June 2020, Volume 23，No17 Abstracts（A）
Author：尹鹏 Source：CGP Published： [07-01] views： 16
Recent Advances in Diabetic Cystopathy GUO Wenmin1，SUN Libin2，WANG Dongwen2*
1.First Clinical Medical College of Shanxi Medical University，Taiyuan 030001，China
2.Department of Urologic Surgery，First Hospital of Shanxi Medical University，Taiyuan 030001，China
*Corresponding author: WANG Dongwen，Professor；E-mail: firstname.lastname@example.org
【Abstract】 We systematically reviewed recent advances in diabetic cystopathy at home and abroad.On the basis of summarizing epidemiological characteristics and research history of diabetic cystopathy，we analyzed the pathogenesis of this disease from a novel perspective of detrusor cell injury，nerve pathway disorder and urinary tract dysfunction，and found that the treatment of detrusor injury has become a hot research topic.Many researchers are trying new methods other than traditional treatment（urine training，pharmacological therapy，integrated Chinese and western treatment，etc.）.In addition，various physiotherapies and bladder repair using tissue engineering technologies are emerging.These new treatment ideas are current research hotspots and indicate the focus of future clinical applications.
【Key words】 Diabetic cystopathy；Diabetes complications；Epidemiology；Signs and symptoms；Therapy；Review
Application of Microarray Gene Chip in Newborn Hearing Loss Screening CHANG Liang1，2，KE Jia3，ZHANG Ke3，ZHAO Nan1，2，LIU Ping1，2*，LI Rong1，2
1.Center for Reproductive Medicine，Department of Obstetrics and Gynecology，Peking University Third Hospital，Beijing 100191，China
2.National Clinical Research Center for Obstetrics and Gynecology，Beijing 100191，China
3.Department of Otorhinolaryngology，Peking University Third Hospital，Beijing 100191，China
*Corresponding author: LIU Ping，Chief physician；E-mail: email@example.com
【Abstract】 Background Newborn hearing screening is widely performed worldwide，and plays an important role in early detection，diagnosis，and intervention of hearing loss.Concurrent hearing and genetic screening in the whole newborn population in Beijing was launched in January 2012.This concurrent testing is expected to play important roles.Objective To screen for genetic deafness mutations in newborns with microarray gene chip，and to evaluate the frequency and type of mutations in four common deafness genes as well as their correlations with deafness，providing clinical research evidence for promoting newborn hearing gene screening.Methods Participants were 17 824 newborns recruited from Center for Reproductive Medicine，Department of Obstetrics and Gynecology，Peking University Third Hospital in 2017.Heel blood was collected three days after birth.Nine mutation sites of four common deafness genes were screened by microarray gene chip，and the positive results were sequenced and verified.Results 890（4.99%） were found with positive results of the testing，including 501（2.81%） with heterozygous mutations in the GJB2 gene，290（1.63%） with heterozygous mutations in the SLC26A4 gene，1（0.01%） with homozygous mutations in the SLC26A4 gene，41（0.23%） with mitochondrial DNA 12S rRNA mutations，41（0.23%） with homozygous mutations in the GJB3 gene，and 16（0.09%） with double heterozygous mutations.Conclusion GJB2 gene mutation and SLC26A4 gene mutation are the most common mutations in neonatal deafness.Microarray gene chip may effectively detect congenital deafness，delayed deafness and drug-induced deafness-associated gene mutations as early as possible.Being a rapid and highly efficient means for screening newborn deafness，microarray gene chip screening is of great significance for early diagnosis and intervention and genetic consultation of the disease.Therefore，its combined use with neonatal hearing loss screening should be popularized in China.
【Key words】 Hearing loss；Hereditary hearing loss；Neonatal screening；Genes；Microarray gene chip
Recent Advances in Clinical Application of GA/HbA1c Ratio ZHANG Donghong，LI Qiang*
Department of Endocrinology and Metabolism，the 2nd Affiliated Hospital of Harbin Medical University，Harbin 150086，China
*Corresponding author: LI Qiang，Professor；E-mail: QiangLi26@126.com
【Abstract】 Glycated albumin（GA） reflects the mean level of blood glucose within 2-3 weeks，and glycated hemoglobin（HbA1c） reflects the mean blood glucose level within 2 to 3 months.GA/HbA1c ratio with shorter half-life，reflects the glycemic fluctuation shorter than the circulating half-life of GA，is a new glycemic control indicator for diabetic patients，which can be used in the diagnosis of fulminant type 1 diabetes，determination of the islet cell function，screening and diagnosis of diabetes，diagnosis of diabetic nephropathy and diabetic retinopathy，and predicting cognitive impairment in the elderly.GA/HbA1c ratio in combination with other glycemic indicators can reflect blood glucose level more accurately.
【Key words】 Hemoglobin A，glycosylated；Glycated albumin；Ratio of glycated albumin to glcated hemoglobin；Blood glucose；Diabetes mellitus
Randomized Cross-over Controlled Clinical Study on the Effect of Intradermal Acupuncture of Auricular Branch of Vagus Nerve on the Peak Postprandial Blood Glucose in Patients with Type 2 Diabetes Mellitus LIU Xiaoru1，WANG Hong1，LI Likun2，YANG Sen1，JIANG Jinfeng1*
1.Nanjing University of Chinese Medicine/Key Laboratory of Acupuncture and Medicine Research of Ministry of Education，Nanjing 210029，China
2.North China University of Science and Technology Affiliated Hospital，Tangshan 063000，China
*Corresponding author: JIANG Jinfeng，Professor，Master supervisor；E-mail: Dr.firstname.lastname@example.org
【Abstract】 Background Studying the integration and metabolism of the afferent signals from the vagus nerve is a potential strategy for discovering new therapeutic targets to restore energy and glucose balance in patients with diabetes and obesity.Our team found the hypoglycemic effect of auricular needle implantation in the preliminary study.On the basis of implanting needles，we developed the technique of auricular intradermal acupuncture，which is a new technique of vagus nerve stimulation.Objective To explore the effect of auricular intradermal acupuncture on peak postprandial blood glucose in patients with type 2 diabetes mellitus.Methods A single-blind，randomized，cross-over，controlled clinical study was conducted.Thirty-one patients with type 2 diabetes mellitus with fixed diet，exercise，lifestyle and hypoglycemic medication regimen from the Endocrine Ward，Jiangsu Province Hospital of Chinese Medicine and Jiangsu Second Hospital of Chinese Medicine were enrolled during December 2017 to March 2018 and were randomly divided into groups A and B，with a total observation period of six days.At 7:30 a.m.on the second day（the first acupuncture intervention day），group A was given true acupuncture，group B was given sham acupuncture.At 7:30 a.m.on the fifth day（the second acupuncture intervention day），group A was given sham acupuncture，group B was given true acupuncture，and no acupuncture intervention was given on other observation days.Fasting blood glucose，postprandial（2 and 4 hours after eating breakfast） capillary blood glucose levels were measured in both groups on six consecutive days 〔the first day（the day before the first acupuncture intervention），the second day（the day of receiving the first acupuncture intervention），the third day（the day after receiving the first acupuncture intervention），the fourth day（the day before the second acupuncture intervention），the fifth day（the day of receiving the second acupuncture intervention），the sixth day（the day after receiving the second acupuncture intervention）〕.Results In group A，the mean 2-hour post-breakfast capillary blood glucose level on the day of and the day after receiving true acupuncture was lower than that on the day before receiving true acupuncture（P<0.05）.And it on the day of receiving true acupuncture was lower than that on the day of receiving sham acupuncture（P<0.05）.Similar conditions were found in group B.Two groups showed significant differences in the mean 2-hour post-breakfast capillary blood glucose level on the day of receiving the first acupuncture intervention as well as on the day of receiving the second acupuncture intervention（P<0.05）.Conclusion Auricular intradermal acupuncture could significantly reduce the blood sugar level in patients with type 2 diabetes mellitus at 2 hours after breakfast.
