October 2017, Volume 20, No.30 Abstracts
Author：尹鹏 Source：CGP Published： [10-27] views： 1351
Status of Elderly Care Services and Community-based Elderly Care Services in China WANG Ting1，JIA Jian-guo2*
1.School of General Practice and Continuing Education，Capital Medical University，Beijing 100069，China
2.Xuanwu Hospital Capital Medical University，Beijing 100053，China
*Corresponding author:JIA Jian-guo，Professor，Doctoral supervisor;E-mail:firstname.lastname@example.org
【Abstract】 China has become the first aspiring global power that grows old before it can grow rich.And the challenges in delivering elderly services for aging population need to be tackled urgently.Based on the analysis of the status of elderly care services in China，we put forward that community-based elderly care services is the most appropriate kind of services for addressing the needs of an aging population.Moreover，in view of the challenges in delivering such services，we proposed some suggestions，such as improving relevant laws，establishing long-term care insurance system，enhancing service quality，improving service facilities，all these would lead the community-based elderly services to be utilized all over the country.
【Key words】 Aged；Aging society；Community-based elderly care
Development of a Service Quality Assessment Scale for Integrated Medical and Nursing Care Services Delivered by Elderly Care Institutions LI Yu-meng1，FA Ruo-bing1，WANG Chang-qing2*
1.School of Health Economics and Management，Nanjing University of Chinese Medicine，Nanjing 210023，China
2.Nanjing Medical University，Nanjing 210029，China
*Corresponding author:WANG Chang-qing，Professor，Doctoral supervisor;E-mail:email@example.com
【Abstract】 Background China′s current healthcare service quality evaluation system is mainly for urban healthcare services，but not for the elderly care institutions including those deliver integrated medical and nursing care services.11111111Objective To develop a Service Quality Assessment Scale for Integrated Medical and Nursing Care Services Delivered by Elderly Care Institutions and test its reliability and validity，in order to provide a theoretical basis for health administration and other relevant departments to formulate the corresponding policies.Methods Based on literature review，expert scoring and pre-investigation，we developed a Service Quality Assessment Scale for Integrated Medical and Nursing Care Services Delivered by Elderly Care Institutions including 29 items，and 5 factors（dimensions） of hardware facilities and environment，operation management，security protection，humanistic care and basic health.From March to May 2017，we mailed 1 218 questionnaires to elderly care institutions located in large and medium-sized cities of China（774 questionnaires for 258 elderly care institutions in Jiangsu Province and 444 questionnaires for 148 elderly care institutions in Shanghai ）.A total of 825 questionnaires were returned，and 501（60.7%） of them were responsive.And the reliability and validity of the Service Quality Assessment Scale for Integrated Medical and Nursing Care Services Delivered by Elderly Care Institutions were analyzed.Results The KMO value of the scale was 0.798，Bartlett′s Test of Sphericity showed χ2=3 763.128，df=406，P＜0.001，indicating that it was suitable for confirmatory factor analysis.The Spearman-Brown split-half coefficient，Cronbach′s α and Guttman split-half coefficient of the scale were 0.830，0.918 and 0.814，respectively，which indicated that the reliability of the scale was acceptable.The expert consultation and scoring conducted during the development of the scale，and the Cronbach′ s α coefficients of all the 29 items were＞ 0.90，which showed that the content validity of the scale was reliable.The construction validity test showed that most inter-item correlation coefficients were about 0.60，indicating the construct validity of the scale was good.Conclusion The Service Quality Assessment Scale for Integrated Medical and Nursing Care Services Delivered by Elderly Care Institutions presents good reliability and validity in this study.However，its reliability and validity need to be tested further in elderly care institutions of different sizes in different cities and provinces，by which，the scale will be more reliable and valid.
【Key words】 Aged;Elderly care institutions;Service quality evaluation
Research Status of Elderly Care Assessment at Home and Abroad and Its Enlightenment to the Hierarchical Elderly Care in China SUN Xin-ran，SUN Jin-hai*
Department of Military Health Management，Second Military Medical University，Shanghai 200433，China
*Corresponding author:SUN Jin-hai，Professor；E-mail：firstname.lastname@example.org
【Abstract】 The elderly care assessment and the hierarchical elderly care based on it are the premises to guarantee the equitable distribution of the resources for the elderly，which still needs to be improved in China.This article reviewed the current situation of elderly care assessment at home and abroad and analyzed the self-care ability，cognitive function，disease and health index，nutritional status and demand，and psychological status and demand.Therefore，some suggestions were put forward to promote the construction of elderly care assessment system and improve the establishment of hierarchical elderly care system，including constructing the assessment system based on above five basic ability dimensions to ensure the fairness，making the hierarchical elderly care match assessment results scientifically，introducing the third party evaluation mechanism and so on.
【Key words】 Aged；Care for the aged；Assessment；Grading
Correlation of Diabetic Gastroparesis and Renal Function Damage in Type 2 Diabetes Mellitus ZHOU Yong-jing1*，LI Shan-lin2，LIU Li3，LIU Hong-mei4，QIN Yong-mei5
1.Department of Digestive Medicine，Zhengzhou Central Hospital，Zhengzhou 450002，China
2.Department of Digestive Medicine，Zhoukou Central Hospital，Zhoukou 466099，China
3.Department of Digestive Medicine，the Third People′s Hospital of Zhengzhou，Zhengzhou 450000，China
4.Department of Endocrinology，Zhengzhou Central Hospital，Zhengzhou 450002，China
5.Department of Gastroenterology，the First Affiliated Hospital of Xinxiang Medical University，Xinxiang 453000，China
*Corresponding author:ZHOU Yong-jing，Resident physician；E-mail：email@example.com
【Abstract】 Objective To investigate the relationship between diabetic gastroparesis（DGP） and renal function damage in patients with type 2 diabetes mellitus（T2DM）.Methods The enrolled participants were 103 T2DM patients receiving treatment and other age- and sex-matched 10 healthy volunteers（control group） undergoing physical examination in Physical Examination Center，in Zhengzhou Central Hospital from July 2015 to March 2016.The gastric emptying half-time（GET1/2） of both groups was measured by radionuclide imaging.Based on the GET1/2 of control group，the T2DM patients were divided into the normal gastric emptying group（n=45，GET1/2≤64.7 min） and delayed gastric emptying group（n=58，GET1/2＞64.7 min）.The serum creatinine（Scr），Cystatin C（CysC），plasma glycosylated hemoglobin（HbA1c） and 24 h urinary albumin excretion rate（24 h-UAER） of the normal and delayed gastric emptying groups were determined，and estimated glomerular filtration rate（eGFR） was calculated.Sex，age，body mass index（BMI），course of T2DM and plasma HbA1c level were compared between the normal and delayed gastric emptying groups.The T2DM patients were divided into 5-10 years group（n=25），11-15 years group（n=30），16-20 years group（n=28），21-25 years group（n=20）;5.9%-7.2% group（n=13），7.3%-8.5% group（n=25），8.6%-9.8% group（n=33），9.9%-11.1% group（n=32） according to the duration of T2DM and plasma HbA1c level respectively with quartile division，and GET1/2 of all the groups was compared.Scr，24 h-UAER and eGFR were compared between the normal gastric emptying group and delayed gastric emptying group.And the correlations of GET1/2 with Scr，24 h-UAER and eGFR were analyzed.Results Compared with the normal gastric emptying group，delayed gastric emptying group had longer duration of T2DM as well as higher plasma HbA1c level（P＜0.05）.The 5-10 years group presented shorter GET1/2 than both the 16-20 years group and 21-25 years group（P＜0.05）.GET1/2 was shorter in the 5.9%-7.2% group than in 8.6%-9.8% and 9.9%-11.1% groups（P＜0.05）.The delayed gastric emptying group had higher Scr and 24 h-UAER but lower eGFR compared with the normal gastric emptying group（P＜0.05）.GET1/2 was positively correlated with the Scr level and 24 h-UAER（r=0.560，0.346，P＜0.001），but negatively correlated with eGFR（r=-0.225，P=0.023）.Conclusion With Scr level，24 h-UAER increasing and eGFR decreasing，gastric emptying time is prolonged in T2DM patients，and the occurrence of DGP is related to renal function damage closely.
