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April 2017, Volume 20, No.12 Abstracts

 Six Principles of Prevention and Control of Osteoporosis among the Middle-aged Aged People Based on Chinas National Condition

TONG Di-yi1,LIANG Xing-lun1*,ZHAO Yan2

1.Yangpu Hospital,Tongji University School of Medicine,Shanghai 200090,China

2.School of Biological Science,Nanyang Technological University,Singapore 637551

*Corresponding author:LIANG Xing-lun,Chief physician;E-mail:liangxinglun.love@163.com

    Abstract  Being a common disease endangering the health of middle-aged and aged people,osteoporosis has become one of the three major killers that affects peoples health.Fractures and other complications caused by osteoporosis have seriously affected the quality of life and prognosis of patients.According to the research results both at home and abroad and Chinas national conditions,the authors put forward that the identification,diagnosis,treatment of osteoporosis should provide accessible and continuous services to the target population in a people-centered,family-oriented and community-based way.In the long-term treatment and follow-up processes of patients with osteoporosis,we summarize 6 principles related with prevention and control of osteoporosis among the middle-aged aged people:community,early stage,combination,full course,intermittent,supervision.The article describes these 6 principles in detail.

    Key words  Osteoporosis;Middle aged;Aged;Prophylaxis and treatment

 

Hierarchical Diagnosis and Treatment from the Perspective of Patients Needs

ZHANG Wei,SUN Rui-ling*

School of Health Economics and Management,Nanjing University of Chinese Medicine,Nanjing 210046,China

*Corresponding author:SUN Rui-ling,Professor;E-mail:zww_921216@163.com

    Abstract  The paper elaborates the importance of hierarchical diagnosis and treatment,and analyzes the existing problems in its promoting process.Furthermore,the hierarchical characteristics of patients medical needs,and feasible mode of medical service system based on patients needs are analyzed through hierarchy of needs theory.Finally,from perspectives of multilevel medical demand and patients rights and interests,the paper puts forward the implementation path and policy suggestions of building hierarchical diagnosis and treatment service system.

    Key words  Hierarchical medical care of patients;Health services needs and demand;Hierarchical diagnosis and treatment

 

Establishment of Triangle Hierarchical Classification Management Standards of Discharged Patients with Hypertension

WU Lin-xiu1,YING Yan-ping2*,LUO Xian-yu3

1.Department of Nursing,Guangxi Medical College,Nanning 530021,China

2.The First Affiliated Hospital of Guangxi Medical University,Nanning 530021,China

3.Hunan Polytechnic of Environment and Biology,Hengyang 421005,China

*Corresponding author:YING Yanp-ing,Professor of nursing,Master supervisor;E-mail:982215958@qq.com

    Abstract  Objective  To establish Triangle hierarchical classification management standards of discharged patients with hypertension,so as to better utilize medical resources efficiently.To promote an optimized compliance behavior,drug administration behavior self-management behavior at different levels by stratifying and prioritizing patients,and finally to effectively control hypertension,reduce complications,achieve the best quality of life and social regression.Methods  From January to September 2014,referring to Triangle chronic disease management model proposed by Kaiser Permanente,a large-scale management and care institution in State of California,Hypertension Prevention and Cure Guideline of China in 2010,domestic and foreign literatures,and opinions from medical and nursing experts in hypertension of our hospital,a follow-up of hypertension care-related hierarchies questionnaire was initially made.The questionnaires were sent to the experts through two-way approach of e-mails and paper letters,the Delphi expert consultation method was used to develop Triangle hierarchical classification management standards of discharged patients with hypertension.Results  The positive coefficient,the judgment coefficient and the authority coefficient of experts was 100%,0.808,and 0.816 respectively.The coordination coefficient of expert consultation in the first round and in the second was 0.312 and 0.431 respectively.Conclusion  Through the evaluation indicators in the Delphi expert consultation method,high positive indicator,big authority good coefficient,good coordination degree of experts,low variable-coefficient and high recognition of the evaluation indicators were presented during the process of investigation.The Triangle hierarchical classification management standards established by Delphi expert consultation method of discharged patients with hypertension are feasible.

