July 2019, Volume 22，No.21 Abstracts（A）
Author：尹鹏 Source：CGP Published： [07-05] views： 321
Interpretation of the 2018 ESC/ESH Guidelines for the Management of Arterial Hypertension CHENG Wenli
Hypertension Department，Beijing Anzhen Hospital，Capital Medical University，Beijing 100029，China
【Abstract】 As the concept of prevention and treatment of cardiovascular diseases has gradually transferred from passive prevention to active prevention，hypertension，a primary risk factor for cardiovascular diseases，has been receiving more and more attention.The 2018 ESC/ESH Guidelines for the Management of Arterial Hypertension released at the 2018 European Society of Cardiology Congress was based on recent clinical evidence of the benefits of anti-hypertension treatment for cardiovascular diseases.Compared with the 2013 version，hypertension management and control have been significantly updated in the new guidelines，but some previous ideas are still being followed.The new guidelines comprehensively and detailedly elaborates the hypertension diagnosis，blood pressure measurement，risk stratification of hypertension，initiation of antihypertensive treatment，blood pressure treatment targets，hypertension treatment，and management of resistant and secondary hypertension，with efforts intensified in the prevention and control，in particular，the initiation time and threshold value for blood pressure-lowering drug treatment and initiation of drug combination.Besides，priority recommendation of single tablet regimen of fixed compound preparations，and concepts of blood pressure monitoring and comprehensive management in patients with hypertension，are also worthy of clinical reference and learning.
【Key words】 Hypertension；Guidebooks；General practitioners；Blood pressure measurement；Antihypertensive therapy
Recent Advances in Intervention Model of Advance Care Planning for Patients with Advanced Cancer QIU Yeyin，ZHANG Jianghui，MIAO Jiarui，CHEN Liuliu，DENG Renli*
Department of Nursing，the Fifth Affiliated Hospital of Zunyi Medical University，Zhuhai，Zhuhai 519100，China
*Corresponding author：DENG Renli，Professor； E-mail：email@example.com
【Abstract】 Advance care planning，which focuses on the communication process among patients，medical care personnel and family members of patients，can help people with advanced cancer to express their preference of end-of-life care，decrease excessive treatments and improve their quality of life and dignity.It has already become a part of the conventional treatment in many western developed countries.There is no empirical study on the intervention model of patients with advanced cancer in China.This paper reviews the literature on the intervention models of advance care planning to build a local intervention model for patients with advanced cancer and provide basis for empirical research on this topic.
【Key words】 Neoplasms；Advance care planning；Intervention model；Review
LIU Z R，XU X F，XU T，et al．Analysis of collaboration obstacles and corresponding strategy optimization of the diagnosis and treatment of outpatients with mental disorders among general practitioners and psychiatrists based on multiple interviews［J］．Chinese General Practice，2019，22（21）：2530-2537．
Analysis of Collaboration Obstacles and Corresponding Strategy Optimization of the Diagnosis and Treatment of Outpatients with Mental Disorders among General Practitioners and Psychiatrists Based on Multiple Interviews LIU Zhongren1，2，XU Xiaofeng1，XU Tao2，ZHANG Hanzhi3*，YU Dehua3
1.Tongji University School of Medicine，Shanghai 200092，China
2.Wuliqiao Community Health Service Center，Shanghai 200023，China
3.Yangpu Hospital，Tongji University，Shanghai 200090，China
*Corresponding author：ZHANG Hanzhi，Lecturer，Attending physician；E-mail：firstname.lastname@example.org
【Abstract】 Background The incidence of mental illness is increasing，and the cost of curing psychological disorders is burdensome，which sets a higher requirement for today's health service system and mode.The collaborative clinic system of general practitioners（GPs） and psychiatrists is of great value for the diagnosis and treatment of psychological disorders，but the current collaboration in China does not work quite satisfactorily.Objective To discover and analyze the obstacles of the collaborative clinic system of GPs and psychiatrists with the purpose to optimize the collaborative strategies.Methods A total of 20 GPs and 30 patients with mental disorders or their families from one general hospital（H1），two urban community hospitals（H2，H3） and one suburban community hospital（H4），and 10 psychiatrists from the same areas were randomly selected for the investigation and interviews from August 1st to September 30th in 2018.The interview covered five main aspects of interviewee's cognition，behavior，attitude，questions and opinions related to collaborative diagnosis and treatment system.The interview duration was about half an hour and it was recorded.The recording was transcribed electronically.First，each question was coded at the first level.Then，the corresponding content of each encoding was discussed and condensed to generate the descriptive label for further data induction and classification.Then the subjects were generated by classification，and representative interview speeches were cited by the respondents.Results （1）GPs had a certain cognition of the collaborative diagnosis and treatment，but the current collaboration with psychiatrists did not work quite well.GPs thought that collaboration was of great significance，but it still faced multiple difficulties involving channels，resources，doctors and patients.GPs suggested that collaboration could be promoted with varied forms including collaborative resources and forms，and improving GPs' own expertise.（2）The psychiatrists carried out collaborative diagnosis and treatments in community，including community clinics，but they thought that the effects of collaboration were different.They thought the collaboration was necessary and beneficial to patients' physical and mental health，as well as their family and social problems.However，psychiatrists also mentioned that there were various problems and difficulties in the current collaboration from aspects of allocation of resources and patients.They advised that collaboration required more mutual learning and communication，expanded publicity and platform construction.（3）The patients or their family members had little cognition of collaboration，and they agreed with collaboration but lack of active suggestions.Most of patients had not accepted the collaborative diagnosis and treatment and many of them were sent to different medical institutions without standard treatments.The patients mainly relied on psychiatric drugs without suitable prescriptions.There was a need for collaborative clinic system in community，but patients distrusted the GPs.There were also other problems such as the lack of psychiatric drugs，or small prescriptions in community clinics.Conclusion At present，there are problems and obstacles in the collaboration clinic system between GPs and psychiatrists in the diagnosis and treatment of patients with mental disorders，including the incoordinate information and resources between doctors and patients，and lack of effective implementation of collaboration platforms and strategies.The optimization strategies include improving the ability of GP to diagnose and treat mental disorders，improving the collaboration modes and channels，and implementing and utilizing the existing collaboration platforms and resources.Policy encouragement and patient education should also be strengthened.
