Chinese General Practice-Forthcoming Articles

Research on the Legalization about the system of the General Assistant Practitioners in Rural Areas under the Background of the Medical Practitioner Law

ZHAO Yue, LIU Lan-qiu

As the original and newly introduced Medical Practitioner Law didn’t specify the Medical Licensing Examination of the General Assistant Practitioners in Rural Areas, the General Assistant Practitioners in Rural Areas are facing several difficult situations in practice in the field of qualification admittance and Practicing medicine, causing problems such as unidentified legal identity, the lack of protection of practicing rights, and the lack of Professional self-identity. As the feasibility of the legalization on the examination is sufficient, it is necessary to bring the Examination into the management of the Medical Practitioner Law, establish the employment system of ‘managed by town and work in village’, and improve the code of practice in combination with the rural reality, so as to provide fully guarantee for their practicing medicine according to the law.

Analysis of Prenatal Diagnosis Results and Pregnancy Outcome of Non-invasive Prenatal Screening High-risk Fetuses

LUO Yan, ZHAO Bing-yi, SUN Yan-mei, et al.

Objective With the development of whole-genome sequencing, small chromosomal deletions and duplications could be found by NIPT. This study is to evaluate the clinical significance of fetal chromosomal karyotype analysis and chromosomal microarray analysis (CMA) to clarify the clinical significance of 528 cases of high-throughput sequencing noninvasive prenatal screening suggesting high-risk cases. Methods Non-invasive prenatal screening showed that the fetus 21, 18, 13, sex chromosomes, and other chromosomes are at high risk of aneuploidy and fetal chromosome copy number variations (CNVs) are at high risk, requiring prenatal diagnosis Pregnant women are the research objects. After obtaining informed consent, fetal cells were obtained by amniocentesis or umbilical vein puncture for chromosomal karyotype and CMA analysis. All cases of childbirth were followed up by telephone over a period of 1 year. Results Among 528 fetuses, 447 were at high
risk of aneuploidy. The positive predictive value (PPV) for trisomy 21(T21), trisomy 18 (T18), trisomy 13 (T13), sex chromosome aneuploidies (SCAs), and other chromosome aneuploidy was 82.86%, 51.52%, 12.5%, 50.82%, and 5.88% respectively. Another 81 cases of non-invasive prenatal screening suggest CNVs High risk. The PPV for CNVs was 34.57% .Among them, CNVs has a clear pathogenic significance can reach 24.69% . Follow-up of childbirth cases: Of the 62 pregnant women diagnosed with fetal SCA, 13 chose to continue their pregnancy, and the overall continued pregnancy rate was 20.97% (13/62); CNVs has no clear significance/no disease reported in 8 cases, 1 case After being lost to follow-up, all 7 cases chose to continue their pregnancy. One of the children was not informed about the specific situation; one girl had six fingers on both hands, and the rest had no abnormal growth; the remaining five children developed normally. Conclusion This study has obtained relatively reliable PPV data for NIPT screening for chromosomal aneuploidy, which provides a reliable basis for clinical genetic counseling and treatment; it is recommended to perform prenatal diagnosis and perform chromosomal nucleus when non-invasive and high-risk prompts suspicious chromosomal abnormalities (over/under/microdeletion/microduplication). Type and CMA inspection, so that the inspection is more comprehensive and not easy to miss the diagnosis.

The value of CD62P and TAB2 in evaluating the efficacy and prognosis of ischemic stroke in different parts

MENG Can-can, CHENG Yan, JIAO Li-yan, ZHANG Zhi-wei, YANG Zhi-tang

objective: To explore the role of platelet activation degree in evaluating the curative effect and prognosis of ischemic stroke in different parts. Methods: Subjects with ischemic stroke were hospitalized in the Department of Neurology of the Affiliated Hospital of Hebei University of Engineering from October 2019 to June 2021. They were collected as the observation group (n=44). According to the infarct location, the observation group was randomly divided into two subgroups: ACC(Anterior Cerebral Circulation) infarction group (n=23) and PCC(Posterior Cerebral Circulation) infarction group (n=21). In the same period, healthy subjects (n=28) were taken as the control group. The age, gender, medical history and blood routine related indicators were compared among the three groups. The NIHSS score was used for evaluating neurological function and the mRS score was used for assessing prognosis. The concentrations of serum CD62P and TXB2 were detected by ELISA before and 7th, 30th day after treatment. Results: The concentrations of CD62P and TXB2 in ACC infarction group and PCC infarction group were significantly higher than those in control group (P<0.05). There was no significant difference in general data, medical history and NIHSS score between the ACC and PCC infarction group, the repeated measures ANOVA suggested on the7th and 30th day after same treatment, the NIHSS score, CD62P and TXB2 concentrations in the ACC infarction group were lower than those in the PCC infarction group (P<0.05). The prognosis on the 30th day，the score of mRS, CD62P and TXB2 concentrations in the PCC infarction group raised compared with those in the ACC infarction group (P<0.05). Conclusion: The CD62P and TXB2 in PCC infarction group are significant increase contrast with those in ACC infarction group, and the prognosis is poor. It is suggested that CD62P and TXB2 play a certain role in evaluating the curative effect and prognosis of ischemic stroke in different parts.

Association of Sleep Duration and Hyperuricemia among Residents in Haidian DistrictofBeijing

LIU Zhenyu, WANG Jiangmin, WEI Yunpeng, YING Huaqing

Background Withtheaccelerationofsocialrhythm, sleepproblemsarecommonamong residents.Studies showing that sleep duration is associated with chronic diseases such as hypertension and diabetes, while research related to hyperuricemia is relatively lacking.Objective To study the relationship between sleep duration and the prevalence of hyperuricemia in adults aged 18-79 years. Methods The data comes from the surveillance of adult chronic diseases and their risk factors in Haidian District of Beijing in 2019. A multivariate logistic regression model was used to analyze the relationship between sleep duration and the risk of hyperuricemia, and restricted cubic spline regression was used to analyze the dose-response relationship between sleep time and the risk of hyperuricemia. Results A total of 5380 people were enrolled in this study, their age was (46.9±16.0) years old, and their sleep time was (7.24±1.16) hours. After adjusting the demographic characteristics, lifestyle and health status, ccompared with those who sleep for 7-9 hours, people who sleep ＜7h and >9h have a higher risk of hyperuricemia〔OR＜7h（95%CI）=1.37(1.17，1.62)，OR>9h（95%CI）=1.39(1.07，1.81)〕. Restricted cubic spline regression results showed that the correlation strength between sleep duration and hyperuricemia showed a U-shaped distribution (non-linear test,χ2=27.530, P<0.001). ConclusionToo longer or shorter sleep duration will increase the risk of hyperuricemia among Residents in Haidian District of Beijing.

A Comparative Study of Serum biomarkers in patients with different stages of asthma

BackgroundAsthma is a complex heterogeneous disease, frequent acute attacks seriously affect the quality of life of patients, and cause a heavy economic burden. In recent years, the development of serum biomarkers provides a new idea for the accurate treatment of asthma and the diagnosis and treatment of refractory asthma. Objective to analyze the distribution difference of serum biomarkers between patients with asthma and healthy people, and to explore the potential of different serum biomarkers to identify acute attack. Methods A cross-sectional study was conducted on 293 patients with asthma treated in the first affiliated Hospital of Henan University of traditional Chinese Medicine from November 2018 to December 2020, including 155 in acute attack and 138 in non-acute attack. In the same period, 39 healthy volunteers were recruited in the hospital physical examination center. Elisa method was used to detect the content of serum biomarkers in the three groups, and SPSS25.0 software was used for statistical analysis. Results The results showed that the levels of serum eosinophil chemokine and chtinase⁃3⁃1ike⁃1 protein in acute attack were significantlyhigher than those in non-acute attack and healthy volunteers (P<0.05). The serum levels of IL-4, IL-6, IL-8, IL-17, TGF-β2, TNF-α, HMGB1,TIgE and SIgE in acute attack group were higher than those in healthy volunteer group, and those in non-acute attack group were significantly higher than those in healthy volunteer group (P<0.05). The level of INF-γ in acute attack group was lower than that in healthy volunteer group, and that in non-acute attack group was significantly lower than that in healthy volunteer group
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(P<0.05), and the level of Periostin in non-acute attack group was significantly lower than that in healthy volunteer group (P<0.05), however, there was no significant difference between acute attack group and non-acute attack group (P<0.05). There was no significant difference in serum ECP and LTD4 among the three groups (P>0.05). Conclusion Eotaxin and TKL-40 have the potential to identify the acute attack of asthma.

Comparison of clinical characteristics and response to glucocorticoid therapy in patients with different inflammatory phenotypes of AECOPD and ACO.

Objective Comparison of clinical characteristics of acute exacerbation of chronic obstructive pulmonary disease(AECOPD) with different inflammatory phenotypes and Asthma-COPD overlapping (ACO) patients,the responses of AECOPD with different inflammatory phenotypes and ACO to glucocorticoid therapy were observed，so as to provide reference for further guiding the application of glucocorticoids. Methods The basic data, lung function, inflammatory indicators, coagulation indicators and other results of AECOPD and ACO patients hospitalized in the Department of Respiratory and Critical Care Medicine of the Second Hospital of Hebei Medical University from January 2018 to December 2020 were collected. Using peripheral blood eosinophil (EOS) percentage 2% as the threshold group, EOS%≥2% as the EOS group, and EOS% < 2% as the non-EOS group, the clinical characteristics, inflammatory indicators, lung function, and glucocorticoid response of AECOPD patients in EOS group and non-EOS group, EOS group and ACO group were analyzed. Results In AECOPD patients,
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the EOS group had lower hs-CRP, neutrophil absolute value, neutrophil/lymphocyte ratio (NLR), fibrinogen/serum albumin (FAR), higher albumin (ALB), and less possibility of pulmonary and systemic steroid use，fewer total applications, shorter courses of treatment, and shorter hospital stays,comparing with the non-EOS group. Conclusions The level of inflammation in the EOS group of AECOPD patients is lower than that in the non-EOS group, and the response to hormones is better. EOS can be used as an important indicator to evaluate the severity of AECOPD and guide the treatment of glucocorticoid. The causes of acute exacerbations of COPD patients in the EOS group were mostly considered to be caused by non-infectious factors, and the treatment of antibiotics may be more prudent. AECOPD patients in EOS group have different clinical characteristics , and it is of positive significance to grasp their unique clinical characteristics for the early identification of chronic airway disease and accurate treatment decision.

