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July 2017, Volume 20, No.21 Abstracts

 Eyes on Diabetes Complications,Focus on Blood Glucose Decrease and Weight Loss--Interpretation of 2017 Consensus Statement by the AACE/ACE on the Comprehensive Type 2 Diabetes Management Algorithm
WU Hang1,2,SUN Zi-lin1,2*
1.Department of Endocrine,Zhongda Hospital Southeast University,Nanjing 210009,China
2.Institute of Diabetes,Southeast University,Nanjing 210009,China 
*Corresponding author:SUN Zi-lin,Professor;E-mail:sunzilin1963@126.com
    【Abstract】  Diabetes mellitus is one of the most important chronic non-communicable diseases that threaten human health around the world,and its treatment has always been the focus of research.In 2017,the American Association of Clinical Endocrinologists(AACE)/American Society of Endocrinology(ACE) launched the 2017 version of AACE/ACE consensus statement on the comprehensive type 2 diabetes management algorithm(hereinafter referred to as the 2017 AACE/ACE consensus statement) according to the latest research on diabetes treatment program and the 2016 edition of Food and Drug Administration(FDA) drug update.This paper summarizes the update of the 2017 AACE/ACE consensus statement compared to the 2016 edition,which emphasizes the importance of diabetes complications management,and the necessity of weight loss while reducing blood sugar.In addition,it also provides a brief overview of the differences between AACE/ACE consensus statement and the American Diabetes Association(ADA) guidelines in order to provide a basis for exploring more rational diabetes management programs.
    【Key words】  Diabetes complications;Blood glucose;Weight reduction programs;Consensus
 
Role of General Practitioners in the Three-level Management of Chronic Constipation
ZHANG Han-zhi1,YU De-hua2*,LU Yuan1,PAN Ying1,FAN Hui-qin1
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:YU De-hua,Professor,Chief physician;E-mail:ydh1404@sina.com
    【Abstract】  Chronic constipation(CC) endangers people′s health.Based on CC′s clinical characteristics,status and requirements of diagnosis and treatment,the role of general practitioners(GPs) in the three-level management of CC is intensively analyzed as the following:continuously managing CC in different populations comprehensively;promotively managing CC by delivering intervention services,improving the patient compliance and coordinating in interprofessional collaborative practice;working as the interveners in different levels of CC management;providing a series of services for preventing CC and early management of CC,as well as supplementing and perfecting the aetiology-based intervention;making efforts to early screening and intervening colorectal cancers in primary management;early evaluating the mental status of CC patients and timely offering associated interventions in secondary management;treating CC patients by integrated traditional Chinese and western medicine in tertiary management.The analysis shows that GPs are of great value in optimizing and implementing the three-level management standards of CC.
    【Key words】  Constipation;General practitioners;Three-level management
 
Level of Awareness of the Hierarchical Diagnosis and Treatment for Chronic Constipation and Associated Factors in Chronic Constipation Patients
LIU Zhi-tao1,2,YU De-hua1,2*
1.Department of General Practice,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@sina.com
    【Abstract】  Objective  To study the level of awareness of hierarchical diagnosis and treatment for chronic constipation and associated factors in chronic constipation patients in Yangpu District,Shanghai.Methods  From October 2016 to February 2017,we conducted a survey in 240 selected chronic constipation patients from Yangpu District,Shanghai who had received treatment from the sampled two community health service centers and one tertiary grade B hospital in Yangpu District,Shanghai by sampling survey with a self-developed questionnaire with a Cronbach′s α of 0.768.Results  The survey achieved an effective response rate of 91.25%(219/240).Of the 219 final participants,hierarchical diagnosis and treatment for chronic constipation was completely unknown to 48.9% of them,very familiar to 16.9% of them,moderately familiar to 34.2% of them.Multivariate Logistic regression analysis found that,age(20 to 60 yeas old),educational attainment,frequency of visits to the community health service center within one year before the survey were significantly associated with the level of awareness of the hierarchical diagnosis and treatment for chronic constipation(P<0.05).Conclusion  The level of awareness of hierarchical diagnosis and treatment for chronic constipation in chronic constipation patients in Yangpu District,Shanghai is not satisfactory,and it is affected by age and educational attainment.Therefore,it is suggested that the social and medical institutions should strengthen the propaganda of hierarchical diagnosis and treatment for chronic constipation to improve it,which in turn can promote the rate of community-based first contact care for the disease,and by which the implementation of hierarchical diagnosis and treatment system for chronic constipation can be promoted.
    【Key words】  Constipation;Management of diagnosis and treatment,medical;Hierarchical diagnosis and treatment
 
Effect of Comprehensive Community Intervention on Chronic Constipation:a Meta-analysis
JIN Hua1,QIAN Jie2,YU De-hua1*
1.Department of General Practice,Yangpu Hospital,Tongji University,Shanghai 200090,China
2.Department of Clinical Psychology,Yangpu Hospital,Tongji University,Shanghai 200090,China
3.Department of General Practice,Tongji University School of Medicine,Shanghai 200090,China
*Corresponding author:YU De-hua,Professor,Chief physician;E-mail:ydh1404@sina.com
    【Abstract】  Objective  To explore the effect of comprehensive community intervention on chronic constipation by Meta-analysis.Methods  The main domestic medical databases were searched,including China biomedical literature database(CBM)(from 1978 to 2017),VIP(from 1989 to 2017),CNKI(from 1979 to 2017),Wanfang data knowledge service platform(from 1990 to 2017) and PubMed/Medline(from 1966 to 2017).Randomized controlled trials using general comprehensive intervention as intervention method were screened.Literature related information was extracted and the quality of the included literature was evaluated.Results  Finally 6 articles were included,including 587 cases in the intervention group and 575 cases in the control group.The Meta-analysis result showed that the effective rate of treatment in the intervention group was higher than that in the control group 〔RR=1.50,95%CI(1.18,1.92),P<0.001〕.After 3 months′ treatment,the number of defecation in the intervention group was higher than that in the control group,and the score of defecation traits was lower than that of the control group,and the score of defecation difficulty was lower than that of the control group〔WMD=0.30,95%CI(0.21,0.39),P<0.001;WMD=-1.51,95%CI(-2.09,-0.92),P<0.001;WMD=-0.57,95%CI(-0.67,-0.48),P<0.001〕.After 6 months′ treatment,the number of defecation in the intervention group was higher than that in the control group,and the score of defecation traits was lower than that of the control group,and the score of defecation difficulty was lower than that of the control group 〔WMD=1.65,95%CI(1.55,1.75),P<0.001;WMD=-0.69,95%CI(-0.96,-0.41),P<0.001;WMD=-0.92,95%CI(-1.31,-0.52),P<0.001〕.Conclusion  Comprehensive community intervention has a better curative effect on chronic constipation than single purgative therapy.
    【Key words】  Constipation;Community intervention;Therapy;Meta-analysis
 
