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May 2017, Volume 20, No.15 Abstracts

 Enlightenment of the Implementation of Patient Referral System in Hong Kong to the Carrying out of Hierarchical Medical System in the Mainland of China  CAI Li-qiang,HOU Jin*,LU Xin-jian
Shanghai Pudong New Area Datuan Community Health Service Center,Shanghai 201311,China 
*Corresponding author:HOU Jin,Associate chief physician;E-mail:hjin1012@163.com
    【Abstract】  The hierarchical medical system is one of the main necessary measures carried out to promote China′s medical reform.We studied the factors responsible for successful implementation of patient referral system in Hong Kong based on field training in the department of general practice of Hong Kong public hospitals and community medical centers,deeply interviewing the Hong Kong community healthcare managers and family doctors about this aspect,and analyzing the characteristics of healthcare system and general situation of primary healthcare services in Hong Kong on the grounds of reviewing the related literature.In view of the challenges existing in the hierarchical medical system carried out in the mainland of China,on the basis of Hong Kong′s nice experiences in implementing the patient referral system,we put forward eight suggestions for overcoming these challenges:formulating and enacting and perfecting the supporting policies related to hierarchical medical system;quickening the medical insurance system reform;promoting the cooperation between medical institutions at all levels;constructing a medical information system covering all the treatment data of patients that can be used in nationwide;enhancing the service capabilities of grassroots medical institutions;general practitioners(GPs) should deeply understand the essence of responsibility of family doctor services and fully perform the duty;improving the patient encounter skills in GPs;bettering the residents′ abilities of self-management of health.
    【Key words】  Patient transfer;Progressive patient care;Hong Kong;General practitioners
 
Application of the Internet to Advance the Hierarchical Medical System Development in China Based on Multi-site Practice of the General Practitioners at Home and Abroad  PAN Ying1,2, LU Yuan1,2*, YU De-hua1,2
1.Department of General Practice, Yangpu Hospital, Tongji University, Shanghai 200090,China
2.Department of General Practice, Tongji University School of Medicine,Shanghai 200090,China
*Corresponding author:LU Yuan, Associate chief physician;E-mail:lussy@126.com
    【Abstract】  Literature review was used in this article. We analyzed the development direction and hot spots about multi-practice of general practitioners(GPs) and hierarchical medical system based on interpreting the National Health and Family Planning Talents Development Plan for the 13th Five-Year Plan and Notice of Promulgating the Opinions on Encouragement and Regulation of Multi-site Practice of Physicians, investigated the new development model of general practice(GP) in China based on drawing the GP development experience of Britain, Germany and America, and put forward the ways integrated with the internet technology for promoting the hierarchical medical system development, and elaborated that under the situation of energetically developing GP in China, applying the internet technology to promoting hierarchical medical system development based on multi-site practice of GPs could help overcome the difficulties in accessing health-care services and advance the medical reform.
    【Key words】  General practice;Patient transfer;Multi-site practice;Hierarchical diagnosis and treatment;Internet
 
Treatment and Relationship between Cognitive Dysfunction and Other Systemic Diseases  LIU Qian, LI Shu-juan*
Department of Neurology, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, China
*Corresponding author:LI Shu-juan, Associate professor, Associate chief physician;E-mail:2431965@qq.com
    【Abstract】  Cognitive impairment mainly include mild cognitive impairment(MCI) and dementia, which is manifested as decline in cognitive function, the ability of social activity and activity of daily living, and mental and behavioral symptoms in aspect of neuropsychology.Systemic diseases may cause decline in cognitive function and accelerate the progression of MCI into dementia.It is of great significance in understanding and strengthening the research on the systemic diseases that affect cognitive function to improve the quality of life of patients with cognitive impairment.Cognitive dysfunction and systemic multiple systemic diseases are closely related with complicated mechanisms, and hypertension, coronary heart disease, atrial fibrillation and heart failure can increase the risk of cognitive impairment.Most researches of disease of respiratory system and cognitive impairment are focused on chronic obstructive pulmonary disease and obstructive sleep apnea hypopnea syndrome.Abnormal cholesterol levels may be one of the risk factors of Alzheimer′s disease(AD);there is nonlinear relationship between glomerular filtration rate and cognitive function;dementia may be a major complication of diabetes, and some scholars even propose the concept of "type 3 diabetes".It is important for early screening of cognition impairment to select the appropriate neuropsychological assessment tools.Effective etiological treatment and comprehensive management of patients with systemic diseases may help prevent the occurrence and progression of cognition impairment.
    【Key words】  Cognition disorders;Mild cognitive impairment;Dementia;Systemic disease
 
Current Status of Non-invasive Transcranial Stimulation in the Treatment of Cognitive Impairment  LI Xiao-xuan1,AN Jin2,REN Yan-yan1,TENG Zhen-jie1,LYU Pei-yuan1,3*
1.Graduate School,Hebei Medical University,Shijiazhuang 050017,China
2.Graduate Faculty,Hebei North University,Zhangjiakou 075000,China
3.Department of Neurology,Hebei General Hospital,Shijiazhuang 050051,China
*Corresponding author:LYU Pei-yuan,Chief physician,Doctoral supervisor;E-mail:peiyuanlu@163.com
    【Abstract】  In recent years,non-invasive transcranial stimulation has attracted more and more attention.Repetitive transcranial magnetic stimulation(rTMS) and transcranial direct current stimulation(tDCS) have been gradually applied to the treatment of many neuropsychological diseases for its characteristics of simplicity and convenience,non-invasion and high efficiency.The paper introduces the research progress of rTMS and tDCS in the treatment of cognitive impairment diseases such as Alzheimer′s disease and vascular cognitive impairment,and points out that rTMS and tDCS have great potential in the treatment of cognitive impairment.
    【Key words】  Cognition disorders;Transcranial magnetic stimulation;Electric stimulation
 
Advances in the Study of Asymptomatic Carotid Artery Stenosis and Cognitive Impairment  LI Xiao-xuan1,REN Yan-yan1,AN Jin2,DONG Yan-hong3,LYU Pei-yuan1,3*
1.Graduate School,Hebei Medical University,Shijiazhuang 050017,China
2.Graduate Faculty,Hebei North University,Zhangjiakou 075000,China
3.Department of Neurology,Hebei General Hospital,Shijiazhuang 050051,China
*Corresponding author:LYU Pei-yuan,Chief physician,Doctoral supervisor;E-mail:peiyuanlu@163.com
    【Abstract】  Carotid artery stenosis is one of the risk factors for ischemic stroke.With symptoms such as cerebral and retinal ischemia,it is called symptomatic carotid artery stenosis,without these features,it is referred to as asymptomatic carotid artery stenosis.Asymptomatic carotid artery stenosis has no clinical symptoms,but it is associated with cognitive decline which may eventually result in dementia.Therefore,asymptomatic carotid artery stenosis should not be underestimated.In this paper,the recent progress in the study of asymptomatic carotid artery stenosis and cognitive impairment is summarized.The results show that asymptomatic carotid artery stenosis is an independent risk factor for cognitive decline,it can lead to cognitive impairment by destroying the brain connectivity network,damaging white matter and gray matter microstructure,reducing the cerebral perfusion and interfering with the electrophysiological activity of the cerebral cortex.Therefore,carrying out early clinical intervention,such as carotid endarterectomy(CEA) and carotid artery stenting(CAS),is of great significance for the prevention and treatment of cognitive impairment in patients with asymptomatic carotid artery stenosis.
    【Key words】  Carotid stenosis;Cognition disorders;Endarterectomy,carotid;Carotid artery stenting
 
