Chinese General Practice

Recent Advances in Diagnosis and Medical Therapy for Acromegaly： Interpretation of A Pituitary Society Update to Acromegaly Management Guidelines in 2021　

TAN Huiwen，QIN Meng，YU Yerong，LI Jianwei，CAI Bowen，JIANG Shu

2021, 24(27): 3397-3403. DOI: 10.12114/j.issn.1007-9572.2021.02.016

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Acromegaly is a pituitary neuroendocrine disease characterized by abnormally increased secretion of growth hormone. Oversecreted growth hormone and insulin-like growth factor-1 may greatly influence various organs and systems of the whole body. Acromegaly often has hidden onset，slow progress and complicated clinical symptoms，so its diagnosis and treatment need to be further standardized. In February 2021，the Pituitary released the A Pituitary Society Update to Acromegaly Management Guidelines. Based on the latest evidence-based acromegaly management，this paper interprets the essentials of several aspects mentioned in the guidelines，including clinical manifestations，epidemiological conditions，influencing factors of surgical treatment，patients' quality of life，progress and update of drug treatment，and radiotherapy，with special highlights on the advantages and limitations of the new therapy approved by FDA. All is for improving general practitioners and specialists' understanding of acromegaly，and guiding the standardized diagnosis and treatment of acromegaly to improve patient prognosis.

Postpartum Contraception in China：Status，Problems and Coping Strategies　

ZHANG Meixi，XI Wei

2021, 24(27): 3404-3407. DOI: 10.12114/j.issn.1007-9572.2021.00.597

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Postpartum contraception refers to the important measures taken by the parturient to prevent unintended pregnancy within a specific time after the delivery of placenta. It is a weak part in maternal and child health care and family planning services in China. Postpartum contraception failure occurs mainly due to lack of knowledge and medical services related to postpartum contraception，which seriously threatens maternal and child health. We described current status of postpartum contraception in China，and gave an in-depth analysis of the existing problems，then proposed coping strategies such as giving full play to the guidance of the family planning system，and strengthening the quality of postpartum contraceptive services delivered by hospitals to increase the effective contraception rate of postpartum women to avoid unintended pregnancy，and reduce artificial abortion and short interpregnancy intervals，eventually promoting the reproductive health of women.

Prevalence of Abandoning High-efficiency Contraception Measures First Used after Induced Abortion in Women with Unintended Pregnancy：an Investigation　

DING Jun，WU Qing，YE Huiqin，YAO Xueping，LYU Liqing，CHENG Xianying

2021, 24(27): 3408-3412. DOI: 10.12114/j.issn.1007-9572.2021.00.585

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Background　The post-abortion care（PAC） service facilitates women's choice of high-efficiency contraceptive measures after induced abortion for ending unintended pregnancy. However，some of these women have been reported to abandon high-efficiency contraceptive measures that are first used after induced abortion in follow-up studies. Objective　To investigate the prevalence，causes and associated factors of abandoning high-efficiency contraceptive measures first used after induced abortion in women with unintended pregnancy. Methods　Participants were women who underwent induced abortion to end an unintended pregnancy in Zhejiang Provincial People's Hospital from January to December 2019. All of them received normal PAC services，and took combined oral contraception（COC） formulations or long-acting reversible contraception（LARC） after the surgery. Follow-ups were carried out at 1，3，6，9 and 12 months after menstruation recovery，including return visits，telephone follow-ups，WeChat follow-ups，and so on，to collect data for examining the prevalence，causes，and associated factors of abandoning the use of COC formulations or LARC during follow-up period，and the use of other contraceptive measures as well as unintended pregnancy incidence after the abandoning. Multivariate Logistic regression analysis was used to analyze the influencing factors of abandoning the use of COC formulations or LARC. Results　Altogether，346 cases who completed the study were finally included，and 259 of them（74.9%） used COC，and other 87（25.1%） used LARC for postoperative contraception. The prevalence of abandoning COC during the follow-ups after menstruation recovery was 14.3%-83.4%，showing an increasing trend（P<0.05）. The prevalence of abandoning LARC in the follow-ups after menstruation recovery was 0-19.5%. In those abandoning COC，80.3%（208/259） turned to non-high-efficiency contraceptive measures，and 3.1%（8/259） turned to LARC. In those abandoning LARC，11.5%（10/87） turned to non-high-efficiency contraceptive measures，and 8.0%（7/87） turned to COC. At the 12th month after menstruation recovery，the rate of abandoning COC in those using COC was higher than the rate of abandoning LARC in those using LARC（P<0.05）. And the rate of turning to non-high-efficiency contraception measures was also higher in those using COC（P<0.05）. The main reasons for abandoning COC were：difficulties taking the medicine regularly every day，adverse drug reactions and worrying about the impact on future fertility. The main reasons for abandoning LARC were：adverse drug reactions and complications ，and worrying about the impact on future fertility. Multivariate Logistic regression analysis showed that having reproductive history〔OR=0.492，95%CI（0.304，0.712）〕，repeated abortion〔OR=0.591，95%CI（0.315，0.893）〕 and positive contraceptive attitude〔OR=0.543，95%CI（0.246，0.912）〕were associated with reduced possibility of abandoning high-efficiency contraceptive measures after induced abortion for ending an unintended pregnancy，while younger age〔OR=1.782，95%CI（1.562，3.671）〕was associated with increased possibility（P<0.05）. Conclusion　In this group，the rate of abandoning COC first used after the induced abortion was high，while that of abandoning LARC was low. The major reasons for abandoning COC or LARC were poor adherence，adverse drug reactions，drug-related complications and concerns on future fertility. Age，reproductive history，repeated abortion and contraceptive attitude may be associated factors for the abandoning. So it is suggested to deliver postoperative follow-up services according to personal characteristics related to the abandoning to reduce the possibility of abandoning.