The Changes of Plasma Endothelin-1 and Homocysteine in Patients of Hypertensive Cerebral Hemorrhage Combined Obstructive Sleep Apnea Hypopnea and Its Effects on Cognitive Dysfunction
DONG Bin,XUE Cheng-jing,ZHAO Ya-ning,LI Jian-min*
North China University of Science and Technology Affiliated Hospital,Tangshan 063000,China
*Corresponding author:LI Jian-min,Director,Chief physician;E-mail:nitu0709@126.com
    【Abstract】  Objective  To investigate the changes of plasma endothelin-1 and homocysteine in patients of hypertensive cerebral hemorrhage combined obstructive sleep apnea hypopnea syndrome(OSAHS) and its effects on cognitive dysfunction.Methods  From December 2012 to May 2017,77 patients with OSAHS combined hypertensive cerebral hemorrhage of North China University of Science and Technology Affiliated Hospital were chosen as case group and 83 hypertensive cerebral hemorrhage patients without OSAHS during the same period were collected as control group.Case group were divided into moderate or severe OSAHS complicated with hypertensive intracerebral hemorrhage(n=49) and  mild ones(n=28).All patients underwent polysomnography and recorded AHI and LSaO2.
The cognitive dysfunction was evaluated with MMSE,LOTCA;the levels of plasma endothelin-1 and homocysteine were determined by radiation immunization and cyclic enzymatic method.Results  Compared with the control group,the levels of plasma endothelin-1 and homocysteine were higher in case group(P<0.05);the plasma levels of endothelin1 and Hcy in patients with moderate or severe OSAHS complicated with hypertensive intracerebral hemorrhage were higher than that mild ones(P<0.05);plasma endothelin-1 and homocysteine levels were respectively negatively correlated with AHI,while respectively negative correlated with LSaO2 in case group(P<0.01).Compared with the control group,the total scores of MMSE and LOTCA and each dimension score except directional dimesion score were lower in case group(P<0.05);MMSE and LOTCA total scores and each dimension score of LOTCA of patients with moderate or severe OSAHS complicated with hypertensive intracerebral hemorrhage were lower than mild ones(P<0.05);plasma endothelin-1 and homocysteine levels were respectively negatively correlated with MMSE and LOTCA total scores and each dimension score of LOTCA in case group(P<0.05).Conclusion  Plasma endothelin-1 and homocysteine level in patients with OSAHS complicated with hypertensive cerebral hemorrhage increase,which is related to the cognitive dysfunction of patients;the changes of plasma endothelin-1 and homocysteine can evaluate cognitive dysfunction for OSAHS combined hypertensive cerebral hemorrhage patients.
    【Key words】  Sleep apnea,obstructive;Intracranial hemorrhage,hypertensive;Endothelin1;Homocysteine;Cognition disorders
 
Correlation of CYP2C19 Genetic Polymorphism with Clopidogrel Resistance and Prognosis in Patients with Acute Coronary Syndrome
SHI Lin1,2,CHANG Yi3,WANG Bin1,4*
1.Department of Cardiology,Aerospace Central Hospital,Beijing 100049,China
2.Department of Cardiology,Peking University People′s Hospital,Beijing 100044,China
3.School of Integrative Medicine,Hebei University of Chinese Medicine,Shijiazhuang 050200,China
4.Department of Cardiology,the First Affiliated Hospital of Shantou University Medical College,Shantou 515041,China
*Corresponding author:WANG Bin,Chief physician;E-mail:wangbin_pku@126.com
    【Abstract】  Background  There are general individual differences in the clinical efficacy of clopidogrel,which is related to race and affected by genotype.Objective  To investigate the correlation of CYP2C19 genetic polymorphism with clopidogrel resistance and prognosis in patients with acute coronary syndrome(ACS) in order to provide a basis for individualized antiplatelet therapy guided by genotyping.Methods  From March to December 2012,98 consecutive patients with ACS who were hospitalized at the Department of Cardiology of Aerospace Central Hospital were enrolled.After admission,patients were given clopidogrel at a first dose of 300 mg and then 75 mg/d orally,or administered directly at a regular dose of 75 mg/d.The platelet aggregation rate,platelet inhibition rate and clopidogrel resistance in all ACS patients were evaluated at the time of admission and after a clopidogrel therapy of 3 days.Meanwhile,CYP2C19 gene polymorphisms were determined by Taqman-PCR.Based on CYP2C19 gene test results,according to whether or not the mutant gene A was carried,patients were divided into wild-type group(without mutant gene A in both G681A in fifth exon and G636A in fourth exon,n=34) and mutant group(with mutant gene A in either G681A in fifth exon or G636A in fourth exon,n=64).Follow-up was applied,and major adverse cardiovascular events(MACEs) were recorded.Results  The genotypes of CYP2C19*2 and CYP2C19*3 were in accordance with Hardy-Weinberg′s law of equilibrium(P>0.05),which suggested that the sample included in the study had a good population representativeness.There was no significant difference in baseline platelet aggregation rate between the patients with different CYP2C19*2 genotypes(P>0.05).In genotype CYP2C19*2 patients,clopidogrel resistance rate was significantly higher in GA patients than in GG patients after 3 days′ clopidogrel therapy(P<0.05),and clopidogrel resistance rate was significantly higher in AA patients than in GG and GA patients after 3 days′ clopidogrel therapy(P<0.05).In genotype CYP2C19*2 patients,GA and AA patients had lower platelet inhibition rate than GG patients(P<0.05).In CYP2C19*2 patients,the platelet aggregation rate in GG and GA genotype patients after clopidogrel therapy of 3 days was less than that at admission(P<0.05).There was no significant difference in platelet aggregation rate at admission,platelet aggregation rate after 3 days of treatment and platelet inhibition rate in different CYP2C19*3 genotype patients(P>0.05).In CYP2C19*3 genotype patients,the platelet aggregation rate in GG and GA genotype patients after clopidogrel therapy of 3 days was less than that at admission(P<0.05).Compared with mutant group,wild-type group had lower clopidogrel resistance(P<0.05);compared with mutant group,wild-type group had lower lower MACEs(P<0.05).In genotype CYP2C19*2 patients,GG patients had lower incidence of MACEs than AA patients(P<0.05),and GA patients had lower incidence of MACEs than AA patients(P<0.05).There was no significant difference in the incidence of MACEs in genotype CYP2C19*3 patients(P>0.05).Conclusion  CYP2C19 gene polymorphism was associated with antiplatelet effects of clopidogrel in patients with ACS.Patients with CYP2C19 fifth exon mutation had reduced antiplatelet effects and poor prognosis after receiving conventional dose of clopidogrel,but the fourth exon mutation had relatively little effect on the prognosis of the patients.
    【Key words】  Acute coronary syndrome;Cytochrome P-450 enzyme system;Polymorphism,single nucleotide;Platelet aggregation inhibitors;Platelet aggregation;Prognosis;CYP2C19;Clopidogrel
 