Relationship between Cognition Impairment and Serum Creatinine Level of the Elderly at the Same Level of Renal Function  LI Shu-juan1,LI Yan-xun1,LIU Qian1,JIANG Xiao-yan2,WANG Xiao-feng3,HU Zhi-hao1,HU Wen-li1*
1.Department of Neurology,Beijing Chaoyang Hospital,Capital Medical University,Beijing 100020,China
2.Department of Pathology and Pathophysiology,School of Medicine,Tongji University,Shanghai 200092,China
3.College of Life Sciences,Fudan University,Shanghai 200433,China
*Corresponding author:HU Wen-li,Professor,Chief physician;E-mail:2431965@qq.com
    【Abstract】  Background  The relationship between renal function and cognitive function remains controversial nowadays.There are many factors affecting the cognitive impairment(CI) of the elderly,but the association between serum creatinine(Scr) and CI in the elderly is rarely reported.
Objective  To investigate the relationship between CI and Scr level of the elderly under the same condition of renal function,and to provide the theoretical basis and clinical basis for the clinical treatment of CI in the elderly.Methods  According to the inclusion criteria,1 757 old people from 31 villages of Jiang′an town in Rugao,Jiangsu province were enrolled as research subjects by stratified random sampling method from November 13th,2014 to December 21st,2014.The general information of the subjects was collected and the cognitive function was evaluated by HDS-R.According to HDS-R total score,those >21.5 were assigned into non-cognitive impairment(NCI),≤21.5 were assigned into CI.Laboratory examination results including the level of total cholesterol(TC),triacylglycerol(TG),low density lipoprotein cholesterol(LDL-C),high density lipoprotein cholesterol(HDL-C),and Scr and estimated glomerular filtration rate(eGFR) were recorded.Renal function was classified according to eGFR:grade Ⅰ,normal renal function,eGFR≥90 ml·min-1·(1.73 m2)-1;grade Ⅱ,mild injury of renal function,60 ml·min-1·(1.73 m2)-1≤eGFR<90 ml·min-1·(1.73 m2)-1;grade ≥Ⅲ,moderate-to-severe injury of renal function,eGFR<60 ml·min-1·(1.73 m2)-1.Results  Among the 1 757 subjects,there were 820 males and 937 females with an average age of(75.3±3.9);823 with NCI and 934 with CI;renal function classification:275 subjects in grade Ⅰ(154 with NCI and 121 with CI);1 001 in grade Ⅱ(513 with NCI and 488 with CI);481 in grade ≥Ⅲ(156 with NCI and 325 with CI).In renal function group of grade Ⅰ,proportion of males and level of Scr of subjects with NCI were higher than those of subjects with CI,while incidence of stroke and coronary heart disease and level of TG were lower than those of subjects with CI(P<0.05).In renal function group of grade Ⅱ,proportion of males and level of Scr of subjects with NCI were higher than those of subjects with CI,and their age and TG level were lower than those of subjects with CI(P<0.05).In renal function group of grade ≥Ⅲ,proportion of males and level of Scr of subjects with NCI were higher than those of subjects with CI,and their age was lower than that of subjects with CI(P<0.05).In renal function group of grade Ⅰ,the total score of HDS-R was positively correlated with Scr level(r=0.506,P<0.001);in renal function group of grade Ⅱ,the total score of HDS-R was positively correlated with Scr level(r=0.444,P<0.001);in renal function group of grade ≥Ⅲ,the total score of HDS-R was positively correlated with Scr level(r=0.233,P<0.001).Conclusion  Under the same condition of renal function,higher level of Scr has a protective effect on CI of the elderly,and works well under good condition of renal function.
    【Key words】  Cognition disorders;Serum creatinine;Aged;Renal function
 
Epilepsy and Cognitive Disorders  TI Yue1,ZHENG Wei-hong2*
1.No.1 Department of Clinical Medicine,Fujian University of Traditional Chinese Medicine,Fuzhou 350122,China
2.Department of Neurology,Zhongshan Hospital Xiamen University,Xiamen 361004,China
*Corresponding author:ZHENG Wei-hong,Chief physician;E-mail:zwh610547@xmu.edu.cn
    【Abstract】  Epilepsy is a common chronic neurological disease with high incidence and mortality.With the development of social medicine,more and more attention has been paid to epilepsy population.It has been found that many factors can cause cognitive disorders in epilepsy patients,but the correlation between cognitive disorders and epilepsy is still unknown.In this paper,the mechanism of cognitive disorders caused by epilepsy,the factors affecting the cognitive function of epileptic patients,and the effects of different treatment regimens for epilepsy on cognitive function were analyzed,in order to raise the concern with cognitive disorders in epilepsy,improve the quality of life of patients with epilepsy,and provide research direction for clinical workers.
    【Key words】  Epilepsy;Cognition disorders;Mechanism;Influencing factors;Therapy
 
Value of Serum GDF-15 level on Diagnosis and Evaluation of Chemotherapy Efficacy for Lung Cancer  DENG Jing-jing,XU Ai-hui*
Department of Respiratory Medicine,the First Affiliated Hospital of Anhui Medical University,Hefei 230022,China 
*Corresponding author:XU Ai-hui,Chief physician,Professor,Master supervisor;E-mail:Xuaihui0909@163.com
    【Abstract】  Objective  To study the role of serum growth differentiation factor-15(GDF-15) as a diagnostic marker and a chemotherapy response predictor in lung cancer so as to provide a clinical reference.Methods  The participants met the inclusion criteria of this study were all selected from the First Affiliated Hospital of Anhui Medical University,included 88 inpatients with lung cancer(lung cancer group) and 31 inpatients with pneumonia(pneumonia group) treated in Department of Respiratory Medicine,and 41 healthy controls(normal control group) undergoing health examination in Medical Examination Center,between December 2015 and August 2016.The serum GDF-15 level was measured in both lung cancer and pneumonia groups on the day of admission and in the normal control group on the first day of undergoing health examination.We collected the lung cancer group′s data of smoking history,diabetes history,measurement results of laboratory markers such as hemoglobin(HGB),prealbumin(PA) and lactate dehydrogenase(LDH) and pathological features(T staging,N staging,clinical staging and pathological types of lung cancer),pneumonia and lung cancer groups′ data of measurement results of serum GDF-15,carcinoembryonic antigen(CEA),neuronspecific enolase(NSE) and cytokeratin 19 fragment(CYFRA21-1) levels.ROC curve of serum GDF-15,CEA,NSE and CYFRA21-1 levels for the diagnosis of lung cancer was evaluated,respectively.In lung cancer patients who completed two consecutive cycles of chemotherapy,chemotherapy response was evaluated and serum GDF-15 level was measured for assessing the chemotherapy response.Results  Normal control group had lower serum GDF-15 level than pneumonia group and lung cancer group(P<0.05).Lung cancer group had higher serum GDF-15 level than the pneumonia group(P<0.05).In the lung cancer group,patients with BMI ≥24 kg/m2 had higher serum GDF-15 levels than those with BMI <24 kg/m2(P<0.05);patients with diabetes had higher serum GDF-15 levels than those without(P<0.05),patients with lower serum HGB levels had higher serum GDF-15 levels than those with normal serum HGB levels(P<0.05);Stage T1-2 lung cancer patients had lower serum GDF-15 levels than stage T3-4 lung cancer patients(P<0.05).For the diagnosis of lung cancer,the serum GDF-15 level′s cut off value,sensitivity,specificity,area under the ROC curve(AUC) value,Youden′s index were 1 199.05 ng/L,78.2%,71.0%,0.851〔95%CI(0.774,0.910)〕 and 0.492,respectively.Serum GDF-15 had higher AUC value than serum CEA〔0.630,95%CI(0.537,0.717)〕,NSE〔0.720,95%CI(0.631,0.799)〕 and CYFRA21-1〔0.654,95%CI(0.561,0.739)〕 for the prediction of lung cancer(P<0.05).In the 64 lung cancer cases completing two consecutive cycles of chemotherapy,the condition was partially relieved in 11 cases,stable in 33 cases,and progressive in 20 cases;There was significant difference in serum GDF-15,CEA levels in lung cancer group with different therapeutic effects after chemotherapy(P <0.05). There was no significant difference in serum NSE and CYFRA21-1 levels in lung cancer group with different therapeutic effects after chemotherapy(P>0.05).Conclusion  Serum GDF-15 can be used as a diagnostic marker,and a promising new chemotherapy response predictor in lung cancer.
    【Key words】  Lung neoplasms;Growth differentiation factor 15;Diagnosis;Evaluation of chemotherapy efficacy;Sensitivity;Specificity
 