    Key words  Hypertension;Disease management;Patient discharge

 

Evaluation on Effect and Health Economics of Standardized Three-stage Rehabilitation Program on Acute Stroke Patients Based on Hierarchical Diagnosis and Treatment

MOU Xiao-yang1,WANG Fei1*,WU Xiao-hui1,LI Dong-liang1,MU Feng2,ZHANG Zuo-wen2,ZHANG Guang-liang1,MA Jian3,WANG Man-hua3,YE Dan-dan4

1.Department of Neurosurgery,Jiangjin Central Hospital of Chongqing,Chongqing 402260,China

2.Department of NeurologyJiangjin Central Hospital of ChongqingChongqing 402260China

3.Rehabilitation Center of East Gate Branch,Jiangjin Central Hospital of Chongqing,Chongqing 402260,China

4.Community Health Service Center of Jijiang Street in Jiangjin District,Chongqing 402260,China

*Corresponding author:WANG Fei,Associate chief physicianE-mailmoushine@163.com

    Abstract  Objective  To evaluate the effect and health economic value of standardized three-stage rehabilitation program on acute stroke patients based on hierarchical diagnosis and treatment.Methods  A total of 128 acute stroke patients without operation were selected in Jiangjin Central Hospital of Chongqing from July 2014 to June 2015.Based on whether the patient to accept the standardized three-stage rehabilitation program128 patients were non-randomly assigned to rehabilitation group(n=65) and control group(n=63).Patients in the control group received routine treatment and were allowed to rehabilitation training without special rehabilitation plan;on the basis of routine treatment,patients in the rehabilitation group were intervened by standardized three-stage rehabilitation program based on hierarchical diagnosis and treatment mode.The modified Rankin scale(MRS) and Barthel index(BI) were performed at the recruitment and 30,90 and 180 days after treatment.The total costs were compared between the two groups for the cost-effectiveness analysis.Results  There was significant difference in interaction between time and treatment method in MRS score(P0.05),and the main effect of treatment method and time on MRS score was significant(P0.05).The MRS score of the patients in the rehabilitation group was lower than that of the control group at 90 and 180 days after treatment(P0.05);and both of the 2 groups had significantly lower outcomes of MRS score at 30,90 and 180 days after treatment than that at the recruitment(P0.05).There was significant difference in interaction between time and treatment method in BI score(P0.05),and the main effect of treatment method and time on BI score was significant(P0.05).The BI score of the patients in the rehabilitation group was higher than that of the control group at 90 and 180 days after treatment(P0.05);and both of the 2 groups had significantly higher outcomes of BI score at 30,90 and 180 days after treatment than that at the recruitment(P0.05).The direct medical cost of the rehabilitation group was higher than that of the control group,and the direct non-medical cost and indirect cost were less than those of the control group(P0.05).Decreasing 1 point in MRS scores,the rehabilitation group spenting were less than the control group(P0.05);while elevating 1 point in BI scoresthe rehabilitation group spenting were less than the control group(P0.05).Conclusion  Standardized three-stage rehabilitation program on acute stroke patients based on hierarchical diagnosis and treatment can significantly improve neural function and reduce the medical expense.

    Key words  Stroke;Rehabilitation;Hierarchical diagnosis and treatmentHealth economics evaluation

 

Maturity and Standardization of Hierarchical Diagnosis and Treatment of Chronic Constipation

LIU Zhi-tao1,2,YU De-hua1,2*

1.Yangpu Hospital,Tongji University,Shanghai 200090,China

2.Department of General Medicine,Tongji University School of Medicine,Shanghai 200090,China

*Corresponding author:YU De-hua,Professor,Chief physician;E-mail:ydh1404@126.com

    Abstract  Chronic constipation is a common symptom of gastrointestinal diseases.Hierarchical diagnosis and treatment has an important effect on the curative effect of chronic constipation and the satisfaction of patients.Based on the analysis of literatures,the paper summarizes the existing problems of current diagnosis and treatment of chronic constipation,analyzes the effect of hierarchical diagnosis and treatment in the diagnosis and treatment of chronic constipation,and at the same time explores the mature and standardized way of hierarchical diagnosis and treatment of chronic constipation.

