Table of Content

15 December 2016, Volume 19 Issue 35

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Community Management Status of Subjective Cognitive Decline

HAO Li-xiao, JIA Jian-guo, HAN Ying, SUN Yu, WANG Xiao-ni

2016, 19(35):  4285-4290.  DOI: 10.3969/j.issn.1007-9572.2016.35.001

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With the emergence of an aging population,chronic diseases seriously affect human health.Alzheimer’s disease （AD）,the most common type of senile dementia,has become a serious threat to the mental health and quality of life of the elderly worldwide.As there is no effective curing ways of this disease and its prognosis is poor,early detection,diagnosis and intervention are particularly important.Good community management of the disease can not only delay the disease process,improve disease prognosis,but also can further reduce our burden of family and society.Subjective cognitive decline （SCD） as a pre-clinical stage of AD has caused widespread attention from medical workers both at home and abroad,but there are few studies on community standardized management of this stage internationally and no researches domestically.Intending to review the community management system of SCD,the paper hopes to provide references for establishing guidance on community management of preclinical phase of AD in China.

Status Quo of Community Physicians in the Screening and Early Diagnosis of Prostate Cancer in Community

ZHANG Heng, JIA Dong-mei, MA Li, ZHANG Yong, LI Na, WANG Chen

2016, 19(35):  4291-4294.  DOI: 10.3969/j.issn.1007-9572.2016.35.002

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Prostate cancer is one of the most common urinary tract tumors in Chinese older men.Early diagnosis is essential to improve life expectancy of the patients.In contrast with early diagnosis of prostate cancer expert consensus,there existed many problems in community health service centers,such as the shortage of professional personnel,insufficience of knowledge and skills,lack of relevant diagnostic equipment,lack of diagnostic criteria and standards for process for the early diagnosis of prostate cancer and so on.Some measures should be taken to improve the early diagnosis ability of prostate cancer in the community health centers,such as making general physicians pay more attention to prostate disease,launching health education about prostate cancer in order to prompt patients to seek initiatively medical attention,formulating relevant standards to promote the ability of general physician to early diagnose prostate cancer.By doing so,we can take full advantage of community medical service,improve the early diagnosis of prostate cancer,and improve the prognosis of patients with prostate cancer.

Application of Holistic Function Assessment by Cardiopulmonary Exercise Testing in Exercise Rehabilitation among Patients with Chronic Heart Failure:A Summary of the Research Progress

ZHANG Zhen-ying, SUN Xing-guo, XI Jia-ning

2016, 19(35):  4295-4301.  DOI: 10.3969/j.issn.1007-9572.2016.35.003

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The role of cardiac rehabilitation in secondary prevention in patients with chronic heart failure（CHF） has been emphasized by clinicians,and the exercise rehabilitation is the core of cardiac rehabilitation.Cardiopulmonary exercise testing has a unique advantage in exercise capacity evaluation,exercise prescription formulation,exercise effect and prognosis evaluation.This article reviewed the research progress of application of cardiopulmonary exercise testing in cardiac exercise rehabilitation among CHF patients,including objective and quantitative holistic function assessment,precise formulation of individualized exercise prescription,exercise rehabilitation efficacy evaluation,prognosis estimation,individualized assessment of other rehabilitation program,and holistic health management

Effects of Exercise Intensity Deduced from Cardiopulmonary Exercise Testing on Exercise Rehabilitation Efficacy among Patients with Chronic Heart Failure:A Clinical Study

ZHANG Zhen-ying, SUN Xing-guo, XI Jia-ning, LIU Yan-ling, FENG Jing, JIANG Li-qing, GAO Hua

2016, 19(35):  4302-4309.  DOI: 10.3969/j.issn.1007-9572.2016.35.004

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Objective　To investigate the effects of exercise rehabilitation（ER） on cardiopulmonary function and quality of life（QoL） among patients with chronic heart failure（CHF）,and to explore exercise rehabilitation efficacy under different exercise intensity.Methods　15 patients who were diagnosed with CHF in Beijing Rehabilitation Hospital of Capital Medical University from September 2014 to May 2016,were recruited and randomly divided into three groups:patients in control group（n=5） were treated with conventional therapy without exercise,the overall function of patients in moderate exercise load group（ML group,n=5） and high exercise load group（HL group,n=5） were evaluated objectively and quantitatively by using cardiopulmonary exercise testing（CPET）,and patients in these two groups underwent ER according to individualized moderate intensity exercise prescription（30 min/day,5 days/week,lasted for 12 weeks）,patients in ML group exercised using 80% anaerobic threshold（AT） intensity of cycle ergometer,patients in HL group exercised using exercise intensity of Δ50% power above AT.General information,CPET results,echocardiogram results,6 minute walking distance（6MWD） and QoL score of three groups were recorded respectively before and after treatment.Results　All patients finished symptom limited extreme exercise CPET safely without complications,patients in ML and HL group finished 12-weeks ER.Before treatment,there were no significant difference in AT,peak oxygen uptake,peak oxygen pulse,peak load power,echocardiogram results,6MWD and QoL score among three groups（P>0.05）.After treatment,AT（ml/min,ml·min-1·kg-1）,peak load power（%pred） and 6MWD of patients in ML group were significantly higher than those of patients in control group,QoL score of patients in ML group was significantly lower than that of patients in control group（P<0.05）.AT（ml/min,ml·min-1·kg-1）,peak oxygen uptake（ml/min,ml·min-1·kg-1,%pred）,peak oxygen pulse（ml/time）,peak load power（W,%pred） and 6MWD of patients in HL group were significantly higher than those of patients in control group,QoL score of patients in HL group was significantly lower than that of patients in control group（P<0.05）.AT（ml/min,ml·min-1·kg-1）,peak oxygen uptake（ml/min,ml·min-1·kg-1,%pred） and peak oxygen pulse（ml/time） of patients in HL group were significantly higher than those of patients in ML group（P<0.05）.There were no significant difference in CPET indexes,echocardiogram results,6MWD and QoL score in control group between before and after treatment（P>0.05）.AT（ml/min,ml·min-1·kg-1,%pred）,peak load power（W,%pred）,left ventricular ejection fraction（LVEF）,6MWD and QoL score of patients in ML group after treatment were significantly higher than those before treatment,QoL score of patients in ML group after treatment was significantly lower that before treatment（P<0.05）.AT（ml/min,ml·min-1·kg-1,%pred）,peak oxygen uptake（ml/min,ml·min-1·kg-1,%pred）,peak oxygen pulse（ml/time,%pred）,peak load power（W,%pred）,LVEF and 6MWD of patients in HL group after treatment were significantly higher than those before treatment,QoL score of patients in HL group after treatment was significantly lower than that before treatment（P<0.05）.Conclusion　ER can improve the cardiopulmonary function,exercise tolerance and QoL of CHF patients significantly,high-load ER is more effective in improving cardiopulmonary function safely

Safety and Feasibility of Cardiopulmonary Exercise Testing in Patients with Severe Heart Failure

