Table of Content

15 August 2021, Volume 24 Issue 23

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Monographic Research

Chinese Expert Consensus on Clinical Use of Sacubitril/Valsartan for Cardiovascular Diseases in Primary Care　

General Practitioner Branch of Chinese Medical Doctor Association

2021, 24(23):  2885-2890.  DOI: 10.12114/j.issn.1007-9572.2021.00.593

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As a first-in-class angiotensin receptor neprilysin inhibitor worldwide，sacubitril/valsartan has been proven to be effective and safe for heart failure and hypertension，and has also demonstrated potential therapeutic effects in acute myocardial infarction，arrhythmia and other cardiovascular diseases. As sacubitril/valsartan has been available in China recently，Chinese clinicians，especially general practitioners in primary care，have little experience in clinical use of this drug. Therefore，the General Practitioner Branch of Chinese Medical Doctor Association invited 14 experts in the field of cardiovascular medicine and general practice to develop this consensus in accordance with domestic primary care practice based on medical evidence，and relevant guidelines/consensuses. This consensus mainly focuses on the pharmacological characteristics and mechanism，medical evidence，recommendations in relevant guidelines and clinical application regarding sacubitril/valsartan. This consensus may help general practitioners in primary care to use sacubitril/valsartan reasonably and standardizedly.


Challenges and Progress in the Treatment of Organ Damage Associated by ANCA or Life-threatening ANCA Associated Vasculitis　

HE Xu，XIA Zhengkun

2021, 24(23):  2891-2897.  DOI: 10.12114/j.issn.1007-9572.2021.01.006

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With the development of a large number of clinical studies and the release of national guidelines，the treatment of organ damage associated by ANCA and ANCA associated vasculitis （AAV） has made an important breakthrough，transforming it from a fatal disease into a chronic disease. The role of rituximab （RTX）in induction and maintenance therapy has been strongly supported by evidence-based medicine and it has finally been included in most of the current guidelines. Optimizing treatment drugs，treatment doses and treatment cycles，reducing adverse drug reactions，and ultimately improving patient survival rates are the directions of future clinical research.


The Best Choice of Exercise Therapies for Fibromyalgia Syndrome Remains to be Determined　

QIU Yong，PEI Zuowei，WANG Fang

2021, 24(23):  2898-2901.  DOI: 10.12114/j.issn.1007-9572.2021.00.504

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Patients with fibromyalgia syndrome（FMS） often suffer from sleep disturbances，fatigue，extensive soft tissue tenderness，accompanied by anxiety and depression possibly，severely affecting their quality of life.Exercise therapies have been recommended as a first-line non-pharmacological treatment for FMS.We briefly summarized the evidence about traditional exercise，aerobic exercise，and resistance exercise therapies in improving the symptoms of FMS.Additionally，the potential mechanism of exercise treatment of FMS was analyzed.We hope this review can provide insights into further research.


Hypertension and Diabetes Incidence in Community-dwelling Han and Uygur Chinese People with Obstructive Sleep Apnea：a 7-year Telephone Follow-up Study　

JIANG Xuelong，CHEN Dongmei，WANG Qin，ZHANG Qinglong，LI Jianping，SHI Juan，LI Min，HE Zhongming，HAN Fang，CHEN Yan

2021, 24(23):  2902-2906.  DOI: 10.12114/j.issn.1007-9572.2021.01.004

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Background　Obstructive sleep apnea（OSA） is highly prevalent，which has become a serious disease affecting public health. There are little data comparing the incidence of hypertension and diabetes in Uygur and Han people with OSA，which we assume to be different. Objective　To perform a comparative analysis of the incidence of hypertension and diabetes in Han and Uygur people with OSA. Methods　This prospective study was conducted from October 2010 to October 2017. Participants（n=1 331） were Han and Uygur Chinese snorers aged more than 35 years with no hypertension and diabetes prior to the study who were selected from Tianshan Community，Karamay. All of them received an annual telephone follow-up in each of the seven years，for investigating the incidence of hypertension and/or diabetes，and the results of ambulatory blood pressure monitoring and oral glucose tolerance test performed when having clinical manifestations of hypertension and diabetes. The primary endpoint was diabetes and/or hypertension. General demographics，and parameters of portable home sleep test（apnea-hypopnea index，hypopnea index，lowest oxygen saturation，and mean oxygen saturation during sleep，and the number of 4% desaturations） were collected. The incidence of hypertension and/or diabetes was compared by OSA（assessed by the portable home sleep test） in all participants，in Han people，and Uygur people，and by OSA and ethnic group in participants. Results　All cases were included for final analysis 〔including 532（42.4%） men and 724（57.6%） women with a mean age of（58±13） years〕 except for 75 missed cases. 820 cases（470 Han and 350 Uygur people） were diagnosed with OSA，and 436（164 Han and 272 Uygur people） without. By the end of the follow-up，compared with those without OSA，participants with OSA had higher incidence of hypertension （P<0.05）. Uygur people with OSA had higher incidence of hypertension than those without（P<0.05）. The incidence of diabetes differed significantly between participants with and without OSA（P<0.05）. But the difference in the incidence of diabetes was not significant between Han people with and without OSA，Uygur people with and without OSA，and Han and Uygur people with OSA（P>0.05）. Conclusion　Both Han and Uygur people with OSA were more likely to suffer from hypertension. OSA may be an independent risk factor for hypertension and diabetes. Han people with OSA were more prone to hypertension than Uygur counterparts，so early and aggressive intervention is needed.


The Influence and Combined Effect of Arteriosclerosis and Essential Hypertension on the Pathogenesis of Cardiovascular and Cerebrovascular Diseases：a 8-year Follow-up Study　