【Key words】 Mental disorders；Affective disorders，psychotic；General practitioners；Hospitals，Special；
Analysis of Referrals of Outpatients with Psychological Disorders by General Practitioners and Its Influencing Factors XU Xiaofeng1，2，LIU Zhongren1，ZHANG Hanzhi1，3*，YU Dehua1
1.Department of General Practice，Tongji University School of Medicine，Shanghai 200090，China
2.Malu Town Community Health Service Center，Shanghai 201801，China
3.Department of General Practice，Yangpu Hospital，Tongji University，Shanghai 200090，China
*Corresponding author：ZHANG Hanzhi，Lecturer，Attending physician；E-mail：email@example.com
【Abstract】 Background As psychological disorder has caused more and more problems in the society，the cooperative management of its diagnosis and treatment by psychiatric specialists in the general clinic is considered of great value.The referral process，as an important strategy and method for current collaborative diagnosis and treatment，is deficient and difficult to perform in clinical practice，especially for the utilization of referral routes.At present，studies about this issue are lacking.Objective To understand and analyze the referrals of outpatients with psychological disorders by general practitioners（GPs）and its influencing factors to address the basis for the strategic optimization and the effective referral usage.Methods A total of 12 community health service centers/hospitals in Yangpu District，Huangpu District，Putuo District，Pudong New Area，and Jiading District in Shanghai were included by stratified random sampling from August 1st to 30th 2018.According to the inclusion and exclusion criteria，203 general practitioners were selected.A self-designed questionnaire，including GP's demographic characteristics，out-patient referrals，and expected referrals，was used in this study.Results A total of 190 valid questionnaires out of 203 sent questionnaires were collected with an effective recovery rate of 93.6%.Among 190 GPs，138 of them（72.6%）have suggested their patients to the psychiatric department，only 29 GPs（15.3%）have actually referred their patients.The top 3 situations that GPs consider a referral included difficulties in treatment（143 subjects，75.3%），unclear diagnosis（141 subjects，74.2%），and the primary diagnosis of mental problems or symptoms（131 subjects，68.9%）．Eighty-five subjects（44.7%）had experienced difficulties in referrals.The top three factors that influenced referrals were GPs' lacking of diagnostic assurance（149 subjects，79.3%），lacking of connections with the referred psychiatric specialists or institutions（104 subjects，55.3%），and poor compliance of patients or family members（90 subjects，47.9%）．Sixty-five subjects（60.2%）considered the referral route as the online referral platform；55 subjects（28.9%）understood the referral approaches；93 subjects（48.9%）thought that referrals were practical.83 subjects（43.7%）were aware of the supportive policy in general outpatient clinics；and 170 subjects（89.5%）considered that they were obligated to make referrals.Additionally，73 subjects（38.4%）believed that the key types of psychoactive drugs in their general clinics were generally adequate.Results of multivariate Logistic regression analysis showed that understanding the approach of referral，and the referrals' practical usage were key influencing factors（P<0.05）．Of 190 general practitioners，67.4%（128 cases）expected to have referral channels，53.7%（102 cases）expected expert consultation，and 52.1%（99 cases）expected to have joint clinics with specialists.Conclusion A great demand for the referral of patients with psychological disorders in the current general clinics cannot be neglected.However，the actual referral is insufficient.Factors causing the difficulty of referrals are the difficulties and lack of confidence of diagnosis and treatment for psychological disorders，the lack of referral approaches，and poor compliance of patients.The actual referrals are determined by the understanding of the referrals ways，and the practical usage of referrals.
【Key words】 Affective disorders，psychotic；Outpatients；General practitioners；Patient transfer；Root cause analysis
Collaboration Bottlenecks and Strategies of General Practitioners' Diagnosis and Treatment for Outpatients with Mental Disorders Based on Meta-analysis ZHANG Hanzhi1，2，XU Xiaofeng2，LIU Zhongren2，QIAN Jie3，GE Xuhua1，WANG Zhaoxin1，YU Dehua1*
1.Department of General Practice，Yangpu Hospital，Tongji University，Shanghai 200090，China
2.Tongji University School of Medicine，Shanghai 200092，China
3.Department of Psychology，Yangpu Hospital，Tongji University，Shanghai 200090，China
*Corresponding author：YU Dehua，Professor，Chief physician；E-mail：firstname.lastname@example.org
【Abstract】 Background Mental illness seriously endangers the health and life of residents.General practitioners（GPs）' collaborated with the psychiatric specialists is conductive to the diagnosis，treatment and management of mental disorders.But there are still many problems and obstacles in the current collaboration.More optimization strategies still need to be explored.Objective To analyze and explore the collaboration bottlenecks and strategies of GPs' diagnosis and treatment for outpatients with mental disorders，to provide theoretical basis for the application and optimization of strategies，so as to promote the diagnosis and treatment of mental diseases in communities.Methods Searching the title of（“mental” OR “psycho” OR “psychiatry”）AND（“primary care” OR “general practice” OR “general practitioner” OR “family medicine”）in the databases of Web of Science，Pubmed，Elservier，China National Knowledge Infrastructure，WAN-FANGDATA and CQVIP，we retrieved literatures from January 1，2104 to December 31，2017.With the repeated literatures excluded，we analyzed the selected literatures involving the collaboration between general practice and psychiatric department.Results We retrieved 157 literatures.Eight of them involved the significance of collaboration，which mentioned its important values of clinical effects，cost saving，disease management，reducing stigma and discrimination，improving skills of GPs and saving general psychiatric resources.Three of them involved the deficiency of the collaboration status.Seventy-two of the literatures involved the collaboration strategies between general practice and psychiatric department，41 of which mentioned system plans，programs and models，31 of which mentioned other ways and channels of non-system strategies of collaboration; however，collaboration strategies were mostly in the construction stage，and their application effects in practice needed further study.Seventy-four of the literatures involved subjects being treated in general practice and psychiatric department，29 of which mentioned adolescents and children，and the rest of which mentioned other kinds of peoples.Sixteen of the literatures involved influencing factors of collaborations，including aspects of economy，manpower，drug prescription and technology，and obstacles in clinic，economy，duty and supervision.Seven of the literatures involved opinions of collaborations from GPs，psychiatrists，staff and patients.Eleven of the literatures involved the training of collaboration; they reported the cooperation between general practitioners and psychiatric specialists and the training of related knowledge and skills，but its long-term application and development in practice needed further study.Four of the literatures explored the collaboration between general practitioners and psychiatrists.Conclusion GPs had collaboration obstacles and bottlenecks in the diagnosis and treatment of outpatients with mental disorders，including：the inadequacy of GPs' diagnosis and treatment，both GPs and psychiatrists lacking knowledge in collaboration，and many other obstacles influencing the collaboration.This also indicates the optimized strategies lies in program supports and resource optimizing.It is worth noting that the practice and persistence of the collaboration programs is needed.Resource optimization is reflected in rational investment and application of resources related to limited collaboration and policy support.
