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March 2017, Volume 20, No.8 Abstracts

 Interpretation of American Association of Clinical Endocrinologists and American College of Endocrinology Clinical Practice Guidelines for the Diagnosis and Treatment of Postmenopausal Osteoporosis-2016
LI Jing,CHEN De-cai,WANG Qin*
Department of Endocrine and Metabolism,Osteoporosis Medical Education Center,West China Hospital,Sichuan University,Chengdu 610041,China
*Corresponding author:WANG Qin,Associate professor;E-mail:wq3166@163.com
    【Abstract】  The prevalence of osteoporosis is growing rapidly with the aging of the population.Osteoporosis leads to decrease of physical function and quality of life.Moreover,fracture due to osteoporosis can bring about increased disability rate and mortality,and a great burden on family and society.Thankfully,anti-osteoporotic treatment is able to decrease fractures,and subsequent fractures effectively among those who already suffer from fractures.From the aspects of fracture risk assessment and osteoporosis diagnosis,basic intervention and pharmacological intervention,this article briefly interpreted the updated Clinical Practice Guidelines for the Diagnosis and Treatment of Postmenopausal Osteoporosis jointly issued by American Association of Clinical Endocrinologists (AACE) and American College of Endocrinology(ACE)in 2016,aiming to keep clinicians informed of the recent developments in osteoporosis diagnosis and treatment by which their clinical practice can be improved.
    【Key words】  Osteoporosis,postmenopausal;Guidelines;Fractures,bone;Therapy
 
Reference Range for Bone Turnover Markers in Healthy Premenopausal Women in Western China  FAN Pian-pian1,WANG Qin1,LU Chun-yan1,LI Jing1,XU Yong2,CAO Hong-yi3,XIE Xiao-hua4,WU Xue-yan5,GUO Yan-hong6,LIU Ting7,CHEN Yan8,HUANG Yuan-yuan1,ZHANG Qi1,XU Shen1,CHEN Wen1,CHEN De-cai1*
1.Department of Endocrinology and Metabolism,West China Hospital,Sichuan University,Chengdu 610041,China
2.Department of Endocrinology,the Affiliated Hospital of Southwest Medical University,Luzhou 646000,China
3.Department of Endocrinology,Chengdu Fifth People′s Hospital,Chengdu 611130,China
4.Department of Endocrinology,First People′s Hospital of Liangshan Prefecture,Liangshan Prefecture 615000,China
5.Department of Endocrinology,Guangyuan Central Hospital,Guangyuan 628099,China
6.Department of Endocrinology,Hospital of Chengdu Office of People′s Government of Tibetan Autonomous Region,Chengdu 610041,China
7.Department of Endocrinology,Liangxiang Hospital of Fangshan District,Beijing 102402,China
8.Department of Endocrinology,the First People′s Hospital of Neijiang,Neijiang 641000,China
*Corresponding author:CHEN De-cai,Professor;E-mail:cdc1309@163.com
    【Abstract】  Background  Bone turnover markers(BTMs) are vital indexes in evaluating antiosteoporosis efficacy,predicting bone loss and fracture risk.However,until recently,few researches about premenopausal reference intervals of BTMs are available in western China.Objective  To establish the premenopausal reference intervals of serum N-terminal propeptide of type Ⅰ procollagen(P1NP) and type Ⅰ collagen cross-linked C-telopeptide(CTX) in western China,and investigate the status of P1NP and CTX under different conditions of bone mineral density(BMD) and fractures in postmenopausal women.Methods  This cross-sectional population-based survey was conducted in 4 cities in Sichuan Province from December 2012 to March 2013,which were Chengdu,Guangyuan,Xichang and Luzhou that located in eastern,southern,western and northern Sichuan,respectively.Subjects were females who aged over 30 years old and where voluntarily recruited from 2 communities in each city(one in an urban district and another in a rural area) by using the block-randomization method.Over-night fasting venous blood samples were collected to measure calcium,phosphate,creatinine,parathyroid hormone(PTH),25-hydroxyvitamin D 〔25(OH)D〕,1,25-dihydroxyvitamin D〔1,25(OH)2D〕,P1NP and CTX.BMD in lumbar vertebra(L1-4),femoral neck(FN) and total hip(TH) were measured by dual energy X-ray absorptiometry.All women completed a questionnaire concerning history of fractures and status of menopause.Results  This study population comprised 1 060 women,including 319 pre- and 741 postmenopausal subjects.The BMD in L1-4,FN and TH in postmenopausal women were significantly lower than those in premenopausal group(P<0.05),whereas the BMI,serum levels of calcium,phosphate,creatinine,P1NP and CTX,and the ratio of women who experienced fractures were significantly higher than those of premenopausal women(P<0.05).Significant differences were observed in P1NP,CTX and BMD in L1-4,FN and TH among women in different age groups(P<0.05).Among them,women aged 70 or over had higher P1NP than those aged 30-44(P<0.05);CTX was significantly higher in individuals aged 45 or over than those aged 30-44(P<0.05);individuals aged 55 or over showed a distinctly higher level of CTX than those aged 45-49(P<0.05);women who aged 45 years or over had lower BMD in L1-4 and FN compared with those aged 30-44(P<0.05).Additionally,individuals aged 55 or over had lower BMD in TH than those aged 30-54(P<0.05).The subjects aged 30 - 44 years should be used when establishing BTMs reference interval in premenopausal women,and the reference intervals of P1NP and CTX were 178.36-887.73 μg/L and 0.04-0.67 μg/L,respectively.There were no significant differences in CTX level among postmenopausal women with different BMD(P>0.05).Level of P1NP differed remarkably among postmenopausal women with different BMD(P<0.05),specifically,they were significantly higher in women with osteopenia and osteoporosis than those with normal BMD(P<0.05).CTX was higher in postmenopausal women who had previous fractures than those who had not(P<0.05),while there was no significant difference in the levels of P1NP(P>0.05).Conclusion  This study provided premenopausal reference intervals of serum P1NP and CTX in western China,which were 178.36-887.73 μg/L and 0.04-0.67 μg/L,respectively.Postmenopausal women have faster bone turnover,particularly in those with lower BMD or fracture.
    【Key words】  Osteoporosis,postmenopausal;Bone turnover markers;Reference values;Western China;Bone density
 