【Key words】 Gastroparesis；Diabetes mellitus，type 2；Delayed gastric emptying；Renal function damage
Long-term Prognosis in Patients with Neurologically Asymptomatic Carotid Atherosclerosis Influenced by Serum Uric Acid Level YANG Guo-tao1，ZHAO Hong-ying2，DONG Ai-qin1*
1.No.3 Department of Neurology，Cangzhou Central Hospital，Cangzhou 061001，China
2.Geriatric Ward，Cangzhou Central Hospital，Cangzhou 061001，China
*Corresponding author:DONG Ai-qin，Chief physician；E-mail：firstname.lastname@example.org
【Abstract】 Objective To investigate the impact of serum uric acid（SUA） level on long-term prognosis in patients with neurologically asymptomatic carotid atherosclerosis（NACA）.Methods The clinical data of 656 patients with NACA who received inpatient treatment in Cangzhou Central Hospital from December 2012 to December 2015 were collected.They were divided into 4 groups based on the interquartile range of serum uric acid level，＞75% group（n=161），51%-75% group（n=167），25%-50% group（n=163），＜25% group（n=165）.The baseline information of patients was retrospectively analyzed，including gender，age，BMI，complication（hypertension，diabetes，hyperlipemia），smoking，biochemical markers（level of SUA and Hcy），primary endpoint event（all-cause mortality），ssecordary endpoint event（cardiovascular and cerebrovascular morbidity）.The deadline was December 31st，2015.Results Gender distribution，prevalence of hypertension，hyperlipemia and smoking，levels of SUA and Hcy differed significantly among the 4 groups（P＜0.05）.The all-cause mortality and cardiovascular and cerebrovascular mortality in the 4 groups varied obviously（P＜0.05）.Spearman rank correlation analysis indicated that there was a positive correlation between SUA level and all-cause mortality（rs=0.183，P＜0.001）;SUA level presented a positive correlation with the cardiovascular and cerebrovascular mortality（rs=0.099，P= 0.002）.Up to end point，there were 170 deaths from all causes and 109 deaths due to cardiovascular and cerebrovascular diseases in total.The survival curves of deaths from all causes in the 4 groups were significantly different（χ2=36.100，P＜0.001）.The survival curve of deaths due to cardiovascular and cerebrovascular diseases varied substantially by group（χ2=16.898，P=0.001）.The analysis with Cox proportional hazard regression models manifested that SUA level was an independent associated factor for deaths from all causes〔RR=1.023，95%CI（1.018，1.028）〕 and for deaths due to cardiovascular andr cerebrovascular diseases〔RR=1.011，95%CI（1.008，1.014）〕 in neurologically asymptomatic carotid atherosclerotic patients（P＜0.05）.Conclusion SUA level is closely related to all-cause mortality and cardiovascular and cerebrovascular mortality in patients with neurologically asymptomatic carotid atherosclerosis.Increased SUA level indicates poor prognosis of the patients.
【Key words】 Atherosclerosis;Carotid arteries;Uric acid;Prognosis
Value of Plasma miR-92a-3p，miR-204-5p and miR-186-5p in the Diagnosis of Cholangiocarcinoma MA Jun-ji*，GUO Ping，GUO Yu，WU Jiang-hua
Department of Gastroenterology，the Second Hospital of Hebei Medical University;Hebei Key Laboratory of Gastroenterology;Hebei Institute of Gastroenterology，Shijiazhuang 050000，China
*Corresponding author:MA Jun-ji，Associate professor，Associate chief physician;E-mail:email@example.com
【Abstract】 Background Cholangiocarcinoma（CCA） originates from bile duct epithelial cells.It is occult and highly malignant.The value of circulating miRNA in the diagnosis of CCA remains to be studied.11111111Objective To evaluate the diagnostic value of plasma miR-92a-3p，miR-204-5p and miR-186-5p for CCA，in order to improve the diagnostic level of CAA.Methods Sixteen patients with CCA who met the inclusion criteria and received treatment in the Second Hospital of Hebei Medical University from May 2015 to January 2016 were included in the case group，and other eligible 15 patients without liver and gallbladder diseases treated in the same hospital during the same period were selected as the control group.Reverse transcription-quantitative polymerase chain rection（RT-qPCR） was used to detect the expressions of miR-92a-3p，miR-204-5p and miR-186-5p from plasma samples of all the patients.The Logistic regression equation of miR-92a-3p，miR-204-5p and miR-186-5p was calculated by binary Logistic analysis.Receiver operating characteristic（ROC） curve was drawn to test the diagnostic value of miR-92a-3p，miR-204-5p，miR-186-5p and their combined diagnosis in patients with CCA.The area under the ROC curve（AUC），sensitivity，specificity，and Youden′s index were calculated.Results The miR-92a-3p expression in the case group was higher than that in the control group（P＜0.05）.However，the expressions of miR-204-5p and miR-186-5p were found to be lower in the case group（P＜0.05）.The AUC of miR-92a-3p，miR-204-5p and miR-186-5p for CCA diagnosis was 0.708〔95%CI（0.524，0.892）〕，0.725〔95%CI（0.535，0.915）〕，0.750〔95%CI（0.576，0.924）〕，respectively.The cutoff value of miR-92a-3p，miR-204-5p and miR-186-5p for CCA diagnosis was 0.130 8，0.008 5，0.005 2，respectively.The sensitivity of miR-92a-3p，miR-204-5p and miR-186-5p for CCA diagnosis was 0.938，0.563，0.563，respectively.The specificity of miR-92a-3p，miR-204-5p and miR-186-5p for CCA diagnosis was 0.467，0.933，0.933 respectively.The Youden′s index of miR-92a-3p，miR-204-5p and miR-186-5p for CCA diagnosis was 0.405，0.496，0.496 respectively.Binary Logistic analysis showed that Logit（P）=-0.031+9.167×miR-92a-3p-49.453×miR-186-5p-66.771×miR-204-5p，the AUC for CCA diagnosis was 0.879〔95%CI（0.749，1.010）〕，and the cutoff value，sensitivity，specificity and Youden′s index were 0.095 8，0.938，0.800，and 0.738 respectively.The AUC of miR-92a-3p，miR-204-5p and miR-186-5p for combined diagnosis of CCA was larger than that of miR-92a-3p，miR-204-5p and miR-186-5p for CCA diagnosis alone（P＜0.05）.Conclusion miR-92a-3p，miR-204-5p，and miR-186-5p can be used for the diagnosis of CCA，and their combined diagnosis of CCA is of higher value.
