Chinese General Practice

Application Prospect and Renal Outcomes of Novel Antidiabetic Agents in Patients with Type 2 Diabetes　

YANG Guangran

2021, 24(18): 2245-2250. DOI: 10.12114/j.issn.1007-9572.2021.00.452

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Diabetic nephropathy，a common microvascular complication of type 2 diabetes，has become one of the common causes of end-stage renal disease in China.Several randomized controlled studies conducted in recent years found that，some novel anti-diabetic agents including dipeptidyl peptidase-4 inhibitor，sodium-glucose cotransporter 2 inhibitor and glucagon-like peptide-1 receptor agonist，have significant renal protection outcomes beside hypoglycemia effect in patients with type 2 diabetes，moreover sodium-glucose cotransporter 2 inhibitor and glucagon-like peptide-1 receptor agonist were recommended by clinical guideline or consensus in the prevention and delay of diabetic kidney disease.This paper summarized and analyzed the outcome of novel anti-diabetic agents in renal protection outcomes in patients with type 2 diabetes based on recent clinical guidelines and related randomized controlled trials，in order to provide a reference for the better application of novel anti-diabetic agents in practice.

New Developments in Antidiabetic Agents from the Perspective of Cardiovascular Outcomes　

ZHANG Xuane，ZHOU Zunhai

2021, 24(18): 2251-2259. DOI: 10.12114/j.issn.1007-9572.2021.00.447

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Patients with diabetes mellitus have a significantly higher risk of developing cardiovascular disease（CVD），and CVD is the leading cause of death in adults with type 2 diabetes mellitus（T2DM）.Traditional hypoglycemic drugs，despite their significant hypoglycemic efficacy，lack good evaluation of cardiovascular outcomes.In contrast，new hypoglycemic drugs have undergone large clinical trials before being approved，to ensure their therapeutic efficacy and safety for cardiovascular outcomes.This review introduces the latest clinical developments in traditional and new antidiabetic medications in terms of cardiovascular outcomes （that is，cardiovascular safety），and proposes that some new drugs，such as sodium-glucose cotransporter-2 inhibitors and glucagon-like peptide-1 receptor agonists，have demonstrated good cardiovascular protection，and their therapeutic roles have been raised in multiple guidelines，becoming important therapeutic options for adults with T2DM and CVD.This review is expected to provide more diabetes treatment strategies for clinicians.

Community Practice of the Integration of Sports and Medicine in China：Typical Models，Realistic Dilemmas and Development Paths　

WANG Yijie，WANG Shiqiang，LI Dan1，XU Zhihan，WANG Shaokun

2021, 24(18): 2260-2267. DOI: 10.12114/j.issn.1007-9572.2021.00.512

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The integration of sports and medicine integrates the tangible and intangible resources of the health system and the sports system through policy guidance，uses the theories and methods of medicine and sports science to achieve the purpose of enhancing people's physical fitness and maintaining people's health.As a key part in the construction of sports medical integration，community is not only the foothold but also the focus of sports medical integration.This paper summarizes and analyzes the practice of community sports medical integration in China，analyzes the current difficulties of community sports medical integration service，and puts forward the further improvement path.At present，the integration of community sports and medicine in China has formed three types of service models based on government enterprise cooperation，community sports club and community fitness monitoring center.However，there are still some problems，such as insufficient awareness of the concept of sports and medicine integration，lack of long-term cooperation mechanisms，shortage of talents，lagging platform construction，and insufficient participation of social forces.In view of this，in order to further promote the deep integration of community sports and medicine，it is urgent to enhance the cognition of community sports and medicine integration，establish the system and mechanism of the collaborative governance of multiple entities in the community，strengthen the construction of sports and medicine professionals，build a big data service platform，and mobilize different social forces to participate in the construction of community sports and medicine integration，so as to speed up the process of community sports and medicine integration service and meet the health needs of the broad masses of people health needs.

Health Promotion by Integrating Sports and Medicine in Japan：Experience and Implications　

HUANG Jing，WANG Shiqiang，LIU Qing

2021, 24(18): 2268-2274. DOI: 10.12114/j.issn.1007-9572.2021.00.511

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The integration of sports and medicine is an effective approach to alleviating accelerated aging and sustained high prevalence of chronic diseases in China. Japan has developed a set of standardized health promotion systems by integrating sports and medicine after years of exploration and practice. By further investigation，it has been found that Japan's delivery models for health promotion can be classified into welfare type，integrated medical care and commercial types. In the process of advancing the integration of sports and medicine，Japan has formed a multi-party collaborative health promotion system with clear determination of each party's duties and responsibilities，developed a deeply rooted health promotion concept of integrated sports and medicine，a continuous education program and a social security system for sports medicine professionals，and a sound sports medicine industry. To advance the integration of sports and medicine in China，in consideration of Japan's experience，we put forward the following recommendations: clearly defining the duties of the government，guiding the collaboration of multiple providers of sports medicine services，popularizing the health promotion concept of integrating sports and medicine during the basic education，modifying the training system for sports medicine professionals，establishing multidisciplinary and interdisciplinary teams，developing a consumer market of sports medicine services，and establishing various health promotion programs.