Awareness of Free Contraceptives and Influencing Factors among People of Reproductive Age　

SHU Ting，SUN Chenghong，YANG Yanling，ZHANG Baiyang，WANG Tingting，ZHU Cairong

2021, 24(27): 3413-3419. DOI: 10.12114/j.issn.1007-9572.2021.00.547

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Background　The awareness of free contraceptives is a basic prerequisite for active acquiring them in people of reproductive age. Understanding reproductive age group's awareness of contraceptives and free contraceptives，and identifying people with low awareness of free contraceptive policies can provide a scientific basis for optimizing relevant publicity strategies. Objective　To explore the awareness of contraceptives and free contraceptives，and factors contributing to awareness of free contraceptive policies among the reproductive-aged population in Sichuan. Methods　Data for this study were part of an online cross-sectional survey named Research Project on Quality of Free National Contraceptive Services carried out in Sichuan in 2020，including demographics，awareness of types of contraceptives and free contraceptives，and free contraceptive policies. A multi-stage stratified sampling method was utilized to select the survey sites，from which，quota sampling was conducted to sample the participants. Multi-level Logistic regression models were used to identify factors contributing to the awareness of the free contraceptive policy. Results　Among the 9 890 cases attending the survey，9 395 （94.99%） returned responsive questionnaires，and 8 278 of them（15-49 years old） were included in this analysis. The awareness rates of respondents about contraceptives ranged from 27.64% to 96.61%，among which the awareness rate of condoms was the highest，and the awareness rates of high-efficiency contraceptives were all less than 75.00%. The awareness rates of respondents about free contraceptives ranged from 9.57% to 85.02%，among which the awareness rate of free condoms was the highest，and the awareness rates of other free contraceptives were all lower than 35.00%. In all，7 183 respondents（86.77%） knew the free contraceptive policy. Multi-level Logistic regression analysis showed that，marital status，education level，occupation，and monthly household income per capita were factors affecting the awareness of the free contraceptive policy for different gender groups （P<0.05）. The type of hukou was associated with the awareness of the free contraceptive policy in women（P<0.05）. Sex experience was related to the awareness of the free contraceptive policy in men （P<0.05）. Conclusion　Given the survey results，it is suggested to strengthen the publicity of high-efficiency contraceptive methods，comprehensively enrich the content of free contraceptives publicized，and pay special attention to priority people when carrying out related publicity，such as rural women，men without sex experience，unmarried，low-income，low-educated，non-medical workers，or people with lower average monthly household income per capita.

Association of Obesity with Cardiorespiratory Fitness in Patients with Type 2 Diabetes Mellitus　

BI Lina，ZHENG Xin，QI Yanyan，HU Su，ZHAO Dan，LI Chang，ZHANG Yan

2021, 24(27): 3420-3423. DOI: 10.12114/j.issn.1007-9572.2021.00.496

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Background　Cardiorespiratory fitness（CRF） is closely related to the incidence rate and mortality of type 2 diabetes mellitus （T2DM）. Overweight and obesity are prevalent in a large proportion of patients with T2DM，but it is not clear whether they deteriorate the damage of CRF. Objective　To investigate the characteristics of CRF and its association with overweight and obesity in patients with T2DM. Methods　We enrolled 87 T2DM inpatients and outpatients from Department of Endocrinology，Beijing Boai Hospital，China Rehabilitation Research Center from December 2018 to December 2019. They all completed symptom-limited cardiopulmonary exercise testing（CPET），and parameters such as peakVO2，peakVO2/kg，resting VO2，peak-METs，peakVO2%P，and Peak-WR were compared among normal weight group（n=22），overweight group（n=27）and obesity group （n=38）stratified by BMI to evaluate the association of BMI with CRF parameters. Results　We noted that the level of peakVO2/kg in 59 patients （67.8%） was lower than 20 ml•kg-1•min-1，and the peakVO2%P in 70 patients （80.5%） was lower than 84%. There were significant differences in the peakVO2，peakVO2/kg，resting VO2，and peak-METs among the three groups （P<0.01）. The resting VO2 of overweight group was higher than that of normal weight group（P<0.05）. The peakVO2 of obesity group was higher than that of normal weight group（P<0.05）. The obesity group had lower peakVO2/kg and peak-METs and higher resting VO2 than other two groups（P<0.05）. There were no significant differences in Peak-WR and peakVO2%P across the groups（P>0.05）. Pearson correlation analysis showed BMI was positively correlated with peakVO2，resting VO2，and Peak-WR（r=0.525，0.405，0.222，P<0.05），and was negatively correlated with peakVO2/kg，and peakMETs（r=-0.402，-0.402，P<0.01）. Conclusion　It is suggested that the CRF in most T2DM decreased and the impaired CRF is further aggravated by obesity.

Association of Metabolic Diseases with Thyroid Nodules：an Analysis Using the Panel Data of Four-year Health Checkups of a University's Faculty　