SHANG Guang-pei, SUN Xing-guo, TAN Xiao-yue, GE Wan-gang, LIU Fang

2016, 19(35):  4310-4315.  DOI: 10.3969/j.issn.1007-9572.2016.35.005

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Background　Cardiopulmonary exercise testing（CPET） is the unique method and clinical technology for estimating integrative functional status objectively and quantitatively，which is widely used in management for heart and lung transplantation.With worries over insurance，many domestic specialists abandon evaluating the patients with severe heart failure objectively and quantitatively by using CPET.Objective　To retrospectively evaluate the safety and feasibility of CPET in patients with severe heart failure.Methods　In cardiopulmonary exercise test room of Fuwai Hospital，Chinese Academy of Medical Sciences,77 patients with severe heart failure who were waiting for heart transplantation,underwent CPET during December 2013 to November 2015,they were selected as study subjects,among whom 32 cases were rated as grade Ⅲ,45 cases were rated as grade Ⅳ according to New York Heart Association（NYHA） functional classification,all cases completed symptom-limited extreme exercise according to standard continuous incremental power scheme of Harbor-UCLA Medical Center.Pulmonary function indexes,common indexes，and CPET parameters were detected，the primary reasons for stopping CPET were recorded.Results　There were no significant differences in peak anaerobic threshold（ml/min,ml·min-1·kg-1,%pred）,peak oxygen uptake（ml/min,ml·min-1·kg-1,%pred）,oxygen pulse（ml/time,%pred）,oxygen uptake efficiency platform（OUEP）（ratio,%pred）,equivalent minimum value of carbon dioxide ventilation（ratio,%pred）,carbon dioxide ventilation slope（slope,%pred） between NYHA functional classification grade Ⅲ patients and grade Ⅳ patients（P>0.05）.The most common reason for stopping exercise was fatigue（n=38，49.3%），and other reasons including dyspnea（n=20,26.0%），chest distress（n=7,9.1%），dizziness（n=5,6.5%），dry mouth（n=4,5.2%），palpitation（n=2,2.6%）， and nausea（n=1,1.3%）.There was no significant difference between patients with NYHA functional classification grade Ⅲ and Ⅳ in the reasons of stopping exercise（P=0.442）.Conclusion　Because there is no significant abnormality in pulmonary function indexes,common indexes,and CPET parameters,it is safe and feasible to perform CPET in patients with severe heart failure.There are no statistical difference in the CPET parameters and reasons of stopping exercise between patients with NYHA functional classification grade Ⅲ and gradeⅣ.

Effects of CPET-based Precise Formulation of Individualized Moderate-intensity Exercise Prescription on Hypertension

GE Wan-gang, SUN Xing-guo, LIU Yan-ling, FENG Jing, XI Jia-ning, ZHANG Zhen-ying

2016, 19(35):  4316-4322.  DOI: 10.3969/j.issn.1007-9572.2016.35.006

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Objective　Cardiopulmonary exercise testing（CPET） was used to evaluate the overall function objectively and quantitatively in this study,and based on the results,an individualized moderate intensity exercise prescription was formulated precisely.The aim of this study was to investigate the effects of individualized moderate-intensity exercise prescription with holistic rehabilitation protocols on hypertension.Methods　From Beijing Rehabilitation Hospital of Capital Medical University,we recruited 5 medical workers with confirmed hypertension and administration of anti-hypertensive drugs to perform symptom-limited extreme CPET.According to the data of CPET,an individualized moderate-intensity exercise training protocol with watts between anaerobic threshold and peak was designed,and patients were treated with the overall rehabilitation program including the optimization of drugs,mental and psychological management,living habits,smoking and alcohol restrictions.Blood pressure was continuously monitored during exercise training.Resting blood pressure was measured before and after exercise,respectively.Patients did daily exercise training for 12 weeks,and medication was adjusted according to the stable level of blood pressure during the training period.Results　Patients with hypertension were treated with at least one antihypertensive drug before exercise,then they gradually stopped taking antihypertensive drugs after exercise therapy,and all of them did not take any antihypertensive drugs by the twelfth weeks of exercise therapy.Compared with before exercise training,the SBP of the patients after exercise training was much lower〔（116±10） mm Hg vs.（125±11） mm Hg,1 mm Hg=0.133 kPa,P<0.05〕,and so was the DBP〔（71±7） mm Hg vs. （74±8） mm Hg,P<0.05〕.The resting SBP of the patients before exercise training at the twelfth weeks of exercise therapy was significantly lower than that at the first week（P<0.05）.There was no significant difference in the resting SBP of the patients after exercise training between the first and twelfth weeks of exercise therapy（P>0.05）.The resting DBP of the patients before or after exercise training demonstrated no statistically significant difference between the first and twelfth weeks of exercise therapy（P>0.05）.Conclusion　For patients with hypertension,holistic rehabilitation protocols centered on individualized moderate-intensity exercise prescription precisely designed on the basis of overall function evaluated by CPET objectively and quantitatively,can obtain an amazing effect of decreasing the blood pressure,and the blood pressure still remains stable after stopping taking drugs.It is worth doing an advanced study among more patients in the future

Using Individualized Target Heart Rate Deduced from Cardiopulmonary Exercise Testing to Guide Exercise Rehabilitation in Male Patients with Chronic Obstructive Pulmonary Disease

WU Hao, SUN Xing-guo, GU Wen-chao, QI Guang-sheng, WANG Lin-xuan, GU Xiao-long, WU Xiao-chi

2016, 19(35):  4323-4327.  DOI: 10.3969/j.issn.1007-9572.2016.35.007

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Background　Chronic obstructive pulmonary disease（COPD） is a disease with progressive decrease of exercise tolerance and repetitive acute exacerbations in the later stage,pulmonary rehabilitation is an important treatment for COPD.Objective　The individualized target heart rate can be deduced from the peak heart rate of the cardiopulmonary exercise testing（CPET）,which can guide the sub-maximal exercise rehabilitation of lower extremity of COPD patients,the effects need to be evaluated.Methods　Forty COPD patients who were treated in Shanghai Pudong New Area People’s Hospital from January 2013 to February 2014,were assigned randomly to rehabilitation group（20 cases） and control group（20 cases） by random number table method.The peak heart rate of patients in rehabilitation group was detected by CPET,which was used to calculate the individualized target heart rate,then patients in rehabilitation group accomplished lower extremity sub-maximal exercise rehabilitation（30 min/d,3 times/week,lasted for 12 weeks） on the basis of the original drug treatment.Patients in control group received the original drug treatment and rehabilitation education,and carried out rehabilitation training according to their wishes without guidance.Before and after rehabilitation,all patients completed 6-minute walk distance（6MWT）,COPD Assessment Test（CAT） and Borg Scale（10 point judging system）.Results　The measured peak heart rate of patients in rehabilitation group was 87-149 times/min,with an average value of（116.7±16.4） times/min;the estimated peak heart rate of patients in rehabilitation group was 142-171 times/min,with an average value of（157.4±8.3） times/min,there was significant difference between the two sets of figures（P<0.01）.There were no significant difference in 6MWD，CAT score and Borg score between two groups at baseline（P>0.05）.After rehabilitation,there were significant differences in CAT score and Borg score between two groups（P<0.05）.6MWD of patients in control group after rehabilitation was significantly longer than that before rehabilitation（P<0.05）.There were no significant difference in CAT score and Borg score between before rehabilitation and after rehabilitation（P>0.05）.6MWD of patients in rehabilitation group after rehabilitation was significantly longer than that before rehabilitation,CAT score and Borg score in rehabilitation group after rehabilitation were significantly lower than those before rehabilitation（P<0.05）.Conclusion　Using individualized target heart rate deduced from CPET-detected peak heart rate to guide lower extremity sub-maximal exercise rehabilitation could improve exercise tolerance and ameliorate dyspnea symptoms in COPD patients.