Changes in Glomerular Filtration Rate and Urinary Albumin in Type 2 Diabetes in a Community　

LU Changan，WANG Jian，LUO Jinbing，XIA Lijun，HAO Shiwei，ZHAO Ruiquan，WANG Meng，SONG Fei，ZHANG Mingbao，YANG Guangran

2021, 24(18): 2275-2280. DOI: 10.12114/j.issn.1007-9572.2021.00.478

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Background　Estimated glomerular filtration rate （eGFR） and urinary albumin excretion rates （UAER） are indicators of kidney function and kidney damage.It is still not completely clear whether the changes of these two indicators in type 2 diabetes patients are consistent.Objective　To follow up the changes of eGFR and UAER levels in patients with type 2 diabetes for 5 years，and to analyze the related factors.Methods　Patients with type 2 diabetes in Tuanjiehu Community，Chaoyang District，who were involved in the Beijing Community Diabetes Study from March 2013 to December 2018，were selected，and they were followed up annually for 5 years.The follow-up indicators include duration of diabetes，body mass index （BMI），triglyceride （TG），total cholesterol （TC），high density lipoprotein cholesterol （HDL-C），low density lipoprotein cholesterol （LDL-C），glycosylated hemoglobin （HbA1c），systolic blood pressure （SBP），diastolic blood pressure （DBP），eGFR and UAER.The eGFR progression was defined as decreased eGFR combined with developed chronic kidney disease （CKD） stage，and UAER progression was defined as newly present proteinuria or progression from microalbuminuria to macroalbuminuria.Results　A total of 66 patients were followed up annually from 2013 to 2018 with completed data of UAER and eGFR.The results showed that the differences in DBP，UAER and eGFR levels of patients at baseline and 5 years of follow-up were statistically significant （P<0.05）.According to the changes of eGFR and UAER at the 5th year of follow-up，37 cases （56.1%） of 66 patients had eGFR progression and 10 cases（15.2%） had UAER progression.The changes of eGFR and UAER were consistent in 37 patients（56.1%），while the progression of UAER and eGFR was not parallel in 29 patients（43.9%）.There were no significant differences in BMI，age，TG，TC，HDL-C，LDL-C，HbA1c，SBP，and DBP between the UAER and eGFR progression parallel group and UAER and eGFR progression non-parallel group （P>0.05）.The duration of diabetes in UAER and eGFR progression parallel group was longer than that in UAER and eGFR progression non-parallel group（P<0.05）.Conclusion　Through a 5-year follow-up of patients with type 2 diabetes，it was found that eGFR gradually decreased and UAER gradually increased with the extension of diabetes duration.In 43.9% of patients，the UAER progression and eGFR progression were not parallel，suggesting that during clinical observation of kidney damage in diabetic patients，both eGFR and UAER examinations should be performed simultaneously，especially in patients with diabetic duration less than 10 years.

New Value of CHA2DS2-VASc Scoring System：Screening for Atrial Fibrillation and Ischemic Stroke in Community-living Elderly Population　

YANG Hong，LIU Jun，FENG Zhigang，GAO Dayong，SONG Weihua

2021, 24(18): 2281-2284. DOI: 10.12114/j.issn.1007-9572.2021.00.501

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Background　The elders are a high-risk population for atrial fibrillation（AF）.Improving the level of accurately screening for AF among the elderly in the community can help to reduce the risk of AF-related stroke.Objective　To examine whether the CHA2DS2-VASc scoring system is feasible for the screening of AF and ischemic stroke in the elderly in the community.Methods　The long-term older residents in a community，Beijing's Haidian District，were enrolled from October 2019 to March 2020.Medical history（including basic characteristics，and morbidity of common diseases），and results of normal 12-lead electrocardiogram were collected.Ischemic stroke risk was estimated by using the CHA2DS2-VASc scoring system.Results　A total of 328 olders were enrolled，including 40（12.2%） with AF and 60（18.3%） with ischemic stroke detected by the screen，with a mean CHA2DS2-VASc score of（3.2±1.5） points.Participants with AF had higher mean CHA2DS2-VASc score than those without（P<0.05）.The mean CHA2DS2-VASc score of those with ischemic stroke was higher than that of those without（P<0.05）.The AF prevalence in participants with CHA2DS2-VASc score from 0 to 6 was 0，4.8%（2/42），3.7%（2/54），14.6%（12/82），15.8%（12/76），8.3%（4/48），and 40.0%（8/20），respectively，showing a gradual increase with the CHA2DS2-VASc score（rs=0.248，P<0.001）.The ischemic stroke prevalence in participants with CHA2DS2-VASc score from 0 to 6 was 0，4.8%（2/42），11.1%（6/54），12.2%（10/82），18.4%（14/76），45.8%（22/48），and 30.0%（6/20），respectively，demonstrating a gradual increase with the CHA2DS2-VASc score（rs=0.296，P=0.001）.Conclusion　The CHA2DS2-VASc scoring system could be used to screen for AF and ischemic stroke in community-living elderly population.The olders with a higher CHA2DS2-VASc score may have a higher AF or stroke prevalence.