【Key words】 Bile duct neoplasms；Diagnosis；Plasma；Tumor markers，biological；MicroRNA
Risk Factors for Intrahospital Death of Aortic Dissection Patients ZHANG Wei-zong1，MA Xiang2*，WANG Bao-zhu2，WANG Hao2
1.Cardiovascular Department，First People′s Hospital of Yuhang District，Hangzhou，Hangzhou 311100，China
2.NO.2 Department of Coronary Heart Disease，the First Affiliated Hospital of Xinjiang Medical University，Urumqi 830054，China
*Corresponding author:MA Xiang，Professor，Chief physician;E-mail:maxiangxj @163.com
【Abstract】 Objective To explore the risk factors of intrahospital death in patients with aortic dissection（AD），in order to provide a reference for clinical effective treatment of the disease.Methods We collected the clinical data of 224 AD patients who received treatment in cardiac ICU，the First Affiliated Hospital of Xinjiang Medical University from January 2010 to January 2012 and met the inclusion criteria.According to the intrahospital outcome，they were divided into survival group （n=201） and death group （n=23）.The clinical data （general data，basic signs and values of clinical markers） of patients were retrospectively analyzed.Risk factors of intrahospital death were analyzed.Results The differences in drinking history，hypertension history，onset time，DeBakey type and intrahospital surgical status between the two groups were revealed to be significant （P＜0.05）.The levels of diastolic blood pressure，red blood cell count，hematocrit，percentage of eosinophil，percentage of basophil，eosinophil count，basophil count，hemoglobin，platelet count，thrombocytocrit，total protein，globulin，prothrombin time activity and fibrinogen in the death group appeared to be lower than those in the survival group（P＜0.05）.The death group had higher levels of fasting blood glucose and apolipoprotein AI，longer prothrombin time，higher international normalized ratio，and enlarged aortic sinus diameter compared with the survival group（P＜0.05）.The intrahospital death（dependent variable），and the independent variables of P＜0.01 filtered out by the single factor analysis，were analyzed by multiple Logistic regression analysis.The regression equation is Y=0.555-8.124×basophil count-0.036×value of hemoglobin+0.104× value of aortic sinus diameter.Conclusion Basophil count and value of hemoglobin are the protection factors of intrahospital death of patients with AD，while aortic sinus dimension is an independent risk factor.In view of this，these three markers should be monitored intensively.
【Key words】 Intrahospital mortality;Aortic dissection;Risk factors
Efficacy of Febuxostat versus Allopurinol in the Treatment of Primary Gout and Their Effects on Insulin Resistance MENG Juan，YUAN Xiao-xu，LU Yue-wu*
Department of Rheumatology and Immunology，Beijing Chao-Yang Hospital，Capital Medical University，Beijing 100020，China
*Corresponding author:LU Yue-wu，Chief physician；E-mail:firstname.lastname@example.org
【Abstract】 Objective To investigate the efficacy of febuxostat versus allopurinol in the treatment of primary gout and their effects on insulin resistance.Methods We enrolled 52 primary gout patients who received outpatient treatment in Beijing Chao-Yang Hospital，Capital Medical University from November 2013 to May 2015 and met the inclusion criteria of this study.Using SPSS 19.0 software，they were randomized into febuxostat group receiving oral administration of febuxostat tablets and allopurinol group receiving oral administration of allopurinol tablets at a ratio of 1∶1.The baseline data of both groups were collected.The levels of serum uric acid（UA），aspartate aminotransferase（AST），alanine aminotransferase（ALT），creatinine（Cr），fasting blood glucose（FBG） and fasting insulin（INS） were detected，the homeostasis model assessment of insulin resistance（HOMA-IR） was calculated before treatment and at 24 weeks after treatment.Results The levels of UA，AST，ALT，Cr，FBG and INS and HOMA-IR did not differ significantly between the two groups before treatment（P＞0.05）.After treatment，the levels of UA and INS in febuxostat group were lower than those in allopurinol group（P＜0.05），but the levels of AST，ALT，Cr and FBG and HOMA-IR were still similar in both groups（P＞0.05）.The level of UA after treatment was significantly lower than that before treatment in allopurinol group（P＜0.05）.The levels of UA and INS and HOMA-IR after treatment were significantly lower than those before treatment in febuxostat group（P＜0.05）.Conclusion Compared with allopurinol，febuxostat can better control the serum UA level of patients with primary gout，and it can improve the level of IR.
【Key words】 Gout；Comparative effectiveness research；Allopurinol；Insulin resistance；Febuxostat
Obesity and Hospital Mortality in Mechanically Ventilated ICU Patients LI Zhi-qiang1，WANG Ya-jing2，WANG Hong-yang3*，WANG Guan-da2，PU Jian-yi2
1.Intensive Care Unit，First Hospital of Qinhuangdao，Qinhuangdao 066000，China
2.Intensive Care Unit，North China University of Science and Technology Affiliated Hospital，Tangshan 063000，China
3.Department of Respiratory Medicine，North China University of Science and Technology Affiliated Hospital，Tangshan 063000，China
*Corresponding author:WANG Hong-yang，Chief physician；E-mail：email@example.com
【Abstract】 Objective To evaluate the impact of obesity on hospital mortality in mechanically ventilated ICU patients.Methods We enrolled 210 consecutive inpatients who received treatment in General ICU，North China University of Science and Technology Affiliated Hospital between January and December 2015，and stratified them into the obese group（n=84） and no-obese group（n=126） based on the criteria for the assessment of obesity in Chinese adults.The follow-up period ended at the date of death or at the end of 60-day treament in the ICU.Outcome indicators included ICU mortality，hospital mortality，mortality after receiving 60-day treatment in the ICU，duration of mechanical ventilation（MV），length of stay in the ICU，length of stay，and incidence of complications（duration of MV＞21 days，re-intubation，tracheotomy，ventilator-associated pneumonia，central venous catheter infection，deep venous thrombosis and pressure ulcers）.The influence of BMI on hospital mortality was analyzed.Results No patients were lost to follow up，dropped out of the study or had data loss.The ICU mortality，hospital mortality，mortality after receiving 60-day treatment in the ICU，re-intubation rate，tracheotomy rate，ventilator-associated pneumonia rate，central venous catheter infection rate and deep venous thrombosis rate did not differ significantly between the two groups（P＞0.05）.Patients in obese group had longer duration of MV，longer length of stay in the ICU and length of stay than those in the non-obese group（P＜0.05）.More obese group patients were found with MV for more than 21 days compared with non-obese group ones（P＜0.05）.No pressure ulcer occurred in all patients.BMI was not an independent risk factor for hospital mortality in mechanically ventilated patients〔B=0.041，SE=0.035，OR=1.048，95%CI（0.982，1.118），P=0.158〕.Conclusion Obesity is not an independent risk factor for hospital mortality in mechanically ventilated ICU patients，but it is associated with prolonged duration of MV，increased length of stay in the ICU and length of stay.
