Table of Content

20 May 2018, Volume 21 Issue 15

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Monographic Research

Interpretation of NCCN Clinical Practice Guidelines in Oncology：Distress Management（Version 1.2018）　

QI Wei-jing1，HU Jie1*，LI Lai-you2*

2018, 21(15):  1765-1768.  DOI: 10.3969/j.issn.1007-9572.2018.00.121

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Psychosocial problems of cancer patients are attracting more and more attention.Psychosocial care of cancer patients is becoming more and more recognized as part of the whole medical care.This paper interprets the NCCN Clinical Practice Guidelines in Oncology：Distress Management（Version 1.2018） mainly from four aspects of overview of the guidelines，screening for distress in cancer patients，treatment of distress in cancer patients，and updated interpretation of the new guidelines，in order to provide useful help for clinical oncology care providers.

Research Progress of Influencing Factors of Cancer-related Sarcopenia　

QI Qian1，WU Bei-wen2*，FEI Xiao-yan1

2018, 21(15):  1769-1774.  DOI: 10.3969/j.issn.1007-9572.2017.00.185

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Sarcopenia is a complicated clinical syndrome characterized by the loss of skeletal muscle mass and dysfunction.With the higher morbidity and mortality of cancer around the world，the occurrence and development of cancer-related sarcopenia are related to many factors.Its pathogenesis is complicated，and there is no effective standard treatment of cancer-related sarcopenia now.At present，the study of cancer-related sarcopenia is still in the early stage around the world.This paper reviewed the influencing factors，such as age，physical activity，nutrition status，and cancer therapy，to strengthen the assessment and screening of cancer-related sarcopenia，and provide objective basis for its prevention strategies in the future.?

Recent Developments in the Systemic Clinical Outcome and Routine Evaluation　

WEI Yun，LU Xiao-qin*

2018, 21(15):  1775-1778.  DOI: 10.3969/j.issn.1007-9572.2017.00.187

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The Systemic Clinical Outcome and Routine Evaluation（SCORE） is a self-report family function assessment instrument for routine use in clinical settings to assess client and service outcomes.Although it has only less than 10 years of history，it has become a focused research theme for some foreign experts in family medicine，psychology，sociology and other areas，and has been confirmed as a viable instrument for clinical use.In this paper，we introduced the development of SCORE and analyzed the characteristics of each version of SCORE.

Impact of Diabetes Mellitus on Lung Cancer and Its Biological Mechanism：a Literature Review　

CHENG Xiao-long1，HAN Yi-ping1，2*

2018, 21(15):  1779-1784.  DOI: 10.3969/j.issn.1007-9572.2018.00.073

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 Lung cancer is the most common cancer and the leading cause of cancer-related deaths worldwide.With the aging of population and changes in eating habits，the incidence of diabetes mellitus in recent years increased year by year.The phenomenon of coexistence of lung cancer and diabetes mellitus in the same individual is not infrequent.Studies have shown that diabetes and glucose-lowering therapies can influence the risk and prognosis of lung cancer，but its specific impact and mechanism are not yet fully clear.Based on the review of the relevant literature，we summarized the epidemiological characteristics and common risk factors of both lung cancer and diabetes mellitus，impact of diabetes and glucose-lowering drugs on lung cancer and the relative mechanism.

Health-related Quality of Life and Utilization of Health Services in Patients with Diabetes Alone versus Those with Comorbid Diabetes Mellitus：a Comparative Study　

SONG Chen-xiao，XU Ai-jun*

2018, 21(15):  1785-1789.  DOI: 10.3969/j.issn.1007-9572.2018.00.147

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Objective　To compare the health-related quality of life and health service utilization between patients with diabetes alone and those with comorbid diabetes mellitus.Methods　The data were derived from part of the national survey of health service utilization among residents in 2016.A sample of 517 diabetic patients in 4 provinces of China were enrolled.Their prevalence of chronic comorbidities，demographic characteristics，health-related quality of life，diabetes attack during the survey period and healthcare seeking behavior were analyzed.Results　Among the 517 cases，139（26.9%） had diabetes only，while other 378（73.1%） had comorbid diabetes mellitus.These two groups had significant differences in distribution of age，employment status，and commercial health insurance status（P<0.05）．Compared with those with diabetes only，comorbid diabetes mellitus patients were more likely to suffer from problems associated with mobility，self-care，usual activities，pain/discomfort，anxiety/depression（P<0.05），and they scored much lower in terms of self-rated general health status on the survey day（P<0.05）．Of the 475 with diabetes attack during the survey period，149（31.4%） were found with self-medication behavior or continued the treatment prescribed previously（43 with diabetes，106 with comorbid diabetes mellitus），326（68.6%） sought outpatient treatment（85 with diabetes，241 with comorbid diabetes mellitus）．The type of visited medical institutions differed significantly between diabetic patients and comorbid diabetes mellitus patients seeking outpatient treatment（P<0.05），while the number of visits and services did not（P>0.05）．Conclusion　Comorbid diabetes mellitus patients had poorer health-related quality of life compared with those with diabetes alone.Among those who did not seek outpatient treatment，patients with diabetes alone were more likely to carry out self-medication compared with comorbid diabetes mellitus patients.Of those seeking outpatient treatment，patients with diabetes alone preferred grassroots institutions instead of comorbid diabetes mellitus patients.