Correlation between Age and Immunoreactions of Nerve Root in Patients with Guillain-Barre Syndrome  WANG Min1,ZHOU Zhao-hua2,DENG Shi-biao1,DONG Ze-ya1,ZHU De-sheng3,HE Yun-yan1*
1.Department of Pathogen,Fuzhou Medical College of Nanchang University,Fuzhou 344000,China
2.Department of Laboratory,the Fifth Affiliated Hospital of Nanchang University,Fuzhou 344000,China
3.Department of Neurology,Huashan Hospital,Fudan University,Shanghai 200040,China
*Corresponding author:HE Yun-yan,Chief laboratorian;E-mail:Yunyanhe@tom.com
    【Abstract】  Objective  To explore the association and clinical significance between age and immunoreactions of nerve root in patients with Guillain-Barre syndrome(GBS).Methods  According to the inclusion criteria,78 patients with GBS in Department of Neurology of the Fifth Affiliated Hospital of Nanchang University from January 2006 to June 2016 were included.According to age,GBS patients were divided into the young group(≤45 years old,n=32) and the old group(>45 years old,n=46).General information(including sex,age,Hughes score,upper respiratory tract infection,and gastrointestinal infection) and the level of biochemical indicator〔cerebrospinal fluid(CSF) protein and IgG〕 of monitoring immunoreactions of nerve root of patients with GBS were collected retrospectively.According to the reference values of CSF protein and IgG,patients with GBS were divided into normal level group of CSF protein(n=14) and high level group of CSF protein(n=64),and normal level group of CSF IgG(n=19) and high level group of CSF IgG(n=59).Results  There was no significant difference in gender,and the incidence of respiratory infection and gastrointestinal infection between the young group and the old group(P>0.05).Rate of Hughes score(≥3),CSF protein and IgG levels of the young group were lower than those of the old group(P<0.05).The age of normal level group of CSF protein was younger than that of high level group of CSF protein(P<0.05).The age of normal level group of CSF IgG was younger than that of high level group of CSF IgG(P<0.05).Age was positively correlated with the levels of CSF protein and IgG(r=0.331,P<0.01;r=0.277,P=0.01).Conclusion  The degree of immunoreaction of nerve root is enhanced with the increasing of age among patients with GBS,therefore,age should be taken into consideration in the clinical evaluation of immunoreaction of nerve root of patients with GBS.
    【Key words】  Guillain-Barre syndrome;Neural immune;Nerve root;Age factor;Immunoreaction
 
Predictive Value for Long-term Prognosis of Grace and Crusade Scores in Patients with Atrial Fibrillation and NSTEMI after PCI  WANG Nan-nan1,ZHANG Bo-yang2,LIU Peng-fei1,WANG Yu-bin2,WANG Feng2,YUAN Hai-feng2,XIE Xiu-feng2,TANG Hai-hong2,LI Tian-chang1,2*
1.Clinical College of Navy Medicine,Anhui Medical University,Hefei 230032,China
2.Navy General Hospital PLA China,Beijing 100048,China
*Corresponding author:LI Tian-chang,Professor,Doctoral supervisor;E-mail:ltc909@aliyun.com
    【Abstract】  Objective  To clarify the value of Grace and Crusade scores for predicting the risk of long-term all-cause mortality and major adverse cardiovascular events in patients with atrial fibrillation and non-ST-elevation myocardial infarction(NSTEMI) after percutaneous coronary intervention(PCI).Methods  A retrospective study was conducted on the data of 379 patients with atrial fibrillation and NSTEMI treated by PCI in 11 tertiary grade A hospitals in Beijing from January 2010 to January 2015.Grace score,Crusade score,Grace unite Crusade scores were used to predict the long-term prognosis of these patients.The area under the curve(AUC) of receiver operating characteristic(ROC) of these three predictors were recorded.In accordance with the results of combined assessment of Grace and Crusade scores,the patients were divided into four groups,G1 group(Grace score ≤118 points,Crusade score≤40 points,n=112),G2 group(Grace score ≤118 points,Crusade score ≥41 points,n=20),G3 group(Grace score >118 points,Crusade score ≤40 points,n=143) and G4 group(Grace score >118 points,Crusade score ≥ 41 points,n=104).The area under the curve(AUC) of receiver operating characteristic(ROC) of these three predictors were recorded.The survival curves of  4 groups were drawn and compared.Results  Three hundred and sixty-two of the 379 recruited patients completed the follow-up of(36.8±18.3)months.For predicting the risk of long-term all-cause mortality of these participants,the AUC of Grace score,Crusade score,Grace unite Crusade scores respectively were 0.660 〔95%CI(0.609,0.709)〕,0.702 〔95%CI(0.652,0.749)〕,and 0.707 〔95%CI(0.658,0.754)〕.As for predicting the risk of long-term major adverse cardiovascular events,the AUC of Grace score,Crusade score,Grace unite Crusade scores respectively were 0.559 〔95%CI(0.506,0.611)〕,0.593 〔95%CI(0.540,0.644)〕,0.594 〔95%CI(0.542,0.645)〕.Survival analysis found that survival curve differed significantly among the G1,G2,G3 and G4 groups(χ2=20.07,P<0.01);G4 group had substantially lower survival rate than G1 and G3 groups(P<0.05).Conclusion  For patients with atrial fibrillation and NSTEMI after PCI,these three predictors have certain predictive values in predicting the risk of long-term all-cause mortality,of them,Grace unite Crusade scores can be used for identifying the high-risk patients.The three predictors have similar values in predicting the risk of long-term major adverse cardiovascular events in these patients.
    【Key words】  Atrial fibrillation;Myocardial infarction;Grace score;Crusade score;Angioplasty,transluminal,percutaneous coronary
 
