March 2020, Volume 23，No.9 Abstracts
Author：尹鹏 Source：CGP Published： [03-30] views： 70
Searching Therapeutic Strategies of COVID-19 from Angiotensin-converting Enzyme 2：the Receptor of 2019-nCoV and SARS-CoV TANG Zijian1，2，LI Shuren2*，XU Wenhua3，SHEN Zexue3
1.Graduate School of Hebei Medical University，Shijiazhuang 050000，China
2.Hebei General Hospital，Shijiazhuang 050000，China
3.Graduate School，North China University of Science and Technology，Tangshan 063000，China
*Corresponding author：LI Shuren，Chief physician；E-mail：firstname.lastname@example.org
【Abstract】 The COVID-19 outbreak occurred in Wuhan，China，in December 2019 has aroused wide public concern.Both 2019-nCoV and SARS-CoV belong to the coronaviridae family，and invade target cells through ACE2.So an in-depth understanding of ACE2 and a series of pathophysiological changes caused by the virus invading the human body may help to discover and explain the corresponding clinical manifestations and then deal with them timely.In addition，ACE2 is a potential therapeutic target，according to this，we can find the corresponding treatment strategy.This article explains the role of ACE2 in multiple organ damage caused by 2019-nCoV and SARS-CoV，and blockers targeting ACE2，and inflammation inhibitors，with a view to providing a basis for subsequent related research，diagnosis and treatment，and drug development.
【Key words】 Coronavirus infections；2019-nCoV；SARS-CoV；Angiotensin-converting enzyme 2
Experience of Frontline Clinicians Fighting against COVID-19：a Qualitative Study ZHANG Yu1，HE Miao2，LI Chunhua3*，XU Ruijia4
Shenzhen Samii Medical Center，Shenzhen 518118，China
*Corresponding author：LI Chunhua，Attending physician；E-mail：email@example.com
【Abstract】 Background The COVID-19 is characterized by a long incubation period，high contagion and general susceptibility.Due to lack of specific preventive measures and targeted drugs，it brings great panic to the society.All regions across China launched first-level responses to this public health emergency.Medical workers in the county stick to their post to save patients，among them frontline clinicians fighting against COVID-19 have great pressure caused by excess workload with a high risk of infection，whose psychological status should be concerned and intervened by relevant departments.Moreover，the survey of their psychological status may also provide a basis for the improvement of emergency plan and public health management.Objective To investigate the experience and feelings of frontline clinicians fighting against COVID-19，providing a reference for the delivery of corresponding psychological intervention for this group and for epidemic control and prevention.Methods A qualitative study using in-depth individual interviews and a phenomenology method was implemented between February 1 and 7，2020.Participants were frontline clinicians fighting against COVID-19 from hospitals in some cities or provinces，China.The Colaizzi's method was adopted to analyze the interview results and extract themes.Results Six themes were extracted：complex and diverse feelings （fear of infection，panic caused by the epidemic，anger and helplessness induced by noncooperation of some patients and residents，and self-accusation caused by non-efficient life saving efforts ），insufficient clinical experience，high work pressure，being disrespected and misunderstood by some patients and residents，sense of responsibility and duty to heal the wounded and rescue the dying，and insufficient self-protective materials.Conclusion In view of the feelings（fear of infection，panic caused by the epidemic，great work pressure and being disrespected and misunderstood by some patients and residents，and so on） of frontline clinicians fighting against COVID-19，administrative departments of hospitals should provide them with appropriate psychological guidance，humanistic care and sufficient self-protection materials，as well as intensive education on professional knowledge and emergency management of this disease.
【Key words】 2019-nCoV；COVID-19；Medical staff；Epidemic prevention and control；Qualitative research
The Incidence and Epidemic Characteristics of Medical Staff's Skin Injuries Caused by Personal Protective Equipment for Fighting against 2019-nCoV Infection JIANG Qixia1，LIU Yuxiu2，WEI Wei3，CHEN Aihua4，BAI Yuxuan5，CAI Yinghua6，TAO Liande7，TANG Yongli8，JIANG Zhixia9，XU Guie10，LI Laijuan11，XUE Jiayu1，XIAO Jian12，LI Xiaokun12*
1.Department of Outpatient，General Hospital of Eastern Theater Command，Nanjing 210002，China
2.Department of Medical Statistics，General Hospital of Eastern Theater Command，Nanjing 210002，China
3.Graduate School of Medical School of Nanjing University，Nanjing 210008，China
4.Department of Anorectal Surgery，the Second Affiliated Hospital of Wenzhou Medical University，Wenzhou 325027，China
5.Clinical Academic Department，Zhejiang Top-medical Medical Dressing Co.，Ltd.，Wenzhou 325000，China
6.Nursing Department，Wuxi People's Hospital，Wuxi 214023，China
7.Nursing Department，the Second People's Hospital of Yibin，Yinbin 644000，China
8.Department of Orthopaedics，the First Affiliated Hospital of Chongqing Medical University，Chongqing 400000，China
9.Department of Nursing，Affiliated Hospital of Zunyi Medical University，Zunyi 563003，China
10.Operating Room，the First People's Hospital of Anqing，Anqing 246003，China
11.Wound Stoma Clinic，the First People's Hospital of Lianyungang，Lianyungang 222002，China
12.Medical Center for Wound Repair and Regeneration，School of Pharmaceutical Sciences，Wenzhou Medical University，Wenzhou 325035，China
*Corresponding author：LI Xiaokun，Professor，Doctoral supervisor，Academician of Chinese academy of engineering；E-mail：firstname.lastname@example.org
【Abstract】 Background The medical device-related pressure injury（DRPI），which mainly occurs in critical patients and orthopedic patients，has been a research hotspot for the safety management and specialized care of inpatients worldwide，but there have been few reports on DRPI of medical staff.During the prevention and control of COVID-19，a large number of medical staff are fighting at the front.However，wearing protective equipment for a long time can easily cause skin injury，which seriously harms the medical staff and increases their risk of infection.Therefore，how to protect medical personnel from skin damage is an urgent problem.Objective To investigate the incidence and epidemic characteristics of medical staff's skin injuries caused by personal protective equipment in fighting against the COVID-19 in order to provide a basis for the formulation of effective protection countermeasures.Methods A research questionnaire was developed by our research group，including the basic information of medical staff，the wearing situation of protective equipment，the skin damage situation，preventive measures against skin damage，and the post-injury treatment.The questionnaire was released through the Questionnaire Star website to front-line medical staff fighting against the COVID-19 through Wechat app from February 8 to 15 in 2020.The survey was completed by voluntary participation and online filling.The survey data were collected in one week and a database was established.Statistical analysis was made on the incidence of skin injuries，the types of injuries，and epidemic characteristics.Results A total of 2 901 effective questionnaires were collected from 145 hospitals in 19 provinces，3 autonomous regions and 4 municipalities in China.Among them，there were 214（7.38%） males and 2 687（92.62%） females，and 147（5.07%） doctors and 2 754（94.93%） nurses.And 825（28.44 %） cases of the medical staff suffered skin injuries due to wearing protective equipment，and the total number of skin damage sites was 2 794.The main types of skin injuries were pressure injury〔771（26.58%）cases，2.53 per capita〕，moisture-associated skin damage〔256（8.83%）cases，2.77 per capita〕，and skin tear〔42（1.45%）cases，3.12 per capita〕.Of the 825 medical staff who had skin injuries，221（26.79%） cases had skin injuries≥2 types.Univariate analysis showed that the incidence of skin injuries caused by protective equipment was higher in men than in women（P<0.05），in those aged 31-45 than in those ≤30（P<0.016 7），in those who worked >10 years than in those who worked <5 years（P<0.016 7），in doctors than in nurses（P<0.05），in designated epidemic prevention hospitals in Wuhan than in other hospitals（P<0.003 3）and among other hospitals，in Infectious Disease Department than in other departments（P<0.003 3），and in tertiary protection than in secondary protection followed by primary protection（P<0.016 7）.However，there was no significant difference in the incidence of skin injuries among medical staff with different continuous wearing time of protective equipment（P>0.05）.Conclusion The incidence of skin injuries caused by personal protective equipment in fighting against COVID-19 is high among medical staff.Multiple types and multiple sites of skin injuries are coexisted.It is recommended to take comprehensive preventive measures of pressure relief，friction reduction，moisture absorption，and skin care to reduce skin damage of medical staff.Meanwhile，it is suggested to pay attention to human resource management factors such as gender，age，and job position.