MA Yihan，LI Xingyu，HAN Xu，LIU Qian，LI Guo，WU Shouling，WU Yuntao

2021, 24(23):  2907-2913.  DOI: 10.12114/j.issn.1007-9572.2021.01.204

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Background　Either arterial stiffness or essential hypertension has been sufficiently proved to be a major risk for cardio-cerebrovascular disease，but combined association of them with cardio-cerebrovascular disease has been rarely reported. Objective　To further explore the relationship of arterial stiffness or essential hypertension with cardio-cerebrovascular disease in Chinese population in a large prospective community-based cohort study，and examine whether the former two have a combined association with the latter. Methods　Participants（n=33 820）were selected from individuals attending the four annual follow-up visits（2010—2011，2012—2013，2014—2015，2016—2017）of Kailuan study and had brachial-ankle pulse wave velocity（baPWV）measurement（without any cardio-cerebral vascular events prior to the measurement）and ABI<0.9. Age，gender，systolic blood pressure（SBP），diastolic blood pressure（DBP），baPWV，heart rate，body mass index（BMI），fasting blood glucose（FBG），total cholesterol（TC），triglyceride（TG），low-density lipoprotein cholesterol（LDL-C），high-density lipoprotein cholesterol（HDL-C），uric acid（UA），smoking，drinking，physical exercise，education level，diabetes，and the use of antihypertensive drugs and hypoglycemic drugs were collected. The study was completed until December 31，2017，with the occurrence of a cardiovascular or cerebrovascular event as the endpoint event. Arterial stiffness was defined as baPWV > 1 400 cm/s. By the prevalence of arterial stiffness and essential hypertension during the follow-up period，participants were categorized into group 1（having no essential hypertension and arterial stiffness），group 2（having no essential hypertension but arterial stiffness），group 3（having essential hypertension and arterial stiffness），and group 4（having essential hypertension but no arterial stiffness）. Multivariate Cox regression analysis was used to further investigate the association of arterial stiffness or essential hypertension with cardio-cerebrovascular disease，and the strength of combined association of the former two with the latter. Results　The average follow-up years was（3.34±2.38）. The incidence density of cardio-cerebrovascular disease was 51.67 per 10 000 person-year. The cumulative incidence of cardio-cerebrovascular disease in groups 1-4 was 0.28%，1.94%，1.75%，4.70%，respectively. Four groups had statistically significant differences in male proportion，mean age，baPWV，BMI，FBG，TC，TG，LDL-C，HDL-C，SBP，DBP，heart rate，BMI，FBG，TC，TG，LDL-C，UA，smoking，drinking，physical exercise，diabetes，prevalence of taking antihypertensive drugs，prevalence of taking hypoglycemic drugs，and cumulative incidence of cardio-cerebrovascular disease（P<0.05）. Multivariate Cox regression analysis showed that prevalence of arterial stiffness 〔HR=2.60，95%CI（1.88，3.61）〕，baPWV-SD〔HR=1.22，95%CI（1.12，1.33）〕，prevalence of essential hypertension〔HR=2.05，95%CI（1.59，2.64）〕 and SBP-SD〔HR=1.26，95%CI（1.14，1.38）〕 were the associated with cardio-cerebrovascular disease（P<0.05）. Compared with group G1，the HR of cardio-cerebral vascular events in groups 2-4 was 3.33〔95%CI（2.08，5.33）〕，2.81〔95%CI（1.57，5.03）〕and 5.98〔95%CI（3.79，9.43）〕，respectively. The results suggested there was no interact effect between arterial stiffness and essential hypertension on cardio-cerebrovascular disease（P=0.789）. No result was changed after repeating the above analysis after excluding the population taking antihypertensive medications. Conclusion　Our study found that both arterial stiffness and essential hypertension increased the risk of cardio-cerebrovascular disease，and they had a combined association with cardio-cerebrovascular disease.


Association of Plasma Renin Activity and Early Renal Damage in Essential Hypertensive Patients　

LI Yu，WU Ting，ZHAO Xin，LI Nanfang

2021, 24(23):  2914-2918.  DOI: 10.12114/j.issn.1007-9572.2021.01.202

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Background　Kidney injury is one of the most common target organ damages in essential hypertension. Early detection and intervention will possibly reverse or even eliminate underlying renal damage. Previous studies have shown that plasma renin activity（PRA）plays an important role in appropriate treatment and prognosis evaluation of essential hypertensive patients，but it is unclear whether PRA can predict early hypertensive renal damage. Objective　To investigate the relationship of PRA with early renal damage in essential hypertensive patients. Methods　A total of 1 614 Han Chinese inpatients with essential hypertension were recruited between January 2007 and October 2014 from Department of Hypertension，People's Hospital of Xinjiang Uygur Autonomous Region. Data including gender，age，BMI，course of hypertension，blood pressure，fasting blood glucose，blood lipid，plasma aldosterone（PAC），and renal function indicators（urea nitrogen，creatinine，Cyst C，24-hour urine protein，24-hour urine microalbuminuria）were compared between sitting PRA quartiles 〔low renin（Q1，<0.44 μg?L-1?h-1），medium renin 1（Q2，0.44-1.07 μg?L-1?h-1），medium renin 2（Q3，1.08 -2.36 μg?L-1?h-1）and high renin（Q4，>2.36 μg?L-1?h-1）〕. Multivariate Logistic regression was used to explore factors associated with early hypertensive renal function damage. Results　Q1 group had lower male proportion，and lower levels of mean DBP，PRA and TG，and greater mean age and ARR ratio than other groups（P<0.05）. This group also showed lower levels of mean PAC，TC and LDL-C and longer mean course of hypertension than Q3 and Q4 groups（P<0.05）. Q2 group had greater mean age and longer mean course of hypertension as well as lower mean level of PRA than Q3 group（P<0.05）. Q2 group had lower male proportion，and lower mean DBP，greater mean age and longer mean course of hypertension，lower mean PRA and PAC，and higher mean ARR ratio than Q4 group（P<0.05）. Q3 group had lower male proportion，and lower mean DBP，PRA and PAC as well as greater mean age than Q4 group（P<0.05）. Q1 group had lower mean level of creatinine than Q2 and Q3 groups（P<0.05）. Q1 group showed lower mean levels of creatinine and Cyst C than Q4 group，so did Q3 group（P<0.05）. Multivariate Logistic regression analysis showed that gender，course of hypertension，BMI，SBP，DBP and PRA level were associated with early renal damage（P<0.05）. Conclusion　In Xinjiang Han Chinese people with essential hypertension，female，overweight，longer course of hypertension，higher blood pressure and higher PRA were risk factors for early renal damage.


Lateral and Prone Position Ventilation in Patients with Acute Respiratory Distress Syndrome Due to Different Causes：a Comparative Study　

