September 2019, Volume 22，No.26 Abstracts
Author：尹鹏 Source：CGP Published： [08-29] views： 277
Fundamentals of Case Study Research in Family Medicine and Community Health Sergi Fàbregues1*，Michael D Fetters（writing）2，ZHAO Xinyue3，WANG Yang（translator）3，HAN Jianjun3，XU Yanli3，YANG Hui（reviser）4
1.Department of Psychology and Education，Universitat Oberta de Catalunya，Barcelona 08018，Spain
2.Department of Family Medicine，University of Michigan，Ann Arbor，Michigan 48109，USA
3.Publishing House of Journal of Chinese General Practice，Beijing 100053，China
4.Monash University，Melbourne 3168，Australia
*Corresponding author：Sergi Fàbregues，Professor；E-mail：sfabreguesf@uoc.Edu
【Abstract】 The aim of this article is to introduce family medicine researchers to case study research，a rigorous research methodology commonly used in the social and health sciences and only distantly related to clinical case reports.The article begins with an overview of case study in the social and health sciences，including its definition，potential applications，historical background and core features.This is followed by a 10-step description of the process of conducting a case study project illustrated using a case study conducted about a teaching programme executed to teach international family medicine resident learners sensitive examination skills.Steps for conducting a case study include，conducting a literature review，formulating the research questions，ensuring that a case study is appropriate，determining the type of case study design，defining boundaries of the case（s）and selecting the case（s），preparing for data collection，collecting and organising the data，analysing the data，writing the case study report，and appraising the quality.Case study research is a highly flexible and powerful research tool available to family medicine researchers for a variety of applications.
【Key words】 Family medicine；General practice；Case study research；Community-based participatory research；Health services research；Research methods；Primary health care
Fundamentals of Qualitative Analysis in Family Medicine Wayne A Babchuk （writing）1，2，MA Lan3，WANG Yang（translator）3，
HAN Jianjun3，XU Yanli3，YANG Hui（reviser）4
1.Anthropology，University of Nebraska-Lincoln，Nebraska 68588，USA
2.Educational Psychology，University of Nebraska-Lincoln，Nebraska 68588，USA
3.Publishing House of Journal of Chinese General Practice，Beijing 100053，China
4.Monash University，Melbourne 3168，Australia
【Abstract】 The primary purpose of this article is to provide family physician researchers interested in conducting a qualitative research study a concise guide to the analysis.Drawing from approaches outlined in popular research methodology textbooks and employing an exemplar from a minority health disparities research study，this article outlines specific steps useful for researchers and practitioners in the field of family medicine.This process of qualitative data analysis is situated within the larger framework of qualitative research to better position those new to qualitative designs to more effectively conduct their studies.A 10-step process useful for guiding qualitative data analysis is provided.The 10 steps include（1）assembling data for analysis，（2）refamiliarising oneself with the data，（3）open or initial coding procedures，（4）generating categories and assigning codes to them，（5）generating themes from categories，（6）strategies of validation，（7）interpreting and reporting findings from the participants，（8）interpreting and reporting findings from the literature，（9）visual representations of data and findings，and（10）strengths，limitations，delimitations and suggestions for future research.This work provides clear and accessible guidelines for conducting qualitative data analysis for emerging researchers that is applicable across a wide array of topics，disciplines and settings.
【Key words】 Family medicine；General practice；Qualitative research；Data analysis，statistical；Community-based participatory research；Health services research；Research methods；Primary health care
Epidemiological Features of Death Cases of Ebola Virus Disease，Sierra Leone WU Chen1，2，ZHANG Yixiong1，2*，Meesaq Ahmad3，TAN Boyu1，2，YUAN Zijie1，2，ZHANG Yu1，2，CAI Yi1，2，LI Yanyan1，2，PENG Yunling1，2，WANG Bin1，2，James Bangalie Turay4
1.Department of Emergency，the First Affiliated Hospital of Hunan Normal University/Hunan Provincial People's Hospital，Changsha 410002，China
2.Poisoning Research Laboratory，Hunan Provincial Institute of Emergency Medicine，Changsha 410002，China
3.Danish Medical Store Muridwal，Faisalabad 38000，Pakistan
4.Jui Government Hospital，Freetown 999127，Sierra Leone
*Corresponding author：ZHANG Yixiong，Chief physician；E-mail：firstname.lastname@example.org
【Abstract】 Background From March 2014 to October 2015，Ebola virus disease （EVD） in the Republic of Sierra Leone caused 8 690 cumulative confirmed cases and 3 588 deaths country-wide.Understanding the epidemiological characteristics of EVD deaths is of great significance for improving disease resistance and reducing disaster losses.Objective To analyze the epidemiological characteristics of EVD deaths.Methods The retrospective study of the morbidity，mortality，and time and geographical distributions of death cases of EVD was done with clinical and demographic data mainly collected from medical records of Jui Government Hospital from March 2014 to October 2015，and with supplemented data from records of National Ebola Response Center of Sierra Leone（http：//www.nerc.sl/） and World Health Organization（http：//www.who.int/csr/disease/ebola/en/）．Other data of 747 EVD cases（442 survived and 305 died） diagnosed by Jui Government Hospital were also collected，including gender，age，interval between EVD onset time and admission time，viral load，clinical symptoms，length of stay，discharge or death time.Results In Sierra Leone from March 2014 to October 2015，the incidence rate of EVD was 0.12%（8 690/7 120 722），and the case fatality rate（CFR） of EVD was 41.28%（3 588/8 690）．On March 31，2014，the Ministry of Health of Sierra Leone reported 6 possible and suspicious cases，of whom 5 died （case fatality rate was 5/6）．It fell to a lower level in September 2014 〔29.94% （605/2 021） 〕 and remained basically at a lower level after December 2014.CFR of EVD in Freetown，the capital city，was lower〔38.88%（1 341/3 449）〕.Districts near the capital showed relatively lower CFR，but those far from the capital showed relatively higher CFR.The decreased had greater average age，longer average interval between onset time and admission time，higher rates of weakness，abdominal pain，dyspnea，skin rash and disturbance of consciousness，but had lower average viral load （CT value），and lower rates of fever，vomiting，anorexia，and joint pain compared with the survived（P<0.05）．Multivariate Logistic regression analysis found that the interval between EVD onset time and admission time〔OR=1.510，95%CI（1.373，1.661）〕，viral load （CT value） 〔OR=0.937，95%CI（0.892，0.985）〕，vomiting 〔OR=0.576，95%CI（0.343，0.966）〕，weakness〔OR=0.162，95%CI（0.049，0.533）〕，dyspnea〔OR=1.715，95%CI（1.025，2.871）〕and disturbance of consciousness〔OR=0.389，95%CI（0.217，0.696）〕were independent prognostic factors of EVD（P<0.05）．Conclusion Several factors influenced the outcome of EVD.Coordinated international response is deemed essential to reduce the death cases.Transportation condition could be one of the main factors relating to the mortality rate，earlier admission would improve the prognosis.Older age is associated with a higher risk of death.Clinical characteristics including vomiting，weakness，dyspnea and disturbance of consciousness are also related to prognosis of the disease.