【Key words】 Diabetes mellitus，type 2；Vagus nerve stimulation；Acupuncture，ear；Acupuncture points；Blood glucose；Randomized controlled trial
Functional Difference Exploration of Circulating Immune Complex between Patients with IgA Nephropathy Only and Both with Diabetes Mellitus ZHAI Yaling1，2，LONG Xiaoqing1，2，GAO Jingge1，2，LU Shan1，2，ZHAO Zhanzheng1，2*
1.Department of Nephrology，the First Affiliated Hospital of Zhengzhou University，Zhengzhou 450052，China
2.Institute of Nephrology，Zhengzhou University，Zhengzhou 450052，China
*Corresponding author: ZHAO Zhanzheng，Chief physician；E-mail: email@example.com
【Abstract】 Background IgAN is one of the most common primary glomerular diseases worldwide，and it is recognized that the deposition of circulating immune complexes in the glomerular mesangial area initiates the disease.Likewise，the incidence of diabetes mellitus（DM） in China has increased year by year，which has become a major national health problem.Objective Circulating immune complex （CIC） could promote proliferation and inflammation factors production of glomerular mesangial cells in patients with IgA nephropathy （IgAN），we aimed to investigate if there is functional difference of CIC from patients both with IgAN and DM.Methods 28 patients with primary IgAN （8 both with IgAN and DM，and 20 with IgAN only） who received renal-biopsy in the First Affiliated Hospital of Zhengzhou University were recruited from February 2017 to February 2018.In addition，7 age- and sex-matched physical examinees （as healthy controls） were recruited from the physical examination department of this hospital during the period.Clinical and pathological data of patients with IgAN were collected from medical records.CIC was extracted from 10 ml peripheral blood collected from all participants and was used to stimulate the glomerular mesangial cells at the same concentration，then the mesangial cell proliferation activity was detected by CCK-8 kit and the levels of IL-6 and CXCL1 in the supernatant were tested by commercial ELISA kits.Results The plasma levels of triglyceride，C3 and C4 in the IgAN group were lower than those both with IgAN and DM.The ratio of patients with E1 （capillary endothelial cell proliferation） in the Oxford classification was higher than that in the IgAN with DM group （P<0.05）.The proliferation activity of the mesangial cells in the three groups was significantly different （P<0.001），in particular，it was higher in the IgAN group than that of other two groups （P<0.05），but there was no significant difference between the IgAN with DM group and the normal group （P=0.250）.As to cell supernatant IL-6 and CXCL1 levels，the result showed there was no difference among the three groups （P>0.05）.Conclusion It is seemly CIC from patients with both IgAN and DM have the similar ability to promote mesangial cells to produce inflammatory factors as the ones only with IgAN，but lower ability on promoting the proliferation of mesangial cells，which indicated the component of CIC may be different between patients with IgAN only and both with DM.
【Key words】 Glomerulonephritis，IgA；Diabetes mellitus；Circulating immune complex
Impact of Intimate Relationship between Colorectal Cancer Patients and Their Primary Family Caregivers on Their Quality of Life:an Analysis Based on Actor-partner Interdependence Model WU Xia，LIU Suting，ZHOU Sijia，LI Xinxin，ZHANG Lili*
School of Nursing，Southern Medical University，Guangzhou 510515，China
*Corresponding author: ZHANG Lili，Professor；E-mail: firstname.lastname@example.org
【Abstract】 Background The data showed that the situation for colorectal cancer prevention and control is severe in China in 2019.As cancer patients and their primary family caregivers are closely associated，they adapt to the influence of cancer together.So cancer and related treatment can impair the quality of life in the patients as well as that of their intimate primary family caregivers.Objective To analyze the changes in quality of life of colorectal cancer patients and their primary family caregivers influenced by intimate patient-caregiver relationship based on actor-partner interdependence model（APIM），to provide a theoretical basis for delivering clinical interventions.Methods By use of convenience sampling，colorectal cancer patients treated in Nanfang Hospital，Yunnan Cancer Hospital，the Sixth Affiliated Hospital，Sun Yat-sen University and their primary family caregivers were enrolled during November 2018 to May 2019.Patients and their caregivers received a self-administered survey separately with the Relationship Assessment Scale（RAS） and the Chinese version of 12-item Short-Form Health Survey（SF-12-C） for collecting their subjective satisfaction with the patient-caregiver relationship，and their self-rated quality of life in the past 7 days.An APIM was established based on the survey results and was used to analyze the changes of quality of life in both groups influenced by intergroup intimate relationship.Results A total of 296 patient-caregiver dyads participated in the survey，and 271 of them gave responsive questionnaires，achieving a response rate of 91.6%.According to the survey，the RAS score of the patients was positively correlated with the caregivers' scores of RAS，Physical Component Summary（PCS） and Mental Component Summary（MCS）（P<0.05）.The PCS score of the patients was positively correlated with the caregivers' scores of PCS and MCS（P<0.05）.The MCS score of the patients was positively correlated with the caregivers' MCS score（P<0.05）.APIM-based analysis showed that，in terms of actor-effect，the RAS score of caregivers was positively correlated with their MCS score（P<0.001）.In terms of partner-effect，the RAS score of the patients was positively correlated with the PCS score of caregivers（P<0.001）.And the RAS score of caregivers was positively correlated with the PCS score of patients（P<0.001）.Conclusion The RAS score of the colorectal cancer patients may positively associated with the quality of life of their primary family caregivers，while the RAS score of the caregivers may positively associated with the quality of life of themselves as well as that of the patients.