【Key words】 COVID-19；Coronavirus infections；Protective devices；Medical staff；Occupational injuries；Skin injury；Cross-sectional studies
Prevention and Control of COVID-19 Epidemic Bring Thinking to General Practice WANG Jia1，LU Ning1，CUI Manli1，ZHU Lin1，ZHANG Mingxin1，2*
1.Department of Gastroenterology，the First Affiliated Hospital of Xi'an Medical University，Xi'an 710077，China
2.School of General Medicine，Xi'an Medical University，Xi'an 710077，China
*Corresponding author：ZHANG Mingxin，Associate chief physician，Master supervisor；E-mail：email@example.com
【Abstract】 The COVID-19 broke out in December 2019 has brought severe challenges to medical institutions and health security in China.During the control and prevention of this epidemic，various problems in the healthcare system，including shortage of healthcare resources and medical workers，and poor public health awareness，have been revealed.General practitioners，one of the main providers of primary care，play an extremely important role in the control and management of the epidemic in conjunction with physicians from higher level hospitals.We analyzed the problems and weak links in fighting against COVID-19 epidemic，summarized the development of general practice，and the weaknesses of general practice care revealed in combating the epidemic，with recommendations for improvement，hoping to enhance the role of general practice in the management of major public health events.
【Key words】 Pneumonia，viral；Coronavirus infections；COVID-19；2019-nCoV；General practice；Policy proposal
The Role of Family Physicians in the Control and Prevention of COVID-19 NIE Lianlian1，WU Longhui2*，LI jun1，MIAO Changjun1
1.Jinshan District Zhujing Community Health Center，Shanghai 201599，China
2.Jinshan District Center for Disease Control and Prevention，Shanghai 201599，China
*Corresponding author：WU Longhui，Doctor in charge；E-mail：firstname.lastname@example.org
【Abstract】 Recently，COVID-19 has spread throughout China with new cases increasing abroad.Family physicians，a major provider of community medical services as well as the gatekeeper of residents' health，also play a vital role in the control and prevention of COVID-19.As their duties and working mechanism in combating COVID-19 are not completely clear yet，we tried to develop a sound working mechanism by comprehensively discussing and summarizing the deployment and role of family physicians in combating the epidemic，hoping to give full play of their role in doing the work based on maintaining sound physical and mental health with scientific self-protection，such as collaboratively identifying the suspected cases by screening the priority groups，standardizedly managing the isolated observational cases while managing contracted residents，and delivering individualized health education of COVID-19，by strengthening administrative management，clearing their duties，formulating a working procedure，strengthening the training before combating the epidemic，and caring for their physical and mental health.
【Key words】 COVID-19；Home care services；Family physician；Prevention and control
Relationships of Thyroid Hormone and proBDNF with Depression WANG Na1，FU Xiyue2，ZHANG Fan1，JIANG Yufeng1，YANG Shu1，MO Min1，YANG Caihua1，ZHANG Shaochuan1，ZHOU Li1*
1.Mental Health Center Affiliated to Kunming Medical University/The Mental Hospital of Yunnan Province，Kunming 650224，China
2.Department of Anatomy，School of Basic Medical Sciences，Kunming Medical University，Kunming 650500，China
*Corresponding author：ZHOU Li，Attending physician；E-mail：email@example.com
【Abstract】 Background With the deepening understanding of depression，it has been found that depression is not only a neurodegenerative disease，but also closely related to the hypothalamus pituitary thyroid axis（HPT axis）.The neurotrophic hypothesis of depression suggests that the precursor of brain-derived neurotrophic factor（proBDNF）plays a role in the pathogenesis of depression，but the relationships of depression with thyroid hormone and proBDNF are rarely studied.Objective To investigate the relationships of proBDNF and thyroid hormone level with depression.Methods Forty-three inpatients and outpatients with depression（case group）and 31 healthy examinees（control group）from the Mental Hospital of Yunnan Province were enrolled during October 2017 to June 2018.General information and levels of thyroid hormone〔triiodothyronine（T3），thyroxine（T4），free triiodothyronine（FT3），free thyroxine（FT4），thyrotropin（TSH）and proBDNF〕were collected and compared between the two groups.The relationships of levels of thyroid hormone and proBDNF with the total and subscale scores of HAMD-24 were analyzed.The correlation between thyroid hormone and proBDNF level was assayed.Results There were no significant differences in mean T3 and FT4 levels between the two groups（P>0.05）.Mean T4，FT3 and TSH levels in the case group were lower than those in the control group（P<0.05）.The level of FT3 was positively correlated with the total score of HAMD-24 and the score of cognitive impairment subscale in the case group（P<0.05）.There was no significant difference of proBDNF level between the two groups（P>0.05）.In the case group，the proBDNF level was not correlated with the total score and subscale scores of HAMD-24（P>0.05）.And there was no correlation between thyroid hormone level and proBDNF level（P>0.05）.Conclusion Depression patients are more prone to anxiety，suicide，paranoia，obsession，despair and sleeping problems，and may have hypothyroidism.
