October 2019, Volume 22，No.29 Abstracts（A）
Author：尹鹏 Source：CGP Published： [08-29] views： 145
Interpretation of Nutrition Therapy for Adults with Diabetes or Prediabetes: a Consensus Report CHENG Gaiping*，YOU Qian
Department of Clinical Nutrition，West China Hospital，Sichuan University，Chengdu 610041，China
*Corresponding author：CHENG Gaiping，Technologist-in-charge；E-mail：firstname.lastname@example.org
【Abstract】 In May 2019，Nutrition Therapy for Adults with Diabetes or Prediabetes：a Consensus Report was published in Diabetes Care.This consensus report intended to provide clinical professionals with evidence-based guidance about individualized nutrition therapy for adults with diabetes or prediabetes.This consensus report included in total of 12 aspects of nutrition therapy and they were effectiveness of diabetes nutrition therapy，macronutrients，eating patterns，energy balance and weight management，sweeteners，alcohol consumption，etc.Focusing on the main contents of the consensus report，this paper compares them with relevant Chinese medical nutrition therapy guidelines and discusses the potential application in light of the actual situation in China.
【Key words】 Diabetes mellitus；Prediabetic state；Nutrition therapy；Adult；Consensus
Vitamin D Deficiency，Gestational Diabetes Mellitus and Its Maternal and Fetal Outcomes ZHOU Fang，LI Ping*
Department of Endocrinology，Shengjing Hospital of China Medical University，Shenyang 110022，China
*Corresponding author：LI Ping，Professor，Chief physician；E-mail：email@example.com
【Abstract】 Gestational diabetes can lead to adverse outcomes in mothers and babies.In recent years，the incidence of gestational diabetes in China has been rising.Vitamin D can improve insulin sensitivity and glucose tolerance，and many studies have shown that vitamin D deficiency is associated with an increased risk of gestational diabetes，while some studies have the opposite conclusion.In addition，most of the studies are observational studies，with few randomized controlled trials.Whether vitamin D supplementation can prevent gestational diabetes is still inconclusive.This article systematically reviewed the risk of vitamin D deficiency and gestational diabetes，and reviewed whether vitamin D supplementation can prevent gestational diabetes，improve glycolipid metabolism and maternal and fetal outcomes in patients with gestational diabetes.
【Key words】 Vitamin D deficiency；Diabetes，gestational；Insulin antibodies；Infant，newborn；Review
Relationship between Vitamin K and Glucose Metabolism REN Ruijun，TAN Jing*
North Sichuan Medical College，Nanchong 637000，China
*Corresponding author：TAN Jing，Associate professor；E-mail：firstname.lastname@example.org
【Abstract】 Diabetes is a worldwide public health disease that poses a threat to human health.Vitamin K could act on insulin resistance and glucose metabolism via vitamin K-dependent proteins （VKDPS）——osteocalcin （OC），growth arrest-specific 6 protein （Gas-6），and matrix Gla protein （MGP） and adiponectin，inflammatory factors and lipid，which may provide new ideas for the treatment of diabetes.The relationship between vitamin K and glucose metabolism has been tested in many animal experimentations and clinical experiments.