【Key words】 Colorectal neoplasms；Primary family caregivers；Intimate relationship；Quality of life；Actor-partner interdependence model
Effect of Metabolic Syndrome on Long-term Prognosis of Patients with ST-segment Elevation Myocardial Infarction CHEN Hairong*，LI Minglan，PAN Biyun，CHEN Xunchun，LU Shijuan，WANG Yanying
Department of General Medicine，Central South University Xiangya School of Medicine Affiliated Haikou Hospital，Haikou 570208，China
*Corresponding author: CHEN Hairong，Associate chief physician；E-mail: email@example.com
【Abstract】 Background Metabolic syndrome（MetS） is a collection of conditions，which increases the risk for cardiovascular and cerebrovascular diseases.Its influence on long-term prognosis of ST-segment elevation myocardial infarction（STEMI） patients is rarely reported.Objective To evaluate the impact of MetS on long-term prognosis of STEMI patients.Methods We enrolled 507 STEMI patients treated with PCI from Cardiovascular Department，Central South University Xiangya School of Medicine Affiliated Haikou Hospital from March 2014 to March 2015，including 217 with coexisting MetS（MetS group），and 290 without（non-MetS group）．We collected their general clinical data，and information about severity of conditions，length of stay，incidence of complications during hospitalization，pharmacological treatment within one-month follow-up，and major adverse cardiovascular events（MACE） and death within four-year follow-up.We performed a multivariate analysis of the impact of MetS on MACE and death using the Cox proportional hazard regression model.Results Both groups showed significant differences in sex ratio，mean age，prevalence of history of smoking，hypertension，diabetes，hyperlipidemia，low HDL cholesterol，central obesity，distribution of BMI，and multi-vessel lesions，as well as mean SYNTAX score（P<0.05）．Also，MetS group showed longer mean length of stay than non-MetS group （P<0.05）.At one-month follow-up，the rates of using ACEIs/ARBs，calcium channel blockers，and hypoglycemic agents in MetS group were higher than those of non-MetS group（P<0.05）．During the four-year follow-up，MetS group had higher incidence of angina pectoris，and target vessel revascularization，and lower incidence of receiving repeat PCI/coronary artery bypass grafting than no-MetS group（P<0.05）．The death rate differed significantly by the number of MetS components（P<0.05）．The incidence of MACE also varied significantly by the number of MetS components（P<0.05）．Multivariate analysis with the Cox proportional hazards regression model showed that age 〔HR=1.057，95%CI（1.022，1.090）〕，renal insufficiency 〔HR=3.025，95%CI（1.180，7.759）〕，previous myocardial infarction〔HR=2.430，95%CI（1.488，5.151）〕，left ventricular ejection fraction 〔HR=0.958，95%CI（0.923，0.995）〕，Killip class≥Ⅱ 〔HR=4.641，95%CI（2.188，9.825）〕 were independent risk factors for death in STEMI patients（P<0.05）；age 〔HR=1.029，95%CI（1.006，1.054）〕，renal insufficiency 〔HR=2.826，95%CI（1.229，6.496）〕，left ventricular ejection fraction 〔HR=0.960，95%CI（0.934，0.987）〕，SYNTAX score 〔HR=2.138，95%CI（1.281，3.567）〕，Killip class≥Ⅱ 〔HR=2.098，95%CI（1.131，3.893）〕 and MetS 〔HR=1.833，95%CI（1.162，2.896）〕were independent risk factors for MACE in STEMI patients（P<0.05）．MetS was independently associated with TVR 〔HR=2.204，95%CI（1.273，3.815），P=0.005〕.Conclusion STEMI patients with MetS had longer length of stay and higher long-term MACE incidence after PCI.MetS is not associated with long-term death of STEMI patients，but is independently associated with MACE，especially with TVR.
【Key words】 Myocardial infarction；Metabolic syndrome；Angioplasty，balloon，coronary；Myocardial revascularization；Major adverse cardiac events；Prognosis
Frailty Prevalence and Its Correlation with Cognitive Function in Hospitalized Patients Over 60 Years Old YANG Yanrong，WANG Ziqi*，LI Zheng，FU Liangxiu，HU Tingting
Department of Neurology，Chengdu Fifth People's Hospital，Chengdu 611130，China
*Corresponding author: WANG Ziqi，Attending physician；E-mail: firstname.lastname@example.org
【Abstract】 Background Frailty is a geriatric syndrome，and a common negative consequence of aging，which share some obvious characteristics as cognitive impairment.Preventing and relieving frailty may reduce the possibility of developing cognitive impairment.Objective This study aimed to investigate frailty prevalence and its correlation with cognitive function in hospitalized patients over 60 years old.Methods We enrolled a random sample of hospitalized patients over 60 years old from Chengdu Fifth People's Hospital from November 2015 to May 2016.We used a self-made registration sheet to collect their demographic data（gender，age，nationality，educational level and monthly income），and used the FRAIL Scale to assess the prevalence of frailty，and used the Mini-Mental State Examination（MMSE）with Clock Drawing Test（CDT）to assess cognitive function.We used multiple linear regression analysis to explore the correlation between frailty level and demographic data，and compared cognitive functions by level of frailty.Results Altogether，223 cases were enrolled，including 52（23.3%） who were identified with no frailty（non-frailty group），110（49.3%） with pre-frailty（pre-frailty group），and 61（27.4%） with frailty（frailty group）.By multiple linear regression analysis，age〔β=0.039，95%CI（0.016，0.062）〕 and education〔β=-0.207，95%CI（-0.405，-0.008）〕 were found to be the influencing factors of frailty（P<0.05）.The scores of MMSE，CDT，orientation to time，orientation to place，attention and calculation，recall，and the time and place of the test all decreased with the increase of the level of frailty（P<0.05）.Conclusion The prevalence of frailty is high in hospitalized patients over 60 years old，which is closely related to age and education level，and can lead to the decline of total cognitive impairment manifested mainly in orientation to time，orientation to place，attention and calculation，recall，and the time and place of the test.