A Randomized Controlled Trial on Endoscopic Esophageal Varices Ligation at One-Month and Two-Week Intervals in Preventing Patients with Liver Cirrhosis from Rebleeding

ZHENG Feng-min, LYU Yuan, WU Yong-le, PING Chun-xia, SONG Yan-ming

2016, 19(35):  4328-4332.  DOI: 10.3969/j.issn.1007-9572.2016.35.008

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Background Endoscopic esophageal varices ligation (EVL) is an effective method for preventing rebleeding from esophageal variceal rupture in patients with liver cirrhosis. However, the optimal interval of EVL remains unclear. Objective To compare the effectiveness and safety of EVL at one-month and two-week intervals in preventing rebleeding in patients with liver cirrhosis. Methods Patients with liver cirrhosis complicated with acute esophageal variceal bleeding who were treated in Beijing You'an Hospital, Capital Medical University from January 2009 to October 2012 were selected as the research subjects, and randomly divided into the one-month group and the two-week group by sealed envelope method. The etiology, symptoms, physical signs, endoscopic active bleeding, gastric varices of the patients were recorded, the levels of serum albumin, total bilirubin, aspartate aminotransferase (AST), alanine aminotransferase (ALT) and prothrombin time (PT) were detected. The severity of the disease was evaluated by Child-Pugh classification criteria, Model for End-Stage Liver Disease (MELD) and Beppu scoring system. All patients received emergency EVL within 12 hours after admission. The interval of EVL was 28 days in the one-month group and two weeks in the two-week group. The patients were followed up after operation. The primary endpoint was rebleeding, and the secondary endpoints were esophageal variceal recurrence, EVL-related adverse events and death. Results A total of 70 patients were enrolled in the study, with 35 patients in each group. There was no significant difference in the incidence of rebleeding between the two groups (P>0.05). AST level was an independent influencing factor for rebleeding after EVL in patients with liver cirrhosis 〔HR=1.02, 95%CI (1.00,1.03), P=0.012〕. There was no significant difference in the recurrence rate of esophageal varices between the two groups (P>0.05). There were no significant differences in the incidences of chest distress, retrosternal pain, dysphagia/pain between the two groups (P>0.05). The incidence of ulcer after EVL in the two-week group was higher than that in the one-month group 〔57.1% (20/35) vs. 11.4% (4/35), P<0.001〕. There was no significant difference in the mortality rate between the two groups (P>0.05). Child-Pugh classification was an influencing factor for death after EVL in patients with liver cirrhosis 〔HR=2.95, 95%CI (1.06,8.21), P=0.039〕. Conclusion EVL at one-month and two-week intervals has similar effects in preventing rebleeding, esophageal variceal recurrence and death in patients with liver cirrhosis, but the incidence of post-EVL ulcer is higher in patients receiving EVL at two-week intervals than in those receiving EVL at one-month intervals.

Effect of Infection on D-dimer Cut-off Point in Pulmonary Embolism Patients

SUN Feng, YUAN Qing-zhao, WANG Zai-yi

2016, 19(35):  4333-4337.  DOI: 10.3969/j.issn.1007-9572.2016.35.009

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Background　With the enhancement of diagnosis consciousness of clinicians in pulmonary embolism（PE）,many suspected patients accepted the radiological examination.The latest guidelines for diagnosis and treatment of PE proposed that low or intermediate potential PE patients with D-dimer level below the cut-off point could be basically ruled out PE.Infections could increase the level of D-dimer,therefore the cut-off point of D-dimer need be adjusted in infection patients.Objective　To investigate the optimal cut-off point of D-dimer for excluding PE,in order to reduce unnecessary radiological examinations.Methods　All hospitalized patients with low or intermediate potential PE who presented to the Department of Respiratory of the First Affiliated Hospital of Xinjiang Medical University from October 2013 to January 2015 were enrolled.All patients were assessed by Wells score and underwent multi-slice spiral CT pulmonary angiography（CTPA） examination.The plasma levels of D-dimer and PCT were measured.According to the clinical manifestations and PCT level,all patients were divided into infection group and non-infection group.According to the results of CTPA to confirm the diagnosis of PE.ROC curve of D-dimer levels in the diagnosis of PE were drawed.The optimal cut-off point was selected at the maximal Youden’s index.The sensitivity,specificity,positive predictive value and negative predictive value were calculated.Results　A total of 245 patients with low or intermediate potential PE were enrolled in the study.According to the clinical manifestations and PCT level,32 patients could not be grouped and excluded from the study.213 patients were included in the study finally,including 110 cases of infection group and 103 cases of non-infected group.There were no statistically significant differences in gender,age,Wells score and detection rate of PE between infection group and non-infection group（P>0.05）.There were statistically significant differences in D-dimer and PCT levels between the two groups（P<0.05）.There were no statistically significant differences in Wells score and PCT level between PE and non-PE patients in infected and non-infected groups（P>0.05）.There were statistically significant difference in the level of D-dimer between PE and non-PE patients in the infected and non-infected groups（P<0.05）.The area under the ROC curve of the level of D-dimer in the diagnosis of PE was 0.679 in the infection group and 0.705 in the non-infection group.There was no statistically significant difference between the two groups（Z=0.34,P=0.37）.The optimal cut-off value of D-dimer level in the diagnosis of PE was 1 100 μg/L in the infection group.The sensitivity was 47.7%,the specificity was 89.4%,the positive predictive value was 47.7%,the negative predictive value was 87.9%.The optimal cut-off value of D-dimer level in the diagnosis of PE was 140 μg/L in the non-infection group.The sensitivity was 86.8%,the specificity was 47.7%,the positive predictive value was 86.8%,the negative predictive value was 46.2%.ConclusionFor the infection patients with low or intermediate potential PE,1 100 μg/L as the optimal cut-off point for D-dimer is more specific.More patients would avoid unnecessary radiological examinations and the medical resources would be saved.