【Key words】 Intensive care unit；Ventilation，mechanical；Obesity，abdominal；Root cause analysis
Clinical Efficacy of Docetaxel Alone Versus Docetaxel Combined with Cisplatin in the Treatment of Thymoma with Myasthenia Gravis QI Guo-yan*，LIU Peng，GU Shan-shan，YANG Hong-xia，LIU Chao-ying，ZHANG Xiao-jing
Myasthenia Gravis Treatment Center，the First Hospital of Shijiazhuang，Shijiazhuang 050000，China
*Corresponding author:QI Guo-yan，Professor，Chief physician;E-mail:firstname.lastname@example.org
【Abstract】 Objective To investigate the clinical efficacy of docetaxel alone versus docetaxel combined with cisplatin in the treatment of thymoma with myasthenia gravis（MG），with a view to providing new treatment ideas for clinicians.Methods We enrolled 106 patients who were diagnosed with thymoma and MG and received treatment in the First Hospital of Shijiazhuang from January 2008 to December 2015 and divided them into two groups，group DP（66 cases including 20 with metastatic thymoma after thymoma surgery ） receiving docetaxel combined with cisplatin between January 2008 and January 2015，and group D（40 cases including 17 with metastatic thymoma after thymoma surgery ） receiving docetaxel alone between January 2012 and December 2015.The clinical absolute score was assessed and acetylcholine receptor antibody（AchRAb） level was measured before and after treatment.The clinical efficacy of MG and toxic side effects were observed.Results Before treatment，both groups showed similar clinical absolute scores and AchRAb levels（P＞0.05）;after treatment，they still presented similar clinical absolute scores and AchRAb levels（P＞0.05）.After treatment，the clinical absolute scores and AchRAb levels decreased significantly in group DP as well as group D（P＜0.05）.The effect of treatment for MG did not differ significantly between the groups（P＞0.05）.The incidence of toxic side effects in group DP was higher than that in group D（P＜0.05）.Conclusion For thymoma with MG，docetaxel alone and docetaxel combined with cisplatin can achieve similar clinical efficacy，but docetaxel has less side effects.
【Key words】 Thymus neoplasms;Myasthenia gravis;Cisplatin;Treatment outcome
Aspects Prioritized by Nursing Undergraduates During Choosing a Position in Grassroots Medical Institutions Analyzed Based on the Discrete Choice Experiment WU Di1，SHI Yue2，WU Shuang2*
1.Nursing Department，Tangshan Gongren Hospital，Tangshan 063000，China
2.College of Management，North China University of Science and Technology，Tangshan 063000，China
*Corresponding author:WU Shuang，Lecturer;E-mail:email@example.com
【Abstract】 Background Hierarchical medical system is the top task among the five key tasks of China′s healthcare reform during the 13th Five-Year Plan period.However，the unsatisfied qualification and professional capabilities in primary healthcare providers have become the major obstacles in implementing the hierarchical medical system efficiently.So how to attract and retain high-quality healthcare providers is a significant issue that needs to be resolved during the implementation of the system.11111111Objective To investigate and analyze the aspects prioritized by nursing undergraduates during choosing a position in grassroots medical institutions，and based on this，to propose relevant intervening measures.Methods We conducted a survey in 164 eligible nursing undergraduates who took internship in a tertiary grade A hospital in Tangshan，China with a discrete choice experiment questionnaire in March 2017.The data of the survey were analyzed with mixed-effects logistic regression models.Results Of the 164 questionnaires handed out，153（93.3%） were responsive，the other 11 were irresponsive assessed by logical error correction.The results of the survey showed that，the aspects prioritized by nursing undergraduates during choosing a position in grassroots medical institutions were as follows in the descending order:monthly income，children′s educational conditions，staffing，working place，working conditions，time needed to get the personal promotion in professional and technical title and systematic training opportunity（P＜0.05）.When given the premises that included：monthly income of 2 000 yuan，working in rural areas，no staffing，poor educational conditions for children，5 years needed to get the personal promotion in professional and technical title，no systematic training opportunities，inadequate equipments and facilities，75% of the nursing undergraduates were reluctant to work at the grassroots medical institutions，but if the educational conditions for children were improved，then the percentage slumped to 38%.Conclusion Discrete selection experiment is a method suitable for analyzing the working preference of nursing undergraduates.The factors that affect nursing undergraduates′ intentions to work in grassroots medical institutions consist of both economic and noneconomic factors.Therefore，an effective package of policy interventions should be developed aiming at this population.
【Key words】 Nursing staff；Nursing services；Discrete choice experiments；Primary health work；Preference
Protective Effects of Medicated Serum of Liuwei Dihuang Pill on Aβ25-35-injured Rat PC12 Cells SONG Jun-ying1，YUAN Yong1，WANG Cong-xiao2，ZHANG Zhong-yun1，GONG Hong-tao3，ZHANG Zhen-qiang1*，LIU Wen-di1，GAO Ai-she4
1.Immunology Laboratory of Chinese Medicine，Henan University of Chinese Medicine，Zhengzhou 450046，China
2.The Third Affiliated Hospital of Henan University of Chinese Medicine，Zhengzhou 450008，China
3.The First Affiliated Hospital of Henan University of TCM，Zhengzhou 450000，China
4.School of Basic Medical Sciences，Henan University of Chinese Medicine，Zhengzhou 450046，China
*Corresponding author:ZHANG Zhen-qiang，Professor;E-mail:firstname.lastname@example.org
【Abstract】 Objective To explore the effects and mechanisms of Liuwei dihuang pill（LDP） in the prevention and treatment of alzheimer disease （AD） by studying the protective effects of medicated serum of Liuwei Dihuang Pill （MSLDP） on rat adrenal pheochromocytoma cells （PC12） injured by amyloid-beta peptide 25-35（Aβ25-35）.Methods This study was conducted from March 2012 to April 2013.Twenty SPF grade SD male rats were selected and divided into the control group and the drug group according to the random number table，10 for each group.MSLDP and Aβ25-35 were prepared.According to the intervention concentration of Aβ25-35 and MSLDP，PC12 cells in logarithmic growth phase were taken and divided into 0，10，20，40 μmol/L Aβ25-35 group and 0%，2.5%，5.0%，10.0%，20.0%，30.0% MSLDP group.Then we took other PC12 cells in logarithmic growth phaseand divided into the normal control group （without the intervention of Aβ25-35 and MSLDP），model group （receiving intervention of 20 μmol/L Aβ25-35 for the preparation of AD model），and MSLDP intervention group （receiving intervention of 20% MSLDP + 20 μmol/L Aβ25-35）.The survival rate of PC12 cells in all the groups was detected by MTT.Then we took other PC12 cells in logarithmic growth phase and obtained the same groups by using the above grouping methods and steps.The morphology of PC12 cells in all MSLDP groups，normal control group，model group and MSLDP intervention group were observed under the microscope.The express ion level of vascular endothelial growth factor B （VEGF-B） in PC12 cells in these groups was detected by western blotting.Results The survival rate of PC12 cells in 0 μmol/L Aβ25-35 group was higher than that in the other three Aβ25-35 treated groups（P＜0.05）;the survival rate of PC12 cells in 10 μmol/L Aβ25-35 group was higher than that of 20，40 μmol/L Aβ25-35 group（P＜0.05）;the survival rate of PC12 cells in 20 μmol/L Aβ25-35 group was higher than that of 40 μmol/L Aβ25-35 group（P＜0.05）.The protein expression of VEGF-B was higher in 0，10 μmol/L Aβ25-35 group than in the 20，40 μmol/L Aβ25-35 group（P＜0.05），and it was higher in the 20 μmol/L Aβ25-35 group than in the 40 μmol/L Aβ25-35 group（P＜0.05）.The survival rate of PC12 cells was lower in the 0% MSLDP group than that in other MSLDP groups （P＜0.05）;the survival rate of PC12 cells in the 2.5% MSLDP group was lower than that of the 5.0%，10.0%，20.0%，30.0% MSLDP group（P＜0.05）;the survival rate of PC12 cells in the 5.0% MSLDP group was lower than that of 10.0%，20.0%，30.0% MSLDP group（P＜0.05）;the survival rate of PC12 cells in the 10.0% MSLDP group was lower than that of the 20.0%，30.0% MSLDP group（P＜0.05）；the survival rate of PC12 cells in the 20.0% MSLDP group was lower than that of the 30.0% MSLDP group（P＜0.05）.Microscope observation showed that，the PC12 cells in the 0% MSLDP group were regular in shape and uniform in size;the PC12 cells in 2.5%，5.0% MSLDP group were increased but with normal shape;PC12 cells in 10.0%，20.0%，30.0% MSLDP group displayed aggregated and lamellar growth with small protrusions on the edge and differentiated trend.The protein expression of VEGF-B was lower in 0%，2.5%，5.0% MSLDP group than that in 10.0%，20.0%，30.0% MSLDP group（P＜0.05），and it was lower in the 10.0% MSLDP group than in 20.0% MSLDP group（P＜0.05），but it was higher in the 20.0% MSLDP group than in the 30.0% MSLDP group（P＜0.05）.The survival rate of PC12 cells was higher in the normal control group and MSLDP intervention group than that in the model group（P＜0.05）.Microscope observation demonstrated that，the PC12 cells in the normal control group were regular in shape and uniform in size;the PC12 cells in the model group were reduced and irregular，presenting cellular atrophy or death as well as cellular debris;the PC12 cells in MSLDP intervention group were significantly increased，and part of them were stretched with protrusions.The protein expression of VEGF-B in normal control group was higher than that in the model group and MSLDP intervention group（P＜0.05）;the protein expression of VEGF-B in model group was lower than that of MSLDP intervention group（P＜0.05）.Conclusion MSLDP can increase theactivity of the Aβ25-35-injured PC12 cells and protect them，the mechanism might be related to the increase of the protein expression of VEGF-B.