【Key words】 Marasmus；Cognitive impairment；Aged；Frailty assessment tools；Mini mental state examination；Clock drawing test
Correlation between Intestinal Flora Status and Inflammatory Indexes and Lung Function in Patients with Chronic Obstructive Pulmonary Disease at Stable Phase DENG Sumin，ZHU Taofeng，CHEN Ruhua，MA Xiuqin，GU Xinnan*
Department of Respiratory Medicine，Yixing Hospital Affiliated to Jiangsu University，Yixing 214200，China
*Corresponding author: GU Xinnan，Associate chief physician；E-mail: email@example.com
【Abstract】 Background Chronic obstructive pulmonary disease（COPD） is a common disease characterized by persistent airflow limitation that can be prevented and treated，and chronic airway inflammation is the key to its pathogenesis.The micro-ecology of the human intestinal flora is an important guarantee for maintaining the stability of the body environment，and it can regulate the release of inflammatory mediators.At present，studies on the relationship between intestinal flora and COPD are rarely reported.Objective To study the intestinal flora status of patients with COPD at stable phase in different groups，and to investigate the correlation between intestinal flora status and inflammatory indexes and lung function in patients with COPD at stable phase.Methods This was a prospective cohort study of COPD at stable phase included as the observation group.The 80 patients who met the inclusion criteria at the Department of Respiratory Medicine as well as the respiratory ward of Yixing Hospital Affiliated to Jiangsu University from June 2017 to June 2018 were divided into four groups，A，B，C and D，with 20 patients in each group according to the comprehensive assessment grouping standard in Global Initiative for Chronic Obstructive Lung Disease（GOLD）（2017 report），and 20 healthy outpatients in the same period were chosen as the control group.The intestinal flora status of each group was analyzed and compared，and the correlation between intestinal flora status and inflammatory indexes and lung function in patients with COPD at stable phase were analyzed.Results The contents of lactobacillus and bifidobacterium in group C and D were lower than those in group A，B and the control group，while the contents of enterococcus faecium and enterococcus faecalis in group C and D were significantly higher than those in group A，B and the control group（P<0.05）.The differences among interleukin-8（IL-8），interleukin-6（IL-6），tumor necrosis factor-alpha（TNF-α），endotoxin，forced expiratory volume in the first second（FEV1），forced expiratory volume in one second as percentage of predicted value（FEV1%pred） and FEV1/forced vital capacity（FEV1/FVC） in each group were statistically significant（P<0.05）．The contents of lactobacillus and bifidobacterium were negatively correlated with IL-8（r=-0.50，-0.51），IL-6（r=-0.57，
-0.55），TNF-α（r=-0.57，-0.56），procalcitonin（PCT）（r=-0.27，-0.24） and ndotoxin（r=-0.76，-0.76），and positively correlated with FEV1（r=0.44，0.45），FEV1%pred（r=0.45，0.45） and FEV1/FVC（r=0.51，0.49）（P<0.05），and the contents of enterococcus faecium and enterococcus faecalis were positively correlated with IL-8（r=0.53，0.55），IL-6（r=0.48，0.46），TNF-α（r=0.55，0.58） and ndotoxin（r=0.67，0.68），and negatively correlated with FEV1（r=-0.54，
-0.58），FEV1%pred（r=-0.53，-0.57），and FEV1/FVC（r=-0.56，-0.59）（P<0.05）．The content of bifidobacterium was negatively correlated with C-reactive protein（CRP）（r=-0.22）（P<0.05）．Conclusion Patients with COPD at stable phase in group C and D of are more likely to have the imbalance of intestinal flora than group A and B，and the intestinal flora status is closely related to the inflammatory indexes and lung function in patients with COPD at stable phase.
【Key words】 Chronic obstructive pulmonary disease；Intestinal flora；C-reactive protein；Interleukin-6；Interleukin-8；Tumor necrosis factor-alpha；Procalcitonin；Forced vital capacity
Application Effect of Medication Therapy Management in the Standardized Treatment of Cancer Pain LYU Tianyi*，WU Yu'e，HU Rongchao，WANG Kang，XU Xu
Xingyi People's Hospital，Xingyi 562400，China
*Corresponding author:LYU Tianyi，Associate chief pharmacist；E-mail:firstname.lastname@example.org
【Abstract】 Background At present，some hospitals in China have achieved preliminary results in exploring the medication treatment management（MTM） methods and applying them to cancer pain management.However，the MTM model of cancer pain is still in the exploration stage.There are few empirical studies in the MTM of cancer pain，and the MTM model of cancer pain needs to be constructed.The mode of pharmacists' work and the effects in cancer pain management remain to be examined.Objective To systematically evaluate the efficiency of clinical pharmacists in the use of MTM to participate in the standardized treatment of cancer pain，and to explore how clinical pharmacists use MTM to provide high-quality and efficient pharmacy services for patients with cancer pain.Methods A total of 122 patients with tumor-related pain admitted to the Department of Oncology of Xingyi People's Hospital were enrolled from April 2017 to March 2018.And they were randomly divided into the experimental group（n=61） and the control group（n=61） by random number table method.In the control group，61 patients were routinely treated by doctors and nurses，and the other 61 patients in the experimental group were given MTM services（MTMs） by clinical pharmacists to provide a full-course pharmacy service on the basis of the control group.The Visual Analogue Scale（VAS） scores，clinical outcomes，medication adherence，and the incidence of adverse drug reactions between these two groups were compared.Results After seven days of treatment，the VAS score of experimental group was lower than that of the control group（P<0.05）．The VAS scores of the two groups after seven days of treatment were lower than those before treatment（P<0.05）．There was no significant difference in the incidence of breakthrough pain between the experimental group〔54.1%（33/61）〕 and the control group〔59.0%（36/61）〕（P>0.05）．The remission rate of the breakthrough pain in the experimental group〔72.7%（24/61）〕 was higher than that in the control group〔47.2%（17/61）〕（P<0.05）．After two weeks of treatment，the effective rate of pain relief in the experimental group was 91.8%（56/61），which was higher than 63.9%（39/61） of the control group（P<0.001）．After two weeks of treatment，the medication adherence of the experimental group was superior to that of the control group（P<0.001）．There was no significant difference in medication adherence of the control group before and after two weeks of treatment（P=0.573）．The medication adherence of the experimental group after two weeks of treatment was better than that before treatment（P<0.001）．The incidence of constipation，nausea，vomiting in the experimental group were lower than that in the control group（P<0.05）．Conclusion The application of MTM in the standardized treatment of cancer pain has improved the analgesic effect and medication adherence of patients with cancer pain，and reduced the incidence of adverse drug reactions.The multi-disciplinary team（MDT） treatment model of cancer based on MTM served by clinical pharmacists can effectively promote the development of disciplines，improve the level of diagnosis and treatment of cancer pain，improve the patient experience of medical treatment and further enhance patients' sense of gain.
【Key words】 Drug therapy；Cancer pain；Clinical pharmacist；Pharmaceutical services；Medication therapy management；Multidisciplinary treatment
Comparative Study of Kwak-TI-RADS，ATA and ACR TI-RADS and Malignancy Risk Stratification Systems of Thyroid Nodules in Community Hospitals CHEN Jie1，CUI Mingxiang1，LIU Miao2*
1.Department of Ultrasonography，Minhang District Pujiang Community Health Center，Shanghai 201112，China
2.Department of Ultrasonography，Pudong New Area Gongli Hospital，Shanghai 200135，China
*Corresponding author: LIU Miao，Associate chief physician；E-mail: email@example.com
【Abstract】 Background The malignancy risk stratification system of thyroid nodules can standardize the ultrasound diagnosis of thyroid nodules，which has important significance in guiding the diagnosis and treatment of the disease.However，there is no uniform version currently.Objective To perform a comparative analysis of the values of three malignancy risk stratification systems of thyroid nodules systems in community hospitals，including Thyroid Imaging Reporting and Data System by Kwak（Kwak TI-RADS），the 2015 American Thyroid Association（ATA）Management Guidelines for Adult Patients with Thyroid Nodules and Differentiated Thyroid Cancer（hereinafter referred to as the ATA Guidelines），and the 2017 Thyroid Imaging Reporting and Data Systems by American College of Radiology（ACR TI-RADS）.Methods A retrospective analysis was conducted on the two-dimensional ultrasound sonographic features of 986 thyroid nodules in 825 patients examined by Pujiang Community Health Center，Shanghai Minhang District from January 2012 to August 2018.The ultrasound results of thyroid nodules were all confirmed by surgical pathology or thyroid fine-needle aspiration cytology（FNA）．Kwak TI-RADS，ATA Guidelines and ACR TI-RADS were used to classify the ultrasound results，and their ROC curves in differentiating benign and malignant thyroid nodules were evaluated and compared.Results Of the 986 nodules，479 were malignant and 507 were benign.The AUC of Kwak TI-RADS，ATA Guidelines and ACR TI-RADS were 0.887〔95%CI（0.864，0.909）〕，0.857〔95%CI（0.832，0.882）〕，0.870〔95%CI（0.846，0.895）〕 respectively，and the diagnostic threshold was≥4c，≥high risk，≥5，respectively，indicating that all of them had the value in differentiating benign and malignant thyroid nodules（P<0.05），and Kwak TI-RADS was superior to the latter two ones（Z=4.811，2.513，P<0.05）．Conclusion All these three systems have high values in differentiating benign and malignant thyroid nodules，but the diagnostic performance of Kwak TI-RADS is slightly better.Moreover，Kwak TI-RADS is simple，clear，and is easy to grasp，so it is suitable for promotion in primary hospitals.