Relevance Analysis of Changes in Clinical Indicators and Pulmonary Physiological Parameters and Prognosis of Idiopathic Pulmonary Fibrosis

PENG Shou-chun, LI Xue-ren

2016, 19(35):  4338-4345.  DOI: 10.3969/j.issn.1007-9572.2016.35.010

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Objective　 To assess the relationship between the changing quantities at different times of clinical indicators,pulmonary physiological parameters and the prognosis of patients with idiopathic pulmonary fibrosis（IPF）.Methods　126 patients with IPF，who received treatment in the First Hospital of China Medical University and the Affiliated Hospital of Logistics College of Chinese People’s Armed Police Forces from January 2001 to August 2008，were selected as research objects.According to the follow-up time，the patients were followed up for 6 months（followed-up of 4-8 months，81 cases）and 12 months（followed-up of 9-15 months，52 cases）were analyzed.The relationship between the changing quantity of clinical indicators,pulmonary physiological parameters〔dyspnea score，forced expiratory volume in first second（FEV1），forced vital capacity（FVC），total lung volume（TLC），residual volume（RV），diffusing capacity of carbon monoxide（DLCO），oxygen partial pressure（PaO2），partial pressure of carbon dioxide（PaCO2），oxygen saturation（SaO2）and alveolar-arterial partial pressure of oxygen difference（PA-aO2）〕,compared with underlying variables（underlying variables-variables within follow-up for 6 months；underlying variables-variables within follow-up for 12 months），changing ratio（changing quantity/underlying variables）and the prognosis of the IPF patients was analyzed.At the same time，taking the changing ratio as the grouping standard，the patients who were followed up for 6 months and 12 months in this study were respectively divided into improvement group，stable group and worsening group.Log-rank method was used to compare the differences in between-group survival rates of various clinical and pulmonary physiological parameters at the 6th month and the 12th month.The prognostic factors of IPF patients were analyzed by Cox proportional hazards regression.Results　52 patients had a follow-up of 13 to 84 months，and the median survival time was 51 months〔95%CI（22，56）〕.The results of univariate Cox proportional hazards regression analysis showed as follows：the changing value and ratio of dyspnea scores and the FEV1，FVC，TLC，DLCO，PaO2，SaO2，PA-aO2 at the 6th month and the 12th month were the influencing factors of IPF patients’ prognosis（P<0.05）.There were significant differences of survival rate of improvement group，stable group and worsening group of dyspnea scores，FVC，DLCO，PaO2，SaO2 and PA-aO2 at the 6th and the 12th month，and TLC at the 12th month（P<0.05）.Multivariate Cox proportional hazards regression analysis showed that the changing ratio of dyspnea scores〔HR=1.131，95%CI（1.044，1.311），P=0.027〕, FVC〔HR=0.899，95%CI（0.709，0.945），P<0.001〕 and PaO2〔HR=0.957，95%CI（0.890，0.987），P=0.034〕 were the influencing factors of the prognosis of IPF patients at the 6th month；the changing ratio of FVC〔HR=0.838，95%CI（0.811，0.910），P<0.001〕，TLC〔HR=0.962，95%CI（0.890，0.987），P=0.048〕and DLCO〔HR=0.932，95%CI（0.875，0.967），P<0.001〕 were the influencing factors of the prognosis of IPF patients at the 12th month.ConclusionClinical indicators and pulmonary physiological parameters are easy to determine with good reproducibility，which can be the monitoring indicators of IPF patients’ prognosis.The changing ratio of the parameters at 6th month and 12th month can better predict the prognosis of patients with IPF.

Correlation between CDK5RAP2 Expression and Effect of Neoadjuvant Chemotherapy in Breast Cancer

QIAN Jun-qiang, ZHANG Xiao-bei

2016, 19(35):  4346-4349.  DOI: 10.3969/j.issn.1007-9572.2016.35.011

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Objective　To detect the CDK5RAP2 expression in breast cancer before neoadjuvant chemotherapy（NAC）,and analyze its value in evaluating the effect of NAC.Methods　191 patients with primary invasive breast in Department of Breast Surgery，Tianjin Medical University Cancer Institute and Hospital in 2014 were selected.The clinical and pathological data were collected,including age,family history of cancer,menopausal status,tumor diameter,lymph node metastasis,clinical stage,and molecular type.Breast cancer tissue specimens were needle aspirated and the expression of CDK5RAP2 was determined by immunohistochemistry.After 6 cycles of TEC NAC,patients accepted radical mastectomy or breast-conserving surgery.The chemotherapy effect was preoperatively evaluated.Results　In patients,18 cases（9.4%） got pCR,23 cases（12.1%） got cCR,106 cases（55.5%） got PR and 44 cases（23.0%） got SD.There were statistically significant difference in the efficacy of NAC among patients with different tumor diameter and molecular type（P<0.05）.CDK5RAP2 expression was negative in 38 patients（19.9%） and positive in 153 patients（80.1%）.There was statistically significant difference in the efficacy of NAC among patients between different CDK5RAP2 expression（P<0.05）.There were no statistically significant difference in the efficacy of NAC between different CDK5RAP2 expression among Luminal A,basal-like breast cancer patients（P>0.05）.There were statistically significant difference in the efficacy of NAC between different CDK5RAP2 expression among Luminal B,Her-2 positive breast cancer patients（P<0.05）.Conclusion　The expression of CDK5RAP2 could predict the efficacy of NAC in breast cancer,especially in Luminal B and Her-2 positive breast cancer.

Correlation between Serum Aspartate Beta-hydroxylase and Prognosis of Patients with Hepatocellular Carcinoma after Surgery

ZHANG Ji-zong, HU Liang, HAN Jian-bo, YI Yong-xiang

2016, 19(35):  4350-4353.  DOI: 10.3969/j.issn.1007-9572.2016.35.y04

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Objective　To investigate the correlation between serum aspartate beta-hydroxylase（ASPH） and recurrence or death of patients with hepatocellular carcinoma （HCC） after surgery.Methods　96 HCC patients after surgery who were treated in Department of Hepatobiliary Surgery in Nanjing Second Hospital Affiliated to Southeast University from June 2010 to January 2011,were selected as study subjects.The pathological grading,tumor diameter,pathological stage of liver fibrosis,TNM staging,presence of portal vein tumor thrombus and microvascular invasion of patients were recorded,levels of albumin and total bilirubin after admission were detected.Levels of AFP,GP73 and ASPH were detected before surgery,level of ASPH was detected 1 week,1 month and 2 months after surgery respectively.The patients were followed up for 5 years since surgery，and endpoints were recurrence or death.Log-rank test and multivariate Cox proportional hazard regression model were used to analyze the influencing factors of the prognosis of HCC patients after surgery.Results　ASPH express level of HCC patients before surgery,1 week,1 month and 2 months after surgery was（128.3±19.3） ng/L,（91.2±16.2） ng/L,（33.7±9.4） ng/L,and （22.4±5.7）ng/L respectively,ASPH level of HCC patients 2 months after surgery was within the reference range.According to univariate analysis results,there were significant differences in incidence of recurrence or death among HCC patients after surgery with different tumor diameter,TNM staging,ASPH express level before surgery,between patients with portal vein tumor thrombus or not,between patients with microvascular invasion or not（P<0.05）.According to results of multivariate Cox proportional hazard regression model,TNM staging 〔HR=1.378，95%CI（1.124，1.842）〕,portal vein tumor thrombus〔HR=1.260，95%CI（1.012，1.356）〕,microvascular invasion 〔HR=1.583，95%CI（1.144，2.652）〕,and ASPH express level 〔HR=1.475，95%CI（1.875，2.011）〕 were the influencing factors of recurrence or death of HCC patients after surgery（P<0.05）.Conclusion　ASPH express is an independent factor influencing recurrence or death of HCC patients after surgery,which can be used as a potential indicator for judging the prognosis of postoperative patients with HCC.