Cross controlled trial of traditional health preserving techniques in healthy people: a real world study

Huang binyang, Liu xiaorui, Yang luping, Zheng Shuang, Zhang anren

Objective: To observe the safety and feasibility of traditional Valley health preserving surgery in healthy people in the real world. Methods: in a single center cross-control trial, 280 healthy people were randomly divided into two groups. Then, the propensity score matching (PSM) method in real world study (RWS) was used for 1:1 nearest neighbor matching. 140 cases in group A and 140 cases in group B were obtained. Two rounds of Valley opening were performed in both groups, In the first round, each subject in group A was treated with simple Bigu food restriction for 10 days, and each subject in group B was treated with "medication and Qi" Bigu food restriction for 10 days; Then, after an interval of 1 month, the second round of test was carried out. Subjects in group A were given "medication and Qi" Bigu food restriction for 10 days, and each subject in group B was given separate Bigu food restriction for 10 days. The number of discontinuation cases and adverse reactions of the two groups were counted, and the scores of conscious hunger, body mass, body mass index (BMI) morning blood pressure and fingertip fasting blood glucose of the subjects on the first day and the last day of Valley opening were recorded. Results in terms of the number of discontinued cases and adverse reaction reaction, there were 92 cases of palpitation, trembling and other adverse reactions in group A in the first round, 68 cases of discontinued trial, and the total completion rate was 51.43%; There were 60 cases of adverse reactions in group B and 28 cases of discontinuation of the trial, with a total completion rate of 80%. The discontinuation rate and the incidence of adverse events in group A were higher than those in group B, and the difference was statistically significant (P < 0.05). In the second round, there were 41 cases of adverse reactions in group A;The total completion rate was 86.43%; There were 84 cases of adverse reactions in group B and 59 cases of discontinuation of the trial, with a total completion rate of 57.86%. The discontinuation rate and the incidence of adverse events in group A were lower than those in group B, and the difference was statistically significant (P < 0.05). In terms of perceived hunger intensity score, in the first round, the hunger intensity score of the last day of Bigu in group A was higher than that on the first day of Bigu, and the hunger intensity score of the last day of Bigu in group B was lower than that on the first day of Bigu, the difference was statistically significant (P < 0.05); In the second round, the hunger intensity score of group A was lower than that on the first day of Bigu (P < 0.05); There was no significant difference in hunger intensity score between group B and the first day of Bigu (P > 0.05). In terms of body mass, body mass index (BMI), blood pressure and fasting blood glucose, the body mass, BMI, blood pressure (systolic blood pressure, diastolic blood pressure) and fasting blood glucose of the two groups on the last day of Bigu were lower than those on the first day of Bigu (P < 0.05). In the comparison between the two groups, except the systolic blood pressure in the first round, there was no difference between the other two groups (P > 0.05). Conclusion the "taking medicine and taking Qi" method of traditional Bigu regimen can significantly reduce hunger and adverse reactions, improve the completion rate of Bigu, and provide a certain reference and feasible scheme for the promotion of Bigu.

Validity of the Duke Activity Status Index (DASI) and General Practice Physical Activity Questionnaire and (GPPAQ)Walking Pace Question

Objective to determine the validity of the Duke Activity Status Index (DASI) and General Practice Physical Activity Questionnaire (GPPAQ) walking pace question in assessing physical function and gait speed in Chinese and UK patients with hemodialysis, respectively. Methods40 Chinese and UK patients with HD were assessed physical function and walking pace by using DASI and GPPAQ walking question, respectively. At the same time, the Shuttle Walking Test (SWT) and gait speed test in Short Physical Performance Battery (SPPB) were conducted with two cultural groups to validate these two questionnaires. ResultsSignificant positive correlation between the DASI and Incremental Shuttle Walking Test (ISWT) were shown in the two cultural groups[China: r=0.39 (P < 0.05) and the UK:r=0.67 (P <0.001)]. All categories of the measured gait speed classified by the GPPAQ walking criteria showed significant overlap of results. There was no significant difference between the mean gait speed of the four GPPAQ categories (P=0.107) in Chinese patients. However, there was a significant difference between the mean gait speed of the “slow”, “steady” and “brisk” GPPAQ walking pace categories in UK patients with HD (P=0.008), in particular, the question was capable of identifying patients with slow pace (P=0.003). Conclusion the DASI is valid for providing physical function measurement with patients undergoing HD. In the two different cultural groups, GPPAQ walking question could not help patients accurately report their gait speed. However, it is potentially valuable for distinguishing between “slow” and “not slow”gait speed.

Analysis of clinical features and recurrence-related factors of anti-N-methyl-D-aspartate receptor encephalitis in children

ZHANG Kai, WANG CaiZhen, LIU Kang, SUN SuZhen

Background At present, the recurrence rate of children with anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis is relatively high, and there are relatively few studies, and most medical staff do not understand it. Objective To conduct a comparative study on children with relapsed and non-relapsed anti-NMDAR encephalitis, in order to improve the understanding of anti-NMDAR encephalitis and its recurrence-related factors, so as to provide a basis for personalized treatment and reduce the recurrence rate. Methods A retrospective analysis of 54 hospitalized children with anti-NDMAR encephalitis in the Department of Neurology, Hebei Children's Hospital Affiliated to Hebei Medical University from January 2016 to December 2021 was retrospectively analyzed. Results The number of 54 children with anti-NMDAR encephalitis was slightly higher than that of girls. The school-age group accounted for the highest proportion of 51.8%. The clinical symptoms of the children were diverse. The most common clinical symptom was epileptic seizures, accounting for 61.1% of the cases. The modified Rankin score (mRS) at admission showed that the recurrence group (2.6±0.9) was significantly higher than the non-recurrence group (2.0±0.8); 25 cases of children showed abnormal head MRI, and the abnormal signal was most common in the frontal lobe, followed by the basal ganglia. From the results of immune system examination, the total T cells and CD4+ T cells in the relapsed group were significantly lower than those in the non-relapsed group; there was no significant difference between the mRS two groups after treatment. Conclusion The clinical symptoms of children with anti-NMDAR encephalitis are diverse, but the early clinical symptoms are severe, the total T cells and CD4+ T cells are significantly reduced after admission, and those who are not easy to achieve complete remission after standard immunotherapy should be alert to the risk of recurrence.

Establishment of the Norms of exercise self-efficacy scale for lung cancer patients in Anhui Province

ObjectiveTo establish the norm of exercise self-efficacy scale for lung cancer patients in Anhui Province. MethodsByregional stratified random samplingselected1475 lung cancer patients.According to geographical locationAnhui Provinceweredivided into threeregions : Northern Anhui, centralAnhui and southern Anhui. The patients' exercise self-efficacy scale was used to investigate, and the mean norm, percentile norm and delimitation norm were established.ResultsThe total score of exercise self-efficacy scale for lung cancer patients in Anhui Province was（68.16±14.69）. The score of each dimension: the score of efficacy expectation dimension was（63.67±17.70）; the score of expectation dimension was:（73.88±14.07）; The classification norm wasestablished by gender, age, educational background, medical payment mode, regular exercise habits, accompanying diseases, hospital level, regional division, Department, treatment mode and BMI; The percentile norm of the scale was established with a spacing of 5%; Taking（x± s）and（x± 0.5s）as the boundary points, the exercise self-efficacy level of lung cancer patients was divided into five categories: very low, low, medium, high and very high according to the total score of the scale. ConclusionThis study preliminarily constructs the norm of exercise self-efficacy scale for lung cancer patients in Anhui Province, which can not only provide a reference standard for studying the level of exercise self-efficacy of this population, but also provide a theoretical basis for further exploring the influencing factors of exercise self-efficacy for lung cancer patients.

Effect of Modified Tai Chi Exercise on Gait Balance and Fall Efficiency in Patients with Hemiplegia in Convalescent Period of Stroke

TANG Qiang, WANG Xue, LI Bingyao, SHA Sha, ZHU Luwen

BackgroundGait and balance dysfunction and the risk of falling are common in patients with hemiplegia in the convalescent period of stroke, which seriously affect the daily living ability and prognosis of patients. Chinese traditional exercise therapy such as Taijiquan can give play to its unique advantages as intervention measures, but there are different practice routines and insufficient evidence of evidence-based medicine, which limit the clinical application. Objective
To observe the effect of modified Tai Chi exercise on gait, balance and fall efficiency in patients with hemiplegia in convalescent period of stroke. Methods From June 2020 to July 2021, 68 patients with stroke convalescent hemiplegia admitted to the Second Affiliated Hospital of Heilongjiang University of Chinese Medicine were recruited, and randomly divided into observation group (n=34) and control group (n=34) by random number table. Both groups received routine rehabilitation treatment. At the same time, the control group received exercise relearning training and the observation group received modified Tai Chi skill training, for once a day, 30min per time, 5 days per week, lasting 8 weeks. The two groups were evaluated by Fugl-Meyer assessment of lower extremity (LE-FMA), 6-min walking test (6MWT), Berg Balance Scale (BBS), timed up and go test (TUGT), modified Barthel index (MBI), step length and frequency, gait speed, modified fall efficacy scale (MFES) before and after intervention. Results all patients were included for final analysis except for 1 dropouts (observations). The assessment results of LE-FMA, 6MWT, BBS, TUGT, MBI, step length and frequency, gait speed and MFES were similar across the groups before intervention (P>0.05). After intervention, the assessment results of above-mentioned nine items improved in all groups（P<0.05），but improved more significantly in observation group except TUGT and step length (P<0.05). Conclusion Regular rehabilitation therapy with MT and BWSTT may effectively improve the recovery of walking function in post-stroke hemiplegia patients
The modified Tai Chi exercise can effectively improve the gait, balance function and fall efficiency of patients with hemiplegia in the convalescent stage of stroke.

