Table of Content

15 June 2021, Volume 24 Issue 17

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Monographic Research

Expert Recommendations on Community-based Management of Women with Abnormal Cervical Cancer Screening Test Results　

Chinese Medical Doctor Association（CMDA）'s General Practitioners Sub-association，the Primary Care Branch of Beijing Institute of Obstetrics & Gynecology.Expert recommendations on community-based manag

2021, 24(17):  2117-2121.  DOI: 10.12114/j.issn.1007-9572.2021.00.531

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Chinese Medical Doctor Association（CMDA）'s General Practitioners Sub-association，the Primary Care Branch of Beijing Institute of Obstetrics & Gynecology To reduce the incidence of cervical cancer via standardizing the prevention and control of cervical cancer in primary care，and the management and follow-up of women with abnormal cervical cancer screening test results and those with treatment for cervical lesions，China General Practitioner Association，Chinese Medical Doctor Association，and Community and Primary Care Branch，Beijing Institute of Obstetrics & Gynecology，invited relevant experts to develop the Expert Recommendations on Community-based Management of Women with Abnormal Cervical Cancer Screening Test Results，on the basis of reviewing guidelines on cervical cancer screening and managing women with abnormal cervical cancer screening test results，mainly involving cervical cancer prevention and control issues in primary care，such as creating personal health records，health education，classified management and bi-directional referrals.The recommendations will be vital to the improvement of community-based management of women with abnormal cervical cancer screening test results.


Development of the COVID-19 Cluster Containment Evaluation System Using the Emergency Management Theory　

LIU Jue，LIANG Wannian，LIU Min，YANG Weizhong，LIU Xia，WU Jing，WANG Yadong，SHAN Guangliang，HAN Hui，ZHOU Lei

2021, 24(17):  2122-2126.  DOI: 10.12114/j.issn.1007-9572.2021.00.528

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Background　During the normal prevention and control phase of COVID-19，a number of clusters occurred in China，and all of them have been brought under control．Scientific assessment of the effectiveness of cluster containment helps to timely summarize the experience and shortcomings，contributing to better responding to the epidemic．However，there is still a lack of tools to evaluate the effectiveness of COVID-19 cluster containment．Objective　To develop a COVID-19 cluster containment evaluation system as a tool for assessing the effectiveness of COVID-19 cluster containment．Methods　During November 2020 to February 2021，by use of the emergency management theory，we formulated a theoretical framework，and used it to develop the COVID-19 Cluster Containment Evaluation System involving COVID-19 cluster prevention，responses and containment assessment using literature review and two rounds of Delphi consultation．Results　The system consists of 5 domains（COVID-19 cluster detection and reporting，COVID-19 cluster precise containment，public protection against COVID-19 cluster，medical treatment for COVID-19 cluster，and effectiveness of COVID-19 cluster containment），with 27 items and 107 sub-items．The Kendall's coefficient of concordance ranged from 0.710 to 0.912．The full score for the system is 100 points，and higher score indicates a better effectiveness of containment．Conclusion　This system may be used as an auxiliary tool for assessing the effectiveness of COVID-19 cluster containment in normal prevention and control phase of COVID-19．


Implementation Analysis of Severe Mental Illness Reporting System in Beijing during the Execution of the Civil Code of the People's Republic of China　

WANG Haomin，LI Xiaoyong，JI Yutong

2021, 24(17):  2127-2133.  DOI: 10.12114/j.issn.1007-9572.2021.00.503

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Background　Mental health is a major national public health issue.To actively promote the development of mental health services to safeguard the health rights and interests of citizens，we studied the implementation of serious mental illness reporting system in Beijing. Objective　To explore the implementation of severe mental illness reporting system in Beijing，and identify and analyze the problems，providing suggestions for the improvement of the system.Methods　From November 2018 to March 2019，we conducted a questionnaire survey regarding the implementation of severe mental illness reporting system with psychiatrists （assuming duties of delivering mental illness prevention and management services） selected by stratified random sampling methodfrom community health centers in Beijing's Chaoyang，Xicheng，Daxing and Fangshan Districts. Multiple response analysis and Chi-square goodness-of-fit test were performed using SPSS 25.0. Literature review was performed to find the latest provisions of the system and other scholars' research theories on related issues.Results　In total，214 cases who returned responsive questionnaires were included for final analysis. Among the respondents，54.7%（117/214）thought the system was very important，and 35.1%（75/214） thought it was relatively important，the proportion was 89.8%（192/214）in total.The proportions of respondents knowing the role played by the system in mental illness risk warning，surveillance and community-based management were not statistically different（χ2=0.073，P=0.964）.The implementation effectiveness of the system was rated as excellent，relatively good，and fair by 15.9%（34/214），50.9%（109/214），and 24.8%（53/214） of the respondents，respectively. But 84.1%（180/214） of the respondents thought that the system was not very sound and needed improvements. The proportions of respondents choosing different problems existing in the implementation of the system were statistically different（χ2=88.338，P<0.001）.The proportion of respondents choosing “Considering personal privacy，the patient does not want to let his illness be known by others" was the most〔83.2%（178/214）〕. The proportions of respondents choosing different improvement recommendations for the system were statistically different（χ2=13.579，P=0.019）. The proportion of respondents choosing "Standardizing information collection，registration，correction and summary system" was the most〔76.6%（164/214）〕，and choosing "Standardizing information sharing and patient privacy protection system" was the second〔67.3%（144/214）〕.Conclusion　The implementation of the system involves the privacy of patients，and has imperfections.It is suggested to revise the system to a more detailed and clearer level via modifying the Mental Health Law of the People's Republic of China in accordance with the legislative spirit of the Civil Code of the People's Republic of China，and to improve the reporting criteria，relevant information collection procedures，and error correction updating mechanisms，thereby protecting the basic rights of mental illness patients.