【Key words】 Affective disorders，psychotic；Outpatients；General practitioners；Hospitals，special；Cooperative behavior；Meta analysis；Bottlenecks；Strategies
Cardiac Rehabilitation Referral Model Based on Internet Plus Tertiary Hospitals and Community Health Centers SHEN Yuqin
Department of Cardiac Rehabilitation，Tongji Hospital of Tongji University，Shanghai 200065，China
【Abstract】 Cardiac rehabilitation has been strongly recommended by international guidelines for its beneficial effects.Referral model between tertiary hospitals and community health service centers is worth exploring，because the community-based cardiac rehabilitation will be the major model.At present，the main hospitals in China to carry out cardiac rehabilitation are tertiary hospitals.In the case of limited rehabilitation hospitals，it is necessary to study the referral mode of cardiac rehabilitation between third-level hospitals and community health centers.This review mainly focused on the existing problems and the solutions of referral model based on the Internet plus tertiary hospitals and community health service centers.We，also put forward personal constructive suggestions. that medical treatment partnership and alliance based on the Internet are feasible referral model of cardiac rehabilitation.The aim was to promote the development of cardiac rehabilitation referral model between third-level hospitals and community health centers based on the Internet.
【Key words】 Cardiology；Rehabilitation；Cardiovascular diseases；Patient transfer；Internet+
Effect of 5-ALA Mediated Photodynamic Therapy Combined with Lapatinib on Breast Cancer Cell：a Potential Strategy to Improve HER2-positive Breast Cancer Therapeutic Efficacy SUN Bei，ZHANG Li，LIU Xiaodong，TONG Zhongsheng*
Department of Breast Medical Oncology，Tianjin Medical University Cancer Institute & Hospital/National Clinical Research Center of Cancer/Key Laboratory of Cancer Prevention and Therapy，Tianjin/Key Laboratory of Breast Cancer Prevention and Therapy，Ministry of Education，Tianjin 300060，China
*Corresponding author：TONG Zhongsheng，Chief physician；E-mail：email@example.com
【Abstract】 Background Photodynamic therapy（PDT）has a good therapeutic effect on proliferative diseases，and it shows high efficiency and small toxic and side effects in anti-tumor treatment.Lapatinib（LAP）is an oral tablet，which mainly acts on human epidermal growth factor receptor 1 and 2（HER1 and HER2），and belongs to double-targeted receptor tyrosine kinase inhibitors.However，the synergistic effect of PDT and LAP is still not clear.Objective To investigate the inhibitory effect and mechanism of PDT with a novel photosensitizer，5-aminolaevulinic acid（5-ALA）on HER2 positive breast cancer cells SKBR3，and to discuss the therapeutic effect of PDT with LAP on HER2-positive breast cancer，providing evidence for the treatment and research of HER2 positive breast cancer.Methods This study was conducted from May 2016 to December 2017.SKBR3 cells were randomly divided into blank control group（without intervention），LAP group〔intervened with LAP of different concentration gradients（0.50，1.00，2.00，5.00，10.00 μmol/L）〕and PDT group〔first intervened with 5-ALA of different concentration gradients（0.25，0.50，1.00，2.00，4.00 mmol/L），then were exposed to laser〕，LAP+PDT group〔first intervened with different concentration gradients of LAP（0.50，1.00，2.00，5.00，10.00 μmol/L），then with different concentration gradients of 5-ALA（0.25，0.50，1.00，2.00，4.00 mmol/L），and later were exposed to laser〕，respectively.Half maximal inhibitory concentration（IC50）of LAP and 5-ALA was calculated，respectively，and their optimal concentrations for LAP，PDT and LAP+PDT subgroups were determined.Cell growth inhibition rates in each group at 24，48 hours after intervention with the optimal concentration were estimated and compared.SKBR3 cells in the log-phase of growth were randomly divided into blank control group（without intervention），LAP group（intervened with 1.00 μmol/L LAP），PDT group（intervened with 1.00 mmol/L 5-ALA，followed by laser irradiation），LAP+PDT group（intervened with 1.00 μmol/L LAP，then 1.00 mmol/L 5-ALA，followed by laser irradiation）．Flow cytometry was used to detect the apoptotic status of each group.In addition，fluorescence intensity of green fluorescent protein and mitochondrial membrane potential were detected by Rhodamine 123，and the expression of HER2 was detected by Western blotting.Results The IC50 of LAP was 1.65 μmol/L，and 1.00 μmol/L（the growth inhibition rate of LAP group was 40.12%）was chosen as the administration concentration of LAP and LAP+PDT groups.The IC50 of 5-ALA was 1.57 mmol/L.The administration concentration of 5-ALA in PDT and LAP+PDT groups was determined as 1.00 mmol/L（the growth inhibition rate of PDT group was 41.23%）．When LAP was 1.00 mmol/L and 5-ALA was 1.00 μmol/L，the growth inhibition rate of LAP+PDT group was 79.71%.Combined treatment Q≈1.23.The growth inhibition rates of LAP，PDT and LAP+PDT groups at 24 and 48 hours were higher than those of blank control group（P<0.05）；the growth inhibition rates of PDT group at 48 hours were higher than those of LAP group（P<0.05）；the growth inhibition rates of LAP+PDT group at 24 and 48 hours were higher than those of LAP group and PDT group（P<0.05）．Compared with the blank control group，the cells in LAP and PDT groups mainly manifested as apoptosis，while those in LAP + PDT group showed obvious apoptosis and necrosis，and the proportion of early apoptosis was very low.The fluorescence intensity of green fluorescent protein in LAP and PDT groups decreased，and that of LAP + PDT group decreased most obviously.Mitochondrial membrane potential in LAP，PDT and LAP + PDT groups was lower than that in blank control group（P<0.05）；mitochondrial membrane potential in PDT group and LAP + PDT group was lower than that in LAP group（P<0.05）；mitochondrial membrane potential in LAP + PDT group was lower than that in PDT group（P<0.05）．The expression of HER2 in blank control group was higher than that of other groups（P<0.05），and it in LAP group was higher than that of PDT and LAP + PDT groups，too（P<0.05），and similar status was found when compared HER2 in PDT group with that of LAP + PDT group（P<0.05）．Conclusion 5-ALA had obvious inhibitory effect on SKBR3 cells，and the inhibitory effect became stronger when PDT was used in combination with LAP.The mechanism is related to the reduction of mitochondrial membrane potential and the expression of HER2 in cancer cells.Therefore，PDT combined with LAP is expected to improve the quality of life and survival rate of HER2-positive breast cancer patients，and has a good application prospect.