FU Xiangzhen，LUO Lin，LIU Kui，TIAN Zhouzhou，JIANG Li，CHEN Li

2021, 24(23):  2919-2926.  DOI: 10.12114/j.issn.1007-9572.2021.01.002

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Background　The effectiveness of mechanical ventilation by position in patients with acute respiratory distress syndrome（ARDS） has been explored in some studies，but the therapeutic effect differences between lateral position ventilation （LPV） and prone position ventilation （PPV），and between patients with ARDS originating from pulmonary disease （ARDSp） and ARDS originating from extrapulmonary disease （ARDSexp） have not been clarified. Objective　To compare the therapeutic effects of LPV and PPV in patients with ARDSp and ARDSexp，and to explore their application strategy and value. Methods　85 patients with ARDS （including ARDSp and ARDSexp patients） who received treatment （without experience of changing ventilation position in this episode prior to this study） in the Intensive Care Unit，Affiliated Hospital of North Sichuan Medical College during September 2019 to May 2020 were enrolled，and divided into four groups for comparing LPV and PPV：ARDSp+ LPV group （n=21），ARDSexp+ LPV group （n=21），ARDSp+ PPV group （n=22） and ARDSexp+ PPV group （n=21）.Indices monitored before，and 0.5，1，and 2 hours after changing ventilation position were also collected，including：（1）baseline data such as age，sex，BMI，temperature，heart rate，and APACHEⅡ （2） arterial blood gas parameters：partial pressure of oxygen（PaO2），partial pressure of carbon dioxide （PCO2），arterial oxygen saturation（SaO2） and PaO2/FiO2 ratio；（3） respiratory mechanical parameters：peak airway pressure （Ppeak），rapid shallow breathing index （RSBI），plateau pressure （Pplat） and static pulmonary compliance （Cst）；（4） ICU sonography results：left ventricular ejection fraction （LVEF），inferior vena cava diameter （IVC-D），left ventricular derived cardiac output （CO），tricuspid annular plane systolic excursion （TAPSE），mitral annular plane systolic excursion （MAPSE），ratio of peak E-wave velocity/ peak e' velocity （E/e'），mean arterial pressure （MAP） and lung ultrasound （LUS） score. （5） cardiac biomarker：serum NT-proBNP；（6） prognosis：28-day mortality and incidence of complications. Results　PaO2/FiO2 was influenced significantly by the interaction effect of treatment time and ventilation position （P<0.05）. It was also impacted obviously by the main effect of treatment time（P<0.05），as well as by that of ventilation position （P<0.05）. SaO2 was affected notably by the interaction effect of treatment time and ventilation position（P<0.05）. It was also influenced considerably by the main effect of treatment time （P<0.05），as well as by that of ventilation position （P<0.05）. PaO2 was affected remarkably by the interaction effect of treatment time and ventilation position （P<0.05）. It was also affected greatly by the main effect of treatment time（P<0.05），and by that of ventilation position （P<0.05）. The PaO2/FiO2 and PaO2 in all groups were much better after changing the supine position ventilation（SPV） to LPV or PPV for 0.5，1 and 2 hours （P<0.05）. The PaO2/FiO2 and PaO2 at 0.5，1 and 2 hours after changing SPV to LPV were much higher in ARDSexp+ LPV group than in ARDSp+ LPV group （P<0.05）. The PaO2/FiO2 and PaO2 at 0.5，1 and 2 hours after changing SPV to PPV were much higher in ARDSexp+ PPV group than in ARDSp+ PPV group （P<0.05）. The PaO2/FiO2 and PaO2 at 0.5，1 and 2 hours after postural changes in ARDSexp+ PPV group were higher than those in ARDSexp+ LPV group （P<0.05）. The PaO2/FiO2 and PaO2 at 0.5，1 and 2 hours after postural changes in ARDSp+ PPV group were higher than those in ARDSp+ LPV group （P<0.05）. The SaO2 in all groups increased significantly after changing the SPV to LPV or PPV for 2 hours （P<0.05）. LVEF was influenced by the interaction effect of treatment time and ventilation position （P<0.05）. It was also impacted obviously by the main effect of treatment time（P<0.05），as well as by that of ventilation position（P<0.05）. The LVEF in all groups increased significantly after changing the SPV to LPV or PPV for 1 and 2 hours （P<0.05）. The mean LUS score was influenced significantly by the interaction effect of treatment time and ventilation position （P<0.05）. It was also impacted obviously by the main effect of treatment time（P<0.05），and by that of ventilation position （P<0.001）. The mean LUS score in all groups reduced significantly after changing the SPV to LPV or PPV for 1 and 2 hours （P<0.05）. The mean LUS score was negatively correlated with PaO2/FiO2 during SPV（r=-0.439，P<0.001）. And the correlation between them remained negative after SPV was changed to LPV or PPV for 1 （r=-0.348，P=0.001） and 2 hours（r=-0.327，P=0.002）. No obvious complications were found during the treatment. There was no significant difference in 28-day mortality among the four groups （χ2=1.333，P>0.05）. Conclusion　Changing ventilation posture rapidly and accurately according to patient condition for improving therapeutic effectiveness may be a future research hotspot in ARDS. ARDSexp patients gained more benefits from changing ventilation posture than ARDSp patients. Although PPV was slightly better than LPV in improving lung ventilation，LPV should be considered first when treating patients with complex conditions.


The Effects of Smoking Cessation Intervention on Local Airway Immunity and Life Quality in Patients with Chronic Obstructive Pulmonary Disease in Early Stable Stage　