【Key words】 Vitamin K；Glucose metabolism；Diabetes mellitus；Insulin resistance；Review
Intracoronary Injection of Atropine versus Temporary Cardiac Pacing for Preventing and Treating Reperfusion Arrhythmia in Emergency PCI for Acute Inferior Myocardial Infarction TIAN Kejun1*，ZHONG Yuting2，ZHONG Yiming1，WANG Xiaoping1，ZHOU Aiqin1
1.Cardiovascular Department，First Affiliated Hospital of Gannan Medical University，Ganzhou 341000，China
2.Department of Anesthesiology，First Affiliated Hospital of Gannan Medical University，Ganzhou 341000，China
*Corresponding author：TIAN Kejun，Attending physician，Lecturer；E-mail：email@example.com
【Abstract】 Background In emergency PCI for acute inferior myocardial infarction（AIMI），to prevent and treat the arrhythmia after reperfusion，temporary cardiac pacing or intravenous injection of atropine is often used.But both two methods have insufficiencies.In contrast，intracoronary injection of a small dose of atropine has been found with a remarkable effectiveness and great benefits by First Affiliated Hospital of Gannan Medical University.However，there is no comparative study of intracoronary injection of atropine and intraoperative temporary cardiac pacing for preventing and treating arrhythmia after reperfusion in China.Objective To compare the efficacy of intracoronary injection of atropine and temporary pacemaker implantation for reperfusion arrhythmia in emergency PCI for AIMI.Methods 122 cases of AIMI who underwent emergency PCI from February 2012 to September 2018 in Cardiovascular Department，First Affiliated Hospital of Gannan Medical University were enrolled.14 cases of them were excluded from intergroup comparison because during the operation，4 received emergency temporary pacemaker implantation due to lack of response to intracoronary injection of atropine，and 10 without bradyarrhythmia following reperfusion did not need to receive the aforementioned two interventions，and the remaining 108 cases were randomized into intracoronary injection of atropine group（n=58），and pre-PCI temporary pacemaker implantation group（n=50）．Onset time of atropine after intracoronary injection（effectiveness criterion：ventricular rate>60 beats/min），time used for temporary pacemaker implantation，and puncture-balloon dilation time，average hospital stay and cost，preoperative and intraoperative average arterial pressure，incidence of bradyarrhythmia，malignant ventricular arrhythmia，maintenance of circulation with dopamine above 10 μg·kg-1·min-1 during and after operation were collected.Results The average onset time of atropine after intracoronary injection in the intracoronary injection of atropine group was （11±5）s，which was less than that of temporary pacemaker implantation in the pre-PCI temporary pacemaker implantation group （360±120）s（t=20.54，P<0.001）．Intracoronary injection of atropine group showed less average puncture-balloon dilatation time，average number of hospitalization days per person and average hospitalization expenses per person，lower average arterial pressure and malignant ventricular arrhythmia，and higher incidence rates of bradyarrhythmia than pre-PCI temporary pacemaker implantation group（P<0.05）．Conclusion Intracoronary injection of atropine has a rapid onset and is helpful to shorten the operation time，reduce hospitalization expenses，and decrease the incidence of malignant ventricular arrhythmia.Moreover，it shows better curative effect in most patients than conventional pre-PCI temporary pacemaker implantation.
【Key words】 Inferior wall myocardial infarction；Arrhythmia；Bradycardia；Atropine；Biological clocks；Angioplasty，balloon，coronary；Coronary vessels
Risk of HPV-16/18 Infections in MSM Population：a Latent Class Analysis GONG Zheng，ZHANG Zhanlin，YELEDAN·Mahan，TUO Xiaoqing，CHEN Zhen，GULISIYA·Hailili，DAI Jianghong*
Department of Epidemiology and Health Statistics，School of Public Health，Xinjiang Medical University，Urumqi 830011，China
*Corresponding author：DAI Jianghong，Professor；E-mail：firstname.lastname@example.org
【Abstract】 Background In recent years，men who have sex with men （MSM） become a group with a high incidence of sexually transmitted diseases（STDs），especially HPV 16/18 infection incidence remains high.HPV infection will develop into STDs if it is not effectively controlled.So it is important to research the main influencing factors for high incidence of HPV 16/18 infection in MSM.Objective To explore the risk of HPV 16/18 infection in MSM in Urumqi with latent class analysis （LCA），providing a scientific basis for the delivery of targeted interventions for this population.Methods From March 2016 to August 2017，a survey was conducted in a snowball sample of 884 MSM in Urumqi.Participants' general demographic characteristics，sexual behavior characteristics and HPV infection-related factors were collected.HPV 16/18 genotypes were detected.Class of risk of HPV16/18 infection was identified by LCA.Results Nine variables including sex，sexual intercourse pattern，commercial sexual behavior，use of drugs，history of sexually transmitted infections，condom use，anal intercourse，sexual orientation and circumcision were included.The AIC and BIC models with 3 potential categories are the lowest and the best models.According to the characteristics of sexual behavior and the related factors of HPV infection，the patients were divided into low risk group （520 cases），medium risk group （290 cases） and high risk group （74 cases）． The infection rates for these groups were 9.2%，14.5% and 24.3%，respectively，and high risk group showed much higher infection rate than low risk group（P<0.05）． Conclusion LCA can be used to stratify the risk of HPV-16/18 infections in MSM.