Association of Thyroid Autoantibody and Anti-glutamic Acid Decarboxylase Antibody in Physical Examinees　

LI Jing，DENG Chuiwen，XU Tengda

2021, 24(18): 2285-2290. DOI: 10.12114/j.issn.1007-9572.2021.00.481

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Background　Autoimmune thyroid disease and autoimmune diabetes often exist simultaneously.The frequency of thyroid autoantibody（TA） is higher in autoimmune diabetes patients.Objective　To investigate the association of anti-glutamic acid decarboxylase autoantibody（anti-GADA） and TA in Chinese physical examinees.Methods　The PUMCH Health Management database was searched for physical examinees who had their anti-GADA and TA tested from 2012 to 2015.The results of anti-GADA，thyroid stimulating hormone（TSH），thyroid peroxidase antibody（TPOAb） and thyroglobulin antibody（TgAb）and other data were collected.TA positive was defined as TPOAb positive or TgAb positive.Prevalence of anti-GADA was compared between TA positive and TA negative subjects，and also between diabetic and nondiabetic subjects.Clinical characteristics were compared among subjects with anti-GADA negative，anti-GADA low titer and anti-GADA high titer.Risk factors of TA positivity，TPOAb positivity and TgAb positivity were analyzed by multivariate Logistic regression.Results　There were 36 048 eligible participants totally，among whom 5 000 （13.9%） were TA positive〔3 321（9.2%） were TPOAb positive；3 552（9.9%） were TgAb positive〕 and 31 048（86.1%） were TA negative；2 600 （7.2%） met the diagnostic criteria of diabetes and 33 448 （92.8%） did not；185 （0.5%） were anti-GADA positive and 35 863 （99.5%） were anti-GADA negative.The prevalence of anti-GADA in TA positive subjects （n=51，1.0%） was significantly higher than that in TA negative subjects （n=134，0.4%）（χ2=29.203，P<0.001）.The prevalence of TA positivity was lower in diabetic subjects（n=280，10.8%）than that in nondiabetic ones （n=4 720，14.1%）（χ2=22.558，P<0.001）.The prevalence of anti-GADA is higher in diabetic subjects（n=31，1.2%）than that in nondiabetic ones （n=154，0.5%）（χ2=25.310，P<0.001）.The frequency of TA raised from anti-GADA negative group to anti-GADA low titer group to anti-GADA high titer group （13.8%，23.7%，39.1%，respectively，P<0.05）.In the multivariate Logistic regression，age〔OR=1.015，95%CI（1.012，1.018）〕，sex〔female：OR=3.483，95%CI（3.259，3.723）〕，diabetes〔yes：OR=0.837，95%CI（0.731，0.958）〕，anti-GADA〔low titer：OR=1.900，95%CI（1.266，2.853）；high titer：OR=4.259，95%CI（2.260，8.025）〕were risk factors for presence of TA（P<0.05）.Conclusion　Anti-GADA has a low prevalence in Chinese adult physical examinees.The presence of TA is associated with GADA positivity.

Therapeutic Efficacy of Low-carb Breakfast in New Town Residents with Type 2 Diabetes　

DING Shaoyu，JU Changping，YU Xingxing，WEI Xiaoxia，WANG Tianyun，CUI Lei，CHEN Weixia，YANG Bingquan

2021, 24(18): 2291-2296. DOI: 10.12114/j.issn.1007-9572.2021.00.464

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Background　Diet management is a basic treatment for diabetics，an increasing population in China.Although low-carb diet is beneficial to improving diabetics' glycolipid metabolism，their long-term adherence to this diet is poor，since strict carbohydrate control is significantly different from the traditional diet.Objective　To investigate the effect of low-carb breakfast in the treatment of type 2 diabetes mellitus （T2DM） in new town residents.Methods　By use of convenience sampling，90 new town residents with T2DM were sampled from Dongping Health Center of Lishui District，Nanjing from August 2018 to March 2019 and were equally divided into the experimental group and control group by flipping a coin.Both groups had lunch and supper without restriction of carbohydrates，but the control group had breakfast with health education based on the 2016 Chinese Dietary Guideline（hereafter referred to as the Guideline），while the experimental group had low-carb breakfast.Food volume was estimated with a standard bowl recommended by the Guidelines and a map for quantifying dietary intake.Fasting plasma glucose （FPG），glycosylated hemoglobin （HbA1c），total cholesterol （TC），triglyceride，high-density lipoprotein cholesterol （HDL-C），low-density lipoprotein cholesterol （LDL-C），blood glucose 2 hours after eating breakfast，and the score of Self-Efficacy for Diabetes（SED） were measured at baseline，3 and 6 months after intervention，respectively.Diet adherence was estimated at 2 weeks，3 and 6 months after intervention，respectively.Results　Except 5 dropouts （5.6%），including 2 in the control group due to cerebral infarction recurrence or troubles with diet control，and 3 in the experimental group due to relocation，working outside，or refusal of follow-up，other cases were included for final analysis.After 3 months of intervention，the blood glucose two hours after eating breakfast of the experimental group was lower than that of the control group （P<0.05）.Compared to baseline，the blood glucose two hours after eating breakfast and HbA1c in the control group decreased significantly after 3 and 6 months of intervention （P<0.05）；the blood glucose two hours after eating breakfast，HbA1c，HDL-C，LDL-C，and triglyceride in the experimental group showed significant decrease after 3 months of intervention（P<0.05），and after 6 months of intervention，these 5 indicators still demonstrated a significant decrease，furthermore，FPG also obtained a notable decrease （P<0.05）.After 6 months of intervention，the SED score of the experimental group was higher than that of the control group （P<0.05）.The SED scores increased significantly in both groups after 3 and 6 months of intervention （P<0.05）.Six-month intervention benefited the SED score of the experimental group more significantly than 3-month intervention （P<0.05）.The diet adherence of the two groups showed a successive increase at 2 weeks，3 and 6 months after intervention （P<0.05）.Conclusion　Both two types of breakfast could effectively improve the glycolipid metabolism，self-efficacy and dietary adherence of this group，but low-carb breakfast is more superior in terms of improving glycolipid metabolism and self-efficacy.