LIU Xianbing，LI Fang，XU Ning，ZHU Lifen，ZHENG Xiaoyan

2021, 24(23):  2927-2939.  DOI: 10.12114/j.issn.1007-9572.2021.00.576

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Background　Smoking is harmful to the local airway immune function and life quality of COPD patients. The harm of tobacco is huge，quitting smoking is imminent. Smoking cessation can benefit quitters. There are currently many literatures on smoking cessation interventions，but fewer studies on moking cessation and local airway immunity，and also fewer studies on smoking cessation intervention for early COPD. Objective　To investigate the effect and clinical significance of smoking cessation intervention on airway local immunity and life quality in patients with early stable COPD. Methods　A total of 170 patients with stable COPD who met the following inclusion and exclusion criteria enrolled by People's Hospital of Quzhou in Zhejiang Province from June 2016 to June 2019 were selected and divided into smoking cessation group（106 cases）and non-smoking group（64 cases）. The smoking cessation group was divided into a successful cessation group（48 cases）and a smoking cessation group（58 cases）according to the success or failure of smoking cessation. The gender，age，smoking index，etc of the patients were collected.All patients in the three groups were followed up for 12 months after enrollment（ie：0 month，0.5 month，1 month，3 months，6 months，9 months and 12 months）. Induced sputum immune indicators including T lymphocyte subsets（CD3+，CD4+，CD4+/CD8+，CD8+），immunoglobulins（IgG，IgA，lgM）and complement C3，C4；lung function test result〔first second end of expiration volume（FEV1）〕；life quality indicators including cough（cough score），sputum expectoration（sputum expectoration score），dyspnea〔Dyspnea Scale（mMRC）score〕，COPD condition〔chronic obstructive pulmonary disease assessment test（CAT）Score〕，tobacco dependence（tobacco dependence score），smoking severity index，exhaled CO value，combined anxiety/depression〔depression and anxiety scale（HAD）score〕were recorded.The incidence of respiratory tract infection and the acute exacerbation of COPD within 1 year before the follow-up and during the follow-up were also recorded. The chages in related indicators during follow-up were compared. Results　There is an interaction between the group and time in terms of cough score，expectoration score，FEV1，mMRC score，CAT score，HAD score，tobacco dependence score，smoking severity index score，exhaled CO value，number of respiratory infections and acute exacerbations during follow-up（P<0.05）. The group has the significant main effect on cough score，sputum score，FEV1，mMRC score，CAT score，HAD score，tobacco dependence score，smoking severity index score，exhaled CO value，number of respiratory infections during follow-up，and number of acute exacerbations during follow-up Significant（P<0.05），time in the cough score，sputum score，FEV1，mMRC score，CAT score，HAD score，tobacco dependence score，smoking severity index score，exhaled CO value，respiratory tract infections during follow-up（P<0.05）. With the extension of follow-up time，the non-smoking group cough score，expectoration score，CAT score，mMRC score，HAD score，tobacco dependence score，smoking severity index，exhaled CO value，number of respiratory infections and acute exacerbation of COPD during follow-up gradually increased，and FEV1 gradually decreased（P<0.05）. There is an interaction between group and time in CD3+，CD4+，CD8+，CD4+/CD8+，IgG，IgA，IgM，complement C3，and complement C4（P<0.05）；the main effect of the group was significant on CD3+，CD4+，CD8+，CD4+/CD8+，IgG，IgA，IgM，complement C3，and complement C4（P<0.05），and the main effect of the time was significant on CD3+，CD4+，CD8+，CD4+/CD8+，IgG，IgA，IgM，complement C3，and complement C4（P<0.05）. The levels of CD3+，CD4+，CD8+，CD4+/CD8+，IgG，IgA，complement C3，and complement C4 in the successful smoking cessation group were compared at the rest of the follow-up time with that at the 6-month follow-up，and the differences were statistically significant（P<0.05）. The IgM level of the successful smoking cessation group was compared at the rest of the follow-up time with that at the 12-month follow-up，and the difference was statistically significant（P<0.05）. The levels of CD3+，CD4+，CD8+，CD4+/CD8+，IgG，IgA，IgM，complement C3，and complement C4 in the smoking cessation failure group were compared at the rest of each follow-up time with that at 1 month，and the difference was statistically significant（P<0.05）. At the beginning of the follow-up，the CD3+，CD4+，CD4+/CD8+，IgA，IgG，IgM，complement C3，complement C4 and FEV1 in three groups were positively correlated（P<0.05），and were negatively correlated with HAD score，tobacco dependence score，smoking severity index score and exhaled CO detection（P<0.05）. CD8+ was negatively correlated with FEV1（P<0.05），and positively correlated with HAD score，tobacco dependence score，smoking severity index score and expiratory CO value（P<0.05）. At the end of the follow-up，CD3+，CD4+，CD4+/CD8+，IgA，IgG，IgM，complement C3，and complement C4 were positively correlated with FEV1 in the successful and non-quit smoking group（P<0.05），and were negatively correlated with cough score，sputum score，HAD score，tobacco dependence score，smoking severity index score and exhaled CO value（P<0.05）. CD8+ was negatively correlated with FEV1（P<0.05），and positively correlated with HAD score，tobacco dependence score，smoking severity index score，and exhaled CO value（P<0.05）. Conclusion　Tobacco is harmful to the local airway immune function and life quality of patients with early COPD. Smoking cessation intervention is conducive to airway immune function and life quality. Those who succeed in smoking cessation benefit more，even if smoking cessation fails，patients who quit smoking in the short term can also benefit.However，the harm of tobacco to the human body is continuous，and the indicators can be significantly improved at least 6 months after quitting smoking. Local airway immune function is related to the quality of life. The improvement of airway immune function can improve the life quality and prognosis of patients，among them，T cell subgroups and IgA and IgG can better reflect the airway immune status.


Clinical Study of Characteristics of Acute Poisoning Caused by Difenidol Hydrochloride　

ZHAO Hong，GE Hongxia，MA Qingbian，AN Yuping，GUO Zhiguo

2021, 24(23):  2940-2944.  DOI: 10.12114/j.issn.1007-9572.2021.00.543

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Background　Difenidol hydrochloride is an over-the-counter drug often used to treat dizziness induced by various reasons. There have been recent case reports regarding acute difenidol poisoning due to overdose，but the patients'clinical characteristics according to plasma concentration level have not been summarized. Objective　To report the clinical characteristics and treatment of 9 cases of difenidol poisoning due to overdose with a focus on the value of monitoring plasma concentration in the diagnosis and treatment. Methods　We retrospectively studied a total of 9 patients of acute difenidol poisoning due to overdose admitted by Emergency Department，Peking University Third Hospital from June 2019 to May 2020. We summarized the clinical manifestations，plasma concentration，treatment history and prognosis of the patients. Results　There were 7 female patients and 2 male patients with an average age of（20.7±1.9）years. The average dose was（2 700±1 478）mg. The duration from oral medication to consultation was 3.5（6.5） hours. And the median plasma concentration was 3.15（26.27） mg/L. Severe poisoning was seen in two patients，one of them died，with the maximum plasma concentration of difenidol ≥35 mg/L，and clinical manifestations including coma〔Glasgow Coma Scale score（GCS）equals 3〕，seizure，respiratory failure，persistent hypotension and cardiac arrest. Four patients with maximum plasma concentration ≤2.5 mg/L demonstrated relatively mild clinical manifestations，such as dizziness，nausea，vomiting，fatigue，limb tremor，etc. The first hemoperfusion produced a decrease of about（47.51±22.16）% in difenidol plasma concentration. Eight out of 9 patients were discharged from hospital after recovery. The survival rate was 88.9%. The average hospitalization days were（4.7±3.3）d. Conclusion　Though the relationship of oral dose and maximum plasma concentration was not able to be clarified in patients with overdose difenidol induced poisoning，monitoring the plasma concentration may be beneficial to assessing the severity and prognosis. Caution is suggested against the cardiac arrest risk in patients with coma，respiratory failure and persistent hypotension. Hemoperfusion could effectively reduce the plasma concentration of difenidol hydrochloride.