    Key words  Constipation;Management of diagnosis and treatment,medical;Hierarchical diagnosis and treatment

 

Changing Characteristics of Mineral and Bone Metabolism Indicators in Patients with Chronic Kidney Disease at Different Stages

HU Li-li,TU Wei-ping,FANG Xiang-dong,XU Cheng-yun*

Department of Nephrology,the Second Affiliated Hospital of Nanchang University,Nanchang 330006,China

*Corresponding author:XU Cheng-yun,Associate chief physician;E-mail:183207745@qq.com

    Abstract  Objective  To analyze the changing characteristics of mineral and bone metabolism indicators in patients with chronic kidney disease(CKD) at stage 1 to stage 5 and to provide basis for treatment of patients with CKD in early stages.Methods  According to the inclusion criteria,391 patients with CKD hospitalized in Department of Nephrology of the Second Affiliated Hospital of Nanchang University in 2013 were enrolled and their clinical data were collected retrospectively.On the basis of CKD staging in kidney disease outcomes quality initiative(KDOQI) guidelines,patients were divided into CKD of stage 1 to 2 group(n=32),CKD of stage 3 group(n=67),CKD of stage 4 group(n=79),and CKD of stage 5 group(n=213).Comparison of 4 groups of patients with the general information(gender,age,incidence of diabetes mellitus),serum creatinine,estimated glomerular filtration rate(eGFR) and mineral and bone metabolism indicators {serum calcium,serum phosphorus and serum calcium-phosphorus product,intact parathyroid hormone(iPTH),25-hydroxyvitamin D3 25(OH) D3,bone-specific alkaline phosphatase(BSALP),osteocalcin}of patients in 4 groups were compared;the correlation between eGFR and partial indicators of mineral and bone metabolism iPTH,25(OH) D3,BSALP,osteocalcin of patients with CKD was analyzed;and the qualified rate of serum calcium,serum phosphorus,calcium-phosphorus product,iPTH(qualified rate referred to the reference range of mineral and bone metabolic indicators of CKD patients recommended in KDOQI guidelines ) among CKD of stage 3,stage 4 and stage 5 groups were calculated.Results  The 25OHD3 of CKD of stage 3 group was lower than that of CKD of stage 1 to 2 group(P0.05);the serum phosphorus,serum calcium-phosphorus product,iPTH,BSALP of CKD of stage 4 group were higher than that of CKD of stage 1 to 2 group,its 25OHD3 of was lower and osteocalcin was higher than that of CKD of stage 1 to 2 group and CKD of stage 3 group(P0.05).Serum calcium of CKD of stage 5 group was lower than that of the other 3 groups,while its serum phosphorus,serum calcium-phosphorus product,iPTH,osteocalcin were higher than that of the other 3 groups,and its 25OHD3 was lower than that of CKD of stage 1 to 2 group and CKD of stage 3 group,while BSALP was higher than that of the above 2 groups(P0.05).eGFR was negatively correlated with iPTH,BSALP,osteocalcin(r=-0.49,-0.18,-0.43 respectively,P0.05),and positively correlated with 25OHD3(r=0.34,P0.05).iPTH was negatively correlated with 25OHD3(r=-0.17,P0.05),and positively correlated with BSALP,osteocalcin(r=0.34,0.60 respectively,P0.05).25OHD3 was negatively correlated with osteocalcin(r=-0.11,P0.05) and not correlated with and BSALP(r=-0.10,P0.05).BSALP was positively correlated with osteocalcin(r=0.25,P0.05).The qualified rate of serum calcium of patients in CKD of stage 3,CKD of stage 4 and CKD of stage 5 groups was 86.6%(58/67),79.7%(63/79) and 37.6%(80/213) respectively,the qualified rate of serum phosphorus of patients in the above 3 groups was 82.1%(55/67),69.6%(55/79),46.0%(98/213);their qualified rate of serum calcium-phosphorus product was 100.0%(67/67),97.5%(77/79),76.5%(163/213) respectively,and their qualified rate of iPTH was 43.3%(29/67),26.6%(21/79),39.0%(83/213) respectively.The qualified rate of each indicator reaching the standard of patients in CKD of stage 3,CKD of stage 4 and CKD of stage 5 groups was 31.3%(21/67),19.0%(15/79),11.7%(25/213) respectively.Conclusion  There have been abnormal mineral metabolism indicators in the early and middle stage of patients with CKD.Moreover,with the deterioration of renal function,iPTH,BSALP,osteocalcin have all increased at different degrees.There are obvious changes in serum calcium and serum phosphate in CKD of stage 4 to 5.The phenomenon of insufficient 25OHD3 is prevailing in CKD of stage 1 to 5 among patients with CKD.The qualified rate of indicators of mineral and bone metabolism is very low,especially iPTH,which accords with the reference range of KDOQI guidelines.