Efficacy of Tacrolimus on the Proliferation and Apoptosis of High Glucose-induced HK-2 Cells and Its Possible Mechanism

KE Ben, CHEN Yan-xia, WU Xian-feng, HUANG Chong, QIN Xiao-hua, FANG Xiang-dong, TU Wei-ping

2016, 19(35):  4354-4358,4363.  DOI: 10.3969/j.issn.1007-9572.2016.35.013

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Objective　 To investigate the efficacy of tacrolimus（FK506）on the proliferation，apoptosis and expression of inflammatory factors of high glucose-induced human renal tubular epithelial（HK-2）cells.Methods　From October 2014 to May 2015,HK-2 cells cultured in vitro were randomly divided into a blank control group，high glucose induction group（30 mmol/L high glucose），mannitol induction group（24.5 mmol/L mannitol），20 μmol/L FK506 control group，different concentration FK506 inhibition groups（30 mmol/L high glucose+1，5，10 and 20 μmol/L FK506），and NF-κB signaling inhibitor group（30 μmol/L Bay11-7082+30 mmol/L high glucose）.After 24 hours of intervention，the expression level of NF-κB mRNA was determined by RT-PCR；those of interleukin-6（IL-6）and tumor necrosis factor-α（TNF-α）in supernatant were detected by ELISA；cell proliferation was measured by CCK-8；cell apoptosis was detected by flow cytometry.Results　The difference in the expression level of NF-κB mRNA among the groups showed a statistical significance（P<0.001）.Compared with the high glucose induction group，the expression level of NF-κB mRNA was lower in the blank control group（P<0.05）；and it was also lower in 1，5，10，20 μmol/L FK506 inhibition groups in a concentration dependent manner（P<0.05）.NF-κB signaling inhibitor group had lower expression level of NF-κB mRNA than the blank control group，high glucose induction group，and 1，5，10 μmol/L FK506 inhibition groups（P<0.05）.The expression levels of both IL-6 and TNF-α were statistically significant among all the groups（P<0.001）.Compared with the blank control group，the expression levels of both IL-6 and TNF-α were higher in the high glucose induction group（P<0.05）.The expression levels of both IL-6 and TNF-α were higher in the 1，5，10，20 μmol/L FK506 inhibition groups than those in the blank control group,but lower than those in the high glucose induction group in a concentration dependent manner（P<0.05）.Compared with the NF-κB signaling inhibitor group，the expression levels of both IL-6 and TNF-α were lower in the blank group and higher in the high glucose induction group and 1，5，10 μmol/L FK506 inhibition groups（P<0.05）.CCK-8 method showed that processing method and time exerted interaction effect on the proliferation of HK-2 cells；processing method led to main effect on the proliferation of HK-2 cells；processing time had main effect on the proliferation of HK-2 cells（Finteraction effect=16.315，Pinteraction effect<0.001；Fgroup=24.618，Pgroup<0.001；Ftime=16.315，Ptime<0.001）.The results of flow cytometry analysis showed that the difference in 24 h apoptosis rate of HK-2 cells among all the groups exhibited statistical significance（P<0.001）.Compared with the high glucose induction group，the 24 h apoptosis rate of HK-2 cells was lower in the bland control group；and it was also lower in 1，5，10，20 μmol/L FK506 inhibition groups and the NF-κB signaling inhibitor group（P<0.05）.ConclusionFK506 showed cytotoxicity for human normal HK-2 cells，while the HK-2 cells under high glucose FK506 is manifested protection.High glucose mediated kidney inflammation through NF-κB signaling，and FK506 alleviated the progression of diabetic nephropathy，which may be related to NF-κB signaling.

Level Changes of Myeloid-derived Suppressor Cell and Its Effect on the Proliferation of T Lymphocytes among Patients with Pulmonary Tuberculosis

ZHANG Tao, GE Cheng-qun

2016, 19(35):  4359-4363.  DOI: 10.3969/j.issn.1007-9572.2016.35.014

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Objective　To investigate the level changes of myeloid-derived suppressor cell（MDSC） before and after treatment among patients with pulmonary tuberculosis（PTB）,and to analyze the effects of MDSC on the proliferation of T lymphocytes and it’s mechanism.Methods　30 active PTB patients,and 12 sputum smear microscopy MTB positive and tuberculin skin test positive（TST+） family members of active PTB patients（contacted PTB patients） who were diagnosed in Linyi People’s Hospital during January 2011 to January 2014,15 healthy controls who were excluded PTB patients in Department of Internal Medicine Tuberculosis of Linyi People’s Hospital,and 7 sputum smear microscopy MTB negative patients with pulmonary infectious diseases during the same period,were selected as study subjects.The active PTB patients and contacted PTB patients were given anti-PTB therapy for 6 months.Peripheral blood from patients with active PTB,contacted PTB and healthy control was used to prepare peripheral blood mononuclear cell（PBMC）,and lung lavage fluid from patients with active PTB and pulmonary infectious diseases was used to prepare bronchoalveolar lavage cell（BALC）.The ratio of MDSC to PBMC,and the ratio of MDSC to BALC was detected by flow cytometry respectively.The same method was used to detect the ratio of MDSC to PBMC among active PTB patients after therapy,cured PTB patients and recovery PTB patients.PBMC isolated from healthy controls was stained with CFSE living cell fluorescence dyeing agent（CFSE-PBMC）,CD+11bCD-14MDSC was isolated from PBMC in active PTB patients,and PBMC without MDSC was treated with mitomycin C.2×105 CFSE-PBMC were used as reaction cells,2×105 PBMC without MDSC and 2×105 MDSC was mixed and cultured at different ratio（1∶0，1∶2，1∶4，1∶8）.CFSE signal of CD+3T cell was determined by using flow cytometry.The serum levels of L-arginine,NO and ornithine in active PTB patients and healthy controls were detected.Results　The ratio of MDSC to PBMC among active PTB patients,contacted PTB patients and healthy controls was 0.338（0.274，0.399）,0.115（0.073，0.201） and 0.042（0.031，0.103）,respectively,the difference among the three groups was significant（H=16.450，P<0.001）.The ratio of MDSC to PBMC among active PTB patients was significantly higher than that among healthy controls and that among contacted PTB patients,respectively（P<0.001）.The ratio of MDSC to BALC among active PTB patients〔0.425（0.219，0.483）〕 was significantly higher than that〔0.031（0.011，0.100）〕 among pulmonary disease infection patients（Z=9.675,P=0.004）.After PBMC was mixed with MDSC by 1∶0,1∶2,1∶4 and 1∶8,respectively,CD+3T cell proliferation ratio was 0.874（0.761，0.953）,0.668（0.588，0.818）,0.510（0.477，0.614） and 0.186（0.112，0.290）,respectively,the difference among the four groups was significant （H=9.995，P=0.006）.The serum level of L-arginine in active PTB patients〔31.72（18.37，59.58）μmol/L〕 was significantly lower than that〔57.88（35.11，77.93）μmol/L〕 in healthy controls（Z=9.030,P=0.008）.The serum level of NO in active PTB patients〔63.54（51.83，81.33）μmol/L〕 was significantly higher than that〔30.31（28.19，40.28）μmol/L〕 in healthy controls（Z=10.033,P=0.004）.After treatment,the ratio of MDSC to PBMC in cured PTB patients〔0.024（0.008，0.0389）〕 was significantly lower than that〔0.323（0.264，0.388）〕 in active PTB patients who were under treatment（Z=18.880,P<0.001）.The ratio of MDSC to PBMC in recovery PTB patients〔0.034（0.018，0.039）〕 was significantly lower than that〔0.053（0.017，0.084）〕 in PTB patients who just finished treatment（Z=11.125,P=0.004）.Conclusion　The ratio of MDSC to PBMC and ratio of MDSC to BALC in active PTB patients is high,and these two ratios are markedly low in cured or recovery active PTB patients.MDSC could inhibit T lymphocytes proliferation and it’s mechanism may be related to activated NO signal pathway.

