July 2020, Volume 23，No20 Abstracts
Author：尹鹏 Source：CGP Published： [07-01] views： 14
Time Interval from Onset to First Hospital Admission in Patients with Acute Aortic Dissection XIAO Yaru，HUANG Sufang*，YAN Li，DENG Juan，HE Mei，LI Miqi，ZHOU Quan
Department of Emergency，Tongji Hospital，Tongji Medical College，Huazhong University of Science & Technology，Wuhan 430030，China
*Corresponding author：HUANG Sufang，Chief superintendent nurse；E-mail：email@example.com
【Abstract】 Background Acute aortic dissection（AAD） is characterized by acute onset and rapid progress.Some patients die before reaching hospital.But available studies concerning time interval from onset of AAD to hospital admission are rare.Objective This study aimed to explore the time interval from onset of AAD to first hospital admission and associated factors in AAD patients，providing theoretical support for shortening prehospital time to timely obtain hospital care in such patients.Methods A total of 173 patients with AAD from department of cardiac macrovascular surgery of a grade A tertiary hospital，Wuhan were enrolled during March to November，2018.A self-developed questionnaire named Prehospital Time in Acute Aortic Dissection Patients was used to survey the patients to collect demographics，AAD-related factors and factors possibly associated with prehospital time.Multiple linear regression analysis was used to determine the factors associated with prehospital time.Results The survey obtained a response rate of 86.50%（173/200）.The prehospital time in the 173 respondents was 12-20 350 minutes〔averaged 70.0（36.5，150.0）〕 minutes.The prehospital time varied significantly according to education level，monthly income，prevalence of independent living，time required to access to the nearest medical institution from home，history of past illness（i.e.gastric disease），smoking and drinking prevalence，onset symptoms （chest or back pain，profuse sweating，dyspnea），level of pain at onset，prevalence of persistent pain at onset，history of symptoms similar to onset symptoms，perceptions of AAD，onset time，what is being done at the onset time，bystander response，self-perceived severity of disease，means of admission（by dialing 120 to call an ambulance，going to the hospital by oneself or under the help of others，by calling for help，seeking hospital care due to other diseases），and prehospital interventions（try to rest or relax，bearing the suffering till symptom relief，medication） （P<0.05）.Multiple linear regression analysis showed that education level，time required to access to the nearest medical institution from home，prevalence of persistent pain at onset，bystander response，self-perceived severity of disease，going to the hospital by taxi，and seeking hospital care due to other diseases were associated with the prehospital time（P<0.05）.Conclusion Higher education level was associated with shorter time used to access to the nearest medical institution from home.Higher self-perceived severity of disease was associated with shorter prehospital time.Moreover，having persistent pain at the onset，positive response of the bystanders，and dialing 120 to call an ambulance were associated with shorter prehospital time.However，seeking hospital care due to other diseases was associated with longer prehospital time.In view of this，to shorten the prehospital time to timely obtain hospital care，public perceptions and vigilance consciousness of AAD need to be improved，active interventions should be taken after the onset，and dialing 120 to call an ambulance is recommended.
Advances in Delayed Diagnosis of Aortic Dissection XIAO Yaru，HUANG Sufang*，YAN Li，LI Miqi，ZHOU Quan
Department of Emergency，Tongji Hospital，Tongji Medical College，Huazhong University of Science & Technology，Wuhan 430030，China
*Corresponding author：HUANG Sufang，Chief superintendent nurse；E-mail：firstname.lastname@example.org
【Abstract】 The initial symptoms of aortic dissection are diverse，and the rate of misdiagnosis and missed diagnosis is high.Moreover，timely diagnosis is crucial for prognosis of aortic dissection.The article summarizes the time of diagnosis of aortic dissection，and summarizes the factors affecting the delayed diagnosis of aortic dissection from demographic factors，past medical history，clinical features or signs，and related examinations，show that gender，geographical difference，referral，admission mode，previous history (history of cardiac surgery，history of aortic dissection)，clinical manifestations or signs (typical clinical manifestations or signs，atypical manifestations or signs (no pain，abdominal pain，pleural effusion，dyspnea，etc.)，relevant examination (positive cardiac troponin，abnormal ECG，no mediastinal widening in chest X-ray examination，diagnostic examination number of inspections) are the main influencing factor，in order to provide a theoretical basis for clinicians to quickly identify aortic dissection.At the same time，in the clinical nursing work，it is important to the initial triage of the aortic dissection and the observation of the condition during the observation period.
【Key words】 Aortic diseases；Aortic dissection；Delayed diagnosis；Review
Association of Comorbidity Burden with Complications after Thoracoscopic Lobectomy in Early-stage Non-small Cell Lung Cancer:a Propensity-matched Analysis LYU Yajun，HUANG Yanhong，ZHANG Jiurong*
Changzhou Wujin People's Hospital，Changzhou 213000，China
*Corresponding author:ZHANG Jiurong，Chief physician；E-mail:email@example.com
【Abstract】 Background Thoracoscopic lobectomy can significantly improve the post-surgical prognosis in patients with lung cancer，but it remains controversial that comorbidity burden increases the incidence of complications after thoracoscopic lobectomy.Objective To examine the association of comorbidity burden with the incidence of complications in early-stage non-small cell lung cancer（NSCLC） after thoracoscopic lobectomy.Methods From 2010 to 2017，512 patients with early-stage NSCLC who underwent thoracoscopic lobectomy or segmentectomy in Changzhou Wujin People's Hospital were selected and divided into high and low comorbidity burden 〔Charlson Comorbidity Index （CCI） score ≥3 and < 3，respectively〕 groups.Propensity score was used to control the confounders.A generalized linear mixed model was used to analyze the association of high comorbidity burden with the incidence of postoperative complications.Results High comorbidity burden group〔37.7%（193/512）〕 showed no significantly different incidence of post-surgical death，pulmonary，cardiovascular and other complications as well as overall incidence of postoperative complications compared with low comorbidity burden group〔62.3% （319/512）〕 （P>0.05）.After a propensity score-matched analysis，each group included 193 patients，showing no significant intergroup differences in the incidence of postoperative death，pulmonary，cardiovascular and other complications，as well as the overall incidence of complications （P>0.05）.In the generalized linear mixed model，high comorbidity burden had no significant association with postoperative complications（P>0.05）.Conclusion Thoracoscopic lobectomy may reduce postoperative mortality in early-stage NSCLC patients with multiple comorbidities.Moreover，it may also reduce the possibility of having complications to a certain extent.High comorbidity burden was not related to the incidence of complications after thoracoscopic lobectomy.