Clinical Features of Pulmonary Cryptococcosis in Immunocompromised and Immunocompetent Patients  WANG Qun-zhi,GUO An*,SHENG Mei-ling
Department of Respiratory Medicine,Jinhua People′s Hospital,Jinhua 321000,China
*Corresponding author:GUO An,Chief physician;E-mail:drwqz82@sina.com
    【Abstract】  Objective  To investigate the clinical features of pulmonary cryptococcosis(PC) in immunocompromised and immunocompetent patients with a view to helping clinicians to improve the level of diagnosis and treatment of the disease. 
Methods  A retrospective study was conducted on 84 selected inpatients with PC treated in Jinhua People′s Hospital from January 2008 to December 2015.Of them,those with AIDS,or organ transplant,or long-term treatment with corticoid and immunosuppressive drugs were assigned to the immunocompromised group(43 cases),and the other who had not the above mentioned diseases or treatment were assigned to the immunocompetent group(41 cases).The baseline characteristics,clinical manifestations and auxiliary examination results were collected and compared between the two groups.Results  Compared with the immunocompetent group,the immunocompromised group had shorter time needed to make the diagnosis(time was calculated from the admission),longer length of stay and higher mortality rate(P<0.05).The incidences of headache,nausea and vomiting,and cryptococcal meningitis in the immunocompromised group were higher than those in the immunocompetent group(P<0.05).The white blood cell count,serum albumin level,the positive rate of cryptococcal capsular polysaccharide antigen,CD3+T lymphocytes and CD4+T lymphocytes levels in the immunocompromised group were lower than those in the immunocompetent group(P<0.05).The immunocompromised group had lower incidences of solitary nodule/mass lesion but higher incidences of multiple nodules/mass lesions than the immunocompetent group(P<0.05).The immunocompromised group had higher incidence of cavity and lower incidence of unilateral lung involvement compared with the immunocompetent group(P<0.05).Conclusion  Immunocompromised patients with PC are prone to central nervous system involvement with headache,nausea and vomiting as the main reasons for most initial visits.Moreover,they are characterized by increased mortality rate,decreased positive rate of cryptococcal capsular polysaccharide antigen,and multiple nodules/mass lesions and increased probability of cavities and bilateral lung involvement as the main imaging performance.The immunocompetent patients with PC are often found to have a solitary nodule/mass lesion and unilateral lung involvement as the imaging performance.
    【Key words】  Cryptococcosis;Lung;Immunocompromised host;Clinical features
 
Effect of Labor Treatment Guided by the New Labor Standard on the Delivery Outcome  QIAN Xia-liu*,ZHAN Ze-sen,QIN Hui-feng
Department of Obstetrics,the Third Affiliated Hospital,Sun Yat-sen University,Guangzhou 510630,China
*Corresponding author:QIAN Xia-liu,Nurse-in-charge;E-mail:iamhennessy@163.com
    【Abstract】  Objective  To explore the effect of labor treatment guided by the new labor standard(proposed by ZHANG and others in 2010) on the delivery outcome.Methods  This study was carried out between two sample groups,the study group(709 primiparas who received labor treatment guided by the new labor standard in the Third Affiliated Hospital,Sun Yat-sen University between January and August 2015),and the control group〔819 primiparas who received labor treatment guided by the traditional labor standard(developed by FRIEDMAN in the 1950s) in the same hospital between January and August 2014〕.We compared the delivery mode,postpartum hemorrhage rate,incidence of adverse neonatal outcomes(abnormal Apgar score,percentage of neonates with umbilical cord blood pH value<7.0,incidence of meconium stained amniotic fluid),and duration of labor between the two groups.And we observed the delivery outcome of the primiparas in the study group who were diagnosed with abnormal labor curve by the traditional labor standard but treated with the new labor standard during labor.Results  Compared with the control group,the study group had higher spontaneous labor rate,and lower cesarean section rate(P<0.01).No significant differences were found between the groups in the postpartum hemorrhage rate,proportion of neonates with low 1-min Apgar scores,percentage of neonates with umbilical cord blood pH value <7.0 and incidence of meconium stained amniotic fluid(P>0.05);two groups of 5-min Apgar scores were not abnormal.The study group had longer first stage of labor,second stage of labor,and overall duration of labor than the control group(P<0.05).The spontaneous labor rate of three kinds of primiparas in the study group who were diagnosed with prolonged latent phase of labor(>16 h),prolonged active stage of labor(>8 h) and prolonged second stage of labor(>2 h) by the traditional labor standard but treated with the new labor standard during labor was 45.8%(11/24),69.2%(9/13),84.1%(37/44),respectively.Conclusion  Treatment for labor with the new labor standard,could reduce the cesarean delivery rate and promote the natural childbirth without increasing the risks of postpartum hemorrhage,forceps delivery and adverse neonatal outcomes.
    【Key words】  Labor,vaginal;Cesarean section;Natural childbirth;Postpartum hemorrhage;Perinatal asphyxia neonatorum
 
Efficacy of Scarf Combined with Akin Osteotomies on Moderate and Severe Hallux Valgus  ZHOU Li-hui*,WANG Xu-can,OUYANG Lian,HU Tong-zhou,QI Jia-wu
Department of Orthopaedics,Ningbo Fourth Hospital,Xiangshan 315700,China
*Corresponding author:ZHOU Li-hui,Attending physician;E-mail:lihui_chow@163.com
    【Abstract】  Objective  To study the efficacy of Scarf combined with Akin osteotomies on moderate and severe hallux valgus.Methods  This retrospective study was conducted on 44 patients(57 feet) with moderate and severe hallux valgus〔14 patients(17 feet) with moderate hallux valgus, 40 patients(40 feet) with severe hallux valgus〕 treated by Scarf combined with Akin osteotomies in Department of Orthopaedics,Ningbo Fourth Hospital from June 2012 to May 2015.Hallux valgus angle(HVA),1-2 intermetatarsal angle(IMA) and distal metatarsal articular angle(DMAA) were measured by X-ray examination preoperatively and postoperatively.The efficacy was evaluated in accordance with the American Orthopaedic Foot & Ankle Association(AOFAS) Ankle-Hindfoot Scale.Results  The follow-up of 10-36 months showed that 4 of the 44 patients had postoperative complications,specifically,2 had inflammation reaction in the incision between 1-2 metatarsal bones,but were healed by dress changing,1 case was found with skin numbness at the edge of dorsomedial incision,but improved proved by the findings of X-ray examining 12 months later,1 case had stiffness of the first metatarsophalangeal joint;no patients had recurrence;postoperative HVA,IMA and DMAA were significantly improved in patients with moderate and severe hallux valgus found by X-ray examining of the affected foot with the leg in the weight-bearing position during the last follow-up(P<0.01).AOFAS score showed that the treatment efficacy was excellent in 33 cases,good in 9 cases,and fair in 2 cases.AOFAS score increased significantly in those with moderate and severe hallux valgus postoperatively(P<0.01).Twenty-eight patients were very satisfied and 13 were satisfied with the treatment efficacy,only 3 thought it was fair.
Conclusion  For moderate and severe hallux valgus,Scarf combined with Akin osteotomies can effectively correct the deformity and achieve good therapeutic effect and high patient satisfaction.
    【Key words】  Hallux valgus;Osteotomy;Treatment outcome;Scarf;Akin
 