【Key words】 Depressive disorder；Thyroid hormone；Precursor of brain-derived neurotrophic factor；Hypothalamus pituitary thyroid axis
Risk Factors for Cardiovascular Disease and Hypertension among Female Doctors in Northern China NIE Ning，BAI Xiaojuan*，HAN Lulu，HAN Wen，HUO Yangyang
Department of Geriatrics，Shengjing Hospital of China Medical University，Shenyang 110004，China
*Corresponding author：BAI Xiaojuan，Professor，Doctoral supervisor；E-mail：firstname.lastname@example.org
【Abstract】 Background In China，cardiovascular disease（CVD） is the primary disease that endangers the health of residents，and the leading cause of mortality among adult women.Women working as a doctor，a high-risk occupation for CVD，may have higher risk of developing CVD，but the exposure to risk factors for CVD in this population is still unclear.Objective To analyze the exposure to cardiovascular risk factors and hypertension-associated risk factors among female doctors in Northern China，to provide a scientific basis for CVD prevention，warning and treatment in this group.Methods This case-controlled study was conducted from October 2016 to January 2018.Participants（n=261） consisted of a subcohort in Northern China in A Cohort Study of Cardiovascular Risk Factors among Female Doctors，a public welfare project conducted by Chinese Society of Cardiology Women Health Group in 2016，and community-dwelling healthy women（n=334），a subcohort of the healthy women cohort in a national key basic research program of China named as “Mechanism and Intervention of Multiple Visceral Organs Hypofunction Induced by Heart-kidney Interaction in the Elderly（2013CB530804）” conducted by our research team previously.Intergroup and age-subgroup（35-45 years，46-55 years，and 56-65 years） comparative analyses of age，education level，family history of cardiovascular and cerebrovascular diseases，lifestyle，prevalence of menopause，history of hormone use and laboratory test parameters were performed.The influencing factors for hypertension among female doctors were analyzed.Results Compared with community-dwelling healthy women，female doctors had younger mean age，higher prevalence of postgraduate education，family history of cardiovascular and cerebrovascular diseases，insufficient exercise，tea consumption history，coffee consumption history，and insufficient sleep，and lower prevalence of overweight/obesity，menopause，and lower mean fasting plasma glucose（FPG），serum total cholesterol（TC） and low-density lipoprotein（LDL）（P<0.05）.Female doctors aged 35-45 years had higher prevalence of postgraduate education，family history of cardiovascular and cerebrovascular diseases，tea consumption history，coffee consumption history，insufficient sleep，and higher mean TG，and lower mean PFG compared with community-dwelling healthy women of the same age group（P<0.05）.Female doctors aged 46-55 years showed higher prevalence of postgraduate education，family history of cardiovascular and cerebrovascular diseases，insufficient exercise，tea consumption history，coffee consumption history，insufficient sleep，and hormone use history，and higher mean TC，and LDL，as well as lower prevalence of menopause compared with community-dwelling healthy women of the same age group（P<0.05）.In comparison with community-dwelling healthy women aged 56-65 years，female doctors of the same age group demonstrated higher prevalence of higher prevalence of postgraduate education，family history of cardiovascular and cerebrovascular diseases，insufficient exercise，tea consumption history，coffee consumption history，insufficient sleep，FPG，TC，and LDL（P<0.05）.In female doctors，those aged 46-55 years had lower prevalence of postgraduate education，insufficient exercise，coffee consumption history，and lower mean high-density lipoprotein（HDL），but higher prevalence of family history of cardiovascular and cerebrovascular diseases，menopause，and hormone use history，and higher mean FPG，TG，TC and HDL compared with those aged 35-45 years（P<0.05）.Compared with other two age subgroups（35-45 and 46-55 years），female doctors aged 56-65 years had lower prevalence of postgraduate education，but higher prevalence of overweight/obesity，and menopause，and higher mean FPG，TG，TC and LDL（P<0.05）.Furthermore，they showed lower prevalence of insufficient exercise than those aged 35-45 years（P<0.05）.By multivariate Logistic regression analysis，age〔OR=1.110，95%CI（1.063，1.158）〕，insufficient sleep〔OR=2.273，95%CI（1.085，4.762）〕，obesity/overweight〔OR=5.491，95%CI（2.995，10.067）〕 and increased LDL〔OR=2.975，95%CI（1.371，6.457）〕were considered as the influencing factors of hypertension among female doctors（P<0.05）.Conclusion In female doctors in Northern China，risk factors for CVD that deserved attention are mainly associated with lifestyle，including insufficient exercise，tea and coffee consumption history，and insufficient sleep.The risk factors for hypertension are consisting of older age，insufficient sleep，obesity/overweight and increased LDL.In view of this，priorities should be given to the above-mentioned risk factors to well perform primary prevention of CVD.
【Key words】 Cardiovascular diseases；Physician；Femininity；Primary prevention；Hypertension；Northern China；Root cause analysis
Association of Serum 25（OH）D Concentration with Children's Immune Function and Recurrent Respiratory Infection ZHANG Qi1，DENG Fang1*，BI Liangxue2，XU Fengqin2，XU Chongyu2
1.Department of Pediatrics，First Affiliated Hospital of Anhui Medical University，Hefei 230032，China
2.Department I of Respiration，Anhui Provincial Children's Hospital，Hefei 230051，China
*Corresponding author：DENG Fang，Chief physician；E-mail：email@example.com
【Abstract】 Background High concentration of serum 25-hydroxyvitamin D （25（OH）D） can maintain the normal metabolism of 25（OH）D receptors in human skeletal exocytes，which is closely related to the blood circulation system，respiratory system，connective tissue，autoimmunity and development of tumors.Some studies have shown that supplementation of 25（OH）D3 at 4 000 U per day can significantly reduce the incidence of infection symptoms，number of pathogenic bacteria in nasal swabs and the consumption of antibiotics.It can also reduce the incidence of recurrent respiratory tract infection in children due to imperfect immune function.In this study，we aimed to validate the association between the concentration of 25 （OH） D，immune function and recurrent respiratory tract infection in children.Objective To evaluate the distribution of serum 25（OH）D concentration in children with different levels of immunoglobulin G （IgG） and M （IgM），and to further analyze the association between 25（OH）D and hepatitis B antibody titers （anti-HBs） as well as recurrent respiratory infection.Methods A total of 146 children with recurrent respiratory infection at First Affiliated Hospital of Anhui Medical University from August 2016 to October 2018 were included in the study.According to age，patients were divided into different groups：0-<2 years group，2-<6 years group，6-<12 years group and 12-16 years group.Serum 25（OH）D level was assessed between different groups.Additionally，patients were grouped by the levels of serum IgG and IgM：79 cases in reduced IgG group，38 cases in normal IgG group and 30 cases in elevated IgG group，92 cases in reduced IgM group，29 cases in normal IgM group and 25 cases in elevated IgM group.Serum 25 （OH） D was evaluated in different groups to determine the relationship between the levels of serum 25（OH）D and IgG，IgM.Poisson regression analysis was used to evaluate the association between serum 25（OH）D concentration and the number of repeated respiratory infection in children.Results Compared to 2-<6 years group，6-<12 years group and 12-16 years group，0-<2 years group had higher serum 25（OH）D levels（q=5.202，6.030，8.432，P <0.001）．Serum 25（OH）D levels in 2-<6 years group and 6-<12 years group were higher than that in 12-16 years group（q=5.317，5.559，P<0.05）．Result of Poisson regression showed，increased level of serum 25（OH）D was negatively associated with the number of repeated respiratory infection in children 〔FR=0.94，95%CI（0.89，1.02），P=0.048〕．Conclusion Serum 25（OH）D concentration was no correlation with serum anti-HBs titer，but negatively associated with the number of recurrent respiratory tract infection in children.