    Key words  NephrosisChronic diseaseMineral and bone metabolism

 

Correlation Research between the DAT Gene Polymorphism,Resting-State Functional MRI and in Brain Reward Circuits of Patients with Bipolar Disorder

WANG Hao-jie1*,CHEN Wei2,TAN Yan-hua2,LI Xiang1,ZHOU Miao-ping1

1.Radiology Department,Zhejiang Quzhou Peoples Hospital,Quzhou 324000,China

2.Department of Mental Health,Sir Run Run Shaw Hospital,School of Medicine,Zhejiang University,Hangzhou 310016,China

*Corresponding author:WANG Hao-jie,Associate chief physician;E-mail:feyww0514@163.com

    Abstract  Background  With the rapid improvement of medical technology,resting-state functional magnetic resonance(rs-fMRI) technology has been widely used in the clinical research of bipolar disorder(BD).

Objective  To discuss the correlation between the 40 bp VNTR polymorphism of serum dopamine transporter(DAT) gene,rs-fMRI and human brain reward circuits among patients with BD.Methods  According to the inclusion and exclusion criteria,90 BD patients(aged from 20 to 50,all genders,right-handed),hospitalized in Sir Run Run Shaw Hospital,School of Medicine,Zhejiang University from July 2014 to July 2015 and signed the informed consent,were selected in the study.According to the staging of disease,patients were divided into manic group of 32 patients with BD(group A),depressive group of 31 patients with BD(group B),remission phase group of 27 patients with BD(group C),and control group of 30 healthy persons during the same period(group D).The patients in the 3 groups were conducted with functional magnetic resonance imaging(fMRI),and then rs-fMRI was analyzed by the NIH-developed data processing platform of brain function.The regions of increased and decreased ReHo were investigated by targeting at different neural features.Polymerase chain reaction-restriction fragment length polymorphism(PCR-RFLP) technique was used to detect the polymorphism of DAT gene 40 bp VNTR in peripheral blood of the four groups.The polymorphism of this locus and the association of rs-fMRI with human brain reward circuits were analyzed.Results  The significantly increased ReHo values of rs-fMRI in group A were mainly distributed at the ventral striatum,and the right anterior cingulate gyrus,while the significantly decreased ReHo values were distributed at the bilateral precuneus regions.The significantly increased ReHo values were distributed at the right insular lobe cortex,left middle frontal gyrus,left precuneus,the significantly decreased ReHo values in group B were distributed at the right anterior lobe of cerebellum,right precentral gyrus,etc;and the significantly increased ReHo values in group C were mainly distributed at the ventral striatum,right anterior cingulated gyrus,bilateral hippocampal,while the significantly decreased ReHo values were distributed at the pons,left postcentral gyrus,central,left inferior frontal gyrus and right cingulate gyrus.There was significant difference in the overall distribution of the genotype frequency of DAT gene 40 bp VNTR loci among the subjects in the 4 groups(P0.10).There was no significant difference in the heterozygosity distribution in the 4 groups(P0.10).Conclusion  BD is associated with the abnormal interaction of the related brain regions of brain reward circuits,but their molecular mechanism needs further research and exploration.