Effect and Mechanism of Celastrol on the Renal Clear Cell Carcinoma 786-0 Cells
  ZHANG Xiao-lu1*,DU Mei-hong2,ZHANG Quan1,CHEN Hong-yue2,ZHAO Lin1,GUO Wei-sheng2
1.Department of General Surgery,Henan Province Hospital of TCM,Zhengzhou 450002,China
2.Department of Radiology,Henan Province Hospital of TCM,Zhengzhou 450002,China
*Corresponding author:ZHANG Xiao-lu,Attending physician;E-mail:xiaoisxiao@126.com
    【Abstract】  Background  The incidence rate of renal clear cell carcinoma was high and the cure rate was low.Celastrol could regulate cytokines in tumor cells,then inhibit the proliferation of tumor cells.However,there were few studies on the effect of celastrol on the renal clear cell carcinoma 786-0 cells.Objective  To explore the effect and mechanism of celastrol on the renal clear cell carcinoma 786-0 cells,in order to provide a reference for investigating drugs for the treatment of renal clear cell carcinoma.Methods  From February 2015 to May 2016,renal clear cell carcinoma 786-0 cells and normal renal tubular epithelial cells HK2 cells(renal cells HK2 cells) were cultured.The survival rate of renal clear cell carcinoma 786-0 cells,renal cells HK2 cells were detected after treating with celastrol at different concentrations(0,0.5,1.0,1.5,2.0 μmol/L) for different time(12,24,48 h);cytotoxicity of renal clear cell carcinoma 786-0 cells,renal cells HK2 cells were detected after treating with celastrol at different concentrations(0,0.5,1.0,1.5,2.0 μmol/L),1.5 μmol/L 5-Fu;cell cycle,apoptosis rate of renal clear cell carcinoma 786-0 cells,renal cells HK2 cells were detected after treating with celastrol at different concentrations(0,1.5,2.0 μmol/L),1.5 μmol/L 5-Fu;mitochondrial membrane potential of renal clear cell carcinoma 786-0 cells,renal cells HK2 cells were measured after treating with celastrol at different concentrations(0,0.5,1.0,1.5 μmol/L);cysteine-containing aspartic proteolytic enzymes(caspase)-3,caspase-9 activity,the levels of Bax,B lymphocyte tumor-2(Bcl-2),cytochrome c and polyribosylribitol phosphate(PRRP) in the renal clear cell carcinoma 786-0 cells were detected after treating with celastrol at different concentrations(0,0.5,1.0,1.5,2.0 μmol/L).Results  The survival rate of the renal cell carcinoma 786-0 cells decreased with the increase of concentration when treated with 0,0.5,1.0,1.5,2.0 μmol/L celastrol for 12,24,48 h(P<0.05).The survival rate of the renal cell carcinoma 786-0 cells treated with 1.0 μmol/L celastrol for 24,48 h were less than that for 12 h(P<0.05);the survival rate of the renal cell carcinoma 786-0 cells treated with 1.5,2.0 mumol/L celastrol for 12,24,48 h decreased with the increase of time(P<0.05).Cytotoxicity of renal clear cell carcinoma 786-0 cells,renal cells HK2 cells treated with 0.5 μmol/L,1.0 μmol/L,1.5 μmol/L,2.0 μmol/L celastrol and 1.5 μmol/L 5-Fu were larger than 0 μmol/L celastrol(P<0.05);cytotoxicity of renal clear cell carcinoma 786-0 cells treated with 2.0 μmol/L celastrol was larger than 0.5,1.0,1.5 μmol/L celastrol(P<0.05);cytotoxicity of renal cells HK2 cells treated with 2.0 μmol/L celastrol was larger than 1.0 μmol/L celastrol(P<0.05);cytotoxicity of renal cell carcinoma 786-0 cells and renal cells HK2 cells treated with 1.5 mmol/L 5-Fu was larger than 0.5,1.0,1.5,2.0 μmol/L celastrol(P<0.05).After treated with 0,1.5 mmol/L celastrol,the renal cell carcinoma 786-0 cells and renal cells HK2 cells at the G2/M phase were less than S,G0/G1 phase(P<0.05);after treated with 2.0 umol/L celastrol,1.5 umol/L 5-Fu,renal clear cell carcinoma 786-0 cells,renal cells HK2 cells at G0/G1 phase were more than S phase,while renal clear cell carcinoma 786-0 cells and renal cells HK2 cells at G2/M phase were less than S,G0/G1 phase(P<0.05).Cell apoptosis rate of renal clear cell carcinoma 786-0 cells treated with 1.5 μmol/L,2.0 μmol/L celastrol and 1.5 μmol/L 5-Fu were larger than 0 μmol/L celastrol(P<0.05);cell apoptosis rate of renal clear cell carcinoma 786-0 cells treated with 2.0 μmol/L celastrol and 1.5 μmol/L 5-Fu were larger than 1.5 μmol/L celastrol(P<0.05);cell apoptosis rate of renal cells HK2 cells treated with 1.5 μmol/L 5-Fu were larger than 0 μmol/L,2.0 μmol/L celastrol(P<0.05).Mitochondrial potential of renal clear cell carcinoma 786-0 cells treated with 0,0.5,1.0,1.5 μmol/L celastrol increased in turn(P<0.05).caspase-3,caspase-9 activity of renal clear cell carcinoma 786-0 cells treated with 0,0.5,1.0,1.5 μmol/L celastrol increased in turn(P<0.05).The levels of Bax,cytochrome c,PRRP of renal clear cell carcinoma 786-0 cells treated with 0,0.5,1.0,1.5 μmol/L celastrol increased in turn,while the level of Bcl-2 decreased in turn(P<0.05).Conclusion  Celastrol may inhibit the proliferation of renal clear cell carcinoma 786-0 cells and induce their apoptosis by activating caspase-3,caspase-9 activity,upregulating Bax,cytochrome c,PRRP levels and down-regulating Bcl-2 level.
    【Key words】  Kidney neoplasms;Adenocarcinoma,clear cell;Celastrol;Cell proliferation;Apoptosis
 
Analysis of Association between Initial Symptoms and Time Needed for Diagnosis in Extranodal NK/T-cell Lymphoma,Nasal Type and Effect Factors of Time Needed for Diagnosis
WANG Yu-qing,DENG Yao-tiao,ZHANG Jie,ZHANG Li,JIANG Ming,JIANG Yu,ZOU Li-qun*
Department of Heach and Neck Oncology,Cancer Center,West China Hospital,Sichuan University,Chengdu 610041,China
*Corresponding author:ZOU Li-qun,Attending physician,Professor; E-mail:hxlcyxy@163.com
    【Abstract】  Background  The prognosis of patients with early and advanced extranodal nasal NK/T-cell lymphoma(ENKTCL) is significantly different.However,ENKTCL is usually misdiagnosed as other diseases in clinical practice.Some previous studies suggested that misdiagnosis of ENKTCL might be related to the nonspecific nature of its initial symptoms.Objective  To analyze the relationship between initial symptoms of ENKTCL and time of diagnosis,and explore the factors influencing time of ENKTCL diagnosis in order to provide reference for the early diagnosis of ENKTCL.Methods  We retrospectively collected the clinical data of patients who diagnosed with ENKTCL and met the inclusion criteria between 2009 and 2012 in West China Hospital,Sichuan University.The relationship between initial symptoms of the patients and time of diagnosis and the influencing factors of diagnosis time were analyzed.Results  One hundred and seventy-seven ENKTCL patients were enrolled finally.The median age was 42(22) years.Males were in the majority(accounting for 71.2%).The common initial symptom was nasal congestion(54.8%),followed by nasal rhinorrhea(21.5%),fever(18.1%) and oropharyngeal pain(14.1%).Relatively rare initial symptoms were tinnitus(1.1%),decreased vision(1.1%),hyposmia(1.1%),etc.No one presented weight loss.The diagnosis time of ENKTCL patients was 4(10) months.When the initial symptom was nasal congestion,it was positively correlated with time of diagnosis(rs=0.228,P=0.004).When the initial symptom was oropharyngeal pain or fever,it was negatively correlated with time of diagnosis(rs=-0.203 and -0.258,respectively;P=0.007 and 0.001,respectively).When the initial symptom was epistaxis,rhinalgia,rhinorrhoea,oropharyngeal ulcer,cough,dizziness/headache,night sweats,nodules or masses,it was no linear correlation with time of diagnosis(P>0.05).The results of generalized multivariate linear model showed that it had linear regression relation with the time of diagnosis when the initial symptom was nasal congestion 〔β=0.355,95%CI(0.022,0.687),χ2=4.372,P=0.037〕.Conclusion  Nasal congestion is the most common initial symptom of ENKTCL patients,and the patients with nasal congestion require a longer time of diagnosis.For patients with long-term nasal congestion,the doctor should seriously consider the risk of ENKTCL,and repeated pathological biopsies should be performed in time if necessary.
    【Key words】  Lymphoma,extranodal NK-T-cell;Initial symptom;Early diagnosis;Root cause analysis
 