Effect of TSG on the Expressions of Caspase-3 and APP in Brain Tissues of APP/PS1 Double Transgenic Mouse Model of Alzheimer′s Disease  LIU Ning,LIAO Yan-hua,LAI Shu,HUANG Jian,LI Yun,HUANG Zhong-shi*
Youjiang Medical Collegey for Nationalities,Baise 533000,China
*Corresponding author:HUANG Zhong-shi,Professor;E-mail:hzs1004@163.com
    【Abstract】  Objective  To observe the effect of tetrahydroxy stilbene glucoside(TSG) on the expressions of caspase-3 and amyloid precursor protein(APP) in brain tissues of APP/presenilin-1(PS1) double transgenic mouse model of Alzheimer′s disease(AD),and to investigate the possible mechanisms of therapeutic effect about TSG on AD.Methods  In October 2014,50 SPF rank male APP/PS1 double transgenic mice were randomly divided into model group,huperzine A group and low-dose TSG group,mid-dose TSG group,high-dose TSG group with 10 mice in each based on the random number table.Another 10 SPF rank male C5B7L/6J mice were assigned to the normal control group.Huperzine A group,low-,mid- and high-dose TSG groups,model group and normal control group were respectively given by gavage with huperzine A(0.020 mg/kg),TSG(0.033,0.100,0.300 g/kg),0.9% sodium chloride solution(10.000 ml/kg),0.9% sodium chloride solution(10.000 ml/kg),once a day,for 60 days.At the end of intervention,all the mice were sacrificed and the brain tissues were taken out for experiments.Immunohistochemistry was used to determine the number of caspase-3 positive cells in each group mice′s cerebral cortex and hippocampus,and Western blotting was adopted to detect the expression level of APP in each group mice′s brain tissues.Results  The number of caspase-3 positive cells in the cerebral cortex and hippocampus of the mice in the normal control group,huperzine A group and low-,mid- and high-dose TSG groups were less than those in the model group(P<0.05).The number of caspase-3 positive cells in the cerebral cortex and hippocampus of mice in huperzine A group was not significantly different from that of the mice in low-,mid- and high-dose TSG groups(P>0.05).The mice in the model group had higher expression level of APP in brain tissues than those in the normal control group,huperzine A group and low-,mid- and high-dose TSG groups(P<0.05).The expression level of APP in brain tissues of mice in huperzine A group did not differ substantially from that of the mice in low-,mid- and high-dose TSG groups(P>0.05).Conclusion  TSG has obvious therapeutic effect on APP/PS1 double transgenic mice,the mechanism might be related to the inhibition of the expression levels of caspase-3 and APP so as to reduce the production of amyloid-β protein,and delay the apoptosis of nerve cells.
    【Key words】  Alzheimer disease;Tetrahydroxy stilbene glucoside;Caspase 3;Amyloid precursor protein secretases
 
Reliability and Validity of Physical Activity Scale for the Elderly(Chinese Version) in Old Patients with Chronic Obstructive Pulmonary Disease  TAO Yan-xia1,WANG Lan1,ZHENG Hong2,ZHANG Qing1,ZHAO Yue1*
1.School of Nursing,Tianjin Medical University,Tianjin 300070,China
2.Department of Respiratory Care,Tianjin First Center Hospital,Tianjin 300192,China
*Corresponding author:ZHAO Yue,Professor;E-mail:13821269307@163.com
    【Abstract】  Objective  To test the reliability and validity of the Physical Activity Scale for the Elderly(PASE)(Chinese version) in old patients with chronic obstructive pulmonary disease(COPD),so as to provide an effective tool for evaluating physical activity of older patients with COPD in China.Methods  According to the inclusion criteria,201 patients with COPD receiving treatment in outpatient of Tianjin First Center Hospital from March 2015 to May 2016 were selected as research subjects by convenience sampling method.General Situation Questionnaire,PASE in Chinese version(PASE-C),International Physical Activity Questionnaire-short(IPAQ-S),36-item Short-Form Health Survey Questionnaire(SF-36) and Self-Efficacy for Managing Chronic Disease 6-Item Scale(SES6) were applied to collect patients′ information.A total of 201 questionnaires were sent out and 194 valid questionnaires were collected.The effective response rate was 96.5%.By convenience sampling method,40 patients were selected to carry pedometer and record data for seven consecutive days,and they would complete PASE-C again.Results  The Cronbach′s α coefficient of PASE-C was 0.725.The test-retest reliability of PASE-C was 0.980,the test-retest reliability of leisure time activities was 0.944,the test-retest reliability of household activities was 0.978,and the test-retest reliability of occupational activities was 0.970(P<0.001).In the PASE-C,the Item-Content Validity Index(I-CVI) of leisure time activities was 1.00,I-CVI of household activities was from 0.83 to 1.00,and I-CVI of occupational activities was 0.83;the Scale-Content Validity Index/Universal Agreement(S-CVI/UA) was 0.80,Scale-Content Validity Index/Average(S-CVI/Ave) was 0.97.The total steps of pedometer were positively correlated with the total score of PASE-C(r=0.578,P<0.001).The total scores of PASE-C and IPAQ-S were positively correlated(rs=0.698,P<0.001).The total score of PASE-C was negatively correlated with mMRC score and DOSE index,and positively correlated with total score of SF-36,and score of physiological function(PF),role of physiology(RP),general health status(GH),vitality(VT),social function(SF),role of emotion(RE),mental health(MH),and total score of SES6(P<0.05).Conclusion  The PASE-C has good validity and reliability,which can be applied into the measurement of physical activity of old patients with COPD in China.
    【Key words】  Pulmonary disease,chronic obstructive;Aged;Physical Activity Scale for the Elderly;Reliability;Validity
 