【Key words】 Thyroid nodule；Thyroid imaging report and data system；Ultrasound screening；Community hospital；ROC curve；Sensitivity；Specificity
Influence of Cannabinoid Receptor 1 Gene Polymorphisms on the Clinical Outcomes of Early-stage Type 2 Diabetes Mellitus Treated with Liraglutide REN Lijun，WANG Junjie，MA Haoli，HOU Huijuan，SIMA Panpan，SONG Ruipeng*
Department of Endocrinology，the No.3 Provincial People's Hospital of Henan Province，Zhengzhou 450002，China
*Corresponding author: SONG Ruipeng，Chief physician，Main research in diabetic foot and comprehensive treatment；E-mail:firstname.lastname@example.org
【Abstract】 Background Liraglutide was proved to be effective in reducing the blood sugar level of patients with diabetes during a phase Ⅲ clinical trial.However，great individual difference of the hypoglycemic effect among patients treated with liraglutide has been found in clinical application.And studies have shown that gene polymorphism is one of the reasons for individual differences in actual effects of many drugs in humans.Objective Cannabinoid Receptor 1（CNR1） gene plays an important role in diabetes and its complications.This study was to investigate the influence of CNR1 gene polymorphisms on the clinical outcomes of early-stage type 2 diabetes mellitus treated with liraglutide.Methods Patients with early-stage type 2 diabetes mellitus from Department of Endocrinology，the No.3 Provincial People's Hospital of Henan Province from March 2016 to October 2018 were selected as study subjects.All of them were treated with subcutaneous injection of liraglutide，and the BMI，FPG，2 hPG and HbA1c were evaluated 16 weeks later.Additionally，peripheral venous blood specimens taken from all patients and fresh peripheral venous blood specimens from some of the patients were collected for measuring CNR1 1260G>A genotypes and CNR1 mRNA expression，respectively.Results The mean levels of BMI，FPG，2 hPG and HbA1c decreased significantly after 16 weeks compared with baseline levels（P<0.05）.The prevalence of 1260G>A among the 230 patients was as follows: GG genotype was found in 188 cases（81.7%），GA genotype in 39 cases（17.0%），AA genotype in 3 cases（1.3%），and the minor allele frequency was 0.098.The distribution of three genotypes were in accordance with Hardy-Weinberg equilibrium（P=0.550）.The clinical outcomes analysis indicated that mean levels of BMI，FPG and HbA1c of GA/AA genotype patients decreased more significantly than GG genotype patients（P<0.05）.Mean levels of BMI，FPG，2 hPG and HbA1c of GA/AA and GG genotype patients decreased significantly compared with those before treatment（P<0.05）.Additionally，of the 125 available specimens for CNR1 mRNA analysis，the mean mRNA expression of CNR1 in patients with GG genotype was significantly higher than that of GA/AA genotype patients（P<0.05）.The incidence of nausea and vomiting，hypoglycemia and overall adverse reactions according to genotypes status was not significantly different（P>0.05）.Conclusion Liraglutide is safe and effective in early-stage type 2 diabetes patients.And the clinical outcomes of the patients receiving liraglutide treatment may be influenced by CNR1 1260G>A GA/AA genotype through mediating the mRNA expression of CNR1.
【Key words】 Diabetes mellitus，type 2；Liraglutide；Cannabinoid receptor；Gene polymorphism；Treatment outcome
Actions of Osteocalcin in Glucose Metabolism and Influencing Factors in Elderly Patients with Type 2 Diabetes SU Xiaohui，LI Weixin*
No.2 Department of Geriatrics，the First Hospital of Lanzhou University，Lanzhou 730000，China
*Corresponding author: LI Weixin，Chief physician，Associate professor，Master supervisor；E-mail: email@example.com
【Abstract】 Background Osteocalcin，specifically synthesized and secreted by osteoblasts，is the most abundant non-collagen protein in the bone matrix.Osteocalcin plays a regulatory role in bone mineralization，but it has also been found to be closely involved in glycometabolism regulation by a growing number of studies.Objective To explore the actions of osteocalcin in glucose metabolism and influencing factors in elderly patients with type 2 diabetes mellitus（T2DM）.Methods In this study，a random sampling method was used to select 329 T2DM patients aged 60 and over who were hospitalized at the First Hospital of Lanzhou University from 2017 to 2018.Spearman rank correlation analysis was carried out to examine the associations of demographic factors（sex，age，BMI and course of T2DM） collected at admission with laboratory parameters such as serum homocysteine，uric acid，creatinine，25-hydroxyvitamin D，osteocalcin 〔less and greater than the median level of 11.73 μg/L were defined as low osteocalcin（n=165） and high osteocalcin（n=164），respectively〕，glycosylated hemoglobin（HbA1c），thyroid stimulating hormone（TSH），total thyroxine，plasma blood glucose（FPG），and 2-hour postprandial glucose
（2 hPG）.The results of a 3-hour 100 g OGTT and a 3-hour insulin response test were obtained，including venous plasma glucose levels and insulin levels measured at 0，30，60，120 and 180 min during the tests.Basal insulin sensitivity and secretion were assessed with HOMA-IR，and HOMA-β，respectively.Post-challenge insulin secretion was assessed with AUCINS120/AUCGLU120 ratio，namely，the ratio of insulin AUC（0-120 min） to glucose AUC（0-120 min）.Results Spearman rank correlation analysis showed that osteocalcin was negatively correlated with HbA1c，FPG，and 2 hPG，and positively correlated with TSH（P<0.05）.Compared with those with high osteocalcin，those with low osteocalcin showed lower average TSH level，but higher male ratio，higher average levels of FPG，2 hPG，HbA1c and HOMA-IR（P<0.05）.Osteocalcin did not vary significantly according to HOMA-β level and AUCINS120/AUCGLU120 ratio（P>0.05）.Among those with both T2DM and subclinical hypothyroidism（n=139），low osteocalcin was associated with higher HOMA-IR（P<0.05），but HbA1c，HOMA-β and AUCINS120/AUCGLU120 ratio showed no association with osteocalcin（P>0.05）.In those with normal thyroid function，low osteocalcin was associated with higher HbA1c and HOMA-IR（P<0.05），but HOMA-β and AUCINS120/AUCGLU120 ratio showed no association with osteocalcin（P>0.05）.Among the overweight cases（n=187），HbA1c，HOMA-IR，HOMA-β，and AUCINS120/AUCGLU120 ratio demonstrated no association with osteocalcin（P>0.05）.In non-overweight cases（n=142），low osteocalcin was associated with higher HOMA-IR（P<0.05），but HbA1c，HOMA-β and AUCINS120/AUCGLU120 ratio had no association with osteocalcin（P>0.05）.Conclusion Osteocalcin has a positive regulatory effect on insulin sensitivity and insulin secretion in elderly T2DM patients，which provides a basis for further research on osteocalcin-related hypoglycemic drugs.When combined with subclinical hypothyroidism or overweight，the effect of osteocalcin in regulating glucose metabolism is weakened，which suggests that the impact of subclinical hypothyroidism and overweight on insulin sensitivity should be considered seriously during clinical treatment.