Expression of the Toll-like Receptor-4 in Distal Pulmonary Artery Smooth Muscle Cells of Lipopolysaccharide-induced Chronic Obstructive Pulmonary Disease Model Rats
WANG Peng-yan1,JIANG Ming1,WANG Chang-ming1*,HAN Xu-hui1,LI Lu2
1.Department of Respiration,Affiliated Hospital of Guilin Medical University,Guilin 541001,China
2.Department of Pathology,Affiliated Hospital of Guilin Medical University,Guilin 541001,China
*Corresponding author:WANG Chang-ming,Chief physician;E-mail:wistarrat@163.com
Note:WANG Chang-ming is now working at Guilin People′s Hospital
    【Abstract】  Background  Chronic obstructive pulmonary disease(COPD) is a lung disease that includes two main types,chronic bronchitis and emphysema,characterized by chronic incompletely reversible airflow.It is one of the leading causes of pulmonary hypertension.However,its occurrence and development mechanism is not yet fully clear.Objective  To explore the TLR-4 expression in distal pulmonary artery smooth muscle cells(PASMCs) of COPD model rats induced by lipopolysaccharide(LPS),so as to provide a theoretical basis for studying the role of TLR-4 signaling pathway in inflammation and immune response to COPD.Methods  This study was conducted from December 2015 to March 2016.Twenty-four SPF grade Wistar rats(half males and half females) aging between 6 and 8 weeks were randomly divided into normal group and model group,12 rats in each after feeding adaptively for 1 week.Rats in model group and normal group were respectively administered with 200 μl LPS(1 μg/ml),and 200 μl sodium chloride(0.9%) solutions,via the trachea on the 1st and the 14th day after intervention,and treated by passive inhaling of cigarette smoke in plexiglass cabin for 1 h once daily for 8 weeks.After the intervention,2 rats respectively randomly selected from both groups were sacrificed and the lung tissues were took out for observing the pathological changes via HE staining,and TLR4 expression in PASMCs determined with immunohistochemical(IHC) staining.Six model rats ranomly selected from remaining rats  were sacrificed and the distal PASMCs were isolated and cultured.Cultured cells at passages 3-6(logarithmic phase) were used for experiments.The morphology of PASMCs was observed under the optical microscope(the images were magnified 100 times) and α-SM-actin expression in PASMCs stained by immunohistochemistry was observed under the immunofluorescence microscope(the images were magnified 200 times),then they were randomly divided into control group(no intervention),LPS 12 h group(treatment with 10 μl LPS of 1 μg/ml for 12 h),LPS 24 h group(treatment with 10 μl LPS of 1 μg/ml for 24 h),LPS 48 h group(treatment with 10 μl LPS of 1 μg/ml for 48 h) and LPS 72 h group(treatment with 10 μl LPS of 1 μg/ml for 72 h).The TLR-4 protein expression in PASMCs in these 5 groups were measured with Western blotting.Results  The pathological changes in lung tissues found in the model group were rupture of alveolar walls,alveolar fusion,formation of bullae,dramatically thickened PASMCs layer in artery,a large number of inflammatory cell infiltration,all these were consistent with COPD typical features.TLR-4 expression in pulmonary artery smooth muscle layer:under the inverted phase contrast microscope,in model group,the TLR-4 expression in pulmonary artery smooth muscle layer was seen to be positive,the pulmonary artery smooth muscle layer was yellow,and it was much deeper than that in the normal group.PASMCs morphology and their α-SM-actin expression:under optical microscope,PASMCs were spindle shaped and presented irregular growth.With the extension of culture time,the number of layers were increased,leading to the formation of "peak valley";under immunofluorescence microscopy,it could be seen that α-SM-actin expression in PASMCs was positive,the cytoplasm had a radial distribution of filaments to the cell poles,parallel to the long axis of the cell,the morphology was clear.TLR-4 expression in PASMCs of LPS 12 h group,LPS 24 h group,LPS 48 h group and LPS 72 h group was higher than that of control group(P<0.05);TLR4 expression in PASMCs of LPS 24 h group,LPS 48 h group and LPS 72 h group was higher than that of LPS 12 h group(P<0.05);TLR4 expression in PASMCs of LPS 48 h group and LPS 72 h group was higher than that of LPS 24 h group(P<0.05).Conclusion  TLR-4 expression level increases in distal PASMCs of COPD model rats induced by LPS;it is speculated that LPS could induce the synthesis and secretion of PASMCs through the TLR4 signaling pathway,which aggravated the inflammatory response and pulmonary vascular remodeling.
    【Key words】  Pulmonary disease,chronic obstructive;Lipopolysaccharides;Myocytes,smooth muscle;Pulmonary artery;Toll-like receptor 4
 
Clinical Pathway Management Applied to the Vaginal Delivery for Puerperants with Group B Streptococcal Infection and Term Premature Rupture of Membranes
ZHANG Chen,CHEN Shu-fang,QIU Jun,ZHOU Qian* 
Department of Medical Matters,International Peace Maternity & Child Health Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai 200030,China
*Corresponding author:ZHOU Qian,Attending physician;E-mail:13916681426@163.com
    【Abstract】  Objective  To evaluate the effect of clinical pathway management applied to the vaginal delivery for puerperants with group B streptococcal(GBS) infection and term premature rupture of membranes(TPROM).Methods  The enrolled participants were 311 hospitalized puerperants who were diagnosed with GBS and TPROM in International Peace Maternity & Child Health Hospital,Shanghai Jiao Tong University School of Medicine from June 2011 to December 2015.Among them,those who were admitted between June 2011 and June 2014(clinical pathway management was implemented initiatively in the hospital in this period) and did not choose clinical pathway management after having been informed were assigned to the control group,and those who were admitted between July 2014 and December 2015(clinical pathway management was formally implemented in the hospital in this period) and chosen clinical pathway management after having been informed were assigned to the clinical pathway group.Comparison age, parity,period between premature rupture of membranes and start of delivery, times of manual examination of the vaginal, analgesia delivery, the use of antibiotics, abortion, hospitalization expenses and length of stay, maternal and neonatal adverse outcomes incidence between the two groups.Results  There were no significant differences between the two groups in terms of age,parity,period between premature rupture of membranes and start of delivery,times of manual examination of the vagina,rate of using analgesics for delivery,proportion of using antibiotics between the period of after 38 weeks of gestation and start of delivery,and induction rate(P>0.05).The median value of hospitalization expenses in the control group was much higher than that in the clinical pathway group(¥4 964.7 vs. ¥4 336.7,u=-3.100,P=0.002),two groups had no differences in length of stay(u=-0.960,P=0.336).The control group had significantly higher maternal infection rate than the clinical pathway group(7.7% vs.2.4%,χ2=4.104,P=0.043).However,when it comes to the rate of neonatal infection,ratio of neonatal hyperbilirubinemia,and proportion of neonates with Apgar scores less than 7,no such differences were detected(χ2=0.143,0.041,0.164,P=0.708,0.840,0.694).Conclusion  Clinical pathway management has active effect on the puerperants with GBS infection combined with TPROM in respect to decreasing the hospitalization expenses and reducing the maternal infection rate.
    【Key words】  Fetal membranes,premature rupture;Critical pathways;Group B streptococcus
 