XIE Xiaoliang，BAO Wei，JIN Honghao，TUO Lin，CHAI Xiaoyuan

2021, 24(27): 3424-3431. DOI: 10.12114/j.issn.1007-9572.2021.02.005

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Background　The correlation between metabolic diseases and thyroid nodules has been mainly explored in community populations，but rarely in university faculty. Moreover，since most of these studies are based on cross-sectional data，in which the association of metabolic diseases and thyroid nodules may not be precisely measured due to potential individual confounders such as gender，age，lifestyle，disease history，and family history. Objective　To further examine the association of metabolic diseases and thyroid nodules using the panel data of health checkups in university faculty. Methods　In this study，we collected the panel data of four-year（from 2015 to 2018） health checkups of a university's faculty in Beijing，including gender，age，height，weight，body mass index，blood pressure，fasting plasma glucose，total cholesterol （TC），triacylglycerol （TG），low-density lipoprotein cholesterol （LDL-C），high-density lipoprotein cholesterol （HDL-C），serum uric acid，thyroid B-mode ultrasound，liver B-mode ultrasound，etc. We calculated the detection rates of thyroid nodules，hypertension，abnormal glucose metabolism，hypercholesterolemia，hypertriglyceridemia，hyper-LDL-cholesterolemia，hypo-HDL-cholesterolemia，hyperuricemia and fatty liver. The two-way fixed effect model was used to measure the strength of association between metabolic diseases and thyroid nodules after controlling the potential confounders such as individual effect and temporal effect. Results　In total，4 725 cases were included for analysis. Among them，2 413 cases of thyroid nodules were detected. In 2018，the detection rate of thyroid nodules was 56.95% （684/1 201）. The top three metabolic diseases detected were dyslipidemia〔42.96% （516/1 201）〕，overweight and obesity〔42.96% （516/1 201）〕，and fatty liver 〔33.64% （404/1 201）〕. Men had higher detection rates of hypertension，hyper-LDL-cholesterolemia，hypertriglyceridemia，hypo-HDL-cholesterolemia，abnormal glucose metabolism，overweight and obesity，hyperuricemia and fatty liver than women （P<0.01）. The middle-aged（41-50 years old） and older groups（≥51 years old） had higher detection rates of thyroid nodules，hypertension，and abnormal glucose metabolism（P<0.05）. Moreover，those aged ≥51 years had higher detection rates of thyroid nodules，hypertension，hypercholesterolemia，hyper-LDL-cholesterolemia，hypertriglyceridemia，abnormal glucose metabolism，overweight and obesity，hyperuricemia and fatty liver than those aged 41-50 or ≤ 40 years （P<0.05）. After controlling for gender and age，it was found that the detection rate of hypertension，hypertriglyceridemia，or overweight and obesity was positively correlated with that of thyroid nodules with varying degrees of strength in the two-way fixed effect model for all participants （P<0.10）. Hypertension caused a 3.3% increase in the detection rate of thyroid nodules and passed the test at the 10% significance level. Hypertriglyceridemia caused a 2.6% increase in the detection rate of thyroid nodules and passed the test at the 10% significance level. Overweight and obesity caused a 1.6% increase in the detection rate of thyroid nodules and passed the test at the 1% significance level. Conclusion　The prevalence of metabolic diseases and thyroid nodules were high. The prevalence of thyroid nodules was increased with age in the university faculty. Those with hypertension，hypertriglyceridemia，overweight and obesity may be more susceptible to thyroid nodules，hence，early screening may be a measure to prevent thyroid nodules and thyroid cancer for them.

Prevalence and Associated Factors of Depressive Symptoms in China's Rural Elderly　

LI Lei，MA Mengyuan1，PENG Hongye，YAN Zaofang，WANG Miyuan，HU Mengchao，LIU Jia，ZHAO Zhenhai

2021, 24(27): 3432-3438. DOI: 10.12114/j.issn.1007-9572.2021.00.577

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Background　Along with the population aging and deepening understanding of healthy aging，the mental health status of a large group，aged people in China's rural areas，has received considerable attention. Objective　To explore the factors associated with depressive symptoms in China's rural elderly，providing evidence for promoting healthy aging in this group. Methods　This study was conducted in November 2020. Participants（3 068 China's rural elderly people aged 60 and over） were part of individuals who attended the 2018 CHARLS supported by Peking University. The short version of the Center for Epidemiologic Studies Depression Scale-Short Form（CES-D-SF） was used to assess the prevalence of depressive symptoms. The random forest algorithm was used to screen and sort the items associated with depression symptoms. Binary Logistic regression analysis was used to identify associated factors of depressive symptoms. Results　The top six of the 15 items associated with depression symptoms ranked in terms of importance were：self-reported health status，nap duration，life satisfaction，night sleep duration，education level，and marital satisfaction.The average score of CES-D-SF for the participants was（9.9±6.9） points.It was found that 1 679 cases（54.7%） had depressive symptoms，and 1 389（45.3%） did not. Binary Logistic regression analysis indicated that gender 〔female：OR=1.710，95%CI（1.422，2.057）〕，education level〔junior high school or above ：OR=0.663，95%CI（0.507，0.866）〕，nap duration〔6-8 h：OR=0.506，95%CI（0.425，0.601）；>8 h：OR=0.435，95%CI（0.324，0.580）〕，intergenerational emotional supports〔more：OR=1.297，95%CI（1.077，1.562）〕，life satisfaction 〔unsatisfied：OR=5.179，95%CI（3.814，7.133）〕，marital satisfaction 〔unsatisfied：OR=3.181，95%CI（2.264，4.526）；no spouse：OR=1.243，95%CI（1.004，1.538）〕，overall self-rated health 〔fair：OR=1.512，95%CI（ 1.199，1.915）；poor：OR=3.918，95%CI（3.056，5.043）〕，chronic diseases 〔have：OR=1.232，95%CI（1.041，1.457）〕，childhood health status 〔fair：OR=1.349，95%CI（1.107，1.644）〕 were associated with depressive symptoms（P<0.05）. Conclusion　The emotional status of the rural elderly was not optimistic，nearly half of them had depressive symptoms，which may be associated with gender，education level，nep duration，intergenerational emotional support，life satisfaction，marital satisfaction，overall self-rated health，chronic disease prevalence，and childhood health status. To promote the development of healthy aging in China，the prevention and control of depressive symptoms in high-risk individuals in this group shall be multifactorial with priority.