【Key words】 Carcinoma，non-small-cell lung；Thoracoscopic lobectomy；Comorbidity；Charlson comorbidity index；Propensity score
Influencing Factors of Primary Healthcare Practitioners' Perception and Barriers of Climate Change Response：Analysis Based on Random Forest Model WANG Ruixin，YANG Lianping*，GU Debin，WANG Jiamin，CHEN Shaoxian，HUANG Cunrui
School of Public Health，Sun Yat-sen University，Guangzhou 510080，China
*Corresponding author:YANG Lianping，Lecturer，Master supervisor；E-mail:firstname.lastname@example.org
【Abstract】 Background Some studies have pointed out the important role of primary health care in climate change adaptation from a theoretical perspective.However，it is still unclear how the primary health care system in China is currently responding to health risks due to climate change，and what factors affect the perceptions，the support proposed measures and barriers of primary healthcare practitioners in coping with these health risks.Objective To understand the current perceptions，the support proposed measures and barriers of primary healthcare practitioners in coping with health risks due to climate change，explore the influencing factors and conduct an importance evaluation.Methods A stratified cluster sampling method was used to conduct a cross-sectional survey among 733 primary healthcare practitioners from 3 prefecture-level cities based on the regional per capita GDP of Guangdong Province in 2017.A self-designed questionnaire was used to investigate their perceptions to deal with health risks due to climate change，their support for proposed measures to address heatwaves and dengue fever，and barriers in response to climate change.The random forest model was used to analyze the importance of influencing factors.Results The average score of primary healthcare practitioners in the willingness of responding to the health risks due to climate change，was（15.4±3.5）points，of which the average score of concern on vulnerable groups was the highest〔（3.2±0.7）points〕.The support for heatwave response measures's average score（15.7±3.2）points，which the average score of support for protection of high-risk groups was the highest〔（3.2±0.7）points〕.The support for dengue response measures's average score（22.7±4.3）points，which the average score of mosquito control was the highest 〔（3.3±0.7）points〕.Barriers perceived in climate change response，with an average score of（4.9±2.5）points，of which insufficient funds 〔（0.7±0.5）points〕 and the difficulty of setting climate change response as institutional priorities 〔（0.7±0.5）points〕 were major barriers perceived by primary healthcare practitioners.The analysis results of the random forest model showed that education and working area were important factors affecting primary healthcare practitioners' willingness to deal with health risks due to climate change；education and household income per capita were important factors affecting the support for proposed measures to address heatwaves and dengue fever，while seniority and working area were important factors affecting barriers perceived in health risks due to climate change response.Conclusion Primary healthcare practitioners have a generally high willingness to deal with health risks due to climate change and support proposed measures.The lack of funds and the difficulty of setting health risks due to climate change response as institutional priorities are major barriers perceived.Education，working area，income and seniority are important factors affecting the response to health risks due to climate change.
【Key words】 Primary care；Healthcare practitioner；Climate change；Health risk；Health response；Root cause analysis
Schizophrenia Stigma and Mental Disability:Moderated Mediation Analysis MAO Yingying1，WANG Weiliang1，LI Ci1，LIU Dan2，ZHOU Yuqiu1，LYU Yumei1*
1.Nursing School of Harbin Medical University（Daqing），Daqing 163319，China
2.Harbin BaiYuPao Psychiatric Hospital，Harbin 150000，China
*Corresponding author：LYU Yumei，Associate professor；E-mail：email@example.com
【Abstract】 Background Stigma is one of the important factors that cause mental disability in patients with schizophrenia.Previous studies have shown that stigma and hope are significantly correlated with mental disability of resilience，but the interaction mechanism between these factors is not yet clear.Objective To explore the relationships among appearance comparison on stigma，mental disability，hope and resilience in schizophrenia.Methods In Harbin BaiYuPao Psychiatric Hospital and the Third Hospital of Daqing，patients with schizophrenia were selected from September to December 2018 by convenient sampling method.WHO-DASⅡ，Internalized Stigma of Mental Illness Scale，Schizophrenia Hope Scale，Connor-Davidson Resilience Scale were used in this survey.Results A total of 310 questionnaires were sent out and 304 valid questionnaires were returned，with valid response rate of 98.06%.Moderated mediation effect analysis suggested that，stigma positively predicted mental disability（P<0.01）.Both stigma and hope significant predicted mental disability（P<0.01）；and stigma significant predicted hope（P<0.01），hope affect partially mediated the relationship between stigma and mental disability.The product term of hope and resilience significant predicted mental disability（P<0.01），the mediating effect of hope was moderated by resilience.Conclusion The stigma of schizophrenia not only has a mediated effect through hope but also a moderated effect through resilience on mental disability.
【Key words】 Schizophrenia；Mentally handicapped；Hope；Resilience；Stigma；Mediating effect；Predictive function
Correlation between Drinking Behavior and PANSS Score in Schizophrenic Patients before and after Onset WANG Weidong1，2，LIU Huanzhong2，LI Wenzheng3，YAO Xianhu4，XIA Lei2，ZHONG Yi2，ZHANG Zhihua1*
1.Department of Epidemiology and Biostatistics，School of Public Health，Anhui Medical University，Hefei 230032，China
2.Chaohu Affiliated Hospital of Anhui Medical University/Psychiatry Center of Anhui Province，Chaohu 238000，China
3.Department of Psychiatry，Hefei Fourth People's Hospital，Hefei 230022，China
4.Department of Psychiatry，Maanshan Fourth People's Hospital，Maanshan 243000，China
*Corresponding author：ZHANG Zhihua，Associate professor；Email：Zhzhh2002@sina.com
【Abstract】 Background Schizophrenia is a serious neuropsychiatric syndrome with various mental disorders involving perception，emotion，thought，behavior and so on.The Positive and Negative Syndrome Scale（PANSS） is a common，highly reliable and effective tool for assessing the symptoms of schizophrenia.Foreign studies have found that drinking behaviors are associated with PANSS score in schizophrenic patients.However，in China，such studies are rare，especially the influence of alcohol consumption before and after the onset of schizophrenia on PANSS score are even rarer.Objective To determine the correlation between drinking behavior and PANSS score in schizophrenic patients before and after the onset of schizophrenia.Methods A total of 332 inpatients with schizophrenia were recruited from Chaohu Affiliated Hospital of Anhui Medical University，Hefei Fourth People's Hospital and Maanshan Fourth People's Hospital from May 2018 to December 2018.A questionnaire survey was used to collect their clinical data，including sex，age，education level，marital status，household monthly income，course of disease，BMI，smoking，exercise，length of stay，prevalence of hypertension and diabetes，and pharmacological treatment.Drinking behaviors were also surveyed，and 247 never drank before and after the onset of schizophrenia，32 only drank before the onset of schizophrenia，and 53 drank before and after the onset of schizophrenia，were assigned to groups Ⅰ，Ⅱ，Ⅲ，respectively.PANSS was used to measure the severity of clinical mental symptoms.Multiple linear regression was used to analyze the relationship between drinking behaviors and PANSS score.Results Sex ratio and prevalence of smoking differed significantly across the three groups （P<0.05），but mean age，distributions of education level，marital status，household monthly income，course of schizophrenia，BMI，physical exercise，and length of stay，prevalence of diabetes and pharmacological treatment did not（P>0.05）.Multiple linear regression analysis showed that drinking before and after the onset of schizophrenia was associated with PANSS positive score〔β=4.700，95%CI（2.469，6.931）〕，PANSS general psychopathology score 〔β=6.308，95%CI（2.371，10.245）〕and PANSS total score〔β=12.893，95%CI（5.519，20.266）〕（P<0.05）.Conclusion This study demonstrated that sustained alcohol consumption before and after the onset of schizophrenia was associated with increased PANSS scores.Timely quitting alcohol after first episode of schizophrenia is beneficial to control clinical symptoms.