Reliability and Validity of Chinese Version of the Perceptions Regarding Investigational Screening for Memory in Primary Care Questionnaire  JI Hui-cong1,WANG Xiao-ping1,LI Xing-dan2,SUN Dan3,SU Yuan-yuan3,SONG Xiao-yue3,ZHANG Wei-hong3*
1.Department of Infectious Diseases,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450000,China
2.Department of Ophthalmology,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450000,China
3.The Nursing College of Zhengzhou University,Zhengzhou 450000,China
*Corresponding author:ZHANG Wei-hong,Professor;E-mail:18638127788@163.com
    【Abstract】  Objective  To translate the English version of the Perceptions Regarding Investigational Screening for Memory in Primary Care(PRISM-PC)questionnaire into Chinese,and to test the reliability and validity of it,in order to introduce the Chinese version of the PRISM-PC questionnaire and provide the basis for developing an assessment tool of the attitude toward dementia screening in China.Methods  The Chinese version of the PRISM-PC questionnaire(initial version) was developed by translating based on the principles of Brislin translation method,and revising based on cultural adaptation and semantic analysis.During January to June 2015,a total of 225 elderly community residents who met the inclusion criteria were recruited by convenient sampling from Yinghe Road Community,Wenhuagong Road Community,Gongren Road Community and Ribao Community in Zhengzhou(a city in China),and were investigated by the Demographic Data questionnaire and Chinese version of the PRISM-PC questionnaire(initial version).A total of 225 questionnaires were issued,and 215 valid questionnaires were collected with a response rate of 95.6%.Thirty subjects were selected from the 215 ones by random number table method,and were re-surveyed by the Chinese version of the PRISM-PC questionnaire(initial version) 2 weeks later.Extreme group approach and correlation analysis were used for item analysis;expert evaluation method was adopted for content validity analysis;KMO test,Bartlett′s Test of Sphericity,and exploratory factor analysis were employed for structural validity analysis,and internal consistency reliability and retest reliability were used for reliability analysis.Results  The subjects were divided into high-score group(60 cases) and low-score group(59 cases) by extreme group approach.The scores of items 1-20,item 22,item 25,and items 28-34 of Chinese version of the PRISM-PC questionnaire(initial version) were lower in the low-score group than those in the high-score group(P<0.05);while the scores of items 21,24 and 26 of Chinese version of the PRISM-PC guestionnaire(inital version) did not differ significantly between the two groups(P>0.05).The scores of each item of Chinese version of the PRISM-PC questionnaire(initial version) presented positive correlation with the total score(P<0.05).As the correlation coefficients of items 21,24,and 26 with the total score of Chinese version of the PRISM-PC questionnaire(initial version) were less than 0.4,the 3 items were deleted,then the Chinese version of the PRISM-PC questionnaire(initial version 1) was developed.The content validity index(CVI) of items of Chinese version of the PRISM-PC questionnaire(initial version 1) ranged from 0.83 to 1.00.The KMO value of Chinese version of the PRISM-PC questionnaire(initial version 1) was 0.742,and results of Bartlett′s Test of Sphericity were χ2=3 230.012,df=406,P<0.001,all demonstrated that the Chinese version of the PRISM-PC questionnaire(initial version 1) was suitable for exploratory factor analysis.Five common factors were extracted based on the factor extraction principle by the principal component analysis and varimax rotation,which could explain 72.213% of the total variance,with the load values of items of 0.578 to 0.931.The Cronbach′s α of Chinese version of the PRISM-PC questionnaire(initial version 1) was 0.876,and the Cronbach′s α of dimensions were 0.724-0.944.The retested reliability of Chinese version of the PRISM-PC questionnaire(initial version 1) was 0.739.After adjusting the names of items of Chinese version of the PRISM-PC questionnaire(initial version 1),the Chinese version of the PRISM-PC questionnaire(final version) was developed,which consisted of 5 dimensions covering 29 items,specifically,acceptance of dementia screening(6 items),benefits of dementia screening(8 items),stigma of dementia screening(7 items),negative impact of dementia screening on independence(4 items) and suffering related to dementia screening(4 items).Conclusion  The Chinese version of the PRISM-PC questionnaire has acceptable reliability and validity,which is suitable for assessing the attitude toward dementia screening in elderly community residents in China.
    【Key words】  Dementia;Questionnaires;Screening;Community;Reliability;Validity
 
Metabonomics Study on the Urine of Patients with HIV/AIDS Syndrome of Qi Deficiency of Lung and Spleen and Deficiency of Both Qi and Yin  MA Su-na,WANG Juan,ZHANG Hai-yan,ZHANG Miao* 
Henan University of Chinese Medicine,Zhengzhou 450046,China
*Corresponding author:ZHANG Miao,Research assistant;E-mail:1043833307@qq.com
    【Abstract】  Objective  To investigate the value of metabonomics technology in the diagnosis of TCM syndrome types.Methods  A total of 23 patients with human immunodeficiency virus(HIV)/acquired immune deficiency syndrome(AIDS) in an area of Henan Province in December 2011 were selected.Among them,12 with syndrome of Qi deficiency of lung and spleen were taken as HIV/AIDS group of syndrome of Qi deficiency of lung and spleen,and 11 with syndrome of deficiency of both Qi and Yin were taken as HIV/AIDS group of syndrome of deficiency of both Qi and Yin.The metabolic components of urine of 23 patients with HIV/AIDS were detected by liquid chromatography-mass spectrometry(LC-MS),and the differential metabolites of urine of patients with HIV/AIDS were analyzed by combining with analysis techniques of principal component analysis(PCA) and t test.Results  Through the t test and principle of 1.5 times,the preliminary screening of data found that the possible metabolites with karyoplasmic ratio(m/z) of 317 and 213 were differential metabolites of two groups,the expression changes of the peak intensity in HIV/AIDS group of syndrome of deficiency of both Qi and Yin were lower than those in HIV/AIDS group of syndrome of Qi deficiency of lung and spleen(P<0.05).PCA showed that ions with m/z of 967,155,317 and 213 ions were far away from other ions,which could be considered as the potential differential metabolites between the two groups.Conclusion  The LC-MS in metabonomics technologies can differentiate the urine of patients between the two groups from the profile of metabolites,and achieve the comparison of differential metabolites in different TCM syndromes.The metabonomics technologies has a good application value in guiding diagnosis of syndrome of TCM.
    【Key words】  Acquired immunodeficiency syndrome;Metabolomics;Symptom complex
 
Effects of Qinjiao in Different Combinations on the Content of Serum Inflammatory Cytokines and Ankle Pathology in Rats with Wind-cold-damp Rheumatoid Arthritis  MA Teng-mao1,QIANG Yu-jing1,LUO Kui-yuan1,LIU Fei1,WU Guo-tai1,2,GAO Hui-qin1*
1.Gansu University of Chinese Medicine,Lanzhou 730000,China
2.Gansu Provincial Key Laboratory of TCM Pharmacology and Toxicology,Lanzhou 730000,China
*Corresponding author:GAO Hui-qin,Professor,Master supervisor;E-mail:ghq@gszy.edu.cn
    【Abstract】  Objective  To elaborate the correlation of traditional Chinese medicine(TCM) properties with syndrome differentiation and treatment effect by observing the effects of Qinjiao(Gentianae Macrophyllae Radix) in different combinations on the content of serum inflammatory cytokines and ankle pathology in rats with wind-cold-damp rheumatoid arthritis(RA).Methods  This study was conducted between March and December 2015.Eighty SPF grade SD rats were randomly divided into the blank group,collagenⅡmodel group,wind-cold-damp arthralgia model group,Tripterygium group,single Qinjiao group,Qinjiao-Weilingxian(Clematidis Radix et Rhizoma) group(hereinafter referred to as Qin-Wei group),Qinjiao-Sangjisheng(Taxilli Herba) group(hereinafter referred to as Qin-Sang group),Qinjiao-Fangji(Stephaniae Tetrandrae Radix) group(hereinafter referred to as Qin-Fang group).For modeling,the collagenⅡmodel group was induced by collagenⅡemulsion,other model groups except the blank model group were induced by collageⅡ and exposed in wind-cold-damp environment.After modeling,the blank group,collagenⅡmodel group,wind-cold-damp arthralgia model group were given the same amount of 0.9% sodium chloride solution,each of the other groups was gavaged with 15 ml/kg corresponding drug solution,once a day with administration duration of 30 min,for 28 days.The changes of general condition,paw swelling and arthritis index(AI) were observed.The serum levels of TNF-α and IL-1β were determined.Pathological changes of ankle joint were detected by HE staining.Results  Specifically,compared with the blank group,the collagenⅡmodel group and wind-cold-damp arthralgia model group had higher average AI scores (P<0.05);the average AI scores in Tripterygium group,single Qinjiao group,Qin-Wei group,Qin-Sang group,Qin-Fang group were lower than those in the collagenⅡmodel group and wind-cold-damp arthralgia model group(P<0.05);the average AI scores of Qin-Wei group were significantly lower than those of single Qinjiao group,Qin-Sang group and Qin-Fang group(P<0.05).The serum TNF-α levels in the wind-cold-damp arthralgia model group were higher than those in blank group,collageⅡmodel group,Tripterygium group,single Qinjiao group and Qin-Wei group(P<0.05);the serum TNF-α levels in single Qinjiao group and Qin-Wei group were lower than those in Qin-Fang group(P<0.05).The serum IL-1β levels in collageⅡmodel group and wind-cold-damp arthralgia model group were higher than those in the blank group(P<0.05);the serum IL-1β levels in Tripterygium group,single Qinjiao group,Qin-Wei group,Qin-Sang group except Qin-Fang group were lower than those in collageⅡmodel group(P<0.05);Tripterygium group,single Qinjiao group,Qin-Wei group,Qin-Sang group and Qin-Fang group had lower serum IL-1β levels than wind-cold-damp arthralgia model group(P<0.05).Pathological changes of ankle joint detected by HE staining showed that,the inflammation and pathological destruction were alleviated in Tripterygium group,single Qinjiao group,Qin-Wei group,Qin-Sang group and Qin-Fang group in varying degrees,joint tissue morphology improved better in Qin-Wei group,and pathological changes improved the poorest in Qin-Fang group.Conclusion  For the wind-cold-damp RA,herb with mild property combined with that with warm property,has better effect than two kinds of herbs with mild properties,and herb with mild property combined with that with cold property,and single herb does.The experimental results are consistent with the clinical treatment principles of TCM,"treating the cold disease should use the hot medicine".The mechanism of Qinjiao-Weilingxian compatibility having good effect on the disease may be related to its ability,which can reduce the serum TNF-α and IL-1β levels as well as synovial hyperplasia and cartilage destruction.
    【Key words】  Arthritis,rheumatoid;Models,animal;Tumor necrosis factor-alpha;Ankle joint;Wind-cold-damp arthralgia
 