Evaluation of Primary Health Service Quality for Patients with Chronic Diseases in Chaozhou, Guangdong Province

Background The number of patients with chronic diseases has risen in China. Providing prevention and control services has become an important long-term work of primary health service institutions. However, there are many problems in the provision of primary health service, which seriously affect the residents' perception of service, especially for patients with chronic diseases.Objective To evaluate the quality of primary healthservice for patients with chronic diseases in Chaozhouand to provide basis for improvingthe service quality.Methods 630 chronic disease patients in Chaozhou were selected by multistage random sampling and interviewed by questionnaire containing PCAT-AS scale, supplemented by interviews with primary care workers. ResultsThere were 553 valid questionnaires. The average score of PCAT scale was95.88±13.44. (The total score was 132). The score ofcomprehensiveness (services available) was the highest (12.63±2.74), followed by the accessibility (12.35±2.07) and the first contact (9.09±1.54). And the community-oriented was the lowest among the all dimensions. The results of multiple linear regression analysis showed that those non-resident, in well self-rated health status, satisfied, and lived in Xiangqiaodistrict, preferred community health service center, visited to primary medical institution more, and those whose annual income was 20,000 yuan or less scored higher（P<0.05）.Conclusion The evaluation of patients with chronic diseases on the quality of primary health servicewas at a good level in Chaozhou.However, the service quality of community-oriented, family-oriented andcoordination (including information systems and referrals) needed to be improved. We can focus on improving the health service capacity of village clinics and township hospitals by building a stable team of primary medical talents and the information platform. And the implementation of theHierarchical Diagnosis and Treatment should be promoted to protect the health of patients from family and community and other aspects with the contracted services of family doctors as the starting point.

Stroke Pre-Hospital Delay Behavior Intention Status in Guangdong Province and Its Influential Factors

Background: Stroke seriously affects the quality of people's life and brings a heavy burden on the society, family and individuals. Although the government has vigorously promoted the prevention and treatment of stroke, stroke pre-hospital delay is not optimistic in China. The stroke pre-hospital delay behavior intention can predict the possibility of The stroke pre-hospital delay behavior to some extent, but the study of the influencing factors is rarely reported. Objective: The aim of this study was to investigate the current status of stroke pre-hospital delay behavior intention in Guangdong Province and explore the influential factors. Methods: From July to September 2021, 645 Guangdong residents were selected by the convenience sampling method.Ten-Item Personality Inventory in China, Perceived Social Support Scale, Simplified Coping Style Questionnaire and Stroke Pre-Hospital Delay Behavior Intention scale were used to investigate the personality characteristics, social support, coping styles and stroke pre-hospital delay behavior intention of Guangdong residents. Multiple linear regression was used to analyze the influential factors of prehospital delayed behavioral intention before stroke. Results: The stroke pre-hospital delay behavior intention was in the middle level (70.7±18.50) among these subjects. The score of stroke warning signs dimension was higher than the norm, but the scores of non-treatment justification dimension, symptom attribution dimension, habitual response style dimension, emergency system use dimension and stroke pre-hospital delay behavior intention were lower than norme (P＜0.01). Multiple linear regression analysis indicated that age, living with a partner, awareness of the "stroke 120", open personality, emotional stability personality, social support and negative response were influential factors of stroke pre-hospital delay behavior intention(P <0.05). Conclusion: Guangdong residents have poor stroke pre-hospital delay behavior intention and insufficient cognition of stroke symptoms. The community should strengthen the education of "stroke 120", and draw up personalized and diversified stroke education mode according to the individualized differences of residents, so as to effectively improve the level of stroke pre-hospital delay behavior intention and reduce the stroke pre-hospital delay rate.

Disease burden prediction of chronic obstructive pulmonary disease in China based on ARIMA and NNAR models

ZHAO Chuang-yi, YANG Yuan, YUAN kong-jun, ZHOU Guang-qing, LI Hai-yan

ObjectiveTo describe and analyze the status and changing trends of chronic obstructive pulmonary disease (COPD) disease burden in China from 1990 to 2019, and to forecast the disease burden in the next 5 years to provide a basis for scientific prevention and control of COPD in China. MethodsThe disease burden indicators of COPD prevalence, mortality and DALYs in Global Burden of Disease 2019 (GBD2019) were extracted, and the trend of rate change was analyzed using the average annual percentage change (AAPC), and R 4.1.0 was applied to establish COPD prevalence, mortality and DALYs rates in China from 1990-2016 ARIMA model and NNAR model, and the data from 2017-2019 were used to evaluate the fitting effect of the two models, and finally the best-fitting model was used to predict the COPD prevalence, mortality and DALYs rates in China from 2020-2024.Results From 1990 to 2019, the prevalence of COPD in the whole population of China showed an increasing trend, and the mortality and DALYs rates showed a decreasing trend (P < 0.05). the predictions of ARIMA (0, 2, 0) and NNAR (1, 1) models were basically consistent with the actual trends, and the relative errors, RMSE, MAE and MAPE of the former predicted values were smaller than the actual values. The ARIMA model predicted that the COPD prevalence, mortality and DALYs rates in China in 2024 were 3352.25/100,000,76.75/100,000 and 1494.05/100,000, respectively.Conclusion The disease burden of COPD in China shows an increasing trend from 2020 to 2024, and the ARIMA model has good fitting effect and accuracy in fitting COPD prevalence, mortality and DALYs rate applications, which can provide a reference for short-term prediction of disease burden.

The Effect of a Mobile App-Based Pelvic Floor Muscle Training during Pregnancy for Postpartum Urinary Incontinence: Exploratory Analysis of a Randomized Controlled Trial

CHEN Ling, LI Tiantian, CAI Wenzhi

Objectives:This study intends to conduct an exploratory analysis of the negative result of a pelvic floor muscle training program during pregnancy based on a mobile app, aiming to explore the factors affecting the preventioneffect of postpartum urinary incontinence (UI) and the subgroups that benefit.Methods:The data comes from a randomized controlled trial carried out in the obstetrics clinic of a hospital in Shenzhen from June to October 2020, including 63 cases in the intervention group and 63 cases inthe control group.The control group received the usual care. The intervention group received the usual care plus UIW app-based intervention. Logistic regression analysiswas used to explore the confounding factors and their interaction with intervention methods on the occurrence of postpartum UI.Result:A total of 103 subjects completed the follow-up. The average age is (28.75±3.33) years. There was no significant difference between the intervention methods (app-based intervention orusual care) accepted in the case group (postpartum UI occurred) and the control group (postpartum UI did not occur) (P=0.274); Logistic regression analysis found that the presence of UI at the time of recruitment was a significant risk factor for postpartum UI (P<0.001); in addition, the interaction between BPMSSE scores and intervention methods predicted postpartum UI (P<0.001). Further subgroup analysis found that for pregnant women with UI symptoms at the time of enrollment, app-based intervention showed a better effect of preventing postpartum UI (P=0.041), while for pregnant women without UI symptoms at the time of enrollment, the effect did not been observed (P=0.284).Conclusion:It is recommended that pregnant women with UI symptoms use "UIW" APP to prevent postpartum UI. For those without UI symptoms, the evidence is not yet sufficient. In addition, regardless of UI symptoms, pregnant women with high PFMT self-efficacy are expected to benefit from "UIW" APP.

Development and Item Selection of the Inflammatory Bowel Disease Patient-Reported Outcome Scale Based on the Health Theory of Traditional Chinese MedicineLUO

Background The prevalence of inflammatory bowel disease (IBD) increases annually in China. Integrated traditional Chinese and western medicine is helpful to alleviate and control symptoms of patients with IBD.Quality of life is an important index of clinical efficacy evaluation of IBD. Objective This study was to develop an inflammatory bowel disease patient-reported outcome (IBDPRO) scale based on the health theory of traditional Chinese medicine, and determine the conceptual framework and items of the IBDPRO. Methods The IBDPRO was developed based on the international processes and norms of scale development, including literature research, core-group discussion and expert consultation, ect. The conceptual framework was established, the item pool was generated, and items were determined. The first draft of the IBDPRO was formed. Pilot-survey was conducted unsing the first draft of the IBDPRO. Item selection was carried using discrete trends method, Cronbach's α, correlation coefficient analysis. Results The IBDPRO was composed of two domains: body-spirit syncretism, and correspondence between nature and human. Body-spirit syncretism domain consisted of 2 facets: body constituents and emotions.The IBDPRO contained 27 items. Conclusion The IBDPRO was developed based on health theory of TCM. It can be used to evaluate the quality of life of patients with IBD. However, furthersurvey and verification study are needed to improve the IBDPRO.