Mediating Effect of Abnormal TCM-based Constitution on the Association between Sedentary Behavior and Cognitive Frailty in Elderly People　

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

2021, 24(18): 2297-2302. DOI: 10.12114/j.issn.1007-9572.2021.00.450

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Background　Sedentary behavior is associated with mild cognitive impairment and frailty in elderly people，but the mechanism of association is still unclear.TCM-based constitution theory may provide a new theoretical source for this.Objective　To investigate the mediating effect of abnormal TCM-based constitution on the association between sedentary behavior and cognitive frailty among elderly people.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，the International Physical Activity Questionnaire-Short Form （used to assess sedentary behavior），Constitution in Chinese Medicine Questionnaire（used to assess TCM-based constitution），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 association of sedentary behavior and abnormal TCM-based constitution with cognitive frailty.Results　In all，1 091 cases（96.55%） who returned responsive questionnaires were included for final analysis.Among the respondents，358（32.8%）had sedentary behavior and other 733（ 67.2%）did not；448 （41.1%） had balanced TCM-based constitution while 643 （58.9%） had abnormal；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，marital status，education level，and prevalence of at least one chronic disease，sedentary behavior，and TCM-based constitution（P<0.05）.Multivariate Logistic regression analysis showed that sedentary behavior〔OR=1.914，95%CI（1.193，3.072）〕and abnormal TCM-based constitution 〔OR=6.501，95%CI（3.035，13.923）〕were associated with the onset of cognitive frailty （P<0.05）.Sedentary behavior was associated with TCM-based constitution 〔OR=1.463，95%CI（1.111，1.927）〕（P<0.05）.Mediation analysis found that there was mediating effect of abnormal TCM-based constitution on the association between sedentary behavior and cognitive frailty（Z=2.323，P<0.05），accounting for 11.22% of the total effect.Conclusion　Sedentary behavior may not only directly affect cognitive frailty，but also indirectly impact it through abnormal TCM-based constitution.In view of this，we should further highlight the role of differentiation and regulation of TCM-based constitution in the prevention and intervention of cognitive frailty.

Expression of Rectal Mucosal Sensory Receptors in Patients with Idiopathic Pruritus Ani　

XU Li，DAI Qun，HE Xiaokang，LI Min

2021, 24(18): 2303-2308. DOI: 10.12114/j.issn.1007-9572.2021.00.471

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Background　It is not clear for what reason causes anal moisture and leakage to stimulate the sensory nerve endings of perianal skin and form a vicious circle of pruritus and scratching so far，but research has shown that perianal moisture and leakage may be related to the abnormity of rectal sensory receptors besides perianal flora.Objective　To analyze the expression of rectal mucosal sensory receptors in patients with idiopathic pruritus ani，including transient receptor potential vanilloid type 1（TRPV1），5-HT and P2RX2 polyclonal antibody.Methods　Participants were recruited from the First Affiliated Hospital of Zhejiang Chinese Medical University during January 2017 to June 2019，including 30 outpatients and inpatients with idiopathic pruritus ani（pruritus group）from Departments of Anorectal Surgery and Gastroenterology，and 29 physical examinees（healthy group）.Immunohistochemical method and real-time fluorescence quantitative polymerase chain reaction（PCR）were used to detect the expression of TRPV1，5-HT and P2RX2 polyclonal antibody in rectal mucosal tissue.Results　Immunohistochemical results showed that，TRPV1 and 5-HT were positively expressed but P2RX2 polyclonal antibody was negatively expressed in rectal mucosal tissue of pruritus group.MOD value and HIS score of TRPV1 and 5-HT in pruritus group were significantly higher than those in healthy group（P<0.01）.But there was no significant difference of MOD value or HIS score of P2RX2 polyclonal antibody between the two groups（P>0.05）.Real-time fluorescence quantitative PCR results showed that，the pruritus group had significantly higher relative expression quantity of mRNA of TRPV1 and 5-HT than healthy group（P<0.01），but there was no significant intergroup difference of relative expression quantity of mRNA of P2RX2 polyclonal antibody between the two groups（P>0.05）.Conclusion　The expression of rectal mucosal sensory receptors including TRPV1 and 5-HT significantly increase in patients with idiopathic pruritus ani，and the over-expression of TRPV1 and 5-HT may be related to reduced rectal compliance and increased rectal sensory threshold，which may be due to sensitization or phenotypic alteration of transmitters in rectal mucosal sensory transmission.

Value of Serum Advanced Glycation End Product Peptides in Early Screening for Type 2 Diabetes in Uygur Population　

JIMILANMU·Maimaitiming，MUNILA·Abudunaiyimu，WANG Xinling，ABULAITI·Aizezi，REZIWANGULI·Wusiman，MA Yanrong，ZHANG Kaidi