Investigation of Effects of Chronic Diseases on Activities of Daily Living Abilities of the Elderly in China

QIAN Jia-hui, CAO Pei-ya, WU Kan, LUO Hui-qiang, REN Xiao-hui

2016, 19(35):  4364-4369.  DOI: 10.3969/j.issn.1007-9572.2016.35.015

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Objective　To explore the effects of number and types of chronic diseases on activities of daily living（ADL） abilities among the elderly in China.Methods　From November 2015 to March 2016，7 970 respondents aged 60 or over who received ADL survey were analyzed by adopting the trace data in China Health and Retirement Longitudinal Study in 2013.According to the sickness status of chronic diseases of respondents and situations of ADL and instrumental activities of daily living（IADL） disability，the effects of number and types of chronic diseases on ADL and IADL of the elderly were analyzed by Logistic regression analysis.Results　Of the 7 970 research objects，1 762（22.1%）with no chronic diseases，5 061（63.5%） with 1 to 3 types of chronic diseases，1 059（13.3%）with 4 to 6 types，and 88（1.1%）with at least 7 types；chronic diseases with the top three prevalence were arthritis/rheumatism（37.6%，2 999/7 970），hypertension（35.8%，2 857/7 970）and stomach diseases（24.2%，1 928/7 970）；rates of ADL and IADL disability were 23.8%（1 898/7 970）and 35.4%（2 822/7 970）respectively.There were significant difference in rates of ADL and IADL disability between subjects with different number of chronic diseases（P<0.01）；the rate of ADL disability of patients with hypertension，dyslipidemia，diabetes，chronic lung diseases，heart diseases，stroke，kidney diseases，stomach diseases，mentally emotional problems，memory-related diseases，arthritis/rheumatism and asthma was higher than that of patients without corresponding chronic diseases（P<0.05）；the rate of IADL disability of patients with hypertension，malignant tumor，chronic lung diseases，heart diseases，stroke，kidney diseases，stomach diseases，mentally emotional problems，memory-related diseases，arthritis/rheumatism and asthma was higher than that of patients without corresponding chronic diseases（P<0.05）.Multivariate Logistic regression analysis showed that the number people suffering from chronic diseases was the influence factor of ADL and IADL disability on condition that the specific chronic diseases were not taken as independent variables（P<0.001）；when the specific chronic diseases were taken as independent variables，hypertension，dyslipidemia，diabetes，chronic lung diseases，heart diseases，stroke，kidney diseases，stomach diseases，memory-related diseases，arthritis/rheumatism were the influence factors of ADL disability（P<0.05）；1 to 3 types of chronic diseases，4 to 6 types of chronic diseases，malignant tumor，chronic lung diseases，heart diseases，stroke，mentally emotional problems，memory-related diseases，and arthritis/rheumatism were the influence factors of IADL disability（P<0.05）.Conclusion　The number of chronic diseases is not the most important influencing factor of ADL among the elderly.Attention should be paid to specific chronic diseases,including stroke and memory-related diseases.

Investigation in Detection Rate and Influencing Factors of Nodular Goiter in Xiangshan County of Zhejiang Province

YE Zhong, CHEN Lei, LU Yu-yang, ZHENG Guang-yong, CHEN Zi-meng

2016, 19(35):  4370-4374.  DOI: 10.3969/j.issn.1007-9572.2016.35.016

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Objective　To investigate the detection rate of nodular goiter and the influencing factors for nodular goiter in Xiangshan county.Methods　Used the multi-stage cluster random sampling in 2013,5 towns were sampled from 17 towns in Xiangshan county;2 villages were sampled from those 5 towns respectively,hence 10 villages were sampled in total.The population was divided by topographical features into 4 groups:town group,mountain group,plain group and island group.Residents older than 18 years old and resided in Xiangshan county longer than 6 months were enrolled in this study.The people included were examined if they suffered from thyroid nodules by color Doppler ultrasonography.The patients diagnosed with nodular goiter were arranged into case group;the same amount of people without nodular goiter diagnosed by B-ultrasonography in the same townships and villages were arranged into control group;the two groups matched in gender,age（±3） and region,and the match ratio was 1∶1.The research objects included were surveyed with questionnaire about influencing factors such as occupational exposure history,personality and psychology,lifestyle,diet and medical history.The data was analyzed by univariate and multivariate Logistic regression method.Results　1 220 cases were screened and 510 patients were diagnosed with nodular goiter,with detection rate of 41.80%.There wassignificant difference in the detection rate of nodular goiter for people lived in different areas（χ2=5.43，P<0.05）.The detection rate of nodular goiter in town group was higher than that in mountain group（χ2=39.54，P<0.007）.The detection rate of nodular goiter in female was higher than that in male〔47.91%（298/622）vs.35.45%（212/598），χ2=18.94，P<0.01〕.The results of multivariate Logistic regression model analysis indicated that the independent influencing factors of nodular goiter included being female〔OR=2.33，95%CI（1.59,4.12）〕,working in knitting textile〔OR=2.31，95%CI（1.89,4.52）〕,die casting〔OR=2.58，95%CI（1.52,4.85）〕,long-term depression〔OR=2.11，95%CI（1.28,3.22）〕,consumption of marine products〔OR=2.35，95%CI（1.04,4.44）〕,X ray examination〔OR=3.54，95%CI（2.17,5.88）〕,CT examination〔OR=2.14，95%CI（1.85,3.98）〕（P<0.05）.Conclusion　The detection rate of nodular goiter in Xiangshan county is 41.80%.Necessary occupational protection for special type of work,keeping a happy mood,rational diet,avoiding unnecessary X ray and CT examinations,and taking precautionary measures in advance for people in cities & towns and females are important manners to prevent nodular goiter.