Evaluation of Potentially Inappropriate Medication in Elderly Patients with Multiple Medications　

SHU Bing，FANG Yuting，LI Min，ZHANG Shengyu，SHEN Aizong

2021, 24(17):  2134-2139.  DOI: 10.12114/j.issn.1007-9572.2021.00.489

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Background　China has entered an aging society，and the elderly patients are susceptible to multiple chronic diseases，resulting in the common problems in multidisciplinary clinic and multiple medications.A number of researches have shown that the incidence of potentially inappropriate medication（PIM） in elderly patients is relatively high.Therefore，selecting elderly patients with multiple medications to evaluate PIM is conducive to identifying the influencing factors of PIM in elderly patients，which will provide a basis for improving the level of rational medication in older adults.Objective　To evaluate PIM and its influencing factors in elderly patients with multiple medications in cardiovascular medicine department，so as to provide reference for clinical rational medication.Methods　From February to June 2019 a total of 394 medical records of the elderly inpatients from the First Affiliated Hospital of the USTC were collected to evaluate their PIM based on Beers criteria（2019 edition） and Criteria of Potentially Inappropriate Medication for Elderly People In China，and multivariate Logistic regression analysis was used to investigate the influencing factors of PIM in elderly patients with multiple medications in cardiovascular medicine department.Results　Totally 394 patients aged（74.1±6.2）were included，the average hospital stay length was （8.1±4.4）d，and the average number of the types of drug used were（6.8±1.8）.According to Beers criteria（2019 edition），there were 270 items of PIM in 199 patients（50.5%）.The drugs with a high frequency of PIM were proton pump inhibitors，benzodiazepines and amiodarone.14 cases of PIM related to disease or symptoms，37 cases caused by drugs which shoulbe used with caution among the elderly，12 cases of drug interactions which should have been avoided，22 cases of renal insufficiency which should have been avoided or reduced in dose were detected.Diltiazem was used in 12 patients with heart failure，spironolactone was used in 20 cases with creatinine clearance below 30 ml/min.According to the Criteria of potentially inappropriate medications for older adults in China，there were 320 items of PIM in 262 patients （66.5%）.The drugs with a high incidence of PIM were clopidogrel，Warfarin and amiodarone.Multivariate Logistic regression analysis showed that the common influencing factors of PIM based on Beers criteria are age and the type of medicine used（P<0.05）；the common influencing factor of PIM based on Criteria of potentially inappropriate medications for older adults in China is the type of medicine used（P<0.05）.Conclusion　The current situation of potentially inappropriate medication in elderly patients with multiple medications is not optimistic，and the level of rational medications in older adults needs to be improved，and the type of drug used is the influencing factor of PIM.It is suggested that the elderly patients should streamline administration.For the drugs which should be avoided in patients with certain diseases or pathological conditions，attention should be paid to drug interactions to reduce the damage of multiple drugs to elderly patients.


Causes and General-specialty Prevention Strategies for Drug-induced Renal Injury in the Elderly　

WEI Shan，LIU Yingli

2021, 24(17):  2140-2147.  DOI: 10.12114/j.issn.1007-9572.2021.00.115

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Drug-induced kidney injury（DKI）is a drug-induced kidney disease caused by adverse drug events or reactions，which may result in acute or chronic renal failure，seriously reducing the patients' quality of life，and increasing the economic burden on families and society. So the prevention of DKI has important clinical and social significance. The elderly is a high-risk group of DKI，among whom the incidence of DKI is about 10% to 65%.Therefore，identifying the causes of DKI，studying the special clinical medication characteristics，and strengthening medication education and management in the elderly are extremely important to promote medication safety and prevent DKI in this group. This review discusses the pathophysiological mechanism，risk factors，causes and general-specialty prevention strategies for DKI in the elderly.


A Six-year Follow-up Study on the Prognosis in Elderly Patients with Ischemic Stroke Combined with Atrial Fibrillation and Coronary Heart Disease　

DONG Min，XU Lei，HE Qinghua，PEI Zuowei，QU Yimei，YANG Jiefu，WANG Fang

2021, 24(17):  2148-2156.  DOI: 10.12114/j.issn.1007-9572.2021.00.527

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Background　In recent years，patients with atrial fibrillation and coronary heart disease have attracted more and more attention in clinic.Recent clinical studies mainly focused on the prevention and treatment of stroke and thromboembolic events.Objective　To evaluate the long-term survival rate of elderly patients with ischemic stroke combined with atrial fibrillation and coronary heart disease，and analyze the risk factors which affected the prognosis.Methods　We conducted a retrospective cohort study.A retrospective analysis of 406 patients over 60 years admitted to hospital due to acute ischemic stroke for the first time were enrolled，and 164 patients with atrial fibrillation and coronary heart disease were selected from them as cerebrovascular disease group，164 patients without cerebrovascular disease but with atrial fibrillation and coronary heart disease matched with age，gender and comorbidities were selected from concurrent hospitalized patients in the Department of Cardiology as non-cerebrovascular disease group.The clinical data，including demographic information，types of diseases，types of medications，blood pressure，heart rate，cardiovascular diseases and other diseases of the two groups were collected，laboratory test，echocardiographic parameters，treatment plan.The CHA2DS2-VASc score and CHADS2 score were used to assess the risk of stroke and thromboembolism，and the HAS-BLED score was used to assess the risk of bleeding.The patients were followed up for at least 6 years by telephone，outpatient and inpatient records after discharge，to record the death，readmission and major adverse cardiovascular events（MACE），and to explore the factors that affect his long-term prognosis.Results　Compared with non-cerebrovascular disease group，the proportion of hyperlipidemia and chronic gastrointestinal disease in cerebrovascular disease group was lower.LVEDD，CHA2DS2-VASc score，CHADS2 score，and the HAS-BLED score in cerebrovascular disease group were higher（P<0.05）.In the 164 patients with cerebrovascular disease group，2 cases were lost to follow-up（1.2%），and 80 cases died（49.4%）.They were divided into death group（80 cases） and survival group（82 cases） according to the survival outcome.The death group was older and had lower systolic and diastolic blood pressure than the survival group，and the proportion of hypertension，hyperlipidemia，serum albumin and the use of statins were also lower than the survival group.The resting heart rate and the proportion of old myocardial infarction，the proportion of heart failure，chronic kidney disease，NYHA，D-dimer and NT-proBNP levels in death group were higher than the survival group（P<0.05）.The results of multivariate Cox regression analysis showed that for every 10 years of age increase〔HR=1.63，95%CI（1.05，2.51）〕，history of old myocardial infarction〔HR=2.19，95%CI（1.14，4.22）〕 and D-Dimer ≥148 μg/L〔HR=6.99，95%CI（2.10，23.28）〕 were independent risk factors for long-term mortality in elderly patients with ischemic stroke combined with atrial fibrillation and coronary heart disease，while hypertension〔HR=0.28，95%CI（0.11，0.72）〕 and statins use〔HR=0.38，95%CI（0.19，0.78）〕 were the protective factors for long-term death in these patients.Conclusion　The long-term mortality of patients with atrial fibrillation and coronary heart disease after the first occurrence of cerebrovascular disease is not related to the coexisting cerebrovascular disease，but related to aging，history of old myocardial infarction and D-dimer level.Maintaining an appropriate blood pressure level and using statins may reduce the long-term mortality patients with atrial fibrillation and coronary heart disease.