【Key words】 Breast neoplasms；Photochemotherapy；Lapatinib；Receptor，epidermal growth factor
Prevalence of Depression and Influencing Factors in Patients with Type 2 Diabetes：a Multi-center Study in Beijing，China WU Yuxiang1，CHENG Yuxia2，LI Lijun2，JIA Junhong3，WANG Wenbo4，GUO Xiaohui5，WU Yanqiao6，LI Yufeng7，LIU Yanjun2，WANG Aihong1，2*
1.Clinical Medicine College of 306th Hospital of PLA，Anhui Medical University，Beijing 100101，China
2.Department of Endocrinology，306th Hospital of PLA，Beijing 100101，China
3.Department of Endocrinology，Fourth Medical Center of PLA General Hospital，Beijing 100853，China
4.Department of Endocrinology，Peking University Shougang Hospital，Beijing 100144，China
5.Department of Endocrinology，Peking University First Hospital，Beijing 100034，China
6.Research Institute of Petroleum Exploration & Development，Beijing 100083，China
7.Department of Endocrinology，Beijing Pinggu Hospital，Beijing 101200，China
*Corresponding author：WANG Aihong，Associate professor，Associate chief physician；E-mail：firstname.lastname@example.org
【Abstract】 Background The prevalence of depression is increasing in the growing diabetic patients.Depression is a mental disorder that not only affects the quality of life，but also is not conducive to the control of diabetes mellitus.Objective To investigate the prevalence and influencing factors of depression in type 2 diabetes mellitus （T2DM） patients in Beijing.Methods From the year 2016 to 2017，we conducted surveys among T2DM outpatients and inpatients in 6 hospitals in Beijing （306th Hospital of PLA，Fourth Medical Center of PLA General Hospital，Peking University Shougang Hospital，Peking University First Hospital，Research Institute of Petroleum Exploration & Development and Beijing Pinggu Hospital）．We used questionnaires in the surveys，which include a general personal information form 〔sociodemographic characteristics，visiting method，number of annual visits，number of hospitalizations in the past 3 years，satisfaction with life quality，duration of T2DM，body mass index （BMI），blood pressure，fasting blood glucose（FBG），glycosylated hemoglobin （HbA1c），hypoglycemic treatment，comorbidities，diabetic complications〕 and two depression scales〔Patient Health Questionnaire Depression Scale （PHQ-9） combined with Hamilton Depression Rating Scale （HAMD-17）〕.The prevalence of depression was evaluated，and the influencing factors were analyzed by univariate and multivariate Logistic regression analysis.Results A total of 635 patients participated in the survey，and 615 of them responded effectively，achieving a response rate of 96.85%.Among the respondents，151（24.55%） were found with depression，and other 464 without（75.45%）．There were significant differences between the depressed and non-depressed respondents in gender ratio，education level，occupation，average monthly household income per person，visiting method，number of hospitalizations in the past 3 years，satisfaction with life quality，systolic blood pressure，hypoglycemic treatment，prevalence of coexistence of cardiovascular disease history，and cerebrovascular disease history，prevalence of diabetic retinopathy，diabetic peripheral neuropathy（DPN），diabetic nephropathy，diabetic angiopathy of lower extremities，and diabetic foot（P<0.05）.Multivariate Logistic regression analysis showed that gender 〔female：OR=2.072，95%CI （1.316，3.262），P<0.05〕，average monthly household income per person 〔>1 500-3 000 yuan：OR=0.201，95%CI （0.077，0.522），P<0.05；>3 000-5 000 yuan：OR=0.172，95%CI （0.072，0.413），P<0.05；>5 000-10 000 yuan：OR=0.365，95%CI（0.160，0.835），P<0.05；>10 000 yuan：OR=0.154，95%CI （0.055，0.429），P<0.05〕，visiting method 〔hospitalization：OR=2.592，95%CI （1.613，4.166），P<0.05 〕，satisfaction with life quality〔OR=0.980，95%CI （0.968，0.993），P<0.05〕，FBG〔OR=1.084，95%CI （1.018，1.154），P<0.05〕，history of cardiovascular disease 〔OR=1.642，95%CI （1.006，2.682），P<0.05〕，DPN 〔OR=3.758，95%CI （2.246，6.287），P<0.05〕，were independent influencing factors of depression in T2DM.Conclusion The prevalence of depression in T2DM patients was 24.55% in Beijing.So psychological screening should be actively conducted in this population，especially those who are women，have low income，a hospitalization，poor level of satisfaction with life quality，poor glycemic control，a history of cardiovascular disease or DPN.
【Key words】 Diabetes mellitus，type 2；Depression；Multicenter study；Root cause analysis；Beijing
Effect of Non-pulmonary Vein Triggers Ablation on Paroxysmal Atrial Fibrillation in Prognosis of Patients with Low Left Ventricular Ejection Fraction CAO Zhongnan1，DU Xinping1*，ZHANG Minghui1，ZHANG Xiangcan1，WU Qinqin2
1.Department of Cardiology，Tianjin Fifth Central Hospital，Tianjin 300450，China
2.The Central Hospital of Wuhan Affiliated to Tongji Medical College， Huazhong University of Science and Technology，Wuhan 430014，China
*Corresponding author：DU Xinping，Chief physician；E-mail：email@example.com
【Abstract】 Background Non-pulmonary vein triggers ablation combined with pulmonary vein isolation can effectively reduce postoperative complications，but its efficacy and long-term outcome on atrial fibrillation in patients with low left ventricular ejection fraction（LVEF） were still unclear.Objective To investigate the effects of non-pulmonary vein triggers ablation on prognosis in patients with atrial fibrillation and low LVEF and its influencing factors.Methods A total of 307 patients with paroxysmal atrial fibrillation who underwent primary catheter ablation admitted to Tianjin Fifth Central Hospital from December 2015 to January 2016 were enrolled and divided according to their LVEF：LVEF≤40 % were in groupⅠ（83 cases），LVEF >40.00% in groupⅡ（224 cases）；the patients in groupⅠwere further divided intoⅠA subgroup（41 cases，non-pulmonary vein triggers ablation combined with pulmonary vein isolation） andⅠB subgroup（42 cases，pulmonary vein isolation）．Pulmonary vein isolation was applied in groupⅡ.The patient's clinical data〔age，gender，duration of disease and treatment history，underlying disease，left atrial diameter（LAD），LVEF，medication history，New York Heart Association （NYHA） cardiac function classification〕were recorded at admission.Surgical parameters（total operating time，fluoroscopy time，ablation time，and proportion of non-pulmonary vein triggers） in each group were recorded during operation.During the follow-up period，the success rate，complications，recurrence of atrial fibrillation after operation of each group were recorded.At the end of follow-up，the LVEF of two subgroups were analyzed and compared with preoperative data.The Kaplan-Meier method was used to draw survival curves of postoperative recurrence of atrial fibrillation and then was compared by Log-rank test.Factors influencing postoperative recurrence of atrial fibrillation in patients with low LVEF were analyzed by multivariate Cox regression analysis.Results The utilization rate of pacemaker/implantable cardioverter defibrill（ICD），left atrial diameter（LAD），angiotensin converting enzyme（ACE） inhibitor/angiotensin receptor blockers（ARBs），and roportion of patients with non-pulmonary vein triggers in groupⅠwas higher than those in groupⅡ（P<0.05）．The total operation time，fluoroscopy time and ablation time of patients in subgroupⅠA were significantly longer than those in subgroupⅠB（P<0.05）．The success rate of operation in groupⅡwas higher than that in groupⅠ，and success rate of subgroupⅠA was higher than that of subgroupⅠB（P<0.05）．There were significant difference in survival curves of recurrence of atrial fibrillation between groupⅠand groupⅡ（P<0.001）；there were significant difference in survival curves of recurrence of atrial fibrillation between subgroup ⅠA and Ⅱ subgroup（P=0.029）；and there was no significant difference in the incidence of complications between groupⅠand groupⅡ（P=0.875）．The LVEF〔（36.54±4.17）%〕at the end of follow-up in subgroupⅠA was higher than that before operation〔（32.17±2.48）%〕（P<0.001）;There was no significant difference in LVEF in subgroupⅠB before〔（31.94±3.15）%〕and after operation〔（31.86±2.21）%〕（P>0.05）．The results of multivariate Cox regression analysis showed that coronary artery disease，LVEF≤40.00% and non-pulmonary vein triggers were influencing factors of recurrence of atrial fibrillation（P<0.05）．Conclusion There are more non-pulmonary vein triggers in patients with atrial fibrillation and low LVEF and pulmonary vein isolation combined with non-pulmonary vein triggers ablation can improve the success rate of patients with low-paroxysmal atrial fibrillation.The coronary artery disease，LVEF≤40.00% and non-pulmonary vein triggers were the influencing factors of recurrence of atrial fibrillation.