Correaltion of Metabolic Syndrome and Its Components with Osteoporotic Fractures  CAO Ting,ZHANG Qiao*,SHI Li-xin,PENG Nian-chun,ZHANG Miao,ZHANG Song,XU Shu-jing
Department of Endocrinology and Metabolism,the Affiliated Hospital of Guizhou Medical University,Guiyang 550004,China
*Corresponding author:ZHANG Qiao,Chief physician;E-mail:zhangqiao@medmail.com.cn
    【Abstract】  Objective  To explore the association of metabolic syndrome(MS) and its components with osteoporotic fractures in residents aged 40 or over in Guiyang.Methods  The subjects enrolled in this study were 9 908 residents aged 40 or over in Yunyan district of Guiyang who participated in a survey of chronic diseases in 2011.A self-developed questionnaire was used to survey the subjects,which included gender,age,living habits,medical history and history of osteoporotic fractures.We measured the height,body weight,waist circumference,blood pressure,fasting plasma glucose(FPG),triglyceride(TG),high-density lipoprotein cholesterol(HDL-C) levels in the subjects.Results  Of the 9 908 participants,23.87%(2 365/9 908) had MS;17.65%(1 749/9 908)had a history of osteoporotic fractures.There were no significant differences in age,proportions of residents without drinking tea and wine,ratio of residents drinking milk,BMI,prevalence rate for MS,waist circumference,systolic and diastolic blood pressure,FPG,TG,and HDL-C levels between male with a history of osteoporotic fractures and those without(P>0.05).Female with a history of osteoporotic fractures had older age,higher proportion of residents drinking milk,higher BMI and prevalence rate for MS,longer waist circumference,higher systolic pressure and TG,but lower HDL-C than those without(P<0.05).Multivariate Logistic regression analysis found that,after adjusting for confounding factors,such as age,drinking tea,wine and milk,and BMI,MS and its components had no relationship with osteoporotic fractures in male participants(P>0.05);MS〔OR=1.224,95%CI(1.065,1.407)〕,central obesity〔OR=1.399,95%CI(1.187,1.647)〕,elevated level of TG〔OR=1.273,95%CI(1.121,1.446)〕,decreased level of HDL-C〔OR=1.142,95%CI(1.009,1.294)〕 were significantly associated with increased odds of osteoporotic fractures in female participants(P<0.05).Conclusion  MS and its components of central obesity and dyslipidemia are risk factors for osteoporotic fractures in females aged 40 or over.
    【Key words】  Osteoporotic fractures;Metabolic syndrome X;Risk factors;Obesity,abdominal;Dyslipidemias
 
Effect of Physiological Variations of Thyroid Stimulating Hormone on Bone Mineral Density and Osteoporosis in Postmenopausal Women  WANG Jia-dan1,ZHANG Qiao2*,SHI Li-xin2,PENG Nian-chun2,ZHANG Miao2
1.Department of Endocrinology,3201 Hospital,Hanzhong 723000,China
2.Department of Endocrinology and Metabolish,the Affiliated Hospital of Guizhou Medical University,Guiyang 550004,China
*Corresponding author:ZHANG Qiao,Chief physician;E-mail:zhangqiao@medmail.com.cn
    【Abstract】  Objective  To investigate the effect of the fluctuation of thyroid stimulating hormone(TSH) level in the normal range on the bone mineral density(BMD) and osteoporosis of postmenopausal women with normal thyroid function.Methods  234 postmenopausal women with normal thyroid function who participated in the health survey of community residents in Guiyang from November 2009 to February 2010 were selected as the research objects.The thyroid function,vitamin D,parathyroid hormone(iPTH),serum calcium,and serum phosphorus levels of the subjects were detected;the BMD of left femoral neck,L1-4,total hip,greater trochanter,and ward triangle were measured by dual energy X-ray bone sonometers.According to the TSH level,subjects were divided into 3 groups by tri-sectional quantile method:group Q1(0.73-2.67 mU/L),group Q2(2.68-3.83 mU/L),group Q3(3.84-6.14 mU/L),78 cases in each group.Results  The BMD of the femoral neck,total hip,greater trochanter,and ward triangle,and the T value of the BMD of the femoral neck in these groups were significantly different(P<0.05).The BMD of greater trochanter in group Q2 was higher than that in group Q1,the BMD of the femoral neck,total hip,and ward triangle in group Q3 was higher than that in group Q1,and the T value of the BMD of the femoral neck in group Q3 was higher than that in group Q1 and Q2(P<0.05).There was a positive correlation between the TSH level and BMD of femoral neck,total hip and ward triangle(r=0.17,0.14,0.16,P<0.05).Multivariate linear regression analysis showed that TSH level and the BMD of femoral neck(b=0.012,b′=0.134) and ward triangle(b=0.013,b′=0.125) were independently related after correcting age,menopausal years,BMI,vitamin D and iPTH,(P<0.05).There was significant difference in the detection rate of osteopenia in femoral neck(P<0.05).Among them,the detection rate of osteopenia in femoral neck in group Q3 was lower than that in group Q1 and Q2(P<0.016).Conclusion  The physiological variation of THS level of postmenopausal women with normal thyroid function may have certain effect on BMD of the femoral neck,total hip,and ward triangle.Moreover,the TSH level may be the independent influencing factor of femoral neck and ward triangle,and low level of TSH is associated with a higher incidence of osteopenia.
    【Key words】  Osteoporosis,postmenopausal;Thyroid-stimulating hormone;Bone density
 
Prevalence and Correlation Factors of Osteoporosis in Middle-aged and Elderly People of Zhuang Nationality in Yunnan Based on A Survey  LUO Wen-dong,ZHAO Gang*,SHU Jun,LAO Han-chang,LIN Feng,GUO Li-min,HE Shao-xuan,YUAN Yong
Department of Traumatic Surgery,Osteoporosis Research Center of Yunnan Province,the Second Affiliated Hospital of Kunming Medical University,Kunming 650101,China
*Corresponding author:ZHAO Gang,Associate professor;E-mail:zhaogang907@163.com
    【Abstract】  Objective  To investigate the prevalence and correlation factors of osteoporosis in middle-aged and elderly people of Zhuang nationality in Wenshan Prefecture,Yunnan Province.Methods  This survey was conducted in October 2013.Cluster sampling and stratified sampling were used to select the subjects of this study,the Zhuang population aged≥40 years old from 3 Zhuang villages(a well-developed,a moderate-developed,and a poor-developed) in Bamei Town,Guangnan County,Wenshan Prefecture,Yunnan Province.A self-developed Questionnaire of Risk Factors for Osteoporosis in Middle-aged and Elderly People of Zhuang Nationality in Wenshan Prefecture was adopted in the survey,which encompasses demographic data,lifestyle and eating habits,status of exercise,treatment of previous medical illness,female pregnancy and childbearing histories.Osteoporosis Self-assessment Tool for Asians(OSTA) was applied to assess the risk for osteoporosis,and the OSTA index was recorded.Dual-energy X-ray absorptiometry(DXA) was employed to measure the lumbar bone mineral density(BMD),and the minimum T value was noted down.Results  A total of 124 subjects(50 males and 74 females) were enrolled in the study.The prevalence of osteoporosis in all the subjects,in male subjects and female subjects was 8.1%(10/124),6.0%(3/50),9.4%(7/74),respectively.There were significant differences in the prevalence of osteoporosis between males of different age groups(P<0.05).The prevalence of osteoporosis did not differ significantly between females of different age groups(P>0.05).There were no difference in the prevalence of osteoporosis between males and females of each age cluster(P>0.05).There were significant differences in T value among each cluster of male and female(P<0.05),and T value of 60-69 and 70-79 years old was lower than in 40-49 and 50-59 years old of male and female,and T value of 70-79 years old was lower than 60-69 years old of male(P<0.05).T values of female were lower than in males in age groups of 40-49,50-59 and 60-69(P<0.05).The OSTA index was(-2.3±4.0) in subjects with osteoporosis,and that was (0.7±3.4) in those with normal bone mass or osteopenia.Multiple linear regression analysis found that,in male subjects,increased hip circumference and higher OSTA index were the protective factors for BMD(P<0.05),while drinking tea and riding were the risk factors for BMD(P<0.05);in female subjects,higher body mass index,delayed menopause were the protective factors for BMD,whereas advanced age,hormone treatment,and multiple pregnancies were the risk factors for BMD(P<0.05).Conclusion  The prevalence of osteoporosis in middle-aged and elderly people of Zhuang nationality in Yunnan Province is relatively low.In terms of risk factors for decrease in BMD,drinking tea and riding are risk factors for males,while advanced age,hormone treatment,and multiple pregnancies are those for females.
    【Key words】  Osteoporosis;Zhuang nationality;Prevalence;Risk Factors;Cross-sectional studies
 