Therapeutic Efficacy of High-flow Nasal Cannula and Noninvasive Positive-pressure Ventilation in AECOPD Patients with Various APACHE Ⅱ Scores after Extubation　

HU Shu-li*，TANG Hao，FAN Xue-peng

2018, 21(15):  1790-1795.  DOI: 10.3969/j.issn.1007-9572.2017.00.258

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Objective　To evaluate the therapeutic efficacy of high-flow nasal cannula（HFNC） and noninvasive positive-pressure ventilation（NPPV） in patients with acute exacerbations of chronic obstructive pulmonary disease（AECOPD） and various APACHE Ⅱ scores after extubation.Methods　We enrolled 120 patients with AECOPD undergoing tracheal intubation in the Department of Critical Care Medicine，Wuhan First Hospital from December 2014 to November 2016.All patients were assigned to either Group A（APACHE Ⅱ score <12），B（APACHE Ⅱ score of 12 to 24） or C（APACHE Ⅱ score >24） according to the APACHE Ⅱ score，with 40 cases in each group.The patients in each group were then divided into Subgroups Ⅰ（undergoing HFNOT，n=20） and Ⅱ（undergoing NPPV，n=20） using a random number table.The patients' general characteristics were recorded，along with the respiratory parameters and the incidence of endpoints and complications.Results　There were no interactionswith pH value，oxygenation index（OI），partial pressure of carbon dioxide（PaCO2），respiratory rate（RR） and blood lactic acid（Lac） concentration in Group A in terms of the treatment option and duration（P>0.05），and the main effect was not significant in relation to pH value，OI，PaCO2，RR or blood Lac concentration in terms of the treatment option and duration（P>0.05）．In addition，there was no significant difference in the occurrence rate of re-intubation and atelectasis between Subgroups Ⅰ and Ⅱ in Group A（P>0.05），and a significantly lower incidence rate of abdominal distention was seen in Subgroup Ⅰ compared with Subgroup Ⅱ（P<0.05）．In Group B，there were no interactions with pH value，OI，RR or blood Lac concentration in terms of the treatment option and duration（P>0.05），and an interaction was seen with PaCO2（P<0.05），while the main effect was not significant in relation to pH value，OI，RR or blood Lac concentration in terms of the treatment option and duration（P>0.05），but significant in relation to PaCO2（P<0.05）．In addition，the occurrence rate of re-intubation was not significant difference in Subgroup Ⅰ and Subgroup Ⅱ（P>0.05），and a significantly lower incidence rate of abdominal distention and atelectasis was seen in Subgroup Ⅰ compared with Subgroup Ⅱ（P<0.05）．In Group C，there were no interactions with pH value or blood Lac concentration in terms of the treatment option and duration（P>0.05），and there were interactions with OI，PaCO2 and RR（P<0.05）．The main effect was not significant in relation to pH value or blood Lac concentration（P>0.05），but significant in relation to OI，PaCO2 and RR（P<0.05），in terms of the treatment option and duration.Moreover，the occurrence rate of re-intubation was significantly higher in Subgroup Ⅰ than in Subgroup Ⅱ（P<0.05），and a significantly lower incidence rate of abdominal distention and atelectasis was seen in Subgroup Ⅰ compared with Subgroup Ⅱ（P<0.05）．Conclusion　There was no significant difference in the preventive efficacy of sequential therapy with HFNC and NPPV for respiratory failure in elderly AECOPD patients with APACHE Ⅱ scores of <24 after extubation；however，the preventive efficacy of HFNC was inferior to NPPV for respiratory failure in elderly AECOPD patients with APACHE Ⅱ scores of > 24 after extubation.