Dynamic Study on the Time of Stone Formation in Rat Nephrolithiasis Model Induced by Nanobacteria
CHU Hao,WANG Qin-zhang,WU Shuang,QIAN Cheng,WANG Yi-he,QIAN Biao*
Department of Urology Surgery,the First Affiliated Hospital of Medical School of Shihezi University,Shihezi 832000,China
*Corresponding author:QIAN Biao,Associate professor,Associate chief physician;E-mail:qb2003_2000@163.com
    【Abstract】  Objective  To dynamically observe the stone formation in rat nephrolithiasis model induced by nanobacteria by using micro computed tomography(Mirco-CT) examination and histopathological examination.Methods  From November 2015 to June 2016,60 SPF class Wistar rats were adaptively fed for one week.Then the rats were randomly divided into two groups:control group and induced stone group,30 rats in each group.The rats in the control group were injected with 1.2 ml of 0.9% sodium chloride solution via the tail vein at one time,the rats in the induced stone group were injected with 1.2 ml of nanobacterial suspension at one time.Three rats in each group were sacrificed every week from the 1st to 10th week after injection,bilateral renal tissues were collected to be tested.The kidneys of the two groups of rats were examined by Mirco-CT,the detected high density shadow in the kidneys of the two groups of rats at the 1st to 10th week was statistically analyzed.The crystal formation in the renal tissues of the two groups of rats was observed under light microscope,and the positive condition in the renal of the two groups of rats at the 1st to 10th week was statistically analyzed.Results  Mirco-CT scan results showed that there was no high density shadow in the kidneys of rats in the control group from the 1st to 10th week,while there were white high density granules in the kidneys of the rats in induced stone group from the 7th to 10th week.From the 1st to 10th week,high density shadow was detected in the renal tissues of 4 rats(13.3%) in induced stone group,while not in the control group.At the end of the 10th week,there was no significant difference in the detection rate of high density shadow in renal tissues between the two groups(P=0.056).Histopathological findings showed that there were no crystal deposits in the kidneys of the rats in the control group from the 1st to 10th week.At the 4th week and the 6th to 10th week,greyish white crystals were detected in the renal tissues of the rats in the induced stone group.From the 1st to 10th week,crystals were detected in the renal tissues of 11 rats(36.7%) in induced group,but not in the control group.At the end of the 10th week,the crystal detection rate by paraffin section in the renal tissues of rats in induced stone group was higher than that in the control group,the difference was statistically significant(P<0.001).Conclusion  Nanobacteria begin to induce the formation of crystals in the kidneys of the rats at the 4th week.The pathological process persists at the 6th to 10th week.Finally,the Mirco-CT examination shows the formation of high density stone like substance at the 7th to 10th week.Nanobacteria may induce the formation of crystals by early renal injury and further produce stones.
    【Key words】  Kidney calculi;Nanobacteria;Models,animal;Tomography,spiral computed
 
Association of Protein C Gene Polymorphisms and Plasma Protein C Levels with the Susceptibility to Chronic Mountain Sickness
LUO Wei*,CUI Sen,JI Lin-hua,WANG Hong-xin,LI Yu-li,MA Xiao-jing,MA Jie
Department of Hematology,Qinghai University Affiliated Hospital,Xining 810001,China 
*Corresponding author:LUO Wei,Associate professor,Associate chief physician,Master supervisor;E-mail:luoweili992@126.com
    【Abstract】  Objective  To explore the association of protein C(PC) gene polymorphism and plasma PC levels with the susceptibility to chronic mountain sickness(CMS).Methods  This study was conducted in 60 young males of Han nationality who moved to Yushu County,Yushu Zang Autonomous Prefecture,Qinghai Province from January 2014 to October 2015,including 30 cases with CMS(CMS group),and 30 healthy cases without CMS volunteered for this study(control group).PCR-direct sequencing was used to detect the PC gene polymorphism at the -1654C/T,-1641A/G and -1476A/T loci.Plasma PC levels were determined by ELISA.Comparisons were made between the groups in terms of the PC gene polymorphisms at the three loci and plasma PC levels.Results  Significant differences were found between the two groups in the PC gene polymorphism genotype frequencies at the -1654C/T locus(P<0.05),but not in PC gene polymorphism allele frequencies at it(P>0.05).The PC gene polymorphism genotype frequencies at the -1641A/G locus differed significantly between the two groups(P<0.05),while the PC gene polymorphism allele frequencies at it did not(P>0.05).Notable differences were found between the two groups in terms of the PC gene polymorphism genotype frequencies at the -1476A/T locus(P<0.05),but not in PC gene polymorphism allele frequencies at it(P>0.05).The plasma PC levels in CMS group were lower than those in the control group(P<0.05).Conclusion  PC polymorphisms at the -1654C/T,-1641A/G and -1476A/T loci genetic loci -1654C/T,-1641A/G and -1476A/T may be associated with the susceptibility to CMS.Therefore,in order to prevent CMS,PC polymorphisms measured can be used for identifying the susceptible population of CMS.
    【Key words】  Altitude sickness;Protein C;Alleles;Polymorphism,single nucleotide
 
Visualization of Domestic and Abroad Medical Data Mining Based on Knowledge Mapping
SHI Xi-min,CHEN Juan,YANG Jun-xue,ZHAO Wen-long* 
College of Medical Informatics,Chongqing Medical University,Chongqing 400016,China
*Corresponding author:ZHAO Wen-long,Professor;E-mail:cqzhaowl@163.com
    【Abstract】   In order to promote the development and application of medical data mining in China,we made a comparative analysis of the similarities and differences between the domestic and abroad researches based on quantitatively and qualitatively analyzing the articles about medical data mining included in CNKI and Web of ScienceTM from 1998 to 2016 using bibliometrics and knowledge mapping from the aspects of number of articles,core authors and research institutions,and the hotspot and research frontier.
    【Key words】  Bibliometrics;Knowledge mapping;Data mining;Clinical medicine;Visualization
 