Velocity Time Integral Guides Fluid Therapy for COPD Patients with Septic Shock：a Clinical Study　

YU Jiangquan，ZHENG Ruiqiang，ZHU Jin，ZHAO Yuan，YANG Penglei

2021, 24(23):  2945-2949.  DOI: 10.12114/j.issn.1007-9572.2021.01.003

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Background　Central venous pressure（CVP） provides little value for guiding fluid therapy for septic shock in chronic obstructive pulmonary disease（COPD） patients as they often have right heart insufficiency. The widespread application of ultrasound in the ICU has made bed-side measurement of left ventricular outflow tract velocity-time integral （LVOT VTI） become possible，which is superior to CVP in reflecting volume responsiveness as it is similar to the stroke volume. Objective　To examine the clinical value of LVOT VTI in guiding fluid therapy for COPD patients with septic shock. Methods　COPD patients with septic shock were selected from the Intensive Care Unit，Northern Jiangsu People's Hospital of Jiangsu Province from March 2017 to June 2018，and randomized into CVP group（treated with fluid therapy guided by CVP，till CVP reaching 15 mm Hg），global end-diastolic volume index（GEDVI） group（treated with fluid therapy guided by GEDVI，till GEDVI reaching 800 ml/m2），and VTI group （treated with fluid therapy guided by LVOT VTI，till the increase of LVOT VTI <15%）. Baseline data（age，gender，APACHEⅡ score，SOFA score，mean arterial pressure，CVP，blood lactate，oxygenation index，and pulmonary hypertension prevalence at ICU admission），fluid treatment-related data （the volume of fluid administered and norepinephrine dosage during the first six and 24 hours of resuscitation，blood lactate level and blood lactate clearance during the first 24 hours of resuscitation，APACHEⅡ score and SOFA score during the first 72 hours of resuscitation），renal replacement therapy rate，mechanical ventilation time，ICU hospital stay，and in-hospital mortality were compared between the groups. Results　Three groups showed statistically significant differences in the volume of fluid administered and norepinephrine dosage during the first 24 hours of resuscitation（P<0.05），but showed no significant differences in the volume of fluid administered and norepinephrine dosage during the first six hours of resuscitation，blood lactate level and blood lactate clearance during the first 24 hours of resuscitation，APACHE Ⅱ score and SOFA score during the first 72 hours of resuscitation，renal replacement therapy rate，mechanical ventilation time，ICU hospital stay，and in-hospital mortality（P>0.05）. CVP group received less volume of fluid during the first 24 hours of resuscitation than other groups（P<0.05）. VTI group used less norepinephrine dosage during the first 24 hours of resuscitation than other groups（P<0.05）. Conclusion　LVOT VTI used in fluid therapy may help to evaluate the required fluid volume more accurately and reduce the dosage of norepinephrine more significantly，so it may have a good clinical application prospect.


Investigation of the Application of Pulmonary Function Tests in Guangdong Province　

WU Zhongping，ZHENG Jinping，SHEN Beilan，WU Qiaohui，ZHONG Liping，GAO Yi

2021, 24(23):  2950-2954.  DOI: 10.12114/j.issn.1007-9572.2021.00.553

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Background　Pulmonary function tests are key means for detecting respiratory diseases. The 13th Five-Year Plan on hygiene and healthcare （2016—2020） and Healthy China Action （2019—2030） plan issued by the State Council of the People's Republic of China proposed that pulmonary function tests shall be listed as the routine tests and pulmonary function detection capability in primary care shall be improved. However，according to relevant reports in 2002，pulmonary function tests have been used limitedly with regional imbalances in China. Objective　To investigate the application of pulmonary function tests in Guangdong Province，and problems that need to be improved in the process of development. Methods　This investigation was conducted in 2016. From 21 prefecture-level cities in Guangdong Province，771 hospitals（including 141 tertiary hospitals，327 secondary hospitals，137 primary hospitals and 166 ungraded hospitals ） were extracted，from which medical workers were selected to attend an on-site in-person interview by assistants of this project and medical consultant assistants qualified by uniform trainings. Results　 The investigation achieved a response rate of 100%. The results showed that pulmonary function tests had been implemented in 30.35%（234/771） of the hospitals，44.9% and 47.4% of which were secondary and tertiary hospitals. And the most widely implemented was pulmonary ventilation /perfusion test（100.0%），followed by bronchodilation test（79.1%），and bronchial provocation test（51.7%）. In terms of pulmonary ventilation /perfusion test，of the hospitals，64.5% often calibrated the spirometer，23.5% used the lower limit of normal for the FEV1/FVC ratio，58.1% used a five-level method（mild，moderate，moderate to severe，severe，very severe） to grade the test results，and 38.9% only printed the test data and graphics on the report sheet once. The workers performing pulmonary function tests in 43.3%（334/771） of the hospitals had received related trainings，82.6% and 17.4% of whom had received short-term training （1-5 days） and long-term training （1-3 months），respectively. Conclusion　The popularization rate of pulmonary function tests in Guangdong was low，with unbalanced development. Besides that，few primary care hospitals conducted such tests，and the types of tests carried out were also few. In addition，the methods used for pulmonary function tests，quality control，report format and interpretation of results were nonstandard. There is an urgent need to strengthen the standardized training for workers performing pulmonary function tests.


Prognostic Value of Geriatric Nutritional Risk Index in Patients with Chronic Heart Failure　

LI Wenjing1，2，LI Shuren2*，SUN Mingchao3，SHEN Zexue4，LUO Fei3，HAO Xiao2，XUN Liying2

2021, 24(23):  2955-2961.  DOI: 10.12114/j.issn.1007-9572.2021.00.541

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Background　Currently，there are few studies on objective nutritional assessment tools in patients with heart failure，and there is no recognized nutritional assessment method for such patients. Objective　To evaluate the prognostic value of geriatric nutritional risk index（GNRI） in hospitalized patients with chronic heart failure. Methods　A total of 293 chronic heart failure inpatients were selected from Heart Center，Hebei General Hospital between January and December 2017.Clinical data（including general demographics，admission heart rate and blood pressure，NYHA class，laboratory indices，and echocardiographic indices） collected through consulting electronic medical records were compared between patients divided by GNRI〔GNRI group 1（100 cases with GNRI≤98，having a risk of malnutrition），and GNRI group 2（193 cases with GNRI>98，and normal nutrition）〕. All cases were followed up by telephone till 2019-04-25. All-cause mortality was used as the endpoint. ROC analysis was conducted to estimate the predictive value of GNRI，BMI and serum albumin for death in chronic health failure. The Kaplan-Meier curve was plotted to estimate the survival in two GNRI groups. The Cox proportional-hazards model was adopted to examine the association of GNRI with the risk of death in chronic heart failure. Results　The median follow-up time was 509（253）days. For predicting death in chronic heart failure，GNRI〔AUC=0.702，95%CI（0.633，0.772） with the optimal cut-off value of 97.87〕 had higher accuracy than serum albumin 〔AUC=0.657，95%CI（0.586，0.728） with the optimal cut-off value of 35.65 g/L〕，and BMI〔AUC=0.645，95%CI（0.572，0.718） with the optimal cut-off value of 22.88 kg/m2〕. Kaplan-Meier survival analysis found that GNRI group 2 had a statistically higher survival rate than GNRI group 1（P<0.001）. Univariate Cox regression analysis of factors showing statistically intergroup differences and potential factors associated with death revealed that age 〔HR=1.048，95%CI（1.026，1.071）〕，GNRI level〔HR=3.283，95%CI（2.085，5.171）〕，history of diabetes 〔HR=1.955，95%CI（1.245，3.071）〕，history of old cerebral infarction 〔HR=1.779，95%CI（1.131，2.800）〕，use of ACEI/ARB〔HR=0.470，95%CI（0.300，0.763）〕，hospital stay 〔HR=1.036，95%CI（1.018，1.054）〕，diastolic blood pressure 〔HR=0.984，95%CI（0.969，0.999）〕，NYHA class 〔HR=1.546，95%CI（1.066，2.240）〕，serum hemoglobin 〔HR=0.987，95%CI（0.979，0.995）〕，serum creatinine〔HR=1.003，95%CI（1.001，1.005）〕，and glomerular filtration rate 〔HR=0.985，95%CI（0.975，0.995）〕 were associated with death in chronic heart failure（P<0.05）. Multivariate Cox regression analysis of the above-mentioned factors showed that age 〔HR=1.030，95%CI（1.006，1.054）〕，GNRI level 〔HR=2.821，95%CI（1.727，4.616）〕，and diabetes history 〔HR=2.031，95%CI（1.261，3.273）〕 were associated with the risk of death in chronic heart failure（P<0.05）. Conclusion　Malnutrition may be a risk factor for poor prognosis in hospitalized patients with chronic heart failure. The prognostic value of nutritional status assessed by GNRI may be higher than that of serum albumin or BMI，which will help to predict the prognosis of such patients.