【Key words】 Hemorrhagic fever，ebola；Ebolavirus；Sierra Leone；Epidemiologic studies
Screening of Optimal Liver Protection Scheme for Acute Liver Injury Induced by Transarterial Chemoembolization in Primary Liver Cancer WU Zhonglin，WU Yongchao，RONG Xiaocui，GU Tieshu，HAO Xiaoguang，YANG Dongqiang，LI Shunzong*
Department of Radiological Intervention，the Fourth Hospital of Hebei Medical University，Shijiazhuang 050011，China
*Corresponding author：LI Shunzong，Professor；E-mail：email@example.com
【Abstract】 Background There is no clear guidelines and medication standards at home and abroad for liver protection treatment of acute liver injury（ALI） caused by transarterial chemoembolization（TACE）．Pharmacoeconomic method was used to screen out optimal liver protection program for ALI caused by TACE，which can not only enable patients to obtain reasonable and effective liver protection treatment，reduce the pain caused by ALI，but also reduce the economic burden of patients.Objective To carry out cost-efficacy analysis （CEA） of different liver protection schemes for primary liver cancer（PLC） after TACE by using pharmacoeconomic methods，providing a reference for the selection of liver protection therapy after TACE.Methods A total of 180 patients with PLC admitted to the Fourth Hospital of Hebei Medical University from October 2013 to October 2016 were selected and divided into 6 groups （A，B，C，D，E，F） with 30 cases in each group.Group A received protectant for hepatocyte membrane repair + detoxification.Group B received protectant for hepatocyte membrane repair +anti-inflammatory drugs.Group C received protectant for hepatocyte membrane repair +cholagogic drugs.Group D received detoxification+ anti-inflammatory drugs.Group E received detoxification+ cholagogic drugs.Group F received anti-inflammatory+ cholagogic drugs.Clinical efficacy and cost-efficacy ratio（CER） were compared between the six groups.Results There were significant differences in the total efficacy rate between the six groups on the 4th and 6th day after interventional therapy （χ2=18.311，P=0.003；χ2=23.563，P<0.001）．The CER of the 6 groups were 6.38，9.38，10.05，7.70，9.86 and 9.26，respectively，on the 4th day after interventional operation.Group A，as the control group，had the lowest cost.The incremental CER of other five groups were 20.19，76.30，11.09，52.95 and 13.99，respectively.The CER of the sensitivity analysis of the 6 groups on the 4th day after intervention were 5.74，8.44，9.05，6.93，8.88 and 8.34，respectively；group A，as the control group，had the lowest cost，with incremental CER of 18.17，68.67，9.98，47.65 and 12.59，respectively in other five groups.The CER of the 6 groups were 7.48，10.79，10.61，9.95，10.93 and 13.43，respectively，on the 6th day after interventional operation.Group A，as the control group，had the lowest cost.The incremental CER of other five groups were as follows：21.64，28.59，19.41，0 and 32.98 respectively.The CER of sensitivity analysis of the 6 groups were 6.74，9.71，9.55，8.96，9.84 and 12.09，respectively；group A，as the control group，had the lowest cost.The incremental CER were 19.47，25.73，17.46，0 and 29.68，respectively in other five groups.Conclusion The use of hepatoprotective drugs after TACE can effectively improve the level of liver biochemical indexes in patients.In terms of efficacy，anti-inflammatory+cholagogic drugs are the best.In terms of pharmacoeconomics，anti-inflammatory+ detoxification are the most economical and reasonable option.
【Key words】 Liver neoplasms；Transarterial chemoembolization；Liver injury；Treatment outcome；Cost-benefit analysis
Effect of Tomatis Listening Therapy on Sleep Structure in Patients with Acute Cerebral Hemorrhage CHENG Jie1，2*，WANG Qian2，DONG Lihuan1，WANG Weiliang1
1.North China University of Science and Technology Affiliated Hospital，Tangshan 063000，China
2.North China University of Science and Technology，Tangshan 063210，China
*Corresponding author：CHENG Jie，Chief superintendent nurse；E-mail：firstname.lastname@example.org
【Abstract】 Background Sleep-wake disorders are most likely to occur in patients after cerebral hemorrhage，which can delay the recovery process.But long-term pharmaceutical treatment can cause low response.Tomatis listening therapy can stimulate and improve the interconnections between human ears and the nervous system，thereby regulating the sleep structure via listening to the music consisting of sounds with the sudden transition from low-to-high frequencies and vice versa.Objective To explore the effect of Tomatis listening therapy on sleep structure in patients with acute cerebral hemorrhage.Methods 138 patients with sleep disorders after acute cerebral hemorrhage were recruited from Neurosurgery Department，North China University of Science and Technology Affiliated Hospital，from July 2017 to July 2018.By use of a table of random numbers，they were equally divided into control group，music therapy group，and listening therapy group，receiving conventional nursing，conventional nursing and common music therapy，conventional nursing in combination with Tomatis listening therapy （listening to the music consisting of sounds with the sudden transition from low-to-high frequencies and vice versa），respectively.The intervention lasted for consecutive 14 days for all participants.Sleep quality data were collected by overnight PSG monitoring.Sleep structure was compared between the groups before and after intervention.Results There were significant differences in non-REM latency，REM latency，ratios of non-REM latency to total sleep time， stage 3 non-REM sleep time to total sleep time，stage 4 non-REM sleep time to total sleep time，and REM sleep time to total sleep time after intervention among three groups （P<0.05）．Self-controlled comparisons showed that，compared with baseline，after intervention，sleep quality changed insignificantly in the control group （P>0.05）；ratio of stage 4 non-REM sleep time to total sleep time increased in music therapy group （P<0.05）；ratios of total sleep time to total recording time，stage 3 non-REM sleep time to total sleep time，stage 4 non-REM sleep time to total sleep time，and REM sleep time to total sleep time increased while non-REM latency，and ratios of non-REM latency to total sleep time decreased in listening therapy group （P<0.05）．Intergroup comparisons found that three groups showed significant differences in post-intervention ratios of non-REM latency to total sleep time，and REM latency to total sleep time，non-REM sleep time to total sleep time，stage 3 non-REM sleep time to total sleep time，stage 4 non-REM sleep time to total sleep time，and REM sleep time to total sleep time （P<0.05）．Moreover，pre- and post-intervention differences in ratios of non-REM latency to total sleep time，and non-REM sleep time to total sleep time，“slow wave” （stages 3 and 4 non-REM） sleep time to total sleep time，and REM sleep time to total sleep time differed significantly between the groups （P<0.05）．To be specific，music therapy group had a greater pre- and post-intervention difference in ratio of stage 4 non-REM sleep time to total sleep time than the control group ，compared with listening therapy group，pre- and post-intervention differences in ratios of non-REM sleep time to total sleep time，“slow wave” sleep time to total sleep time，and REM sleep time to total sleep time，and pre- and post-intervention difference in non-REM latency were all less in the control group，and they were also less in music therapy group except the latter aspect （P<0.017）．Conclusion Tomatis listening therapy in combination with conventional nursing can effectively improve the sleep structure and sleep quality in patients with acute cerebral hemorrhage.