Introduction of CanMEDS-family Medicine Framework and Its Application Example Analysis  ZHENG Jia-tang1,2,KONG Yu-xia1,2,DONG Ai-mei1,2,3*
1.Department of General Practice,Peking University First Hospital,Beijing 100034,China
2.School of General Practice,Peking University Health Science Center,Beijing 100191,China
3.Department of Endocrinology,Peking University First Hospital,Beijing 100034,China
*Corresponding author:DONG Ai-mei,Associate chief physician;E-mail:dongaimei1975@sina.com
    【Abstract】  Based on the framework of CanMEDS released by the Royal College of Physicians and Surgeons of Canada(RCPSC),the College of Family Physicians of Canada(CFPC) revised the CanMEDS-FM framework(CanMEDS-family Medicine).The paper describes the four basic principles and seven post competencies (interpreted in the CanMEDS-FM framework) required by the general practitioners in providing comprehensive and ongoing care and practice,and detailedly analyzes how to train and assess post competencies of the general practitioners combined with the living examples in pediatric practices.Thus the paper hopes to achieve the final goal of improving general practitioners′ quality of care towards patients and make sure the post-graduate training in the field of general medicine is in keeping with the needs of society.
    【Key words】  General practice;CanMEDS-FM;General practitioners;Post competencies
 
Thematic Discussion on "Sustainable Development of Community Health Service Centers"  WANG Jun,ZHANG Zhi-hui,WANG Bing-bing,LI Yu-hong,LIU Ying,SONG Bao-qi,ZHAO Yan-fu,LIANG Hong,LI Ya-nan,YANG Zhao,LIU Wei-yan,LYU Jing
    【Abstract】  The sustainable development of community health service centers(CHSCs) is crucial to the achievement of hierarchical medical treatment in China.As the CHSCs in some parts of China are having some challenges in their development,such as lack of highly-qualified general practitioners,inadequate medical equipment,low-level intention of going to the doctor in CHSCs in patients and so on,and Changchun has made good performance in the sustainable development of CHSCs,we specially interviewed a number of experts in this field in Changchun for sharing their excellent experience.WANG Jun presented that,by delivering special services,the CHSCs in Changchun have improved their awareness and acceptance levels in community residents.ZHANG Zhi-hui introduced that,the CHSCs in Chaoyang District provide better services for community residents by reorganizing family physician team,improving the capabilities of medical staff via multi-level trainings,and extending the scope of contract services delivered by family physicians.WANG Bing-bing made a point that,the service capabilities of their center have been improved comprehensively by focusing on the development and delivery of traditional Chinese medicine(TCM) services and performance evaluation of the medical staff.LI Yu-hong shared their good experience on chronic disease management,referral and health education.LIU Ying added that they gain acceptance and appreciation in community residents by a variety of propagandist means and delivering special services.SONG Bao-qi stated that in order to achieve the sustainable development of their center,they have taken a variety of measures to improve the service capabilities based on increasing their acceptance in the residents.ZHAO Yan-fu described that,they have enhanced their service capabilities by carrying out diversified TCM services based on the demands of key population.LIANG Hong illustrated that,for better providing services for the residents by family physicians,they have standardized the quality of the services delivered by family physicians,and publicized the family doctor system by many ways.LI Ya-nan introduced what they have done for developing their center sustainably,such as changing the service model(providing services actively instead of passively) and improving the popularity of their center.YANG Zhao added that they provide services in accordance with the needs of the residents,and introduced how they do to innovate the service model in detail.LIU Wei-yan presented that they have improved their service capabilities by enhancing the level of techniques of family physicians via various forms of training.LYU Jing said that they have upgraded their service capabilities and quality by incentivizing the family physicians through the evaluation of the performance of the family doctor team.It is hoped that the above experience shared by the experts from Changchun can provide a reference for the sustainable development of CHSCs in China,so that the CHSCs can better satisfy the needs of the people as the health "gatekeeper".
    【Key words】  Community health services;Health services administration;Physicians,family
 
Association between Leptin/Adiponectin Ratio and Type 2 Diabetes Mellitus with Mild Cognitive Impairment  LI Yuan1,ZHANG Qiu1*,LIU An-nuo2*,DAI Fang1,YIN Qian-qian1
1.Department of Endocrinology,the First Affiliated Hospital of Anhui Medical University,Hefei 230022,China
2.Nursing School of Anhui Medical University,Hefei 230601,China
*Corresponding authors:ZHANG Qiu,Professor,Doctoral supervisor;E-mail:aynfmk@163.com
LIU An-nuo,Associate professor,Master supervisor;E-mail:w971002y@sohu.com
    【Abstract】  Objective  To explore the association between leptin/adiponectin(L/A) ratio and type 2 diabetes mellitus(T2DM) with mild cognitive impairment(MCI).Methods  We enrolled 30 T2DM patients in Endocrinology Department of the First Affiliated Hospital of Anhui Medical University from March to July in 2016 as T2DM group,30 T2DM patients with macroangiopathy as T2DM+V group and 30 T2DM patients with obesity as T2DM+OB group,another 30 healthy individuals who received physical examination as control group.We compared the obtained clinical data〔gender,age,years of education,height,weight,BMI,waistline,hip circumference,waist-to-hip ratio(WHR),systolic blood pressure(SBP) and diastolic blood pressure(DBP)〕 and results of laboratory testing〔fasting blood glucose(FBG),total cholesterol(TC),triacylglycerol(TG),high-density lipoprotein cholesterol(HDL-C),low-density lipoprotein cholesterol(LDL-C),very low-density lipoprotein cholesterol(VLDL-C),HbA1c,serum creatinine(Scr),urea nitrogen(BUN),LEP,APN and L/A ratio〕 among the four groups.We evaluated cognitive function of the four groups with the Montreal Cognitive Assessment(MoCA)(MoCA score <26 points was defined as MCI).Pearson correlation analysis and multivariable linear regression analysis were used to study the factors related to MoCA score.Results  The differences in weight,BMI,waistline,hip circumference,WHR,SBP,DBP,FBG,TG,HDL-C,VLDL-C,HbA1c,BUN,LEP,APN,L/A ratio among the four groups were statistically significant(P<0.05).The differences in MoCA score and positive rate of MCI among the four groups were statistically significant(P<0.05);MoCA score in T2DM group,T2DM+V group,T2DM+OB group was lower than that in control group(P<0.05);positive rate of MCI in T2DM+V group,T2DM+OB group was higher than that in control group(P<0.007).Pearson correlation analysis showed that MoCA score was positively correlated with years of education(r=0.532,P<0.001) and APN(r=0.652,P<0.001)while negatively correlated with BMI(r=-0.192,P=0.035),waistline(r=-0.182,P=0.046),hip circumference(r=-0.184,P=0.045),FBG(r=-0.297,P=0.001),HbA1c(r=-0.297,P=0.001),LEP(r=-0.722,P<0.001)and L/A ratio(r=-0.793,P<0.001).The results of multivariable linear regression analysis demonstrated that MoCA score was positively correlated with years of education〔β=0.197,95%CI(0.109,0.284),P<0.001〕,while negatively correlated with L/A ratio〔β=-2.532,95%CI(-2.966,-2.099),P<0.001〕.Conclusion  Macroangiopathy and obesity may be the risk factors aggravating the severity of MCI.L/A ratio may become a new pre-clinical sign of T2DM patients with MCI,which is of important reference significance in the early detection and prevention of MCI.
    【Key words】  Diabetes mellitus,type 2;Leptin;Adiponectin;Mild cognitive impairment
 