【Key words】 Respiratory tract infections；Vitamin D；Immunity；IgG；IgM；Anti-HBs titer
Predictive Value of Neutrophil-to-lymphocyte Ratio Combined with Mean Platelet Volume for Nosocomial Major Adverse Cardiovascular Events in Patients with Acute STEMI after PCI CHEN Xinsen，HUANG Zhong，LI Guihua*
Department of Emergency，the First Affiliated Hospital of the Medical College，Shihezi University，Shihezi 832000，China
*Corresponding author：LI Guihua，Chief physician；E-mail：firstname.lastname@example.org
【Abstract】 Background Neutrophil-to-lymphocyte ratio （NLR） and mean platelet volume （MPV） are novel inflammatory response markers that can be used to predict the prognosis of patients with acute ST-segment elevation myocardial infarction （STEMI）.However，there are few studies exploring the clinical value of NLR combined with MPV in predicting the prognosis of STEMI patients.Objective To investigate the predictive value of NLR combined with MPV in the occurrence of nosocomial major adverse cardiovascular events （MACE） after emergency percutaneous coronary intervention （PCI） in patients with acute STEMI.Methods A total of 516 consecutive patients diagnosed as STEMI with emergency PCI in the First Affiliated Hospital of the Medical College，Shihezi University from October 2015 to September 2018 were selected.According to the median peripheral blood NLR and MPV on emergency admission，our cohort was divided into low NLR combined with low MPV group（NLR≤2.51 and MPV≤10.70 fl，n=135），low NLR and high MPV group（NLR≤2.51 and MPV>10.70 fl，n=123），high NLR combined with low MPV group（NLR>2.51 and MPV≤10.70 fl，n=137），high NLR combined with high MPV group（NLR>2.51 and MPV>10.70 fl，n=121）.Our cohort was divided into high-risk group（GRACE score>140 points，n=212），medium-risk group （108 <GRACE score≤140 points，n=222），low-risk group （GRACE score ≤108 points，n=82） according to baseline GRACE score.According to the occurrence of MACE during hospitalization，our cohort was divided into MACE group （n=71） and non-MACE group （n=445）.Comparisons of pre-PCI clinical and laboratory data，post-PCI medication，laboratory and color Doppler echocardiography data within 24 hours after PCI were performed by NLR with MPV，and the incidence of MACE，respectively.Logistic regression analysis was used to investigate the influencing factors of post-PCI MACE.ROC curve analysis was used to evaluate the value of NLR，MPV and NLR combined with MPV in predicting the occurrence of post-PCI MACE.The correlation between NLR and MPV before PCI was analyzed.The pre-PCI NLR and MPV were compared by GRACE score.Compared the incidence of no reflow and in-hospital MACE in hospital after PCI by NLR with MPV，and GRACE score，respectively.Results Low NLR combined with high MPV group showed lower rate of pre-infarction angina and higher mean GRACE score than low NLR combined with low MPV group （P<0.05）.High NLR combined with low MPV group showed higher prevalence of hypertension and higher mean GRACE score，and lower rate of pre-infarction angina than than other three groups stratified by NLR and MPV（P<0.05）.Low NLR combined with high MPV group had higher mean HCT，and higher mean peak values of HCT and TnT，and lower mean HDL-C and CRP than low NLR combined with low MPV group（P<0.05）.High NLR combined with low MPV group showed higher mean neutrophil count，NLR and MPV，and higher mean peak values of CK-MB and TnT，as well as lower mean lymphocyte count and LVEF than low NLR combined with high MPV group（P<0.05）.In comparison with high NLR combined with high MPV group，low NLR combined with low MPV group had lower mean neutrophil count，NLR，MPV，peak CK-MB and peak TnT，and CRP，and higher mean lymphocyte count and LVEF（P<0.05），low NLR combined with high MPV group showed lower mean neutrophil count，NLR，MPV，peak CK-MB and peak TnT，Scr，HDL-C and CRP，as well as higher mean lymphocyte count and LVEF（P<0.05），and high NLR combined with low MPV group demonstrated lower mean NLR，MPV，peak TnT，and CRP，and higher mean lymphocyte count and LVEF（P<0.05）.Multivariate Logistic regression analysis showed that heart rate （OR=1.025），Killip classⅡ-Ⅳ（OR=4.231），GRACE score （OR=1.031），NLR （OR=2.716），MPV （OR=2.106），TnT peak （OR=1.215），CRP （OR=1.011），LVEF （OR=0.923） were independent influencing factors for the occurrence of in-hospital MACE in STEMI patients （P<0.05）.The AUC of NLR，MPV and NLR combined with MPV for predicting MACE in STEMI patients after PCI was 0.670〔95%CI（0.609，0.730）〕，0.678〔95%CI （0.616，0.741）〕，and 0.732〔95%CI （0.671，0.791）〕，respectively.There was significant difference between NLR with MPV and NLR or MPV alone in predicting AUC of post-PCI MACE （P=0.012，0.023，respectively）.NLR was positively correlated with MPV （rs=0.168，P=0.008）.Mean NLR and MPV increased successively in low-risk，medium-risk，and high-risk groups（P<0.05）.Low NLR combined with low MPV group showed lower incidence of no-reflow and in-hospital MACE after PCI compared with other three groups stratified by NLR and MPV （P<0.05）.The incidence of no-reflow and in-hospital MACE in both high NLR combined with low MPV and high NLR combined with high MPV groups was higher than that of low NLR combined with high MPV group（P<0.05）.High NLR combined with high MPV group showed higher incidence of no-reflow and in-hospital MACE than high NLR combined with low MPV group （P<0.05）.The incidence of no-reflow and in-hospital MACE in both low-risk and medium-risk groups was lower than that in the high-risk group （P<0.05）.Conclusion High NLR and high MPV at the early stage of admission are independent risk factors for nosocomial MACE in patients with STEMI after PCI.And NLR combined with MPV can more effectively predict the occurrence of in-hospital MACE，which can be used as a good indicator for prognosis evaluation of early STEMI patients.
【Key words】 Myocardial infarction；Neutrophils；Lymphocytes；Hematocrit；Prognosis；Root cause analysis
British Journal of General Practice 论文摘要汇编
Rational Comprehensive Geriatric Assessment Screening for Mild Cognitive Impairment and Multidimensional Analysis Conditions YANG Yanrong，WANG Ziqi*
Department of Neurology，Chengdu Fifth People's Hospital，Chengdu 611130，China
*Corresponding author：WANG Ziqi，Attending doctor；E-mail：email@example.com
【Abstract】 Background Cognitive function is an important factor affecting people's function and quality of life.In the process of aging，cognitive function will decline.Some people may have mild cognitive impairment（MCI），even dementia.Rationalizing Comprehensive Geriatric Assessment （CGA），screening MCI and multidimensional analysis of the disease are conducive to treat the disease timely，slow down the progress of the disease and reduce dementia.Objective To take rational comprehensive geriatric assessment screening for mild cognitive impairment，and multidimensional analysis condition.Methods We enrolled 225 inpatients aged >60 years in Chengdu Fifth People's Hospital from November 2015 to May 2016.According to 2018 Guidelines for the Diagnosis and Treatment of Dementia and Cognitive Impairment in China （V）：Diagnosis and Treatment of Mild Cognitive Impairment，the study subjects were divided into 65 cases of normal cognitive function group and 108 cases of MCI group （the other 52 cases did not exclude the possibility of dementia and were not included）．The basic data of patients were collected，including sex，age，educational level，smoking and alcohol consumption．They were surveyed by a suit of scales of comprehensive geriatric assessment，including Geriatric Depression Scale（GDS），Geriatric Anxiety Inventory（GAI），Mini Nutrition Assessment（MNA），Activities of Daily Living（ADL）〔including Physical Self-maintenance Scale（PSMS）Instrumental Activities of Daily Living（IADL）〕，Frail Scale（FRAIL），Berg Balance Scale（BBS），Fall Risk Assessment，Family APGAR Index （APGAR），Pittsburgh Sleep Quality Index（PSQI），and the Short-Form Health Survey Questionnaire
（SF-36）．The correlation between the scores of Mini-Mental State Exam（MMSE） and the basic data was analyzed and comprehensive geriatric assessment scales were compared between the two groups.Results Multipe linear regression analysis showed that there was no line correlation between gender，age，educational level，daily smoking，daily drinking and cognitive function（P>0.05）．The scores of MNA and Berg balance scale in MCI group were lower than those in normal cognitive function group，while the scores of ADL，IADL and FRAIL in MCI group were higher than those in normal cognitive function group（P<0.05）．Conclusion Patients over 60 years should take rational CGA，screen MCI，and multidimensionally analyse the condition，identify and reduce reversible factors，help MCI transform into normal cognitive function，and reduce the incidence of dementia.