【Key words】 Cerebral hemorrhage；Tomatis auditory training；Sleep structure；Polysomnography；Sleep time
Acknowledge and Use of Automatic External Defibrillators among the Resident in China NI Shaozhou1，ZHU Jiayong2，LI Shunqing1，JIN Xiaoqing1*
1.Emergency Department，Zhongnan Hospital of Wuhan University，Wuhan 430071，China
2.Zhongnan Hospital of Wuhan University，Wuhan 430071，China
*Corresponding author：JIN Xiaoqing，Attending physician；E-mail：email@example.com
【Abstract】 Background Nowadays，the incidence of sudden cardiac arrest in China is high，but the survival rate of out-of-hospital resuscitation is extremely low.The application of automated external defibrillator （AED） in public place could effectively increase the survival rate of the out-of-hospital resuscitation.Therefore，the use of AED by the general public is the key to deal with this issue.Objective To inquire about the acknowledge and learning willingness of using AED by the general public in China.Methods Participants of the 9th course of Emergency Common Sense （http：//www.icourses.cn/mooc/） were selected to conduct a questionnaire survey from 10 October 2017 to 10 November 2017.The questionnaire included the basic information of the respondents，the knowledge about AED and the attitude towards the use of AED.Results A total of 2 130 questionnaires were collected，with 1 918 valid questionnaires and an effective rate of 90.05%.Of the 1 918 subjects，697 （36.34%） had been exposed to CPR-related learning or training，including 378 （67.74%，378/558） worked in medical profession，319 （23.46%，319/1 360） in non-medical profession；35.61% （683/1 918） could accurately describe the name of AED，25.60% （491
/1 918） could clearly describe the role of AED，and 22.94% （440/1 918） could accurately describe the use of AED.1 623 patients （84.62%） were willing to rescue，all of who mastered the methods of CPR and AED；1 856 （96.77%） were willing to rescue under the premise of AED knowledge；1 832（95.52%） were willing to learn AED related knowledge.The awareness rate of the role and usage of AED in medical group was higher than that in non-medical group，and the proportion of people willing to learn AED related knowledge was lower than that in non-medical group （P<0.05）．The proportion of people willing to help in medical group was higher than that in non-medical group，and the proportion of people willing to learn AED related knowledge in medical group was lower than that in non-medical group （P<0.05）．Among 295 people reluctant to learn，75 answered the reasons，of whom 31 （41.33%） did not dare to rescue for lack of relevant first aid knowledge；34 （45.33%） expressed concern about improper operation and aggravation of the patient's condition；10 （13.34%） were reluctant to contact strangers for personal reasons.Conclusion Nowadays the resident in China still know very little about AED，but they are willing to learn and use it.It is necessary to change the current situation by making efforts to improve the knowledge of application of AED.
【Key Words】 Heart arrest；Defibrillators；Automated external defibrillator；Acknowledge and attitude；Network survey
Relationship between Infection and Frailty in Elderly Patients on Maintenance Hemodialysis CHEN Yan，YE Hanyang，LI Zhanyuan，JIN Lingwei，ZHOU Zhihong，ZHENG Yu*
Department of Nephrology，the Second Affiliated Hospital & Yuying Children's Hospital of Wenzhou Medical University，Wenzhou 325027，China
*Corresponding author：ZHENG Yu，Associate chief physician；E-mail：firstname.lastname@example.org
【Abstract】 Background As one of the most important geriatric syndromes，frailty seriously affects the quality of life and the survival time of the elderly patients undergoing chronic hemodialysis.Infection is also considered to be an important factor affecting the prognosis of elderly dialysis patients．Objective To investigate the incidence of infection and its relationship with frailty in elderly patients on maintenance hemodialysis （MHD）．Methods A total of 115 elderly patients on MHD admitted in the Blood Purification Center of the Second Affiliated Hospital & Yuying Children's Hospital of Wenzhou Medical University were recruited into our study from January 2015 and January 2016.Infection was recorded and clinical data and blood biochemical data of enrolled patients were collected in the one-year follow-up.Frailty was assessed by Fried's Frailty Phenotype，and the correlation of infection and frailty was analyzed by Spearman's rank correlation coefficient analysis and multivariate Logistic regression analysis. Results After one-year follow-up，41 cases （35.7%） had infection．There were significant differences between the infection group and the non- infection group in C-reactive protein （CRP），plasma albumin，pre albumin，monocyte chemoattractant protein 1 （MCP-1） and frailty （P<0.05）．Spearman's rank correlation coefficient analysis showed that infection was positively correlated with CRP，MCP-1 and frailty （rs=0.187，0.269，0.239，P=0.045，0.004，0.010，respectively），while it was negatively correlated with plasma albumin，pre albumin levels （rs=-0.216，-0.192，P=0.021，0.041）.Multivariate Logistic regression analysis showed that CRP 〔OR=1.008，95%CI（1.007，1.095）〕，MCP-1 〔OR=1.008，95%CI（1.001，1.014）〕 and frailty 〔OR=1.997，95%CI（1.156，3.450）〕 were the independent risk factors for the progression of infection in elderly patients on MHD.Conclusion A high prevalence of infection occurred in elderly patients on MHD. CRP，MCP-1 levels and frailty are the risk factors for aggravation of infection in such population.
【Key words】 Hemodialysis；Infection；Frailty；Aged；Relationship；Root cause analysis
Clinical and Pathological Features of High-risk HPV-negative Cervical Cancer CHEN Wenzeng1，2，CHEN Yaxia1*
1.Women's Hospital，School of Medicine Zhejiang University，Hangzhou 310006，China
2.Tongde Hospital of Zhejiang Province，Hangzhou 310012，China
*Corresponding author：CHEN Yaxia，Chief physician；E-mail：email@example.com
【Abstract】 Background Cervical cancer is a common malignant tumor of the female reproductive system，which mainly caused by persistent infection of high-risk human papillomavirus （HPV）．However，clinical studies found that a considerable number of cervical cancer patients are high-risk HPV-negative，and such patients have increased risks of postoperative recurrence，cancer cell invasion and metastasis.Objective To describe the clinical and pathological features of high-risk HPV-negative cervical cancer patients.Methods This analysis was performed on 1 416 cervical cancer inpatients with complete clinicopathological data recruited from Women's Hospital，School of Medicine Zhejiang University during 2003 to 2016.Among them，1 296 were high-risk HPV-positive，and 120 were high-risk HPV-negative showed by preoperative Hybrid Capture II HPV Test （HCII）．Paraffin-embedded cervical cancer samples of high-risk HPV-negative patients were reexamined by real-time PCR，and those were truly negative for high-risk HPV were assigned to high-risk HPV-negative group，and were compared with the same number of high-risk HPV-positive patients randomly selected from the 1 296 cases.Data about age of onset，age at first birth，number of births，clinical stage，and pathological type of the two groups were collected.Results The rate of high-risk HPV-negative detected by HCII was 8.5%（120/1 416）．And of these 120 cases，89 were found to be truly negative for high-risk HPV by real-time PCR，achieving a rate of truly high-risk HPV-negative of 6.3%.The coincidence rate of the two tests was 74.2% （89/120）．The mean onset age for high-risk HPV-negative，and high-risk HPV-positive patients was （45.2±4.2） years （range 28-75），（46.3±5.1） years（range 21-78），respectively.No significant differences were observed in terms of mean age of onset，distribution of onset age，distributions of age at first birth，number of births，and clinical stage between the two groups （P>0.05），but there was significant difference in pathological type distribution between them （χ2=22.062，P=0.001）．Conclusion Real-time high-risk HPV test is highly sensitive in detecting high-risk HPV DNA.Compared with high-risk HPV-positive cervical cancer，although the overall incidence rate of HPV-negative cervical cancer is not high，the incidence rates of adenocarcinoma，adenosquamous carcinoma and other rare histologic subtypes are higher.