Analysis of Situation and Hot Fields of Community Nursing of Diabetes in China from 2010 to 2015
ZHENG Ya-ping
Department of Oncology,Suzhou Kowloon Hosital,Shanghai Jiao Tong University School of Medicine,Suzhou 215021,China
    【Abstract】  Objective  To explore the current status and hot topics of the diabetes community nursing in past five years in China.Methods  This paper based on 3 databases:CNKI,Wanfang Data knowledge service platform and VIP network.The retrieval time was from January 2010 to November 2015.Taking "diabetes"+"community nursing" as retrieval terms,the relevant literatures about diabetes community nursing in Chinese database were retrieved.Then the year,research types,periodicals and key words of the literatures were analyzed using the bibliometric and social network analysis methods.Results  Nine hundred and fifty-seven articles on diabetes community nursing were included finally.Since 2010,there had been an upward trend in the literatures on diabetes community care.As the retrieval time ended in November 2015,the volume of literatures declined slightly in 2015.In the 957 articles,there were 354 articles(36.99%) of randomized controlled trials(RCT),285 articles(29.78%) of the experimental literature,39 articles(4.07%) of the status quo survey,80 articles(8.36%) of review,199 articles(20.79%) of experience summary.The vast majority of the literatures on diabetes community care(865 articles) were published in non-nursing journals,only a small number of literatures(92 articles) were published in nursing journals.The top 10 in key words frequency were type 2 diabetes mellitus,health education,elderly diabetes mellitus,medical compliance,quality of life,old age,diabetic foot,blood glucose,compliance,and glycemic control.At present,the research focus group of diabetes mellitus community nursing were the elderly,type 2 diabetes mellitus and patients combined with other diseases.The research hot topics were health education,compliance,quality of life,complications,biochemical index monitoring,community nursing service,self-management,nursing intervention model,diet care.Conclusion  Community nursing of diabetes in China is in a preliminary stage of development.The quality of scientific research is not high,and there is lack of relevant qualitative research.The research is mainly focus on patients,lack of concern for community nurses.So it is the direction of future researchers′ efforts to improve the quality of research and pay attention to all links that may affect community care,such as community nurses and community hospitals.
    【Key words】  Diabetes mellitus;Nursing research;Medical literature analysis and retrieval system
 
Astragaloside Effect on the Differentiation of Rat Bone Marrow Mesenchymal Stem Cells into Cardiomyogenic Cells in Vitro
ZHAO Jing-miao,HU Ji-hong*,WANG Qiu-ping
Gansu Key Laboratory for the Prevention and Treatment of Major Diseases by Molecular Medicine and Chinese Medicine,Gansu University of Chinese Medicine,Lanzhou 730000,China
*Corresponding author:HU Ji-hong,Associate professor;E-mail:hujihonghappy@163.com
    【Abstract】  Objective  To investigate the astragaloside(AST) effect on the differentiation of bone marrow mesenchymal stem cells(BMSCs) into cardiomyogenic cells in SD rats.Methods  BMSCs were subcultured on behalf of BMSCs.The proliferation of BMSCs was detected by MTT assay at 24,48,72 h after the inducing with different concentrations of AST.The 4th generation of BMSCs were divided into BMSCs group,5-azacytidine group(5-AZA group) and AST group,cultured with the culture medium with 10% fetal bovine serum,the culture medium with 10 μmol/L 5-AZA,and the culture medium with 100 μmol/L AST,respectively.
Morphological changes of BMSCs were observed by phase contrast fluorescence inverted microscopy.The expression levels of Desmin mRNA,α-Sarcomeric actin(α-SCA) mRNA and troponin(cTnI) mRNA in the BMSCs group,5-AZA group and AST group were measured by Real-time qPCR,and the expression levels of cTnT in these three groups were detected by western blotting.Results  The proliferation of BMSCs was the best when they were induced for 72 h by AST at the concentration of 100 μmol / L(P<0.05).Morphological differentiation of BMSCs induced by AST in vitro was similar to that of cardiomyogenic cells.The BMSCs group had lower expression levels of Desmin mRNA,α-SCA mRNA and cTnI mRNA than 5-AZA group and AST group(P<0.05).Compared with 5-AZA group,the expression levels of Desmin mRNA,α-SCA mRNA and cTnI mRNA in AST group were higher(P<0.05).5-AZA group and AST group had higher cTnT expression levels than the BMSCs group(P<0.05).Compared with 5-AZA group,AST group had lower expression levels of cTnT(P<0.05).Conclusion  The differentiation of BMSCs into cardiomyogenic cells in vitro can be promoted after being induced by AST with a concentration of 100 μmol/L for 72 hours,but the induction effect of AST is weaker than 5-AZA.
    【Key words】  Myocytes,cardiac;Cell differentiation;Bone marrow mesenchymal stem cells;Astragaloside
 
Effect and Mechanism of Atractylodes Qiwu Granules on C-kit Expression Level in Colon Tissues of STC Rats with Qi-yin Deficiency
LIN Ren-jing1,LU Hai-yan1*,HE Yong-heng1,NIE Jing2
1.Anorectal Department,the Second Affiliated Hospital of Hunan University of Chinese Medicine,Changsha 410005,China
2.Hunan SJA Laboratory Animal Co.,Ltd,Changsha 410100,China
*Corresponding author:LU Hai-yan,Attending physician;E-mail:850157636@qq.com
    【Abstract】  Objective  To investigate the changes of c-kit expression level in colon tissues of STC model rats with qi-yin deficiency under the intervention of Atractylodes qiwu granules,and to explore the possible mechanism of action of Atractylodes qiwu granules in treating the disease.Methods  This study was conducted from September to November 2015.A total of 70 SPF grade SD rats were randomized into the blank group(10 males and 10 females) and the model group(25 males and 25 females).Rats in the model group and blank group were subcutaneously injected 2.5 ml/kg of morphine hydrochloride injection,2.5 ml/kg of 0.9% sodium chloride injection,once daily for 45 consecutive days,respectively.The rats in the model group were gavaged with 13 g/kg of the solution with dissolved granules of pericarpium citri reticulatae viride,fructus aurantii and radix aconite carmichaeli on the 16th day of prescribing morphine hydrochloride injection,for 30 consecutive days to establish the STC rat models with qi-yin deficiency.The STC rat models with qi-yin deficiency were verified to be established successfully after the above 45d-intervention by examining the sacrificed 10 of the rats from the model group.The rest 40 rats in the model group were randomized into the model control group,high-dose Atractylodes qiwu granules group,low-dose Atractylodes qiwu granules group,and mosapride group,with 10 evenly composed of males and females in each group.After stopping the previous intervention for 7 days,the model control group,high-dose and low-dose Atractylodes qiwu granules groups,mosapride group and blank group were gavaged with solution of 0.9% sodium chloride injection,high-dose Atractylodes qiwu granules,low-dose Atractylodes qiwu granules,mosapride,0.9% sodium chloride,respectively.RT-PCR and immunohistochemistry were used to detect the expression levels of c-kit in the colon tissue samples taken from the rats of all the groups.Results  The intestinal propulsion rate of model group was lower than that of blank group(P<0.05).The model control group had lower intestinal propulsion rate than low-dose and high-dose Atractylodes qiwu granules groups and mosapride group(P<0.05).The expression levels of c-kit mRNA in the model control group were lower than those in low-dose and high-dose Atractylodes qiwu granules groups and mosapride group(P<0.05).The expression levels of c-kit mRNA in low-dose Atractylodes qiwu granules group were lower than those in high-dose Atractylodes qiwu granules group(P<0.05).The model control group had lower expression levels of c-kit than high-dose Atractylodes qiwu granules group and mosapride group(P<0.05).Conclusion  Atractylodes qiwu granules acts by increasing the c-kit level in colon tissues to treat STC with qi-yin deficiency.
    【Key words】  Constipation;Qi-yin deficiency;Rats;C-kit
 