Value of T-SPOT.TB for the Diagnosis of Tuberculosis in Elderly Patients  SUN Bei-bei,ZHAO Li-min*,MA Li-jun,KUANG Hong-yan,CAO Fan
Department of Respiratory and Critical Care Medicine,Henan Provincial People′s Hospital,Zhengzhou 450003,China
*Corresponding author:ZHAO Li-min,Chief physician;E-mail:zlm9898@126.com
    【Abstract】  Objective  To investigate the value of T-SPOT.TB for the diagnosis of tuberculosis in elderly patients.Methods  The participants recruited were 140 outpatients and inpatients with tuberculosis diagnosed in Henan Provincial People′s Hospital between February 2013 and February 2014.In accordance with the age,they were divided into the elderly group(≥60 years old,n=68),and the young and middle-aged group(<60 years old,n=72).Both groups underwent T-SPOT.TB and tuberculin skin test(TST),and the testing results of them were compared.Results  There was no significant difference in the positive rate of T-SPOT.TB between the elderly and the young and middle-aged patients(P>0.05).The positive rate of TST in the elderly group was lower than that in the young and middle-aged group(P<0.05).The positive rate of T-SPOT.TB was higher than that of TST in both groups(P<0.05).Conclusion  As a new diagnostic technique,T-SPOT.TB has a good application value in the clinical diagnosis of tuberculosis in elderly patients.
    【Key words】  Tuberculosis,pulmonary;Aged;Tuberculin test;T-SPOT.TB
 
Clinical and Dynamic Imaging Manifestations of Mitochondrial Encephalomyopathy  ZHENG Xiao-lu1*,CHEN Xiao-li1,CHEN Wei-an1,PAN Si-pei1,HU Zhang-yong2
1.Department of Neurology,the First Affiliated Hospital of Wenzhou Medical University,Wenzhou 325000,China
2.Department of Imaging,the First Affiliated Hospital of Wenzhou Medical University,Wenzhou 325000,China
*Corresponding author:ZHENG Xiao-lu,Resident physician;E-mail:124374020@qq.com
    【Abstract】  Background  There are certain challenges for imaging diagnosis of mitochondrial encephalomyopathy(ME).And the study of dynamic imaging data during the progression of the disease is still deficient.
Objective  To investigate the clinical and dynamic head CT and MRI manifestations in patients with ME,and MELAS(mitochondrial encephalomyopathy,lactic acidosis,and stroke-like episodes) syndrome in particular.Methods  The clinical and dynamic cranial imaging manifestations during the 19 episodes of 9 patients with ME diagnosed in the First Affiliated Hospital of Wenzhou Medical University from 2010 to 2015 were reviewed,of which the signal changes of diffusion-weighted imaging(DWI) and apparent diffusion coefficient(ADC) during the progression of disease were observed dynamically.Results  Most of the 9 cases were young males(6 cases),their clinical manifestations included seizures,stroke-like episodes,cognitive impairment,headaches or dizziness,decrease in hearing or vision,obvious muscular atrophy and so on.Nine patients were found with 23 lesions involving in the lobes of the brain.Head CT scanning found low-density lesions,and bilateral basal ganglia with high-density shadow.Head MRI scanning indicated that,the intracranial lesions had low signal intensity on T1 and opposite on T2;initially the lesions were swelling,the affected gyri had high signal intensity on DWI and low signal intensity on ADC;the adjacent subcortex was found with nebulously high signal intensity on ADC and that existed steadily for a long time;over time the signal intensity on DWI decreased slowly in gyri while that on ADC increased;in the progression of the disease,it was found that the range of partial lesions narrowed down,and there were irreversible findings including enlarged adjacent ventricle,or widened sulci and faveolate liquefaction in parenchyma when nervous tissue necrosis was involved.Head CT scanning detected that 4 cases had high-density shadow(iron deposition/calcification) in bilateral basal ganglia.Conclusion  The clinical manifestations of these ME patients are complicated and various,most of them are cortex-involved.Head CT scanning can provide some information of iron deposition or calcification in nucleus.As for head MRI scanning,DWI and ADC can dynamically reflect the changing process of ME to some extent.
    【Key words】  Mitochondrial encephalomyopathies;MELAS syndrome;Diffusion-weighted imaging;Apparent diffusion coefficient;Encephalatrophy;Iron deposition
 
Application Value of Ultrasonic Testing of Lower Uterine Segment Thickness during Late Pregnancy in Predicting Uterine Rupture in Scarred Uterus Surgery  DENG Hua-dong*,ZOU Kai-hua,XU Jing-hua,SHI Hong-wei
Department of Ultrasound,Lishui People′s Hospital,Lishui 323000,China
*Corresponding author:DENG Hua-dong,Attending physician;E-mail:402571598@qq.com
    【Abstract】  Objective  To evaluate the application value of ultrasonic testing of lower uterine segment(LUS) thickness during late pregnancy in predicting uterine rupture in scarred uterus surgery among women with a previous cesarean section(CS).Methods  A total of 150 women with previous cesarean section choosing to deliver in Lishui People′s Hospital from January 2015 to January 2016 were selected.The ultrasonic testing was used to test LUS thickness within 3 days before re-caesarean section.The relationship between the status of rupture(women were divided into uterine rupture group and non-uterine rupture group) and thickness of the LUS identified in the surgery was analyzed.The receiver operating characteristic(ROC) curve was used to evaluate the predicative value of uterine rupture during surgery according to LUS thickness.Results  There were 53 cases in uterine rupture group and 97 cases in non-uterine rupture group.LUS thickness was significantly different between uterine rupture group and non-uterine rupture group 〔(1.21±0.34)mm and(2.17±0.53)mm respectively,t=12.009,P<0.00〕.The cut-off value of predicting uterine rupture during surgery according to LUS thickness was 1.55 mm,its predictive sensitivity and specificity was 0.903 and 0.210 respectively,the area under the ROC curve was 0.913.Conclusion  The LUS thickness <1.55 mm indicates a high risk of uterine dehiscence.
    【Key words】  Scarred uterus;Cesarean section,repeat;Ultrasonography;Pregnancy;Lower uterine segmen;Uterine rupture
 