Effects of Season and Temperature on Gastrointestinal Bleeding in Patients With Ischemic Heart Disease

MA Liang, YAN Hai-lin, LONG Yi, et al

ObjectiveTo investigate the seasonal distribution of gastrointestinal bleeding (GIB) in patients with ischemic heart disease (IHD) and also the effect of environmental temperature. Methods The clinical data of 730 inpatients diagnosed with IHD complicated with GIB in West China Hospital of Sichuan University from 2014 to 2018 were collected, as well as the contemporaneous meteorological data. The differences of incidence of these patients between different months and seasons were compared, and the relationship between temperature and IHD complicated with GIB patients was analyzed. Results The mean age of IHD combined with GIBpatients was 72.84 years, with the highest percentage of both male and female patients in the 70-79 years age group, 35.29% and 39.66%, respectively. The temperature was highest in July and August, and lowest in December and January, with a large variation in temperature each spring. The incidence of IHD combined with GIBpatients was higher in winter and spring than in summer and autumn (58.71% vs. 41.29%, P＜0.01), and the number of hospitalizations for IHD combined with GIB was significantly higher in spring compared with summer and autumn (P＜0.05, P＜0.05). Hospitalizations of patients with IHD combined with GIB were significantly higher in winter compared to summer (p＜0.05). However, there were no statistically significant differences in hospital admissions between winter and spring or fall seasons, and between spring and fall seasons. Spearman correlation analysis showed a negative correlation between hospital admissions for IHD combined with GIB patients and monthly mean temperature (r= -0.280, P＜0.05), and a positive correlation with monthly temperature difference (r= 0.260, P＜0.05). The cold winter environment increased the incidence of acute coronary syndrome (30.7%), non-variceal upper gastrointestinal bleeding (29.4%), lower gastrointestinal bleeding (32.7%), and unexplained gastrointestinal bleeding (31.6%) and mortality (36.2%) in patients with IHD combined with GIB.Conclusions The morbidity of IHD combined with GIBpatients is closely related to the season and climatic temperature, with peak morbidity in winter and spring, and low temperatures increasing the risk
of mortality in IHD combined with GIBpatients.

Rebounding Hyperkalemia Caused by Potassium Supplementation in Patients with Thyrotoxic Periodic Paralysis: ThreeCases Reports and Literature Review

YUAN Haixia, HE Chunyan, ZHANG Jing, ZHOU Feng

Thyrotoxic periodic paralysis (TPP) is an endocrine emergency caused by thyrotoxicosis. TPP mainly manifests as periodic muscle weakness and hypokalemia, which seriously threatens the health of patients. Hypokalemia in TPP patients is closely related to the severity of myasthenia. Potassium supplementation can
alleviate myasthenia and hypokalemia quickly and effectively in TPP patients. Unreasonable potassium supplementation can induce acute rebound hyperkalemia in patients with TPP, which threatens the health of patients. In this article we reported three cases of potassium supplementation induced rebound hyperkalemia in TPP patients, analyzed the underlying causes and provides more information for the clinical treatment of TPP.

Longitudinal Associations between Serum Bilirubin Level and Carotid Intima-Media Thickness in a Health Screening PopulationQIN

Background At present, several cross-sectional studies have shown that the level of bilirubin is related to the progress of atherosclerosis, but the large sample tracking research in China even around the world are very limited. ObjectiveTo explore the correlation between the average exposure levels of total bilirubin (TBIL) and indirect bilirubin (IBIL) and the progress of carotid plaque, and to explore the role of bilirubin in different populations.MethodsThis study included people who underwent repeated medical examinations in Hebei General Hospital from January 2010 to December 2019. The eligible participants were followed up during the subsequent physical examination. The general population data were collected, and the correlation between bilirubin level and carotid plaque progression was analyzed by Cox proportional hazard regression model. Stratified analysis was used to explore whether TBIL and IBIL had different effects on carotid plaque in people with different genders, ages, body mass index, hypertension, diabetes, smoking and drinking.ResultsOf the 12,643 participants, 1,771 had carotid plaques during follow-up. After controlling the potential confounding factors, for each standard deviation increase of TBIL and IBIL, thehazard ratio and 95% confidence interval of carotid plaque progression were 0.909 (0.857, 0.963) and 0.803 (0.755, 0.854) respectively. Stratified analysis showed that the protective effects of TBIL and IBIL on different subgroups were not statistically different（P＞0.05）.ConclusionThe levels of TBIL and IBIL are independent factors affecting the progress of carotid plaque in the population. IBIL has a stronger protective effect. Mildly elevated bilirubin level provides a new idea for the prevention and treatment of cardiovascular and cerebrovascular diseases.

Effect of precise exercise prescription on cardiopulmonary fitness and sleep quality of stroke patients

QIAN Zhen, LU Tongbo, HE Jun, RUAN Qiu Xiang, WANG Chao Lan, WANG Xin

Objective To observe the effect of precise exercise prescription on cardiopulmonary fitness and sleep quality of stroke patients.Method 64 cases of stroke patients were selected, and the basic data of them were collected. All patients underwent cardiopulmonary exercise test (CPET) and their sleep quality were evaluated by Pittsburgh sleep quality index (PSQI) before rehabilitation training. Then according to the random principle, the stroke patients were divided into two groups. 32 cases of the control group were treated with routine rehabilitation and 32 cases of the test group were treated with routine rehabilitation training + precise exercise prescription training. After 12 weeks of training, all patients were reevaluated with CPET and PSQI.Result 64 stroke patients successfully completed 2 CPET and 2 PSQI assessments.On the basis of routine rehabilitation, the precise exercise prescription
was carried out in the test group, and no adverse events occurred.After rehabilitation training, V02peak、VO2peak%pred、HRpeak、METpeak、Loadpeak and AT in the test group were higher than those before treatment (P < 0.05),and higher than those of the control group (P < 0.05).Borg (dyspnea), Borg (fatigue of legs) and PSQI scores (except inertia sleep efficiency) were lower than before treatment (P < 0.05), and lower than the control group(P < 0.05). Conclusion The precise exercise prescription formulated by CPET can significantly improve the cardiopulmonary fitness,exercise intensity exercise endurance ,sleep quality,and reduce exercise fatigue of stroke patients.

Sex differences in the management and outcome of elderly patients with acute myocardial infarction

Background Elderly women with acute myocardial infarction (AMI) may differ from elderly men in terms of treatment and outcome. However, few studies reported sex differences in management and prognosis of elderly patients with AMI in China. Objective Toassess the sex differences in the management strategies, in-hospital mortality and 1-year cardiovascular mortality. Methods We analyzed data from 1579 elderly(＞60 years of age) patients with AMI admitted to 11 tertiary general hospitals in Chengdu between January 2017 and June 2019, including 1056 men and 523 women. Clinical characteristics, management strategies and 1-year outcome were investigated between two groups. Results The prevalence of smoking, alcohol consumption, history of percutaneous coronary intervention (PCI) and chronic obstructive pulmonary disease (COPD) were higher in men than women. Women were significantly older and had more diabetes, less typical symptoms, higher ratio of Killip classification≥II and higher lipid level than men(P＜0.05). There was no significant difference in reperfusion treatment between the two groups(P＞0.05). Compared to elderly men, median symptom onset to first medical contact(S-to-FMC) time and first medical contact to balloon dilation(FMC-to-B) time[414.0(220.3,863.3) min vs. 317.5(196.5,621.5) min, P=0.004; 143.5(92.8,285.0) min vs. 122.0(81.0,220.0) min, P=0.005] were significantly longer, and the use of dual antiplatelet agents and statins was significantly lower(70.7% vs. 75.9%, P=0.026; 77.1% vs. 83.0%, P=0.005) in women with AMI. Thus, the in-hospital mortality rate and 1-year cardiovascular mortality rate were both higher in women(11.3% vs. 7.1%, P=0.005; 10.8% vs. 6.9%, P=0.043). Multivariate Cox regression analysis showed sex, age, ST segment elevation myocardial infarction, cardiogenic shock, creatinine and PCI were the independent influencing factors of 1-year cardiovascular death(P＜0.05). Conclusion The rates of reperfusion treatment in women and men were similar, but there were differences in treatment efficiency and prognosis. Elderly women had greater delays in medical care, lower rates of drug use and higher in-hospital mortality and 1-year cardiovascular mortality.

AssessmentTools for Identification of Elder Abuse: a Systematic Review

ReviewXU Wen-xian, SHEN Yu-cong, ZHENG Chong-hao, et al.

ObjectiveTo systematically review the relevant researches on elder abuse assessment tools.MethodsAComprehensive search of PubMed,CHINAL,PsycINFO、Embase、Scopus、Web of Science、Cochrane Library,VIP,Wangfang Date,CNKI,Taiwan Scholar Datebase was undertaken from inception to Dec 31,2020.All studies were screened for inclusion criteria by two independent reviewers. Data were extracted, and the quality of literature was evaluated usingan authenticity assessment tool for scale measurement properties.ResultsA total of 29 studies involving 19 elder abuse assessment tools,including 18 English questionnaires and 1Chinese questionnaire.According to the differences in the evaluation content, it mainly includes two levels: the risk of elder abuse (7) and elder abuse (12), where ATDEA and the scale of family caregivers’ misbehavior toward elderlies on hemodialysis can be used for screening the severity of elder abuse. ConclusionAs the issue of elder abuse has attracted widespread attention, different types of assessment tools for different populations, institutions and cultural backgroundshavebeen developed by the international community.Researchers should select assessment tools in a targeted manner according to the research purpose, study population and research institution, and develop an elder abuse assessment tool that is appropriate to our cultural context.

Prevalence and risk factors of stroke recurrence among 40 years old and#br# above patients in urban areas of Liaoning province#br#

Background Nowadays, stroke is the 3rd leading cause of death among urban residents in China, and the combination of risk factors such as hypertension, diabetes, and dyslipidemia is high among urban high-risk groups. Liaoningprovince is a high incidence area for stroke in China, however, there are few studies on the recurrence of stroke and its combined risk factors in the northern urban areas.ObjectiveTo explore the prevalence and risk factors of stroke recurrence among urban residents in Liaoningprovince and provide population-based evidences for secondary prevention of stroke.MethodsUsing stratified clusterrandom sampling, we recruited 6349 permanent urban residents aged ≥ 40 years in Liaoyang, Dandong, Benxi, and Chaoyang cities of Liaoning Province A cross-sectional survey, including questionnaire interview, physicalexamination and laboratory detection, was carried out to collect the information on stroke recurrence and its associates amongthe residents between September 2018 and December 2020.Results The recurrence rate of stroke in urban areas of Liaoning Province was 27.9% (136/488), with no statistical difference between men and women (29.5% vs 26.2%, P=0.419). The rates of current smoking, current alcohol consumption, physical inactivity and overweight or obesity in recurrent patients were 25.0%, 15.4%, 38.2% and 69.9%, respectively. The prevalence, awareness, treatment and control rates of hypertension in relapsed patients were 83.8%, 85.1%, 78.1% and 14.9%, respectively; the prevalence, awareness, treatment and control rates of diabetes mellitus were 46.3%, 74.2%, 71.0% and 27.3%, respectively; and the prevalence, awareness, treatment and control rates of dyslipidemia were 57.5%, 46.8%, 35.1% and 18.2%, respectively. The prevalence, awareness, treatment and control rates of dyslipidemia were 57.5%, 46.8%, 35.1% and 18.2% respectively. Conclusion The recurrence rate of stroke patients in urban areas of Liaoning Province is high, and the recurrence patients have multiple risk
factors and are poorly controlled, it is urgent to implement comprehensive and effective secondary prevention measures to reduce the risk of recurrence, disability and death in stroke patients.