Effect of Conventional Antihypertensive Drugs Combined with Progressive Muscle Relaxation Training on Improving Blood Pressure and Depression of Hypertensive Patients with Depressive State in Community  XIONG Xiang-feng1,XU Gao-jie1,CHEN Hua2,PENG Yun3*
1.Department of General Medicine,Yingbo Community Health Service Center of Shanghai Pudong New Area,Shanghai 200125,China
2.Department of Psychological Medicine,Zhongshan Hospital,Fudan University,Shanghai 200032,China
3.Department of Prevention Care,Sanlin Community Health Service Center of Shanghai Pudong New Area,Shanghai 200124,China
*Corresponding author:PENG Yun,Competent physician;E-mail:13501831377@163.com
    【Abstract】  Objective  To study the effect of antihypertensive drugs combined with progressive muscle relaxation training on improving blood pressure and depression of hypertensive patients with depressive state in community.Methods  One hundred and twelve hypertensive patients with mild to moderate depression,whose blood pressure control was not up to standard after management of Yingbo Community Health Service Center of Shanghai Pudong New Area in May 2015,were selected as the research objects.The patients were divided into intervention group and control group by random number table method,each had 56 cases.The two groups were treated with conventional antihypertensive drug treatment and standardized chronic disease management,and on this basis the intervention group took progressive muscle relaxation training.The patients in intervention group were weekly given group intensive intervention to relax the whole body muscles from the hand,forearm,upper arm,forehead,eye,jaw,neck,shoulder,chest,abdomen,waist,back,buttocks,thigh,cruses to foot orderly,30 minutes each time,and patients also did progressive muscle relaxation training twice a day at home,20 to 30 minutes each time.Blood pressure of the patients in two groups before and 1 week after intervention,and at the 1st,3rd and 6th month was measured respectively.At the same time,the depression status was assessed by Hamilton Depression Scale(HAMD).Results  There was no significant difference in the effects on hypertension,control rate of blood pressure and improving status of depressive state at the 1st week after intervention between the two groups(P>0.05).The 1st,3rd and 6th month after intervention,effects on hypertension,control rate of blood pressure and improving status of depressive state in the intervention group were better than those in control group(P<0.05).Conclusion  Conventional antihypertensive drugs combined with progressive muscle relaxation training can effectively reduce the blood pressure,improve control rate of blood pressure,and improve depressive state of hypertensive patients with depressive state in community.
    【Key words】  Hypertension;Depression;Muscle relaxation training;Treatment outcome
 
Seroepidemiologic Study of Chronic HBV-infected Patients  CHEN Hong-ying,DING Jie,YOU Jing*
Department of Infectious Diseases,First Affiliated Hospital of Kunming Medical University,Kunming 650032,China
*Corresponding author:YOU Jing,Professor;E-mail:jingyoukm@126.com
    【Abstract】  Background  With the development and research of clinical cure of chronic hepatitis B (CHB),testing of serum immune markers of HBV and HBV DNA load can provide reference for the clinical treatment study of CHB.Objective  To analyze the serological pattern in chronic HBV-infected patients and its correlation with HBV DNA load.Methods  The subjects enrolled in this study were the chronic HBV-infected outpatients and inpatients(n=2 425) who received treatment in Department of Infectious Diseases,First Affiliated Hospital of Kunming Medical University from March to December 2015.Serum immune markers and HBV DNA load were measured in the subjects by ARCHITECT i2000SR Immunoassay Analyzer with matched chemiluminescence reagent,and PGQ-PCR Amplification with HBV nucleic acid quantitative detection kit,respectively.HBsAg,HBsAb,HBeAg,HBeAb and HBcAb was labeled as 1,2,3,4,and 5,respectively.And their serological patterns were analyzed.Results  Of the 7 serological patterns found in the 2 425 patients with chronic HBV infection,there were 5 patterns which occupied a proportion more than 1.00%,respectively;the patterns of "1,3,5""1,4,5""1,3,4,5""1,5" and "1,2,3,5" accounting for 55.05%,37.69%,3.26%,1.86% and 1.53%,respectively.The rare for other patterns of "1,2,4,5" and "2,4,5" was 0.53% and 0.08%,respectively.The age and HBV DNA load were significant differences among the 5 main patterns (P<0.05),but the gender was no significant differences among them (P>0.05).Notable difference in age distribution was observed among the 5 main patterns(χ2=266.625,P<0.001).Patterns of "1,3,5""1,3,4,5""1,5" and "1,2,3,5" mainly occurred in age groups of 21-30 and 31-40,while the pattern of "1,3,5" chiefly in age groups of 31-40 and 41-50.In chronic HBV-infected patients with pattern of "1,3,5",the HBV DNA load was positively correlated with HBsAg and HBeAg(P<0.05),while negatively correlated with HBcAb(P<0.05);HBsAg was positively related to HBeAg(P<0.05).Among chronic HBV-infected patients with pattern of "1,4,5" "1,3,4,5",the HBV DNA load was positively associated with HBeAg and HBcAb (P<0.05).HBV DNA load was positively associated with HBsAg,HBeAg and HBcAb,HBsAg was positively associated with HBeAg in chronic HBV-infected patients with pattern of "1, 2, 3, 5"(P<0.05).Conclusion  There were 7 kinds of patterns in chronic HBV-infected patients with positive HBV DNA,predominated by the patterns of "1,3,5" and "1,4,5".Significant differences by age and HBV DNA load existed among the 5 main patterns.
    【Key words】  Hepatitis B virus;Viral load;Seroepidemiologic studies
 
Influence Factor of Acute Pancreatitis Recurrence in the Short Term  YUAN Shuai*,ZHOU Hai-hua
The Affiliated Xiaolan Hospital of Southern Medical University,Zhongshan 528415,China
*Corresponding author:YUAN Shuai,Associate chief physician,Researching in clinical and endoscopic diagnosis and treatment of gastrointestinal,pancreatic and biliary diseases;E-mail:yuanshuaishuai888@126.com
    【Abstract】  Objective  To investigate the risk factors of short-term recurrence of acute pancreatitis.Methods  One hundred and thirty patients with first-attack acute pancreatitis in the Affiliated Xiaolan Hospital of Southern Medical University from May 2011 to December 2013 were selected for the research.A follow-up of 12 months was given to patients after discharge.Patients were divided into recurrence group and non-recurrence group according to whether there was acute pancreatitis recurrence.The clinical data were recorded,and the risk factors of short-term recurrence of acute pancreatitis were analyzed.Results  There were 36 patients in the recurrence group and 94 in non-recurrence group.The recurrence rate was 27.7%.There was no significant difference in gender,age,drinking rate,body mass index(BMI),the incidence of cholelithiasis and endoscopic retrograde cholangiopancreatography(ERCP),MCTSI score,Rason score,C-reactive protein(CRP),serum calcium,total calcium cholesterol(TC),high density lipoprotein cholesterol(HDL-C),low density lipoprotein cholesterol(LDL-C) and fasting blood glucose between two groups(P>0.05).There was significant difference in triglyceride(TG) and postprandial 2-hour blood glucose between two groups(P<0.05).Multivariate Logistic regression analysis showed that impaired glucose tolerance was a risk factor of the recurrence of acute pancreatitis in the short term〔OR=1.473,95%CI(1.027,3.342),P<0.05〕.The recurrence rate of acute pancreatitis combined with impaired glucose tolerance in 1 year was 68.8%,while the recurrence rate of not combined with impaired glucose tolerance was 31.2%,and there was significant difference in the two recurrence rates(χ2=15.821,P=0.013).Conclusion  Impaired glucose tolerance is an independent risk factor of the recurrence of acute pancreatitis in the short term.Controlling postprandial 2-hour blood glucose level of patients with acute pancreatitis may help to reduce the short-term recurrence rates.
    【Key words】  Pancreatitis;Recurrence;Impaired glucose tolerance;Risk factors
 
