyxia，sense of impending death and other symptoms，which is prone to generalized anxiety disorder as the patient always worries about the onset of the attacks or averts relevant situations. The prevalence rate of panic disorder is about 2.1% worldwide，which is increasing yearly with growing disease burden. In China，panic disorder is initially diagnosed almost entirely in general hospitals，but the possibility of diagnostic errors is high，and there is a lack of rapid and effective treatment. We described and analyzed the diagnosis and treatment of a 35-year-old female panic disorder patient using the biopsychosocial approach，revealing the key steps and application of psychological differentiation and psychotherapy，in order to provide a reference for general practitioners to understand and apply integrated psychotherapy.

New Advances in Three-level Prevention of Elder Abuse　

DU Yage，ZHANG Liping，LIU Jie，DOU Haoying，ZHANG Chunmei

2021, 24(9): 1131-1135. DOI: 10.12114/j.issn.1007-9572.2021.00.066

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Elder abuse is recognized as a global public health and social issue，which can destroy the health of the elderly by declining their physical，psychological and social functions，even result in death. Timely and effective intervention can reduce the prevalence of elder abuse and improve the quality of life of the elderly. We elaborated the three-level prevention and relevant interventions for elder abuse at home and abroad，and put forward recommendations for improving domestic elder abuse，such as further improving the health legislation for the elderly，carrying out extensive education of elder abuse in the community and society，strengthening the training for professionals such as physicians，nurses，lawyers and social workers to enhance their ability to identify and intervene elder abuse，delivering diversified secondary preventive measures and properly relocating the abused elderly.

Recent Improvements in Sedentary Behavior and Depression in the Elderly　

JIANG Yan，CHU Aiqin

2021, 24(9): 1136-1139. DOI: 10.12114/j.issn.1007-9572.2020.00.639

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Sedentary behavior is extremely common in the elderly，which is a major factor causing physical and mental health problems in this population.Depression is the most common mental problem among the elderly and can be caused by lots of factors，among which sedentary behavior is a hot focus in recent years.We reviewed recent studies on sedentary behavior and depression in the elderly at home and abroad，and summarized the actions of possible causative mechanisms between the two，and brought forth insights into the guidance on related healthcare research as well as new ideas for the prevention of depression or reducing the risk of depression in the elderly.

Clinical Characteristics，Diagnosis and Treatment of 17α-hydroxylase Deficiency：Analysis of Two Adults 　

LIU Junjing，REN Li，ZHANG Wei，YOU Zhiqing，CHENG Ying，LANG Hongmei，GUO Wei

2021, 24(9): 1140-1143. DOI: 10.12114/j.issn.1007-9572.2020.00.571

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Objective　To analyze the clinical characteristics，diagnosis and treatment of two adults with 17α-hydroxyase deficiency，expecting to improve clinicians' recognition of this disease.Methods　Clinical data of two adults with 17α-hydroxyase deficiency admitted to the Department of Endocrinology，the General Hospital of Western Theater Command in 2013 and 2019，respectively，were collected.Clinical manifestations and diagnostic and therapeutic process were analyzed in detail.Results　The two patients were female in terms of social gender role，aged 24 and 31，respectively.Although their clinical manifestations in adulthood had some differences，they showed various degrees of hypokalemia，hypertension，abnormal sexual development and sexuality，and adrenal hyperplasia.Gene sequencing revealed that both of them had two heterozygous mutations in CYP17A1 gene，with CYP17A1：c.1459_c.1467delGACTCTTTC as the common variation site.The karyotypes of chromosomes were 46XX and 46XY by chromosome karyotype detection，respectively.Both of them were relieved after glucocorticoid treatment.Conclusion　17α-hydroxylase deficiency has a low morbidity，and its clinical features may present certain degrees of variations in adult patients.Early diagnosis and treatment can improve the adulthood quality of life，thus clinicians should improve the levels of early diagnosis and differential diagnosis of the disease.

Clinical and Gene Variation Analyses of a Case of Complex Glycerol Kinase Deficiency　

CUI Qingyang，SANG Guimei，CAO Yinli，SHANG Yun，TANG Chenghe

2021, 24(9): 1144-1147. DOI: 10.12114/j.issn.1007-9572.2020.00.640

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Complex glycerol kinase deficiency is a kind of contiguous gene syndrome caused by partial deletion of Xp21 chromosome，which is mainly manifested as glycerol kinase deficiency，adrenal cortical dysfunction，Duchenne muscular dystrophy and mental retardation.Timely gene detection is helpful for early diagnosis.This paper reported a neonatal case of complex glycerol kinase deficiency with manifestations mainly consist of adrenocortical hypofunction （hyponatremia and hyperkalemia），elevated creatine kinase and urine glycerol levels.Whole exome sequencing and CNV Seq tests were performed to confirm the diagnosis.