Associations of Sleep Quality and Sleep Duration with Corrected QTc Interval on the Ambulatory Electrocardiogram　

WANG Xiaoxu，SHI Jianming，JIANG Xiaoyan，WANG Xiaofeng

2021, 24(17):  2157-2162.  DOI: 10.12114/j.issn.1007-9572.2021.00.495

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Background　Sleep is essential for maintaining human health.The quality and duration of sleep are associated with the occurrence of many diseases.Previous studies showed that sleep deprivation was associated with prolonged QT interval in occupational groups.However，there is no study on the association of sleep quality and sleep duration with corrected QTc interval（QTc）in the general population.Objective　To explore the association of sleep quality and sleep duration with QTc in Chinese older adults.Methods　From November to December 2017，the data on electrocardiogram（ECG）and sleep of Rugao Longevity and Aging Cohort Study were selected.According to the Pittsburgh Sleep Quality Index（PSQI）score，the participants were divided into normal sleep group（n=776），mildly impaired sleep quality group（n=214），and poor sleep quality group（n=152）.ECG parameters were collected by interpreting the resting ECG 〔including QTc，heart rate，atrial depolarization wave，QRS interval，the time interval from the end of the P wave to the beginning of the QRS complex，R wave in lead V5（RV5），and S wave in lead V1〕．Multiple linear regression analysis was used to explore the factors associated with the PSQI score and QTc.Results　The mean PSQI score of the participants was（4.6±2.6）points，and the mean night sleep duration was（9.2±1.8）hours.Three groups showed significant differences in the distribution of gender，education level，alcohol consumption，cognitive function，physical activity，QTc and RV5，as well as diabetes prevalence（P<0.05）.After adjusting for multiple confounding factors，multiple linear regression analysis showed that the PSQI score〔β=1.63，95%CI（0.23，3.04），P=0.023〕，sleep duration ≤6 h〔β=21.22，95%CI（6.28，36.16），P=0.005〕and sleep duration >10 h 〔β=8.81，95%CI（0.24，17.39），P=0.044〕 were associated with the QTc.Conclusion　Poor sleep quality，long or short sleep duration were associated with QTc in Chinese elderly people，suggesting that sleep quality and sleep duration may be associated factors of QTc，and improving quality of sleep may prevent QTc prolongation，thereby preventing cardiac death.


Relationship of Related Items of Comprehensive Geriatric Assessment with Ankle Brachial Index　

WANG Yaoling，QI Benling，LIU Lihua，WANG Ruiyun，BAI Lijuan，LIU Yun，HE Linfeng

2021, 24(17):  2163-2168.  DOI: 10.12114/j.issn.1007-9572.2021.00.124

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Background　The Geriatric Comprehensive Assessment（GCA） is widely used to evaluate the basic functions within the elderly population.And vascular disease is the pathological basis of various system diseases in the elderly population.The ankle-brachial index（ABI） can effectively reflect the vascular status.Interpretation of the clinical significance of GCA-related items in vascular pathology will contribute to screening and intervening early vascular disease in patients and eventually improving prognosis.Objective　To evaluate the relationship of GCA-related items with ABI，and the performance of GCA-related items in predicting the risk of low ABI.Methods　A total of 74 patients with data of ABI measurement and GCA〔including the Mini Nutritional Assessment Short-Form（MNA-SF），FRAIL Scale，Morse Fall Scale（MFS），Pittsburgh Sleep Quality Index（PSQI），Basic Activities of Daily Living（BADL），Instrumental Activities of Daily Living（IADL），timed up and go test（TUGT），Five Times sit-to-stand test（FTSST），and Mini-Mental State Examination（MMSE）〕 were recruited from Department of Geriatrics，Union Hospital，Tongji Medical College，Huazhong University of Science and Technology from May to November 2019.GCA items were compared between those with low ABI（ABI<0.9）and normal ABI（0.9≤ABI<1.3）.The relationship between each item of CGA and ABI was evaluated by correlation analysis，and the predictive value of each item for low ABI was evaluated using Logistic regression analysis and ROC curve analysis.Results　Low and normal ABI patients had no significant differences in sex ratio，mean age，smoking prevalence，drinking prevalence，mean scores of MNA-SF，MFS，PSQI，BADL，IADL，FTSST and MMSE（P>0.05），but showed notable significant differences in mean scores of FRAIL Scale and TUGT（P<0.05）.But low ABI patients had higher mean BMI（28.1 kg/m2 vs 23.8 kg/m2）（P<0.05）.ABI showed a significant negative correlation with age，score of MFS，TUGT，or FTSST，and a significant positive correlation with BADL or IADL score.After adjustment for multiple variables，the scores of FRAIL and TUGT were found to be effective in predicting low ABI〔 age-adjusted OR=2.19，95%CI（1.07，5.14）；age-adjusted OR=1.18，95%CI（1.06，1.38）〕．The AUC of FRAIL Scale for the diagnosis of low ABI was 0.82〔95%CI（0.69，0.95）〕，with the score for prefrail as the optimal threshold value.The AUC of TUGT for the diagnosis of low ABI was 0.89〔95%CI（0.75，0.89）〕，the optimal threshold value was 13.5 s.Conclusion　The FRAIL Scale and TUGT showed good predictive value for low ABI.Focusing on the vascular health of pre-frail and frail elderly population and those with TUGT results greater than 13.5 s is of great significance for the detection，prevention，and early intervention of vascular diseases and multisystemic downstream diseases.