【Key words】 Schizophrenia；Drinking；Positive and negative syndrome scale；PANSS score；Alcohol；Correlation analysis；Root cause analysis
Risk Factors for Early Respiratory Complications after Acute Traumatic Cervical Spinal Cord Injury WANG Rong，MA Xinwen，YANG Tao，LIU Yanlu，HU Wei，DONG Zhenyu，HUANG Yifei*
The Affiliated Hospital of Traditional Chinese Medicine of Xinjiang Medical University，Urumqi 830000，China
*Corresponding author：HUANG Yifei，Chief physician，Professor；E-mail:firstname.lastname@example.org
【Abstract】 Background Acute traumatic cervical spinal cord injury（TCSCI） can lead to diaphragmatic paralysis，impairing the breathing exercises.Such patients need surgical treatment to reduce the incidence of respiratory complications and improve prognosis.However，the risk factors for respiratory complications within 1 week after acute TCSCI have been rarely studied.Objective To assess the risk factors for respiratory complications occurred within 1 week after acute TCSCI.Methods Participants were 74 cases of acute TCSCI who received treatment in the Affiliated Hospital of Traditional Chinese Medicine of Xinjiang Medical University during November 2016 to July 2018 and a 3-month follow-up，including 43 with respiratory complications within 1 week after acute TCSCI（disease group），and 31 without（control group）.A retrospective analysis was performed on their data about sex，age，BMI，history of smoking，comorbidities（hypertension，diabetes），pathogeny，level of spinal cord injury and ASIA motor score evaluated by the ASIA Impairment Scale，prevalence of injury，anatomic level of injury，Injury Severity Score（ISS），Clinical Pulmonary Infection Score（CPIS），treatment regimen，surgical approach and duration，length of stay，and prevalence of dropout.Multivariate Logistic regression model was used to analyze the variables possibly associated with respiratory complications after acute TCSCI.Results Of the 43 cases（58.1%） with respiratory complications，5 had pneumonia，1 had pulmonary edema，and 37 had mechanical ventilation.Mechanical ventilation was performed preoperatively in 31 cases（21 cases via endotracheal tube，and 10 via tracheotomy）.The disease group had higher prevalence of complete spinal cord injury，higher prevalence of coexisted injuries，lower mean ASIA motor score，higher mean ISS and CPIS，and higher rate of having surgery using a posterior approach，as well as longer mean length of stay compared with the control group（P<0.05）.Multivariate Logistic regression analysis the level of spinal cord injury 〔OR=3.290，95%CI（1.214，6.862）〕，AMS score〔OR=2.430，95%CI（1.103，5.436）〕，CPIS〔OR=1.235，95%CI（1.036，3.264）〕，and surgical approach〔OR=1.225，95%CI（1.033，3.106）〕 were independent factors associated with for respiratory complications within 1 week after acute TCSCI（P<0.05）.Conclusion The level of spinal cord injury and ASIA motor score evaluated by the ASIA Impairment Scale，CPIS and surgical approach are independent factors predicting respiratory complications after acute TCSCI.Early enhanced respiratory management and active mechanical ventilation should be given to those with complete spinal cord injury，higher AMS or CPIS，and having the surgery via a posterior approach.
【Key words】 Traumatic cervical spinal cord injury；Respiratory complications；Injury Severity Score；Clinical pulmonary infection score；Risk factors；Root cause analysis
Prognostic Value of Serum Cell Adhesion Molecules in Septic Acute Kidney Injury JIANG Wei1，ZHANG Jianfeng2，LI Shanfeng1，JIANG Daishan1，HUANG Zhongwei1*
1.Department of Emergency，Affiliated Hospital of Nantong University，Nantong 226001，China
2.Department of Gastroenterology，Affiliated Hospital of Nantong University，Nantong 226001，China
*Corresponding author：HUANG Zhongwei，Chief physician；E-mail：email@example.com
【Abstract】 Background Cell adhesion molecules are biomarkers of organ dysfunction caused by acute severe sepsis（such as kidney injury），but it is not clear whether serum cell adhesion molecules have clinical value in the prediction of acute kidney injury（AKI） in sepsis.Objective To study the predictive value of serum cell adhesion molecules for AKI in sepsis.Methods From January 2016 to December 2017，84 patients with sepsis from the EICU，Affiliated Hospital of Nantong University were enrolled，and were divided into AKI group and non-AKI group（AKI was identified by the relevant diagnostic criteria）.The clinical data were collected within 24 hours after admission，and the Acute Physiology and Chronic Health Evaluation（APACHE）Ⅱ score，sequential organ failure assessment（SOFA），and Charlson comorbidity index（CCI） were calculated.The inflammatory indices such as C-reactive protein（CRP），procalcitonin（PCT），lactate（LAC） and the levels of serum cell adhesion molecule-1（ICAM-1），vascular cell adhesion molecule-1（VCAM-1），platelet selectin（p-selecin），endothelial selectin（E-selectin） were measured.Pearson correlation analysis was used to analyze the relationships of inflammatory indices，serum cell adhesion molecule with AKI severity.ROC curve analysis was used to evaluate the relationships of inflammatory indices，and serum cell adhesion molecule with AKI prognosis.Results The incidence of shock，the proportion of receiving mechanical ventilation，mean APACHE Ⅱ score，SOFA score，Scr，LAC，ICAM-1，VCAM-1 and E-selectin in AKI group were higher than those in non-AKI group（P<0.05）.Pearson correlation analysis showed that E-selectin was positively correlated with Scr（r=0.223，P=0.041）.For predicting septic AKI，the area under the ROC curve（AUC） of CRP，PCT，LAC，ICAM-1，VCAM-1 and E-selectin was 0.523〔95%CI（0.421，0.687）〕，0.637〔95%CI
〔95%CI（0.623，0.871）〕，respectively，among which the predictive value of E-selectin was the largest，with a predictive value of 117.2 μg/L（79.8% sensitivity and 71.0% specificity）.Conclusion The mortality of patients with septic AKI is higher than that of patients with sepsis.E-selectin is related to the severity of AKI，which may be an important clinical marker for predicting AKI in sepsis.
【Key words】 Sepsis；Acute kidney injury；Cell adhesion molecules；Predictive value；Inflammatory markers；Sensitivity；Specificity
Factors Associated with Treat-to-target Therapies Effect for Gout PANG Yubing1，WANG Hui2，ZHANG Minmin2，WEI Hua2，SHEN Weigan3，ZHANG Yu2，3*
1.Affiliated Hospital of Yangzhou University，Yangzhou 225000，China
2.Northern Jiangsu People's Hospital，Affiliated Hospital to Yangzhou University，Yangzhou 225001，China
3.Yangzhou University Medical College，Yangzhou 225009，China
*Corresponding author：ZHANG Yu，Professor；E-mail：firstname.lastname@example.org
【Abstract】 Background Gout is a common crystal-induced arthritis.Although treat-to-target therapies for gout have been reported in many recent studies，the effectiveness of such therapies in China is not satisfactory.Objective To explore the prevalence and associated factors of achieving target uric acid（UA）level in gout patients.Methods 113 patients with a clinical diagnosis of gout were randomly sampled from Northern Jiangsu People's Hospital，Affiliated Hospital to Yangzhou University from September 2016 to January 2019，and all patients received 6 months of gout treatment up to standard.The clinical data were collected by questionnaire，and the patients were examined in laboratory and imaging.According to the UA standard of patients after treatment，the patients were divided into compliance group and non compliance group.Multiple Logistic regression analysis was used to explore the influencing factors of UA standard of gout patients.Results Out of 113 patients，105 completed the survey.The rate of achieving target UA was 65.7%（69/105）.Both the UA level and urate crystal deposition decreased after treatment（P<0.05）.Those who achieved target UA level had higher rates of normal BMI，no tophus and no hyperlipidemia，disease duration greater than 5 years，increased / similar drinking volume，no less than 2 000 ml of drinking water，exercising less than 5 times a week，and normal liver function compared with those who did not（P<0.05）.Multivariate Logistic regression analysis showed that abnormal liver functions（OR=9.641），increased / similar drinking volume（OR=13.970），no less than 2 000 ml of drinking water（OR=0.189）and exercise frequency greater than 5 times a week is not less than five times a week（OR=3.421）were associated with the rate of achieving target UA level（P<0.05），while different uric acid-lowering drug therapies were not associated with it（χ2=1.357，P=0.716）.Conclusion The treat-to-target therapy can significantly reduce the content of urate crystal in the gouty joints and surrounding tissues.Abnormal liver function，increased / similar drinking volume，and exercising 5 or more times a week are independent factors associated with decreased effectiveness of treat-to-target therapy while no less than 2 000 ml of drinking water is associated with increased effectiveness of treat-to-target therapy.