Predictive Value of Glycogen Protein 125 Combined with Brain-Derived Neurotrophic Factor for Acute Heart Failure in Elderly Patients with Acute Myocardial Infarction　

WANG Yating，YAO Jie，GUAN Shihe，CHENG Cheng

2021, 24(23):  2962-2966.  DOI: 10.12114/j.issn.1007-9572.2021.00.594

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Background　Acute myocardial infarction （AMI） is currently an important clinical cause of sudden cardiac death in patients. The occurrence of AMI in general patients can easily lead to myocardial damage，which can lead to acute heart failure （AHF）. Early diagnosis of AHF in AMI patients has positive significance for improving the prognosis of patients and reducing the risk of death. At present，the main clinical diagnosis of AHF is based on brain natriuretic peptide （BNP），but there are many related factors which can affect BNP，and when BNP reaches a diagnostically meaningful value，AHF has occurred in the patient，which may seriously affect the prognosis and survival of the patient. Therefore，a more accurate diagnosis method is needed to predict the occurrence of AHF in the early stage of AMI. Objective　To explore the diagnostic value of glycogen protein 125 （CA-125） combined with brain-derived neurotrophic factor （BDNF） in predicting the occurrence of AHF in elderly patients with AMI. Methods　144 patients with AMI admitted to the Department of Cardiology of The Second Affiliated Hospital of Anhui Medical University from September 2017 to March 2020 were enrolled. The clinical data of all patients were collected at the time of admission and their fasting venous blood was drawn after admission to measure serum CA-125 and BDNF levels by an automatic immunoassay analyzer. The enrolled patients were divided into heart failure group （42 cases） and control group （102 cases） according to whether AHF occurred within 1 week after coronary reperfusion therapy. The clinical data of the two groups were compared，and the multivariate logistic regression was used to analyze the independent risk factors that affect the occurrence of AHF in AMI patients. Receiver operating characteristic （ROC） curve was drawn to analyze the predictive value of CA-125 combined with BDNF for AHF in elderly patients with AMI. Results　The patients in the heart failure group had higher cardiac troponin （cTnI）. BNP，CA-125，BDNF，and higher number of diseased branches than the control group （P<0.05）. Multivariate Logistic regression analysis showed that elevated levels of BNP 〔OR=1.015，95%CI （1.003，1.026）〕，CA-125 〔OR=23.228，95%CI （4.095，131.748）〕and BDNF 〔OR=1.455，95%CI （1.148，1.845）〕 were independent risk factors for AHF in AMI patients （P<0.05）. The ROC curve shows that the area under the ROC curve of CA-125 combined with BDNF in prediction of AHF in AMI patients is higher than that of CA-125 and BDNF alone （P<0.05），with a diagnostic sensitivity of 78.57% and a specificity of 89.22%. Conclusion　Monitoring serum CA-125 and BDNF levels can effectively predict the risk of AHF in elderly patients with AMI.


Recent Evidence on Angiotensin Receptor-neprilsin Inhibitor in Heart Failure with Preserved Ejection Fraction　

GAO Man，BAI Wenlou，CHENG Siyao，QI Xiaoyong

2021, 24(23):  2967-2971.  DOI: 10.12114/j.issn.1007-9572.2021.00.587

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Heart failure is the end stage of most cardiac diseases with high morbidity and mortality. Heart failure with preserved ejection fraction（HFpEF），as a clinical focus，accounts for about 50% of all cases of heart failure，and is associated with increased incidence of hospitalization due to low rate of diagnosis and multiple comorbidities. Angiotensin receptor-neprilsin inhibitor（ARNI） has been proved to significantly decrease the rates of death and readmission，and is widely used as the recommended drugs of class Ⅰ in heart failure with reduced ejection fraction（HFrEF）. However，the mechanism of action of ARNI in HFpEF is still unclear. Thus we summarized the latest clinical evidence on its mechanism of action in HFpEF. This article reviews the mechanism of the effect of ARNI in HFpEF and the latest clinical evidence for it，expounds the advantages of ARNI in improving heart and kidney function and reversing ventricular remodeling in patients with HFpEF，in order to provide new treatment ideas for HFpEF.