【Key words】 Atrial fibrillation；Stroke volume；Pulmonary veins；Catheter ablation；Prognosis；Root cause analysis
Bayes Discriminant Analysis for In-hospital Death of Aortic Dissection ZHANG Weizong1，MA Xiang2*，YUAN Hong1*，SUN Jindong1，HU Haiqiang1，SHI Mingjuan1，YU Huamin1，HE Haiying1，YE Li1
1.Cardiovascular Department，First People's Hospital of Yuhang District，Hangzhou 311100，China
2.No.2 Department of Coronary Heart Disease，the First Teaching Hospital of Xinjiang Medical University，Urumqi 830000，China
*Corresponding authors：MA Xiang，Professor，Chief physician；E-mail：firstname.lastname@example.org
YUAN Hong，Professor，Chief physician；E-mail：email@example.com
【Abstract】 Background Aortic dissection（AD） is an acute critical disease of the cardiovascular system characterized by acute onset and high mortality.There is lack of studies in which effective models for predicting the in-hospital outcome in patients with AD are reported.However，there is an urgent clinical need for an effective and reliable model for predicting in-hospital outcomes of AD as AD incidence has recent increases.Objective To develop Bayes formulas to predict in-hospital death of AD patients，providing a reference for the formulation of effective treatments of this disease.Methods According to the unified inclusion and exclusion criteria of this study，553 cases of AD were enrolled during January 2010 to December 2015，including 228 from First People's Hospital of Yuhang District，and 325 from the First Teaching Hospital of Xinjiang Medical University.Clinical data such as general personal characteristics，basic signs，and laboratory indices were collected.By the in-hospital outcome，participants were divided into the survival group （n=470） and death group（n=83）．Differential variables were identified based on the results of univariate analysis.A sample set was selected using a computer-based random number generator，and their data were included in the Bayes formulas derived from Bayes discriminant analysis.The remaining participants were defined as a test set，and their data were included in the Bayes formulas to verify the accuracy of the formulas.Results The participants had a mean age of （51.5±12.3） years，a ratio of male to female of 3.89∶1 and an in-hospital mortality rate of 15.0%（83/553）．The variables finally substituted in the Bayes formulas were onset time（a1），DeBakey types （a2），urea nitrogen （a3），random plasma glucose （a4），glycated serum protein（a5），indirect bilirubin （a6），international normalized ratio （a7），and fibrinogen （a8），and the derived formulas were Q1=-1.174×a1+6.813×a2+0.323×a3+0.213×a4+10.522×a5+0.171×a6+25.656×a7+1.014×a8-39.843 and Q2=-13.336×a1+27.131×a2
-1.928×a3-5.030×a4+35.574×a5-0.658×a6+287.333×a7 -3.509×a8-1 707.601.And the significance of the formulas could be explained as：after putting the aforementioned variables（a1-a8） of an AD patient into the formulas，if the value of Q1 is greater than that of Q2，then the patient is determined as a survivor，otherwise he is a deceased.The formulas were found with an accuracy rate of 98.85% and an error rate of 1.15%（P=0.003）after being tested with the data of the participants in the test set，and were identified with an accuracy rate of 98.73%，and an error rate of 1.27%（P<0.001）after being tested with the data of all the participants.Conclusion Our Bayes formulas can be used to predict the in-hospital outcome of AD patients from a statistical perspective.
【Key words】 Aortic diseases；Aneurysm，dissecting；Bayes discriminant analysis；Prognosis
Factors Associated with Elevated Serum CA125 Level in Patients with Cirrhosis ZHU Yipeng，LU Gaofeng*，SUN Chenyi ，LIU Xia，HUANG Lina，WU Jiaxun，LI Min，YANG Jiaojiao，ZHAO Yipin
Department of GI Medicine，the Second Affiliated Hospital of Zhengzhou University，Zhengzhou 450014，China
*Corresponding author：LU Gaofeng，Associate professor，Master supervisor；E-mail：firstname.lastname@example.org
【Abstract】 Background Serum CA125 in patients with cirrhosis shows different degrees of elevation.But the factors associated with it are not complete clear.It is necessary to determine these factors from multiple angles.Objective To explore the factors associated with the increase of serum CA125 level in patients with cirrhosis.Methods A total of 205 inpatients with cirrhosis were recruited from the Second Affiliated Hospital of Zhengzhou University from January 2012 to February 2018.According to serum CA125 level，we divided them into normal CA125 group（n=39） and abnormal CA125 group（n=166），and compared total bilirubin，total bile acid，ALT，AST，prothrombin time（PT），albumin，total protein，prothrombin activity，age and sex between the groups.According to the volume of ascites，we divided them into no-ascites group（n=52），mild ascites group（n=40），moderate ascites group （n=51），and severe ascites group（n=62）．In accordance with the Child-Pugh score，we divided them into Child-Pugh grade A group（5-6，n=46），Child-Pugh grade B group（7-9，n=87），and Child-Pugh grade C group（≥10，n=72）．Abdominocentesis was carried out in 113 cases，and by the level of ascitic nucleated cell count，we divided them into normal nucleated cell count group（n=65） and elevated nucleated cell count group（n=48）．Correlations of serum CA125 with the volume of ascites，Child-Pugh grade，and nucleated cell count level were analyzed.Results Compare with the normal CA125 group，abnormal CA125 group showed higher total bilirubin，total bile acid and AST and longer PT，but lower albumin，total protein，and prothrombin activity（P<0.05）．No-ascites group showed lower serum CA125 level than other 3 ascites groups（P<0.05），so did the mild ascites group when compared with moderate and severe ascites groups（P<0.05）．The serum CA125 level in the elevated nucleated cell count group was higher than that of the normal nucleated cell count group（P=0.023）．Serum CA125 level was lower in Child-Pugh grade A group compared with that of Child-Pugh grade B and C groups（P<0.05）．And it was lower in Child-Pugh grade B group than that of Child-Pugh grade C group（P<0.05）．The volume of ascites，Child-Pugh grade，and ascitic nucleated cell count level were all correlated with serum CA125 level（P<0.05）．Conclusion Elevated serum CA125 level is associated with the volume of ascites，Child-Pugh grade and ascitic nucleated cell count.So it can be used to assess the volume of ascites，the degree of liver damage and the possibility of peritonitis complications in cirrhosis.