Management of Type 2 Diabetes and Prediabetes in the Community：a Survey from Shanghai　

WANG Junwei，GUAN Lihua，XING Yuan，PENG Yan，ZHOU Wanying，XUE Huijuan，LIU Yun，LI Lianxi

2021, 24(27): 3439-3443. DOI: 10.12114/j.issn.1007-9572.2021.00.560

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Background　The prevalence of adult type 2 diabetes and prediabetes is high，but the rates of treatment and control of diabetes are low in China. Prediabetic patients have higher risk and prevalence of diabetic complications compared to the general population. There is currently a lack of evidence on community diabetes management in terms of interventions，screening for chronic complications，and scientific popularization and education of the knowledge about prediabetes. Objective　To investigate and analyze the community-based management of diabetic and prediabetic populations，providing evidence for optimizing community-based diabetes management. Methods　An epidemiological survey using the Epidemiological Questionnaire on Type 2 Diabetes and Prediabetes was conducted from November 2020 to January 2021 among 101 prediabetic patients and 1 055 type 2 diabetic patients selected from five community health centers（Anting，Zhenru，Caoyang，Qingcun，and Taopu） in Shanghai，covering the sociodemographic information，prevalence of receiving lifestyle interventions，medication treatment and screening for chronic complications，prevalence of chronic complications，and receiving the scientific popularization of the knowledge about type 2 diabetes and prediabetes. The data of type 2 diabetic and prediabetic patients were compared. Results　Compared to prediabetic patients，type 2 diabetes patients had higher prevalence of using lifestyle interventions and medication treatment（P<0.05）. Moreover，they also had higher prevalence of screening for chronic complications〔78.6% （829/1 055） vs 19.8%（20/101）〕（P<0.001）. No chronic complications of diabetes were found in the prediabetic population who had been screened for complications，which was lower than that 〔24.7% （205/829）〕 of their counterparts （P=0.022）. The prevalence of receiving the scientific popularization of the knowledge about type 2 diabetes and prediabetes among the prediabetic population was lower 〔27.7% （28/101） vs 67.2% （709/1 055）〕（P<0.001）. Conclusion　Community-dwelling prediabetics had lower prevalence of receiving lifestyle interventions，screening for chronic complications and scientific popularization of the knowledge about type 2 diabetes and prediabetes than community-dwelling diabetics，suggesting that community-based management of this population is under-appreciated and needs to be improved.

Effect of Body Fat Indices on the Relationship between Serum Uric Acid and Bone Mineral Density in Middle-aged and Elderly People（45-70 Years Old）　

AN Miaomiao，JIN Ying，ZHU Yan，LIU Min，LI Dan，XU Haina，RAN Limei

2021, 24(27): 3444-3450. DOI: 10.12114/j.issn.1007-9572.2021.02.011

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Background　The relationship between serum uric acid （SUA） level and bone mineral density（BMD） has been extensively studied，but the effect of body fat indices on their relationship is not well defined. Objective　To explore the effect of body fat indices on the relationship between SUA and BMD of the lumbar spine and femoral neck in middle-aged and elderly individuals aged between 45-70 years. Methods　This study was conducted from January to December 2020. Participants were middle-aged and elderly physical examinees selected from Health Management Center，Affiliated Hospital of Guizhou Medical University，and were invited to attend a survey for investigating general demographics using Osteoporosis-related Factors Questionnaire. Body fat indices，BMD，and SUA were also collected. General demographics，body fat distribution，BMD，SUA and incidence of osteoporosis were compared by sex. The correlation between SUA and BMD was analyzed，and the influence of body fat indices on their relationship was explored. Results　Over all，the response rate of the distributed questionnaires was 94.27%（707/750）. The average age，BMI，waist circumference，hip circumference，and WHR of the 707 respondents（314 women and 393 men） were （55.3±6.6） years，（24.6±6.4） kg/m2，（84.0±9.0） cm，（94.1±6.0） cm，and（0.9±0.1），respectively. There were significant sex-based differences in prevalence of active and passive smoking，and drinking，milk consumption，vitamin D intake，calcium tablets intake，average BMI，waist circumference，hip circumference，WHR，lumbar spine BMD，femoral neck BMD，SUA，and incidence of osteoporosis （P<0.05）. Pearson correlation analysis showed that SUA was weakly but positively associated with lumbar spine BMD and femoral neck BMD （r=0.202，0.164，P<0.05）. Multiple linear regression analysis indicated that SUA was significantly associated with lumbar spine BMD as well as femoral neck BMD after controlling for some demographic covariates（β=0.160，0.035，P<0.05）. And it was also significantly associated with lumbar spine and femoral neck BMD after controlling for covariates including some demographics and BMI （β=0.103，0.095，P<0.05）. Further analysis based on quartiles of waist circumference （<77 cm，77-85 cm，86-90 cm，91-113 cm） revealed that a positive correlation was found between SUA and lumbar spine BMD in participants with waist circumference of <77 cm，or 77-85 cm （r=0.213，0.199，P<0.05）. SUA was positively correlated with BMD of femoral neck in participants with waist circumference of <77 cm（r=0.173，P<0.05）. Conclusion　This study revealed a strong simple correlation between serum SUA level and BMD of the lumbar spine or femoral neck in middle-aged and elderly individuals，which may be partially influenced by some body fat indices. The beneficial effect of SUA on preventing BMD loss was more manifested in those with waist circumference ≤85 cm.