【Key words】 Uterine cervical neoplasms；Human papillomavirus；Pathological conditions，sign and symptom；Polymerase chain reaction
Effects of Hyperbaric Oxygen Therapy on Serum Levels of Nitrogen Monoxide and Endothelin-1 and Corresponding Clinical Efficacy for Patients with Hypertensive Intracerebral Hemorrhage after Minimally Invasive Surgery YAO Xiangrong1，LYU Yunli1，YOU Hong2*，ZHAO Bo1，XU Ruishan3
1.940 Hospital of Joint Logistic Support Force of the Chinese People's Liberation Army，Lanzhou 730070，China
2.Gansu Provincial Hospital，Lanzhou 730000，China
3.Wuwei People's Hospital，Wuwei 733000，China
*Corresponding author：YOU Hong，Chief physician，Professor，Master supervisor；E-mail：firstname.lastname@example.org
【Abstract】 Background Nitrogen monoxide（NO）and endothelin-1（ET-1），as the endothelial vasoactive factors，are mediators of pathophysiological changes of hemorrhagic focus as inflammation and neurological deficit may occur after minimally invasive surgery on patients with hypertensive intracerebral hemorrhage（HICH）．The clinical efficacy of hyperbaric oxygen（HBO）combined with synthesis rehabilitation therapy（SRT）is ambiguous in NO and ET-1 regulation.Objective To explore the efficacy of SRT with HBO for patients with hypertensive intracerebral hemorrhage and to assess their serum levels of NO and ET-1.Methods A total of 128 subjects suffering from HICH treated with minimally invasive surgery at 6 to 24 hours after onset in 940 Hospital of Joint Logistic Support Force of the Chinese People's Liberation Army and 64 healthy subjects were included in the study as the normal group from March 2010 to March 2017.The 128 patients were randomly divided into the control group（64 patients treated with normal SRT） and study group（64 patients treated with SRT and HBO therapy）．Serum levels of NO，ET-1 and NO/ET-1 ratio were detected in the control group and study group before and at day 1，7，14，21，30 and 37 after minimally invasive surgery，and in the normal group.Disability Rating Scale（DRS），United States National Institutes Of Health Stroke Scale（NIHSS），Mini-mental State Examination（MMSE），Barthel Index（BI）for the control group and study group were used before and at day 7，14，21，30，37，90 and 180 after surgery.Results There were correlations between treatment methods or time and NO，ET-1，NO/ET-1 ratio（P<0.05）．The effect of treatment and time on NO，ET-1 and NO/ET-1 ratio were significant（P<0.05）．NO of the control group at day 0，1，7 and the study group at day 0，1，7，14，21，30 was higher than the normal group，and NO of the study group was higher than that of the control group at day 14，21，30（P<0.05）；the ET-1 of the study group at day 0，1，7，14 was higher than the normal group，and that at day 14，21，30 was lower than that of the control group（P<0.05）；the NO/ET-1 of the study group was lower than the normal group at day 1，7，and that at day 21 was higher than the normal group，and that at day 14，21，30 was higher than that of the control group（P<0.05）．Treatment method and time had interaction on DRS，NIHSS score，MMSE score and BI score（P<0.05）；treatment method and time had significant effect on DRS，NIHSS score，MMSE score and BI score（P<0.05）．In the study group，the DRS at day 21，30，37，90 was lower than that of the control group，the NIHSS score at day 21，30，37，90，180 was lower than that of the control group，and the MMSE score ，BI score at day 14，21，30，37，90，180 was higher than that of the control group（P<0.05）．Conclusion By modulating serum levels of NO and ET-1 of HICH patients who are treated with minimally invasive surgery，HBO could improve their consciousness states，neurological functions，cognitive functions and quality of lives，with significant protection on cerebral functions.
【Key words】 Intracranial hemorrhage，hypertensive；Hyperbaric oxygenation；Nitric oxide；Endothelin-1；Treatment outcome；Surgical procedures，minimally invasive
Effects of CpG Oligodeoxynucleotides on Airway Remodeling in Combined Allergic Rhinitis and Asthma Syndrome LI Hongtao，LIN Yusen，ZOU Xiaoling，LI Wenjuan，MENG Ping，ZHANG Tiantuo*
Department of Pulmonary and Critical Care Medicine，the Third Affiliated Hospital of Sun Yat-sen University，Guangzhou 510630，China
*Corresponding author：ZHANG Tiantuo，Professor；E-mail：email@example.com
【Abstract】 Background Glucocorticoids are commonly used in the treatment of combined allergic rhinitis and asthma syndrome（ACAD），while airway remodeling in chronic ACAD may affect their efficacy.Therefore，it is necessary to explore a new immunotherapy，which can produce synergistic effects when being used in combination with glucocorticoids.Previous studies have shown that CpG oligodeoxynucleotides（CpG-ODN） can inhibit airway inflammation in ACAD，but their inhibitory effects on airway remodeling remain unclear.Objective To investigate the effects of CpG-ODN on airway remodeling in mice models of chronic ACAD.Methods This study was carried out from April 2016 to March 2018．In this study，30 clean female BALB/c mice were randomly divided into the groups of Control，ACAD，ACAD/CpG-ODN，ACAD/Budesondine（BUD），and ACAD/CpG-ODN+BUD.ACAD models were made by systemic sensitization and repeated challenge with ovalbumin（OVA） or phosphate buffer saline（PBS） intranasally for 3 successive weeks，followed by aerosolly for 6 weeks.Then，a nasal instillation of CpG-ODN，BUD and CpG-ODN+BUD was given to groups of ACAD/CpG-ODN，CAAD/BUD，and ACAD/CpG-ODN+BUD，respectively，and PBS was administered intranasally to other groups.Within 10 minutes after each nasal or airway stimulation，the numbers of sneezings and scratching the nose due to itch were counted.Pathologic analyses of nasal tissues and lung sections were performed with HE and PAS staining，HE，AB-PAS and Masson's trichrome staining，respectively.The degree of airway inflammation was evaluated according to the peripheral inflammatory cell infiltration.The expression levels of transforming growth factor beta 1（TGF-β1） and alpha-smooth muscle actin（α-SMA） in lung tissues were assessed by immunohistochemical staining with the Image-Pro Plus software.Nasal symptoms were assessed directly after nasal challenge.Results The numbers of scratching the nose and sneezings varied significantly among the groups（P<0.01）．The numbers of scratching the nose and sneezings were much more in ACAD group compared with those of the groups of control，ACAD/CpG-ODN，and ACAD/BUD and ACAD/CpG-ODN+BUD（P<0.05）．The numbers of scratching the nose and sneezings varied significantly among the groups（P<0.01）．The numbers of scratching the nose and sneezings were much more in ACAD group compared with those of other groups（P<0.05）．Histological examinations of nasal tissues stained with HE and PAS showed that the degree of alleviation of pathological changes in nasal mucosa was the greatest in ACAD/CpG-ODN group，followed by ACAD/CpG-ODN group/ACAD/BUD group，then ACAD group.Histological examinations of lung tissue sections with HE，AB-PAS and Masson's trichrome staining found that the degree of alleviation of pathological changes in lung tissues was the greatest in ACAD/CpG-ODN+BUD group，followed by ACAD/CpG-ODN group/ACAD/BUD group，then ACAD group.The scores for the degree of airway inflammation differed significantly among the groups（P<0.01）．ACAD group had higher scores in the degree of airway inflammation than every other group（P<0.05）．The expression levels of TGF-β1 and α-SMA varied obviously among the groups（P<0.01）．ACAD group had higher expression levels of TGF-β1 and α-SMA than every other group（P<0.05）．Conclusion CpG-ODN and BUD can inhibit the occurrence of nasal inflammation and bronchopulmonary remodeling in mice models of chronic ACAD，and they may have synergistic effects in the process.