The Curative Effect of Shouhui Tongbian Capsules in the Treatment of Chronic Constipation may be Better than Conventional Treatment in Western Medicine: a Systematic Review Based On Randomized Controlled Trials　

WANG Tianyuan，CHEN Zhaoxia，WANG Yanbo，HU Jing，FENG Shuo，ZHANG Huina，LI Bo

2021, 24(23):  2972-2977.  DOI: 10.12114/j.issn.1007-9572.2021.00.514

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Background　Chronic constipation has become a common gastrointestinal motility disease，which may be associated with negative effect of some social factors，exerting a great impact on the life quality of patients. Most common treatments are laxatives，which may lead to drug dependence and adverse reactions. Comparatively speaking，TCM treatment using holistic approach for chronic constipation has certain advantages. But there is no research on Shouhui Tongbian Capsules for chronic constipation. Objective　To systematically evaluate the efficacy and safety of Shouhui Tongbian Capsules in treating chronic constipation. Methods　Literature retrieval was performed through databases of PubMed，EMBase，The Cochrane Library，CNKI，SinoMed，CQVIP and Wanfang Data from inception to May 25，2020 to select randomized controlled trials（RCT）investigating the efficacy and safety of Shouhui Tongbian Capsules in the treatment of chronic constipation. Data extraction was performed，including the first author's name，publication time，sample size，sample age，intervention measures，course of treatment，and outcome indices（defecation frequency，clinical response rate，defecation difficulty，incidence of constipation，occurrence of adverse reactions）. The quality of the included studies was evaluated using the Cochrane risk-of-bias tool. Meta-analysis was conducted with RevMan 5.3. Results　In all，three RCT were included，involving 241 patients. All were evaluated with relatively low quality. Meta-analysis demonstrated that the improvement in bowel movement frequency〔SMD=0.73，95%CI（0.31，1.15），P=0.000 6〕，and defecation difficulty〔SMD=0.50，95%CI（-0.01，1.00），P=0.06〕and clinical response rate〔RR=1.20，95%CI（1.07，1.34），P=0.002〕 in experimental group were superior to those in the control group. Moreover，the frequency of constipation in experimental group（9%）was lower than that of control group（48%）. All these RCT studied the safety of treatment，but no adverse effects were identified. Conclusion　Compared to routine western medicine treatment alone，its combination with Shouhui Tongbian Capsules improves defecation frequency and difficulty in chronic constipation patients more significantly，indicating that the combination therapy has better efficacy. Furthermore，the incidence of adverse reactions related to the combination therapy is low，indicating that the therapy has good safety. However，due to limited number and low quality of included RCT，more high-quality clinical RCT are needed to verify the above conclusion. As for outcome indices，internationally recognized ones are recommended.


Gemcitabine Has a Lower Recurrence Rate and Less Side Effects than Mitomycin for Non-muscular Invasive Bladder Cancer after TURBT：a Meta-analysis of Randomized Controlled Trials　

PENG Lei，MENG Chunyang，LI Jinze，LI Yunxiang，LI Jinming，ZHAO Pan，WEI Tangqiang，WU Ji

2021, 24(23):  2978-2984.  DOI: 10.12114/j.issn.1007-9572.2021.01.201

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Background　Gemcitabine and mitomycin are both chemotherapy drugs for non-muscular invasive bladder cancer（NMIBC）after transurethral resection of bladder tumor（TURBT）. However，no final conclusion has been reached on these two drugs in terms of differences in clinical efficacy and safety. Objective　To evaluate the effectiveness and safety of gemcitabine versus mitomycin in the treatment of NMIBC after TURBT. Methods　Published randomized controlled studies（RCT）comparing gemcitabine and mitomycin for NMIBC after TURBT were searched in databases of PubMed，EMBase，Web of Science，The Cochrane Library，CNKI，Wanfang Data，SinoMed，and CQVIP from inception to 2020-10-01，and enrolled according to the inclusion and exclusion criteria.Data of included RCT were extracted，including the first author，publication year，design，level of evidence，sample age，sample size，tumor growth，WHO classification，TNM staging，drug infusion dosage，cancer recurrence（recurrence within one and two years after surgery），and chemotherapy perfusion-related adverse events（bladder irritation，hematuria，liver and kidney damage，rash，nausea and vomiting，suprapubic pain）. The patients were divided into GEM group and MMC group according to the drug use after TURBT. Meta-analysis of recurrence within one and two years after surgery and incidence of chemotherapy perfusion-related adverse events was performed in two groups. Results　A total of seven RCT were included，involving 484 patients，with high quality rated by the Jadad Scale. Meta-analysis showed no statistically significant difference in one-year recurrence rate between the two groups of patients〔OR=0.86，95%CI（0.29，2.56），P=0.17〕. But gemcitabine group gained more benefits in reducing the two-year recurrence rate〔OR=0.37，95%CI（0.23，0.59），P=0.01〕. Furthermore，gemcitabine group demonstrated lower overall incidence of chemotherapy perfusion-related adverse events〔OR=0.28，95%CI（0.18，0.43），P=0.01〕，lower incidence of bladder irritation〔OR=0.30，95%CI（0.17，0.54），P=0.04〕as well as lower incidence of other complications（rash，nausea and vomiting，suprapubic pain）〔OR=0.46，95%CI（0.24，0.88），P=0.01〕. There were no statistically significant intergroup differences in the incidence of postoperative hematuria〔OR=0.52，95%CI（0.21，1.26），P=0.22〕and liver and kidney damage〔OR=0.51，95%CI（0.29，0.85），P=0.16〕. Conclusion　Gemcitabine may be more effective and safe for NMIBC after TURBT，owing to its better effects on lowering the recurrence rate and incidence of adverse events.


Advances in the Treatment of Primary IgA Nephropathy

YU Baisong，LIU Bing

2021, 24(23):  2985-2991.  DOI: 10.12114/j.issn.1007-9572.2021.00.156

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Primary IgA nephropathy is the most common type of primary glomerulonephritis，with pathological features of mesangial deposition of IgA. With increasingly intensive understanding of primary IgA nephropathy，it is found that it is not a benign kidney disease. In about 20 years，30%-40% of primary IgA nephropathy develops into end-stage renal disease，requiring kidney replacement therapy. Therefore，primary IgA nephropathy needs effective and precise treatment to delay its progression. This article mainly reviews the advances in the treatment of primary IgA nephropathy：supportive therapy has become the main treatment. Besides，tonsillectomy，hormone therapy，immunosuppressive therapy and other treatments can be used under certain circumstances. Recently emerged treatments can also be used as treatment options for choice.


New Progression in Influencing Factors and Risk Prediction Models for Lymphoma-associated Venous Thromboembolism　

YANG Jingshi，ZOU Liqun

2021, 24(23):  2992-2997.  DOI: 10.12114/j.issn.1007-9572.2021.00.600

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Venous thromboembolism（VTE）is a common complication，and the second leading non-cancer cause of death in cancer patients. Lymphoma is a type of cancer with a high incidence of VTE. However，there is no consensus on the risk factors and prevention methods for lymphoma-associated VTE. To provide the latest guidance on the prevention and treatment of lymphoma-associated VTE，in reviewing the recent guidelines and literature，we overviewed the influencing factors of lymphoma-associated VTE，including types and treatment of lymphoma，clinical laboratory indicators and anti-tumor therapies. Besides that，we also summarized and analyzed the recently developed risk prediction models for lymphoma-associated VTE，including the Khorana Risk Score，Ottawa Score，Michigan Risk Score and ThroLy Lymphoma Score.