【Key words】 Diabetes mellitus，type 2；Osteocalcin；Aged；Hypothyroidism；Overweight
Impact of Optimized Intravenous Thrombolysis Process on the Construction of Advanced Stroke Center in Primary Hospitals DING Xueping1*，YONG Xianyi1，REN Zhouming1，LE Tian1，MA Qianli1，ZHANG Xuyan1，YAO Wei1，LYU Lan1，CHEN Zhonghua1，YAO Juan1，SU Xuhong1，ZHANG Qi2，ZHANG Yongwei2，LIU Jianmin2
1.Department of Neurology，Haining People's Hospital，Haining 314400，China
2.Cerebrovascular Disease Center，Changhai Hospital，Shanghai 200433，China
*Corresponding author: DING Xueping，Associate chief physician；E-mail: firstname.lastname@example.org
【Abstract】 Background Acute ischemic stroke（AIS） is one of the main causes of death and disability in the adult population，and recovery from it is a major health concern worldwide.Although considerable progress has been made in developing effective prevention and treatment，substantial challenges remain to improve the quality of care.In particular，concern has focused on the speed of emergency response.Intravenous thrombolytic therapy，as the only treatment proven to improve the outcome，is accessible in only a minority of such patients.Objective To investigate the effects of optimized intravenous thrombolytic process on door-to-needle time（DNT）in AIS patients and on the construction of stroke center.Methods We enrolled 186 AIS patients with recombinant tissue-type plasminogen activator therapy from Department of Neurology，Haining People's Hospital，and divided them into conventional group（97 treated with conventional thrombolytic process from November 2015 to March 2018），and optimization group（89 treated with optimized thrombolytic process from April to November 2018）.General demographic data，onset-to-door time，door-to-CT time，door-to-laboratory time，DNT，onset-to-thrombolysis time，incidence of symptomatic cerebral hemorrhage，pre- and post-24 hour-thrombolysis and discharge NIHSS scores 〔functional improvement was defined as ΔNIHSS（the difference between post- and pre-treatment NIHSS score）≥4〕，and 3-month post-discharge modified Rankin Scale（mRS） score were obtained and compared between the two groups.Results The optimization group showed lower average admission NIHSS score（P<0.05）.Two groups had no significant differences in average onset-to-door time and discharge NIHSS score，incidence of symptomatic cerebral hemorrhage，and response rate（P>0.05）.The optimization group had lower average door-to-CT time，door-to-laboratory time，DNT，and onset-to-thrombosis time，and higher prevalence of DNT<60 min，as well as lower average 3-month post-discharge mRS score（P<0.05）.Conclusion The optimized intravenous thrombolytic process is worth promoting as it can effectively shorten DNT，and help to control DNT within 60 minutes，as well as improve the long-term prognosis，without increasing the risk of thrombolytic intracerebral hemorrhage.
【Key words】 Stroke；Brain infarction；Thrombolytic therapy；Prognosis；Stroke center
Three-dimensional Motion Analysis of Patients with Knee Osteoarthritis HUANG Ping1，WANG Yi2，CHEN Bo1，GUO Lei1，LIU Zhihong1，QI Jin1，DENG Lianfu1*
1.Shanghai Institute of Traumatology and Orthopaedics/Shanghai Key Laboratory for Prevention and Treatment of Bone and Joint Diseases with Integrated Traditional Chinese and Western Medicine/Ruijin Hospital，Shanghai Jiaotong University School of Medicine，Shanghai 200025，China
2.Shanghai Waterway Hospital，Shanghai 200082，China
*Corresponding author: DENG Lianfu，Researcher；E-mail: email@example.com
HUANG Ping and WANG Yi are co-first authors
【Abstract】 Background The changes of the knee joint deformation，activity limitation，and gait abnormalities in knee osteoarthritis（ KOA ） indicates that KOA is a disease closely related to the biomechanical factors such as kinematics and kinematic mechanics.At present，there is no clinical quantitative index for evaluating these parameters of kinematics and kinematic mechanics.Objective To analyze the condition of KOA patients by using the three-dimensional motion capture system in order to provide a new important reference for the development and implementation of the treatment and rehabilitation plan for clinicians.Methods Ten bilateral KOA patients and 10 healthy people without KOA were recruited from Ruijin Hospital，Shanghai Jiaotong University School of Medicine during October 2010 to June 2017.The KOA patients and the healthy people were tested for walking using the British VICON 3D motion capture system and the walking situation and the biomechanical characteristics（ kinematics，dynamics ） of the knee joint were analyzed.Results Compared with the healthy people，the KOA patients had the obvious gait and biomechanical characteristics，which showed the cadence，limp index，step length，stride length，and walking speed were shortened significantly，and the double support，single support，step time，and stride time were extended significantly（ P<0.05 ）.The knee flexion angle peak，the initial angle of the coronal knee joint，and the maximum range of motion of the knee joint in all three directions were decreased significantly（ P<0.05 ） ；the peak and average of knee joint angular velocity and knee joint angular acceleration were decreased significantly（ P<0.05 ） ；the knee joint extension torque peak were decreased significantly（ P<0.05 ）.The peak value of the floor reaction force in the Y-axis and Z-axis directions were decreased significantly（ P<0.05 ）.Conclusion The biomechanical environment in and around the joints of KOA patients has changed significantly，and abnormal lower limb movements have occurred at the same time.The three-dimensional gait analysis of KOA patients and normal people using VICON motion capture system is helpful to better understand the parameters of knee joint kinematics and kinematic mechanics，which provides an important reference for the diagnosis，treatment and research of KOA.