【Key words】 Allergic combined airway disease；Airway remodeling；CpG oligodeoxynucleotides；Budesonide；Mice；Nasal cavity；Bronchi
Research Status and Hotspots of Sedentary Behaviors：a Bibliometric Analysis YU Zhen1，PAN Liniu1，ZHANG Shuang1，CHEN Ying1，JIANG Zongliang1，SUN Naya1，ZHANG Weihong1，2*
1.The Nursing College of Zhengzhou University，Zhengzhou 450001，China
2.Community Health Maintenance System Henan Engineering Laboratory，Zhengzhou 450000，China
*Corresponding author：ZHANG Weihong，Professor；E-mail：firstname.lastname@example.org
【Abstract】 Background The prevalence of sedentary behavior is increasing，which is closely related to the occurrence and development of many diseases.Therefore，analyzing current international research status and hotspots of sedentary behaviors may provide a reference for related studies in China.Objective To explore the current research status and hotspots of sedentary behaviors by analyzing the related articles.Methods PubMed database was searched from inception to December 31，2018.BICOMB software and gCluto visual clustering toolkit were applied for data retrieval and analysis.Results Altogether，
7 349 articles were retrieved，of which 7 332 were published in the last decade，accounting for 99.77% of the total.The number of articles was most in the United States.A total of 43 high-frequency subject headings were extracted，which were classified into 7 clusters：sedentary related concepts studies，influencing factors of sedentary behaviors，relationship between sedentary behavior and epidemiology of cardiovascular and metabolic diseases，workplace sedentary behavior interventions，sedentary behavior studies in children and adolescents，prevention and etiology studies of sedentary behaviors and cardiovascular and metabolic diseases.Conclusion The study of sedentary behavior is still in its infancy.There are few studies in this field in China.Further domestic studies can conducted on any of the research hotspots of sedentary behaviors to promote the rapid development of this field.
【Key words】 Sedentary lifestyle；Bibliometrics；Cluster analysis
Analysis of Research Status and Hot Spots about Integration of Medical and Elderly Care in China Based on CiteSpace Software MA Siting1，FU Hang2，LI Guohong1，2，SHEN Jie2，3*
1.School of Public Health，Shanghai Jiao Tong University，Shanghai 200025，China
2.China Hospital Development Institute，Shanghai Jiao Tong University，Shanghai 200025，China
3.Renji Hospital，Shanghai Jiao Tong University School of Medicine，Shanghai 200031，China
*Corresponding author：SHEN Jie，Associate chief physician；E-mail：email@example.com
【Abstract】 Background The current situation of aging in China is severe.With a large number of elderly population，the number of incapacitated elderly is growing rapidly resulting in the increase of chronic disease burden and social dependency ratio in China.Objective To clarify the current situation and hot spots in the research field of integrated medical and elderly care in China.Methods With the subject term of “combination of medical care and pension”，the relevant literature published in CNKI database from November 2010 to November 2018 was retrieved.The bibliographic references of included literature were analyzed by CiteSpace software for the statistical analysis of basic information，researchers and institutions，and high-frequency words.Results A total of 2 209 articles were included in this study.It was found that the number of articles issued per year showed an increasing trend.The institutes that studied the integrated medical and elderly care were mainly colleges and universities or their subordinate research institutes.The research topics focused on health management，social security，and health economic management.There were four hot spots，including pension and medical resources，elderly care at home and wisdom endowment，PPP model and financial sustainability，and long-term care insurance and social pension security.Conclusion The research hot spots of the integrated medical and elderly care are pension and medical resources，elderly care at home and wisdom endowment，PPP model and financial sustainability，and long-term care insurance and social pension security.The government should lead the direction of developing the integration of medical and elderly care，and promote the multi-cooperation between research and practice.
【Key words】 Health services needs and demand；Combination of medical care and pension；Research hotspots；
Multidimensional Analysis of the Healthcare Big Data Policy Documents in China YU Qi1，JING Shengjie2，TAI Yangfang1，WU Shengnan1，CHANG Jiangyi2，HE Peifeng1，2*
1.School of Management，Shanxi Medical University，Taiyuan 030001，China
2.School of Humanities and Social Sciences，Shanxi Medical University，Taiyuan 030001，China
*Corresponding author：HE Peifeng，Professor；E-mail：firstname.lastname@example.org
【Abstract】 Background China has promulgated a series of healthcare big data policies in recent years.The analysis of these policy documents is mostly qualitative，so there is a lack of the quantitative analysis.Objective To analyze China's state-level healthcare big data policy documents from multidimensional perspectives，and to grasp the basic characteristics and policy objectives of these documents on the whole，in order to provide a new idea and practical reference for the formulation and improvement of healthcare big data policy in China.Methods In this article，the Python program was used to capture the policy texts on the official website of the National Health Commission，from which 179 healthcare big data policy documents were chosen as the research objectives.The search deadline was December 31，2017.Statistical methods were used to analyze the external features of healthcare big data policy documents from three dimensional perspectives，i.e.policy year，policy type and policy subject.The VOSviewer was used to cluster the keywords that characterize the content of the policy texts.The visualization was done by Pajek.Results From the perspective of external characteristics，the development of China's state-level healthcare big data policy had experienced a budding period and entered a period of rapid development.The efficiency-led policies account for the majority，including “letter” “opinion” and “notification”，accounting for 34.1%（61/179），17.9%（32/179），and 16.2%（29/179），respectively.The National Health Commission issued the most in 143 solo-issued policy documents，accounting for 69.9%（100/143），and participated most in the joint-issued policy documents，accounting for 16.3%（28/172）．There was a wide cooperation among policy subjects involving various aspects of government，industry and academy.From the perspective of internal themes，the relevant policies focused on healthcare big data in its construction，applications，services and artificial intelligence assisted treatment.Conclusion From the perspective of external characteristics，China's state-level healthcare big data policy documents are currently focusing on the promotion and popularization of policies.The National Health Commission is the main force of policy formulation.From the perspective of internal themes，the construction of China's healthcare big data is still in its infancy，and healthcare big data can be applied to various fields such as diseases，medicine，and old-age care，based on which telemedicine，hierarchical diagnosis and treatment，and community healthcare can be developed in order to provide convenience and benefit for people.The relevant policy documents emphasize the standardization of intelligent medical technology based on big data covering a wide range of topics.