Clinical Efficacy of Dexamethasone Combined with CTX in the Treatment of Middle-aged and Elderly Type 2 Diabetic Patients with Idiopathic Membranous Nephropathy　

TAO Zhihu，CHEN Jiahe，LI Xiaojian，MO Chao，SU Chaodong，HUANG Xuexia

2021, 24(17):  2169-2173.  DOI: 10.12114/j.issn.1007-9572.2021.00.063

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Background　Glucocorticoids combined with immunosuppressive agents is are common treatment for idiopathic membranous nephropathy（IMN），but the use of short-term，long-acting hormones combined with cyclophosphamide（CTX）to treat diabetes with idiopathic membranous nephropathy has been rarely reported.Objective　To explore the clinical efficacy of dexamethasone combined with CTX in the treatment of middle-aged and elderly type 2 diabetes patients with IMN，and evaluate its safety and pharmacoeconomic value.Methods　According to the random number table method，86 patients hospitalized in the Department of Nephrology，the First Affiliated Hospital of Guangxi University of Traditional Chinese Medicine from 2014 to 2016 with type 2 diabetes and IMN who were divided into treatment group（41 cases）and control group（45 cases）.In the control group，2 patients had serious adverse reactions and withdrew from the trial，and finally 43 patients were included.The treatment group received 10 mg of dexamethasone sodium phosphate injection and 100 ml of 0.9% sodium chloride injection by intravenous drip every month，once a day，for 3 consecutive days；0.4 g of CTX for injection was added to 250 ml 0.9% sodium chloride injection by intravenous drip 1 time/d，for 2 consecutive days，the monthly dosage is 0.8 g，and the total amount reaches 8 g.The control group was given prednisone 1 mg•kg-1•d-1 combined with tacrolimus capsule 0.05 mg•kg-1•d-1，and the tacrolimus blood concentration need to maintain at 3-5 μg/L.After 8 weeks，the dose of prednisone was gradually reduced by 5 mg every 2 weeks until it reduced to 0.5 mg•kg-1•d-1 for maintaining 4 weeks，and the dose reduction was stopped at 10 mg/d for no less than 6 months.Test the liver function，blood routine，24 hour urinary protein，plasma albumin，serum creatinine（Scr），blood sugar，glycosylated hemoglobin and other indicators before treatment and 1，3，and 6 months after treatment，and compare the clinical efficacy，conduct drug reactions and pharmacoeconomic value between the two groups.Results　The incidence of adverse reactions in the treatment group 〔12.02%（5/41）〕was lower than that in the control group 〔44.2%（19/43）〕（χ2=10.525，P=0.001）.The 24 hour urinary protein of the treatment group was higher than the control group after 1 month and 3 months of treatment，and the plasma albumin level was lower than the control group（P<0.05）；the 24 hour urinary protein of the treatment group was lower than the pre-treatment after 3 months and 6 months of treatment，plasma albumin was higher than the pre-treatment（P<0.05）；24 hour urinary protein in the control group was lower than the pre-treatment after 1 month，3 months and 6 months of treatment，and plasma albumin was higher than pre-treatmen（P<0.05））.The blood glucose levels of patients of the treatment group were lower than the control group after 1 month，3 months of treatment（P<0.05）；the blood glucose and HbA1c levels of the control group were higher than pre-treatment（P<0.05）after 1 month and 3 months of treatment.The complete remission rate and total effective rate of the treatment group after 3 months of treatment were lower than the control group，and the inefficiency was greater than the control group（P<0.05）.There was no significant difference in each index and clinical efficacy between the two groups after 6 months of treatment（P>0.05）. The cost-effectiveness analysis results showed that the control group had a significantly higher cost-effectiveness ratio（164.75）than the treatment group（30.51）.Conclusion　The clinical efficacy of dexamethasone combined with CTX in the treatment of middle-aged and elderly patients with type 2 diabetes with IMN is equivalent to that of hormone combined with tacrolimus，C/E is significantly reduced，and the effect on blood sugar is small.


Short-and Long-term Effects of Yiqihuoxuezhitong Decoction Combined High Frequency Repetitive Transcranial Magnetic Stimulation on Pain and Sleep Quality in Elderly Patients with Postherpetic Neuralgia　

CHEN Xin，LIAO Pengfei，SHI Qiang，ZHOU Li，LUO Qin，YUN Duan，ZHU Qi

2021, 24(17):  2174-2178.  DOI: 10.12114/j.issn.1007-9572.2021.00.490

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Background　 The protracted pain caused by postherpetic neuralgia，a common complication of shingles，may lead to anxiety and sleep disorders，seriously impairing the quality of life of patients.Objective　To evaluate the efficacy and safety of Yiqihuoxuezhitong Decoction with high frequency repetitive transcranial magnetic stimulation（TMS） on postherpetic neuralgia comprehensively.Methods　From January 2017 to May 2019，96 patients with postherpetic neuralgia and qi stagnation and blood stasis were recruited from Department of Integrative Traditional Chinese and Western Medicine and Department of Neurology，Zigong First People's Hospital，and equally randomized into control group，TMS group and combined group，receiving gabapentin capsules and pseudo-TMS，gabapentin capsules and high frequency（10 Hz） repetitive TMS，gabapentin capsules with high frequency（10 Hz） repetitive TMS and Yiqihuoxuezhitong Decoction（developed by our research group），respectively，for 2 weeks.Statistical analyses were performed to compare three groups' pain level using the Visual Analog Scale（VAS） score，somatosensory impairment using the somatosensory evoked potential（SEP） test，and sleep quality using the Athens Insomnia Scale（AIS） at baseline and 2，4，12 and 36 weeks after treatment，as well as the occurrence of adverse reactions.Results　The interactive effect of treatment method and treatment time was significant on VAS and AIS scores，and SEP grade（P<0.05）.The main effects produced by treatment method and treatment time were significant on VAS and AIS scores，and SEP grade（P<0.05）.In combined and TMS groups，the VAS and AIS scores and SEP grade at 2，4，12，36 weeks after treatment were all decreased significantly compared to baseline（P<0.05）.For the control group，the VAS score and SEP grade at 2，4，12，36 weeks after treatment，and the AIS score at 4，12，36 weeks after treatment were all decreased significantly compared to baseline（P<0.05）.Compared to control group，combined group showed lower VAS score at 2，4，12，and 36 weeks after treatment（P<0.05），and TMS group showed lower VAS score at 2 and 4 weeks after treatment（P<0.05）.Compared to TMS group，combined group showed lower VAS score at 4，12，and 36 weeks after treatment（P<0.05）.Compared with control group，combined group showed better SEP grade at 2，4 and 12 weeks after treatment（P<0.05），but TMS group only showed better SEP grade at 2 weeks after treatment（P<0.05）.Combined group had better SEP grade at 2，4 and 12 weeks after treatment than TMS group（P<0.05）.Compared to control group，combined group showed better AIS score at 2，4，12，and 36 weeks after treatment（P<0.05），but TMS group only showed better AIS score at 2 and 4 weeks after treatment（P<0.05）.Combined group had better AIS score at 2，4，12，and 36 weeks after treatment than TMS group（P<0.05）.The incidence of adverse reactions showed no statistically significant difference among the three groups（P>0.05）.Conclusion　Yiqihuoxuezhitong Decoction with high frequency repetitive TMS may have good short-and long-term effects on pain and sleep quality in elderly patients with postherpetic neuralgia with good safety and reliability，which is worthy of clinical application.