Value of A2DS2 Score Combined with FT3 in Predicting Stroke-associated Pneumonia　

YAO Yangyang，ZHANG Meng，TONG Shumin，SU Yijie，MA Liansheng

2021, 24(27): 3451-3456. DOI: 10.12114/j.issn.1007-9572.2021.00.491

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Background　The A2DS2 score is the most commonly used scale to predict stroke-associated pneumonia （SAP），by assessing clinical symptoms. Previous studies revealed that FT3 can predict the occurrence of infection after stroke with a simple measurement method. However，it remains unclear whether free triiodothyronine （FT3） can predict the occurrence of SAP and whether the predictive value of A2DS2 score combined with FT3 for SAP can be higher. Objective　To explore the predictive value of A2DS2 score with FT3 for SAP. Methods　We retrospectively enrolled 300 acute ischemic stroke patients with and without SAP（according to relevant diagnostic criteria） from Department of Neurology，First Hospital of Shanxi Medical University in 2019. Baseline data were collected，and FT3 level and A2DS2 score were assessed within 7 days after admission. Univariate and multivariate Logistic regression analyses were performed to investigate factors associated with SAP. The receiver operating characteristic （ROC） curves of A2DS2 score，FT3 level and A2DS2 score with FT3 in discriminating SAP were plotted and their values were compared. Results　There were 43 cases with SAP and 257 without.Multivariate Logistic regression analysis showed that age≥75〔OR=4.631，95%CI（1.427，15.031）〕，atrial fibrillation〔OR=3.745，95%CI（1.154，12.153）〕，higher NIHSS score at admission〔OR=1.255，95%CI（1.061，1.486）〕，lower FT3〔OR=5.024，95%CI（1.526，16.543）〕，and higher A2DS2 score 〔OR=1.781，95%CI（1.182，2.683）〕 were independent risk factors of SAP（P<0.05）. The AUC of A2DS2 score in predicting SAP was 0.875〔95%CI（0.803，0.947）〕，with 4.5 points determined as the optimal cut-off value （sensitivity 0.689，specificity 0.957）. The AUC of FT3 was 0.874〔95%CI（0.744，0.903）〕，with 3.53 pmol/L determined as the optimal cut-off value （sensitivity 0.744，specificity 0.903）. The AUC of A2DS2 score combined with FT3 was 0.932〔95%CI（0.883，0.980）〕，with a sensitivity of 0.885 and a specificity of 0.860. The AUC of A2DS2 score with FT3 was significantly higher than that of A2DS2 score（Z=2.159，P=0.03）or FT3 （Z=2.392，P=0.02）. Conclusion　A2DS2 score combined with FT3 showed higher value in predicting SAP，facilitating early identification of patients with high risk of SAP and prompt interventions.

Impact of Early Active Fluid Resuscitation on Patients Initially Assessed as Non-severe Acute Pancreatitis　

LIU Jun，WU Pengyu，LIU Li，SUN Xiaobin

2021, 24(27): 3457-3463. DOI: 10.12114/j.issn.1007-9572.2021.00.454

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Background　Fluid resuscitation is considered as the key of early treatment of acute pancreatitis（AP），but there are few reports about the fluid resuscitation scheme in patients initially assessed as non-severe AP，moreover，the impact of early active fluid resuscitation on the progression of non-severe AP to severe AP and prognosis is inconclusive. Objective　To investigate the impact of early active fluid resuscitation on patients initially assessed as non-severe AP. Methods　From 1 January to 31 December，2018，219 patients initially assessed as non-severe AP were selected from Department of Gastroenterology，the Third People's Hospital of Chengdu and divided into control group（n=118，using conventional treatment plus regular fluid resuscitation with fluid volume<3 200 ml administered within 24 hours of admission）and observation group（n=101，using conventional treatment plus active fluid resuscitation with fluid volume ≥3 200 ml administered within 24 hours of admission）. Total volume of fluid resuscitation at 24，48 and 72 hours after admission，clinical outcome，rate of reaching the improved criteria by fluid resuscitation as well as rate of progression to severe AP 3 and 7 days after treatment were compared between the two groups，and subgroup analysis was conducted. Results　Compared to control group，observation group had larger total volume of fluid resuscitation administered within 24 hours of admission，longer fasting time for solids and liquids，higher rate of reaching the improved criteria by fluid resuscitation and lower rate of progression to severe AP 3 and 7 days after treatment，as well as lower incidence of systemic inflammatory response syndrome（SIRS）（P<0.05）. Subgroup analysis indicated that，compared to the controls，mild patients in observation group had longer fasting time for solids and liquids，and higher incidence of SIRS（P<0.05）. In control group，longer fasting time for solids and liquids as well as hospital stays，higher rates of undergoing mechanical ventilation and invasive/interventional treatment，transferring to ICU and progression to severe AP 3 and 7 days after treatment were found in moderate patients compared to the mild patients（P<0.05）. In observation group，longer fasting time for solids and liquids，and higher rate of progression to severe AP 7 days after treatment were found in moderate patients compared to mild patients（P<0.05）. Conclusion　In patients initially assessed as non-severe acute pancreatitis，early active fluid resuscitation（total volume of fluid resuscitation administered within 24 hours of admission is suggested to be larger than half of that administered within 48 hours of admission or ≥3 200 ml）may be helpful to improve the clinical outcome，rate of reaching the improved criteria by fluid resuscitation，and reduce the risk of progression to severe AP，with no association with the degree of AP（mild or moderate）at diagnosis.

Relationship of Serum Levels of Visinin-likeprotein-1，CXC Chemokine Ligand 16 and Anticardiolipin Antibody with the Severity and Prognosis in Patients with Acute Cerebral Infarction　

CHEN Shengjun，LI Bo，CHEN Guozhu，YANG Dan

2021, 24(27): 3464-3468. DOI: 10.12114/j.issn.1007-9572.2021.00.586

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Background　Acute cerebral infarction is a common clinical cerebrovascular disease that seriously threatens human life. Studies have shown serum test indicators have good accuracy in assessing brain injury，but it is necessary to find indicators with higher specificity and accuracy，providing insights into the prediction of the progression and prognosis of acute cerebral infarction. Objective　To explore the relationship of serum levels of visinin-like protein-1（VILIP-1），CXC chemokine ligand 16（CXCL16） and anticardiolipin antibody （ACA） levels with the severity and prognosis in patients with acute cerebral infarction.Methods　Patients with acute cerebral infarction （n=116） and healthy examinees （n=60） were selected from the First People's Hospital of Fuyang District，Hangzhou from June 2019 to August 2020. Serum levels of VILIP-1，CXCL16 and ACA were compared between acute cerebral infarction patients and healthy examinees，and between subgroups of acute cerebral infarction patients divided by degree of neurological impairment〔mild subgroup （n=36），moderate subgroup（n=48） and severe subgroup（n=32）〕，head CT-detected infarction size 〔small infarction subgroup（n=31），medium infarction subgroup （n=55），and large infarction subgroup （n=30）〕，and prognosis assessed by the modified Rankin Scale〔good prognosis subgroup（n=70），poor prognosis subgroup（n=46）〕. The ROC curve of the serum VILIP-1，CXCL16 and ACA was plotted to examine the prognostic value of each of them for acute cerebral infarction. Results　Acute cerebral infarction patients had significantly higher levels of VILIP-1，CXCL16 and ACA than the healthy examinees （P<0.05）. The levels of VILIP-1，CXCL16 and ACA showed a significant increase successively across mild，moderate and severe subgroups （P<0.05）. The level of these three parameters also demonstrated a notable increase successively across small，intermediate and large infarction subgroups （P<0.05）. Furthermore，they were much higher in poor prognosis subgroup than those in good prognosis subgroup （P<0.05）. The AUC of serum VILIP-1 for predicting the prognosis of acute cerebral infarction was 0.848，with 82.61% sensitivity，and 75.71% specificity.The AUC of serum CXCL16 was 0.820，with 89.13% sensitivity，and 64.29% specificity.The AUC of serum ACA was 0.784，with 73.91% sensitivity，and 71.43% specificity. Conclusion　Elevated VILIP-1，CXCL16 and ACA were found in patients with acute cerebral infarction，whose expression levels were closely related to the degree of cerebral infarction and clinical prognosis，so they may be used as prognostic indicators for acute cerebral infarction.