【Key words】 Benchmarking，health care；Healthcare big data；Bibliometrics；Policy text；Content analysis；China
Changes in High-risk Factors of Pregnancy and Application of Hierarchical Management in 2015—2017 ZHU Xuhong*，JIANG Liyuan
Ministry of Women's Health，Hangzhou Maternity and Child Health Care Hospital，Hangzhou 310008，China
*Corresponding author：ZHU Xuhong，Associate chief physician；E-mail：email@example.com
【Abstract】 Background Maternal and infant safety is the premise of women and children's health. However，the number of high-risk pregnant and puerperal women has increased dramatically in recent years.How to carry out effective management of high-risk pregnant women and puerperas has become the focus and a difficult issue at present.Objective To analyze the changes of high risk factors in pregnancy from 2015 to 2017，so as to provide basis for formulating effective hierarchical management measures.Methods The data of pregnant women reported by information systems of all districts and counties in Hangzhou from 2015 to 2017 were collected，and the changes of high-risk factors were analyzed statistically.Results The total number of pregnant women was 329 135 from 2015 to 2017，including 212 148 （64.46%）high-risk pregnant women and puerperas．From 2015 to 2017，the total number of high-risk pregnant women and puerperas and incidence of high risk pregnancies increased significantly （χ2trend=891.12，P<0.001）．The top 3 high-risk factors were the same from 2015 to 2017，respectively：uterine scar （history of cesarean section，uterine fibroids exenteration，etc），surgery time≥2 years，abortion （natural，artificial）≥2 times，age≥35 years，and other high-risk factors were different in different years.There was significant difference in the number of high-risk factors between 2015 and 2017（χ2=1 112.49，P<0.001）among which，the number of single high-risk factor decreased significantly，and the number of 2 and more than 2 high-risk factors increased significantly（χ2trend=712.40，P<0.001）.To compare different high-risk scores and grades between 2015 and 2017，the difference had statistical significance （χ2=26.89，P<0.001）， among which，the proportion of grade A high-risk score was higher，while the proportion of grade C high-risk score was lower（P<0.017）.Age，average numbers of pregnancies，deliveries and examinations，the number of examinations>10 and 0 follow-up visit of high-risk pregnancy was less than that in normal pregnancy（t=136.04，P<0.001；t=365.84，P<0.001；t=90.10，P<0.001；t=151.89，P<0.001；χ2=24 345.92，P<0.001；χ2=408.58，P<0.001）.Conclusion The proportion of high-risk pregnant women and puerperas increased significantly from 2015 to 2017，and risk factors are different in different years.Therefore，early screening of high-risk pregnant women and puerperas should be emphasized，especially for those with uterine scar （history of cesarean section，uterine fibroids exenteration，etc），surgery time≥2 years，abortion（natural，artificial）≥2 times，age≥35 years.At the same time，appropriate hierarchical management measures can help improve pregnancy outcomes and ensure the safety of pregnant women and fetuses.
【Key words】 Pregnancy；High-risk；Pregnant women；High-risk factors；Hierarchical management；High-risk score
Association between Urinary Iodine Levels and Sensory Integration Dysfunction in Preschool Children LI Dong1，2，LI Ju3，LI Li2，GUO Huailan4，5，WANG Jing3，4，5*
1.School of Nursing，Hubei University of Medicine，Shiyan 442000，China
2.Department of Nursing，Shiyan Renmin Hospital，Shiyan 442000，China
3.Department of Endocrinology，Shiyan Renmin Hospital，Shiyan 442000，China
4.School of Public Health and Management，Hubei University of Medicine，Shiyan 442000，China
5.Center for Environment and Health in Water Source Area of South-North Water Diversion，Hubei University of Medicine，Shiyan 442000，China
*Corresponding author：WANG Jing，Professor，Master's supervisor；E-mail：firstname.lastname@example.org
【Abstract】 Background Iodine is the main element in the synthesis of thyroid hormone.Iodine deficiency in fetus can cause hypothyroidemia and irreversible neurological damage and cognitive impairment.And sensory integration dysfunction（SID）is susceptible to cause learning difficulties and behavioral disorders in children，but there are few studies on the relationship between iodine and SID in China.Objective To investigate the association between urinary iodine levels and SID in preschool children and provide scientific evidence to improve the development of children's sensory integration.Methods Five kindergartens were selected by cluster sampling in Yunxi County，Shiyan City，Hubei Province from October to November 2017.The urinary iodine of children aged 3-6 years in kindergartens was measured in the morning.The basic information was investigated by epidemiological questionnaires.The sensory integration ability of children was tested by the Children Sensory Integration Development Assessment Scale.The urinary iodine and SID of preschool children in different genders and age were compared.Multivariate logistic regression was used to analyze the influencing factors of sensory integration in preschool children.Results A total of 800 questionnaires and urine samples were sent out.710 valid questionnaires and qualified urine samples were obtained，with the effective rate of 88.8%.There were significant differences in birth weight，BMI，spontaneous delivery，urinary iodine and SID between different sex subjects（P<0.05）．The urinary iodine of preschool children was 192（144，271）μg/L，9.4%（67/710）of who were deficient in iodine，42.8%（304/710）of who were iodine-replete，30.4%（216/710）of who had mild and moderate iodine excess and 17.3%（123/710）of who had extreme iodine excess.There was significant difference in urinary iodine level between preschool children in different genders（P<0.05），and there was no significant difference in urinary iodine level between preschool children in different age groups（P>0.05）．The incidence of SID was 55.8%（396/710），of which 30.3%（215/710）had mild SID and 25.5%（181/710）had severe SID.There were significant differences in the incidence of SID among preschool children of different genders（P<0.05）；and the incidence of total SID and severe SID in boys were higher than that in girlss（P<0.05）.There was no significant difference in the incidence of SID between preschool children in different age groups（P>0.05）．Multivariate Logistic regression analysis showed that urinary iodine status of preschool children was the influencing factor of vestibular imbalance 〔OR=1.250，95%CI（1.018，1.534），P=0.033〕 and proprioceptive dysesthesia〔OR=1.247，95%CI（1.015，1.531），P=0.035〕.Conclusion Urinary iodine levels in preschool children may affect the SID，and low-level urinary iodine may increase the risk of children's vestibular imbalance and proprioceptive dysfunction.