Effect of Epirubicin-based Chemotherapy on Cardiotoxicity of Breast Cancer Patients Combined with Diabetes  SUN Fang-yi1,WANG Hong-fang2*,SHI Jing3,LIU Ying-zi4
1.Department of Cardiology,Fourth Hospital of Hebei Medical University,Shijiazhuang 050011,China
2.College of Pharmacy,Hebei University of Traditional Chinese Medicine,Shijiazhuang 050011,China
3.Office of Scientific Research,Fourth Hospital of Hebei Medical University,Shijiazhuang 050011,China
4.Department of Neurosurgery,Fourth Hospital of Hebei Medical University,Shijiazhuang 050011,China
*Corresponding author:WANG Hong-fang,Lecturer;E-mail:ydsysfy2012@163.com
    【Abstract】  Objective  To analyze the effect of epirubicin-based chemotherapy on cardiotoxicity of breast cancer female patients combined with diabetes.Methods  A total of 108 female patients underwent radical resection of the tumor in the breast center of Fourth Hospital of Hebei Medical University from October 2013 to October 2015 were selected and were clearly diagnosed with breast cancer after the pathological examination.The epirubicin-based chemotherapy(epirubicin+cyclophosphamide) was conducted firstly,3 weeks a course and totally 6 courses.Among the subjects,55 patients combined with type 2 diabetes were assigned into diabetic chemotherapy group and 53 patients not combined with diabetes were assigned into non-diabetic chemotherapy group.At the same time,50 age-matched female diabetic patients without breast cancer in the outpatient of endocrinology department were selected as the diabetic control group.Measurement of routine indicators,Doppler ultrasound inditators,and oxidative stress indicators were conducted to patients with breast cancer before the application of chemotherapy regimens(baseline) and after chemotherapy,and to patients in diabetic control group at the time of enrollment and after 4.5 months.Results  Fifty patients were selected from diabetic chemotherapy group and non-diabetic chemotherapy group respectively.At baseline,total cholesterol,triglyceride and glycosylated hemoglobin in diabetic chemotherapy group and diabetic control group were higher than those in non-diabetic chemotherapy group(P<0.05).There were no significant differences in Δbody mass index,Δblood pressure,Δhemoglobin,Δtotal cholesterol,Δtriglyceride and Δglycosylated hemoglobin among patients in the three groups after chemotherapy(P>0.05).At baseline,E/Ea in diabetic chemotherapy group and diabetic control group was higher than that in non-diabetic chemotherapy group(P<0.05).At the end of chemotherapy,ΔEa in diabetic chemotherapy group was significantly lower than that in diabetic control group and non-diabetic chemotherapy group,and its ΔE/Ea was significantly higher than that in diabetic control group and non-diabetic chemotherapy group(P<0.05).At baseline,SOD in diabetic chemotherapy group and diabetic control group was lower than that in non-diabetic chemotherapy group,MDA was higher than that in non-diabetic chemotherapy group(P<0.05).After chemotherapy,there were significant differences in ΔSOD and ΔMDA in pairwise comparison between groups(P<0.05).Conclusion  The epirubicin-based chemotherapy leads to a significant aggravation in diastolic dysfunction among female breast cancer patients combined with diabetes,and indicates that combination of diabetes aggravates themyocardial damage of the epirubicin-based chemotherapy.
    【Key words】  Breast neoplasms;Diabetes mellitus;Epirubicin;Cardiotoxins;Chemoradiotherapy,adjuvant
 
Setup Errors and Registration Algorithm of Intensity Modulated Radiation Therapy after Breast Conserving Surgery of Breast Cancer Based on Cone-beam CT  WU Zhi-qin,YU Jian-yi,YAN Hua-wei,YANG Gui-qiang,LIN Li,HUANG Bao-ji,WANG Zhi-wei,PAN Han-hui,JIN Xian-ce*
Department of Radiotherapy and Chemotherapy,the First Affiliated Hospital of Wenzhou Medical University,Wenzhou 325000,China
*Corresponding author:JIN Xian-ce,Senior engineer;E-mail:physics@wzhospital.cn
    【Abstract】  Objective  To investigate the setup errors and registration algorithm under different breast thickness of intensity modulated radiation therapy(IMRT) after breast-conserving surgery of breast cancer based on cone-beam CT(CBCT). 
Methods  Eighty five patients who received IMRT after breast conserving surgery in Department of Radiotherapy of the First Affiliated Hospital of Wenzhou Medical University from March to October 2016 were selected.Based on the onboard CBCT of Elekta Synergy accelerator,setup verification was made before IMRT treatment.Match the CBCT reconstructed image with the scheduled CT image.The setup error in the six-dimensional direction was calculated,and the above error on-line was automatically calibrated.The thickness of the breast of each patient(the largest diameter of the breast tissue,that is,the most salient point of the breast tissue to the nearest margin of the chest wall) was measured,and based on the bone-based registration and grey-based registration,the setup error of horizontal movement in X(left and right),Y(upper and lower),Z(front and rear) axes and the sagittal position(GX),coronal position(GY) and transverse position(GZ) were comparatively analyzed.Results  There was significant difference in the setup error between the X axis and the GY of the 85 patients based on the bone-based registration and grey-based registration(P<0.05).In the automatic bone-based registration,there was no significant difference in the setup error among A group(thickness of breast ≤30 mm),B group(30< thickness of breast ≤45 mm) and C group(thickness of breast >45 mm)(P>0.05).In the automatic grey-based registration,there was no significant difference in the setup error of each direction among the three groups(P>0.05).Conclusion  There are no significant differences in setup errors under different breast thickness of IMRT after breast-conserving surgery of breast cancer.The grey-based registration is recommended first in the two registration methods.The error calibration before radiotherapy can significantly improve the accuracy of breast cancer treatment,and thus realize the precise radiotherapy.
    【Key words】  Breast neoplasms;Radiotherapy,intensity-modulated;Cone-beam CT;Registration;Setup errors
 
Recent Developments in the Mechanism of Ginkgo Biloba Extract in the Treatment of Chronic Obstructive Pulmonary Disease  ZHANG Peng-fei1,LIAO Li-jun1,TAN Yu-ping2*
1.Guangxi University of Chinese Medicine,Nanning 530001,China
2.Department of Respiratory Medicine,Ruikang Hospital Affiliated to Guangxi University of Chinese Medicine,Nanning 530011,China
*Corresponding author:TAN Yu-ping,Chief physician;E-mail:tanlaoshi1226@126.com
    【Abstract】  Chronic obstructive pulmonary disease(COPD) is a kind of chronic inflammation involving the airway,lung parenchyma and vessels,which is characterized by progressive development of incompletely reversible airflow limitation.With the development of medical technology,interventions for COPD have made great progress,but the incidence and mortality of COPD remain high.Therefore,finding the new treatment regimen on the basis of western medicine therapy becomes a focus of current research.As treating COPD with Ginkgo biloba extract(GBE) has obtained some achievements in recent years,we reviewed the mechanism of GBE in treating the disease,with a view to providing a theoretical reference for clinical treatment.
    【Key words】  Pulmonary disease,chronic obstructive;Molecular mechanisms of pharmacological action;Review;Ginkgo biloba extract
 
Research Progress of the Correlation between Anemia and Osteoporosis  HUA

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