    Key words  Bipolar disorder;Receptors,dopamine;Reward circuits

 

Correlation between Pentraxin 3 and Vascular Endothelial Dysfunction in Patients with Chronic Kidney

LI Yan-chun1,ZHAO Su-mei1,LI Zhong-xin1,LI Xin1,ZHANG Xin1,XU Chen1,LIU Jing1,HUANG Jing1,SHEN Shen1,JIA Xiao-yue2,SUN Qian-mei3*

1.Department of Nephrology,Beijing Chao-Yang Hospital Affiliated to Capital Medical University,Beijing 100020,China

2.Department of Nephrology,Beijing Jishuitan Hospital,Beijing 100035,China

3.General Department,Beijing Chao-Yang Hospital Affiliated to Capital Medical University,Beijing 100020,China

*Corresponding author:Sun Qian-mei,Professor;E-mail:sunqianmei5825@163.com

    Abstract  Objective  To investigate the relationship between pentraxin 3(PTX3) and vascular endothelial dysfunction in non-dialysis patients with chronic kidney disease(CKD).Methods  According to the inclusion criteria,seventy CKD patients hospitalized Department of Nephrology or treated in the outpatients in Beijing Chao-Yang Hospital Affiliated to Capital Medical University from April 2012 to December 2013 were selected.The estimated glomerular filtration rate(eGFR) was obtained by simplified MDRD formula.Patients were divided into group of CKD 1-3 stage(group A,n=30) and group of CKD 4-5 stage(group B,n=40) according to eGFR.Another 30 healthy people after health examination in Center of Health Examination of Beijing Chao-Yang Hospital Affiliated to Capital Medical University during the same period were selected as the control group.ELISA was used to detect serum PTX3 and peripheral arterial tension test was used to detect reactive hyperemia index(RHI).Collect the general information gender,age,incidence of diabetes,incidence of hypertension,smoking rate,systolic blood pressure(SBP),diastolic blood pressure(DBP),pulse pressure(PP),mean arterial pressure(MAP),body mass index(BMI),laboratory examination indicators white blood cell count(WBC),neutral granulocyte fraction(NE),hemoglobin(HGB),albumin(ALB),total cholesterol(TC),triglyceride(TG),high-density lipoprotein cholesterol(HDL-C),low-density lipoprotein cholesterol(LDL-C),blood urea nitrogen(BUN),serum creatinine(Scr),uric acid(UA),serum calcium,serum phosphorus,parathyroid hormone(PTH),inflammatory indicators high-sensitivity C reactive protein(hs-CRP),PTX3,vascular endothelial function indicators(endothelin,RHI) of the 3 groups were collected,and the correlation between PTX3 and each indicators of patients with CKD was analyzed.Results  SBP and MAP of group A were higher than those of the control group(P0.05).SBP,PP and MAP of group B were higher than those of the control group and group A,while DBP was higher than that of the control group(P0.05).NE,LDL-C,UA of group A were higher than those of the control group,while HGB,ALB were lower than those of the control group(P0.05);NE,BUN,Scr,serum phosphorus and PTH of group B were higher than those of the control group and group A,while HGB and serum calcium were lower than those of the control group and group A,ALB was lower than that of control group,and LDL-C and UA were higher than those of control group(P0.05).PTX3 and RHI of group A was respectively higher and lower than that of the control group(P0.05);hs-CRP,PTX3,endothelin of group B were higher than those of the control group and group A,while RHI was lower than that of the control group(P0.05).The result of Pearson correlation analysis showed that PTX3 was positively correlated with WBC(r=0.300,P=0.046),NE(r=0.422,P=0.004),Scr(r=0.320,P=0.032),hs-CRP(r=0.342,P=0.022),endothelin(r=0.307,P=0.036),while negatively correlated with RHIr=-0.374P=0.011.Conclusion  PTX3 of patients with CKD is positively correlated with endothelin,while negatively correlated with RHI.Compared with hs-CRP,PTX3 may be a better indicator for predicting endothelial dysfunction in patients with CKD.