Reliability and Validity of the Chinese Version of the Quality of Life in Late-Stage Dementia Scale (QUALIDS)

MAO Pan, Lily Dongxia Xiao, ZHANG Meng-xi, XIE Fei-ting, FENG Hui

2016, 19(35):  4375-4378.  DOI: 10.3969/j.issn.1007-9572.2016.35.017

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Objective To translate the Quality of Life in Late-Stage Dementia Scale (QUALIDS) into Chinese and test its reliability and validity, so as to explore its applicability in China. Methods From December 2015 to January 2016, 205 patients with late-stage dementia from special care units of elderly care institutions in Hunan Province were selected as research subjects by multi-stage cluster sampling. The English version of QUALIDS was translated into Chinese and then back-translated into English. The back-translated version was sent to the original authors for review, and the Chinese version of QUALIDS was formed after repeated comparison and revision. The caregivers of the patients filled out the scale independently, which was distributed and collected on-site. Two caregivers on different shifts from two large elderly care institutions in Changsha filled out the Chinese version of QUALIDS repeatedly for 23 patients, and the Chinese version of QUALIDS was re-evaluated two weeks later. The reliability of the scale was evaluated by internal consistency, inter-rater reliability, test-retest reliability and split-half reliability; the validity was evaluated by content validity, criterion-related validity and construct validity. Results The Cronbach's α coefficient of the Chinese version of QUALIDS was 0.738, and the correlation coefficients (r values) between each item and the total score ranged from 0.354 to 0.755. For the 23 patients, the intraclass correlation coefficients (ICCs) of each item filled out by two caregivers on different shifts were 0.783-0.964, and the total score ICC was 0.892. After two weeks, the Chinese version of QUALIDS was re-evaluated for the 23 patients. The test-retest correlation coefficients of each item were 0.575-0.878, the total score test-retest correlation coefficient was 0.819, and the split-half reliability was 0.874. According to expert feedback, the content validity index (CVI) was 0.910. The correlation coefficients between the Chinese version of QUALIDS and the Global Deterioration Scale (GDS), the severity subscale of the Neuropsychiatric Inventory-Questionnaire (NPI-Q), the distress subscale of the NPI-Q, and the Physical Self-Maintenance Scale (PSMS) scores were -0.270, 0.598, 0.576, and 0.267, respectively (P<0.01). Factor analysis yielded 3 common factors: common factor 1 included items 2, 3, and 4; common factor 2 included items 6, 7, and 11; common factor 3 included items 1, 9, and 10. Conclusion The Chinese version of QUALIDS has good reliability and validity and can be used to evaluate the quality of life of patients with late-stage dementia.

Development of Empty-nest Elderly Mental Health Self-help Ability Scale and Testing of Its Reliability and Validity

WANG Li-na, SU Hong, LI Sha-sha, YAO Jin-lan, ZHOU Yu-qiu

2016, 19(35):  4379-4384.  DOI: 10.3969/j.issn.1007-9572.2016.35.018

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Objective　To develop a scale for evaluating the mental health self-help ability of empty-nest elderly and to test its reliability and validity.Methods　Samples of pre-measurement and formally measurement were selected from the ageing population in 2 communities in Chifeng,Inner Mongolia from June 2013 to April 2015.Based on Maslow’s a theory of human motivation，the theory of multi-factors of health related behaviors and analyses of literature，we conducted an open-ended survey in 20 empty-nest elderly and a semi-structured interview in 15 empty-nest elderly，and 31 items of behaviors related to mental health self-help ability were collected.Secondly，in terms of content and expression of items，we counseled several experts and identified 25 items of the original scale.There were 218 questionnaires （230 in all） were available and valid with a 94.78% response rate in pre-measurement stage.In the formally measurement，214 questionnaires （230 in all） were available and valid with a response rate of 93.04%.We tested the reliability and validity of this scale by applying SPSS 17.0.We set 27% of the subjects with the highest total scores and 27% with the lowest total scores as the high-score group and low-score group，respectively，and compared the scores of each item between the two groups.Validity of this scale was tested by exploratory factor analysis，and principal components were exacted by principal component analysis.Reliability of this scale was tested by Cronbach’s α coefficient and composite reliability（CR），and AVE.Results　The scores of item 9，12 and 23 in the original scale（25 items） between the two groups were not statistically significant（P>0.05），we deleted these 3 items，and 22 items left.There were fourprincipal components exacted by principal component analysis，namely，the ability of seeking mental support，effectively solving mental problem skills，the ability to participate in mental health promotion activities and the ability of self-realization.The cumulative variance contribution rate was 60.76%,the scale’s tall Cronbach’s α=0.890.The results of confirmatory factor analysis showed that the differences of critical ratio values for all items were statistically significant（P<0.05）;and CR values of principal components were above 0.800，AVE were 0.499-0.547.Conclusion　The Empty-nest Elderly Mental Health Self-help Ability Scale has good reliability and validity.It can be used for evaluating empty-nest elderly mental health self-help ability in China.For the empty-nest elderly correlation research it may provide more objective evaluation indicators.

Clinical Symptoms of POEMS Syndrome：17 Cases Report and Literature Review

WANG Jiao, ZENG Xiang-xia, HU Kai-xiang, LIU Ying, XU Ji-xiong

2016, 19(35):  4385-4387.  DOI: 10.3969/j.issn.1007-9572.2016.35.019

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Objective　To analyze the clinical features of POEMS syndrome for improving early diagnostic rate of POEMS syndrome and to reduce misdiagnosis.Methods　17 patients with POEMS syndrome admitted to the First Affiliated Hospital of Nanchang University from 2008 to 2015 were selected and their clinical features were analyzed,and related literatures were also reviewed.Results　The initial symptoms of 10 patients were numbness,weakness and pain,and 7 patients were bloating.16 patients had polyneuropathy,15 patients electromyography showed slowed motor nerve conduction,normal proximal amplitude and obviously lowered distal amplitude；increased protein could be found through lumbar puncture examination of 5 patients.14 patients had swelled organs,and swelled lymphadenopathy biopsy presented chronic inflammatory reaction or Castleman’ s disease of plasmocyte types.14 patients had endocrine abnormality with manifestation of gonad axis,thyroid axis,hypothalamic pituit-aryadvenal axis and glucose metabolism.4 patients had positive M-protein;12 patients underwent bone marrow aspiration,and the proportion of plasmocyte in bone marrow smears increased with 4 cases.16 patients had skin changes,manifested by skin blackening and redness,tough skin hardening,and pale fingernails.16 patients had increased water-loading with peripheral edema,pleural effusion,ascites and hydropericardium.3 patients had sclerotic bone lesion.ConclusionPOEMS syndrome has complicated clinical features with high misdiagnosis rate.Clinical doctors should raise awareness of the disease and perform careful examinations for suspected patients so as to avoid misdiagnosis.

Genetic Analysis of One Patient with Disorders of Sexual Development Combined with Mental Retardation Due to Partial Duplication of Short Arm of Chromosome 6

FENG Zhan-qi, JING Zhi-an, HU He-ping, HUANG Fei-fei, LI Ji-hua, WU Hui, WANG Hong-dan

2016, 19(35):  4388-4391.  DOI: 10.3969/j.issn.1007-9572.2016.35.020

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Objective　To identify the genetic causes of one patient with disorders of sexual development combined with mental retardation.Methods　One patient with disorders of sexual development combined with mental retardation,who received treatment and genetic counseling in Department of Urology of Zhengzhou First People’s Hospital and Research Institute of Medical Genetics of Henan Provincial People’s Hospital in February 2015,were selected.Venous blood of the patient and her parents was taken,conventional G-banding was applied to determine the chromosome karyotype;genome DNA was extracted,array comparative genomic hybridization （aCGH） was used for scanning and analyzing,changes of aneuploidy of chromosome and gene copy number variations （CNVs） that over 200 kb were screened,UCSC,DGV,DECIPHER,ISCA and Online Mendelian Inheritance In Man （OMIM） were retrieved to compare and identify pathogenicity.Results　Both the karyotype and scanning results of aCGH of the patient’s parents were normal.The karyotype of the patient was 46XX,der（6）?dup（6）（p21.3p21.1）;the scanning results found that there was one duplicated CNVs in the short arm of chromosome 6,at 6p21.32-p21.1（hg19:32261671-43333192）,the segment size was 11.07 Mb,and 180 genes were in the regions,of which 23 were in OMIM genes.Conclusion　The chromosome duplication at 6p21.32-p21.1 region may be the main cause of the disease of this patient with disorders of sexual development combined with mental retardation;G-banding combined with aCGH technique can make accurate positioning of microvariations of the chromosome,and help provide genetic references for clinical diagnosis and treatment.