【Key words】 Mild cognitive impairment；Aged；Comprehensive geriatric assessment；Brief psychiatric rating scale；Dementia；Alzheimer disease
Appropriate Cardiovascular Health Factors and Behaviors in Community-dwelling Residents：Findings of a Survey from Ningxia WU Jiajia1，ZHAO Junxiang2，WU Yating1，GUO Yiqiong1，YUAN Xiao1，TAO Xiujuan1，FAN Yanna1，YANG Jianjun1*
1.School of Public Health and Management，Ningxia Medical University，Yinchuan 750004，China
2.Yinchuan Women and Children Healthcare Hospital，Yinchuan 750001，China
*Corresponding author：YANG Jianjun，Professor，Doctoral supervisor；E-mail:firstname.lastname@example.org
【Abstract】 Background In China，the mortality of cardiovascular disease is high，and its annual incidence is increasing，but the incidence risk can be reduced by effective comprehensive management and prevention interventions.Appropriate cardiovascular health factors and behaviors are closely associated with cardiovascular disease.However，due to sex-，age-，and regional differences in cardiovascular health factors and behaviors，it is urgently needed to develop targeted health management regimens.Objective To explore sex- and age-specific differences in cardiovascular health factors and behaviors in community-dwelling populations in Ningxia，providing evidence for the development of health education and management programs.Methods By use of cluster sampling，2 486 community-dwelling residents undergoing physical examination in Ningxia International Travel Healthcare Center were enrolled in March 2016.General data，including sex，age，laboratory parameters，cardiovascular health factors and behaviors，were collected.Comparisons of laboratory parameters and cardiovascular health factors and behaviors were performed by sex and age group.Results Men showed greater mean age，SBP，DBP and FPG，but lower mean TC，scores，and number for appropriate health factors and behaviors，rates of non-smokers，physical exercisers（P<0.05）.In men，those aged less than 50 years had better mean blood pressure than those of age groups of 55-59，60-64，65-69 and greater than 70 years（P<0.05）.Those aged 50-54 years had better mean blood pressure than those of age groups of 60-64，65-69 and greater than 70 years（P<0.05）.Those aged less than 50 years had better FPG compared with those of other age groups（P<0.05）.But mean BMI，TC，prevalence rates of smoking and healthy diet were similar across all age groups（P>0.05）.In women，those aged less than 50 years had better mean blood pressure compared with those of other age groups（P<0.05）.Those aged 50-54 years had better mean blood pressure than those of age groups of 65-69 and greater than 70 years（P<0.05）.Those aged 55-59 years had better mean blood pressure than those of age groups of 65-69 and greater than 70 years（P<0.05）.Those aged less than 50 years showed better TC compared with those of other age groups（P<0.05）.Those aged less than 50 years demonstrated better mean FPG than those of 60-64 age group（P<0.05）.The rate of physical exercisers was higher in 50-54 age group than that of 60-64 and 65-69 age groups（P<0.05）.Mean BMI，prevalence rates of smoking and healthy diet were similar across all age groups（P>0.05）.The average number of appropriate cardiovascular indices in women was more than that of men （P<0.001）.The prevalence rate of 5-7 appropriate cardiovascular indices in women was also more than that of men （P<0.001）.Conclusion In community-dwelling populations in Ningxia，cardiovascular health factors and behaviors present sex- and age-specific differences.To improve the overall cardiovascular health level in these people，cardiovascular health interventions should be delivered to men，a target priority group，and also should be delivered to those aged 50-70 years.
【Key words】 Cardiovascular diseases；Health behavior；Disease management；Ningxia
Prevalence and Influencing Factors of Chronic Diseases among Rural Women in Jiangxi of China in the Situation of Labor Mobility XU Wenyan，XIE Fei，JIANG Xiaoqing，WEN Xiaotong，LI Xuyang，JIA Zhihui，LIN Yixiang，YUAN Zhaokang*
School of Public Health，Nanchang University/Jiangxi Provincial Key Laboratory of Preventive Medicine，Nanchang 330000，China
*Corresponding author：YUAN Zhaokang，Professor；E-mail：email@example.com
【Abstract】 Background China is a country owing a large mobile labor force，in particular，Jiangxi is a major province for labor force output.In rural families，women often play a key role in supporting their families.But as a vulnerable group，their chronic disease prevalence is often ignored.Objective To investigate the prevalence and influencing factors of chronic diseases among rural women in Jiangxi Province in the situation of labor mobility.Methods From 2006 to 2014，a household questionnaire survey was conducted every two years in 15 634 females（≥15 years） from 3 600 households in 27 villages of Jiangxi by multistage cluster sampling and stratified random sampling.Data about chronic diseases prevalence，and demographic characteristics（age，occupation，marital status，educational level，income level，labor force，permanent resident/ migrant） were analyzed.Multivariate Logistic regression was used to find influencing factors of prevalence of chronic diseases.Results The unweighted total number of rural women was 15 631，and 11 660（74.60%） of them were permanent residents.The weighted total number of rural women was 2 245 283，including 1 621 026（72.20%） permanent residents.The annual prevalence of chronic diseases was 11.2% in the weighted overall sample，among which permanent residents had a higher prevalence than those migrated（14.5% vs 2.8%）（χ2=428.035，P<0.01）.The survey year（2008：OR=0.778，95%CI（0.767，0.789）；2010：OR=1.569，95%CI（1.546，1.592）；2012：OR=0.820，95%CI（0.808，0.833）；2014：OR=0.818，95%CI（0.805，0.831）〕，age〔35-54 years：OR=5.425，95%CI（5.324，5.529）；≥55 years：OR=9.807，95%CI（9.609，10.009）〕，occupation〔farmer：OR=1.371，95%CI（1.353，1.388）〕，marital status〔married/ cohabitation：OR=1.424，95%CI（1.386，1.463）；divorced/ widowed：OR=1.198，95%CI（1.163，1.235）〕，educational level〔primary school and below：OR=1.371，95%CI（1.353，1.388）〕，income level 〔medium：OR=0.898，95%CI（50.888，0.908）；high：OR=0.899，95%CI（0.885，0.914）〕，labor force〔not：OR=1.618，95%CI（1.600，1.636）〕，migration prevalence〔permanent resident：OR=1.667，95%CI（1.637，1.697）〕 were associated with chronic diseases（P<0.05）.Conclusion The prevalence of chronic disease in rural women of Jiangxi Province was 11.2%，among whom，the permanent residents had a higher prevalence than those migrated.The survey year，age，occupation，marital status，educational level，income level，whether being in the labor force，and being a migrant were the influencing factor of chronic diseases.