2021, 24(18): 2309-2313. DOI: 10.12114/j.issn.1007-9572.2021.00.463

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Background　In view of increasing incidence and decreased age of onset of type 2 diabetes mellitus（T2MD），early screening for T2MD for getting a timely diagnosis is becoming ever-growing important.Some studies have found that serum advanced glycation end product peptides（AGE-P） are superior to glycosylated hemoglobin （HbA1c） in terms of early screening for T2MD.Objective　To explore the value of serum AGE-P in early screening for T2MD in Uygur population.Methods　A total of 1 100 Uygur health check-up examinees were recruited from People's Hospital of Xinjiang Uygur Autonomous Region from February 2018 to December 2019 and divided into diabetic group （n=75） and normal glucose tolerance group （n=1 025） by the results of an OGTT.Intergroup comparisons were performed in terms of age，waist circumference，BMI，diastolic blood pressure，systolic blood pressure，fasting plasma glucose （FPG），2-h postprandial plasma glucose （2 hPG），HbA1c，AGE-P，total cholesterol （TC） and triglyceride，high-density lipoprotein cholesterol （HDL-C） and low-density lipoprotein cholesterol （LDL-C），urea nitrogen，uric acid and serum creatinine.ROC curves of serum FPG，2 hPG，HbA1c and AGE-P in screening for T2DM were plotted.Results　Compared to those with normal glucose tolerance，diabetic cases had greater average age，and higher average BMI，waist circumference，DBP and SBP （P<0.05）.Moreover，they also demonstrated higher average levels of serum FPG，2 hPG，HbA1c，TC，triglyceride，and LDL-C（P<0.05）.However，serum levels of AGE-P，HDL-C，urea nitrogen，uric acid and serum creatinine were similar in the two groups （P>0.05）.In screening for T2DM，the Youden's index of serum FPG was 0.854，with 88.0% sensitivity and 97.4% specificity，and AUC of 0.957〔95%CI（0.943，0.968），Z=25.718，P<0.001〕.The Youden's index of serum 2 hPG was 0.814，with 82.7% sensitivity and 98.7% specificity，and AUC of 0.937〔95%CI（0.921，0.951），Z=21.222，P<0.001〕.The Youden's index of serum AGE-P was 0.055，with 74.7% sensitivity and 19.8% specificity，and AUC of 0.507〔95%CI（0.477，0.537），Z=0.203，P=0.839〕.Conclusion　The serum AGE-P level did not show a significant increase in Uygur population with T2DM，and it had lower specificity and Youden's index in screening for T2DM.So it is recommended to use traditional indicators，such as FPG and OGTT，instead of AGE-P for screening for T2DM in Uygur population.

Predictive Value of 20-week Ultrasound Scan of Fetal Bowel Diameter for Adverse Pregnancy Outcome　

LI Na，SU Jianqiang，SUN Congxin，ZHANG Yanhong，ZHAO Wei，GENG Xuna，WANG Weijing

2021, 24(18): 2314-2317. DOI: 10.12114/j.issn.1007-9572.2021.00.494

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Background　Fetal bowel abnormalities are associated with various adverse pregnancy outcomes，severely threatening the safety of newborns.Objective　To explore the predictive value of 20-week ultrasound scan of fetal bowel diameter for adverse pregnancy outcomes.Methods　150 women with a singleton pregnancy who underwent 20-week scan by Doppler ultrasound at the Fourth Hospital of Shijiazhuang from January 1，2019 to May 3，2020 were selected，by which 50 cases of fetal bowel dilatation and 100 cases of normal fetal bowel were found.Adverse pregnancy outcomes in this study were defined as polyhydramnios，chromosomal abnormalities，induced labor，stillbirth，fetal skin edema，and premature delivery.The value of this scan in predicting adverse pregnancy outcomes was estimated.The association of the location of fetal bowel diameter dilation and incidence of adverse pregnancy outcomes was examined.And the association of the fetal bowel diameter with the Apgar score was analyzed.Results　In total，47 women had adverse pregnancy outcomes.The 20-week scan demonstrated 93.6% sensitivity，94.2% specificity，97.0% negative predictive value，88.0% positive predictive value，and 94.0% diagnostic accuracy.The 50 cases of fetal bowel dilatation included 23 cases of duodenal dilatation，15 of jejunum and ileum dilatation，and 12 of colon dilatation.Women with fetal duodenal dilatation had higher incidence of polyhydramnios，induced labor，and premature delivery than those with fetal jejunum and ileum dilatation or fetal colon dilatation（P<0.05）.The inner diameter of the fetal duodenum，jejunum and ileum，and colon was negatively correlated with the Apgar score （r= -0.740，-0.721，-0.659，P<0.05）.Conclusion　The 20-week ultrasound scan of fetal bowel diameter may has good predictive value for adverse pregnancy outcomes，such as polyhydramnios，chromosomal abnormalities，induced labor，stillbirth，and premature delivery.Moreover，fetal bowel diameter may be associated with Apgar score.

Preventive Effect of Different Chinese Patent TCM Injections for Activating Blood Circulation and Removing Blood Stasis with Usual Hydration on Contrast-induced Nephropathy：a Network Meta-analysis　

HUANG Yingjie，LIU Jiayue，ZHAN Qunzhang，HUANG Lei，YE Jiajia，ZHANG Yueyao，HE Yuchun，LI Junzhe