Primary Hyperoxaluria Type 1：Report of One Pediatric Case and Literature Review　

ZHOU Xudong，ZHAO Xinghua，XU Changbao，LI Wuxue，ZHAO Yongli

2021, 24(9): 1148-1151. DOI: 10.12114/j.issn.1007-9572.2020.00.560

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Primary hyperoxaluria type 1 （PH1） is an autosomal recessive genetic disease，with clinical manifestations of repeated kidney stones and progressive renal calcification，usually starting in childhood，and eventually developing to end-stage renal disease as the progressive deterioration of the disease.Currently，AGXT gene sequencing has gradually substituted liver biopsy，and become a first diagnostic method for PH1.And early treatment options of PH1 are mainly conservative therapies.We reported a pediatric case of PH1，with detailed analysis and summary of the clinical characteristics and management methods，aiming to provide a reference for clinicians to diagnose and treat the disease.

Advances in the Relationship between Osteosarcopenic Obesity Syndrome and Type 2 Diabetes　

WAN Jiamin，ZHAO Kexiang，SUN Yue，DENG Zidan，LUO Cheng，XIAO Qian

2021, 24(9): 1152-1157. DOI: 10.12114/j.issn.1007-9572.2021.00.062

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The incidence of age-related diseases increases with rapid population aging.The coexistence of multiple diseases causes great harm to the health of the elderly，but the treatment for which may be assisted by the theoretical evidence derived from exploring the relationship between osteosarcopenic obesity syndrome and type 2 diabetes.This article reviews the relationship between osteosarcopenic obesity syndrome and type 2 diabetes，and concludes that the two have a close relationship and influence each other，so comprehensive treatment can effectively improve the overall prognosis and quality of life.

Recent Developments in the Diagnosis of Hepatogenous Diabetes　

TIAN Caiyun，HU Han，ZHANG Guoyuan，LIN Shide

2021, 24(9): 1158-1164. DOI: 10.12114/j.issn.1007-9572.2021.00.068

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Hepatogenous diabetes（HD）can be defined as a kind of glucose metabolic disorders secondary to impaired liver functions caused by liver cirrhosis，the final stage of chronic liver disease associated with progressive liver fibrosis. HD may increase the risk of common complications of liver cirrhosis，such as hepatic encephalopathy，upper gastrointestinal bleeding，spontaneous peritonitis，ascites and infection，as well as the risk of progression from cirrhosis to liver cancer and the mortality of liver cancer. As glycemic control is an effective means to improve the prognosis of HD，early identifying and intervening HD are of great clinical significance. At present，it is still difficult to make a clinical diagnosis of HD，and there are no systematic diagnostic strategies for HD in China. In this paper，we reviewed the recent developments in HD diagnosis，with a view to helping early clinical identification of HD to improve the prognosis of patients with liver cirrhosis.

Recent Advances in the Relationship between Intestinal Flora and Respiratory Diseases　

XIAO Siyao，ZHANG Shunan

2021, 24(9): 1165-1172. DOI: 10.12114/j.issn.1007-9572.2021.00.003

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Intestinal flora is a large microbial community inhabiting in the intestinal tract.Studies have shown that intestinal flora plays an important role in metabolism，immune system development and inflammation in the human body，and is closely associated with diseases of digestive，immune，nervous，and respiratory systems.With the development of technologies for microbial analysis，the relationship between intestinal flora and respiratory diseases has drawn increasing attentions and concerns.The proposal of gut-lung axis provides a new idea for studying the pathogenesis and treatment of respiratory diseases.This paper reviews the correlation between intestinal and respiratory flora and their interaction with gut-lung axis，focusing on the relationship and mechanism of action of intestinal flora with respiratory diseases such as respiratory infectious diseases，airway allergic diseases，chronic obstructive pulmonary diseases，cystic fibrosis，pulmonary tuberculosis，lung cancer and so on，providing new insights into the pathogenesis research and treatment of respiratory diseases.

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