【Key words】 Sexually transmitted diseases；Men who have sex with men；Human papillomavirus 16；Human papillomavirus 18；Latent class analysis
Gut Microbiota Assessed by High-throughput Sequencing and Coronary Heart Disease LI Junyan1，SUN Zhiyuan2，YUAN Yu1*
1.CCU，the First Affiliated Hospital of Xinxiang Medical University，Weihui 453100，China
2.School of International Education，Xinxiang Medical University，Xinxiang 453000，China
*Corresponding author：YUAN Yu，Chief physician，Master supervisor；E-mail：email@example.com
【Abstract】 Background Coronary heart disease（CHD） is one of the most common causes of deaths in developed and developing countries．The composition of gut microbiota plays an important role in the pathological process of CHD．More and more evidences show that the imbalance of gut microbiota induce lipid metabolism disorder，low-grade inflammation，insulin resistance and elevated blood pressure，increasing the risk of CHD．Objective To explore the risk factors for CHD by examining the characteristics（including composition and diversities） of gut microbiota in CHD patients，providing a new diagnostic and treatment method for such patients．Methods This study was conducted in the First Affiliated Hospital of Xinxiang Medical University during July 2016 to June 2017 between 62 cases of CHD from CCU and Cardiovascular Department and 30 health examinees（control group）．CHD patients were divided into mild CHD group（n=27） and moderate-to-severe CHD group（n=35） by Gensini score．Fecal samples were collected，from which DNA was extracted and amplified by polymerase chain reaction in the bacterial 16S rDNA V3 region，and the final PCR amplification products were analyzed by bioinformatics．Results Mild CHD group，moderate-to-severe CHD group and control group had no significant differences in PE_reads，Nochimera，AvgLen，GC and Effective（P>0.05）．ACE，Chao1，Shannon and Simpson differed significantly among mild and moderate-to-severe CHD groups and control group（P<0.05），and they were much lower in the former two compared with the latter one showed by pairwise comparisons（P<0.05）．The relative abundances of bacteroidetes and proteobacteria differed significantly among control group and mild and moderate-to-severe CHD groups（P<0.05），and the relative abundances of bacteroidetes in the former one were much higher than the latter one，the relative abundances of proteobacteria in the former one were much lower than the latter one （P<0.05）．The relative abundances of bacteroidia and fusobacteria varied significantly among control group and mild and moderate-to-severe CHD groups（P<0.05），and the relative abundances of bacteroidia were much lower in the moderate-to-severe CHD group compared with the mild CHD group，and the relative abundances of fusobacteria were much higher in the moderate-to-severe CHD group compared with the mild CHD group，and and the relative abundances of bacteroidia were much lower in mild CHD group compared with the control group，and the relative abundances of fusobacteria were much higher in mild CHD group compared with the control group（P<0.05）．Mild and moderate-to-severe CHD groups and control group showed significant differences in the relative abundance of bacteroides （P<0.05）．Moderate-to-severe CHD group had much lower relative abundance of bacteroides than the mild CHD group and control group，as did the mild CHD group compared with the control group（P<0.05）．Metastats analysis showed that significant differences were found between the control group and mild CHD group in terms of the relative abundances of bacteroides，Barnesiella，Desulfovibrio，Escherichia Shigella and Phascolarctobacterium（P<0.05），and between the control group and moderate-to-severe CHD group in terms of the relative abundances of Barnesiella，Dialister，Flavonifractor，Parasutterella and Phascolarctobacterium（P<0.05），and between the mild and moderate-to-severe CHD groups in terms of the relative abundances of Desulfovibrio，Dialister，Escherichia-Shigella，Flavonifractor，and Paraprevotella（P<0.05）．Conclusion Changes in the diversity and structure of gut microbiota are risk factors for CHD．Therefore，regulation of gut microbiota and fecal microbiota transplantation may be used as the new treatments for CHD．
【Key words】 Coronary disease；Biodiversity；Computational biology；Intestinal flora；Multilocus sequence typing
Influencing Factors of Multidisciplinary Perioperative Pain Management ZHANG Haijing1，LIU Lihui2，ZHOU Zhuo1，GUAN Lei1*
1.Department of Operation and Anaesthesia，Beijing Shijitan Hospital，Capital Medical University，Beijing 100038，China
2.Department of Nursing，Beijing Shijitan Hospital，Capital Medical University，Beijing 100038，China
*Corresponding author：GUAN Lei，Chief physician；E-mail：firstname.lastname@example.org