Relationship of Red Blood Cell Distribution Width with Polysomnography Parameters in Patients with Hypertension and Sleep Apnea Hypopnea Syndrome　

LIU Guixin，CHENG Wenli，YU Jing，MA Huijuan

2021, 24(17):  2179-2184.  DOI: 10.12114/j.issn.1007-9572.2021.00.523

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Background　There is a controversy about the relationship of inflammatory factors with upper airway obstruction.Polysomnography serves as a “gold standard” in support of the diagnosis of obstructive sleep apnea syndrome （OSAS），it is not suitable for repeated monitoring due to complex operation，time-consuming and high cost.Objective　To explore the relationship of red blood cell distribution width（RDW-CV） with polysomnography parameters and its influencing factors by retrospectively analyzing relevant data of hypertensive patients with OSAS.Methods　Participants（n=287） were hypertensive patients discharged from Beijing Anzhen Hospital，Capital Medical University during 2017 to 2019 were collected at admission.High sensitivity C-reactive protein（hs-CRP），RDW-CV，oxygen desaturation index，lowest and mean oxygen saturation，apnea-hypopnea index（AHI），24 hSBP and 24 hDBP were detected during hospitalization.Those who were found with OSAS were stratified into mild，moderate and severe（number of apneas 5-15，16-30 and >30 times/h） subgroups by AHI level.Results　At baseline，there were 62 patients without OSAS and 225 with OSAS，including 50 mild cases，78 moderate cases and 97 severe cases.Patients with OSAS had greater mean age，BMI，24 hSBP，RDW-CV and hs-CRP，as well as higher cardiovascular disease prevalence than those without（P<0.05）.The RDW-CV value in patients with OSAS was positively correlated with age，BMI，24 hSBP，oxygen desaturation index，AHI and hs-CRP，and negatively correlated with the lowest and mean oxygen saturation（P<0.05）.Multivariate Logistic regression analysis showed that age，AHI and hs-CRP were associated with RDW-CV（P<0.05）.Conclusion　RDW-CV may be related to polysomnography parameters in patients with hypertension and OSAS，indicating that it could be used as an easily monitored parameter.


Effect of Vascular Cell Adhesion Molecule-1 and Activin A on Multiple Myeloma　

WANG Yan，HUANG Zhongxia，HU Wanli，WEI Yujun，WANG Linyue

2021, 24(17):  2185-2191.  DOI: 10.12114/j.issn.1007-9572.2021.00.522

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Background　Multiple myeloma（MM） is a plasma cell tumor with hypercalcemia，renal insufficiency，anemia，and bone lesions that often occurs in middle-aged and elderly people.There is a trend showing a notably increased incidence of MM recently.However，the pathogenesis of MM is unknown，which may be related to the complex and abnormal tumor microenvironment.Objective　To estimate the correlation of vascular cell adhesion molecule-1（VCAM-1），activin A and other cytokines in tumor microenvironment with the pathogenesis of MM and related clinical significance in MM patients.Methods　Participants were selected from Beijing Chao-yang Hospital（West），Capital Medical University from January 2012 to April 2014，including 20 healthy physical examinees（healthy group） and 50 inpatients with MM from Department of Hematology and Oncology（MM group）.MM patients were classified into newly diagnosed（n=18），relapsed（n=18），and response（n=14） subgroups by post-treatment conditions，kidney impairment（n=12） and non-kidney impairment subgroups（n=38） by kidney impairment prevalence （serum creatinine>177 μmmol/L），anemia（n=29 and non-anemia subgroups（n=21） by anemia prevalence（Hb<100 g/L），and severe bone lesion（n=27） and non-severe bone lesion subgroups（n=23） by bone lesion level.ELISA was used to measure VCAM-1，activin A，bone metabolic markers〔25-（OH）D3，serum bone-specific alkaline phosphatase，tartrate-resistant acid phosphatase，serum pyridinoline cross-linked carboxy-terminal telopeptide of type I collagen，IL-6，IL-6R，TNF-α and VEGF〕in MM patients were detected and compared by ELISA.Pearson correlation analysis was conducted.The best cutoff values of VCAM-1 and activin A were evaluated by receiver operating characteristic curve （ROC），draw survival curve.Results　The healthy controls had lower mean levels VCAM-1 and activin A than newly diagnosed and relapsed MM patients（P<0.05）.Response MM patients had lower mean levels VCAM-1 and activin A than newly diagnosed and relapsed MM patients（P<0.05）.The kidney impairment MM patients had higher mean levels of VCAM-1 and activin A than healthy controls（P<0.05），so did non-kidney impairment MM patients （P<0.05）.The kidney impairment MM patients showed higher mean levels of VCAM-1 and activin A compared to non-kidney impairment MM patients（P<0.05）.Anemia MM patients had higher mean levels of VCAM-1 and activin A than non-anemia MM patients（P<0.05）.Both MM patients with and without severe bone lesions had higher mean level of activin A than healthy controls（P<0.05）.The mean level of activin A in MM patients with severe bone lesions was significantly higher than those without （P<0.05）.VCAM-1 was positively correlated with activin A（r=0.627，P<0.001），serum creatinine（r=0.415，P=0.004），β2-microglobulin（r=54.97，P=0.001），lactate dehydrogenase（r=0.968，P=0.028），and the number of myeloma cells in the bone marrow microenvironment（r=1 684.38，P=0.045），but was negatively correlated with albumin（r=-0.589，P<0.001） and Hb（r=-0.589，P<0.001）.ROC curve analysis found that in predicting MM，the optimal diagnostic threshold of VCAM-1 was 1 443.3 μg/L，and that of activin A was 550.7 ng/L.Survival analysis found that MM patients with VCAM-1>1 443.3μg/L had significantly lower cumulative survival rate（χ2=17.105，P<0.001）.And MM patients with activin A> 550.7 ng/L had significantly lower cumulative survival rate（χ2=15.379，P<0.001）.Conclusion　Both elevated VCAM-1 and activin A in the tumor microenvironment are related to the pathological process of nephropathy，anemia and bone disease，and together participate in the progression of MM，suggesting that they may become a new target for anti-MM therapy in the future.