Effects of Group Psychological Intervention on Emotion and Quality of Life of Esophageal Cancer Patients Receiving Concurrent Chemoradiotherapy  JIAO Miao-rui1*,YANG Fu-na2,WANG Yi-zhuo1,ZHANG You-gai1,LI Xiu-jie3,WEI Li2
1.Department of Digestive Radiotherapy,Affiliated Cancer Hospital of Zhengzhou University,Henan Cancer Hospital,Zhengzhou 450008,China
2.Department of Nursing,Affiliated Cancer Hospital of Zhengzhou University,Henan Cancer Hospital,Zhengzhou 450008,China
3.Department of Gynecology and Oncology,Affiliated Cancer Hospital of Zhengzhou University,Henan Cancer Hospital,Zhengzhou 450008,China
*Corresponding author:JIAO Miao-rui,Co-chief nurse;E-mail:jiaomiaorui@126.com
    【Abstract】  Objective  To explore the effects of group psychological intervention on anxiety,depression and quality of life on esophageal cancer patients receiving concurrent chemoradiatherapy.Methods  A total of 150 esophageal cancer patients who received concurrent chemoradiatherapy in Henan Cancer Hospital from December 2013 to December 2015 were selected as research objects and randomly divided into control group and intervention group by using random number table method.Each group had 75 cases.The control group received routine care during concurrent chemoradiotherapy,while the intervention group took part in a seven-week group psychosomatic intervention on the basis of routine nursing,activities included relaxation training,cognitive behavior therapy,psychological education,singing therapy,exercise therapy,and homework therapy.The psychological state and quality of life of the patients were evaluated by using Self-rating Anxiety Scale(SAS),Self-rating Depression scale(SDS),and Quality of Life Questionnaire:Core-30(QLQ-C30) respectively before and after intervention.Results  After intervention,4 and 3 cases were respectively dropped from control group and intervention group in the study.There were no significant differences in SAS and SDS scores between two groups before intervention(P>0.05).After intervention,the scores of SAS and SDS in intervention group were significantly lower than those in control group (P<0.05).Before intervention,there were no significant differences in the scores of the overall health status item,the symptom items,single items and functional items of patients between two groups (P>0.05).After intervention,the scores of health status,role function,cognitive function and emotional function in the intervention group were higher than those in the control group,the scores of fatigue,nausea and vomiting,insomnia items were lower than those in the control group (P<0.05).Conclusion  Group psychological intervention can effectively improve anxiety,depression and sleep quality,relieve fatigue,nausea and vomiting symptoms,and improve the overall quality of life of esophageal cancer patients who received concurrent chemoradiatherapy.
    【Key words】  Esophageal neoplasms;Group psychological intervention;Chemoradiotherapy;Anxiety;Depression;Quality of life
 
Deregulated Id-1 Expression on the Metastasis and Invasion of Human Colon Carcinoma SW480 Cells in Vitro  WU Xue-liang1,WANG Li-kun2,XUE Jun1*,YANG Dong-dong1,QU Ming1,GUO Fei1,YANG Rui-min2,LIU Bo4
1.Department of Vascular & Gland Surgery,the First Affiliated Hospital of Hebei North University,Zhangjiakou 075000,China
2.Department of Ultrasonography,the First Affiliated Hospital of Hebei North University,Zhangjiakou 075000,China
3.Department of Gastrointestinal Surgery,the First Affiliated Hospital of Hebei North University,Zhangjiakou 075000,China
4.Department of Pathology,the First Affiliated Hospital of Hebei North University,Zhangjiakou 075000,China
*Corresponding author:XUE Jun,Chief physician,Master tutor;E-mail:xuejun@163.com
    【Abstract】  Background  Up-regulation of Id-1 expression playing an important role in the occurrence and development of colorectal cancer has been proved by some previous studies,but down-regulation of it on the invasion of colorectal cancer cells and corresponding mechanism of action are less studied.Objective  To explore the effect of deregulated Id-1 expression on the proliferation,metastasis and invasion of human colon carcinoma SW480 cells and investigate its mechanisms of action.Methods  This study was conducted from January to June in 2016.SW480 cells with Id1-specific siRNA transfection,no transfection,and blank load transfection were selected as the inhibition group,blank group and blank load transfection group,respectively.Expressions of Id-1 mRNA,Ki-67 mRNA,Id-1 and Ki-67 in these 3 groups were detected by reverse transcription polymerase chain reaction(RT-PCR) and Western blotting.Cell proliferation in vitro was assessed by MTT assay.Effect of Id-1 on SW480 cells was observed by wound healing assay,Transwell migration assay,and Matrigel invasion assay.Results  There were significant differences in the expressions of Id-1 mRNA,Ki-67 mRNA,Id-1 and Ki-67 among three groups(P<0.05).The expressions of Id-1 mRNA,Ki-67 mRNA,Id-1 and Ki-67 in the inhibition group were lower than those in the blank group and blank load transfection group(P<0.05).The growth curves of SW480 cells showed that,on the 1st and 2nd days of culture,the differences in the OD value indicating the SW480 cells proliferation ability among three groups were not significant (P>0.05),but on the 3rd to the 7th days of culture,the differences in the OD value indicating the SW480 cells proliferation ability among three groups were significant (P<0.05),and OD value indicating the SW480 cells proliferation ability in the inhibition group was significantly weaker than that in the blank group and the blank load transfection group (P<0.05).The results of wound healing assay showed that SW480 cells in the inhibition group migrated to the scratched area and closed the wound slowly,while those in the blank group and blank load transfection group did so more quickly,but the difference between the latter two groups was not distinct.Results of Transwell migration assay and Matrigel invasion assay demonstrated that the number of migrating and invading SW480 cells differed significantly among three groups(P<0.05);the inhibition group had less the number of migrating and invading SW480 cells than the other two groups(P<0.05).Conclusion  Deregulated Id-1 has significant inhibition effect on the proliferation,metastasis and invasion of human colon carcinoma SW480 cells.The mechanism of action might be related with the reduced effect of Ki-67.
    【Key words】  Colonic neoplasms;Inhibitor of differentiation protein 1;Neoplasm metastasis;Neoplasm invasiveness
 