【Abstract】 Background Postoperative pain management not only includes pharmacological pain relief management，but also includes collaborative pain relief management involving surgical，anesthetic，nursing，and rehabilitation healthcare workers as well as the patient himself.Multidisciplinary pain management is a kind of scientific and rational tools for pain diagnosis and treatment.Objective To develop improvement measures for multidisciplinary pain management on the basis of a postoperative pain management survey.Methods This survey was implemented in a convenience and volunteer sample of 700 surgical patients who received surgery in Beijing Shijitan Hospital，Capital Medical University during October to December 2015.A questionnaire co-developed by multidisciplinary pain management teams from Peking University People's Hospital，and Beijing Shijitan Hospital，Capital Medical University，was used in the survey for collecting the data about postoperative pain management in the patients.And influencing factors of postoperative pain management status were analyzed.Results All the questionnaires were completed and returned，and 627 of them were found to be responsive，the response rate was 89.6%.In terms of postoperative pain management，366 cases （58.4%） and 221 cases （35.2%） were very satisfied，and satisfied with it，respectively.And 39 cases（6.2%） thought it was OK，only 1 case（0.2%） was dissatisfied with it.Partial correlation analysis found that age，level of pain，and whether receiving pain relief methods from healthcare workers before consulting them when having pain had low correlations with patient satisfaction with postoperative pain management（P<0.05）．Multivariate Logistic regression analysis showed that age 〔OR=1.360，95%CI （1.093，1.692）〕，level of pain 〔OR=2.043，95%CI （1.369，3.047）〕，and whether receiving pain relief methods from healthcare workers before consulting them when having pain 〔OR=5.531，95%CI（2.396，12.770）〕 were the influencing factors of patient satisfaction with postoperative pain management（P<0.05）．Conclusion Pain assessment is supposed to be performed based on age.Healthcare workers' active introduction of pain-related knowledge and methods of pain relief can effectively improve patient satisfaction with pain management.
【Key words】 Pain，postoperative；Pain management；Pain measurement；Pain relief；Questionnaires；Root cause analysis
Effect of Febuxostat on Incidence of Contrast-induced Nephropathy in Patients with Coronary Heart Disease Complicated with Hyperuricemia PAN Zhuang，ZHANG Lihua*，NIU Shaohui，JIANG Youxu，LI Yuan
Department of Cardiovascular，the Second Affiliated Hospital of Zhengzhou University，Zhengzhou 450014，China
*Corresponding author：ZHANG Lihua，Chief physician，Main research in basic and clinical study of coronary heart disease，hypertension and arrhythmia；E-mail：email@example.com
【Abstract】 Background The morbidity and mortality of coronary heart disease（CHD） are increasing year by year.More than 1 million people die from CHD every year.Wide application of percutaneous coronary intervention（PCI） for CHD brings about an incidence of contrast-induced nephropathy （CIN） of 2%-30%，which increases the financial burden of patients and society，and affects the prognosis of such patients.Studies have found that there is a close relationship between serum uric acid（sUA） and CIN，and elevated sUA can increase the risk of CIN.Objective To investigate the preventive effect of uric acid lowering therapy on CIN in patients with CHD complicated with hyperuricemia.Methods A total of 100 cases of CHD with hyperuricemia receiving PCI treatment were selected from Department of Cardiovascular，the Second Affiliated Hospital of Zhengzhou University from January 2017 to January 2018，and were randomly and evenly divided into experimental group and control group.Both groups received coronary angiography or coronary stent implantation with secondary prevention therapies for CHD，the difference was that the experimental group took oral febuxostat 40 mg 24 hours and immediately before the surgery，while the control group did not take any drugs for lowering uric acid.Levels of serum creatinine（Scr），sUA and serum cystatin C（Cys-C） measured at 48 hours before surgery and 72 hours after surgery，and the incidence of CIN of both groups were collected and compared.Results The average sUA and Cys-C levels were much lower in the experimental group（P<0.05），while average Scr was similar in both groups at 72 hours after surgery（P>0.05）．Compared with baseline，the average Scr and Cys-C levels at 72 hours after surgery changed insignificantly in the experimental group（P>0.05），but average sUA level decreased（P<0.05）；in the control group，average Scr and sUA levels had little changes（P>0.05），but Cys-C level increased significantly（P<0.05）．The incidence of CIN was 18.0% （9/50） in the experimental group，and 22.0% （11/50） in the control group，showing no significant intergroup difference （χ2=0.250，P=0.617）．Multivariate Logistic regression analysis showed that age 〔OR=1.362，95%CI（1.030，1.802） 〕，LDL-C〔OR=1.988，95%CI（1.239，3.190）〕，contrast agent dosage 〔OR=1.426，95%CI（1.097，1.853） 〕，Cys-C at 72 hours after surgery〔OR=3.374，95%CI（2.482，4.581）〕were all factors associated with CIN （P<0.05）．Conclusion Although preoperative uric acid lowering treatment could not reduce incidence of CIN，it could inhibit the increase of postoperative Cys-C level.However，its long-term effect on postoperative renal function still needs to be examined by large-scale clinical trials.