【Key words】 Liver cirrhosis；CA125；Child-Pugh grade；Ascites volume；Peritoneal inflammation
Comfort Level for In-patients Inhaling Oxygen via Nasal Cannula and Its Influential Factors ZHU Yijun1，LI Ping2，HAN Yinping1，3*
1.Department of General Practice Training Resident，Changhai Hospital，Shanghai 200433，China
2.Department of Cardiovascular Medicine，Renhe Hospital，Baoshan District，Shanghai 200431，China
3.Department of Respiratory and Critical Care Medicine，Changhai Hospital，Shanghai 200433，China
*Corresponding author：HAN Yiping，Professor，Chief physician；E-mail：email@example.com
【Abstract】 Background A lot of literatures have reported the refusal or the reduction of oxygen use by patients inhaling via nasal cannula which is more often caused by discomfort they have in such process.Some scholars believed that the occurrence of this discomfort was related to the physicochemical properties of oxygen supply apparatus and thus suggested many ways to improve it.However，none of them is simple and with good clinical popularity.A foreign study has suggested that some treatment related factors and individual factors of a specific patient may have impact on the comfort level of oxygen inhaling.China so far does not have any study in this field.Objective To understand the comfort level for in-patients inhaling of oxygen via nasal cannula，and to further explore and analyze its possible influential factors.Methods Cluster sampling method was adopted in selecting in-patients from various departments of Changhai Hospital on June 5th，2018.A self-designed questionnaire Survey on In-patients Inhaling of Oxygen via Nasal Cannula was used to conduct a one by one and face to face questionnaire survey on each of those in-patients.The questionnaire included 11 close-ended questions and 1 semi-closed question in total，which mainly covered general information （sex，age，expense categories，level of education，history of chronic rhinitis and times of hospitalization），treatment related factors （position being maintained while receiving oxygen therapy，flow rate of oxygen being inhaled，time for oxygen therapy，frequency of oxygen inhaling and days of oxygen inhaling） and main complaints of discomfort while inhaling oxygen.The evaluation of the comfort level in the case of inhaling oxygen via nasal cannula was conducted by whether or not there was any discomfort reported as a main complaint from the patients inhaling oxygen.Multivariate Logistic regression analysis was adopted to analyze the factors influencing the comfort level for patients inhaling oxygen via nasal cannula.Results A total of 329 copies of questionnaires were sent and we received 324 copies of effective ones，with an effective response rate of 98.5%.Among 324 patients，187 were male （57.7%），and 137 were female （42.3%）；their age ranged from 23 to 96 years，with average age of （59.1±14.9） years.One hundred and seventy-eight patients were older than 65 years （54.9%）；304 cases （93.8%） had medical insurance；180 patients （55.5%） had the level of education which equals to primary school or below，100 had the level of education of junior or senior middle school（30.9%），and 44 had the level of education of undergraduate or above（13.6%）；22 patients （6.8%） had the medical history of chronic rhinitis；58 patients （17.9%） had a record of multiple hospitalization.Of the 324 patients，275 patients （84.9%） believed that the oxygen therapy was comfortable while 49 patients （15.1%） felt that it was discomfort.The results of multivariate Logistic regression analysis showed that the medical history of chronic rhinitis 〔OR=9.764，95%CI（1.427，66.824），P<0.05〕，flow rate of the oxygen being inhaled 〔OR=3.528，95%CI（2.134，5.830），P<0.05〕，time for oxygen therapy 〔0.5~15.0 h：
OR=13.751，95%CI（3.114，60.729），P<0.05；>15.0 h：OR=29.902，95%CI（6.857，130.408），P<0.05〕 and frequency of oxygen inhaling 〔2 times/day：OR=9.252，95%CI（1.383，61.896），P<0.05；≥3 times/day：OR=11.120，95%CI（2.320，53.297），P<0.05〕 were the factors influencing the comfort level for in-patients inhaling oxygen via nasal cannula．Conclusion The comfort level for in-patients inhaling oxygen via nasal cannula，in general，is acceptable but still there is room for further improvement.Influential factors of oxygen inhalation through nasal cannula include history of chronic rhinitis，oxygen flow rate，time and frequency of oxygen inhalation.Clinical medical care personnel should follow the Guidelines for Emergency Oxygen Therapy for Adults.On the premise that the purpose of oxygen therapy is achieved，they should try to control the flow rate of the oxygen being inhaled，and time and frequency of oxygen inhaling so as to avoid the excessive use of oxygen and reduce the occurrence of discomfort in the process of oxygen therapy，thus increasing the comfort level for inhaling of oxygen via nasal cannula.