Time of Iron Supplementation for Low-birth-weight Infants:A Meta-analysis  MEN Guang-guo1*,WANG Li-li2,WANG Feng-min1,CUI Ying-bo1
1.Department of Neonatology,Ningbo Women & Children′s Hospital,Ningbo 315012,China
2.The People′s Hospital of Dong′e,Liaocheng 252201,China
*Corresponding author:MEN Guang-guo,Attending physician;E-mail:qingpingguo911@163.com
    【Abstract】  Objective  At present,the best time of preventive enteral iron supplementation for preterm and low-birth-weight (LBW) infants is not very clear.This study aims to compare the efficacies between early and late enteral iron supplementation in LBW infants.Methods  The databases of PubMed,Cochrane Library,CNKI and Wanfang Data were searched by using computer up to December 31st,2015.Randomized controlled trials about assessing the efficacy of early iron supplementation (at 2 weeks after birth) and late iron supplementation (at 4 weeks after birth) in LBW infants were collected.We evaluated the quality and extracted the data of the included literature.The data about the levels of serum ferritin,hemoglobin(Hb),blood transfusion rate,neonatal necrotizing enterocolitis(NEC) in the included literature were analyzed by RevMan 5.3 software.Results  A total of 4 high-quality literature was included,which involved in 418 LBW infants consisting of 209 with early enteral iron supplementation and 209 with late enteral iron supplementation.The results of meta-analysis showed that the extent of decline in serum ferritin level was less in early enteral iron supplementation group than in late enteral iron supplementation group〔MD=14.08,95%CI(9.08,19.08),P<0.001〕.The level of Hb decreased less in early enteral iron supplementation group than it did in late enteral iron supplementation group〔MD=0.87,95%CI(0.71,1.02),P<0.001〕.Compared with late enteral iron supplementation group,early enteral iron supplementation group had lower blood transfusion rate〔OR=0.44,95%CI(0.27,0.71),P<0.001〕.No difference in the incidence of NEC was found between early and late enteral iron supplementation groups〔OR=0.73,95%CI(0.33,1.60),P=0.43〕.After the susceptibility analysis by leave one-out method,the results were not influenced by excluding the literature successively,showing high reliability of our research.Conclusion  Early enteral iron supplementation can reduce the decline extent for both serum ferritin and hemoglobin levels in LBW infants.However,caution should be taken to avoid excessive iron intake and the possibly resulted long-term negative effects on neural development.
    【Key words】  Anemia,iron-deficiency;Infant,low birth weight;Meta-analysis
 
Efficacy and Safety of Fexofenadine Versus Cetirizine in the Treatment of Allergic Rhinitis:A Meta-analysis  ZHANG Cheng-bin1,YANG Xu-ping1,HUANG Yi-lan1*,ZHONG Xiao-yan1,YU Bin2
1.Department of Pharmacy,the Affiliated Hospital of Southwest Medical University,Luzhou 646000,China
2.School of Pharmacy,Southwest Medical University,Luzhou 646000,China
*Corresponding author:HUANG Yi-lan,Professor;E-mail:hyl3160131@163.com
    【Abstract】  Objective  To evaluate the efficacy and safety of fexofenadine versus cetirizine for allergic rhinitis(AR).Methods  Randomized controlled trails(RCTs)about fexofenadine versus cetirizine for AR were searched from PubMed,EMBase,Cochrane Library,CNKI,VIP and Wanfang Databases up to June 10th,2016.The reviewers extracted the data and assessed the quality of the included studies according to the method of Cochrane systematic review.Meta-analysis was carried out by RevMan 5.2 software.And the total symptom score,overall response rate and incidence of adverse events were compared between the patients treated by fexofenadine and those by cetirizine.Results  A total of 10 RCTs were included,involving 2 165 patients.Results of meta-analysis indicated that the total symptom score in fexofenadine group was not statistical different from that in cetirizine group〔WMD=-0.33,95%CI(-0.77,0.11),P=0.14〕.The overall response rate in fexofenadine group was significantly higher than that in cetirizine group〔OR=1.76,95%CI(1.27,2.44),P=0.000 6〕.There was no statistically significant difference in the incidence of adverse events between fexofenadine and cetirizine groups〔RR=1.08,95%CI(0.93,1.25),P=0.32〕.Conclusion  Compared with cetirizine,fexofenadine could improve the overall response rate while they have similar safety for AR.Due to the limited quantity and quality of the included studies,the above conclusion should be probed by more large-scale multicenter high-quality studies in the future.
    【Key words】  Allergic rhinitis;Fexofenadine;Cetirizine;Meta-analysis
 
Investigation on Current Status of Obesity and Its Correlation with Hypertension among Residents in Gansu Province  LIANG Wei,ZHANG Xiao-wei,YU Heng,YU Jing*
Department of Hypertension,Second Hospital,Lanzhou University,Lanzhou 730030,China
*Corresponding author:YU Jing,Doctoral supervisor,Chief physician,Research direction is hypertension;E-mail:yujing2304@126.com
    【Abstract】  Objective  To investigate the current status of overweight and obesity and to explore its correlation with hypertension among residents in Gansu province,so as to provide a scientific basis for developing intervention measures.Methods  From September 2013 to July 2014,the residents aged 15 or over in Gansu province was selected to investigate by a multistage stratified cluster random sampling method.Questionnaire survey and physical examination were given to the subjects.The body mass index (BMI) and waist circumference (WC) were measured,and the diagnosis of hypertension was also carried out in the study.The correlation between overweight,obesity and hypertension was analyzed.Results  A total of 16 000 subjects were involved in this survey.15 431 questionnaire were valid with an effective response rate of 96.44%.Among them,889(5.76%) cases in low body mass,9 440(61.18%) with normal weight,4 074(26.40%) were overweight,1 028(6.66%) were obesity;6 796(44.04%) with central obesity;3 993(25.88%) with hypertension.BMI,WC,body fat percentage and visceral adiposity index (VAI) in people with normal blood pressure were lower than those in patients with hypertension(P<0.05).There was significant difference in systolic blood pressure and diastolic blood pressure among people of low body mass,normal weight,overweight and obesity (P<0.05).Among the people of low body mass,normal weight,overweight and obesity,there was no significant difference in the prevalence of hypertension between men and women (P>0.05).The prevalence of hypertension increased with age among the people of low body mass,normal weight,overweight and obesity (P<0.01).Multivariate Logistic regression analysis showed that low body mass was a protective factor of developing hypertension〔OR(95%CI)=0.654(0.537,0.796),P<0.001〕,overweight,obesity,and central obesity were independent risk factors of developing hypertension〔OR(95%CI)=2.058(1.896,2.233),4.259(3.734,4.858),1.733(1.431,2.015),P<0.001〕.Conclusion  The prevalence of overweight and obesity among resident in Gansu province was lower than the national average level.The prevalence risk of developing hypertension increased obviously in overweight and obesity people,which suggests that controlling weight is of great significance in the prevention of hypertension.
    【Key words】  Overweight;Obesity;Hypertension;Gansu
 