【Key words】 Coronary disease；Hyperuricemia；Febuxostat；Contrast induced nephropathy；Root cause analysis
Effects of Dioscin on the Growth of Tamoxifen-resistant Breast Cancer Cells CHEN Haiyan，DING Xiaoqing*
Department of Hematology，Dongfang Hospital Affiliated to Beijing University of Chinese Medicine，Beijing 100078，China
*Corresponding author：DING Xiaoqing，Associate chief physician，Mainly engaged in the diagnosis and treatment of hematological tumors related diseases with integrated traditional Chinese and Western medicine；E-mail：firstname.lastname@example.org
【Abstract】 Background Tamoxifen is a main drug used for endocrine treatment of breast cancer.It is difficult to treat breast cancer resistant to tamoxifen，and new treatments are needed urgently.Diosgenin（Dio） can inhibit the growth of cancer to some extent.Studying the effect of Dio on the growth of tamoxifen-resistant（TAM-R） breast cancer cells can provide a reference for clinical treatment.Objective To study the effects of Dio on the growth of TAM-R breast cancer cells.Methods From January 2017 to June 2018，TAM-R breast cancer cells were cultured.Corresponding experiments were carried out on cell growth and apoptosis，autophagy and apoptotic markers，and anti-cancer proteins.The details are as follows：automated cell counters were used to count the number of TAM-R breast cancer cells in six groups（control，Dio 0.625 μg/ml，Dio 0.800 μg/ml，Dio 1.000 μg/ml，Dio 1.250 μg/ml and Dio 2.500 μg/ml） after being treated by different doses of Dio for five days，and to measure the apoptosis of TAM-R breast cancer cells in 6 groups（control，TAM 10-7 mol/L，Dio 1 μg/ml，Dio 2 μg/ml，TAM 10-7 mol/L
+Dio 1 μg/ml，and TAM 10-7 mol/L+Dio 2 μg/ml） treated with different doses of TAM and Dio for three days.Immunoblotting was used to detect the effects of different doses of Dio on TAM-R autophagy markers LC3 and Beclin-1，and apoptotic markers Bax，Bim，pAMPK and p53 proteins in four groups（control，Dio 0.80 μg/ml，Dio 1.25 μg/ml，and Dio 2.50 μg/ml）．Autophagy of TAM-R breast cancer cells treated with Dio and its inhibitors and inducers in six groups（control，Rapamycin 20 nmol/L，Chloroquine 10 μmol/L，TAM 10-7 mol/L，Dio 1 μg/ml，and TAM 10-7 mol/L+Dio 1 μg/ml） was observed by autophagic fluorescence microscopy.Results The number of TAM-R breast cancer cells differed significantly across different groups （P<0.05）．To be specific，the control group had much less TAM-R breast cancer cells than Dio groups（P<0.05）．The number of apoptotic TAM-R breast cancer cells varied obviously across different groups（P<0.05）．Specifically，the control group showed much less apoptotic TAM-R breast cancer cells than other five groups（P<0.05）．Moreover，TAM 10-7 mol/L+Dio 2 μg/ml group showed significantly less TAM-R breast cancer cells than Dio 2 μg/ml group（P<0.05）．The expressions of LC3，Beclin-1，Bax，Bim，pAMPK and p53 varied significantly across the groups （P<0.05）．Fluorescence microscopy showed that autophagic activity level of TAM 10-7 mol/L + Dio 1 μg/ml group was higher than that of Dio 1 μg/ml group and TAM 10-7 mol/L group.Conclusion Dio could inhibit the growth of TAM-R breast cancer cells，and strengthen the growth inhibition and apoptosis enhancement effects of TAM on such cells.Moreover，both autophagy and apoptotic marker proteins were also influenced.