【Key words】 Oxygen inhalation therapy；Comfort level；Root cause analysis；Cross-sectional studies；Inpatients
Efficacy of Eltrombopag Combined with Azathioprine in the Treatment of Refractory Immune Thrombocytopenic Purpura and Its Effect on Cellular Immune Function LUO Hongqiang*，ZHONG Yonggen，FENG Weiying
Department of Hematology，Shaoxing People's Hospital，Shaoxing 312000，China
*Corresponding author：LUO Hongqiang，Chief physician；E-mail：firstname.lastname@example.org
【Abstract】 Background The treatment of refractory immune thrombocytopenic purpura（RITP） has always been a major clinical problem.At present，there is no unified safe and effective treatment，and there is a risk of death for some patients with extremely low platelet count.Eltrombopag，as a new drug for increased platelet counts，provides a safe and effective treatment for RITP.Objective To study the efficacy of Eltrombopag combined with Azathioprine in the treatment of RITP and its effect on cellular immune function.Methods A total of 46 patients with RITP who were hospitalized in Hematology Department of Shaoxing People's Hospital from January 2013 to January 2018 were selected.They were randomly divided into treatment group and cyclosporine（CSA） group，each with 23 cases.Another 25 healthy persons who had physical examination in our hospital during the same period were selected as the control group.Patients in the treatment group were treated with Eltrombopag combined with Azathioprine.The CSA group was treated with Cyclosporine combined with Danazol.Therapeutic effect was evaluated after 3 months of treatment.The clinical effects of treatment group and CSA group were compared.Th1 cytokines（IL-2，IFN-γ） and Th2 cytokines（IL-4，IL-5），B1 lymphocyte（percentage of CD+19 lymphocyte and CD5+CD+19 lymphocyte），PLT in peripheral blood of treatment group and CSA group were collected before treatment and 3 months after treatment，and compared with the control group.The adverse reactions in the treatment group and CSA group were recorded.Results The total effective rate was 69.9%（16/23） in the treatment group and 73.9%（17/23） in the CSA group.There was no significant difference in the total effective rate between the two groups（χ2=0.107，P=0.743）．Before treatment，the percentage of IL-2，IFN-γ，CD+19 lymphocyte and CD5+CD+19 lymphocyte in the treatment group and CSA group was higher than that in the control group，while the number of IL-4 and IL-5 and platelet count in the treatment group and CSA group was lower than that in the control group（P<0.05）．After 3 months of treatment，the percentage of IL-2，IFN-γ，CD+19 lymphocyte and CD5+CD+19 lymphocyte in the treatment group and CSA group was lower than that before treatment，while the number of IL-4 and IL-5 and platelet count was higher than that before treatment（P<0.05）．Eight patients in the treatment group and 16 patients in the CSA group suffered from liver function injury.The incidence of liver function injury in the treatment group（34.8%） was lower than that in the CSA group（69.6%），and the difference was statistically significant（χ2=6.527，P=0.013）．Conclusion Eltrombopag combined with Azathioprine in the treatment of RITP is safe，effective and well tolerated.Eltrombopag combined with Azathioprine may play a therapeutic role by regulating Th lymphocyte and B1 lymphocyte in peripheral blood of patients with RITP，thereby promoting platelet formation.
【Key words】 Purpura，thrombocytopenic，idiopathic；Eltrombopag；Azathioprine；T-cell antigen receptor specificity
Epidemiology of Allergic Rhinitis in Tongliao Grassland of Inner Mongolian MA Tingting1，ZHUANG Yan1，LEI Tong2，ZHANG Tiejun3，BAO Xiuzhi4，ZHANG Fangfang2，HAI Changjiang2，ZHANG Biao5，WANG Xueyan1*
1.Allergic Consulting Department，Beijing Shijitan Hospital，Capital Medical University，Beijing 100038，China
2.Tongliao City Hospital，Tongliao 028000，China
3.Jarud Banner People's Hospital，Tongliao 029100，China
4.Kailu People's Hospital，Kailu 028400，China
5.Institute of Basic Medical Sciences Chinese Academy of Medical Sciences/School of Basic Medicine，Peking Union Medical College，Beijing 100005，China
*Corresponding author：WANG Xueyan，Chief physician；E-mail：email@example.com
【Abstract】 Background In recent years，the prevalence of allergic rhinitis（AR） is increasing all over the world，but little research has been done on grassland areas in eastern Inner Mongolia，China．Objective To investigate the prevalence of AR and to analyze the clinical symptoms and allergic causes in Tongliao，Inner Mongolia，so as to provide the basis for the prevention，diagnosis and health management departments to formulate relevant policies．Methods A total of
2 013 permanent residents in Tongliao City，Jarud Banner and Kailu County were selected by stratified random sampling method from May to August 2015．Questionnaire survey and skin prick test of allergens were conducted by specialists （10 common inhalation allergens were detected in grassland areas）．The diagnosis of AR was mainly based on the related guideline．The questionnaire mainly included basic sociological data （age，sex，nationality，place of residence，region），clinical symptoms （nasal symptoms，eye symptoms，other symptoms），combined diseases，food and drug allergies，and seasonal changes of clinical symptoms．The skin prick test results of allergens in patients with confirmed AR were analyzed.Results A total of
2 013 questionnaires were sent out，and 1 954 valid questionnaires were recovered，with a recovery rate of 97.1%．Among 1 954 residents，the self-reported AR prevalence rate was 30.8% （601 cases） and the confirmed AR prevalence rate was 18.1%（353 cases）．The average age of 353 AR patients was （45.3±15.0） years；161 were male，192 were female，and the ratio of male to female was 1∶1.2；193 were Han，143 Mongolian，and Han and Mongolian ratio was 1.3∶1．There were significant differences in AR prevalence among residents of different ages，places of residence，and regions （P<0.05）．There were no significant differences in gender and ethnic group in terms of AR prevalence （P> 0.05）．The main nasal symptoms of AR patients were sneezing （95.8%），itching （92.4%） and running nose（85.3%）．Eye itching was the main symptom （61.8%）of eye symptoms．Other symptoms were fatigue （42.5%） and drowsiness （40.5%）．In AR patients，conjunctivitis （64.0%），urticaria （29.5%） and hypertension（17.8%） were main complications．Patients with AR complicated with food allergy accounted for 17.3% （61/353），and those complicated with drug allergy accounted for 24.9% （88/353）．The peak period of clinical symptoms of AR patients in this area in 2015 was April and July，and the peak period of pollen appeared was April and August．The peak period of AR clinical symptoms in April in this area coincided with the peak period of pollen in Spring，but the peak period of AR clinical symptoms in summer was July，which was one month ahead of the peak period of pollen．The first three allergens with positive rate of allergen skin prick test was Artemisia pollen （21.96%），Chenopodiaceae pollen （21.49%） and Humulus pollen （20.06%）．Most patients were allergic to three or more pollens〔71.10%（251/353）〕.Conclusion The prevalence of AR in Tongliao，Inner Mongolia stays at a high level．Sneezing and itching are the main symptoms of nasal symptoms，itching is the main symptom of eye symptoms，and fatigue and sleepiness are the main symptoms of other symptoms．Conjunctivitis and urticaria are the main complications associated with AR．Pollen exposure is one of the most important factors causing AR，and the influence of Artemisia pollen in spring and summer can not be ignored.