【Key words】 Psychophysiologic disorders；Urinary iodine；Sensory integration dysfunction；Child，preschool；Investigation
Distribution of Serum Uric Acid and Risk Factors of Hyperuricemia in Children and Adolescents in Tangshan CHEN Xinchun*，KOU Yongmei，GU Xiaona，YANG Zhenpeng，ZHAO Yongsheng，YANG Xuebing
Department of Pediatrics，Tangshan People's Hospital，Tangshan 063001，China
*Corresponding author：CHEN Xinchun，Attending physician；E-mail：email@example.com
【Abstract】 Background Hyperuricemia is an independent factor for cardiovascular diseases，and is also closely related to metabolic syndrome and its components.The incidence of hyperuricemia in children is increasing year by year，which can impair their quality of life without early intervention.At present，there are no domestic studies about the distribution of serum uric acid （UA） and risk factors of hyperuricemia in children and adolescents in Tangshan，Hebei Province，a district with its unique geographical and dietary characteristics.Objective To investigate the distribution characteristics of UA and the risk factors of hyperuricemia in children and adolescents in Tangshan，Hebei Province，providing a theoretical basis for early diagnosis and prevention of hyperuricemia-related diseases.Methods We randomly selected 1 039 children and adolescents in the age group of 4-15 years from Department of Pediatrics，Tangshan People's Hospital，during January 1，2012 to December 31，2017，and finally enrolled 1 000 of them who received blood sampling for biochemical analysis after obtaining written informed consent from their parents.We obtained their general physical data，and biochemical data〔UA，total cholesterol （TC），triglyceride （TG），and glucose （GLU）〕.We analyzed the distribution characteristics of UA by sex and age，and the risk factors for hyperuricemia.Results The level of UA differed significantly among the participants by sex （t=5.90，P<0.001） and age.And it varied obviously among the same sex groups by age （P<0.05）．The detection rates of hyperuricemia in all the participants，male and female participants were 13.5% （135/1 000），12.3% （69/560），and 15.0% （66/440），respectively.The detection rate of hyperuricemia varied significantly by age （P<0.05），but not by sex （χ2=1.514，P=0.219）．The detection rate of hyperuricemia differed significantly in the same-sex groups by age （P<0.05）．Correlation analysis showed that UA level in males was positively correlated with age （r=0.39），BMI （r=0.33），systolic pressure（r=0.28），diastolic pressure（r=0.20），TC （r=0.12）and TG （r=0.21），negative correlated with WHtR （r=-0.25）（P<0.05），while in females，it was positively correlated with BMI （r=0.17），TG （r=0.21） and GLU （r=0.11）（P<0.05）．Multiple linear regression analysis showed that age 〔β=9.42，95%CI（6.96，11.89），P<0.001〕，BMI 〔β=4.07，95%CI（2.49，5.66），P<0.001〕，TG 〔β=21.77，95%CI（12.09，31.45），P<0.001〕 were the influencing factors of SUA level in males；BMI 〔β=3.56，95%CI（1.50，5.62），P=0.001〕，WHtR 〔β=243.25，95%CI（52.17，434.34），P=0.013〕，and TG 〔β=32.25，95%CI（17.80，46.70），P<0.001〕 were the influencing factors of SUA level in females.Multivariate Logistic regression analysis showed that age 〔OR=1.46，95%CI（1.34，1.64），P<0.001〕，BMI 〔OR=2.03，95%CI（1.16，3.53），P=0.013〕，TG 〔OR=1.49，95%CI（1.09，2.04），P=0.013〕 were the influencing factors of hyperuricemia in males，and TG 〔OR=1.93，95%CI （1.21，3.07），P=0.006〕 was an influential factor of hyperuricemia in females.Conclusion There is a significant sex difference in UA level among children and adolescents in Tangshan.UA level in males is higher than that of females.UA level increased significantly from the age of 9 years in males.There is no significant sex difference in the detection rate of hyperuricemia.BMI and TG are the influencing factors of UA level in children and adolescents.And age，BMI and TG are the influencing factors of hyperuricemia.
【Key words】 Hyperuricemia；Serum-uric acid；Adolescent；Child
Construction of a Performance Evaluation System for Elderly Care Institutions Delivering Integrated Medical and Nursing Care XIAO Xiaohua，HUANG Zhuomin，WU Yafei，YAN Mengqi，LI Bei*
School of Health Services Management，Southern Medical University，Guangzhou 510515，China
*Corresponding author：LI Bei，Associate professor，Master's supervisor；E-mail：firstname.lastname@example.org
【Abstract】 Background At present，it is difficult to ensure the quality of services of elderly care institutions delivering integrated medical and nursing care in China，partly due to the imperfect performance evaluation mechanism for such institutions.But correct evaluation results are directly related to the quality of elderly care and the development of such institutions，so it is necessary to construct a sound performance evaluation system for such institutions.Objective To construct and verify a scientific and rational performance evaluation system for elderly care institutions delivering integrated medical and nursing care.Methods From August to November 2018，we conducted two rounds of telephone-based or face-to-face consultations using Delphi technique in experts with 10 years of research experience in social welfare industry management，elderly care institutions management，geriatric disease management，health administration，health management teaching，and clinical medicine and with an associate professor or professor title.We used analytic hierarchy process and analysis of membership function to determine the 3 dimensions（input，outcome and outcomes）and indicator weights of the performance evaluation system for elderly care institutions delivering integrated medical and nursing care.We tested the reliability the system using Cronbach's alpha coefficient.Results The degree of familiarity（Cs）of the experts' authority in the two rounds of consultation was 0.679 and 0.768，respectively.The selection basis（Ca）was 0.614 and 0.657，respectively，and the authoritative coefficient（Cr）was 0.646 and 0.713，respectively.The Kendall's W of the two rounds of expert consultation was 0.394 and 0.426，respectively，showing a significant difference（χ2=481.049，504.768，P<0.001）．In accordance with the consultation results，we revised and improved the initial system，and established a performance evaluation system for elderly care institutions delivering integrated medical and nursing care finally，which consists of 3 first-level dimensions，and 8 second-level dimensions，and 49 third-level indicators，and assigned weight to each indicator.The weights for 3 first-level domains were 0.216 3，0.576 2，0.207 5，respectively，and the combined weights CR were all <0.10.The reliability test results showed that the Cronbach's alpha coefficients of each dimension and the total Cronbach's alpha coefficients were all>0.800.Conclusion Our system was proved to have high reliability and validity，which can provide scientific and feasible supports for decision-making by related departments.