Investigation on KAP about Measles among Healthcare Workers in Fengtai District in Beijing  MAO Wen-wen,WANG Zhong-zhan*
Department of Immunization Prevention,Fengtai Center for Disease Control and Prevention,Beijing 100071,China
*Corresponding author:WANG Zhong-zhan,Associate chief physician;E-mail:ftjm1302@126.com
    【Abstract】  Objective  To investigate the status of knowledge,attitude about measles and measles vaccination rate among healthcare workers (HCWs) in Fengtai District,Beijing.Methods  From April to June in 2016,using stratified random sampling method,we selected 19 medical institutions from Fengtai District of Beijing,and conducted a survey in HCWs from the institutions with a self-developed questionnaire covering the aspects of status of knowledge,attitude about measles and measles vaccination rate.Results  A total of 711 questionnaires were issued and 681 ones were returned with a response rate of 95.78%.Of the 681 HCWs,the level of knowledge about measles was good in 249(36.56%),fair in 286(42.00%) and poor in 146(21.44%).Gender,age,registered permanent residence,length of service,educational status,hospital level,type of position,with measles vaccination history or not were the factors causing statistically significant differences in possessed knowledge level of measles between the HCWs (P<0.05).Among the 681 HCWs,the attitude towards measles vaccination was negative in 77(11.31%),fair in 369(54.18%),and positive in 235(34.51%).Gender,registered permanent residence,educational status,hospital level,type of position,with measles vaccination history or not were the factors resulting in statistically significant differences in the attitude towards measles vaccination between the HCWs (P<0.05).There were 430 HCWs (63.14%) who had received measles vaccine,but 251(36.86%) had not.Educational status,hospital level,type of position,level of knowledge about measles,attitude toward measles vaccination were the factors leading to the statistically significant differences in measles vaccination rate between the HCWs (P<0.05).Results of multivariate Logistic regression analysis demonstrated that educational status,hospital level,attitude toward measles vaccination were the factors influencing measles vaccination in HCWs(P<0.05).Conclusion  This study revealed that HCWs from Beijing Fengtai District have unsatisfactory level of knowledge about measles,negative attitude toward measles vaccination and low measles vaccination rate.Therefore,it is suggested that propaganda and education of knowledge about measles should be strengthened HCWs-orientatedly,in-hospital measles vaccination system for HCWs should be established and improved in order to protect the health of HCWs and patients,and control the nosocomial infection of measles.
    【Key words】  Healthcare workers;Measles;Measles vaccine;Vaccination
 
Comorbidities and Medication of Patients with Cervical Spondylosis:A Study Based on Hospital Information System Database  LU Feng-yan1, YANG Jing2, XIE Yan-ming2,CHANG De-you3*
1.Institute of Acupuncture, China Academy of Chinese Medical Sciences, Beijing 100700,China
2.Institute of Basic Research in Clinical Medicine ,China Academy of Chinese Medical Sciences, Beijing 100700,China
3.Wangjing Hospital, China Academy of Chinese Medical Sciences, Beijing 100700,China
*Corresponding author:CHANG De-you,Attending physician;E-mail:changdeyou@sohu.com
    【Abstract】  Objective  To explore the comorbidities of cervical spondylosis patients and the characteristics of combination medication.Methods  In December 2015,34 102 patients with the first diagnosis of cervical spondylosis were selected from the database of the Institute of Basic Research in Clinical Medicine of China Academy of Chinese Medical Sciences,which collected 30 3-A-grade General hospitals at home from December 6,2001 to May 23,2011,were selected as study subjects.Patients′ informations including gender,age,department of hospital admission,comorbidities,and types of medicines,were extracted.Results  The most frequent comorbidities were hypertension〔16.78%(5 724/34 102)〕,coronary heart disease〔16.40%(5 593/34 102)〕,cerebral infarction〔14.47%(4 935/34 102)〕,and cerebral arterial insufficiency〔13.04%(4 448/34 102)〕.The frequently-used western drugs were analgesic-antipyretic〔39.32%(11 342/28 844)〕,hypotensor〔35.44%(10 221/28 844)〕,neurotrophic drug〔35.05%(10 110/28 844)〕,and antibacterial drug〔31.67%(9 136/28 844)〕,the most frequently-used traditional Chinese medicines were the drug which has the function of promoting blood circulation to remove meridian obstruction〔66.50%(19 181/28 844)〕.The most frequently-used combination were TCM of promoting blood circulation to remove meridian obstruction and hypotensor and neurotrophic drug.Conclusion  The most frequent comorbidities of cervical spondylosis patients are hypertension,coronary heart disease,cerebral infarction,and cerebral arterial insufficiency.The western medicine treatment is mainly symptomatic treatment according to comorbidities,the traditional Chinese medical herbal treatment is mainly focus on promoting blood circulation to remove meridian obstruction.
    【Key words】  Cervical spondylosis;Drug therapy,combination; Comorbidities; Hospital information system
 
Virulence Genes in Community-acquired Uropathogenic Escherichia coli and Its Correlation with the Prognosis of the Disease  MAO Guo-feng1*,LUO Zhen-gang2
1.Department of Clinical Laboratory, Shaoxing People′s Hospital, Shaoxing 312000, China
2. Department of Urology Surgery, Shaoxing People′s Hospital, Shaoxing 312000, China
*Corresponding author:MAO Guo-feng,Senior technologist;E-mail:gfmaomao@126.com
    【Abstract】  Objective  To understand the virulence gene and drug tolerance of community-acquired UPEC and explore the correlation between virulence gene and the prognosis of the disease.Methods  We collected 56 strains of community-acquired UPEC from patients with urinary tract infection(UTI) who received treatment in Shaoxing People′s Hospital from 2013 to 2014.We conducted drug sensitive test by K-B method and microdilution method.The results of the drug sensitive test were determined according to CLSI 2014 drug sensitive test standard.Virulence genes were detected by using PCR,including papA,cnf1,cnf2,cfaB,ipaB,hofQ and ompT.Analysis of disease development and relapse was performed based on clinical data.Results  Among the 56 strains of UPEC,we found 20(35.7%) ompT-positive strains and 4(7.1%) papA-positive strains;no other virulence genes were found.ompT-positive strains and ompT-negative strains had no drug resistance to piperacillin/tazobactam,meropenem,amikacin,ertapenem,imipenem and tigecycline.ompT-positive strains had higher drug resistance rate to ceftazidime than ompT-negative strains(P<0.05).One-week after medication,15(75.0%) patients did not cure and 11(55.0%) patients had relapse among 20 patients with ompT-positive strains;10(27.8%) patients did not cure and 6(16.7%) patients had relapse among 36 patients with ompT-negative strains.There were significant differences in the rate of not being cured and relapse between patients with ompT-positive strains or papA-negative strains(χ2=11.601,8.936;P<0.05).Conclusion  Community-acquired UPEC carrying ompT may be related to its resistance to ceftazidime,and the strains have strong virulence,and usually cause repeated infections.
    【Key words】  Uropathogenic escherichia coli;Community-acquired infections;Virulence;Drug resistance
 