Effect of Integrated Management on Death of Chronic Heart Failure Patients and Analysis on Influence Factors for Death

YIN Zhao-xia, XIAO Tao, JIN Xiao-min, ZHANG Ya-nan, CHEN Yang

2016, 19(35):  4392-4396.  DOI: 10.3969/j.issn.1007-9572.2016.35.021

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Objective　To analyze the death of chronic heart failure（CHF）patients during 2-year-integrated management，to observe the outcome of integrated management，and to analyze the influence factors for death.Methods　A total of 381 CHF patients who arrived at Yuetan Community Health Service Center or Fuxing Hospital at least once medical consultation every 3 months from 2012 to 2013，were divided into management group（194 cases） and control group（187 cases）according to random principle and the patients’ desire.Patients in management group received the comprehensive management，which included patients self-management，management by GPs，and regular instruction by specialists.Patients in control group received routine treatment.Patients were followed up for 2 years，the death and cause of death were recorded，Cox proporational hazards regression model was used to analyze influence factors for death.Results　There were significant differences in history of renal insufficiency，levels of Cr，eGFR，albumin，TC and TG at baseline，taking rates of ACEI/ARB and β-receptor blocking agent at follow-up between two groups of patients（P<0.05）.During the follow-up period，130 cases（67.0%）in management group completed 2-year-follow-up，39 cases（20.1%）died，among whom 13 cases died from cardiac diseases，11 cases died from infectious diseases，15 cases died from other causes；104 cases（55.6%）in control group completed 2-year-follow-up，56 cases（29.9%）died，among whom 18 cases died from cardiac diseases，25 cases died from infectious diseases,13 cases died from other causes.There was significant difference in all-cause mortality between two groups（χ2=7.36，P=0.007），and there was significant difference in infection-induced mortality between two groups（χ2=8.47，P=0.004）.However，there were no significant difference in cardiac and other causes mortality between two groups（χ2=2.15，χ2=0.03，P>0.05）.According to Cox proporational hazards regression model analysis，the independent factors for cardiac mortality included aged，lower LVEF level，higher FPG level，lower HDL-C level at baseline and no use of β-receptor blocking agent during follow-up（P<0.05）；the independent factors for infection-induced death included non-comprehensive management,aged，COPD，history of cerebrovascular disease，and higher Cr level at baseline（P<0.05）；aged and lower LVEF level at baseline were independent factors for other causes mortality（P<0.05）.Conclusion　Non-cardiac mortality is more common among CHF patients.CHF management can reduce all-cause mortality，mainly can reduce infection-induced mortality.To reduce mortality，comprehensive management for CHF patients should be carried out.

Effect of Management Led by the Management Team of Special Disease on Patients with Inflammatory Bowel Disease

CHEN Chen, DAI Xin-juan, LI Jun, XING Jing, SHI Qi, XU Shan-shan

2016, 19(35):  4397-4402.  DOI: 10.3969/j.issn.1007-9572.2016.35.022

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Objective　To explore the effect of management led by the management team of special disease on patients with inflammatory bowel disease（IBD）.Methods　131 patients with IBD who received treatment in Department of Spleen and Stomach Disease in Affiliated Hospital of Nanjing University of TCM from March 2014 to February 2015 were selected by convenience sampling method，and were divided into control group（65 cases）and intervention group（66 cases）by random number table method.The patients in control group received routine clinical follow-up of special disease，and patients in intervention group received disease management and follow-up led by special disease management team.Medication compliance，quality of life score，anxiety and depression situation，and symptom severity degree of patients before intervention，intervention the third month and intervention in the sixth month were evaluated by Morisky medication adherence scale（MMAS），IBD questionnaire of quality of life（IBDQ），hospital anxiety and depression scale（HADS）and IBD symptoms and signs rating scale.Results　The main effect of the intervention method and intervention time on MMAS score was significant（P<0.05）；at the third and sixth month of the intervention，the MMAS score of the intervention group was higher than that of the control group（t=6.530，P<0.001；t=3.813，P=0.006）.Intervention method and time had significant effects on the scores of intestinal symptoms，systemic symptoms，social function and IBDQ total score（P<0.05）.The anxiety and depression situation of the intervention group were better than those of the control group at the third and sixth month of the intervention（P<0.05）.Intervention method and time had significant effect on the IBD symptoms and signs rating scale（P<0.05）；at the third and sixth month of the intervention，the IBD symptoms and signs rating scale of intervention group was lower than that of control group（t=2.114，P=0.035；t=2.239，P=0.020）.Conclusion　IBD management，which is led by special disease management team，can effectively improve the medication compliance of patients with IBD，improve the quality of life，reduce the level of anxiety and depression，and improve the disease symptoms.

Research Progress of Etiology,Diagnosis and Treatment and Prognosis of Symptomatic Massive Pericardial Effusion

WANG Chuang-chang, WU Wei, WEI Wei-chao

2016, 19(35):  4403-4407.  DOI: 10.3969/j.issn.1007-9572.2016.35.023

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The main etiologies of symptomatic massive pericardial effusion are tumor-association,infectivity,iatrogenicity,autoimmune,uremia and idiopathicity.With the relevant guidelines and previous literatures,the paper reviewed the etiology,diagnosis,treatment and prognosis.With the development of diagnostic techniques,programmed diagnosis process combined with dynamic follow-up process,based on medical history,physical and chemical examination of underlying diseases,interventional cardiac-diagnosis techniques,helps improve diagnostic rate of etiology.Currently the treatment principles of symptomatic massive pericardial effusion are mainly dominated by etiological treatment,reasonable and timely pericardial drainage of pericardial effusion to relieve symptoms and reduce the forward incidence rate of constrictive pericarditis.Besides relating to primary disease,the survival prognosis is also related to complications such as early cardiac tamponade,recurrent pericardial effusion,and pericardial constriction.

Research Progress of Risk Early-warning Factors of Acute Exacerbation of Chronic Obstructive Pulmonary Disease

LI Xiao-jun, WANG Ming-hang, LI Su-yun

2016, 19(35):  4408-4412.  DOI: 10.3969/j.issn.1007-9572.2016.35.024

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Patients with acute exacerbation of chronic obstructive pulmonary disease（AECOPD） are always in complicated conditions with multiple diseases,and of poor prognosis.Scientific risk early-warning factors and early warning system of AECOPD can provide convenience for clinical treatment,help to optimize the clinical treatment of COPD,reduce the occurrence of AECOPD,and reduce the risk of poor prognosis.The paper summarizes the research status of the risk early-warning factors of AECOPD through the single factor assessment,multi-factor evaluation and comprehensive evaluation methods.