Effect of Ganning Decoction on the mRNA and Protein Expression Levels of GRP78 Associated with Hepatic Endoplasmic Reticulum Stress
LI Chun-ying1,WEN Bin2,LI Fu-ying1,DENG Xin2*
1.Guangxi University of Chinese Medicine,Nanning 530000,China
2.Ruikang Hospital Affiliated to Guangxi University of Chinese Medicine,Nanning 530011,China
*Corresponding author:DENG Xin,Post-doctoral;E-mail:3379806575@qq.com
    【Abstract】  Objective  To investigate the effect and significance of Ganning Decoction on the mRNA and protein expression levels of GRP78 associated with hepatic endoplasmic reticulum stress(ERS).Methods  This study was conducted from October 2015 to July 2016.We prepared the serum with Ganning Decoction by using the abdominal aortic blood taken from 20 intervened SPF grade healthy SD rats,and tunicamycin culture medium by adding culture medium containing fetal bovine serum to the DMSO solution with completely dissolved tunicamycin.HL-7702 hepatocytes were divided into normal control group,ERS model group,and Ganning Decoction treatment group,cultured with normal culture medium,tunicamycin culture medium,tunicamycin culture medium containing serum with Ganning Decoction,respectively.The mRNA and protein expression levels of GRP78 associated with hepatic ERS in all the groups were detected by qRT-PCR,and western blotting,respectively.Results  The expression level of GRP78 mRNA in hepatocytes of ERS model group was higher than that in the normal control group(P<0.05).The expression level of GRP78 mRNA in hepatocytes of Ganning Decoction treatment group was lower than that in the ERS model group(P<0.05).The normal control group had lower expression level of GRP78 protein than the other two groups(P<0.05).Ganning Decoction treatment group had lower expression level of GRP78 protein than the ERS model group(P<0.05).Conclusion  Ganning Decoction can effectively improve the impaired liver function and reduce the apoptosis of hepatocytes.The mechanism may be related to the inhibition of the expressions of GRP78 in hepatocytes.
    【Key words】  Hepatocytes;Endoplasmic reticulum stress;Ganning Decoction;Glucose-regulated protein 78
 
Research on the Weight Computing of Evaluation Index System of Reputation of Public Hospital from Perspectives of both Doctors and Patients
  YANG Yi1,ZHANG Xin-nan1,TIAN Kan1,2*
1.School of Health Economics and Management,Nanjing University of Chinese Medicine,Nanjing 210023,China
2.Nanjing Branch,Research Center of Health Development,National Health and Family Planning Commission,Nanjing 210023,China
*Corresponding author:TIAN Kan,Professor,Doctoral supervisor;E-mail:tiankane@aliyun.com
    【Abstract】  Background  Our research group has designed the evaluation index system of reputation of public hospital from the perspectives of both doctors and patients in early stage,but we have not made weight assignment to the indexes.Objective  To compute the weight of every index at different levels of the evaluation system of reputation of public hospital from the perspectives of both doctors and patients,thus to improve the index system and lay the foundation for carrying out the reputation evaluation of public hospital.Methods  In June 2015,the weight of each index at different levels of this system was determined by analytic hierarchy process,which consists of four steps:the establishment of hierarchical structure model,the construction of two judgment matrix,single hierarchical sorting and total hierarchical sorting.Results  The hierarchical structure model was divided into four levels:target level(evaluation index system of reputation of public hospital),criterion level(perspectives of both doctors and patients),sub-criteria level(first-grade indicator) and program level(second-grade indicator).A total of 450 judgment matrices(15 judgment matrices per expert,30 experts totally) were constructed.In the single hierarchical sorting,all the CR of the judgment matrix of each index at different levels was less than 0.100,and had satisfactory consistency.And in the total sorting of the hierarchy,the overall sorting consistency of the doctors,patients and the whole index system finally was 0.050,0.020 and 0.032 respectively,all were less than 0.100,and the overall ranking of the hierarchy of the index system had satisfactory consistency.Conclusion  The index evaluation system of reputation of public hospital from the perspectives of both doctors and patients after weight assignment can be tried to apply into the actual evaluation work of the reputation of public hospital.
    【Key words】  Hospitals,municipal;Physician-patient relations;Quality indicators,health care;Reputation evaluating;Weight computing;AHP
 
Reliability and Validity of the Chinese Version of the Brief Form of the Social Phobia and Anxiety Inventory for Adolescent
LIU Li,ZHANG Rui-xue,LIU Kun*
College of Nursing,Jinzhou Medical University,Jinzhou 121000,China
*Corresponding author:LIU Kun,Professor;E-mail:405376967@qq.com
    【Abstract】  Objective  To analyze the reliability and validity of the simplified Chinese version of Brief Form of the Social Phobia and Anxiety Inventory(SPAI-B) for adolescents,and verify its application in Chinese adolescents,in order to provide a reliable tool for measuring social anxiety in adolescent.Methods  From April to May 2016,two primary schools and two junior high schools were selected in Zhangwu County Liaoning Province by convenient sampling method,and 6 classes in each school were selected by multi-stage,stratified and cluster sampling method,then 440 cases of students met the inclusion criteria were selected as the investigation objects.With the consent and providing of the original author of SPAI-B,Chinese version of the SPAI-B was obtained after converting into Chinese.The Chinese version of SPAI-B was used to investigate the subjects.A total of 440 questionnaires were distributed and 404 valid questionnaires were collected.The effective recovery rate was 91.8%.The subjects were divided into group A(n=197) and group B(n=207) by simple random sampling method.The results of group A were used for reliability and validity analysis of Chinese version of SPAI-B.The results of group B were used for validity analysis of Chinese version of SPAI-B.Fifty subjects were chosen from group A by convenient sampling method and retested two weeks later.Results  The internal consistency Cronbach′s α coefficient of the Chinese version of SPAI-B was 0.903,split-half reliability was 0.859 and the retest reliability was 0.871.There was positive correlation among the score of each item in Chinese version of SPAI-B,and the score of each item in Chinese version of SPAI-B was positively correlated with the total score(P<0.05).The content validity index of Chinese version of SPAI-B was 0.803.The KMO of Chinese version of SPAI-B was 0.915.Bartlett′s spherical test χ2 was 1 198.823,P<0.001,indicating that it was suitable for exploratory factor analysis.One common factor with eigenvalue >1.000 was extracted after rotation by the maximum variance method,using the principal component analysis method,the eigenvalue was 6.605,the cumulative variance contribution rate was 41.284%,and the load values of each item were all >0.400.The confirmatory factor analysis showed that χ2/df=1.985,the comparative fit index(CFI)=0.909,the goodness of fit index(GFI) =0.899,adjusted goodness of fit index(AGFI) =0.868,normalized fit index(NFI) =0.834,the tucker-lewis index(TLI)=0.895,the incremental fit index(IFI)=0.910,the root mean square error of approximation(RMSEA)=0.069.The regression coefficient of un-standardized single factor model of Chinese version of SPAI-B was 0.34-0.69,the regression coefficient of standardized single factor model was 0.43-0.73.Conclusion  The Chinese version of SPAI-B has good internal consistency and stability in assessing social anxiety in adolescents,it can be used to assess the social anxiety level of adolescent students.
    【Key words】  Anxiety;Adolescent;SPAI-B;Reliability;Validity
 