Research progress of continuous blood glucose monitoring in patients with gestational diabetes

Gao Yuan, Zhou Min

In June 2021, the "Decision of the Central Committee of the Communist Party of China and the State Council on Optimizing the Fertility Policy to Promote the Long-term Balanced Development of the Population" was issued, making a major decision to implement the three-child policy, and the number of pregnant women will increase significantly. As one of the common complications during pregnancy, gestational diabetes seriously affects the health of pregnant women and fetuses. Continuous blood glucose monitoring is called "the road map for effective self-management", and it is very important in the blood glucose management of patients with gestational diabetes. This article reviews the development of continuous blood glucose monitoring and its application and impact in patients with gestational diabetes. It aims to promote the clinical application of continuous blood glucose monitoring, encourage patients with gestational diabetes to participate in diabetes response and improve accurate blood glucose management, and achieve population eugenics Provide reference for excellent education.

Rosuvastatin calcium combined with metformin protects kidney in diabetic rats by regulating GLUT4 expression

Shang Gechu, Wang Xiaoyong, Gao Yan

Objective: To investigate the protective effect and mechanism of rosuvastatin calcium combined with metformin in streptozotocin (STZ)-induced kidney injury in type 2 diabetic rats. Methods: 40 Wistar rats were randomly divided into control group (C group), DM model + metformin group (M group), rosuvastatin calcium low dose + metformin group (M+RL group) and rosuvastatin calcium highdose + metformin group (M+RH group),with 10 rats in each group.The DM model was established by intraperitoneal injectionof streptozotocin in the model group. After 6 weeks of intervention, the rats were sacrificed, and blood and kidney tissue samples were collected. Then，Hematoxylin-eosin (HE) staining, periodic acid leuco fuchsin (PAS) staining, and Masson staining were used to observe the degree of kidney tissue damage in each group of rats; real-time quantitative polymerase chain reaction (PCR) was used to detect the expression of glucose transporter 4 (GLUT4) mRNA in kidney tissue of rats in the group; Western blot was used to detect the expression of GLUT4 protein in kidney tissue. Results: Compared with group C, the glomerular structure of rats in the model group was obviously damaged, accompanied by inflammatory cell infiltration (P＜0.05) and interstitial fibrosis (P＜0.05). Compared with group C, the expression of GLUT4mRNA and protein in group M decreased significantly (P＜0.05). Compared with the M group, the expression of GLUT4mRNA and protein increased significantly in the M+RL group and M+RH group (P＜0.05). Conclusion: Rosuvastatin calcium combined with metformin can alleviate glomerular and tubular inflammatory cell infiltration, alleviate glomerular basement membrane thickening, tubular vacuolar degeneration and renal interstitial fibrosis in diabetic rats, suggesting rosuvastatin calcium combined with metformin may achieve a protective effect on the kidneys of diabetic rats by regulating the expression of kidney GLUT4mRNA.

A qualitative study on the status and influencing factors of children's admission by community general practitioners

QI Zhennan, ZHANG Jiawei, BAI Wei, CHI Chunhua, SUN Wanhui, QI Jiaguang

Background Community general practitioners are the main providers of children's basic medical services, and their reception capacity directly reflects the level of primary pediatric medical care. There are large regional differences in the supply and demand of children's medical services in my country, and the capacity of primary pediatric medical services is insufficient. t is important to understand the current situation and influencing factors of children treated by general practitioners in the community. Objective From the perspective of the backbone of general practitioners in Miyun District, Beijing, we can understand the current situation of community general practitioners receiving children, and analyze the main factors restricting general practitioners from receiving children, in order to provide reference for the development of graded diagnosis and treatment of children. Methods In June 2021, the semi-structured interview method was used to conduct a sample selection of general practitioners in the "Medical Community Construction and General Practitioners Comprehensive Service Capability Improvement Project in Miyun District, Beijing" as the research objects. Four focus groups were set up and data were collected through interviews, audio recordings and text transcription. The NVivo12 software was used to code and classify the interview content, and the main framework analysis method was used to sort out and analyze the data and extract the interview theme. Results A total of 19 interviewees were included, and four themes were extracted based on the interview data. (1) The number of children generally attended by the community is small and general practitioners have low confidence in receiving children. Most of the children treated by community general practitioners were children over 3 years old, and the main diseases they receive are common diseases among children. (3) Various factors such as unclear referral system, low parental trust, lack of medicines and auxiliary examinations, and insufficient ability of doctors to diagnose and treat children's diseases have restricted community general practitioners from receiving children. (4) Community visits by pediatric experts, the addition of medicines for children, and auxiliary examinations are conducive to community general practitioners in receiving children. Conclusion There are still many problems and challenges in receiving children from general practitioners, and the current situation of children receiving care at the grassroots level is worrying. Strengthening the training of general practitioners' children's diagnosis and treatment capabilities and improving the general practice/pediatric collaboration are of great significance to the improvement of the hierarchical diagnosis and treatment system for children.

Health-related quality of life in children with nephroticsyndrome

ZENYYue, DU Yue

Objective To assess and analyze the health-related quality of life (HRQoL) of children with nephrotic syndrome(NS). Methods A total of 174 children from 2 to 18 years old and their parents who attended the Pediatric Renal Rheumatology Department of Shengjing Hospital Affiliated to China Medical University from October 2019 to December 2020 and met the selection criteria were selected as the research subjects. The PedsQL4.0 core universal scale was used for cross-sectional research. ResultsThere were significant differences in the total score of PedsQL between child self-report 77.71 (68.48,88.86)and parent proxy-report 80.69 (71.24,91.67). Both children and parents had lower scores in the school function dimension. Except the scores of the school function dimension of female children with NSwas lower than that of male children, gender didn’t affect the overall scores and other three dimensions. In terms of age, except for children with NS aged 2-4 years, the overall scores of other age groups gradually increased with age, especially in the physical and emotional aspects, the difference was statistically significant. Children with immunosuppressive agents had lower overall scales and four dimensions, and the difference was statistically significant. There were no significant differences in the length of the disease,frequency of recurrence, and family residence. Conclusion The scores of children with NS in physical, emotional, social,and school functions were reduced. When treating the disease, clinicians need to pay attention to the children’s physical, psychological and social adaptability, and intervene in time,improve the quality of life of children.

Hyperglycemia in subclinical Cushing’s syndrome of adrenalincidentaloma, Cushing’s syndrome with adrenal adenoma and changes after operation

ZHANG Zheng, ZHANG Wei, ZHANGYing, DU Juan, ZOU Dajin

Objective The purpose of the study was to look for some features of hyperglycemia in patients with subclinical Cushing’s syndrome (SCS) of incidental adrenal adenoma, Cushing’s syndrome with adrenal adenoma (CSA) and the changes after operation. Methods Thirty-sixSCS patients (Group 1) and 41CSA patients(Group 2)were evaluated. All of them measured 8:00, 24:00 plasma cortisol, urinary free cortisol, 8:00, 24:00 plasma ACTH, HbA1c and underwent oral glucose tolerance test (OGTT) to calculate, HOMA IR, area under the curve of glucose (AUCGlu) and insulin (AUCIns). The results were compared with 47 patients of nonfunctional adrenal adenoma (NAA, Group 3) and 53controls (Group 4). All SCS and CSA patients were underwent adrenal operation. The data after operation was compared with that of before operation.Results ①As defined by WHO, the prevalence of hyperglycemia was 41.7%, 51.2%, 25.5% and 24.5% in all groups. The HbA1c, 2h postprandial plasma insulin (2h PIN),AUCGlu and AUCIns in patients of Group 1were higher than Group 4. The fasting insulin (FIN), AUCIns and HOMA IR in patients of Group 2 were higher than the other three groups. The HbA1c, fasting glucose (FPG), 2h postprandial plasma glucose (2h PPG), 2h PIN and AUCGlu in patients of Group 2 were higher than Group 3 or 4. ②After operation, the 2h PIN and AUCIns were decreased in patients of Group1, and the FIN, 2h PIN, AUCGlu, AUCIns and HOMA IR were
3
decreased in patients of Group2. The prevalence of hyperglycemia was 33.3% and 39.0% in two groups. Conclusions Our study indicates that patients ofsubclinical Cushing’s syndrome and Cushing’s syndrome with adrenal adenoma have a significantly high prevalence of hyperglycemia. It is related with over secretion of glucocorticoid. After operation, accompanying normalization of hormonal secretion, the condition of hyperglycemia is improved.