【Key words】 Gout；Treat to target；Root cause analysis；Uric acid
Human Brucellosis in Chengde District from 2010 to 2018：Clinical Analysis of 340 Cases MIAO Guangxin1，GAO Jian2*，ZHANG Kexin1，WANG Lina1，LIU Jinxia1*
1.Chengde Medical University，Chengde 067000，China
2.Department of Infectious Diseases，the Third Hospital of Chengde，Chengde 067000，China
*Corresponding authors：GAO Jian，Associate chief physician；E-mail：email@example.com
【Abstract】 Background Brucellosis belongs to the category B infectious disease which seriously endangers the public health safety in China's law on the prevention and control of infectious diseases.It has a high incidence rate，wide distribution，long duration and complex clinical manifestations.Therefore，the clinical diagnosis is difficult，the misdiagnosis rate，recurrence rate and disability rate are high，so it is necessary for clinicians to make early diagnosis and correctly select the type and course of antibiotics.Objective To investigate epidemiology，clinical characteristics，laboratory examination，use of antibiotics，prognosis and recurrence in patients with brucellosis in Chengde，in order to provide guidance for the diagnosis and treatment of brucellosis.Methods The demographic data，epidemiological data，clinical characteristics，laboratory results，treatment programs and prognosis of 340 patients suffering from brucellosis from the Third Hospital of Chengde from January 2010 to August 2018 were analyzed retrospectively.Meanwhile，100 blood samples of health examinees were collected during the same period.Results Among the 340 cases，322（94.7%） had a definite history of contacting with infected sheep，and other 18（5.3%） had not.Higher rates of infecting with brucellosis were found in those raising cattle and sheep（59.2%），contacting with aborted or decreased cattle and sheep（20.5%），and engaging in slaughtering and fur processing（5.1%）.Main symptoms and signs included fever（81.5%），fatigue（71.5%），and joint pain，low back pain and leg pain（65.3%）.Compared with the control group，patients with brucellosis had lower mean white blood cell count，and neutrophil count and higher mean procalcitonin and C-reactive protein（P<0.05）.There are seven options that can be adopted for the treatment of brucellosis.Specifically，options 1，2，3，4，5，6，7 were used in 157，141，36，3，2，1，0，cases，respectively.The overall cure rate was 94.7%（322/340）.The cure rates for the used 6 options were 96.2%（151/157），95.0%（134/141），86.1%（31/36），100%，100%，100%，respectively.Option 1 achieved higher cure rate than option 3（χ2=4.92，P=0.026）.There were no significant difference in terms of cure rate between options 1 and 2（χ2=0.38，P=0.53），and between options 2 and 3（ χ2=3.09，P=0.08）.The adverse reactions of option 1 were liver injury〔5.1%（8/157）〕，gastrointestinal reactions 〔7.6%（12/157）〕 and agranulocytosis〔1.3%（2/157）〕.And those of option 2 were liver injury〔3.5%（5/141）〕，gastrointestinal reactions 〔4.3%（6/141）〕 and agranulocytosis〔0.7%（1/141）〕.Option 3 yielded adverse reactions such as liver injury〔5.6%（2/36）〕 and gastrointestinal reactions 〔8.3%（3/36）〕.Options 1，2，and 3 had no significant difference in the incidence of adverse reactions（χ2=2.22，P=0.14）.Conclusion The diagnosis of brucellosis depends on epidemiological data（history of contacting with infected cattle and sheep and so on），complicated and diverse clinical manifestations，and specific laboratory examinations.However，due to lack of typical clinical features，involving various organ systems and yielding many complications，clinicians should increase their understanding of this disease.There are 7 therapeutic schemes for brucellosis，which can be selected according to the specific situation of patients.
【Key words】 Brucellosis；Epidemiology；Clinical characteristics；Analysis of curative effect；Prognosis
Effect of Ultrasound-detected Improvement in Synovitis in Evaluating Clinical Response to Tumor Necrosis Factor Inhibitor in Rheumatoid Arthritis Patients XIE Lihu，OU Daming*
Department of Rheumatology and Immunology，the First Affiliated Hospital of University of South China，Hengyang 421001，China
*Corresponding author：OU Daming，Associate chief physician；E-mail：firstname.lastname@example.org
【Abstract】 Background Exploring the factors influencing the efficacy of tumor necrosis factor （TNF） inhibitors in the treatment of rheumatoid arthritis （RA） can help to develop individualized treatment strategies and improve the efficiency of RA treatment.Synovitis status detected by ultrasound，a low-cost and easy-to-operate imaging method，may evaluate the joint damage from RA.Objective This study aimed to evaluate the value of ultrasound-detected improvement in synovitis in predicting the clinical response to TNF inhibitor therapy in RA patients.Methods 80 active RA patients from the First Affiliated Hospital of University of South China were consecutively enrolled from January 2015 to June 2017，and received TNF inhibitor therapy （etanercept 25 mg administered twice a week by subcutaneous injection） for 24 weeks.28 joints （bilateral shoulder joints，wrist joints，elbow joints，knee joints，1-5 metacarpophalangeal joints and 1-5 proximal interphalangeal joints） of RA patients were examined by ultrasound at baseline，4，12，and 24 weeks after treatment，and the number of synovitis joints measured at each time was recorded.The clinical response was assessed at different time points after initiation of treatment by DAS28-ESR score.Results The number of ultrasound-detected synovitis joints was positively correlated with TJC （r=0.452，P<0.001），SJC （r=0.454，P<0.001），and DAS28-ESR score （r=0.451，P<0.001）at baseline.At the end of the 4th，12th，and 24th weeks of treatment，the number of ultrasound-detected synovitis joints was positively correlated with the DAS28-ESR score （r=0.451，P<0.001；r=0.369，P=0.001；r=0.534，P<0.001）.The number of ultrasound-detected synovitis joints differed significantly across the measurement time points （P<0.05）.To be specific，it showed a successive decrease over the 4 measurements （P<0.05）.The cases with response to TNF inhibitor therapy at the end of 4th，12th and 24th weeks of treatment numbered 23（28.8%），41（51.2%），and 54（67.5%），respectively.During the 24-week treatment，the number of ultrasound-detected synovitis joints measured at the 4 time points showed no significant differences between those with responses and those without （P>0.05）.The overall clinical response rate at the end of treatment was higher in those with ultrasound-detected improvement in synovitis at the end of 4 weeks of treatment than that of those without （P<0.05）.But the overall clinical response rate was not associated with ultrasound-detected improvement in synovitis after 12 and 24 weeks of treatment （P>0.05）.Conclusion Ultrasound-detected synovitis status is positively correlated with RA activity.And improvement in synovitis in short-term （4-week） treatment detected by ultrasound may have an impact clinical response in RA patients treated with TNF inhibitor.