【Key words】 Osteoarthritis；Three-dimensional motion analysis；Knee osteoarthritis；Gait analysis；Kinematics；Motion mechanics
The Choice of Therapeutic Options for Coronary Heart Disease with End-stage Renal Disease ZHANG Yunting1，2，ZHENG Jingang1，2*
1.Graduate School of Peking Union Medical College，Chinese Academy of Medical Sciences，Beijing 100730，China
2.Department of Cardiology，China-Japan Friendship Hospital，Beijing 100029，China
*Corresponding author: ZHENG Jingang，Chief physician；E-mail: firstname.lastname@example.org
【Abstract】 Background There is a high risk of death in patients with coronary heart disease（CHD）combined with end-stage renal disease（ESRD）because of cardiovascular diseases.Most of the available studies exclude cases of this kind of special situation，because of the severe and complex coronary lesions and the small number of research cases.There are different viewpoints on the therapeutic options for patients with CHD and ESRD at present，while the best treatment decision is still inconclusive.Objective To explore the best treatment strategy for patients with CHD and ESRD.Methods A total of 100 patients with CHD and ESRD who were treated in China-Japan Friendship Hospital from 2012 to 2018 were selected as the research subjects.According to the results of coronary angiography combined with the judgments of cardiologists and cardiac surgeons and wishes of patients，these patients were divided into coronary artery bypass grafting（CABG） group（20 cases），percutaneous coronary intervention（PCI） group（44 cases） and drug treatment group（36 cases）.The incidence of complications，mortality rate，all-cause mortality rate，cardiogenic mortality rate，and the incidence of major adverse cardiovascular events（MACE） were compared among groups.Results The incidence of complications of patients in the CABG group，PCI group and drug treatment group during hospitalization were 15.0%（3/20），11.4%（5/44） and 11.1%（4/36），and the mortality rates were 15.0%（3/20），9.1%（4/44） and 8.3%（3/36）.The all-cause mortality rates during follow-up were 40.0%（8/20），36.4%（16/44） and 27.8%（10/36）.The cardiogenic mortality rates were 15.0%（3/20），27.3%（12/44）and 16.7%（6/36）.The incidence of MACE were 20.0%（4/20），36.4%（16/44） and 33.3%（12/36）.There was no significant difference among three groups（P>0.05）.Conclusion For patients with CHD and ESRD，revascularization therapy has no obvious advantage over drug treatment.
【Key words】 Coronary heart disease；End-stage renal disease；Coronary artery bypass，off-pump；Angioplasty，gasbag，coronary artery；Percutaneous coronary intervention；Therapy
Modeling Method and Validation Research of Partially Observable Markov Decision-making Process Model in the Optimization of Clinical Treatment for Unstable Angina Pectoris with Integrated Traditional Chinese and Western Medicine FENG Yan1，FENG Qi2，WANG Yixin1*，QIU Yu3，ZHOU Xuezhong2，XU Hao3
1.Department of General Practice，Beijing Anzhen Hospital，Capital Medical University，Beijing 100029，China
2.School of Computer and Information Technology，Beijing Jiaotong University，Beijing 100044，China
3.Department of Cardiology，Xiyuan Hospital，China Academy of Chinese Medical Sciences，Beijing 100091，China
*Corresponding author:WANG Yixin，Chief physician；E-mail:email@example.com
【Abstract】 Background Partially observable Markov decision-making process is a mathematical algorithm for solving sequential decision-making problems.It is often used in the dynamic optimization of complex treatment schemes in the medical field.Now it has been tried to be used in the optimization of clinical treatment for unstable angina pectoris.Objective To introduce in detail the modeling method of the optimized process of clinical treatment for unstable angina pectoris with integrated traditional Chinese and western medicine，and to preliminarily verify the reliability of the model.Methods A total of 111 060 structured medical records were collected from 2 212 patients with unstable angina pectoris from 2008 to 2010 in Xiyuan Hospital，Guang'anmen Hospital，China-Japan Friendship Hospital，Beijing Hospital of Traditional Chinese Medicine，Tongzhou District Hospital of Traditional Chinese Medicine，Dongzhimen Hospital，Huairou District Hospital of Traditional Chinese Medicine，and Peking University People's Hospital.Patients with unstable angina pectoris of Qi deficiency and blood stasis were randomly divided into the test group（n=732） and the verification group（n=732）.The core prescriptions of the optimal treatment scheme were obtained by observing Markov decision model in the test group.The patients eligible for the scheme in the verification group were selected as the optimization group，and those who did not conform to the scheme were selected as the control group.The blood stasis scores and the occurrence of long-term end-point events were compared to verify the clinical efficacy of the scheme.The primary end-point events included cardiovascular death，nonfatal myocardial infarction，revascularization，and secondary end-point events included stroke，readmission due to acute coronary syndrome，cardiac insufficiency，and other thrombotic complications.Results The decrease of blood stasis scores in Qi deficiency optimization group（n=152） and blood stasis optimization group（n=127） was （5.29±2.64） and （4.87±3.04）respectively，which were higher than those in the control group，with statistical significance（P<0.05）.Compared with the control group，the long-term end-point event rates of qi deficiency optimization group and blood stasis optimization group were 16.4%（25 / 152） and 12.6%（16 / 127），respectively，with no significant difference（P>0.05）.Conclusion Partially observable Markov decision-making process model can realize the optimization of clinical treatment for unstable angina pectoris with integrated traditional Chinese and western medicine.The model has been proved to be stable and reliable.It could be possible to provide more detailed and in-depth optimization programs for other diseases clinically.
【Key words】 Angina，unstable；Coronary heart disease；Partially observable Markov decision-making process；Modeling method；Validation
Safety and Efficacy of Home-based Negative Pressure Wound Therapy for Chronic Wounds JIANG Qixia1*，ZHOU Jihong2，DONG Shan3，NIU Niu4，PENG Qing1，HUANG Xiuling1
1.Outpatient Wound Care Center，Jinling Hospital，Nanjing University School of Medicine/General Hospital of Eastern Theater Command，PLA，Nanjing 210002，China
2.Burn and Plastic Surgery，Jinling Hospital，Nanjing University School of Medicine/General Hospital of Eastern Theater Command，PLA，Nanjing 210002，China
3.School of Nursing，Nanjing University of Chinese Medicine，Nanjing 210023，China
4.Colorectal Cancer Research Center，Jiangsu Cancer Hospital，Nanjing 210009，China
*Corresponding author:JIANG Qixia，Chief superintendent nurse，Master supervisor；E-mail:firstname.lastname@example.org
【Abstract】 Background Negative pressure wound therapy（NPWT），a globally recognized effective technology，is widely used in hospitals，communities and home-based settings at abroad，but is mainly used in hospitals in China.Studying whether this technique can be carried out safely and effectively in home-based settings facilitates the improvement of level and effect home-based NPWT for chronic wound patients in China.Objective To evaluate the safety and efficacy of home-based NPWT for chronic wounds，providing a basis for the use of this technology in home-based settings.Methods This non-randomized control study was conducted among 128 patients with chronic wounds who were enrolled from January 2015 to December 2018.By patient subjective choice of care，they were divided into the control group（n=62） and the intervention group（n=66） treated with a 14-consecutive-day NPWT delivered in the wound care clinic，and delivered in home-based settings，respectively，then a 3-month follow-up treatment with standardized moist wound healing therapy.The safety was evaluated by adverse events occurred during treatment，including wound bleeding，skin immersion，air leakage alarm and moisture-associated skin damage（MASD），and outcome was evaluated by post-14-day treatment positive rate of bacteria，wound area，and rate of reduction in wound depth，and healing rate and healing time a the end of follow-up treatment.Results Altogether，57 receiving outpatient-based NPWT and 65 receiving home-based NPWT who completed the treatment were included in the finally analysis，after excluding 6 dropouts〔5（8.1%） in the control group and 1（1.5%） intervention group with no intergroup difference in dropout rate，P>0.05〕．There were no significant differences between the two groups in the frequency of skin immersion，air leakage alarm and the incidence of MASD（P>0.05）.The intervention group and control group showed similar mean overall NPWT time 〔（18.4±7.9） d vs（17.5±7.6） d〕（P>0.05）.The rate of post-14-day-treatment wound area reduction in the intervention group was higher than that of the control group〔（49.4±22.1）% vs （33.4±20.2）%，P<0.05〕.No wound bleeding occurred during treatment.The wound healing rate of the intervention group and the control group were 81.5%（53/65） and 54.4%（31/57），respectively（P<0.05）.The mean healing time of the former was shorter than that of the latter 〔（51.7±16.9）d vs（61.9±17.1）d，
P<0.05〕．Conclusion The home-based NPWT showed high safety and treatment effect in out study，which may be contributive to the wound outcome，and may be used for home care of chronic wounds.