【Key words】 Health services for the aged；Medical care combination；Pension agency；Service performance evaluation；Delphi technique
Localization of Subjective Cognitive Decline Questionnaire and Its Reliability and Validity Test HAO Lixiao1，HU Xiaochen2，HAN Ying3，4，5，6*，JIA Jianguo7，8*
1.Department of Geriatrics，Xuanwu Hospital Capital Medical University，Beijing 100053，China
2.Department of Psychiatry，Cologne University School of Medicine，Cologne 50923，Germany
3.Department of Neurology，Xuanwu Hospital Capital Medical University，Beijing 100053，China
4.Center of Alzheimer's Disease，Beijing Institute for Brain Disorders，Beijing 100053，China
5.Beijing Institute of Geriatrics，Beijing 100053，China
6.National Clinical Research Center for Geriatric Disorders（Xuanwu Hospital）—AD Preclinical Alliance in China，Beijing 100053，China
7.Department of General Surgery，Xuanwu Hospital Capital Medical University，Beijing 100053，China
8.Department of Education Department，Xuanwu Hospital Capital Medical University，Beijing 100053，China
*Corresponding author：HAN Ying，Professor，Chief physician；E-mail：email@example.com
JIA Jianguo，Professor，Chief physician；E-mail：firstname.lastname@example.org
【Abstract】 Background Alzheimer's disease （AD），as a chronic neurodegenerative disease，cannot be cured.Thus，it is especially important to achieve “early detection，early diagnosis and early treatment”.Subjective cognitive decline（SCD）has attracted attention in the field of AD as it can indicate the preclinical stage of AD.The development of simple screening tools can help general practitioners to identify possible preclinical stage of AD，meanwhile reduce the burden on patients and doctors further.Objective To explore the early simple screening tools for AD by translating English-version SCD questionnaire 9 （SCD-Q9）．Methods The English version of SCD-Q9 was translated into Chinese via “two-person literal translation，back-translation” method of Brislin after obtaining the original author's authorization.Then the original author compared the nuances in language and culture between the Chinese and the original version.The first draft of SCD-Q9 questionnaire was revised and culturally adjusted after the expert panel discussion and pre-survey.From September 6 to 15，2016，two hundred local residents in ShunYi District were selected by random sampling method.The questionnaire which included general situation and Chinese version SCD-Q9 were used for the investigation.A total of 200 questionnaires were distributed and all of them were effectively recovered，with an effective recovery rate of 100.0%.Project analysis was carried out by using the comparative method between extreme groups （the top 27% of high group and the bottom 27% of low group）of project differentiation degree and the correlation coefficient method of project homogeneity.Cronbach's α coefficient and Spearman-Brown coefficient method were used for reliability analysis.And content validity was analyzed by expert evaluation.KMO test，Bartlett's sphericity test and exploratory factor analysis （EFA）were used for structural validity analysis.Results The Chinese version of SCD-Q9 contained 2 dimensions and 9 items，including the overall memory function and time comparison （4 items）and daily activity ability （5 items）．The subjects were divided into high score group （54 cases）and low score group （54 cases）by item differentiation（top 27% as the high group and bottom 27% as the low group）．The differences between the two groups were statistically significant in each item （P<0.05）．The correlation analysis of each item and the total score showed that there was a negative correlation between them （P<0.05），the absolute value of the correlation coefficient was >0.400，and all items could be retained.Results of reliability test were showed，the Cronbach's α coefficient of the Chinese version of SCD-Q9 was 0.886.After deleting any item of the questionnaire，the Cronbach's α coefficient ranged from 0.870 to 0.881.With no specific high value，there was no prompt to delete entries.Spearman-Brown's split-half coefficient was 0.892.We also found that the KMO value of the questionnaire was 0.883 and the Bartlett's spherical test χ2 was 1 059.320，df=36，P<0.001，which indicated that the questionnaire was suitable for further factor analysis.Two common factors were extracted by EFA with eigenvalue≥1，and the eigenvalue of common factor 1 was 5.116，whose variance contribution rate was 56.846%，the eigenvalue of factor 2 was 1.231，whose variance contribution value was 13.673%，and the cumulative variance contribution value of two common factors was 70.519%.Conclusion The internal validity and reliability of the Chinese version of SCD-Q9 questionnaire is good.The development of this questionnaire lays the foundation for its subsequent application in the Chinese population，and provides a simple screening tool for the exploration of SCD.
【Key words】 Alzheimer's disease；Subjective cognitive decline；Questionnaires；Screening；Reliability；Validity；SCD questionnaire 9
Progress in the Mechanism of Pancreatitis Associated with Clozapine LI Wenzheng1，2，XIA Lei3，HAO Rui3，REN Zhenhua4，LIU Huanzhong3，5*
1.The Fourth People's Hospital of Hefei，Hefei 230022，China
2.Affiliated Psychological Hospital of Anhui Medical University，Hefei 230022，China
3.Anhui Psychiatric Center，Chaohu 238000，China
4.Basic Medical，Anhui Medical University，Hefei 230022，China
5.Chaohu Hospital of Anhui Medical University，Chaohu 238000，China
*Corresponding author：LIU Huanzhong，Chief physician，Doctoral supervisor；E-mail：email@example.com
【Abstract】 Pharmaceutical therapy is still the primary treatment for schizophrenia.For refractory schizophrenia，which affects about 30% of the patients with schizophrenia，clozapine is a first choice.However，although the efficacy of clozapine is definite，the complex and intractable adverse reactions associated with its use have been troubled psychiatrists，such as granulocytopenia，aspiration pneumonia，intestinal obstruction，pancreatitis，and myocarditis.For clozapine-induced pancreatitis，the development process involves direct toxic effects of clozapine on the pancreas and pancreatic hypersensitivity to clozapine.Moreover，the complex inflammatory responses to clozapine，and a large number of inflammatory mediators and complex cellular pathways are also involved.We reviewed the studies about drug-induced pancreatitis in animal models，basic research，and human case reports，and based on this，summarized recent advances in clozapine-induced pancreatitis，providing ideas and directions for subsequent studies.
【Key words】 Pancreatitis；Schizophrenia；Clozapine；Drug toxicity；Molecular mechanisms of pharmacological action；Review
Repetitive Transcranial Magnetic Stimulation in the Treatment of Refractory Epilepsy：Research Progress and Technology Optimization PENG Yan，LI Yingxuan，LIN Hua*
Department of Neurology，Xuanwu Hospital Capital Medical University，Beijing 100053，China
*Corresponding author：LIN Hua，Associate chief physician，Associate professor；E-mail：firstname.lastname@example.org
【Abstract】 Epilepsy is a group of chronic neurological disorders caused by excessive neuronal activity in the cortex of the brain.Repetitive transcranial magnetic stimulation （rTMS） is a non-invasive neuroelectrophysiological technology which can modulate cortical excitability.Researches have showed that rTMS delivered into epileptogenic foci had an antiepileptic effect on patients with refractory epilepsy or status epilepticus and appears to be safe.Thus，rTMS may become one of the most promising neuro-stimulation modalities for refractory epilepsy.Further multi-center，large-sample randomized controlled trials are warranted to provide basis for evidence-based medicine.Meanwhile，rTMS for treatment of epilepsy still faces some challenges，especially on how to map targets accurately and how to prolong the treating effect.Based on present key problems，future researches should focus on developing high-resolution positioning technology，optimizing equipment and stimulus mode and exploring brain network connections and relevant TMS mechanism.
【Key words】 Epilepsy；Transcranial magnetic stimulation；Therapy；Status epilepticus；Stereotaxic techniques；Nerve net；Review
New Developments in Stroke in HIV-infected Patients GAO Haibin1，LI Zimu1，TANG Beibei1，RUAN Qingting1，LUO Longjiang1，WU Xixi1，JIANG Feng2*
1.Guangxi University of Chinese Medicine，Nanning 530001，China
2.Ruikang Hospital Affiliated to Guangxi University of Chinese Medicine，Nanning 530011，China
*Corresponding author：JIANG Feng，Chief physician，Main research in the treatment of infectious diseases with traditional Chinese medicine；E-mail：email@example.com
【Abstract】 With the wide application of highly active antiretroviral therapy （HAART），and the acceleration of HIV-infected population aging，studies about the relationship between stroke and HIV infection have received increasing attention.Stroke is considered to be a serious complication after HIV infection，with high mortality and disability.At present，the epidemiology and pathogenesis of the disease are not completely clear，and there are no effective prevention and treatment measures.This article reviews recent developments in epidemiology，pathogenesis，prevention and treatment，and TCM knowledge concerning HIV-infected patients with stroke，in order to provide a reference for the prevention and treatment of HIV-related stroke.
【Key words】 Acquired immunodeficiency syndrome；HIV；Stroke；Highly active antiroviral therapy；Complications；Review