    Key words  Nephrosis;Endothelial cells;Pentraxin 3;Reactive hyperemia index

 

Mechanism of Different Frequencies of Electroacupuncture in Treating Neuropathy in Rats with Alzheimers Disease

GAO Shan,KONG Li-hong*,YU Chao-chao,YAO Guo-jin

Hubei University of Chinese Medicine,Wuhan 430000China

*Corresponding author:KONG Li-hongProfessorE-mail:xiyu1618@sina.com

    Abstract  Objective  To explore the mechanism of different frequencies of eletroacupuncture in the treatment of neuropathy in Alzheimers disease(AD) rats,so as to provide a theoretical basis for clinical treatment of AD with electroacupuncture.Methods  This study was conducted between March and June 2016.Ninety healthy male Wistar rats(SPF) were selected and qualified rats were screened by Morris water maze after 1 week of adaptive feeding.Then the qualified rats were divided into normal group,sham operation group,model group,2 Hz,30 Hz and 50 Hz electroacupuncture treatment groups according to the random number table method with 15 in each.The normal group was not given any treatment.The AD rats were established by injecting Aβ1-42 oligomer into the lateral cerebral ventricle in model group,2 Hz,30 Hz and 50 Hz electroacupuncture treatment groups,whereas the rats in the sham operation group were constructed with 0.9% sodium chloride solution.And the success of modeling was confirmed by Morris water maze test again.After that,the rats in 2 Hz electroacupuncture treatment group were treated by G6805-type electroacupuncture instrument stimulation at Baihui and Shenshu acupoints with the frequency of 2 Hz.The rats in the 30 Hz and 50 Hz electroacupuncture treatment groups received the same treatment with the same parameters and operations as the 2 Hz electroacupuncture treatment group received except for electroacupuncture frequencies,30 Hz was selected for the 30 Hz electroacupuncture treatment group,and 50 Hz for the 50 Hz electroacupuncture treatment group.The rats in normal group,model group and sham operation group were grabbed in the same way as those rats in the electroacupuncture treatment groups but were put back without any treatment.The rats were sacrificed after intervention and samples of brain hippocampus,cortical tissues were collected.The expression levels of Tau protein,levels of phosphorylated Tau protein at serine 262,369,404 sitesTau(pS262),Tau(pS396),Tau(pS404),14-3-3ζ and AMPA receptor protein in hippocampus and cortical tissue of rats were detected by Western blotting.Results  Compared with the normal group,the expression levels of Tau protein in hippocampus tissue of AD rats in model group significantly decreased(P0.05),whereas the levels of Tau(pS262) and Tau(pS396) increased obviously(P0.05).The 50 Hz electroacupuncture treatment group had higher expression level of Tau protein but lower expression levels of Tau(pS262) and Tau(pS396) in the hippocampus tissue than model group,2 Hz and 30 Hz electroacupuncture treatment groups(P0.05).Compared with the normal group,the model group had lower expression level of Tau protein and higher expression levels of Tau(pS262) and Tau(pS404) in the cerebral cortex(P0.05).The 50 Hz electroacupuncture treatment group had higher expression level of Tau protein whereas lower expression level of Tau(pS404) in the cerebral cortex than the model group,2 Hz and 30 Hz electroacupuncture treatment groups(P0.05).The expression levels of 14-3-3ζ in the hippocampus and cortex of the model group were higher than those in the normal group,whereas the expression level of AMPA receptor protein in hippocampus was lower than that in the normal group(P0.05).The 50 Hz electroacupuncture treatment group had lower expression levels of 14-3-3ζ in hippocampus and cortex but higher expression level of AMPA receptor protein in hippocampus than the model group,2 Hz and 30 Hz electroacupuncture treatment groups(P0.05).Conclusion  Different frequencies of electroacupuncture treatment probably improved the neuropathy of AD rats by regulating the expression levels of Tau protein and phosphorylated Tau protein and related proteins(14-3-3ζ and AMPA),and thus achieved the effect of the treatment of AD.

    Key words  Alzheimers diseaseElectroacupunctureTau proteins

 

Role for IL-18 in Temporomandibular Joint Arthritis

HUANG Fang1,HU Ya-lin1,JIANG Cheng-jin1,LIU Jing-fang1,HE Shao-heng2*,LI Zhi-gang3*

1.Jinzhou Medical University,Jinzhou 121000,China

2.Allergy and Clinical Immunology Research Centre,the First Affiliated Hospital of Jinzhou Medical University,Jinzhou 121000,China

3.Department of Prosthodontics,the Second Affiliated Hospital of Jinzhou Medical University,Jinzhou 121000,China

*Corresponding author:HE Shao-heng,Professor;E-mail:shoahenghe@126.com

LI Zhi-gang,Professor;E-mail:ZGLi700103@163.com

   

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