【Key words】 Breast neoplasms；Dioscin；Tamoxifen；Apoptosis；Autophagy
Expression and Significance of S1PR1 in Primary Testicular Diffuse Large B-cell Lymphoma Tissue LIAO Yedan1，LI Mei2，CHEN Yun2，YU Shunling1，ZHOU Yonghong1，ZHOU Ling1，XIE Lin1*
1.No.1 Department of Medical Oncology，Yunnan Cancer Hospital/the Third Affiliated Hospital of Kunming Medical University，Kunming 650118，China
2.Department of Pathology，Yunnan Cancer Hospital/the Third Affiliated Hospital of Kunming Medical University，Kunming 650118，China
*Corresponding author：XIE Lin，Associate professor，Associate chief physician；E-mail：email@example.com
【Abstract】 Background Studies have shown that sphingosine-1-phosphate receptor 1 （S1PR1） can be used as a drug target for the treatment of various diseases.Primary testicular diffuse large B-cell lymphoma （PT-DLBCL） is an extranodal lymphoma with a low incidence but a high degree of invasiveness.The overall prognosis is very poor after treating by existing therapies and it is urgent to find new therapeutic targets.Objective To explore the expression of S1PR1 in pathological tissue of PT-DLBCL，and analyze its relationship with the prognosis of PT-DLBCL，then to find out the potential of S1P/S1PR1 as a therapeutic target for this disease.Methods From Yunnan Cancer Hospital，37 cases of PT-DLBCL and 37 cases of diffuse large B-cell lymphoma （DLBCL） were randomly recruited from May 1994 to March 2016.Immunohistochemistry was used to detect the expressional level of S1PR1 in paraffin wax block with the embedded PT-DLBCL and DLBCL tissues.Clinical data of PT-DLBCL cases were reviewed，and relationship of S1PR1 expressional level with the prognosis of PT-DLBCL was analyzed.Results S1PR1 expression level was negative in 45.8%（n=17） of the PT-DLBCL cases，and in 70.3%（n=26） of the DLBCL cases.The prevalence of positive S1PR1 expression level was 54.1%（n=20） in the PT-DLBCL cases，and 29.7% （n=11） in the DLBCL cases，showing a significant difference（χ2=4.497，P=0.034）．The median overall survival （OS） was （21.9±4.6） months and the median progression-free survival （PFS） was （10.1±2.3） months in 20 PT-DLBCL patients with S1PR1 positive expression，and in 17 PT-DLBCL patients with S1PR1 negative expression，the median OS was （71.9±9.6） months and the median PFS was （64.6±10.9）months.3 and 5 years OS rates（15.0% and 10.0%） in the positive expression of S1PR1 were lower than those in the negative expression of S1PR1 （52.9% and 35.3%）（χ2=10.971，P=0.001）．3 and 5 years PFS rates（5.0% and 0） in the positive expression of S1PR1 were lower than those in the negative expression of S1PR1 （35.3% and 23.5%）（χ2=15.833，P<0.001）.Conclusion The expression rate of S1PR1 in PT-DLBCL was higher than that in intranodal DLBCL，and its expression was related to the prognosis of PT-DLBCL.S1P/S1PR1 has the potential as a therapeutic target for the disease.
【Key words】 Lymphoma，large B-call，diffuse；Neoplasms，multiple primary；Sphingosine-1-phosphate receptor 1；Primary testicular diffuse large B-cell lymphoma；Prognosis
Efficacy and Safety of Vonoprazan versus PPI in the Eradication of Helicobacter Pylori：a Meta-analysis LUO Hongli*，XIAO Shunlin，LI Xiuying，ZHAO Jungang
Department of Pharmacy，the Affiliated Hospital of Southwest Medical University，Luzhou 646000，China
*Corresponding author：LUO Hongli，Associate chief pharmacist；E-mail：firstname.lastname@example.org
【Abstract】 Background Eradication of Helicobacter pylori （H.pylori） promotes the healing of peptic ulcer and reduces the incidence of ulcer complications.However，due to increased resistance of H.pylori to antimicrobial drugs and inadequate gastric acid inhibition by some proton pump inhibitors （PPI），the eradication rate of H.pylori is often significantly reduced.Vonoprazan inhibits gastric acid secretion by competing binding sites with potassium ions，which has the characteristics of rapid onset of action，and strong and lasting effect.Objective To assess the efficacy and safety of vonoprazan-based triple therapy （VTT） versus conventional PPI-based triple therapy （PTT） for the eradication of H.pylori.Methods Databases of PubMed，EMBase，Cochrane Library，CNKI，VIP and Wanfang were searched from inception to June 30，2018 for clinical studies of VTT（experimental group） versus PTT（control group） for H.pylori eradication.Data extraction and quality assessment of the included studies were conducted following the Cochrane handbook.Meta-analysis was performed by using RevMan 5.2 software.Results A total of 18 studies with 16 727 patients were included.The results indicated that the eradication rate of VTT was much higher than that of PTT when used as first-line therapy 〔OR=2.34，95%CI（1.94，2.81），P<0.000 01〕.