【Key words】 Negative pressure wound therapy；Chronic wounds；Wound infection；Home care；Wound healing
Sources of Management Burden and Solutions among Primary Family Caregivers of the Alzheimer's Disease Patient: a Qualitative Study CHEN Yuanyuan，SHEN Qin*，YANG Lili，CHEN Chuyuan，SUN Junfei
School of Nursing，Zhejiang Chinese Medical University，Hangzhou 310051，China
*Corresponding author：SHEN Qin，Associate professor；E-mail：email@example.com
【Abstract】 Background Alzheimer's disease is commonly seen in older people in China，in particular，its prevalence reaches 5.14% in those aged over 65 years，bringing huge management burden to primary family caregivers of the patient.It has received extensive attention worldwide.Objective To investigate the sources of management burden and major solutions among primary family caregivers of the Alzheimer's disease patient，providing a basis for further development of the family management system for such patients.Methods By use of purposive sampling，the primary family caregivers of 12 re-examined outpatients with Alzheimer's disease were recruited from Hangzhou Seventh People's Hospital and Zhejiang Provincial Hospital of TCM from September to December 2018 were recruited，and were interviewed intensively using a phenomenological approach.Colaizzi's seven-step analysis was performed to analyze the interview results.Results Five subthemes of management burden sources of the primary family caregivers for the Alzheimer's disease patient were summarized as follows: lack of sufficient care knowledge to cope with the patient's complex conditions，social burden，emotional burden，physical burden and unappreciated care.For the solutions to the management burden，two themes of caregiver self-management strategies and patient family management strategies with six subthemes such as rational acceptance and active accommodation and so on arose.Conclusion Medical professionals and others need to provide effective emotional support and adequate care knowledge for primary family caregivers for the Alzheimer's disease patient to help them form effective family management strategies.At the same time，the diversified long-term care system should be improved to reduce the burden of care.
【Key words】 Alzheimer disease；Foster home care；Primary family carers；Cost of illness；Disease management；Qualitative analysis
Multiple Medication Experience of Elderly Patients with Multimobidity at Home：a Qualitative Study WANG Yongli，LUAN Wenyan，GUO Yawen，LIN Beilei，QI Bei，ZHANG Zhenxiang*
School of Nursing and Health，Zhengzhou University，Zhengzhou 450001，China
*Corresponding author：ZHANG Zhenxiang，Professor，Doctoral supervisor；E-mail：firstname.lastname@example.org
【Abstract】 Background The polypharmacy in elderly patients with multimobidity has become a serious problem in recent years，which greatly reduces patient's quality of life.Paying attention to patient's medication experience is the key factor to alleviate their medication problems.The study of multiple medication experience of elderly patients with multimobidity at home can provide a new perspective to solve their medication problems.Objective To explore the multiple medication experience of elderly patients with multimobidity at home and its influencing factors，in order to provide basis for the formulation of effective intervention programs.Methods Three community health service centers were selected from two urban districts（Gaoxin District and Jinshui District） of Zhengzhou City by convenient sampling method.Each community health service center selected four to five elderly patients with multimobidity and polypharmacy，and finally 14 patients were included in the study.Semi-structured and in-depth interviews were conducted to interview 14 participants from May to August in 2019.The main contents of the interview included the effect of polypharmacy on patient's life，the current situation and problems of medication management and how to solve them，and what kind of help was hoped for in the course of polypharmacy.The interview data were sorted out and analyzed to refine the main topics.Results Through the analysis of the interview data，six themes were extracted：a large demand of knowledge related to medication，heavy economic pressure，poor practice of medication management，changes in emotional cognition，obstacles to daily life，and the lack of family support.Conclusion The multiple medication experience of the elderly patients with multimobidity at home is not optimistic，and health care institutions at all levels should pay attention to this phenomenon.The health education of drugs commonly used for chronic diseases should be strengthened to improve the level of drug literacy among the whole people.The training and management mechanism of clinical pharmacists and general practitioners should be standardized to improve the medical insurance system for chronic diseases.Attention should be paid to patient's psychological feelings so as to strengthen the role of family and social support，in order to improve patient's medication experience and quality of life.
【Key words】 Aged；Chronic disease；Multimorbidity；Polypharmacy；Medication experience
Influence of Healthcare Workers on Influenza Vaccination among Elderly People in Beijing：Qualitative Study YAO Xi1，YU Mengke1，WU Jiang2，LYU Min2，XIE Zheng1*
1.School of Public Health，Peking University，Beijing 100191，China
2.Beijing Center for Diseases Prevention and Control，Beijing Research Center for Preventive Medicine，Beijing 100013，China
*Corresponding author: XIE Zheng，Associate professor；E-mail: email@example.com
【Abstract】 Background Influenza vaccination is effective to protect the elderly from influenza and its complications.The healthcare worker is one of the most important information sources for the elderly to acquire knowledge of influenza and influenza vaccine，so their behaviors and perception affect the influenza vaccination of the elderly.Objective To understand the knowledge，attitude and practice of healthcare workers on influenza，influenza vaccine and related free policies，and to explore the influence of healthcare workers on influenza vaccination among the elderly in Beijing.Methods The data were collected and analyzed using the Excel thematic framework method through depth interviews with 21 healthcare workers in primary community health service centers and township health centers in Beijing in January 2017.Results The knowledge of healthcare workers on the influenza and its vaccine was uneven，and most of them were not vaccinated.Departments were lack of cooperative propaganda，and combined publicity of influenza vaccine and chronic disease management had little effect.Healthcare workers tended to be conservative on influenza vaccination among elderly people.Conclusion Healthcare workers will affect influenza vaccination among elderly people.Strengthening related training of influenza and its vaccine among healthcare workers and enhancing their confidence in influenza vaccine will help the influenza vaccination work develop smoothly and promote the vaccination rate of the elder population.
【Key words】 Influenza vaccines；Influenza，human；Medical staff；Aged；Vaccination；Qualitative research