Research Methodology

The Chinese Version of the Demoralization Scale- Ⅱ: Development, Reliability and Validity in Chinese Cancer Patients

OU Na, HU Xiaoping, QI Sanyang, LUO Xiaoyan, NIE Wenjie

2021, 24(23):  2998-3004.  DOI: 10.12114/j.issn.1007-9572.2021.00.516

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Background

Demoralization syndrome is a kind of psychological pain caused by a series of negative life events. It is a new psychiatric diagnosis, and closely related to suicidal ideation. It has a high incidence in cancer patients, but relevant effective evaluation may be an early warning indicator for intervention. However, there is a lack of assessment tools for demoralization syndrome in China.

Objective

To develop a Chinese version of the Demoralization Scale- Ⅱ (DS- Ⅱ) and test its reliability and validity.

Methods

From August 2019 to January 2020, 410 cancer inpatients from Affiliated Nanhua Hospital, University of South China, Hengyang, Hunan Province were recruited and investigated with a self-compiled questionnaire named Socio-demographic and Disease-related Information (Cronbach's α=0.87), Chinese version of the DS- Ⅱ (formed by forward and backward translation, expert review and pre-testing research), Hospital Anxiety and Depression Scale (HADS), and Edmonton Symptom Assessment Scale (ESAS). Item scores of the DS- Ⅱ were compared between high and low score groups (the top-ranked and bottom-ranked 27% of patients). The content validity, construct validity, convergence validity, discrimination validity and internal consistency of the Chinese version of DS- Ⅱ were evaluated.

Results

Two groups showed significant differences in the score of each of the 16 items of the DS- Ⅱ (P<0.05). The item-total correlation coefficients of the DS- Ⅱ ranged from 0.532 to 0.663 (P<0.05). The items of the scale had adequate content validity (I-CVI=0.83-1.00, S-CVI=0.94). Exploratory factor analysis showed that KMO value was 0.887, Bartlett spherical test χ²=4 018.126, P<0.001. Two common factors with an eigenvalue greater than 1 were extracted by varimax rotation, which could explain 61.342% of the total variation. The load value of each item was more than 0.400, without double load. Both factors 1 and 2 contain 8 items, and the factor attribution of the item is consistent with the original scale. The item-domain correlation coefficients ranged from 0.60 to 0.86, and the inter-domain correlation coefficient was 0.15. The total score of the Chinese version of DS- Ⅱ was positively correlated with the total score (r=0.581), and the anxiety (r=0.443) and depression (r=0.655) subscales scores of the HADS, and also positively correlated with the total score of the ESAS (r=0.512) and its items including pain (r=0.393), tiredness (r=0.266), depression (r=0.497) and anxiety (r=0.418), but was negatively correlated with the score of KPS (r=-0.249, P<0.05). The Cronbach's coefficient of the Chinese version of DS- Ⅱ was 0.877.

Conclusion

The Chinese version of DS- Ⅱ has good psychometric properties, which may be a reliable tool for evaluating demoralization syndrome in Chinese cancer patients.

Monographic Research

Validating the Performance of a Prediction Model for Spontaneous Ureteral Calculus Passage Using Artificial Neural Network：a Multicenter Clinical Trial　

ZENG Kai，WANG Xinmin，NI Zhao，WANG Qinzhang，LI Qiang

2021, 24(23):  3005-3008.  DOI: 10.12114/j.issn.1007-9572.2021.01.203

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Background　As a new auxiliary tool for diagnosis and analysis，artificial intelligence technology has been gradually applied to imaging medicine，medical big data analysis，diagnostics and medical expense budget. The prediction model for spontaneous ureteral calculus passage developed using artificial neural network by our hospital（First Affiliated Hospital，School of Medicine，Shihezi University）has proven to have satisfactory performance，but has not been tested by recognized multicenter clinical trials. Objective　To evaluate the accuracy and applicability of the prediction model of spontaneous ureteral calculus passage using artificial neural network developed by our hospital using a multicenter clinical trial，to provide evidence facilitating its promotion. Methods　From September 2017 to March 2020，we enrolled 1 620 urological patients with ureteral calculus who received conservative stone treatment in six hospitals（First Division Hospital，Fourth Division Hospital，Seventh Division Hospital，Ninth Division Hospital，and 13th Division Red Star Hospital of the Xinjiang Production and Construction Corps，and First Affiliated Hospital，School of Medicine，Shihezi University）. Nine parameters were collected，containing age，pain degree，calculus size，location，leucocyte count，neutrophil count，neutrophil percentage，lymphocyte count and C-reactive protein level，which were applied as predictive parameters included in the model developed using artificial neural network with the result of previous research for reference for predicting spontaneous ureteral calculus passage in patients with at least a small （≤1 cm）calculus，and large（>1 cm）calculus，and the prediction results were compared with actual conditions in a 4-week follow-up to estimate the accuracy of the model. Results　During the follow-up period，992 cases had spontaneous ureteral calculus passage，accounting for 61.23% of the total cases，who included 763 （68.06%）from the small calculus group（n=1 121），and 229 （45.89%）from the large calculus group（n=499）. The distribution of pain level，mean calculus diameter，leucocyte count，and C-reactive protein level differed obviously between those with and without spontaneous ureteral calculus passage（P<0.05），but distribution of calculus location，mean age，neutrophil percentage，and lymphocyte count did not（P>0.05）. For predicting the overall spontaneous ureteral calculus passage，the sensitivity，specificity and accuracy of the model were 87.10%，85.99% and 86.67%，respectively. For patients with at least one small calculus，the sensitivity，specificity and accuracy of the model were 84.28%，84.44% and 84.37，respectively. For patients with at least one large calculus，the sensitivity，specificity and accuracy of the model were 87.94%，87.15% and 87.69%，respectively. Conclusion　The accuracy of the model in predicting spontaneous passage of ureteral calculi，especially the calculus larger than 1 cm in diameter，has been recognized in our multicenter clinical trial.


Diagnosis and Treatment of Involuntary Weight Loss：a General Practice Perspective　

MA Renjie，CHEN Yangyang，REN Jingjing，LIU Ying

2021, 24(23):  3009-3012.  DOI: 10.12114/j.issn.1007-9572.2021.00.439

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Involuntary weight loss（IWL） is a common outpatient complaint in general practice. As IWL is an undifferentiated disease，the sufferers often seek treatment in multiple departments but could not obtain organized and standardized management，which wastes substantial healthcare resources，impairs patient health-seeking experience，and brings a lot of inconveniences to the patient's life. We reviewed the literature on IWL，discussed its diagnosis and treatment from a general practice perspective，hoping to help general practitioners with standardized diagnosis and treatment and continued management of IWL.