Hemodynamic Changes in Patients with High-altitude Pulmonary Edema　

SHI Jianguo，JI Huaqing，CHEN Xianggui，FU Changhuai，XIAN Wen

2021, 24(17):  2192-2197.  DOI: 10.12114/j.issn.1007-9572.2021.00.473

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Background　High-altitude phlmonary edema（HAPE）is a severe acute altitude illness that potentially threatens the life，which is increasingly studied，and the treatment outcome of it is getting better．In China，there are studies on invasive hemodynamic monitoring of HAPE，with rare cases and limited cardiac indices，but there are no studies about non-invasive hemodynamic monitoring，blood flow，cardiac preload and afterload of HAPE cases．Objective　To study the hemodynamic changes of patients with HAPE，providing a theoretical basis for the treatment of this disease．Methods　Twenty-two patients with HAPE were selected from Emergency Medical Center，Qinghai Provincial Traffic Hospital from February 2016 to October 2019，and were compared with 20 healthy volunteers living in the local area．Indices such as serum pH value，oxygen saturation（SaO2），partial pressure of carbon dioxide（PaCO2），lactic acid（Lac），heart rate（HR），cardiac output（CO），cardiac index（CI），stroke volume（SV），total peripheral resistance（TPR），TPR index，absolute value of CO（△CO），absolute value of stroke volume（△SV），inferior vena caval diameter，and inferior vena cava respiratory variability of the control group were compared with pre-and post-treatment levels of these indices of HAPE group．Central venous pressure（CVP），central venous oxygen saturation（ScvO2），and central venous-to-arterial partial pressure of carbon dioxide difference（Pcv-aCO2）in HAPE group were compared before and after treatment．Results　Compared with the control group，pre-treated HAPE group had higher average serum pH value and Lac，and lower average SaO2 and PaCO2（P<0.05）．Moreover，pre-treated HAPE group had greater average HR，TPR，TPR index and inferior vena caval diameter and less average CO，CI，SV，△CO，△SV and inferior vena cava respiratory variability（P<0.05）．Post-treated HAPE group showed similar levels of HR，CO，CI，SV，TPR，TPR index，△CO，△SV，inferior vena caval diameter and inferior vena cava respiratory variability to the control group（P>0.05）．Compared to baseline，post-treatment levels of HR，TPR，TPR index and inferior vena caval diameter decreased，and CO，CI，SV，△CO，△SV and inferior vena cava respiratory variability increased in the HAPE group（P<0.05）．Moreover，post-treatment levels of CVP and Pcv-aCO2 decreased and ScvO2 increased in the HAPE group（P<0.05）．Conclusion　The increased cardiac preload and afterload may lead to heart failure in HAPE patients with hemodynamic manifestations of reduced CO and increased peripheral vascular resistance．


Predictive Values of Blood and Urine Analyses for Renal Colic and Appendicitis　

CHEN Xiaobing，WU Guichang

2021, 24(17):  2198-2201.  DOI: 10.12114/j.issn.1007-9572.2021.00.486

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Background　Appendicitis and renal colic are two common causes of acute non-traumatic abdominal pain.Whether they can be diagnosed by common laboratory blood and urine analyses has become a focus of medical institutions with limited medical resources.Objective　To explore the predictive value of blood and urine analyses for renal colic and appendicitis.Methods　From January to December 2019，117 patients with a definite diagnosis of appendicitis or renal colic were recruited from The Sixth Affiliated Hospital of Sun Yat-sen University.General clinical data，results of laboratory blood and urine analyses were collected.Laboratory blood indicators〔white blood cell（WBC） count，red blood cell（RBC） count，neutrophil（NEUT） count，neutrophil percentage（NEUT%），ratio of WBCs to RBCs〕，and urine indicators〔WBC count，RBC count and ratio of WBC count to RBC count in urine〕 were compared between appendicitis and renal colic patients，and the predictive value of indicators with significant intergroup differences for renal colic and appendicitis was estimated using the receiver operating characteristic（ROC） curve analysis.Results　Appendicitis and renal colic patients demonstrated no significant differences in mean WBC count，RBC count and NEUT count，NEUT% and ratio of WBC count to RBC count（P>0.05）.But appendicitis patients had lower mean RBC count and WBC count in urine，and higher ratio of WBC count to RBC count in urine（P<0.05）.So the ROC curve for estimating the predictive value of RBC count，WBC count，and ratio of WBC count to RBC count in urine for renal colic was plotted and the analysis revealed that the AUC of RBC count in urine was 0.921〔95%CI（0.877，0.964），P<0.01〕，with 0.892 sensitivity，0.864 specificity when the optimal cut-off value was chosen as 14.52/μl；the AUC of WBC count in urine was 0.705〔95%CI（0.628，0.782），P<0.01〕，with 0.486 sensitivity，0.864 specificity when the optimal cut-off value was chosen as 16.5/μl.The ROC curve for estimating the predictive value of RBC count，WBC count and ratio of WBC count to RBC count in urine for appendicitis was plotted and the analysis demonstrated that the AUC of ratio of WBC count to RBC count in urine was 0.742〔95%CI（0.662，0.822），P<0.01〕，with 0.838 sensitivity，0.606 specificity when the optimal cut-off value was chosen as 0.922.Conclusion　RBC count，WBC count in urine may have good diagnostic value for renal colic，and the ratio of WBC count to RBC count in urine may have good diagnostic value for appendicitis.