Reliability and Validity of the Chinese Version of Patient Empowerment Scale among the Elderly with Chronic Diseases
WANG Shan-shan1,LIU Yan-hui2,SHAN Qiu-ju3,ZHANG Yang4,ZHANG Cui-hong4,ZHANG Zhen-xiang1*
1.The Nursing College of Zhengzhou University,Zhengzhou 450052,China
2.School of Nursing,Tianjin University of Traditional Chinese Medicine,Tianjin 300073,China
3.The Second Affiliated Hospital of Zhengzhou University,Zhengzhou 450001,China
4.The First Affiliated Hospital of Zhengzhou University,Zhengzhou 450001,China
*Corresponding author:ZHANG Zhen-xiang,Professor;E-mail:zhangzx6666@126.com
    【Abstract】  Objective  To translate the English version of Patient Empowerment Scale(PES) into Chinese,and to test the reliability and validity,and assess the serviceability of the Chinese version of PES among the elderly with chronic diseases.Methods  We adapted the English version of PES following the Brislin′s classic model for translation and validation of instruments guidelines for cross-cultural research,including translation,back translation,expert consultation for adjusting the items,then,after a pilot survey using the initial scale,we developed the formal Chinese version of PES.Three hundred elderly patients with chronic diseases who were older than 60 selected by convenient sampling from the First Affiliated Hospital of Zhengzhou University and the Second Affiliated Hospital of Zhengzhou University were surveyed by the Chinese version of PES between April and June 2015.Thirty participants were selected from those who had actively responded to the survey for the test-retest two weeks later.SPSS 17.0 and AMOS 17.0 were used for data analysis.The content validity index(CVI) was used to measure the content validity;exploratory factor analysis was used to measure the construct validity;common factors were extracted with principal component analysis and maximum variance orthogonal rotation,and maximum likelihood method was used for confirmatory factor analysis.The Cronbach′s α,split half,and test-retest were used for reliability analysis.Results  A total of 94.7%(284/300) of the participants actively responded to the initial questionnaire survey.The item-total correlation coefficient in the Chinese version of PES ranged from 0.570 to 0.828(P<0.01).There were significant differences in the scores of 20 items between the high-score group and low-score group(P<0.05).The S-CVI was 0.96.I-CVI ranged from 0.90 to 1.00.The KMO value for the scale by exploratory factor analysis was 0.851,and result of Bartlett′s test of sphericity was χ2 = 1 099.428(P<0.01).Four common factors were extracted by exploratory factor analysis,which could explain 73.458% of the total variance.The confirmatory factor analysis revealed a good model fit,P=0.348.The Cronbach′s α of the Chinese version of PES was 0.931,split-half reliability was 0.814,test-retest reliability was 0.820(P<0.01).Conclusion  The Chinese version of PES is reliable and valid,so it can be used to assess the empowerment of elderly patients with chronic diseases.
    【Key words】  Chronic disease;Aged;Reliability;Validity
 
Study of Clinical Diagnostic Model of Early Comprehensive Score of EMs
ZHOU Zan-hua1,DONG Hai-na1*,WEI Zhe1,SHI Qian2,ZHOU Li-hong3,MAO Xue-mei3
1.College of Medicine and Health,Lishui University,Lishui 323000,China
2.Department of Pathology,the Central Hospital of Lishui City,Lishui 323000,China
3.Department of Gynaecology and Obstetrics,the Central Hospital of Lishui City,Lishui 323000,China
*Corresponding author:DONG Hai-na,Lecturer;E-mail:helna125@126.com
    【Abstract】  Background  Endometriosis(EMs) seriously affects the quality of life of patients.It is important to explore a safe and effective early diagnostic method of EMs for improving the accuracy of clinical diagnosis and avoiding laparoscopic surgery.Objective  To establish a clinical diagnostic model of early comprehensive score of EMs based on dysmenorrhea,chronic pelvic pain,results of gynaecological examination,ultrasound results,serum epithelial ovarian cancer antigen(CA125) test results,and aromatase cytochrome(P450arom) test results of endometrial tissue of EMs patients as variables.And to investigate the early diagnostic value of the model for EMs in order to explore a safe,effective,economical and practical diagnostic method for improving the accuracy for early diagnosis of EMs and reducing the possibility of laparoscopic operation.Methods  A total of 150 patients with clinical diagnosis of pelvic EMs met the inclusion criteria were selected as study subjects,who were on the waiting list to undergo the laparoscopic operation in the Department of Gynecology and Obstetrics of the Central Hospital of Lishui from January 2015 to October 2016.These patients were divided into modeling group(n=100) and validation group(n=50) by simple random sampling.General data of patients were collected,including medical history,critical symptoms,gynaecological examination results.The results of ultrasound examination,serum CA125 test,and P450arom test of endometrium tissue were recorded.Laparoscopic surgery combined with histopathological findings was the gold diagnostic standard for EMs.Clinical diagnostic model of early comprehensive score of EMs was established by using multivariate stepwise Logistic regression analysis.The receiver operating characteristic(ROC) curve of clinical diagnostic model of early comprehensive score of EMs for diagnosing EMs was drawn.The area under the ROC curve(AUC),sensitivity and specificity were calculated.Results  There were 78 positive cases diagnosed as EMs by the gold standard and 22 negative cases in modeling group.Meanwhile,24 positive cases and 26 negative cases in validation group.In modeling group,the positive rate were 91.0%(91/100),64.0%(64/100) and 76.0%(76/100) by ultrasonic examination,serum CA125 test and P450arom test of endometrium tissue,respectively.A clinical diagnosis model of early comprehensive score of EMs was established by multivariate stepwise Logistic regression analysis:y=-10.77+4.96×dysmenorrheal+1.88×chronic pelvic pain+3.02×positive signs of gynecological examination+3.68×positive ultrasound examination+1.41×positive serum CA125 test+4.56×positive P450arom test of endometrium tissue.AUC of diagnosing EMs by serum CA125 test in modeling group was 0.735,95%CI(0.614,0.857),sensitivity was 74.4% and specificity was 72.7%.AUC of diagnosing EMs by P450arom test of endometrium tissue in modeling group was 0.841,95%CI(0.732,0.951),sensitivity was 91.0% and specificity was 77.3%.AUC of diagnosing EMs by clinical diagnosis model of early comprehensive score of EMs in modeling group was 0.969,95%CI(0.936,1.000),diagnosis cutoff value was 0.833,sensitivity was 93.6% and specificity was 86.4%.The clinical diagnosis model of early comprehensive score of EMs was used in validation group,AUC was 0.881,95%CI(0.777,0.985),sensitivity was 91.7% and specificity was 88.5%.Conclusion  The clinical diagnosis model of early comprehensive score of EMs established by this study has improved the accuracy of early diagnosis of EMs to a certain extent.As a minimally invasive diagnostic method,the model can be used in the early clinical diagnosis of EMs.
    【Key words】  Endometriosis;Early diagnosis;Model
 
Clinical Characteristics and Diagnosis of Dengue Fever
LIANG Zeng-wei*,XIE Xu-shuo,WEN Huan-lian,OU Ying-yan,ZENG Wen-ding
Department of Infectious Diseases,the First Affiliated Hospital of Guangzhou Medical University,Guangzhou 510120,China
*Corresponding author:LIANG Zeng-wei,Associate professor;E-mail:liangzengwei@sina.com
    【Abstract】  Objective  To study the clinical characteristics of dengue fever in order to provide a reference for the diagnosis and treatment of the disease.Methods  Retrospective analysis of the clinical data of 650 cases of dengue fever patients in the First Affiliated Hospital of Guangzhou Medical University from June 2014 to October 2016.Two hundred and thirty-eight of them underwent the routine blood testing on the 1st,3rd and 5th days after the onset of the disease,the indexes included white blood count and platelet count change.Results  Among the 650 cases,the common manifestations included fever〔100.0%(650/650)〕,fatigue 〔96.2%(625/650)〕,myalgia 〔89.1%(579/650)〕,disgusting〔86.2%(560/65

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