【Key words】 Alzheimer disease;Liuwei dihuang decoction;Vascular endothelial growth factors;Amyloid beta-peptides
Effect of Sanhuangtangshenkang Granule on the Micro Inflammatory State in Early Diabetes Nephropathy Model Rats XI Yue1，LI Jing-lin2*
1.The Third Affiliated Hospital of Jinzhou Medical University，Jinzhou 121000，China
2.Liaoning University of Traditional Chinese Medicine，Shenyang 110032，China
*Corresponding author:LI Jing-lin，Professor，Chief physician;E-mail:email@example.com
【Abstract】 Objective To explore the effect of Sanhuangtangshenkang granule on the micro inflammatory state in rats with early diabetes nephropathy.Methods The study was conducted from August to October in 2012.The study animals were 90 grade SPF Wistar rats，female and male were half and half.10 rats were randomly selected as normal control group and fed with conventional pellet feed.The remaining 80 rats were randomly divided into model group，western medicine group，traditional Chinese medicine prevention group，traditional Chinese medicine low dose group and traditional Chinese medicine high dose group.There were 16 rats in each group，and they were fed with high fat and high sugar diet.One week later，all the rats in each group were given intraperitoneal injection of streptozotocin（STZ） solution 42 mg/kg，except for the normal control group，in order to induce diabetic model.8 rats failed to make the model;the remaining 72 rats were collected 24 h urine after 2 weeks to detect urinary microalbumin（MALB） to determine whether the early diabetic nephropathy model was successful，among them 6 rats failed to make diabetic nephropathy model.In the course of the experiment，3 rats in the model group died，1 rat in the western medicine group died，2 rats in the traditional Chinese medicine low dose group and high dose group of died，respectively.Both the normal control group and model group were given distilled water by gavage.The rats in traditional Chinese medicine prevention group began the administration at the beginning of the success of early diabetic nephropathy model，and continued for 10 weeks;the other groups were given corresponding medicine by gavage 2 weeks after the model success，and continued for 8 weeks.The western medicine group was given benazepril gavage，the traditional Chinese medicine high dose group used the liquid medicine of 3.84 g/ml Sanhuangtangshenkang concentration，the traditional Chinese medicine prevention group and the traditional Chinese medicine low dose group used the liquid medicine of 1.28 g/ml Sanhuangtangshenkang concentration.After the experiment，fasting blood glucose（FBG），glycosylated hemoglobin type A1c（HbA1c），microalbuminuria（MALB），β2 microglobulin（β2-MG），serum creatinine（Scr），blood urea nitrogen（BUN），C-reactive protein（CRP）in serum and renal tissues，renal tissue nuclear factor κB（NF-κB），monocyte chemoattractant protein-1（MCP-1）and cell surface chemokine receptor 2（CCR2） mRNA and protein expression levels were detected in all rats.The renal pathological morphological changes were observed under light microscope（HE staining and PAS staining）.Results The FBG，HbA1c and MALB in model group，western medicine group，traditional Chinese medicine prevention group，low dose group and high dose group were higher than those in normal control group（P＜0.01）.The FBG，HbA1c，MALB，CRP in serum and kidney tissues，expression levels of NF-κB，MCP-1 and CCR2 mRNA and protein in kidney tissues in western medicine group，traditional Chinese medicine prevention group，low dose group，high dose group were lower than those in the model group（P＜0.01）.The FBG and MALB in traditional Chinese medicine prevention group were lower than those of western medicine group，traditional Chinese medicine low dose group and high dose group（P＜0.05）.The levels of BUN in normal control group，western medicine group，traditional Chinese medicine prevention group，low dose group and high dose group were lower than that in model group（P＜0.01）.The BUN in the traditional Chinese medicine low dose group was higher than that in the normal control group（P＜ 0.05）.The CRP in serum and kidney tissues，expression levels of NF-κB，MCP-1 and CCR2 mRNA and protein in kidney tissues in model group were higher than those in normal control group（P＜ 0.01）.The expression levels of NF-κB mRNA and protein in kidney tissues in traditional Chinese medicine low dose group and high dose group were higher than those in traditional Chinese medicine prevention group（P＜ 0.01）.The expression levels of NF-κB mRNA and protein in kidney tissues in western medicine group were higher than those in traditional Chinese medicine prevention group，while lower than those in traditional Chinese medicine low dose group（P＜ 0.01）.The expression levels of MCP-1 and CCR2 mRNA and protein in the rat kidney tissues in traditional Chinese medicine prevention group were significantly lower than those in western medicine group and traditional Chinese medicine low and high dose group（P＜ 0.05）.The expression levels of MCP-1 and CCR2 mRNA and protein in western medicine group were lower than those in traditional Chinese medicine low and high dose group（P＜ 0.05）.The renal pathological changes degree of rats in western medicine group，traditional Chinese medicine prevent group，traditional Chinese medicine low and high dose group were significantly lighter than that in the model group.Conclusion Sanhuangtangshenkang granule could effectively reduce FBG，HbA1c，MALB，BUN，CRP in serum and renal tissues of rats with diabetic nephropathy model，down regulate the mRNA and protein expression levels of NF-κB，MCP-1 and CCR2，improve the renal morphological and pathological changes and alleviate the micro inflammatory state of diabetic nephropathy.