【Key words】 Rheumatoid arthritis；Synovitis；Tumor necrosis factor inhibitor；Clinical response
Single-nucleotide Polymorphism of Mitochondrial DNA Displacement Loop and Age -at -onset of Rheumatoid Arthritis WU Chensi1，GUO Zhanjun2，PENG Chenxing3，LAI Ruixue2，ZHANG Xiaoyun2*
1.Department of Gastroenterology，the Fourth Hospital of Hebei Medical University，Shijiazhuang 050011，China
2.Department of Rheumatology and Immunology，the Fourth Hospital of Hebei Medical University，Shijiazhuang 050011，China
3.Department of Rheumatology and Immunology，the Second Hospital of Hebei Medical University，Shijiazhuang 050000，China
*Corresponding author：ZHANG Xiaoyun，Attending doctor；E-mail：email@example.com
【Abstract】 Background Rheumatoid arthritis（RA）is a common clinical disease，the cause of which remains unknown.Previous studies have shown that 40 to 60 years old is the high incidence age of RA.The single-nucleotide polymorphisms（SNPs）of mitochondrial DNA（mtDNA）displacement loop（D-loop）have been shown to have predictive value for the age-at-onset of various diseases including tumor and kidney disease，but its relationship with the age-at-onset of RA patients has not been reported.Objective To explore the relationship of SNPs in the mtDNA D-loop with the age-at-onset of RA.Methods 85 patients with RA who were hospitalized in the Department of Rheumatology and Immunology，the Second Hospital of Hebei Medical University from May to December 2017 were selected.PCR amplification and sequence analysis were used to analyze the SNPs in the D-loop of mtDNA in peripheral blood.The survival curves associated with age-at-onset were drawn by Kaplan-Meier method，and were compared by the Log-rank test.And the Cox proportional hazards model was used to analyze the risk factors of age-at-onset.Results Log-rank test results showed that the age-at-onset of patients with minor allele T genotype was earlier than that of those with major allele C genotype（χ2=5.395，P=0.020 ）in the nucleotide 16519 of mtDNA D-loop.The results of the Cox proportional hazards model showed that the nucleotide 16519 in the mtDNA D-loop was an independent predictor of age-at-onset of RA〔HR=1.750，95%CI（1.047，2.925），P=0.033〕.Conclusion The age-at-onset of RA may be related to the SNP in the mtDNA D-loop.Analysis of the SNP in the mtDNA D-loop can help identify high-risk patients with early-onset of RA.
【Key words】 Arthritis，rheumatoid；mtDNA；Polymorphism，single nucleotide；Rheumatoid arthritis；Age of onset
Effect and Safety of Endothelin-receptor Antagonists for Diabetic Nephropathy：a Meta-analysis YUAN Wenming，LI Bin，WANG Kai，CHENG Genyang，DOU Yanna，ZHAO Zhanzheng*
Kidney Disease Hospital，the First Affiliated Hospital of Zhengzhou University，Zhengzhou 450052，China
*Corresponding author：ZHAO Zhanzheng，Chief physician；E-mail：firstname.lastname@example.org
【Abstract】 Background Diabetes mellitus is an important factor leading to cardiovascular events and end-stage renal disease.Although it has been confirmed that many drugs may reduce proteinuria in patients with diabetic nephropathy and delay the progression of nephropathy，their adverse reactions limit clinical application.As a new attempt to treat diabetic nephropathy，endothelin antagonists have been paid more and more attention.Objective To evaluate the effectiveness and safety of endothelin receptor-antagonists in patients with diabetic nephropathy.Methods Wanfang Data Knowledge Service Platform，CNKI，VIP，PubMed，EMBase，Cochrane Library and other databases were retrieved as of October 2018 for randomized controlled trials（RCTs）of endothelin-receptor antagonists for diabetic nephropathy，and RCTs listed as references of the RCTs in the databases in printed form，and related conference records in printed form were also reviewed.RCTs inclusion，data extraction and quality assessment were performed by using the Cochrane methods for conducting systematic reviews by two researchers independently.When differences of views arise，the decision is made by the third person evaluation.RevMan 5.3 was used for meta-analysis of aspects〔all-cause mortality，incidence rate of cardiovascular disease，urinary protein，estimated glomerular filtration rate（eGFR），incidence rates of adverse reactions and severe adverse reactions〕determining effectiveness and safety.Results Six RCTs involving 2 082 patients were included for analysis.Meta-analysis showed that endothelin-receptor antagonists could reduce urinary protein levels in patients with diabetic nephropathy 〔SMD=-0.66，95%CI（-0.76，-0.56），P<0.000 01〕，but could not reduce all-cause mortality〔RR=1.49，95%CI（0.81，2.76），P=0.20〕.Although endothelin-receptor antagonists group and placebo group showed no significant difference in the incidence rate of adverse reactions〔RR=1.06，95%CI（0.99，1.13），P=0.08〕，endothelin-receptor antagonists group had much higher incidence rates of severe adverse reactions〔RR=1.34，95%CI（1.12，1.61），P=0.001〕and cardiovascular diseases〔RR=1.45，95%CI（1.07，1.97），P=0.02〕.Endothelin-receptor antagonists group demonstrated much lower systolic blood pressure〔MD=-3.88，95%CI（-5.36，-2.40），P=0.000 1〕，diastolic blood pressure〔MD=-2.65，95%CI（-4.30，-1.01），P=0.002〕，and hemoglobin level〔MD=-0.69，95%CI（-0.87，-0.51），P=0.000 1〕than placebo group.Conclusion Endothelin-receptor antagonists can reduce urinary protein level in patients with diabetic nephropathy.But their long-term efficacy and safety need to be confirmed by RCTs with larger sample sizes.
【Key words】 Diabetic nephropathy；Endothelin-receptor antagonists；Systematic review；Meta-analysis；Adverse drug reaction；Cardiovascular diseases
Supplementary Therapy with Omega-3 Polyunsaturated Fatty Acids Improves Metabolic Indices in Children with Non-alcoholic Fatty Liver Disease：a Meta-analysis HU Chenling1，SHI Xiaoyan1，YAO Jia1，CHEN Junmin1，CHEN Qiu2*
1.Chengdu University of TCM，Chengdu 610075，China
2.Department of Endocrinology，Affiliated Hospital of Chengdu University of TCM，Chengdu 610072，China
*Corresponding author：CHEN Qiu，Professor，Chief physician，Doctoral supervisor；E-mail：email@example.com
【Abstract】 Background Non-alcoholic fatty liver disease （NAFLD） has become one of the chronic liver diseases in children in developed countries.With the globalization of economy，there are 155 million overweight and obese children globally with an increasing prevalence of NAFLD.However，no effective drugs for NAFLD in children have been found，and the use of drugs is still controversial.Objective To systematically evaluate the effect of omega-3 polyunsaturated fatty acids （n-3PUFA） as an supplementary therapy on metabolic indices in children with NAFLD.Methods Databases of PubMed，the Cochrane Library，EMBase，and Web of Science were searched from inception to May 15 2019 for RCTs about improvement in metabolic indices in NAFLD children treated with an supplementary therapy with n-3PUFA （intervention group） versus that in those with placebo as the supplementary therapy or without supplementary therapy（control group）.Meta-analysis was conducted by using RevMan 5.2.Results A total of 6 studies were included，with a total of 378 patients.Meta-analysis showed that the intervention group showed lower mean levels of alanine aminotransferase 〔SWD=-0.34，95%CI（-0.55，-0.13）〕，aspartate aminotransferase 〔SWD=-0.27，95%CI（-0.51，-0.03）〕，triglyceride 〔SWD=-0.43，95%CI（-0.64，-0.22）〕，fasting blood glucose 〔SWD=-0.22，95%CI（-0.44，0.00）〕，fasting insulin 〔SWD=-0.38，95%CI（-0.60，-0.16）〕，homeostatic model assessment for insulin resistance （HOMA-IR） 〔SWD=-0.31，95%CI（-0.52，-0.11）〕，and body mass index 〔SWD=-0.71，95%CI（-1.13，-0.30）〕，and higher mean high-density lipoprotein cholesterol 〔SWD=0.55，95%CI（0.10，1.00）〕 compared with the control group （P≤0.05）.Conclusion The meta-analysis demonstrated that supplementary treatment with n-3PUFA may improve metabolic indices such as alanine aminotransferase，aspartate aminotransferase，triglyceride，high-density lipoprotein cholesterol，fasting blood glucose，fasting insulin，HOMA-IR，and body mass index in children with NAFLD.