【Key words】 Rhinitis，allergic，seasonal；Prevalence；Clinic symptom；Pollen
Clinical Effect of Intrauterine COOK Balloon Tamponade on Hemorrhage from the Lower Uterine Segment Secondary to Placenta Previa during the Cesarean Section DUAN Ya，ZHAO Shan，LI Min，JIN Ying，LI Jibin，WANG Li，TANG Zengjun*
Department of Obstetrics，Hebei General Hospital，Shijiazhuang 050051，China
*Corresponding author：TANG Zengjun，Professor，Chief physician；E-mail：firstname.lastname@example.org
【Abstract】 Background At present， there are many hemostasis methods for placenta previa complicated with postpartum hemorrhage. Compared with other methods， Balloon packing compression hemostasis is simple， non-traumatic and has obvious hemostasis effect.Objective To explore the efficacy of intrauterine tamponade with Cook balloon（a double balloon device） versus Bakri balloon on hemorrhage from the lower uterine segment due to placenta previa during the cesarean section.Methods From Hebei General Hospital，we recruited 78 cases who had hemorrhage from the lower uterine segment due to placenta previa in the cesarean section during January 2012 to January 2018，42 of whom were treated with intrauterine tamponade with Cook balloon（Cook balloon tamponade group），and other 36 were treated with intrauterine tamponade with Bakri balloon（Bakri balloon tamponade group）．The intraoperative indicators（duration of operation，time-to-hemostasis，blood loss during operation，rate of achieving effective hemostasis，blood transfusion rate），and postoperative indicators （total amount of bleeding within 24 hours after operation，duration of antibiotic therapy，rate of postoperative infections，and length of hospital stay） in the two groups were compared.Results There were no significant differences between the two groups in the average duration of operation，rate of achieving effective hemostasis，and blood transfusion rate（P>0.05）．The average time-to-hemostasis，and average blood loss during operation in Cook balloon tamponade group were significantly less compared with those of Bakri balloon tamponade group（P<0.05）．Furthermore，the average total amount of bleeding within 24 hours after operation was also obviously less in Cook balloon tamponade group compared with that of Bakri group（P<0.05）．However，the average duration of antibiotic therapy，rate of postoperative infections，and average length of hospital stay showed no significant differences between the two groups（P>0.05）.Conclusion Compared with those using Bakri balloon tamponade，patients used Cook balloon tamponade had less average amount of bleeding within 24 hours after operation，although both groups had similar average duration of operation，duration of antibiotic therapy，rate of postoperative infections and length of hospital stay，indicating that Cook balloon tamponade has better hemostatic effect.
【Key words】 Uterine hemorrhage；Uterine tamponade；Cesarean section；Placenta previa；Postpartum hemorrhage；COOK double-balloon
Healthcare Providers' Perspectives on the Admission Criteria for Hospice Care：a Qualitative Study ZENG Jie，JIN Lei，SUN Yao，PAN Li，LI Yafang，SHI Baoxin*
School of Nursing，Tianjin Medical University，Tianjin 300070，China
*Corresponding author：SHI Baoxin，Professor；E-mail：email@example.com
【Abstract】 Background The number of deaths in China is about 960-990 million a year，of which only a small number receive hospice care services.The referral criteria of hospice care can help healthcare providers identify patients who should be transferred to hospice care，so that end-stage patients can receive hospice care in time.However，up to now，the criteria and methods have not been established to determine patients' entry into hospice care.Objective To investigate hospice care providers' perspectives on the admission criteria for hospice care，providing a reference for the development of admission criteria for hospice care in China.Methods In-depth face-to-face interviews were conducted with a purposive sample of 21 hospice care providers from 3 tertiary grade A hospitals during the period between April and May 2018.Discussions were audiotaped and transcribed into a text within 24 hours after the interviews.And Colaizzi method was used to analyze the data.Results Following the analysis of the interview data，three themes were extracted，including（1） The eligibility for hospice care admission was different among the providers.（2） Condition，psychoemotional status，and informed consent of patients and their families were considered generally as the essential dimensions of the hospice care admission criteria.（3） As no unified admission criteria and ways for hospice care have been developed in China，such admission is usually determined based on patients' disease progression，subjective feelings，and basic conditions，and clinicians' experience.The rationality and scientificalness of this practice，as well as its needs of further improvement，were approved by most of the hospice care providers.Conclusion The routine admission criteria for hospice care used clinically should be improved further on the basis of retaining the original scientific and reasonable content.For improvement，further studies can use Delphi method.Moreover，mature admission criteria in foreign countries can be referred to develop the domestic admission criteria after being screened and culturally adapted.
【Key words】 Hospice care；Referral criteria；Cognition；Qualitative study；Hospice care
Reliability and Validity of the Chinese Version of the Short Abridged Autism Spectrum Quotient-Children's Version LI Hongcheng1，2，LI Xue1，LIU Jing1*，JIA Meixiang1，YANG Liu1，ZHANG Aiwu1，PANG Jin1
1.Peking University Institute of Mental Health/Peking University Sixth Hospital/Key Laboratory of Mental Health，Ministry of Health（Peking University）/National Clinical Research Center for Mental Disorders（Peking University Sixth Hospital），Beijing 100191，China
2.No.7 Clinic，Ankang Hospital，Tianjin Public Security Bureau，Tianjin 300240，China
*Corresponding author：LIU Jing，Chief physician；E-mail：firstname.lastname@example.org
LI Hongcheng and LI Xue are co-first authors
【Abstract】 Background There are few scales for the screening of autism in children in primary care in China.Studies show that the Short Abridged Autism Spectrum Quotient-Children's Version（AQ-Child-Short）is suitable for screening autism in children in primary care.Objective To test the validity and reliability of the Chinese version of AQ-Child-Short，so as to provide a new effective tool for screening autism in children in primary care in China.Methods 101 children with autism（58 of high-functioning，and other 43 of low-functioning）were enrolled during June to September，2015 and September to December，2017 from those consecutive outpatients of Peking University Institute of Mental Health.They were compared to age-matched 124 normal children selected from an ordinary kindergarten and an ordinary primary school in Tianjin.The Chinese version of AQ-Child-Short was used to screen autism symptoms in all the children，which was administered by a parent who knows the child best（the child's mother in general）．At the same time，10 children were selected from each group，and their another caregiver who knows the child well also filled out the Chinese version of AQ-Child-Short.Two weeks later，10 children were chosen from each group，and received the survey again，the scale was administered by the same caregiver participating in the first round of survey.Discriminant validity and criterion-related validity were used for validity analysis.Inter-rater reliability，retest reliability and internal consistency reliability were used for reliability analysis.Results There was no significant difference in the mean total score of Chinese version of AQ-Child-Short between high and low functioning autism children（P>0.05）．But the mean total score of Chinese version of AQ-Child-Short of the autism children was higher than that of the normal controls（P<0.05）．The diagnostic accuracy of this scale was compared with the gold standard，namely，the diagnosis made by the chief physician of Pediatric Psychiatry Department，Peking University Institute of Mental Health following the DSM-Ⅳ.ROC analysis of the scale showed that，in diagnosing autism，the AUC of the scale was 0.97（P<0.01），with corresponding sensitivity of 0.94，and specificity of 0.89，when the critical value of the scale's total score was determined as 15.The inter-rater reliability test results show that the intraclass correlation coefficient（ICC）of the total scale score was 0.90（P<0.05）and of the item scores was 0.60-0.86（P<0.05）．The test-retest reliability results show that the ICC of the total scale score was 0.97（P<0.05）and of the item scores was 0.82-0.92（P<0.05）．The Cronbach's α of the scale was 0.85（P<0.01）．Conclusion The Chinese version of the AQ-Child-Short has good validity and reliability，and high sensitivity and specificity.It could be used as an instrument for screening autism in children.
【Key words】 Autistic disorder；Chinese Version of the Abridged Autism Spectrum Quotient-Children's Version；Validity；Reliability