Moreover，subgroup analysis indicated significant superiority of VTT in both patients with clarithromycin-susceptible strains 〔OR=2.03，95%CI（1.30，3.18），P=0.002〕 and those with clarithromycin-resistant strains 〔OR=5.92，95%CI（3.70，9.46），P<0.000 01〕.However，VTT did not show superiority to PTT in second-line therapy 〔OR=1.04，95%CI（0.77，1.40），P=0.81〕.Finally，randomized control trial （RCT） subgroup analysis showed the safety of VTT was better than that of PTT 〔OR=0.71，95%CI（0.53，0.95），P=0.02〕，whereas there was no significant difference in this regard for non-RCT subgroup analysis 〔OR=1.10，95%CI（0.90，1.34），P=0.34〕.Conclusion The efficacy of vonoprazan is superior to PPI in first-line H.pylori eradication therapy but not in second-line therapy.The safety of vonoprazan appears to be equal or even superior to PPI.Adequate multicenter and high-quality RCT are needed to support our results.
【Key words】 Vonoprazan；Proton pump inhibitor；Helicobacter pylori；Ulcer；Eradication therapy
Signal and Evaluation of Adverse Vascular Reactions Associated with Triptans ZHOU Hu1，YANG Junqing2，YU Yue3，LYU Yalan1，ZHAO Wenlong1*
1.School of Medical Informatics，Chongqing Medical University，Chongqing 400016，China
2.School of Pharmacy，Chongqing Medical University，Chongqing 400016，China
3.Division of Biomedical Statistics and Informatics，Mayo Clinic，Rochester MN 55901，U.S.A
*Corresponding author：ZHAO Wenlong，Professor；E-mail：email@example.com
【Abstract】 Background Adverse drug reaction （ADR） is one of the major problems in the field of medicine, which may increase the length of stay, economic burden, and risk of death for hospitalized patients.It may even cause major public health incidents, which seriously threaten life and health.Objective To detect and analyze the ADR signals of triptans after marketing and provide references for clinical rational drug use.Methods Reporting odd ratio （ROR） was used to investigate adverse reaction signals of triptans in the Adverse Event Reporting System （AERS） of the Food and Drug Administration of the United States from January 2004 to June 2017, and the results were analyzed and evaluated.Results Totally 5 531 574 reports were found for all drugs, among which 21 905 reports were mainly induced by seven triptan drugs.A total of 502 ADR signals, of which 35 were serious adverse reaction signals, were mainly related to heart, blood and lymphatic system.The high risk signals with clinical reference mainly included coronarospasm 〔ROR=21.17，95%CI（17.00，26.35）〕, cerebral vasoconstriction 〔ROR=35.32，95%CI（25.27，49.37）〕, variant angina 〔ROR=33.00，95%CI（22.96，47.43）〕, vasospasm 〔ROR=25.29，95%CI（17.38，36.81）〕, artery dissection 〔ROR=22.34，95%CI（12.67，39.38）〕, coronary dissection 〔ROR=15.47，95%CI（8.64，27.70）〕, Raynaud's syndrome 〔ROR=4.31，95%CI（2.96，6.35）〕 and others.Conclusion Studies on ADR signals in the real world are helpful to evaluate the post-marketing safety of drugs and provide references for drug use in clinical medication.