Association of Single Nucleotide Polymorphisms of ARL15 and PGC-1α Genes with Diabetic Kidney Disease　

TU Yingye，ZHANG Hongjiang，KANG Chun，DU Fei，CUI Jiahui，SHAO Wei，YUAN Zhimin，WANG Weijie，YANG Kangjuan

2021, 24(27): 3469-3476. DOI: 10.12114/j.issn.1007-9572.2021.02.015

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Background　ADP-ribosylation factor-like protein 15（ARL15） rs4311394 and peroxisome proliferator-activated receptor-γ coactivator 1α（PGC-1α） rs7656250 have been demonstrated to be closely correlated with dyslipidemia，a key risk factor for diabetic kidney disease （DKD），but whether these gene loci have an association with DKD remains unknown. Objective　To explore the association of single nucleotide polymorphisms （SNPs） of ARL15 and PGC-1α genes with DKD. Methods　Participants were China's Han and Korean individuals who were enrolled during 2018—2019，including 393 with T2DM（T2DM group，including 205 Han and 188 Korean cases），and 90 with DKD（DKD group，including 55 Han and 35 Korean cases） from Yanbian University Hospital and Yanji Municipal Hospital，and 268 workers with normal glucose tolerance （NGT） undergoing physical examination in Yanbian University Hospital （NGT group，including 137 Han and 131 Korean cases）. Data were collected，comprising physiological and biochemical indicators，alleles and genotypes of ARL15 rs4311394 and PGC-1α rs7656250 detected by single-base extension assay，and levels of ARL15 and adiponectin proteins detected using ELISA. Results　The results exhibited no statistically significant differences regarding both allele and genotype frequencies of ARL15 rs4311394 and PGC-1α rs7656250 between Han and Korean cases in the NGT group （P>0.05）. Also，the differences in both allele and genotype frequencies of ARL15 rs4311394 and PGC-1α rs7656250 across three groups were not statistically significant （P>0.05）. In addition，no statistically significant differences were noted in allele and genotype frequencies of ARL15 and PGC-1α gene loci among the three groups （P>0.05）. However，the FPG level was higher in carriers of CT genotype of PGC-1α rs7656250 than in carriers of CC or TT genotype of PGC-1α rs7656250 （P<0.05）. The adiponectin protein level was lower in carriers of CT or TT genotype of PGC-1α rs7656250 than in carriers of CC genotype of PGC-1α rs7656250，and also lower in carriers of TT genotype of PGC-1α rs7656250 than in carriers of CT genotype of PGC-1α rs7656250 （P<0.05）. Besides，the adiponectin protein level in T2DM patients was lower than that in individuals with NGT （P<0.05）. And ARL15 and adiponectin protein levels in DKD patients were higher than those in individuals with NGT and T2DM patients （P<0.05）. Furthermore，Spearman's correlation analysis suggested a positive correlation between ARL15 level and adiponectin level （rs=0.372，P<0.05）. Conclusion　Although SNPs in ARL15 and PGC-1α shared no correlation with DKD，the adiponectin protein level was reduced in carriers of CT or TT genotype of PGC-1α rs7656250.

Clinical Efficacy of Dangguibuxue Decoction as an Adjuvant Therapy for Diabetic Nephropathy：a Meta-analysis　

CHENG Liying，WANG Mengxi，ZHANG Zhu，SHAO Fengmin

2021, 24(27): 3477-3483. DOI: 10.12114/j.issn.1007-9572.2021.00.563

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Background　Excessive inflammatory response and renal fibrosis play key roles in the progression of diabetic nephropathy to end-stage renal disease. However，the usual western treatment for diabetic nephropathy has no significant anti-inflammatory and anti-fibrosis effects. Dangguibuxue Decoction（DD） is often used as an adjuvant therapy clinically due to its notable anti-inflammatory and anti-fibrosis effect，but there is a lack of relevant medical evidence. Objective　To systematically study the efficacy and safety of DD as an adjuvant therapy for diabetic nephropathy. Methods　Databases of CNKI，Wanfang Data，VIP，SinoMed，PubMed，The Cochrane Library，EMBase，ChiCTR，and ClinicalTrials.gov were searched from inception to December 2020 to identify randomized controlled trials（RCTs） regarding diabetic nephropathy patients treated by usual integrated treatment and modified DD compared with those treated by usual integrated treatment.Data extraction of the included RCTs were performed. The Cochrane Collaboration's tool for assessing risk of bias was used to evaluate the methodological quality. Review Manager 5.4 was used for meta-analysis. Results　A total of 10 RCTs meeting the inclusion criteria were included，involving 879 patients. The results of meta-analysis found that the combined therapy of usual integrated treatment with modified DD could further improve the overall response rate〔RR=1.18，95%CI（1.10，1.28），P<0.000 1〕，reduce the 24-hour urinary protein quantification〔MD=-69.22，95%CI（-76.96，-61.48），P<0.000 01〕 and urinary albumin excretion rate〔MD=-31.32，95%CI（-59.87，-2.76），P=0.03〕，decrease the levels of serum creatinine〔MD=-10.24，95%CI（-11.51，-8.98），P<0.000 01〕 and urea nitrogen 〔MD=-0.95，95%CI（-1.61，-0.29），P=0.005〕 with no significant effect on adverse events〔RR=1.00，95%CI（0.30，3.34），P>0.05〕. Conclusion　The clinical effect of DD in adjuvant treatment of diabetic nephropathy is significant and has good safety.