【Key words】 Chronic disease；Rural population；Women；Root cause analysis；Home care services
Investigation and Association Analysis of Job Satisfaction，Psychological Capital and Work Engagement of General Practitioners in Jiading District of Shanghai JIAO Jie1，2，WANG Hongbao3*
1.Tongji University School of Medicine，Shanghai 200092，China
2.Jiading District Waigang Community Health Center，Shanghai 201806，China
3.Yangpu Hospital，Tongji University，Shanghai 200090，China
*Corresponding author：WANG Hongbao，Chief physician；E-mail：firstname.lastname@example.org
【Abstract】 Background General practitioners（GPs） are the primary providers of general health services.General practitioners play the roles of clinician，health educator，communicator，gatekeeper，manager and organizational coordinator.General practice started late in China and there are few studies on GPs.Objective To investigate the job satisfaction，psychological capital and work engagement of GPs in Jiading District of Shanghai，to provide strategies for community health centers to retain high-quality talents，and to provide a reference for health administration department for policymaking.Methods Follow the principle of voluntary survey，GPs from 13 community health centers in Jiading District of Shanghai were studied in July 2018.Demographic data of GPs（gender，age，marital status，household registration，educational background，prevalence of participating in standardized residency training，professional title，years of general practice work） were collected.The short-form Minnesota Satisfaction Questionnaire（including external and internal satisfaction subscales），Psychological Capital Questionnaire（including efficacy，optimism，resilience and hope subscales） and Utrecht Work Engagement Scale（including vigor，dedication and absorption subscales）.The associations of the subscales of the aforementioned scales were analyzed.Results A total of 245 cases participated in the survey and 235（95.9%） of them who handed in responsive questionnaires who finally included.The total score of short-form Minnesota Satisfaction Questionnaire was（71.54±12.60）.The total score of short-form Minnesota Satisfaction Questionnaire was（71.54±12.60）.The total score，and mean score were（106.63±18.05）〔（4.44±0.75），full score=6〕 for the Psychological Capital Questionnaire，respectively，and（61.37±11.94）〔（3.61±0.70），full score=5〕 for the Utrecht Work Engagement Scale，respectively.The internal satisfaction and the external satisfaction were positively associated with each dimension of the Psychological Capital Questionnaire and Utrecht Work Engagement Scale（P<0.05）.Multiple linear regression analysis showed that both internal and external satisfaction and psychological capital had effects on vigor，dedication and absorption subscales（P<0.05）.Conclusion The internal satisfaction and external satisfaction of GPs in Jiading District of Shanghai were correlated with psychological capital and work engagement，and internal satisfaction and psychological capital had impact on three dimensions of work engagement.
【Key words】 General practitioners；Job satisfaction；Psychological capital；Work engagement；Questionnaire
Job Burnout and Associated Factors in Trainees Attending the Standardized General Practice Residency Training LIU Fang1，TANG Dalong2，LIU Weinan1，ZHOU Wen1，ZHU Binhai2*
1.School of Health Policy & Management，Nanjing Medical University，Nanjing 211166，China
2.Department of Education，the First Affiliated Hospital with Nanjing Medical University，Nanjing 210029，China
*Corresponding author：ZHU Binhai，Researcher，Master supervisor；E-mail：email@example.com
【Abstract】 Background In China，Standardized General Practice Residency Training （SGPRT） is the most important way for cultivating high-quality general practitioners（GPs），the key supporting force for primary health care system and hierarchical medical system.However，the trainees are prone to job burnout due to current unsatisfactory practice situation.Analyzing the associated factors of job burnout can provide a basis for improving the management of SGPRT and strengthening the GP force.Objective To explore the prevalence and associated factors of job burnout in trainees of SGPRT.Methods From March to April 2019，a survey was conducted in 682 trainees from 13 national SGPRT sites in 13 cities（one site from each city），Jiangsu Province by use of cluster sampling with a self-designed sociodemographic questionnaire and the MBI-GS.Multiple linear regression was used to identify the associated factors of job burnout.Results 682 questionnaires were issued，the overall response rate of the survey was 88.6%（604/682）.The mean scores for the subscales of emotional exhaustion，depersonalization，and personal accomplishment were （15.34±7.02） （9.17±6.36） （13.61±8.12），respectively.The prevalence of no，mild，moderate and severe job burnout was 43.7%（264/604），27.3%（165/604），21.5%（130/604），and 7.5%（45/604），respectively.Education level，exercise frequency，duration of sleep，the year of attending the SGPRT，income level were associated with depersonalization.Sex，enrolment source，and exercise frequency were associated with diminished personal accomplishment.Conclusion The rate of job burnout among the trainees is high.Exercise frequency，duration of sleep，the year of attending the SGPRT，income level，education level，sex，and enrolment source are associated with job burnout in trainees of SGPRT.In view of this，to reduce the job burnout level，it is recommended to strengthen the physical exercise and psychological construction of the trainees，explore the mode for training medical social workers，strengthen the construction of primary training bases，and improve the income level of the trainees.
【Key words】 Fatigue；Occupations；General practitioners；Resident physician of general standardized training；Root cause analysis
Regulating Effects of Kidney-nourishment & Blood-activation Decoction on COX-2，PGE2 in Serum and Decidua of ACA（+） RSA Patients CHANG Zhuo1，LI Na2，ZHANG Yang2，WANG Wei2，CHEN Lu2，ZHAO Yan2，FENG Xiaoling2*
1.School of Basic Medical Sciences，Heilongjiang University of Chinese Medicine，Harbin 150040，China
2.No.2 Department of Gynecology，First Affiliated Hospital，Heilongjiang University of Chinese Medicine，Harbin 150040，China
*Corresponding author：FENG Xiaoling，Chief physician，Professor，Doctoral supervisor；E-mail：firstname.lastname@example.org
【Abstract】 Background Recurrent spontaneous abortion（RSA） is one of the common diseases during pregnancy.Current etiological research shows that ACA（+） is closely related to its pathogenesis.COX-2 plays a role in regulating platelet aggregation and peripheral vasoconstriction，and catalyzing the inducible production of prostaglandin.So COX-2 and COX-2-catalyzed synthesis of PGE2 may be associated with ACA（+） RSA with the trend of blood hypercoagulability and affect pregnancy outcomes.Objective Clarify the relationship between ACA（+） RSA and the abnormal expression of its COX-2 and PGE2, and explore the therapautical effect and molecular mechanism of method of invigorating the Kidney-nourishment & blood-activation decoction（KBD） to ACA（+） RSA.Methods All the participants were recruited from First Affiliated Hospital，Heilongjiang University of Chinese Medicine during March 2015 to March 2016，including 16 ACA（+） outpatients and inpatients with a history of RSA and current pregnancy loss undergoing curettage（experimental group 1），11 ACA（+） RSA outpatients and inpatients with a history of RSA undergoing tocolytic therapy due to possible miscarriage symptoms and signs during current pregnancy（experimental group 2），15 outpatients undergoing normal artificial abortion（control group 1），and 13 cases undergoing normal antenatal care（control group 2）.RT-PCR was used to detect the expression levels of COX-2 and PGE2 mRNA in decidua samples of experimental group 1 and control group 1，but 30 cases were finally included（one case in the experimental group 1 was excluded later because chromosome abnormality was found to be the culprit for RSA）.The experimental group 2 received KBD，while control group 2 received no interventions.ELISA was used to measure the expression levels of COX-2 and PGE2 in venous blood samples of experimental group 2 and control group 2 before and after the intervention period.Finally，only 20 cases in these two groups were enrolled because one case in the experimental group 2 was excluded due to later spontaneous abortion，and three cases in control group 2 actively dropped out.Results （1）The control group 1 showed higher mean expression levels of COX-2 mRNA and PGE2 mRNA in decidual tissues compared with experimental group 1（P<0.05）.（2）At baseline，the control group 2 and experimental group 2 had significant differences in mean serum progesterone，β-HCG，COX-2 and PGE2 levels（P<0.05）.But after receiving KBD，the experimental group 2 showed insignificant different mean levels of serum progesterone，β-HCG，and COX-2（P>0.05），and higher mean serum level of PGE2 compared with the control group 2（P<0.05）.（3）Serum progesterone，β-HCG，COX-2 and PGE2 increased significantly in experimental group 2 after treatment（P<0.05）.Conclusion Decreased expression levels of COX-2 and PGE2 in serum and decidual tissues of ACA（+） RSA patients indicate that both COX-2 and PGE2 may be involved in the occurrence of the disease.And KBD contributes to the maintenance of pregnancy possibly by regulating COX-2 and PGE2.