【Key words】 Non-alcoholic fatty liver disease；Omega-3 polyunsaturated fatty acids；Child；Alanine transaminase；Aspartate aminotransferases；Meta-analysis
Analysis on the Prevalence of Major Non-communicable Chronic Diseases and Its Influencing Factors among Adults Aged 40-70 in Yangzhong City FENG Xiang1，2，HUA Zhaolai2，ZHOU Qin2，SHI Aiwu2，QIAN Dongfu3*
1.School of Public Health，Nanjing Medical University，Nanjing 211166，China
2.Yangzhong Cancer Research Institution，Yangzhong 212200，China
3.School of Health Policy and Management，Nanjing Medical University，Nanjing 211166，China
*Corresponding author：QIAN Dongfu，Professor，Doctoral supervisor；E-mail：firstname.lastname@example.org
【Abstract】 Background Non-communicable chronic diseases（NCDs）are one of the major public health problems，which endangers residents' health and brings huge burden to individual，family and the society.Objective To understand the prevalence of major NCDs （ the top five diseases of NCDs prevalence in Yangzhong City ），among adults aged 40-70 in Yangzhong City and analyze its influencing factors so as to provide a theoretical basis for the prevention and control of NCDs.Methods A multi-stage stratified cluster sampling method was used and 2 591 adults were selected.The prevalence of major NCDs were obtained by questionnaire，physical examination，endoscopy examination，pathology examination and laboratory examination from September 2018 to March 2019.Univariate and multivariate Logistic regression analysis were used to analyze the influencing factors of NCDs.Results The top 5 major NCDs of prevalence rate were chronic gastritis（72.52%），hypertension（62.52%），dyslipidemia（34.89%），hysteromyoma（12.50%），and diabetes（10.61%），respectively.The prevalence of hypertension，cholecystitis/cholangitis and gallstones in men was lower than that in women，while the prevalence of diabetes，upper gastrointestinal precancerous lesion，duodenal ulcer and atrophic gastritis in men was higher than that in women（P<0.05）.The prevalence of hypertension，diabetes increased with the increase of age，and the prevalence of dyslipidemia decreased with the increase of age，while the prevalence of hypertension decreased with the increase of education level（P<0.05）.Univariate Logistic regression analysis indicated that age，gender，education level，household annual income，smoking，passive smoking，intake of meat and its products，intake of poultry and its products，intake of eggs and its products，intake of fruit，intake of dairy products，family history of NCDs，racing heart and BMI were associated with hypertension（P<0.05）；age，drinking tea，intake of poultry and its products，exercise frequency，manual labor，family history of NCDs and BMI were associated with dyslipidemia（P<0.05）；age，gender，education level，household annual income，smoking，drinking tea，exercise frequency，manual labor，family history of NCDs，racing heart and BMI were associated with diabetes（P<0.05）.Multivariate Logistic regression analysis showed that age，smoking，passive smoking，intake of dairy products，family history of NCDs，racing heart and BMI were influencing factors of hypertension（P<0.05）；intake of poultry and its products，family history of NCDs and BMI were influencing factors of dyslipidemia（P<0.05）；age，gender，education level，smoking，exercise frequency，family history of NCDs，racing heart and BMI were influencing factors of diabetes（P<0.05）.Conclusion The situation of major NCDs in adults aged 40-70 in Yangzhong City is severe.The prevalence of hypertension in men is lower than that in women，while the prevalence of diabetes is higher.Thus，the management of diabetes in men and hypertension in women should be strengthened.In addition，obesity or overweight，family history of NCDs and racing heart are the common risk factors of NCDs，which should be focused on.
【Key words】 Chronic disease；Influencing factor；Hypertension；Diabetes mellitus；Dyslipidemias；Prevalence；Burden of illness
Situation of Health Managers for Severe Mental Disorders of Township Health Centers in Guangxi Zhuang Autonomous Region XU Tingting1，FENG Qiming1，QIN Xianjing1，PENG Rong1，WEI Xiaofei1，CHEN Faqin2，GAO Hongda1，ZHAO Jinmin1*
1.Center for Health and Health Policy Research，Guangxi Medical University，Nanning 530021，China
2.Health Commission of Guangxi Zhuang Autonomous Region，Nanning 530021，China
*Corresponding author：ZHAO Jinmin，Professor；E-mail：email@example.com
【Abstract】 Background The severe mental disorder health manager（SMDHM） of Township Health Centers（THCs） in Guangxi Zhuang Autonomous Region is a solid foundation for the network of rural mental health prevention and treatment（MHPT），and is the most basic force for ensuring the smooth progress of rural MHPT.So the investigation of the SMDHM has positive practical significance.And there are few related references and reports at present.Objective To understand the general situation and existing problems of SMDHMs in Guangxi THCs.Methods Forty-five THCs in Guangxi were selected by stratified random sampling.A self-designed questionnaire was used to investigate 102 SMDHMs in THCs.Results In the 45 THCs surveyed，there were 4 274 to 110 043 people in service，with an average of（34 328.2±20 135.4）.The number of villages served by each THC was 4 to 29，with an average of （12.2±5.8）.None of the 45 THCs had set up mental health department，but 95.6%（43/45） of the THCs have set up mental disease management office，which is responsible for the management of serious mental disorders in their jurisdiction，and the rest of the THCs let the public health department in charge of it.In this survey，we investigated 102 SMDHMs.Of them，44 （43.1%）were males and 58 （56.9%）were females.Age rang was 20-55 and the average of age was （34.3±8.9）.For title，8（7.8%） had senior professional title，22（21.6%） were intermediate level and 72（70.6%） were primary or to be employed.For education background，17（16.7%） were undergraduate，50（49.0%） were junior college，35（34.3%） were secondary or high school.For education major，42（41.2%） were clinical medicine，26（25.5%） were nursing，14（13.7%） were pharmacy，4（3.9%） were preventive medicine，16（15.7%） were non-medical specialty，and there were no psychiatry professionals.The working life of MHPT was 0.5 to 10 years，with an average of （4.8±6.3） years.There are 27（26.5%） full-time workers and 75（73.5%） part-time workers for MHPT.A total of 105 000 yuan was invested in training SMDHMs in 45 sample THCs with an average of 2 300 yuan each.The average working time of SMDHMs was（43.6±6.0）h per week，and 52.0%（53/102） SMDHMs worked more than 40h per week.45.1%（46/102） of the SMDHMs were satisfied with their work.The average monthly income of SMDHMs was 2 500-6 500 yuan，with an average of
（3 380.5±1 004.9）yuan.7（6.9%） SMDHMs were very satisfied with the salary，18（17.6%） were relatively satisfied，49（48.1%） were average，19（18.6%） were satisfied，and 9（8.8%） were very dissatisfied.Conclusion SMDHMs in THCs are mainly young and middle-aged，with low professional titles and low educational background，lack of full-time staff，high mobility and inadequate manpower allocation.The professional structure of personnel needs to be further optimized.The training funds are low and there is a lack of professional further study.Working hours are long and job satisfaction is low.The salary income is not high and the salary satisfaction is low.