【Key words】 Triptans；Drug toxicity；Signal detection；Vascular events；Adverse drug reaction；Odds ratio
Meta-analysis of the Association of Beta-blocker Use with Falls in the Elderly CHEN Shi，YANG Xiangyu*，GAO Jing，WU Chenxi，BAI Dingxi，ZHAO Xia，YU Jingya，ZHONG Yizhu
School of Nursing，Chengdu University of TCM，Chengdu 611137，China
*Corresponding author： YANG Xiangyu，Associate professor；E-mail：firstname.lastname@example.org
【Abstract】 Background The relationship between antihypertensive drugs and the risk of falls in the elderly is controversial.As a common antihypertensive drug, beta-blocker has a unclear relationship with falls among the elderly.Objective To systematically evaluate the association between beta-blocker use and falls in the elderly，so as to provide a basis for relevant clinical decision making.Methods Data of cohort studies and case-control studies of beta-blocker use and falls in the elderly were collected by searching eight electronic databases： PubMed，EMBase，CENTRAL，CINAHL，CBM，CNKI，VIP and Wanfang Data Knowledge Service Platform from inception to November 2017.Two reviewers independently screened studies according to the inclusion and exclusion criteria，extracted data，and assessed methodological quality with the Newcastle-Ottawa Scale （NOS）．Then，data synthesis was performed using RevMan 5.3 software.Results A total of 13 studies involving 72 539 patients were included （eight cohort studies and five case-control studies）．Meta-analysis of results from cohort studies with a crude OR showed that beta-blocker use did not increase the risk of falls in elderly patients 〔OR=1.07，95%CI（0.98，1.18），P=0.14〕.Moreover，beta-blocker use was still not associated with an increased risk of falls in elderly patients in those studies with an adjusted OR 〔adjusted OR=1.04，95%CI（0.93，1.15），P=0.50〕.Meta-analysis of results from case-control studies with a crude OR showed that beta-blocker use was associated with an increased risk of falls in elderly patients〔OR=1.10，95%CI（1.05，1.15），P<0.000 1〕，while those studies with an adjusted OR indicated that beta-blocker use was not associated with an increased risk of falls in elderly patients 〔adjusted OR=0.95，95%CI（0.90，1.00），P=0.06〕.Conclusion Meta-analyses of cohort and case-control studies with an adjusted OR showed that beta-blocker exposure did not increase the risk of falls in older adults.In consideration of the quantity and quality of included studies，this result needs to be further confirmed by larger prospective cohort studies.
【Key words】 Adrenergic beta-antagonists；Accidental falls；Aged；Meta-analysis
A Survey of Mobile Phone Dependence and Anxiety，Depression and Sleep Quality amongst Medical College Freshmen XU Bixia1，2，ZHANG Bin1*
1.Department of Psychiatry，Nanfang Hospital，Southern Medical University，Guangzhou 510515，China
2.Department of Internal Medicine，Zhaoqing Medical Colleage，Zhaoqing 526020，China
*Corresponding author：ZHANG Bin，Chief physician；E-mail：email@example.com
【Abstract】 Background With the development of communication technology，mobile phone has become an essential and important carry-on article for college students.Mobile phone can make people more closely connect with each other.However，the development of the internet and various functions of mobile phone may lead to mobile phone dependency in some mobile phone users，especially in college freshmen，a group facing new life，and some of them having no pressures of entering graduate school.Objective To investigate the association of mobile phone dependency with sleep quality，anxiety and depression in medical college freshmen.Methods In June 2017，we conducted a survey in a cluster sample of 1 050 freshmen majoring in clinical medicine，stomatology or traditional Chinese medicine of Zhaoqing Medical College.Sociodemographic questionnaire developed by our research group，Chinese version of Mobile Phone Involvement Questionnaire （MPIQ），Pittsburgh Sleep Quality Index（PSQI），Self-rating Anxiety Scale（SAS），and Beck Depression Inventory（BDI）were used in the survey to assess the sociodemographic characteristics，mobile phone dependency，sleep quality，anxiety and depression，respectively.Multiple linear regression was used to examine the associations of mobile phone dependency with sociodemographic factors，sleep quality，anxiety and depression.Results Altogether，944 of the students responded to the survey，obtaining a response rate of 89.90%.MPIQ score changed significantly according to sex，interest in learning，learning pressure，SAS score and BDI score（P<0.05）．Both interest in learning（r=-0.217），and learning pressure（r=-0.229）were negatively correlated with the MPIQ score（P<0.05）．But SAS score（r=0.114），BDI score（r=0.380）and neck circumference（r=0.110）were all positively correlated with the MPIQ score（P<0.05）．Multiple linear regression analysis showed that sex 〔β=2.713，95%CI（1.394，4.032）〕，interest in learning〔β=-3.040，95%CI（-4.353，-1.728）〕，learning pressure〔β=-3.108，95%CI（-4.374，-1.842）〕，SAS score〔β=2.492，95%CI（0.524，4.459）〕，and BDI score 〔β=1.517，95%CI（1.029，2.005）〕were independent influencing factors for MPIQ score（P<0.05）．Conclusion Female is associated with higher possibility of having mobile phone dependency.So mobile phone dependency in this group should be paid more attention.Moreover，mobile phone dependency can cause anxiety and depression in medical college freshmen，which should to be highly concerned by families and schools.
【Key words】 Anxiety；Depression；Sleep disorders；Questionnaires；Mobile phone dependence；College students