2021, 24(18): 2318-2330. DOI: 10.12114/j.issn.1007-9572.2020.00.574

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Background　Many clinical trials have confirmed that a variety of Chinese patent TCM injections for activating blood circulation and removing blood stasis with usual hydration may prevent contrast-induced nephropathy（CIN）to some extent，but there is a lack of systematic review.Objective　To evaluate the effect of different Chinese patent TCM injections for activating blood circulation and removing blood stasis with usual hydration on preventing CIN，providing evidence-based evidence for clinical rational use of such medicines.Methods　Databases including Cochrane Library，EMBase，PubMed，CNKI，SinoMed，CQVI and Wanfang Data were searched for RCTs about different Chinese patent TCM injections for activating blood circulation and removing blood stasis with hydration（test group）versus usual hydration（control group）in preventing CIN from inception to November 2019.Stata 15.0 was used to conduct network meta-analysis.Results　A total of 19 RCTs were included，involving 2 433 patients.The analysis revealed that，the therapies were ranked as follows in terms of effect of decreasing the incidence of CIN：Ligustrazine injection with usual hydration>Xuebijing injection with usual hydration>Ginseng and aconite injection with usual hydration>Danhong injection with usual hydration>Erigeron breviscapus injection with usual hydration>Miltiorrhizae and ligustrazine injection with usual hydration>Miltiorrhizae and ligusticum wallichiiand glucose injection with usual hydration>Shenkang injection with usual hydration>Sofren injection with usual hydration>Miltiorrhizae polyphenolate injection with usual hydration>Yinxingdamo injection with usual hydration> usual hydration.For decreasing the Ccr after CAG/PCI，the ranking results were：Miltiorrhizae and ligusticum wallichiiand glucose injection with usual hydration>Erigeron breviscapus injection with usual hydration>Yinxingdamo injection with usual hydration>Sofren injection with usual hydration>Xuebijing injection with usual hydration>Miltiorrhizae and ligustrazine injection with usual hydration>Ginseng and aconite injection with usual hydration>Danhong injection with usual hydration>usual hydration.For decreasing the Scr after CAG/PCI，the ranking results were：Erigeron breviscapus injection with usual hydration>Miltiorrhizae and ligusticum wallichiiand glucose injection with usual hydration>Ligustrazine injection with usual hydration>Miltiorrhizae and ligustrazine injection with usual hydration>Sofren injection with usual hydration>Yinxingdamo injection with usual hydration>Shenkang injection with usual hydration>Ginseng and aconite injection with usual hydration>Xuebijing injection with usual hydration>Danhong injection with usual hydration>usual hydration.For decreasing the BUN after CAG/PCI，the ranking results were：Ginseng and aconite injection with usual hydration>Miltiorrhizae and ligustrazine injection with usual hydration>Sofren injection with usual hydration>Danhong injection with usual hydration>usual hydration.Conclusion　The available literature evidence indicates that，Ligustrazine injection with usual hydration may be an optimal therapy for decreasing the incidence of CIN；Miltiorrhizae and ligusticum wallichiiand glucose injection with usual hydration may be an optimal therapy for decreasing Ccr after CAG/PCI；Erigeron breviscapus injection with usual hydration may be the best therapy in decreasing Scr after CAG/PCI，and Ginseng and aconite injection with usual hydration may be the best therapy in decreasing BUN after CAG/PCI.

Network Meta-analysis of Effects of Different Statins on Liver Function　

DI Yurong，FENG Yingna，YANG Dahong，HOU Yuli

2021, 24(18): 2331-2341. DOI: 10.12114/j.issn.1007-9572.2021.00.488

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Background　As one of the most commonly used drugs，statins’ adverse reactions，especially hepatotoxicity，have become a growing concern. However，the assessment of the effects of different statins on liver function still varies at present. Objective　To systematically review the effects of different statins on liver function. Methods　We searched electronic databases，including Cochrane Library，PubMed，EMBase and Medline to collect randomized controlled trials （RCTs） about abnormal liver function associated with statins as the intervention from inception to September 10th 2020. Literature review，data extraction，and risk of bias evaluation were performed by two researchers. Stata 14 was used for network meta-analysis. Results　All in all，46 RCTs were included，containing 6 types of Statins as interventions for 54 499 cases，including 21 with atorvastatin，10 with rosuvastatin，10 with simvastatin，7 with pitavastatin，4 with lovastatin，and 3 with pitavastatin. The results of network meta-analysis were as follows: the incidence of liver dysfunction induced by atorvastatin was higher than that caused by rosuvastatin or pravastatin. The incidence of liver dysfunction induced by atorvastatin was higher than that by placebo，so did that induced by rosuvastatin （P<0.05）. The SUCRA value for Statins and placebo ranked from highest to lowest were: placebo（77.2%）>pitavastatin（70.9%）>pravastatin（64.1%）>simvastatin（60.7%）>rosuvastatin （40.4%）>lovastatin（31.6%）>atorvastatin（5.1%）. The incidence of liver dysfunction caused by statins metabolized by CYP450 enzyme was higher than that by placebo（P<0.05）. The ranking results of statins with different metabolic pathways and placebo by SUCRA were: placebo（95.6%）>statins not metabolized by CYP450 enzyme（51.9%）>statins metabolized by CYP450 enzyme（2.6%）. The incidence of liver dysfunction caused by liposoluble statins was higher than that by placebo（P<0.05）. The ranking results of statins with different solubilities and placebo by SUCRA were: placebo（97.4%）>hydrosoluble statins（48.7%）>liposoluble statins （3.9%）. The incidence of liver dysfunction induced by high-intensity atorvastatin was higher than that by medium-intensity pitavastatin，medium-intensity pravastatin，medium-intensity simvastatin，high-intensity rosuvastatin or medium-intensity rosuvastatin（P<0.05）. The incidence of liver dysfunction caused by high-intensity atorvastatin or high-intensity rosuvastatin was higher than that by placebo（P<0.05）. The ranking results of different doses of statins and placebo by SUCRA were: medium-intensity rosuvastatin（76.4%）>medium-intensity pitavastatin（71.6%）>placebo（69.1%）>medium-intensity simvastatin （67.5%）>medium-intensity pravastatin（55.1%）>low-intensity pravastatin（41.7%）>high-intensity rosuvastatin（40.9%）>medium-intensity atorvastatin（37.9%）>low-intensity lovastatin（31.0%）>high-intensity atorvastatin（8.8%）. Conclusion　Liposoluble statins，statins metabolized by CYP450 enzymes and high-dose statins tend to lead to a higher incidence of liver dysfunction. With an analysis of the reports of many fair-quality RCTs，this study may be used as guidance for clinical medication. However，due to some eligible RCTs with low quality，more high-quality RCTs are needed to verify our conclusion.