A Meta-analysis of the Therapeutic Effects of Intermittent Fasting on Overweight or Obesity　

ZHANG Jiapeng，GUAN Yingjun，HUANG Qixia，CHEN Jing

2021, 24(27): 3483-3488. DOI: 10.12114/j.issn.1007-9572.2021.00.529

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Background　Intermittent fasting （IF） is an option for overweight or obesity，a risk factor for many cardiovascular diseases，but it is not recommended as a usual treatment by current international clinical guidelines due to many treatment-emergent adverse reactions. Objective　To evaluate the therapeutic effect of IF in overweight or obese people. Methods　The electronic databases，PubMed，Web of Science，CNKI，Wanfang Data，CQVIP and SinoMed，were searched from inception to November 8，2020 for randomized control trials（RCTs） about adults with overweight or obesity receiving IF（experimental group） compared with those receiving usual diet（control group）. RCTs enrollment，data extraction，and methodological quality assessment were performed by two reviewers independently. RevMan was used for meta-analysis. Results　Seven RCTs were included. Analysis revealed that compared to the control group，the experimental group showed lower mean weight and low-density lipoprotein〔MD=-2.75，95%CI（-3.64，-1.86），P<0.000 01；MD=0.58，95%CI（0，1.16），P<0.000 1〕，but demonstrated insignificantly differences in fat free mass，and blood glucose〔MD=-0.89，95%CI（-1.81，0.04），P=0.06；SMD=-0.56，95%CI（-1.40，0.28），P=0.19〕. GRADE assessment indicated that the quality of evidence on improving weight，blood glucose，fat free mass and low-density lipoprotein was moderate，low，very low，and very low，respectively. Conclusion　Current evidence suggests that IF is effective in reducing weight and low-density lipoprotein in overweight or obese people，but it needs to be verified whether it improves blood glucose and fat free mass. Further research is recommended to be conducted in more multi-center and large-sample RCTs.

Expert Opinions and Suggestions Regarding Home-based Rehabilitation for Ischemic Stroke：a Qualitative Study　

MA Jiajia，MAO Yafen，NIU Shuzhen，WANG Li，WANG Bin，WU Songqi，SHI Yan

2021, 24(27): 3489-3493. DOI: 10.12114/j.issn.1007-9572.2021.00.565

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Background　It is necessary to carry out home-based rehabilitation for ischemic stroke to reduce the recurrence rate and fatality rate，improve the prognosis，and decrease the burden of stroke in China. Objective evaluation of the effect of home-based rehabilitation for ischemic stroke will contribute to the sound and sustainable development of home-based rehabilitation program，but there are few relevant reports. Objective　To investigate expert opinions and recommendations regarding home-based rehabilitation for ischemic stroke，to provide a reference for the development of a home-based rehabilitation for ischemic stroke assessment system. Methods　From October to December，2020，by use of purposive sampling，22 experts in home-based rehabilitation for ischemic stroke（involving nursing management，clinical neurology treatment，and rehabilitation）were selected from seven regions of China，and invited to attend an individual interview using a semi-structured framework. The interview results were analyzed using Colaizzi's descriptive phenomenological method，and thematic analysis with Nvivo 12. Results　Four themes emerged：（1）the evaluation of home-based rehabilitation for ischemic stroke is an urgent need for both doctors and patients；（2）patient health outcome is the core content of the evaluation；（3）the level of knowledge-attitude-practice is an important evaluation dimension；（4）the evaluation should be carried out flexibly according to the patient's own characteristics. Conclusion　Patient health outcome，and levels of knowledge-attitude-practice of patients and their primary caregivers are key points in the evaluation of home-based rehabilitation. To improve the accuracy and efficiency of the evaluation，it is suggested to set up an evaluation team consisting of multidisciplinary professionals with clear and detailed determination of each member's responsibility and duty，and to improve the team professional level continuously. Moreover，to facilitate the implementation of the evaluation，it is suggested to strengthen the informatization construction，and build a multi-cooperation platform within the region.

Characteristics and Related Factors of Recurrence Risk Perception in Stroke Patients：a Qualitative Study　

ZHANG Zhenxiang，GUO Yunfei，LIN Beilei，LIU Qingxuan，CHANG Hong，AN Baoxia，SHI Danqing，CHEN Zhanying

2021, 24(27): 3494-3500. DOI: 10.12114/j.issn.1007-9572.2021.00.570

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Background　Recurrence risk perception is associated with recurrence risk awareness and healthy behaviors of patients to a certain extent，however，there have been few studies about recurrence risk perception in stroke patients. Objective　To explore the characteristics and related factors of recurrence risk perception in stroke patients，to provide a recurrence risk perception-based reference for forming healthy behavior habits and improving health outcomes in the stroke patients. Methods　Convenience sampling was used to select 17 stroke patients hospitalized in the Fifth Affiliated Hospital of Zhengzhou University，Zhengzhou Central Hospital and Hua County People's Hospital of Henan Province from April to October 2019. Semi-structured，in-depth，face-to-face interviews were conducted to understand patients' recurrence risk perception and associated factors，analyzed and categorized into dominant themes. Results　Three dominant themes identified were factors，contents and characteristics of recurrence risk perception. Factors of recurrence risk perception were mainly stroke-related knowledge，attitude and psychology，health behavior awareness，and family and social environment. The contents of recurrence risk perception mainly included recurrence possibility，recurrence risk factors and recurrence severity. The main characteristics of recurrence risk perception were subjective underestimation of recurrence risk，subjective avoidance of recurrence problems，and objective perception of recurrence risk with individual experience limitations. Conclusion　The perceived risk of recurrence in stroke patients is not homogeneous，which is influenced by multiple factors and problematic. In view of this，medical workers should pay attention to provide scientific and appropriate recurrence risk perception assessment and management services for these patients to help them develop correct awareness of recurrence risk perception，master recurrence risk related knowledge and develop healthy habits.