【Key words】 Diabetic nephropathies;Rats;Inflammation;Sanhuangtangshenkang granule
Mechanism of Catgut Implantation at Acupoints for the Protection of Myocardium from Ischemia-reperfusion Injury in Hyperlipidemia Rats with Type 2 Diabetes Mellitus WANG Yi-ming1*，ZHANG Xin-xin2，SHU Yan-ye1
1.Department of Acupuncture and Moxibustion，Affiliated Hospital of Jiangsu University，Zhenjiang 212001，China
2.Jiangsu University Hospital Workers，Zhenjiang 212013，China
*Corresponding author:WANG Yi-ming，Attending TCM doctor；E-mail:firstname.lastname@example.org
【Abstract】 Objective To explore the mechanism of catgut implantation at acupoints for the protection of myocardium from ischemia-reperfusion injury in hyperlipidemia zucker diabetic fatty （ZDF）rats，models of type 2 diabetes mellitus，in order to provide a theoretical basis for clinical treatment.Methods This study was conducted during January 2015 to May 2016.Twenty-four ZDF rats were selected and randomly divided into control group，ischemia reperfusion （IR） group，ischemic pretreatment （IP） group and catgut implantation （CI） group，with 6 in each.On the 7th day after one week of adaptive feeding，myocardial tissues of the control group were taken out via thoracotomy，the other three groups were used for establishing IR models after ligation of the left anterior descending coronary artery.IR group first received myocardial ischemia treatment for 30 min，then received reperfusion for 60 min.IP group received 3 rounds of 5-min myocardial ischemia treatment and 5-min reperfusion，then received 30-min myocardial ischemia treatment and 60-min reperfusion.CI group received the same treatment given to IR group except on the first day after one week of adaptive feeding，they received catgut implantation at Neiguan，Danzhong，and Xinshu acupoints.The ultrastructure and level of autophagy of myocardium of ZDF rats were observed by transmission electron microscope.Western blotting was used to detect the levels of myocardial endoplasmic reticulum stress-related protein glucose-regulated protein 78 （GRP78） and autophagy-related protein Beclin-1.The levels of myeloperoxidase （MPO） and malondialdehyde （MDA） were measured by enzyme-linked immunosorbent assay （ELISA）.Results Transmission electron microscope observation showed that，the control group demonstrated normal mitochondria and cardiomyocytes without many autophagysomes;IR group presented significantly swollen mitochondria and cardiomyocytes with ruptured cell membrane and leaked contents，leaving vacuoles or cavities and a small amount of autophagic vacuoles.Compared with IR group，the myocardial cell ultrastructural damage in IP and CI groups was lighter and the number of autophagic vacuoles was significantly increased.The myocardial cell ultrastructural damage in IR group was the most serious，even there were no many autophagic vacuoles.The levels of GRP78，Beclin-1，MPO and MDA were significantly lower in the control group than in the other three groups （P＜0.05）.IR group had lower levels of GRP78 and Beclin-1 but higher levels of MPO and MDA compared with IP and CI groups （P＜0.05）.Conclusion Catgut implantation at Neiguan，Danzhong，and Xinshu acupoints may play a role in the protection of myocardium from ischemia-reperfusion injury by increasing the levels of GRP78 and Beclin-1.
【Key words】 Reperfusion injury;Rats;Endoplasmic reticulum stress;Autophagy;Ischemic pretreatment，myocardium;Catgut implantation at acupoints
Common Psychological Problems and Influencing Factors Among the Community-dwelling Elderly in Shanghai CHEN Yu-ming，ZHUANG Xiao-wei*，LIU Han，YU Qi-sang
Jing′an Mental Health Center，Shanghai 200040，China
*Corresponding author:ZHUANG Xiao-wei，Attending doctor;E-mail:email@example.com
【Abstract】 Objective To explore the common psychological problems and influencing factors in the community-dwelling elderly in Shanghai，China，in order to offer a reference for delivering community-based mental health services for the elderly.Methods Using cluster random sampling，600 individuals aged 60 or over were chosen as the participants from 6 neighborhood committees located in Jing′an District，Shanghai from October 15 to December 30，2015.They were surveyed by a self-administered questionnaire and a face-to-face interview.The questionnaire consists of influencing factors including demographic data（gender，age，education level，occupation），living habits and health status（smoking history，drinking history，tea drinking history，prevalence of exercising，hobby，diet，gerontic nap habit） and functional evaluation〔Ascertain Dementia 8-item Informant Questionnaire（AD8，Chinese version），Self-rating Anxiety Scale（SAS，Chinese version），Geriatric Depression Scale（GDS，Chinese version），Social Support Rating Scale（SSRS，Chinese version） and Activities of Daily Living Scale（ADL，Chinese version）〕.Results The survey achieved a response rate of 100.0%.Among the 600 participants，there were 68 cases of memory dysfunction（11.3%），56 cases of anxiety disorders（9.3%），and 65 cases of depressive disorders（10.8%）.Multivariate Logistic regression analysis was conducted and the results revealed that gender，age，education level，occupation，tea drinking，exercising，hobby，diet（plant-based diet），gerontic nap habit，SSRS score，subjective support score，obvious impairment of daily life ability and varying degrees of daily life ability decline were the influencing factors for memory dysfunction in the elderly（P＜0.05）.Gender，age，education level，occupation，exercising，hobby，diet，gerontic nap habit，SSRS score，subjective support score，objective support score and obvious impairment of daily life ability and varying degrees of daily life ability decline were the influencing factors of anxiety disorders in the elderly（P＜0.05）.Gender，age，education level，occupation，exercising，hobby，diet，gerontic nap habit，SSRS score，subjective support score，objective support score，utilization of support score，obvious impairment of daily life ability and varying degrees of daily life ability decline were influencing factors of depressive disorders（P＜0.05）.Conclusion The prevalence of memory dysfunction，anxiety disorders and depressive disorders were respectively 11.3%，9.3%，10.8% in the community-dwelling elderly in Jing′an District，Shanghai，which are significantly associated with unhealthy lifestyles.Therefore，it is suggested that such a population should develop a healthy lifestyle，appropriately exercise more and drink more tea，take a nap，maintain daily work habits，which can keep them healthy and prevent mental illness，thereby the achievement of healthy aging can be promoted.
【Key words】 Aged;Psychophysiologic disorders;Cross-sectional studies；Root cause analysis
Self-rated Health and Associated Factors in Traffic Policemen with Different Lifestyles in Guangdong Province WU Zhi-hua1*，WU Wei-xuan2，XU Jun2，ZHANG Jin-hua3
1.Department of Scientific Research，Nanfang Hospital，Southern Medical University，Guangzhou 510515，China
2.Department of Health Economics and Management，Nanfang Hospital，Southern Medical University，Guangzhou 510515，China
3.Department and Planning Department，Southern Medical University，Guangzhou 510515，China
*Corresponding author:WU Zhi-hua，Associate professor；E-mail：firstname.lastname@example.org
【Abstract】 Objective To investigate the self-rated health and associated factors in traffic policemen with different lifestyles in Guangdong Province.Methods This cross-sectional study was carried out from August 2014 to August 2015.The initially enrolled 1 100 traffic policemen were selected from 4 traffic police brigades in Guangzhou，Shenzhen，Zhongshan and Foshan in Guangdong Province by stratified random sampling.They were surveyed anonymously by Traffic Policemen Health Survey Questionnaire consisting of sociodemographic data，lifestyle，and Self-rated Health Measurement Scale（SRHMS V1.0）.Multiple linear stepwise regression analysis was performed to investigate the associated factors for the total score of SRHMS V1.0.Results The survey achieved a response rate of 82.4%（907/1 100）.The average total score of SRHMS V1.0 and average scores of its 3 subscales，Self-rated Physical Health，Self-rated Mental Health，and Self-rated Social Functioning respectively were（66.5±14.5），（71.5±14.8），（60.1±17.2），（67.4±17.7）.The average total score of SRHMS V1.0 and average scores of its 3 subscales，Self-rated Physical Health，Self-rated Mental Health，and Self-rated Social Functioning significantly varied by smoking prevalence，alcohol prevalence，breakfast prevalence，status of nutrition，dietary pattern，duration of noon catnap，duration of sleep，status of physical exercise，staying up late prevalence（P＜0.05）.Stepwise multiple linear regression analysis found that，age （β=-0.177，t=-3.126，P=0.002），status of nutrition（β=4.715，t=6.874，P＜0.001），dietary pattern（β=-3.088，t=-2.935，P=0.003），duration of sleep（β=4.988，t=6.632，P＜0.001），status of physical exercise（β=1.750，t=4.363，P＜0.001）and staying up late（β=-2.547，t=-3.614，P＜0.001）were the associated factors for the total score of SRHMS V1.0 of the traffic policemen.Conclusion The results of the survey indicate that the traffic policemen in Guangdong Province are in fair health generally although some of them have unhealthy lifestyles.Age，status of nutrition，dietary pattern，duration of sleep，status of physical exercise and staying up late are associated factors for the selfrated health of traffic policemen.Therefore，it is necessary to carry out health education and advocate healthy behaviors in this population.