Pediatric Healthcare Providers' Awareness of Dyslipidemia Incidence in Children and Adolescents and Willingness to Get Their Child（ren） Screened for Lipid Level：a Survey from Beijing　

YAN Hui，ZHAO Jie，LIU Ying，LI Xueying，ZHANG Xin，QI Jianguang

2021, 24(17):  2202-2206.  DOI: 10.12114/j.issn.1007-9572.2021.00.479

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Background　Dyslipidemia is a major cause of atherosclerosis.The incidence of dyslipidemia in Chinese children is rising recently.As a basis for early detection，correct diagnosis and treatment of childhood dyslipidemia，and a key to developing children's appropriate dietary habit and healthy lifestyle，pediatric healthcare providers and parents' appropriate awareness levels of dyslipidemia play an important role in early detection，prevention and control of dyslipidemia in childhood and adolescence.Objective　To explore Beijing pediatric healthcare providers' awareness of dyslipidemia incidence in childhood and adolescence and their willingness to get their child（ren） screened for lipid level，providing a reference for early detection，prevention and control of dyslipidemia in children and adolescents.Methods　A questionnaire survey was conducted among pediatric healthcare providers with a child or children younger than 20 years who attended Beijing Projects for Comprehensive Early Childhood Development and Scientific Rearing from April to September 2019，mainly focusing on their awareness levels of dyslipidemia incidence in childhood and adolescence and willingness to get their child（ren） screened for lipid level，specifically including their child（ren）'s gender and age，awareness of dyslipidemia incidence in children and adolescents，residential area（rural or urban），workplace，occupation，family history of early-onset cardiovascular and cerebrovascular diseases in first-and second-degree relatives，awareness level of lipid in their child（ren） and willingness to get him（them） screened for lipid level，as well as education level of their own and their spouse.Those who chose “children have a dyslipidemia incidence greater than 5%”，and those who chose “children have a dyslipidemia incidence less than 5%” or “children have unstable lipid level” were assigned to correct and incorrect knowledge groups，respectively.Multivariate Logistic regression analysis was used to explore the influencing factors of pediatric healthcare providers' knowledge of dyslipidemia in children and adolescents.Results　There were 247 cases（46.2%） in correct knowledge group，and 288（53.8%） in incorrect knowledge group〔including 109（20.4%） and 179（33.5%） who chose “children have a dyslipidemia incidence less than 5%” or “children have unstable lipid level”〕．Two groups had significant differences in workplace and education level（P<0.05）.Multivariate Logistic regression analysis showed that education level was associated with awareness of dyslipidemia in children and adolescents （P=0.042）.Of the respondents，the rates of knowing their child（ren）'s blood lipid level，knowing the importance of screening for lipid level and willing to get their child（ren） screened for lipid level were 8.2%（n=45），90.4%，and 95.4%（n=523），respectively.Conclusion　More than half of these pediatric healthcare providers had insufficient knowledge of the incidence of dyslipidemia in children and adolescents.Education level may be associated with their awareness level.The overwhelming majority of them did not know their children's blood lipid levels，but thought that dyslipidemia in children was noteworthy and supported the screening for lipid level in children and adolescents.


Effect of Hyperthermia on M2 Polarization of Macrophages and Invasion and Migration of Lung Cancer Cells：an in Vitro Experimental Study　

RAO Ziqi，LIU Jing，CHEN Binglin，DENG Yongran，LIU Wenqi

2021, 24(17):  2207-2213.  DOI: 10.12114/j.issn.1007-9572.2021.00.518

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Background　Hyperthermia is a safe adjuvant therapy that can suppress the occurrence and progression of tumor cells by inhibiting DNA repair，promoting cell apoptosis and improving immunity．However，little is known about whether hyperthermia can indirectly affect tumor cells by interfering with macrophages．Objective　This study aimed to examine the regulatory efficacy of M2 macrophages on lung cancer cells（LCCs）under in vitro hyperthermia．Methods　This study was implemented from June to December，2019．RAW264.7 cells were stimulated with interferon-γ（INF-γ，10 000 ng/L）+lipopolysaccharide（LPS，100 000 ng/L），and interleukin-4（IL-4，20 000 ng/L）for 72 h to induce M1 and M2 macrophages，respectively．The expression of surface antigens CD86 and CD206 in M1 and M2 macrophages were evaluated by flow cytometry．Secretion levels of IL-10 and IL-12 were measured by ELISA．Then，CCK-8 assay was used to detect the proliferation inhibition of M2 macrophages at 24，48 and 72 h after hyperthermia at different temperatures of 41℃，42℃ and 43℃．Real-time polymerase chain reaction（RT-PCR）and Western blotting were performed to determine the mRNA and protein expression of Arg-1，Fizz-1 and Ym-1 in M0 macrophages，M2 macrophages and M2 macrophages after hyperthermia（42 ℃），respectively．Transwell assay was utilized to measure the invasion and migration abilities of LCCs in LCCs+M2 and LCCs+M2+42℃ hyperthermia groups．Results　IFN-γ+LPS-and IL-4-induced RAW264.7 cells were successfully transformed into M1 and M2 macrophages，respectively．Flow cytometry results showed that the expressions of CD86 and CD206 in M2 macrophages were higher than those in M0 and M1 macrophages（P<0.001）．ELISA results revealed that the secretion level of IL-10 in M2 macrophages was higher than that of M0 and M1 macrophages（P<0.001）．The secretion level of IL-12 in M1 macrophages was higher than that of M0 and M2 macrophages（P<0.001）．Besides，we also found that the inhibition level of macrophages by hyperthermia at 42℃ was higher than that at 41℃ and 43℃（P<0.001）．RT-PCR results showed that M0 macrophages，the mRNA expressions of Ym-1，Arg-1 and Fizz-1 in M2 macrophages were increased（P<0.001）．But the mRNA and protein expressions of Ym-1 and Arg-1 in M2 macrophages were decreased after hyperthermia（42 ℃，P<0.001）．In addition，compared with LCCs+M2 group，hyperthermia（42 ℃）significantly decreased the invasion and migration abilities of LCCs（P<0.001）．Conclusion　In summary，hyperthermia may inhibit the invasion and migration of LCCs by downregulating the mRNA expression of Arg-1 and Ym-1 in M2 macrophages．


Interpretation of the Canadian Stroke Best Practice Recommendations：Mood，Cognition and Fatigue following Stroke　

WANG Meijie，DENG Yufang，ZHOU Xiang，CUI Xiaomin，YAO Zhuoya，LIU Fangli

2021, 24(17):  2214-2217.  DOI: 10.12114/j.issn.1007-9572.2021.00.449

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In February 2019，the Canadian Stroke Consortium updated the 6th edition of Canadian Stroke Best Practice Recommendations（CSBPR） for Mood，Cognition and Fatigue following Stroke based on the 2015 edition，with supplements and improvements for the best practice recommendations，screening and assessment，and treatment for post-stroke depression，cognitive impairment，and fatigue.And a new section，named clinical considerations has been added to each area where evidence is insufficient，representing recommendations derived from weaker evidence and/or expert consensus-based practices.In the depression section，new evidence has been included，suggesting that prophylactic use of antidepressants is effective in some stroke patients.In addition，information on assessment tools for screening for vascular cognitive impairment and management of post-stroke fatigue has been updated.Given that there are no specific guidelines or consensus on post-stroke depression，cognitive impairment，and fatigue in China，we interpreted this edition of the CSBPR，hoping to provide a scientific basis for Chinese care providers to deliver standardized stroke management to improve the patient outcomes.
Stroke；Depression；Cognition；Fatigue；Evidence-based practice；Canada