Epidemiological and Clinical Characteristics of Patients with Brucellosis  WANG Rong-ying,HE Zhen-yin*,CHEN Ya-jin,WANG Wei-jie,ZHAO Wen-wen,WANG Jin-yan,WANG Ya-yi
Department of General Practice,the Second Hospital of Hebei Medical University,Shijiazhuang 050000,China
*Corresponding author:HE Zhen-yin,Chief physician,Professor;E-mail:hezhenyin2008@163.com
    【Abstract】  Objective  To analyze the epidemiological and clinical characteristics of patients with brucellosis,so as to improve the clinical awareness of brucellosis, provide basis for early diagnosis and prevention of misdiagnosis.Methods  A total of 110 brucellosis patients hospitalized in the Second Hospital of Hebei Medical University from 2014 to 2015 were selected as the research objects.Referring to the medical records of patients,epidemiological characteristics of the patients(including gender,age,professional title,disease time and route of infection),clinical symptoms,laboratory inspection,visited department,treatment and outcome conditions were recorded.Results  Among the 110 patients with,there were 78 males and 32 females;the patients were aged from 10 to 78 years old,and the majority was between 41 and 60 years old(81 patients,73.6%),and between 21 and 30 years old(22 patients,20.0%);most of their occupations were farmers(66 patients,60.0%).Each quarter the number of patients was 16(14.6%),46(41.8%),31(28.2%),and 17(15.4%) respectively;There were 30 patients(27.3%) who had clear contact history of animals such as cattle and sheep,and polluted products.Fever(100 patients,90.9%),joint and muscle pain(52 patients,47.3%),fatigue(31 patients,28.2%),gastrointestinal symptoms(26 patients,23.6%) were the main clinical manifestations.Hepatic function damage(41 patients,37.3%),increased erythrocyte sedimentation rate(40 patients,36.4%),increased or reduced white blood cell count(37 patients,33.6%),reduced albumin level(33 patients,30.0%),and increased C-reactive protein level(23 patients,20.9%) were the main presentation of laboratory inspections.The brucella antibodies of 106 cases were positive,22 cases blood culture were positive,the blood culture of three cases was positive,and the joint fluid culture of one case was positive.Patients with brucellosis received treatment mainly in respiratory medicine(31 patients,28.2%),general medical department(25 patients,22.7%),immune rheumatology department(17 patients,15.4%) and digestive system department(10 patients,9.1%),the others were admitted to other departments due to atypical clinical features.There were 51(46.4%) patients using doxycycline hydrochloride combined with rifampicin,44(40.0%) using doxycycline hydrochloride combined with streptomycin,seven(6.4%) receiving minocycline hydrochloride combined with rifampicin,three(2.7%) using doxycycline hydrochloride combined with rifapentini,three(2.7%) receiving minocycline hydrochloride alone,and two(1.8%) receiving doxycycline hydrochloride alone.One patient developed sepsis and septic shock,the rest had good prognosis.Conclusion  The clinical manifestations of patients with brucellosis are complicated and changing.Early diagnosis and normalized therapy can quickly relieve symptoms of patients,avoid chronicity,and reduce disability rate.
    【Key words】  Brucellosis;Signs and symptoms;Therapy
 
Clinical Features and Prognosis of Acute Herpes Simplex Viral Encephalitis and Meningitis Patients  LI Jin,DONG Li-zhao,CHEN Yi-bing,FAN Guo-feng*,QIAN Jian,XU Peng,SHA Du-juan,WANG Jun,ZHANG Jun
Department of Emergency,Nanjing Drum Tower Hospital,the Affiliated Hospital of Nanjing University Medical School,Nanjing 210008,China
*Corresponding author:FAN Guo-feng,Attending physician;E-mail:fanguofeng98@163.com
    【Abstract】  Objective  To present the clinical manifestations,cerebrospinal fluid (CSF) characteristics,imaging studies and to investigate the risk factors for adverse clinical outcomes among adults with herpes simplex virus (HSV) encephalitis or meningitis.Methods  The subjects enrolled in this study were 80 patients with HSV encephalitis (n=20) or meningitis(n=60) treated in Department of Emergency,Nanjing Drum Tower Hospital,the Affiliated Hospital of Nanjing University Medical School from 2009 to 2015.We recorded the data of the patients,such as gender,age,clinical manifestations,neural imaging and EEG examination results.The measurement of white blood cell count,lymphocyte percentage,granulocyte percentage,red blood cell count,protein and glucose levels in CSF collected through lumbar puncture was performed in the patients.Glasgow Outcome Scale was used to evaluate the clinical prognosis at discharge.Results  Seven patients had abnormal change of cranial CT,among them,2 had abnormal density shadow in the unilateral temporal lobe or temporal frontal area,1 had subacute infarction on the left insular cortex,1 had high-density shadow on the inside of left temporal bone,and 3 had nonspecific changes.Fourteen cases of cranial MRI had abnormal changes,including 5 cases in unilateral temporal lobe or temporal frontal zone,1 case in bilateral temporal frontal zones,1 case with dotted hemorrhage and subacute infarction in the left insular cortex,1 case with diffuse high-density shadows on bilateral frontal cortexes,6 cases with nonspecific changes.Nine patients had abnormal EEG changes,of whom,3 had unusual waveforms in frontal or temporal lobe areas,and 6 had nonspecific changes.Ten cases had adverse clinical outcomes,including 2 of vegetative state,7 of severe impairments and 1 of moderate function defect.Significant differences were observed between HSV encephalitis and meningitis patients in terms of age,proportions of patients with headache,changes in state of consciousness,seizures and focal neurologic deficits,neck stiffness,abnormal CT,MRI,and EEG,as well as the length of stay,and the incidence of adverse clinical outcome (P<0.05).Multivariate Logistic regression revealed that the risk factors for adverse clinical outcomes were comorbidity〔β=2.701,SE=0.804,OR=14.895,95%CI(3.081,72.013)〕 and HSV encephalitis〔β=3.766,SE=0.750,OR=43.207,95%CI(9.934,187.917)〕(P<0.05).Conclusion  HSV encephalitis and meningitis have differences in clinical presentations,imaging and EEG manifestations and clinical outcomes.Adverse clinical outcome are observed more frequently in those patients with comorbidities and an HSV encephalitis presentation.
    【Key words】  Encephalitis,herpes simplex;Meningitis,viral;Signs and symptoms;Prognosis;Risk factors
 
IgG4-related Lymphadenopathy:Two Cases Report and Literature Review  CHEN Yan,LI Xiao-ming*,XING Hong-yun,WU Peng-qiang,MA Tao,HU Min
Department of Hematology,the Affiliated Hospital of Southwest Medical University,Luzhou 646000,China
*Corresponding author:LI Xiao-ming,Chief physician;E-mail:lxm6358@21cn.com
    【Abstract】  Objective  To deepen the understanding of clinical manifestations on IgG4-related lymphadenopathy.Methods  Two patients with IgG4-related lymphadenopathy in Department of Hematology of the Affiliated Hospital of Southwest Medical University on September 12th 2013 and July 22nd 2015 were selected.Their clinical features,laboratory test indicators,treatment and transformation and development of the disease were retrospectively analyzed,and discussed with related literature review.Results  The first patient was a 52-year-old female.The main clinical manifestations were systematic multiple painless lymph nodes enlargement and irregular vaginal bleeding.Her lymph node biopsy tended to be diagnosed with IgG4-related lymphadenopathy.The patient was treated with glucocorticoid and cyclophosphamide,and her systemic lymph nodes narrowed and vaginal bleeding stopped,but at the nineth day of chemotherapy she was complicated with tumor lysis syndrome,and died after invalid rescue.The second patient was a 30-year-old male.His main manifestations were systematic multiple painless lymph nodes enlargement,night sweating,weight loss,dryness of mouth and eyes and serum IgG4 over 3.56 g/L.The diagnosis of IgG4-related lymphadenopathy was proposed by lymph node biopsy.After receiving glucocorticoid treatment,his symptoms were relieved and the systemic lymph nodes narrowed obviously.He then went into the follow-up observation stage clinically.Conclusion  IgG4-related lymphadenopathy has a low clinical incidence.Its main manifestation is painless lymph node enlargement,and extranodal organs are often affected.Some patients may have systemic symptoms,and are very sensitive to glucocorticoid,most of their prognosis is good,but when there is severe systemic systemic multiple lymph nodes enlargement,pretreatment should be performed to avoid the occurrence of tumor lysis syndrome.
    【Key words】  Immunoblastic lymphadenopathy;Immunoglobulin G;Glucocorticoid;Case reports;Historical article
 
Tetralogy of Fallot Combined with Massive Pulmonary Embolism in An Adult:Case Report and Literature Review  WANG Yan-bo,JIANG Xing-xing,FAN Wei-ze,GU Xin-shun*
Department of Cardiology,the Second Hospital of Hebei Medical University,Shijiazhuang 050000,China
*Corresponding author:GU Xin-shun,Professor,Chief physician,Main

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