【Key words】 Abortion，habitual；Anticardiolipin antibody；Cyclooxygenase 2；Dinoprostone；Kidney-nourishment & blood-activation decoction
Protective Effect of Bushen Jiedu Prescription on Radiation-induced Thymus Injury in Mice YU Lei1，YANG Yunshuang2，LI Yanhui2，LIU Xiaochen2，DU Lei2，WANG Sinian3，ZHANG Rong4*
1.PLA Rocket Force Characteristic Medical Center Training Base，Jinzhou Medical University，Jinzhou 121000，China
2.Department of Medical Affairs，PLA Rocket Force Characteristic Medical Center，Beijing 100088，China
3.Department of TCM and Rehabilitation Medicine，PLA Rocket Force Characteristic Medical Center，Beijing 100088，China
4.Nuclear and Radiation Damage Laboratory，PLA Rocket Force Characteristic Medical Center，Beijing 100088，China
*Corresponding author：ZHANG Rong，Chief physician；E-mail:email@example.com
【Abstract】 Background Thymus is the most important central immune organ，which is vulnerable to radiation damage resulting in immune damage.At present，there are still some defects in thymus protective agents developed at home and abroad：Traditional Chinese Medicine has attracted more and more attention because of its high efficiency and low toxicity.Objective To study the protective effect of Bushen Jiedu prescription on radiation-induced thymus injury in mice.Methods A total of 90 mice were randomly divided into blank group（BG），radiation group（RG），radiation+amifostine group（AG），radiation+Bushen Jiedu prescription prevention and treatment group（BPT），radiation+Bushen Jiedu prescription prevention group （BP），with 18 mice in each group in January 2019.After 3 days of adaptive feeding，BPT group and BP group were intragastrically administered with Bushen Jiedu prescription（0.25 ml/rat） and RG group，AG group were intragastrically administered with the same amount of 0.9% sodium chloride solution for 10 days.On the 11th day after the experiment，all mice except those in BG group received one-time 4 Gy 60Co gamma-ray radiation at the same distance，and AG group was injected 200 mg/kg of amifostine into the left abdominal cavity 30 minutes before irradiation.After irradiation，BPT group continued to be intragastrically administered with Bushen Jiedu prescription，while the remaining four groups were given 0.9% sodium chloride solution at the same dose.The general condition of mice was observed.At the 1st，7th and 14th day after radiation，the thymus index was calculated and histological structure of thymus was observed under light microscope on the 7th day after irradiation.Results After irradiation，the general situation of five groups of mice was worse than that before irradiation，with specific manifestations of decreased activity，poor mental state，and decreased gloss of fur，especially RG group，with five mice had hair mass exfoliation.On the 1st，7th and 14th day after irradiation，thymus index of BG group was higher than that of the other four groups（P<0.01）：on the 7th day after irradiation，thymus index of BPT and AG groups were higher than that of RG group，and that of BP group was lower than that of BPT group（P<0.01）：on the 14th day after irradiation，thymus index of BPT group was higher than that of RG，AG and BP groups（P<0.05）．The structure of thymus in BG group was complete，medulla could be seen in the cortex，and round or oval thymic corpuscles could be seen in the center.Trabecular structure in RG group was destroyed with unclear boundaries and blurred thymic corpuscles.The other three groups had the same pathological manifestations，some had destroyed trabecular lobules，dimly visible thymic corpuscles，and unclear cortical and medullary boundaries.BP group also showed more inflammatory cell infiltration.Conclusion Bushen Jiedu prescription can reduce radiation-induced thymus tissue damage in mice and plays a good role in radiation protection.
【Key words】 Radiation injuries；Thymus gland；Mice；Bushen Jiedu prescription
Clinical Response and Changes in Intestinal Barrier Function，Inflammatory Markers and Neuropeptide Y among Diarrhea-predominant Irritable Bowel Syndrome with Liver-qi Stagnation and Spleen Deficiency Syndrome Patients Treated with Anchang Decoction CAI Linkun1，HUANG Shi2*，PENG Zhuoyu3*，HUANG Yalan1，TAO Lifen1，LAN Siying1
1.Guangxi University of Chinese Medicine，Nanning 530001，China
2.Department of Gastroenterology，Ruikang Hospital Affiliated to Guangxi University of Chinese Medicine，Nanning 530011，China
3.Department of Gastroenterology，the First Affiliated Hospital of Guangxi University of Chinese Medicin，Nanning 530022，China
*Corresponding author：HUANG Shi，Chief physician，Professor；E-mail：firstname.lastname@example.org
PENG Zhuoyu，Chief physician，Professor；E-mail：email@example.com
【Abstract】 Background Diarrhea-predominant irritable bowel syndrome（IBS-D） is a common disease and frequently-occurring disease of digestive system.Clinical responses to western medicine treatment scheme in IBS-D patients are not significant，especially the improvement of visceral sensitivity is unsatisfied.Furthermore，the patients are prone to recurrence after the treatment.So it is necessary to find a more effective treatment.Objective To explore clinical responses and changes in intestinal barrier function，inflammatory markers and neuropeptide Y（NPY） among IBS-D with liver-qi stagnation and spleen deficiency syndrome patients treated with Anchang Decoction Methods Sixty-four IBS-D gastroenterology outpatients and inpatients meeting the research criteria from Ruikang Hospital Affiliated to Guangxi University of Chinese Medicine were enrolled from February to December 2018.By use of a random number table，they were evenly divided into the control group and observation group，treated with 8-week oral administration of Trimebutine Maleate Capsule，Trimebutine Maleate Capsule with Anchang Decoction，respectively.Clinical efficacy，and pre-and post-treatment Irritable Bowel Syndrome Quality of Life（IBS-QOL） score，Hamilton Anxiety Rating Scale（HAMA） score，Hamilton Depression Rating Scale（HAMD） score，serum levels of diamine oxidase（DAO），D-lactate，intestinal fatty-acid binding protein（I-FABP），interleukin-6（IL-6），interleukin-8（IL-8），tumor necrosis factor-alpha（TNF-α），and NPY were measured.Results The overall clinical response of the observation group was better than that of the control group（Z=2.163，P<0.05）．After treatment，the observation group showed higher average IBS-QOL score and lower average HAMA and HAMD scores than the control group（P<0.05）．The average IBS-QOL score increased and average HAMA and HAMD scores decreased significantly in both groups after treatment（P<0.05）．The average post-treatment serum levels of DAO，D-lactate and IFABP of the observation group were significantly lower than those of the control group（P<0.05）．The average serum levels of DAO，D-lactate and IFABP decreased significantly in both groups after treatment compared with baseline（P<0.05）．After treatment，the observation group showed lower average serum levels of IL-6，IL-8 and TNF-α and higher average serum NPY than the control group（P<0.05）．The average serum levels of IL-6，IL-8 and TNF-α decreased and serum NPY increased significantly in both groups after treatment（P<0.05）．Conclusion Anchang Decoction is effective in treating IBS-D with liver-qi stagnation and spleen deficiency.It can improve the overall quality of life，relieve anxiety and depression，improve intestinal barrier function，protect intestinal tissue，alleviate inflammation，regulate and control the secretion balance of brain-gut peptide in these patients.