Association of latitude, an indicator of vitamin D from sunlight, with infection and mortality#br#

ChenXiaoYuan, Li Qiangxiang, Zhenhua Liu

The coronavirus disease (COVID-19) is an infectious disease caused by the most recently discovered coronavirus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). This study aims to investigate associations between latitude, an indicator of vitamin D from sunlight, with COVID-19 cases and related deaths in the United States. General regression and Chi-square test were used to examine the associations between latitude and COVID-19 cases and deaths based on the data before the re-openings of most states near the end of May, 2020. The analyses indicated that latitudes were marginally associated with cases (p = 0.0792) and deaths (p = 0.0599), with an increase of 2491 cases and 189 deaths of the total numbers in the mainland of US for every unit of increase of the latitude. When the states were classified into high latitude (>N 370) and low latitude (

Diagnostic value of serum m3AchR-Ab level in alpha fetoprotein negative hepatocellular carcinoma

Background Alpha fetoprotein (AFP) is a commonly used clinical diagnostic marker for hepatocellular carcinoma (HCC), with a sensitivity of about 41% - 65%. Objective To detect the level of muscarinic acetylcholine receptor m3 autoantibody (m3AchR-Ab) in the serum of HCC patients and evaluate its diagnostic efficacy in AFP-negative HCC patients. Methods 257 serum samples from the specimen bank of the First Affiliated Hospital of Xinjiang Medical University (stored from November 2011 to September 2015) were collected, including 90 serum samples from HCC patients used as HCC group, 89 serum samples from patients with benign liver disease (liver cirrhosis and hepatic hemangioma) as benign liver disease group and 78 serum samples from healthy people used as control group. Enzyme linked immunosorbent assay (ELISA) was used to detect the level of serum m3AchR-Ab in each group.The correlation between the level of serum m3AchR-Ab and the clinicopathological features of HCC was analyzed, the efficacy of m3AchR-Ab in the diagnosis of AFP-negative HCC was evaluated by the receiver operating characteristic (ROC) curve. Results The level of serum m3AchR-Ab in patients with HCC was significantly higher than that in patients with benign liver disease and healthy people (P< 0.05), but there was no significant difference in the level of serum m3AchR-Ab between benign liver disease and healthy people (P> 0.05). The level of m3AchR-Ab was correlated with tumor size, TNM stage, lymph node metastasis and the expression of HBsAg in HCC patients (P < 0.05). ROC curve analysis showed that for
AFP-negative HCC patients, the area under the curve (AUC) of m3AchR-Ab serum level in the diagnosis of HCC was 0.69 [95% CI (0.54, 0.83)], the sensitivity was 64.00%, and the specificity was 91.02%. For HCC patients, the AUC of serum m3AchR-Ab combined with AFP was 0.90 [95% CI (0.85, 0.95)], and the sensitivity was 90.00%, which was higher than the AUC (0.89 and 0.88) and sensitivity (88.89% and 71.71%) of using m3AchR-Ab and AFP alone. Conclusion m3AchR-Ab is a potential diagnostic maker for AFP-negative HCC, and the combination of m3AchR-Ab and AFP could improve the diagnostic efficiency of HCC. This work lay a foundation for develop novel diagnostic marker for HCC.

Association between free triiodothyronine and depression in patients with coronary heart disease

BackgroundCardiovascular disease and psychological disease are the two major public health problems threatening the health of Chinese residents, and the current number of coronary heart disease(CHD) patients in China is about 11 million, and inpatients ofCHD comorbid depression can reach 51%, while comorbid major depression is 3.1% - 11.2%. However, there are few studies on the relationship between thyroid function and depression status in CHD patients. Objective To investigate the relationship between thyroid function and the occurrence of depression status in patients with coronary heart disease. Methods 561 patients diagnosed coronary heart disease were selected from the Department of Cardiology of Guangdong Provincial People's Hospital from October 2017 to February 2018. The depression was assessed by the patient health Questionnaire-9 (PHQ-9), and the serum levels of free triiodothyronine (FT3), free thyroxine (FT4), thyroid stimulating hormone (TSH) were used to assess thyroid function, then Analysing the differences of thyroid hormone levels between patients with and without depression in CHD. Results Of the 561 CHD patients, 350 (62.4%) were in the non-depressed group and 211 (37.6%) in the depressed group, including 148 (26.4%) with mild depression, 46 (8.2%) with moderate depression and 17 (3.0%) with severe depression. FT3 levels were significantly (P < 0.05) lower in the CHD with depression group than in the group without depression. There were no significant differences in the levels of FT4 and TSH between depressed and non-depressed groups (P > 0.05). The depression score was negatively correlated with the FT3 level (rs = -0.114,) and positively correlated with age (rs= 0.093), hs CRP (rs = 0.090) (P < 0.05). Univariate and multivariate logistic regression analyses between FT3 and depression suggested that each 1 SD increase in FT3 was associated with a 20% lower risk of incident depression in CHD patients [OR = 0.8, 95% CI (0.67, 0. 96)], and similar results were observed in the FT3 quintile stratified analysis, where the lowest risk of incident depression was observed in CHD patients in the FT3 quartile (4.98-5.34 pmol / L),And the test for trend among each aliquot group was significant (P < 0.05) in univariate analysis (unadjusted). Conclusions Serum FT3 levels were relatively decreased in patients with CHD comorbid depression and the decrease level of FT3 was more significant in major depression group.
FT3 may serve as a potential biochemical marker for depression in patients with CHD, and thyroid function evaluation is recommended in patients with CHD comorbid depression.

Prevalence of Helicobacter pylori infection and associated risk factors among children in China: a Meta-analysis

LI Wen-hong, LI Zi-wei, WANG Na, YIN Jia-xiang

ObjectiveTo obtain the infection prevalence of Helicobacter pylori(H. pylori)among children in China, and to estimate the associated risk factors of Helicobacter pylori infection. MethodsLiteratures onH. pylori infection among Chinese children were collected based on search strategies, database was established from the extracted data, and meta-analysis was performed using R software. ResultsA total of 826 articles were retrieved, thirty-seven papers with 40786 children were included in the meta-analysis, which showed prevalence of H. pyloriamong children in China was 30.31%[95%CI(25.72%, 35.10%)]. Subgroup and single factor meta-regression revealed H. pyloriprevalence was different among different group of regions, the level of economy, published timeand type of test methods, and then the level of economy has influence on H. pyloriinfectionrate(β=0.063,P=0.002). Meta-analysis of associatedfactors indicated poor living conditions, receiving pre-chewed food in early childhood, chewing fingers or toys, sharing toiletries, and history of children and family member with gastrointestinal symptoms wererisk factors, and that washing hands regularly, urban children (compared with ruralchildren) were protective factors. Meanwhile, the H. pyloriinfection rate gradually increased with the age of children(χ2Trend=416.92,P<0.001). ConclusionPrevalence of H. pyloriamong children in China was about30%, and the infection rate increased with the age of children. Childrenin rural and economicbackward areas have a higher risk of H. pylori infection, and therefore screening andhealthpromotionin such areas should be strengthened.

A method for measuring loop gain and its clinical significance in patients with obstructive sleep apnea

DING Ning, ZHANG XI-Long

Anatomic and non-anatomic factors together lead to obstructive sleep apnea (OSA). More and more attention has been paid to the non-anatomic pathogenesis of OSA in recent years. The non-anatomic parameters for evaluating thrapteutic effect inculding critical closing pressure, arousal threshold, loop gain and dilator muscle function, namely PALM. It has been found loop gain (LG) and associated parameters can predict and explain some pathogenesis and efficacy of continuous positive airway pressure therapy of OSA. LG is the amount of increase in ventilatory drive that occurs for a given reduction in ventilation. Higher LG always leads to hypocapnia and inhibition of upper airway respiratory drive. This paper inroduced a method for measuring LG and its clinical significance in patients with OSA.

Risk Factors and Outcomes of Cognitive Frailty in Hospitalized Patients

YAN Xue-dan, CHEN Shan-ping, ZHOU Li-hua, WANG Ling-xiao, YANG Yong-xue, REN Yan

Objectives To investigate the prevalence of cognitive frailty in the elderly inpatients with comorbidities, related risk factors, and to analysis the mortality risk of the elders with cognitive frailty. Methods This is a retrospective cohort study. The general demographic characteristics, disease status, nutritional status, physical function status, cognitive function status and other information was collected from 554 elderly people aged 60 and above who were hospitalized in ACE Unit of Geriatrics Department of our hospital between August 2015 and February 2018. According to whether they had both frailty/pre-frailty and cognitive impairment, the patients were divided into non-cognitive frailty group (466 cases) and cognitive frailty group (88 cases). The general demographic characteristics and clinical data were compared to understand the distribution of cognitive frailty, and the risk factors of cognitive frailty were analyzed. Subjects were followed up by telephone in January 2020, to calculate the total mortality during the whole follow-up period and to analysis whether the patients with cognitive frailty was at a higher risk of death. Results A total of 670 elderly patients were admitted, and 554 of them met the inclusion criteria. 15.9% (88/554) of the elderly inpatients with comorbidities had cognitive frailty. Compared with the non-cognitive frailty group, patients in cognitive frailty group were older, had lower educational background and family care scores, had more patients with malnutrition, depression, ADL independence and balance dysfunction (P＜0.05);Using cognitive frailty as the dependent variable, multivariate Logistic regression analysis showed that malnutrition (OR=3.094, 95%CI=1.499-6.383; P＜0.05), balance dysfunction (OR=3.004, 95%CI=1.341-6.729; P＜0.05) and family care dysfunction (OR=0.843, 95%CI=0.719-0.989; P＜0.05) were independent risk factors of cognitive frailty. During the follow-up period, a total of 410 patients survived, 112 patients died and 32 patients lost in the follow-up. Compared with the survival group, the death group had older age, had lower scores of BMIand MMSE, higher scores of frailty, CCI, more patients with malnutrition, ADL independence, balance dysfunction, congestive heart failure, and diabetes(P＜0.05). Cox regression analysis of 554 hospitalized elderly patients with all-cause mortality showed that patients with cognitive frailty were associated with a higher risk of death(HR=1.967, 95%CI=1.293-2.994; P＜0.05). Conclusion Malnutrition, balance dysfunction and less of family care are independent risk factors for cognitive frailty. Older patients with cognitive frailty are at higher risk of mortality.