【Key words】 Life style;Health status；Cross-sectional studies；Root cause analysis；Traffic policemen
Diagnostic Value of High Frequency Ultrasound in Scrotal Diseases in Male Infertility Patients with Non-sexual Dysfunction LIU Gui-mei1，GE Hui-yu1*，RAN Wei-qiang1，CHEN Wen1，FANG Nan-ning1，MENG Xiu-feng2
1.Department of Ultrasound，Peking University Third Hospital，Beijing 100191，China
2.Department of Ultrasound，Hospital of Tsinghua University，Beijing 100084，China
*Corresponding author:GE Hui-yu，Associate professor，Chief physician;E-mail:email@example.com
【Abstract】 Objective To investigate the diagnostic value of high frequency ultrasound in scrotal diseases in male infertility patients with non-sexual dysfunction.Methods The scrotal high frequency ultrasound examination results and image characteristics of male infertility patients with non-sexual dysfunction in Peking University Third Hospital were retrospectively analyzed from January 2014 to January 2016，mainly including the morphology，internal echo，hemodynamics and other information of testis，epididymis，scrotal part of vas deferens，testis vagina tunic cavity and spermatic vein.Results A total of 1 645 cases of male infertility were selected，and the abnormal rate was 76.8%（1 264/1 645） by high frequency ultrasonography.The abnormal rate of testis was 35.0%（575/1 645），including 249 cases（15.1%） of small testis，95 cases（5.8%） of heterogeneous testicular parenchyma echo，etc.The abnormal rate of epididymis was 59.9%（986/1 645），including 582 cases（35.4%） of epididymal cyst，153 cases（9.3%） of increased epididymis volume，etc.The abnormal rate of scrotal part of vas deferens was 1.8%（29/1 645），including thickening，dilatation，stenosis and occlusion in vas deferens scrotum segment;the abnormal rate of testis vagina tunic cavity was 4.4%（73/1 645），including 52 cases（3.2%） of hydrocele of tunica vaginalis and 21 cases（1.3%） of lithiasis of tunica vaginalis;the rate of varicocele was 34.5%（567/1 645），including 396 cases（24.1%） on the left side，147 cases（8.9%） on the bilateral sides，24 cases（1.5%） on the right side.Conclusion The normal and abnormal sonogram of testis，epididymis and scrotal part of vas deferens，testis vagina tunic cavity and spermatic vein can be clearly demonstrated by the high frequency ultrasound.The scrotal high frequency ultrasonography examination in male infertility patients is helpful for clinical acquisition of diagnosis and treatment basis on some congenital and acquired diseases affecting on male sterility.
【Key words】 Scrotum;Infertility，male;Ultrasonography;Diagnosis
Value of Acoustic Radiation Force Impulse Imaging versus Real-time Shear Wave Elastography in the Diagnosis of Hepatic Fibrosis CHEN Xue-mei1*，JIANG Xiao-ying2，LU Yong-mei1，XIA Liang-hua3
1.Department of Function Examination，Ji′an Hospital，Shanghai East Hospital，Ji′an 331000，China
2.Department of Internal Medicine，Xingan Hospital of Traditional Chinese Medicine，Xingan 331300，China
3.Department of Ultrasound，Tongji University Affiliated Shanghai East Hospital，Shanghai 200120，China
*Corresponding author:CHEN Xue-mei，Associate chief physician;E-mail：firstname.lastname@example.org
【Abstract】 Objective To explore the value of acoustic radiation force impulse imaging（ARFI），versus real-time shear wave elastography（SWE） in the diagnosis of hepatic fibrosis，with a view to providing a reference for clinical work.Methods We enrolled 149 eligible cases diagnosed as chronic liver disease who received treatment in Ji′an Hospital，Shanghai East Hospital from January 2015 to May 2016.The patients′ baseline data were collected，and the liver stiffness（LS） was measured by SWE and ARFI，respectively.According to the results of ARFI，they were divided into group with ARFI-identified LS，and group without ARFI-identified LS.Based on the findings of SWE，they were assigned to group with SWE-identified LS，and group without SWE-identified LS.Comparisons were made between the ARFI-identified groups as well as between the SWE-identified groups in terms of sex distribution，age distribution，BMI and ALT levels.Logistic regression analysis was used to calculate the Logistic regression equation of ARFI and SWE.Ultrasound-guided liver biopsy results were set as the gold standard for assessing the diagnostic value of ARFI，SWE，and ARFI combined with SWE.The receiver operating characteristic（ROC） curve of ARFI，SWE and their combined diagnosis of hepatic fibrosis（stages 2-4，stages 3-4，stage 4） in patients with chronic liver disease were drawn.The area under the ROC curve（AUC），sensitivity and specificity for the diagnosis of hepatic fibrosis was assessed with ROC analysis.Results The rate of LS identified by ARFI was higher than that by SWE（P＜0.05）.Sex distribution，age distribution，BMI and ALT levels did not differ significantly between group with ARFI-identified LS and group without ARFI-identified LS（P＞0.05）.Both of group with SWE-identified LS and group without SWE-identified LS were found with similar sex distribution，age distribution，and ALT levels（P＞0.05）.Patients in group with SWE-identified LS were observed to have lower BMI compared with those in the group without SWE-identified LS（P＜0.05）.For the diagnosis of hepatic fibrosis in stages 2-4 in chronic liver disease，the AUC of ARFI，SWE and ARFI combined with SWE were 0.936〔95%CI（0.895，0.978）〕，0.837〔95%CI（0.754，0.919）〕，0.972〔95%CI（0.949，0.995）〕，respectively，the cut-off value of them were 1.32 m/s，17.14 kPa，-9.228，respectively，the sensitivity of them were 87.8%，80.0%，91.1%，respectively，and the specificity of them were 97.3%，83.8%，91.9%，respectively.For the diagnosis of hepatic fibrosis in stages 3-4 in chronic liver disease，the AUC of ARFI，SWE and ARFI combined with SWE were 0.915〔95%CI（0.859，0.970）〕，0.867〔95%CI（0.796，0.938）〕，0.910〔95%CI（0.851，0.968）〕，respectively，the cut-off value of them were 1.45 m/s，25.36 kPa，7.114，respectively，the sensitivity of them were 90.9%，85.5%，90.9%，respectively，and the specificity of them were 88.9%，87.5%，91.7%，respectively.For the diagnosis of hepatic fibrosis in stage 4 in chronic liver disease，the AUC of ARFI，SWE and ARFI combined with SWE were 0.860〔95%CI（0.746，0.974）〕，0.948〔95%CI（0.902，0.993）〕，0.975〔95%CI（0.949，1.000）〕，respectively，the cut-off value of them were 1.52 m/s，38.54 kPa，1.878，respectively，the sensitivity of them were 88.0%，96.0%，96.0%，respectively，and the specificity of them were 92.2%，93.1%，91.2%，respectively.In terms of identifying hepatic fibrosis in stages 2-4 or stages 3-4 in chronic liver disease，ARFI had larger AUC than SWE（P＜0.05），but for identifying hepatic fibrosis in stage 4，its AUC was smaller than that of SWE（P＜0.05）.As for identifying hepatic fibrosis in stages 2-4 or stage 4 in chronic liver disease，ARFI had smaller AUC than ARFI combined with SWE（P＜0.05），but for identifying hepatic fibrosis in stages 3-4，its AUC was similar to that of ARFI combined with SWE（P＞0.05）.As regards identifying hepatic fibrosis in stages 2-4，stages 3-4 or stage 4，the AUC of SWE was smaller than that of ARFI combined with SWE（P＜0.05）.Conclusion The value of ARFI combined with SWE in diagnosing hepatic fibrosis is better than that of ARFI or SWE alone.