【Key words】 Irritable bowel syndrome；Hepatic stagnation and splenic deficiency；Anchang decoction；Intestinal barrier function；Inflammatory factors；Neuropeptide Y level；Brain-gut peptide；Treatment outcome
Advances in the Application of Precise Health Management Model in Type 2 Diabetes XIE Chunyan，HONG Yirong，HU Tingting，XU Jiao，HE Chaozhu*
Nursing School of Nanchang University，Nanchang 330006，China
* Corresponding author：HE Chaozhu，Professor，Master supervisor；E-mail：firstname.lastname@example.org
【Abstract】 The global incidence rate of type 2 diabetes mellitus has increased dramatically，and type 2 diabetes mellitus has become the third chronic non-infectious disease in the world.It has greatly affected the quality of patients' lives and brought serious medical burden to the society.Traditional health management model is no longer meet people's increasingly growing needs of health.Therefore，it is urgent to take pertinent interventions to improve the prevention rate of the disease.Based on the perspective of precision medicine，this paper reviewed the application status of precise diagnosis，prediction，filing，health improvement and performance evaluation models of type 2 diabetes at home and abroad，with holding a view to promote the target and personalized development of health management.
【Key words】 Diabetes mellitus，type 2；Precise medicine；Health management；Disease management；Health education
Effect Evaluation of Intensive Blood Glucose Monitoring by Family Doctors on Blood Glucose Control in Type 2 Diabetes Mellitus LUO Mingliang1，LIANG Xinglun2，LYU Peng3*
1.Tongji University School of Medicine，Shanghai 200092，China
2.Department of Geriatrics，Yangpu Hospital，Tongji University，Shanghai 200090，China
3.Nanxiang Town Community Health Center，Shanghai 201802，China
*Corresponding author：LYU Peng，Attending physician；E-mail：email@example.com
【Abstract】 Background In China，there are many people suffering from diabetes with poor awareness of blood sugar monitoring，and low rate of meeting glycemic targets.However，the relationship between blood glucose monitoring and control status is still controversial.Objective To explore the effect of intensive blood glucose monitoring by family doctors on blood glucose control in patients with type 2 diabetes，to promote blood glucose monitoring in an appropriate and standardized way in such patients，and to further improve the level of community-based diabetes management.Methods 120 type 2 diabetes patients who received follow-up services from Nanxiang Town Community Health Center but failed to reach glycemic targets were enrolled from July to December 2018，and were equally randomized into monitoring group and control group by using computer software.Both groups received a 6-month intervention，during which the control group underwent blood glucose monitoring once every 3 months at home or at Nanxiang Town Community Health Center according to their own choice，and the monitoring group monitored blood glucose at the family doctors studio once a week，and the results were recorded by family doctors.Moreover，diet and exercise status and corresponding guidance of both groups during the intervention were collected.The intervention results were evaluated by BMI，fasting blood glucose（FBG），2-hour postprandial glucose（2 hPBG），glycosylated hemoglobin（HbA1c），low-density lipoprotein cholesterol（LDL-C），high-density lipoprotein cholesterol（HDL-C），triglyceride（TG）and total cholesterol（TC）at 3，and 6 months after intervention.Results Intervention method and time exerted significant interaction effect on FBG，2 hPBG，HbA1c，LDL-C，TG（P<0.05），but not on BMI，HDL-C and TC（P>0.05）.The main effects of intervention method on BMI，HDL-C and TC were not significant（P>0.05），but were significant on FBG，2 hPBG，HbA1c，LDL-C and TG（P<0.05）.The main effect of intervention time on BMI and TC was not significant（P>0.05），but was significant on FBG，2 hPBG，HbA1c，LDL-C，HDL-C and TG（P<0.05）.At the end of intervention，mean levels of FBG，2 hPBG，HbA1c，LDL-C and TG in the monitoring group were lower than those in the control group（P<0.05）.And FBG，2 hPBG，HbA1c，LDL-C and TG in the monitoring group were lower than before the intervention（P<0.05）.Conclusion Intensive blood glucose monitoring by family doctors is helpful to improve the effect of blood glucose control in patients with type 2 diabetes and reduce the level of blood lipids，which deserves attention and promotion.
【Key words】 Diabetes mellitus，type 2；Disease management；Blood glucose self-monitoring；Intensive blood sugar monitoring；Family doctor
Recent Developments in Self-management Intervention Models in Patients with Chronic Heart Failure MENG Yanfei，MA Li*，MA Desheng
Department of Emergency and Critical Care，Lanzhou University Second Hospital，Lanzhou 730000，China
*Corresponding author：MA Li，Chief physician；E-mail：firstname.lastname@example.org
【Abstract】 Due to recently increased prevalence of chronic diseases，many self-management interventions become increasingly popular.However，self-management status in chronic heart failure patients is not so optimistic.We reviewed the self-management intervention models recently used in chronic heart failure patients under the guidance of doctors and nurses，and summarized that in foreign countries，the guidance is mainly delivered via the advanced remote supervising system，while in China，the guidance is mainly delivered via health education.To improve the prognosis of these patients through enhancing their self-management abilities，we suggest that both the two aforementioned guidance methods for patients are used together，and self-management status is also encouraged to record daily.
【Key words】 Heart failure；Disease management；Self-management；Intervention mode；Review
Progress in the Treatment of Obstructive Sleep Apnea Syndrome ZHU Yue，ZHANG Na，YE Kaiting，XIAO Weidi，DONG Jiahui，SUN Gengyun*
Department of Respiratory and Critical Care，the First Affiliated Hospital of Anhui Medical University，Hefei 230022，China
*Corresponding author：SUN Gengyun，Chief physician；E-mail：email@example.com
【Abstract】 Obstructive sleep apnea syndrome（OSA）is very common and can occur at any age.This article systematically described the current status of OSA diagnosis and treatment and the latest treatment progress，from non-surgical treatment and surgical treatment，respectively.The authors believe that general treatments，such as etiological treatment，lifestyle improvement，weight loss and sleep position intervention，can significantly improve the symptoms of patients with mild to moderate OSA.For patients with moderate to severe OSA，continuous positive airway pressure（CPAP）therapy remains the gold standard.The emerging telemedicine technology（TLC）is a promising medical model that can significantly improve the compliance of CPAP patients.For patients who cannot tolerate CPAP treatment，they can use oral appliance，and drugs.For patients with severe OSA who have congenital or acquired anatomical abnormalities and cannot tolerate CPAP，we recommend surgery.
【Key words】 Sleep apnea，obstructive；Clinical protocols；Review；Continuous positive airway pressure；Oral appliance；Drug therapy；Surgery