【Key words】 Mental disorders；Township health centers；Health managers；Situation survey；Guangxi Zhuang Autonomous Region
Health Status and Utilization of Health Services in Low-income People LI Hongmei，GAO Yuan，MAO Qi，CHEN Anqi，XU Aijun*
School of Health Economics Management，Nanjing University of Chinese Medicine，Nanjing 210023，China
*Corresponding author：XU Aijun，Professor；E-mail：firstname.lastname@example.org
【Abstract】 Background Compared with middle-income and high-income people，low-income people are in a disadvantaged position in access to economic and social resources.According to An Analysis Report of National Health Services Survey in China，2013，the health status of low-income people is significantly lower than the national level，and health problems have become an important issue that plagues them.Objective To understand the health status and utilization of health services in low-income people，providing recommendations for the achievement of universal health coverage.Methods The multi-stage stratified cluster random sampling method was used to select the permanent residents of Xishan District，Wuxi City，Pizhou District，Changzhou City，Wujin District，Suzhou City，Gusu District，Huai'an City，Jinhu County，Zhenjiang City and Yangzhong City as the research objects from September to October 2018.The data of the Jiangsu part of The Sixth National Health Services Survey in China were used for analysis.The surveyed population in Jiangsu was grouped by the internationally used household income five-point method:lowest，second，third，fourth and highest fifth household income quintiles.In this study，the former，the three intermediates，and the latter quintiles were defined as low-，middle- and high income groups，respectively.EQ-5D and VAS were used to measure the health status.Disease prevalence，treatment and hospitalization data were analyzed to explore health service needs and utilization.And multivariate Logistic regression analysis was used to analyze the influencing factors of health service utilization.Results The low-income group showed higher prevalence of self-evaluated health problems assessed by the EQ-5D and lower mean self-rated VAS scores compared with other two groups（P<0.05）.The middle-income group showed higher prevalence of self-evaluated health problems assessed by the self-care，and pain/discomfort dimensions of the EQ-5D，and lower mean self-rated VAS scores compared with the high-income group（P<0.05）.The rate of two-week illness-induced bedridden in low-income group was higher than that of other two groups（P<0.05）.The rate of two-week temporary absence from work/school due to illness in middle-income group was higher than that of high-income group（P<0.05）.Low-income group showed higher prevalence of self-perceived serious disease than middle-income group and high-income group （P<0.05）.The two-week visit rate in the low-income group was higher than that in the middle-income group（P<0.05）.The percentages of seeking healthcare in medical institutions in low-income group was higher than those of middle-income group，the percentages of following their doctors' advice was lower than those of other two groups（P<0.05）.The percentages of seeking healthcare in medical institutions and following their doctors' advice was higher than those of other two groups（P<0.05）.The percentages of seeking healthcare in primary medical institutions was higher than those of other two groups，and the percentages of seeking healthcare in county/district-level hospitals was lower than middle-income group，and the percentages of seeking healthcare in municipal/provincial hospitals was lower than high-income group（P<0.05）.The percentages of seeking healthcare in primary medical institutions was higher than high-income group，and the percentages of seeking healthcare in municipal/provincial hospitals was lower than middle-income group（P<0.05）.Multivariate Logistic regression analysis showed that age，marital status and chronic disease were the influencing factors affecting whether to see a doctor（P<0.05）.The age and urban-rural were the influencing factors affecting whether to seek healthcare in primary medical institutions in the low-income group（P<0.05）.Conclusion The health status of low-income people is generally poor，and the gap between health service needs and utilization is obvious.Rural low-income people aged 45-64 are more likely to use health care services when they are suffering from a chronic disease.
【Key words】 Poverty；Low-income population；Health status；Health service needs and utilization；Root cause analysis
Prevalence and Influencing Factors of Hypertension in Online Car-hailing Drivers in China XU Lirong1，GU Xuefei2，LI Tingting2，PENG Bo3，WU Nina1*
1.School of Public Health，Capital Medical University，Beijing 100069，China
2.China National Health Development Research Center，Beijing 100044，China
3.Institute of Medical Information，CAMS ＆ PUMC，Beijing 100020，China
*Corresponding author：WU Nina，Associate professor，Master supervisor，Main research in health economy and policy，utilization of health services；E-mail：email@example.com
【Abstract】 Background The prevalence of chronic diseases in cruise drivers is significantly higher due to long working hours，high mental stress，irregular diet and sedentary lifestyle.There is no research on online car-hailing drivers in terms of chronic diseases and other health problems，although other cruise drivers have been studied.Moreover，health conditions of online car-hailing drivers have not drawn enough attention from the government and the industry.We studied the prevalence and influencing factors of hypertension in this group，and put forward corresponding health improvement suggestions.Objective To investigate the prevalence and influencing factors of hypertension in online car-hailing drivers，putting forward recommendations for improving the health management of this group.Methods From September to November 2017，we conducted this online survey with an electronic questionnaire developed based on the www.wjx.cn platform among a random sample of online car-hailing drivers with registered accounts in accordance with the principle that one registered account of the driver could only fill out one questionnaire.The survey covered demographic，socioeconomic and work-related characteristics，health behaviors，prevalence of hypertension，healthcare awareness and healthcare needs.Results A total of 9 003 cases participated in the survey，and 8 990 of them（99.86%） returned responsive questionnaires.The overall prevalence of hypertension was 8.64%（777/8 990）.Logistic regression analysis showed that 35-54 years old 〔OR=0.582，95%CI（0.408，0.829） 〕，18-34 years old 〔OR=0.276，95%CI（0.188，0.407） 〕，working in central China 〔OR=1.523，95%CI（1.199，1.953） 〕，working in eastern China 〔OR=1.398，95%CI（1.140，1.716） 〕，at least three years of full-time drivers experience 〔OR=1.218，95%CI（1.044，1.422）〕，driving period at day and night，not fixed〔OR=0.847，95%CI（0.718，0.999） 〕，exercise time outside of the car ≥5 min〔OR=0.784，95%CI（0.670，0.917） 〕，daily sleep time ≥6 h 〔OR=0.806，95%CI（0.681，0.954） 〕，drinking alcohol three or more days each week〔OR=1.383，95%CI（1.112，1.719） 〕，slightly underweight〔OR=2.669，95%CI（1.799，3.961） 〕，and obese〔OR=3.153，95%CI（2.612，3.806） 〕 were associated with the prevalence of hypertension among car-hailing drivers（P<0.05）.Compared with those without hypertension，hypertensive drivers showed higher percentages of having a physical examination within 1 year and having the latest blood pressure measurement within 1 month（P<0.05）.Moreover，they demonstrated higher percentages of obtaining health knowledge via using mobile phone，watching TV，and listening to the radio but showed lower percentages of obtaining such knowledge from the Internet and other ways（P<0.05）.Furthermore，they had higher percentages of obtaining information about hypertension risk prevention，symptom diagnosis，therapeutic effect and hospital specialty care（P<0.05）.Conclusion It is necessary to strengthen the health management in online car-hailing drivers，in particular those who aged 55 or over，work in central and eastern China，work as a full-time driver for at least 3 years，drive in a fixed time period in the day or at night regularly，have no the habit of exercising outside of the car，sleep less than 6 hours per day，drink alcohol three or more days per week，and are slightly underweight or obese.