Community Residents' Perspectives on Stroke-120：a Qualitative Study　

HUANG Jiayan，ZHAN Jiayin，WANG Zheng，QIN Fengyin，TAN Yibing

2021, 24(27): 3501-3505. DOI: 10.12114/j.issn.1007-9572.2021.00.534

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Background　Stroke-120 is the major tool for stroke awareness education in China，but there is short of in-depth research about community residents' perspectives on Stroke-120. Objective　To understand community residents' perspectives on Stroke-120，so as to provide ideas for the publicity，promotion and popularization of Stroke-120. Methods　Purposive sampling was used to select 31 permanent community residents（locally lived over 1 year）who were relatives and friends of the author's research group from July to September 2020，including 15 cases came from Guangdong Province，7 from Hubei Province，6 from Henan Province，1 from Hebei Province，1 from Hunan Province and 1 from Liaoning Province. Semi-structured in-depth interviews guided by an outline and questions related to Stroke-120 was conducted，the interview results were coded by using Nvivo as an auxiliary tool，and analyzed by content analysis. Results　The recognition rate of three warning signs of stroke，namely crooked mouth，unilateral arm weakness and alalia was 64.5%（20/31），22.6%（7/31） and 61.3%（19/31），respectively. The proportion of participants who called 120 when found people around them with sudden appearance of at least one of the three above-mentioned warning signs of stroke was 32.2%（10/31），22.6%（7/31） and 41.9%（13/31），respectively. Insufficient knowledge of warning signs of stroke，and easily confusing stroke with other diseases were important factors affecting community residents' recognition of warning signs of stroke. The severity of warning signs of stroke and awareness of calling 120 were important factors affecting community residents' behavior of calling 120. Conclusion　The education of Stroke-120 in the community should focus on explaining the relationship between warning signs of stroke and stroke，the importance of quick medical treatment and the necessity of calling 120.

Research Progress on Reversion of Mild Cognitive Impairment to Normal Cognition　

QIN Yao，ZHANG Jiajia，WU Yan，GE Xiaoyan，HAN Hongjuan，CUI Jing，BAI Wenlin，YU Hongmei

2021, 24(27): 3506-3509. DOI: 10.12114/j.issn.1007-9572.2021.00.500

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Mild cognitive impairment（MCI） is generally deemed to be a high-risk population and therapeutic target for Alzheimer's disease（AD）. Although older adults with MCI have a 10%-15% annual risk of converting to probable AD，most MCIs remain stable，and partially reverse to normal cognition （NC）. So far，the significance of the reversion of MCI to NC remains extremely inconclusive and controversial，and systematic research at home and abroad is still limited. This article systematically sorts out the reversal rate of MCI，various reasons and influential factors，and proposes the significance of the reversion of MCI to NC and the problems to be solved.

Classification and Clinical Characteristics of Adulthood Leukoencephalopathies　

HAN Jiaqi，WANG Wei

2021, 24(27): 3510-3517. DOI: 10.12114/j.issn.1007-9572.2021.00.493

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Adulthood leukoencephalopathies are pathological changes of white matter with adult-onset，of which the differential diagnosis is still one of the key points and difficulties faced by neurologists. In this paper，these leukoencephalopathies are classified from etiololgy perspective. The clinical and imaging manifestations，diagnosis and treatments of common leukoencephalopathies are summarized. This article emphasizes the importance of detailed classification of leukoencephalopathies for precise clinical diagnosis and treatment. It is considered that craniocerebral imaging is an important means to identify different leukoencephalopathies，which combined with cerebrospinal fluid testing，histopathological examination，brain metabolism testing，next generation sequencing and other auxiliary methods can further improve the diagnostic efficiency.

Latest Developments in the Effect of Meal Sequence on Postprandial Blood Glucose in Diabetic Patients and Its Possible Mechanism　

DING Shaoyu，JU Changping，YANG Bingquan，YU Xingxing，CAI Xue，CUI Lei，CHEN Weixia，ZHOU Xu

2021, 24(27): 3517-3521. DOI: 10.12114/j.issn.1007-9572.2021.00.476

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Postprandial hyperglycemia is a condition where a person has elevated blood glucose （higher than 7.8 mmol/L） 1-2 hours after eating a meal，which is a major contributor to elevated glycosylated hemoglobin，and is related to the occurrence and development of chronic diabetic complications. Therefore，postprandial glycemic control is a key facilitator to reaching the target glycosylated hemoglobin，and preventing and treating chronic diabetic complications. It has been found recently that changing the eating order，a dietary treatment，has notable effect on controlling the postprandial blood glucose of diabetic patients. We reviewed the concept and latest developments in the effect of meal sequence on postprandial blood glucose of diabetics and the potential mechanism，offering evidence for further research.

Fulminant Type 1 Diabetes Mellitus Following Type 2 Diabetes Mellitus：Clinical Diagnosis and Treatment and Literature Review　

BAO Yahui，XU Qian，LIU Fang，ZHANG Yang，CAO Zhibin，QU Junsheng，SUN Xiaodong，HUI Zongguang

2021, 24(27): 3522-3524. DOI: 10.12114/j.issn.1007-9572.2021.00.568

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Fulminant type 1 diabetes mellitus is a novel subtype of type 1 diabetes mellitus. It is a relatively rare disease with no sufficiently clear pathogenesis. With rapid onset and progression，notably destroyed or even failed pancreatic β-cell function as the main clinical features，the prognosis of this disease is very poor. This paper reported a case of fulminant type 1 diabetes mellitus following type 2 diabetes mellitus，and analyzed her clinical features and treatment experience by reviewing relevant literature，so as to improve clinicians' understanding of the disease.

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