Development and Verification of Diabetes Mellitus Diagnosis and Treatment Delayed Cognitive Behavioral Intention Scale　

WANG Ruiqi，JIA Honghong，ZHOU Yuqiu

2021, 24(18): 2342-2348. DOI: 10.12114/j.issn.1007-9572.2021.00.472

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Background　Diagnosis and treatment delay is a kind of phenomenon of objective behavior experiencing a series of psychological activities.Understanding the psychology and causes of diagnosis and treatment delay of patients can effectively improve the effectiveness of their treatment，thereby promoting the continuation of patient health and the efficient allocation of medical and health resources.Objective　To compile the Diabetes Mellitus Diagnosis and Treatment Delayed Cognitive Behavioral Intention Scale （DMDBIS），and conduct reliability and validity tests.Methods　The pool of scale entries was formed through literature review combined with semi-structured interviews，based on the theory of planned behavior from January 2016 to February 2017.And then DMDBIS-Ⅱ was formed through expert assessment and pre-testing.280 diabetes patients with diagnosis and treatment delay were selected from the endocrine ward and outpatient clinics of three general hospitals including Daqing Oilfield General Hospital，the Fifth Hospital of Daqing City and the Fourth Hospital of Daqing as samples using the purposive sampling method，and DMDBIS was finally formed through large sample test.In addition，the SPSS 22.0 and Amos 21.0 statistical software were used for data analysis to test the reliability and validity of DMDBIS.Results　The DMDBIS includes 20 items in 5 dimensions，including namely symptom alertness （4 items），diabetes knowledge（6 items），habit reaction style（3 items），disease control（3 items） and factors of hindrance to medical treatment（4 items）.The results of DMDBIS exploratory factor analysis show that the KMO value was 0.810，and Bartlett spherical test χ2=3 305.296（df=190，P<0.001），which indicates that it is suitable for factor analysis.Principal component analysis shows that the cumulative variance contribution rate was 73.966%.Confirmatory factor analysis results show that the goodness-of-fit χ2=351.451，df=160，χ2/df=2.197，the approximation error root mean square （RMSEA）=0.069，the goodness of fit index（GFI）=0.882，comparison fitting index（CFI）=0.941，adjust the goodness of fit index （AGFI）=0.845，value-added adaptation index （IFI）=0.941，the gauge adapter index （TLI）=0.929，gauged adaptation index （NFI）=0.897.DMDBIS reliability tests showed that Cronbach's α coefficient of each factor ranged from 0.840 to 0.956，and Cronbach's α of the total table was 0.799.Conclusion　Collectively，the preliminary developed DMDBIS consists of 5 dimensions and 20 items with good reliability and validity.Therefore，it can provide a scientific measurement tool for diabetes prevention and treatment workers.

Chinesization of the 21-item Subjective Cognitive Decline Questionnaire　

HAO Lixiao，XING Yue，JIA Jianguo，HAN Ying

2021, 24(18): 2349-2354. DOI: 10.12114/j.issn.1007-9572.2021.00.403

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HAN Ying，Chief physician，Professor，Doctoral supervisor；E-mail：hanying@xwh.ccmu.edu.cn
Background　The development of simple tools for early screening for subjective cognitive decline（SCD），an early manifestation of Alzheimer's disease（AD），is beneficial to early clinical identification of AD.However，some cases of mild cognitive impairment（MCI）may score 0 by completing the 9-item Chinese version of Subjective Cognitive Decline Questionnaire（SCD-Q9-C），which may be associated with insufficient coverage of subjective complaints about SCD.Objective　To modify the SCD-Q9-C to be a 21-item questionnaire（SCD-Q21-C）by adding items screening for SCD selected from the unabridged item pool of SCD-Q21.Methods　After obtaining the permission or authorization of authors of SCD-Q21，we chinesized the SCD-Q21 following the standardized process for localizing foreign questionnaires from 1 July to 31 August 2020，using the Brislin's model for translation and validation of instruments for cross-cultural research，including word-for-word translation，and back-translation，done independently by two individuals，and revised the items for cultural adaptation through panel discussions and a pre-test with a small sample size.Results　After a strict process of chinesization（translation，back-translation，comparison of the back-translation to the original content，item revision，cultural adjustment and a pre-test with a small sample size），the final SCD-Q21-C（with 21 points as the full score）was developed，consisting of 6 three-choice items（the 4th，5th，7th，10th，20th and 21st items）and 15 two-choice items；2 reverse items（the 11th and 19th items）and 19 positive items.Conclusion　The development of SCD-Q21-C is contributive to the further use of SCD-Q in Chinese population，and offers a reference for exploring simple tools for early screening for AD.