The effect of nutritional factors for antibody titer of Hashimoto's thyroiditis#br#

Wan Huina, Zhang Guoyu, Wan Hong, Fu Yu, Wang ZeJin , Yan Shuxun, Wang Ying

The greatest risk of Hashimoto's thyroiditis is that it contributes to hypothyroidism, which is also the primary cause of hypothyroidism. Hypothyroidism may increase the morbidity of physical and mental related diseases, especially myxedema coma. The thyroid antibodies of Hashimoto's thyroiditis not only plays an important role in diagnosis, but also associated with prognosis significantly. A large number of literatures at domestic and abroad suggests that selenium can effectively reduce thyroid antibodies (mainly refers to TPOAb、TgAb). However, the clinical efficacy of selenium supplement is controversial currently. The present study was to review the progress over the past years and analyzed the critical nutritional factors that reduce thyroid autoantibody titers, such as moderate iodine intake, vitamin D Supplementation, iron Supplementation, and obesity.

Study on the relationship hemodynamic changes and bronchopulmonary dysplasia in preterm infants

Objective To investigate the correlation between hemodynamic indexes and bronchopulmonary dysplasia (BPD) in premature infants, and to determine whether the blood lactic acid value, mean arterial pressure (MAP) and pulse perfusion index (PI) have predictive value for the development of BPD.Methods From September 2018 to December 2020, 161 preterm infants with gestational age < 32 weeks in neonatal intensive care unit of Xinxiang Central Hospital were selected as the study subjects, and their basic data were collected. Dynamic PI values of all preterm infants were monitored by Masimo Radical 7 (USA) blood oxygen saturation monitor.PI values were continuously recorded at 1h, 12h, 24h, 48h, 72h, 96h, 5d, 6d and 7d after birth, and blood lactic acid values were recorded at 1h, 12h and 24h after admission. According to the Neonatal Critical illness Score (NCIS), 33 children with critical and extremely critical conditions were selected for invasive blood pressure monitoring.The mean arterial pressure (MAP) at 1h, 12h and 24h were recorded.Preterm infants were divided into BPD group and control group according to the occurrence of BPD.Results Among 161 subjects, 65 were diagnosed with BPD and 96 were not diagnosed with BPD. The prevalence of BPD was 40.3%.(1) There were statistically significant differences in PI values at 1h, 12h and 24h after birth between BPD group and control group (P < 0.05).(2) The lactic acid value of BPD group and control group at 1h after birth had statistical significance (P < 0.05).(3) There were significant differences in neonatal asphyxia, NRDS, neonatal pneumonia and ROP between the two groups (all P < 0.05), and the incidence of neonatal asphyxia, NRDS, neonatal pneumonia and ROP in the BPD group was higher than that in the control group.(4) ROC curve analysis between PI, lactic acid value and BPD showed that the areas under the curve predicted by THE lactic acid value at PI1h, PI12h, PI24h and 1h postnatal were 0.847, 0.776, 0.695 and 0.762, respectively.Conclusion The hemodynamic changes are correlated with the occurrence of BPD. The PI value within 24 hours after birth of preterm infants with gestational age < 32 weeks is of certain value for the early prediction of BPD, but further monitoring is still needed.

Single nucleotide polymorphisms in the mitochondrial displacement Loop and age-at-onset of gastric cancerWANG

BackgroundThe incidence and mortality rates of gastric cancer have remained high for a long time. The situation of prevention and control is grim, and the age of onset is getting younger gradually. However, there are few reports aboutpredicting the age-at-onset of gastric cancer. Objective To investigate the association of single nucleotide polymorphisms (SNPs)in the displacement loop ( D-Loop ) of mitochondrial DNA ( mtDNA ) and age-at-onset in gastric cancer patients. Methods 150 patients with gastric cancer confirmed by gastroscopy and pathology in the Department of Gastroenterology of the Fourth Hospital of Hebei Medical University from July 1, 2007 to December 31, 2008 were selected.The mitochondrial DNA was extracted fromthe peripheral blood of gastric cancer patients, the target fragment was amplified by PCR, and the D-Loop region of mitochondria was sequenced. Kaplan Meier method draws the onset age survival curve of patients with gastric cancer, which is tested by log rank method. Cox proportional hazards model is used to analyze the independent risk factors of the onset age of patients with gastric cancer.ResultsLog-rank test results showedthat the SNPs of 153 in mtDNA D-loop region was related to the age-at-onset. The average age-at-onset patients with 153G genotype was 48.000±5.348, and that of patients with 153A genotype was 60.111±0.794. The age-at-onset of patients with 153G genotype was significantly earlier than that of patients with 153A genotype, and the difference was statistically significant (χ2=7.757, P=0.005). The Cox proportional hazards model showed that the polymorphism of nucleotide 153 in the mtDNA D-loop was an independentpredictor of age-at-onset of gastric cancer (HR=0.320, 95%CI[0.137-0.744]，P=0.008).ConclusionsSNPs in the D-Loop may prove effective for predict age at onset in gastric cancer patients. Analysis of genetic polymorphisms in the D-Loop can help identify gastric cancer patient subgroups at high risk of early onset.

Construction and Application ofInformation Based Multidisciplinary Management Model forOsteoarthritis Patients in Community

Background Osteoarthritis has a high rate of disability and deformity, which can also be associated with a variety of physical and mental diseases. However, the early symptoms of the disease are not obvious. At present, there are problems in the management of community osteoarthritis such as uncoordinated management, imperfect method and system. Objective To construct and evaluate an information-based multidisciplinary management model for osteoarthritis patients in community, to promote the management of community osteoarthritis patients and improve the prognosis of patients. Methods（1）First we built a multidisciplinary model of management for community osteoarthritis patients, including a patient hierarchical management process based on risk factor stratification, the multidisciplinary management team and its division of diagnosis and treatment; We further constructed a multidisci plinary management process based on informatization, and completed the development of information software.（2）From July 2019 to July 2020,80 patients with knee osteoarthritis who attended the general outpatient clinics of Dinghai and Daqiao Community Health Service Centers in Shanghai, and the orthopedics outpatient clinics of Yangpu District Central Hospital were randomly assigned into multidisciplinary management groups and General management group, with 40 patients in each group. The patients in general group were given conventional treatment; the patients in multidisciplinary group were given information-based multidisciplinary management.. We comprehensively evaluated all the 80 patient’s by the visual analogue scale (VAS), osteoarthritis index score (WOMAC),the simplified scale of arthritis quality of life measurement scale (AIMS2),health literacy management scale (HeLMS), and BMI before and after 12 weeks of management.ResultsAfter 12 weeks of treatment,the VAS and WOMAC score of both the multidisciplinary and general groups went down, and the health literacy scores were higher after treatment than before. The difference was statistically significant (P<0.05). The BMI of the patients in the multidisciplinary group decreased after the treatment, the difference of which was statistically significant (P<0.05)while the difference in the ordinary group was not statistically significant (P>0.05). Compared with the general group, the health literacy score of patients in the multidisciplinary group increased significantly, and the difference was statistically significant (P<0.05).The VAS score and WOMAC score decreased more significantly, and the difference was statistically significant (P<0.05). The BMI value decreased more significantly, and the difference was statistically significant (P<0.05).ConclusionThrough the application and evaluation of the information-based multidisciplinary management model for osteoarthritis patients in community, we find that it can more significantly reduce the patients’ joint pain, effectively control their weight, improve their ability of daily living and health literacy, improve the quality of life of patients, and delay the progress of the disease.

ResearchProgressofthePrevention and TreatmentofMetabolicDiseasesBasedonShortChain Fatty Acids

Zeng lin, ZhangPeng-xiang, Huang qian, Wang Gao-xiang, LiHui-lin\

Shortchainfattyacids(SCFAs) are a class of saturated fatty acids containing 1-6 carbon atoms, mainly produced by specific flora in the intestine through fermenting dietary fiber, which plays an significant role in maintaining the stable state of the intestinal environment. The prevention and treatment of the above-mentioned metabolic diseases by regulating SCFAs has become a hot research topic. This review summarizes the research progress of the prevention and treatment of metabolic diseases based on SCFAs.

LI Xiang-jun, BIAN Qi-juan, SHI Ping, WangZhonghua

AbstractObjective: Analyze the concentration of health expenditures for T2MD under the basic medical insurance system, and examine the demographic characteristics and health-seeking behaviors of T2MD with the highestor lowest health expenditures.Methods: Using data on health expenditures of T2MD patients in a certain city in Jiangsu Province, the data was analyzed with descriptive statistical methods.Results: The health expenditures of T2MD has a high degree of concentration, and the concentration of resident medical insurance patients is higher than that of employee medical insurance patients. The T2MD patients with top 10% health expenditures had higher proportion of inpatient and health service utilization in tertiary hospitals. There are significant differences in the concentration of health expenditures of patients of different genders and ages.Conclusion:The high concentration of health expenditures shows that T2MDof top 10% may have problems such as excessive medical treatment and moral hazard. In addition, the reform of medical insurance system should pay attention to T2MD with low health expenditures to improve access to health services.

Research progress in the treatment and prevention of irritable bowel syndrome

GAO Lian, HUANG Xiaoming, WU Qingming

Irritable Bowel Syndrome (IBS) is a chronic disease of gastrointestinal dysfunction. The main clinical symptoms are abdominal pain and abnormal bowel movements. Clinically, IBS is divided into four types: constipation type IBS (IBS-C), diarrhea type IBS (IBS-D), constipation and diarrhea mixed type (IBS-M) and other IBS. Environmental factors and host differences are the causes of IBS, but the exact pathogenesis is still unclear. The diagnosis, treatment, and prevention of IBS are clinically tricky, requiring personalized treatment methods, including both physical and psychological aspects of the patient, including professional guidance and dietary intervention, etc. The treatment methods include non-drug therapies and/or drugs There are two therapies. IBS-D type treatment drugs mainly include antibiotics and peripheral opioid agonists. The first-line treatment of IBS-C mainly includes fillers and osmotic laxatives, while patients with recurrent episodes use lubiprostone and linas. Lootide is treated conservatively. Recent studies have shown that the intestinal flora is also involved in the occurrence and development of IBS, and the use of probiotics and transplantation of intestinal microbiota may become effective measures for the treatment of IBS. This article reviews the latest mechanism, classification, current treatment and prevention strategies of the occurrence and development of IBS, as well as possible future research directions.