【Key words】 Liver cirrhosis；Liver fibrosis；Ultrasonography；Diagnosis；Acoustic radiation force impulse imaging；Real-time shear wave elastography
Diagnosis and Treatment for 23 Cases of Hemorrhagic Fever with Renal Syndrome and Sinus Bradycardia XU Lu1，LIU Lei2，ZHANG Nan2，LI Xin-jian3*
1.Hematology Department，Affiliated Hospital of Jining Medical University，Jining 272000，China
2.General Medicine Department，Affiliated Hospital of Jining Medical University，Jining 272000，China
3.Nephrology Department，Affiliated Hospital of Jining Medical University，Jining 272000，China
*Corresponding author:LI Xin-jian，Chief physician;E-mail：email@example.com
【Abstract】 Objective To explore the clinical characteristics，treatment and prognosis of hemorrhagic fever with renal syndrome（HFRS） complicated with sinus bradycardia.Methods We performed a retrospective cohort study of 110 patients with HFRS at the Affiliated Hospital of Jining Medical University from January 2014 to January 2016，including 23 patients complicated with sinus bradycardia（experimental group） and 87 with no sinus bradycardia（control group）.We obtained and compared the results of blood routine test，cardiac enzyme test，electrolyte markers，liver and kidney function markers of the control group and those of the experimental group measured before the onset of sinus bradycardia，as well as analyzed the diagnosis and treatment of the experimental group.Results The values of blood platelet and HCO3- were lower but the value of fasting blood glucose（FBG） was higher in the experimental group compared with those of the control group（P＜0.05）.However，the values of the other markers were similar in both groups（P＞0.05）.Of the experimental group 14 males and 9 females with a mean age of（42.4±13.0） years，17 were mild HFRS cases，5 were moderate cases and 1 was severe case;the stage that HFRS patients got the sinus bradycardia was:polyuria stage（78.3%，n=18），oliguria stage（8.7%，n=2），fervescence stage（8.7%，n=2），hypotension shock stage（4.3%，n=1）;sinus bradycardia occurred frequently within（8.2±2.0） days after the fever，but the heart beats returned to the reference range values after symptomatic treatment for（6.2±2.2） days.Conclusion The blood platelet，HCO3- and FBG of patients with HFRS complicated with sinus bradycardia are abnormal.If the patients receive systematic treatment，as the primary disease is relieved，the heart beats will return to the reference range values，and they will have a good prognosis.
【Key words】 Hemorrhagic fever with renal syndrome;Bradycardia;Prognosis
Clostridium Difficile Infection Associated with Helicobacter Pylori Eradication:a Case Report and Literature Review TAO He-qing，YAN Xiu-e*
Gastroenterology Department，Peking University Third Hospital，Beijing 100191，China
*Corresponding author:YAN Xiu-e，Associate chief physician；E-mail:firstname.lastname@example.org
【Abstract】 Clostridium difficile infection（CDI） is one serious complication associated with Helicobacter pylori eradication clinically characterized by changes in stool frequency and consistency and even pseudomembranous colitis when it is severe.However，this is not being well understood by many doctors.We reported a case of secondary CDI following the Helicobacter pylori eradication therapy，and reviewed some articles in which the manifestations and possible mechanism of CDI secondary to the Helicobacter pylori eradication therapy were reported，in order to raise doctors′ vigilance to this disease.
【Key words】 Helicobacter pylori；Bacillaceae infections
Posterior Mediastinal Inflammation Accompanied with Hematoma:a Case Report and Review of the Literature WANG Bin-bin，HAN Yi-ping*
Department of General Medicine，Changhai Hospital，the Secondary Military Medical University，Shanghai 200433，China
*Corresponding author:HAN Yi-ping，Professor，Chief physician；E-mail：email@example.com
【Abstract】 Posterior mediastinal inflammation with hematoma is one special type of non-tumor occupying diseases in the mediastinum.The sites and onset modes of it vary among the sick，while chest pain is the first and most common clinical manifestation.And it is easily confused with other common diseases in mediastinum such as tumor，tuberculosis，cyst and so on，which results in misdiagnosis and diagnostic errors.In order to improve the clinicians′ awareness level of non-space-occupying lesion in the posterior mediastinum and to reduce the misdiagnosis and mistreatment，in this paper，we summarized the clinical features of this disease，including the hematoma location，incentives，the basic disease，mode of onset，causes of bleeding，clinical symptoms，misdiagnosis and main examinations，treatment and prognosis based on reporting the clinical diagnosis and treatment of one case of posterior mediastinal inflammation with hematoma combined with the related literature review.
【Key words】 Mediastinis;Hematoma;Mediastinal neoplasms;Anticoagulants；Case reports
Recent Advances in the Methods for Smoking Cessation GUO Shi-tian1，LIN Hui2，CHI Ju-fang2*
1.Department of Clinical Medicine，Hangzhou Normal University School of Medicine，Hangzhou 311121，China
2.Department of Cardiology，Shaoxing People′s Hospital;Shaoxing Hospital of Zhejiang University，Shaoxing 312000，China
*Corresponding author:CHI Ju-fang，Chief physician;E-mail：firstname.lastname@example.org
【Abstract】 Smoking is the biggest factor harmful to health but is controllable.Smoking cessation may reduce the risk of cancer and cardiovascular disease.We systematically reviewed relevant studies for smoking cessation interventions，including behavioral interventions，smoking cessation outpatient treatment，drug treatment，Chinese medicine therapy，electronic cigarettes，the latest nicotine vaccine，and summarized the advantages and insufficiencies of each method，then，put forward that comprehensive treatment based on multiple smoking cessation methods may be an effective therapy for smoking cessation.
【Key words】 Smoking cessation；Tobacco use cessation products；Review
Recent Developments in Demoralization Syndrome of Cancer Patients ZHANG Li-li1*，ZHAO Qian-qian1，YANG Zhi-hui1，FANG Jun-kai2
1.School of Nursing，Southern Medical University，Guangzhou 510515，China
2.Department of Psychiatry，Mackay Memorial Hospital，Taipei 112，China
*Corresponding author:ZHANG Li-li，Professor，Doctoral supervisor；E-mail:email@example.com
【Abstract】 Demoralization syndrome is a clinical syndrome of persistent pain with the loss of life meaning，which is common among cancer patients.Although it has not been recorded as a new diagnosis in the ICD and（or） DSM system，foreign scholars have already tried to explain its content from multi-aspects，and there are certain achievements in the development of assessment instruments.However，there are few related studies in China，only the Taiwan scholars have systematically studied the symptom disorder.We reviewed the history of concept and application of assessment instruments about demoralization syndrome in cancer patients，in the hope of causing the attention of domestic scholars in this field research.
【Key words】 Neoplasms；Demoralization syndrome;Review
Research Status of Epidemiology and Risk Factors of Hypos