Interpretation of Systemic Sclerosis and the COVID-19 Pandemic：World Scleroderma Foundation Preliminary Advice for Patient Management　

CUI Jiehan，YANG Lin，WANG Xiaoping，HE Jingjing，PENG Xiaoxin，FENG Xing，MA Jun，LIU Aijing

2021, 24(17):  2218-2223.  DOI: 10.12114/j.issn.1007-9572.2021.00.445

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Currently，COVID-19 continues to overwhelmingly hit almost all the countries of the world．It is noteworthy that patients with systemic sclerosis are considered to be a group at risk for disease deterioration and even death when they get infected COVID-19 due to the co-morbidity of interstitial lung disease and widespread use of glucocorticoids and immunosuppressive agents．In this case，the World Scleroderma Foundation put forward recommendations for the management of patients with SSc．We introduced and interpreted these recommendations，with a summary of present treatment strategies for SSc patients with COVID-19，aiming to provide more options for clinical management of these patients．
Scleroderma，systemic；COVID-19；Systemic sclerosis；Interstitial lung disease；Treatment


Recent Advances in the Relationship between Plasma Triglyceride/High-density Lipoprotein Cholesterol Ratio and Diabetic Complications　

YAO Weilie，YAN Yaqing，OU Dianqiang，TANG Ruizheng，LI Guiping

2021, 24(17):  2224-2229.  DOI: 10.12114/j.issn.1007-9572.2021.00.419

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As an important public health issue，diabetes and its associated complications seriously affect the patients' quality of life，and impose a serious burden on society and economy.Increasing dyslipidemia prevalence in diabetics and the key role of abnormal lipid metabolism in the development of diabetic complications have attracted increasing attentions.Among the research topics of lipid with diabetes，triglyceride/high-density lipoprotein cholesterol（TG/HDL-C）ratio and diabetes is a clinical focus.Available studies have found that TG/HDL-C ratio plays a vital role in the development of diabetes.We reviewed recent advances in the relationship between TG/HDL-C ratio and diabetic complications. it is found that there is a correlation between TG/HDL-C ratio and diabetic complications，whether it is microvascular complications and macrovascular complications. However，only from the current research，there is no unified standard between TG/HDL-ratio and diabetes specific complications，and further research is needed.


Research Progress in the Prevention and Treatment of Type 1 Diabetes Mellitus Based on Intestinal Flora and Its Metabolite Short-chain Fatty Acids　

SONG Chaojie，ZHANG Xiaoli，CHEN Huanhuan

2021, 24(17):  2230-2235.  DOI: 10.12114/j.issn.1007-9572.2021.00.085

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Type 1 diabetes mellitus is a chronic autoimmune disease in which directed destruction of pancreatic β cell mediated by T lymphocytes.It is more common in children and adolescents.Studies have shown that the intestinal flora and its metabolites short-chain fatty acids play an important role in the prevention and treatment of T1DM.The regulation of intestinal flora will provide new ideas and approaches for the prevention and treatment of T1DM.This article reviews the research progress of the intestinal flora and its metabolites SCFAs in the prevention and treatment of T1DM and explors the current research status of the T1DM improvement by SCFAs，dietary fiber，probiotics and prebiotics，intestinal flora transplantation and Chinese medicine treatment，which providing reference for clinical application.


Clinical Diagnostic and Therapeutic Perspectives in Primary Care Practice：a Case Study of Abnormal Leucorrhea　

WU Qiuping1，ZHENG Ruoheng2，WANG Jing3*

2021, 24(17):  2236-2240.  DOI: 10.12114/j.issn.1007-9572.2020.00.540

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We reported the diagnostic process of a case of abnormal leucorrhea using John Murtagh's safe diagnostic strategy-a method of five clinical questions was adopted：（1）What most common diseases can cause abnormal leucorrhea？（2）What serious problems can not be ignored？（3）Could the patient have an underlying disease？（4）What conditions are easily missed？（5）Is the patient trying to say something？ The patient was diagnosed with gonorrhea with physiological response to stress based on a comprehensive analysis of medical history，physical examination，auxiliary examination and consultation with the safe diagnostic strategy as well as RICE（Reason-Idea-Concern-Expectation）skills.The merits derived from this diagnosis are as follows：（1）When encountering a abnormal leucorrhea patient with psychological problems，besides giving medication for somatic problems，the general practitioner should attentively listen to the patienttrategy as well as RICE（Reason-Idea-Concern-Expectation）skills. The merits derived from this diagnosis are as c support by the patient.（2）Just like the auscultation with a stethoscope，by the consultation using RICE skills，the causes of healthcare seeking can be acquired，and the patient's current health problems can be identified by using the bio-psycho-social approach，showing the features of whole-person care.


Clinical Diagnostic and Therapeutic Perspectives in Primary Care Practice：a Case Study of Abdominal Pain　

CHAI Xichen，WANG Jing2

2021, 24(17):  2241-2244.  DOI: 10.12114/j.issn.1007-9572.2021.01.205

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This article introduces the encountering of a patient with abdominal pain by a general practitioner general using John Murtagh's safe diagnostic strategy，which consists of five questions：（1）What are the common causes of abdominal pain？（2）What severe disorders must not be overlooked？（3）What conditions that may be associated with abdominal pain are often missed？（4）Could the patient have a concealing illness？（5）Is the patient attempting to say something？After detailed consultation，comprehensive physical examination and laboratory test，the patient was diagnosed with centrally mediated abdominal pain syndrome.The revelation of this case is：（1）Abnormal pain associated with a life-threatening organic lesion should be differentiated from simple abdominal pain first.（2）Using comprehensive clinical perspectives in primary care practice may reduce the possibilities of missed diagnosis and misdiagnosis，and find the hidden causes of gastrointestinal functional diseases.Through eliminating the unnecessary concerns of patients，adjusting treatment，and delivering home-based health care，satisfactory results may be achieved.