【Key words】 Hypertension；Online car-hailing driver；Health management；Root cause analysis
Occupational Stress and Carotid Atherosclerosis among Steel Workers：a Cross-sectional Study WU Jianhui，WANG Haidong，WANG Jie，LI Jing，ZHANG Lu，LI Xiaoming，YUAN Juxiang*
Department of Epidemiology and Health Statistics，School of Public Health，North China University of Science and Technology/Hebei Provincial Key Laboratory of Coal Mine Health and Safety，Tangshan 063210，China
*Corresponding author:YUAN Juxiang，Professor；E-mail:firstname.lastname@example.org
【Abstract】 Background Steel workers are at particularly high risk of occupational stress due to engaging in repetitive tasks and often working in hot and noisy environment.Occupational stress may reduce the work efficiency.Moreover，it may adversely affect some biochemical markers，such as total cholesterol and triglyceride，and so on，causing dyslipidemia and even carotid atherosclerosis（CAS）.However，research on the relationship between occupational stress and CAS among steel workers is still lacking.Objective To explore CAS-related risk factors and the relationship between CAS and occupational stress among steel workers.Methods Stratified cluster sampling was used to select employed steel workers with at least one year of work experience who underwent occupational health examination in Physical Examination Center，Tangshan Hongci Hospital during from March to June 2017.CAS was diagnosed by carotid ultrasound.Occupational stress was assessed by the Chinese version of the Job Content Questionnaire.Both univariate and multivariate Logistic regression analyses were used to determine the influencing factors of CAS.Results A total of 4 525 workers were recruited.Overall，the prevalence of CAS and occupational stress was 25.44%（n=1 151），and 7.01%（n=317），respectively.In the univariate analysis，sex ratio，distributions of age，BMI，education level，marital status，and shift work status，as well as prevalence of smoking，drinking，hypertension and hyperlipidemia were independently associated with CAS（P<0.05）.However，two groups showed no obvious differences in the prevalence of occupational stress（P>0.05）.Two groups also had no obvious differences in mean scores of job requirements，job autonomy，and social support as well as the ratio of job requirements mean score to job autonomy mean score（P>0.05）.In multivariate Logistic regression analysis showed that male，older age，lower education level，engaging in shift work，smoking，drinking，and hypertension were independently associated with CAS（P<0.05）.Conclusion CAS is affected by several factors.Our analysis suggests that the available data does not support the relationship between occupational stress and CAS.
【Key words】 Carotid atherosclerosis；Occupational stress；Steel production workers
Clinical Characteristics and Radiological Analysis of Chronic Obstructive Pulmonary Disease Complicated with Pulmonary Nocardiosis Infection：a Report of Three Cases WANG Xiaoling1*，FANG Kai2，WU Jiawen2，CHEN Qingyong3
1.Department of Radiology，Zhejiang Quhua Hospital，Quzhou 324004，China
2.Department of Respiratory Medicine，Zhejiang Quhua Hospital，Quzhou 324004，China
3.Department of Respiratory Medicine，NO.117 Hospital of Chinese People's Liberation Army，Hangzhou 310000，China
*Corresponding author：WANG Xiaoling，Associate chief physician；E-mail：email@example.com
【Abstract】 Objective To investigate the clinical and radiological characteristics of chronic obstructive pulmonary disease（COPD） complicated with pulmonary nocardiosis infection and its diagnosis and treatment and prognosis.Methods The clinical data of three patients with COPD complicated with pulmonary nocardiosis infection who were admitted to Zhejiang Quhua Hospital from March 2017 to September 2018 were analyzed and reported retrospectively and the literature were reviewed.Results Cardinal symptoms of three patients included fever，cough，and coughing up yellow mucus.Computer tomography scan of chest showed nodules or masses，cavities，pleural effusion and consolidation.The most precise diagnosis method is mainly sputum culture.On the basis of Compound Sulphamethoxazole，the patients were treated with other antibiotics.All three patients were cured or in the improved condition.Conclusion Structural pulmonary disease is the basis of pulmonary nocardia infection with non-specific clinical and radiological manifestations.The positive culture of nocardia pathogen is the mainly way of diagnosing the disease.Compound Sulphamethoxazole is the basic choice of treatment in combination with other drugs according to patient's condition.
【Key words】 Pulmonary disease，chronic obstructive；Pulmonary nocardia infection；Nocardia infections；Clinical characteristics；Radiological manifestations；Diagnosis；Therapy；Prognosis
Common Variable Immunodeficiency Associated with a Novel STAT3 Gene Mutation in Infants:a Case Report and Literature Review XU Meixian*，LIU Gang，CAO Lijing，GENG Wenjin，GUO Yanmei
PICU，Children's Hospital of Hebei Province，Shijiazhuang 050030，China
*Corresponding author:XU Meixian，Chief physician，Master supervisor；E-mail：firstname.lastname@example.org
【Abstract】 Common variable immunodeficiency（CVID）is a commonly encountered heterogeneous immunodeficiency syndrome characterized mainly by low immuneglobulinemia，repeated bacterial infections，T or B lymphocyte dysfunction.Most of the patients presented with multigenetic and multifactorial etiological features，but few of them were induced by the single pathogenic gene，of which the STAT3 is regarded as the novel one.We reported an infant with CVID associated with STAT3 gene mutation with a detailed description of the clinical presentations，diagnosis and treatment process.Besides，we introduced the new information about the pathogenesis，diagnosis，treatment and prognosis of STAT3 mutation related CVID based on reviewing related studies.Our study may deepen clinicians' understanding of this disease.
【Key words】 Common variable immunodeficiency；STAT3 gene mutation；Clinical characteristic；Case reports；Diagnosis；Therapy；Prognosis
Skin Metastasis of Breast Cancer Misdiagnosed as Sebaceous Cyst with Infection:a Case Report LI Xiaobin，WANG Bin*
Department of General Surgery，PLA 518 Hospital，Xi'an 710043，China
*Corresponding author：WANG Bin，Associate chief physician；E-mail：email@example.com
【Abstract】 Breast cancer results in the highest morbidity and mortality rates among women.Skin metastasis of breast cancer is uncommon in clinical settings，and is easily misdiagnosed.We reported a case with skin metastasis of breast cancer who was admitted to PLA 518 Hospital on 25 February 2019，with an experience of being misdiagnosed as sebaceous gland cyst accompanied by infection，and reviewed the related cases reported in other studies，then discussed the diverse and complex clinical manifestations as well as pathogenesis of skin metastasis of breast cancer，hoping to enrich clinicians’ knowledge of the disease to reduce the possibility of making a misdiagnosis or missed diagnosis and improve the possibility of making an accurate diagnosis based on clinical manifestations，or in combination with CT scan and pathological examination if necessary，by which proper treatment can be delivered as early as possible.
【Key words】 Breast cancer；Skin metastasis；Sebaceous cyst with infection；Pathogenesis；Diagnostic errors；Case reports；Diagnosis