Gouty Arthritis Complicated with Erectile Dysfunction：a Case Report and Literature Review　

JIANG Wencai，LI Yanzhuo，LI Jia，XU Lin

2021, 24(18): 2355-2358. DOI: 10.12114/j.issn.1007-9572.2021.00.167

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Gouty arthritis is an illness that easily to recur or relapse，typically featured with the deposition of urate in the involved arthrosis and adjacent tissues.Patients with gout have a high risk of complications，to name a few，cardiovascular disease，hyperlipidemia，obesity，chronic renal disease and diabetes mellitus.Erectile dysfunction （ED）has been found to be a complication of gout by increasing foreign scholars recently，but in China，there exists a controversy over whether ED is associated with gout.Besides，ED in gout may often be neglected due to Chinese people's conservative attitude towards sex.We discussed the association of gout and ED，possible pathogenesis and diagnosis and treatment of ED in gout based on the report of a case encountered by us and the results of literature review，to offer useful information and warnings to general practitioners to increase the appropriateness of preventive and therapeutic interventions delivered to such patients.

Clinical Diagnosis and Treatment of Monoclonal Gammopathy of Renal Significance　

WEI Yujun，LI Xin，SHEN Man，ZHANG Jiajia，ZHAN Xiaokai，TANG Ran，HUANG Zhongxia

2021, 24(18): 2359-2363. DOI: 10.12114/j.issn.1007-9572.2021.00.410

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Monoclonal gammopathy of renal significance（MGRS） is a kind of renal damage mediated by monoclonal immunoglobulin（Ig） secreted by low-grade lymphoplasmacytic proliferative diseases.It is an early stage of the disease and is not enough to diagnose multiple myeloma（MM） or lymphoma.This paper analyzed the clinical characteristics，diagnosis and treatment process with a differential diagnosis of renal damage of 1 case of MM with renal damage and 3 cases of different types of MGRS admitted to Department of Hematology，West Hospital of Beijing Chao-yang Hospital from March 2018 to February 2020.Following that，a systematic review was conducted based on the case report and related literature，and recommendations were obtained，such as bortezomib-based option is recommended for patients with abnormal plasma cell clone and rituximab-based option is recommended for those with abnormal proliferation of B lymphocyte clone.It is suggested that for a patient with monoclonal Ig or unexplained renal disease，early renal biopsy is needed to confirm whether he has MGRS.If MGRS is confirmed，then its classification should be determined following the diagnosis consensus and process proposed by the International Kidney and Monoclonal Gammopathy Research Group，which will contribute to early delivery of clone-directed targeted therapy，thereby improving the renal function and prognosis of the patient.

Malignant Perivascular Epithelioid Cell Tumor of the Uterus：a Case Report and Literature Review　

ZHENG Yongfei，ZHENG Hailan，WANG Sheng，HUANG Danjiang*

2021, 24(18): 2364-2367. DOI: 10.12114/j.issn.1007-9572.2021.00.001

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Malignant perivascular epithelioid cell tumor （PEComa） of the uterus is a rare gynecologic tumor，which is easy to be misdiagnosed before operation.We retrospectively analyzed the clinical data，imaging presentations and pathological characteristics of a patient with PEComa of the uterus，and reviewed available studies about the disease，in order to improve the knowledge of the disease among medical workers.

A Brief Analysis of the Common Methodology Problems of Clinical Research in Medical Postgraduate Dissertations　

YANG Jie，SHI Yanyan，ZENG Lin，LI Nan，TAO Liyuan，ZHANG Hua，WANG Xiaoxiao，CHU Hongling，ZHAO Yiming，ZHAN Siyan

2021, 24(18): 2368-2372. DOI: 10.12114/j.issn.1007-9572.2021.00.465

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Background　The quality of dissertations has been attracting more and more attention.It is extremely urgent to guarantee the quality of dissertations comprehensively.The content of the medical postgraduate dissertations often involves clinical research，among which the problems on clinical research methodology need more attention.Objective　To analyze the common problems existing in clinical research methodology in the preliminary drafts of medical postgraduate dissertations during the preliminary review of before blind review in a university，in order to provide the reference for standardizing the writing and self-examination，to improve the quality of the dissertations by medical postgraduates.Methods　Research Center of Clinical Epidemiology in Peking University Third Hospital reviewed the methodological contents of the dissertations by medical postgraduates from a university in 2019 at the internal preliminary review stage from 2019 to 2020，including 47 clinical observational studies.Referring to the items in STROBE list，key elements of clinical research methodology of these dissertations were extracted，coded and then classified one by one to form a database of text review comments.The common problems were summarized and potential solutions were explored.Results　The common problems of the dissertations by clinical medicine postgraduates include incomplete description of statistical method，lack of research objects representation，incomplete inclusion and exclusion criteria，lack of sample size estimation method or insufficient sample size.Besides，the problems include inexact dissertation title，unclear background and value of the topic in abstract，inaccurately description of characteristics of research objects，inadequate representation of results，and not standardized statistical charts.In the discussion section，the common problem was that the main results related to the research objectives were not summarized.Other problems included poorly structured writing and neglected ethics.Conclusion　In addition to strengthening the training of clinical research methodology for graduate students，it is extremely necessary to develop a clear "Checklist for Medical Postgraduate Dissertations at the Concluding Stage" to help graduate students improve their thesis writing and supervisors to review and check their dissertations.

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