Application Prospect and Renal Outcomes of Novel Antidiabetic Agents in Patients with Type 2 Diabetes　

YANG Guangran

Diabetic nephropathy，a common microvascular complication of type 2 diabetes，has become one of the common causes of end-stage renal disease in China.Several randomized controlled studies conducted in recent years found that，some novel anti-diabetic agents including dipeptidyl peptidase-4 inhibitor，sodium-glucose cotransporter 2 inhibitor and glucagon-like peptide-1 receptor agonist，have significant renal protection outcomes beside hypoglycemia effect in patients with type 2 diabetes，moreover sodium-glucose cotransporter 2 inhibitor and glucagon-like peptide-1 receptor agonist were recommended by clinical guideline or consensus in the prevention and delay of diabetic kidney disease.This paper summarized and analyzed the outcome of novel anti-diabetic agents in renal protection outcomes in patients with type 2 diabetes based on recent clinical guidelines and related randomized controlled trials，in order to provide a reference for the better application of novel anti-diabetic agents in practice.

Application Prospect and Renal Outcomes of Novel Antidiabetic Agents in Patients with Type 2 Diabetes　

YANG Guangran

Application Prospect and Renal Outcomes of Novel Antidiabetic Agents in Patients with Type 2 Diabetes　

YANG Guangran

The Interpretation about International Consensus on the Prediction and Identification of Long-term Damage to Survivors of Severe Illness by the Critical Care Medical Association in 2020

YIN Yue，DENG Yufang，SUN Yajun，ZHENG Gaigai，CHEN Shaoru，ZHANG Hongmei，WANG Peixi — 2021-04-20 00:00:00.0

This paper interprets "International Consensus on the Prediction and Identification of Long-term Damage to Survivors of Severe Illness by the Critical Care Medical Association"，published by the American Society for Critical Care Medical Association in November 2020.On the basis of the second "Improving Long-term Outcomes on Discharging from the Hospital for Intensive Care Survivors：a Report of Stakeholder Meetings" in 2012，three new aspects including how to identify high-risk survivors，which assessment and screening tools to use，and the timing of screening for severely ill survivors have been newly added.Considering the fact that there are no guidelines or consensuses specifically on the prediction and identification of long-term damage of survivors of severe illness，the interpretation of the "International Consensus on the Prediction and Identification of Long-term Damage to Survivors of Severe Illness by the Critical Care Medical Association" was intended to provide practical advice to clinical health care workers in China，hoping to improve the outcome of critical care for survivors of severe illness in this study.

Comparison and Interpretation of Chinese and British Guidelines about Therapeutic Drugs for Alzheimer's Disease　

ZHANG Xiaolin，ZENG Jiawei，CHEN Xiao，YUAN Gang — 2021-04-20 00:00:00.0

The clinical symptoms of AD are various，mainly about cognitive function impairment，imposing huge mental and economic burdens on patients and their families.So far，there is no curative treatment for AD.It's widely admitted that acetylcholinesterase inhibitors and memantine could alleviate symptoms of AD，but the clinical efficacy，safety and cost-effectiveness of these drugs are different.To provide safe，effective and inexpensive pharmaceutical treatments for AD，in 2018，China issued the updated Chinese Guidelines for Diagnosis and Management of Cognitive Impairment and Dementia （Ⅱ）：Diagnosis and Treatment of Alzheimer's Disease，with explanation and elaboration of the diagnosis，drug therapies and their clinical efficacies for AD，and the U.K.'s NICE issued Evidence-based Recommendations on donepezil，galantamine，rivastigmine and memantine for the treatment of Alzheimer's disease，with comparative analysis of these common therapeutic drugs for AD in terms of clinical efficacy and pharmacoeconomics.We compared the similarities and differences of drug therapies for AD between these two guidelines，aiming to offer a reference for clinicians or primary care physicians prescribing drugs for AD.

Sedentary Behavior and the Risk of Depression in Patients with Type 2 Diabetes Mellitus

WANG Ya，SUN Juan，ZHANG Xiaoyi，HE Hong，GAO Jing，YIN Lirong — 2020-08-05 00:00:00.0

Background　The adverse effects of sedentary behavior on physical health have been widely studied，but its impact on mental health is rarely reported. The prevalence of sedentary behavior in patients with type 2 diabetes mellitus（T2DM） is relatively high，so it is of great significance to explore the relationship between sedentary behavior level and depression risk in this group. Objective　To explore the correlation between sedentary behavior and depression risk in patients with T2DM，providing a theoretical basis for clinical delivery of health education intervention for such patients. Methods　From January to November 2018，a questionnaire survey was conducted in a convenience sample of 410 T2DM outpatients from the endocrine outpatient clinic of a grade A tertiary hospital in Nantong area，for collecting the data about socio-demographic information，history of disease，subjective assessment of sedentary behavior，depression risk assessed by the Beck Depression Inventory 2nd Edition（BDI-Ⅱ），and physical activity assessed by the International Physical Activity Questionnaire-Short Form（IPAQ-SF）. Correlation analysis and Logistic regression model were used to analyze the relationship between sedentary behavior level and depression risk. Results　A total of 402（98.1%） cases returned responsive questionnaires. The average daily time spent in sedentary behavior was （5.62±2.60）h in all the respondents，and was at least 5 hours in 265（65.9%） cases. The sedentary behavior level differed significantly by average personal monthly income，body mass index（BMI），the number of comorbidities，glycosylated hemoglobin（HbA1c），total cholesterol（TC），triacylglycerol（TG），low-density lipoprotein cholesterol（LDL-C），BDI-II score and physical activity level（P<0.05）. Correlation analysis showed that sedentary behavior level was positively correlated with the number of comorbidities，diastolic pressure，BMI，waist circumference and depression level，and negatively correlated with physical activity level（P<0.05）. After controlling for socio-demographic factors consisting of age，sex，marital status，employment status，prevalence of smoking，drinking，and medical insurance，educational level，average personal monthly income，course of T2DM，number of complications，number of comorbidities，family history of T2DM，depression history，types of drug therapies，insulin therapy，systolic blood pressure，diastolic blood pressure，BMI，waist circumference and physical activity level，partial correlation analysis showed that sedentary behavior level was still positively correlated with depression level（pratial correlation coefficient was 0.637，P<0.001）. Stepwise Logistic regression analysis showed that the OR（95%CI） of depression risk in sedentary group was 29.68（16.11，54.68），and was 64.55（28.40，146.72） after adjusting for the above-mentioned socio-demographic variables. Conclusion　There is a positive correlation between sedentary behavior level and depression risk in patients with T2DM. Clinical workers should pay attention to the health education for reducing sedentary behavior in such patients.

Research Progress on the Leadership of Managers in Primary Medical Institutions

YANG Sen，SHI Jianwei，JIN Hua，CHEN Chen，WANG Zhaoxin，YU Dehua1

With the shift of the focus of medical strategy to the development of community general practice，the complexity of medical environment and the higher requirements of community population health management pose a greater challenge to the leadership of managers in primary medical institutions. However，compared with foreign countries，the theoretical and practical research on the leadership of managers in primary medical institutions in China is very scarce. Based on the contradiction between actual needs and actual lacks，this paper expounds the development process of medical administrators' leadership at home and abroad，summarizes the research ideas and effects of domestic and foreign medical institution managers' leadership，also this paper focuses on the progress and shortcomings of the research on the leadership of medical managers in China，and analyzes the necessity of carrying out the leadership research of managers in general departments at present，which put forwards policy recommendations and theoretical support for the future leadership development and research in primary medical institutions.

Significance and Challenges of Patients' Online Access to Their Electronic Health Records in Community Health Service Centers

PANG Hui，YAO Mi，GAO Chang，CHI Chunhua

Electronic health record（EHR） is one of the most important means of informatization in the development of community health. On June 20，2018，the National Health Commission of the People's Republic of China（formerly the National Health and Family Planning Commission of the People's Republic of China） issued relevant documents requiring community health service centers to gradually open EHRs to individuals. To investigate the potential impact and significance，this paper reviewed the history and development of EHRs in community health service centers at home and abroad as well as related research on the implementation of open EHRs to individuals. It was found that the current utilization rate and maintenance rate of EHRs in China are low，and they have not yet played their due value. The future development direction of promoting patients' online access to their EHRs should include health reminders，doctor-patient communication and self-management，which will significantly improve health outcomes，promote patient-centered care and increase patient satisfaction. However，there are still many problems that need solving，such as national policy support，technical and financial support，personnel allocation and information security risks.

nlightenment of the Typical Models of Integrated Delivery System Abroad to the Development of Integrated Health Management System in China

XIONG Mei，WU Jia，LIU Lixia，LIAO Xiaoyang，ZHAO Qian — 2020-08-15 00:00:00.0

Against the backdrop of aging society，changing disease spectrum and furthering the implementation of Healthy China 2030 strategic blueprint measures，China has ushered in a new era of healthy China construction，during which transforming a regional medical consortium into an integrated health management system（IHMS） via upgrading，and the development of IHMS tend to be inevitable. We analyzed the typical models of integrated delivery system abroad at the micro，meso and macro levels with foci on the historical background，specific measures and achievements，and summarized the successful experience. And based on this，we put forward the following recommendations for addressing the challenges faced by the healthcare system and for improving the development of IHMS in China：integrating health-related factors as many as possible to benefit the whole population through the whole life；strengthening the healthcare talent system development with great emphasis on fostering primary care workers；giving priority to the healthcare needs of key population groups and developing interdisciplinary teams；forming high-efficient healthcare delivery modes；enhancing the informatization construction；developing rational and effective incentive mechanisms.

Significance and Challenges of Patients' Online Access to Their Electronic Health Records in Community Health Service Centers

PANG Hui1，YAO Mi2，3，GAO Chang1，CHI Chunhua1*

2017-03-20 00:00:00.0