Associated Factors for Cancer-related Fatigue in Cancer Patients Receiving Chemotherapy：a Study Based on Structural Equation Model　

ZHANG Shu-yun1*，ZHANG Yan-ping1，CAI Chun-lian1，CHEN Shao-lin2，YANG Fang1，ZHOU Xiao-yan1

2018, 21(15):  1796-1800.  DOI: 10.3969/j.issn.1007-9572.2018.00.123

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Objective　To investigate the status and associated factors for cancer-related fatigue（CRF） among hospitalized patients receiving chemotherapy，proving a reference for oncology nurses for delivering individualized interventions for such patients.Methods　A cross-sectional survey was conducted in a convenience sample of 674 hospitalized cancer patients receiving chemotherapy from the First People's Hospital of Huaihua during July 2015 to June 2016 by a self-developed Baseline Characteristics Questionnaire，Piper Fatigue Scale（PFS），Morse Fall Scale（MFS）（Chinese version），Body Movement Ability Classification Scale（BMACS），and Numerical Rating Scale（NRS）（Chinese version）．Correlations of PFS score with age，MFS score，BMACS score，and NRS score as well as the associated factors for CRF were analyzed.Results　A total of 674 questionnaires were distributed，and 668 valid questionnaires were collected，with an effective recovery rate of 99.1%.PFS score was positively correlated with age，MFS score，BMACS score，NRS score（r=0.236，0.514，0.216，0.129，all P<0.001）．Multiple linear regression and structural equation analyses revealed that age，clinical department，risk of falls，body movement ability，pain，and accompanying care were the associated factors of CRF during chemotherapy.Conclusion　Age，clinical department，risk of falls，body movement ability，pain accompanying care are the associated factors of CRF during chemotherapy.Healthcare workers should pay attention to CRF among cancer patients receiving chemotherapy.



Change and Correlation of Serum Estrogen and miR-365 Expression Levels in Non-small Cell Lung Cancer Patients　

LI Shu-po，LI Peng*，YU Han-dong，ZHAO Jing

2018, 21(15):  1801-1804.  DOI: 10.3969/j.issn.1007-9572.2017.00.237

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Objective　To investigate the change and correlation of serum estrogen and miR-365 levels in non-small cell lung cancer（NSCLC） patients，and to provide new insight for the early diagnosis and treatment monitoring of this disorder.Methods　Fifty-seven patients who underwent resection of primary NSCLC in the Affiliated Renhe Hospital of China Three Gorges University from March 2015 to April 2016 were selected as the NSCLC group；50 healthy volunteers who received physical examinations in the hospital during the same period were selected as the control group.General information of the participants was collected，and the expression levels of serum estrogen and miR-365 were determined.The correlation between serum estrogen levels and miR-365 expression levels were then analyzed.Results　The serum estrogen level in the NSCLC group was significantly higher than that in the control group（t=2.73，P=0.01），while miR-365 expression level in the NSCLC group was significantly lower than that in the control group（t=2.65，P=0.02）．In the NSCLC group，patients with squamous cell carcinoma and adenosquamous carcinoma had higher expression of miR-365 than patients with adenocarcinoma（P<0.05），patients with poor differentiation was associated with a lower expression level of miR-365 than patients with high differentiation（P<0.05）．In the NSCLC group，for the TNM stage，patients in stages Ⅰ-Ⅱ had a higher expression level of miR-365 than patients in stages Ⅲ-Ⅳ（P<0.05）．In the NSCLC group，the expression level of miR-365 in patients with lymph node metastasis was lower than those without lymph node metastasis（P<0.05）．Moreover，in the NSCLC group，the serum estrogen level showed a negative correlation with the miR-365 expression level（r=-0.574，P=0.02）．Conclusion　Serum estrogen levels increased and miR-365 expression levels decreased in patients with NSCLC.The serum estrogen level was negatively correlated with the miR-365 expression level.Both serum estrogen and miR-365 levels were important biomarkers for the early diagnoses of NSCLC and the prediction of patient outcomes.


Clinical Efficacy of Meglumine Adenosine Cyclophosphate Combined with Low Temperature Adjustable Sodium Hemodialysis for Intradialytic Hypotension　

PU Hong-mei1，FENG Jin-hong2*，LIU Bing-cheng2，XU Jing1

2018, 21(15):  1805-1808.  DOI: 10.3969/j.issn.1007-9572.2017.00.225

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Objective　To investigate the clinical efficacy of meglumine adenosine cyclophosphate（MAC） combined with low temperature adjustable sodium hemodialysis（LSHD） for intradialytic hypotension（IDH）．Methods　We enrolled 28 patients with recurrent IDH who were admitted to the Blood Purification Center，Affiliated Hospital of Xuzhou Medical University and the Third Affiliated Hospital of Xuzhou Medical University from June to December 2015 and who met the inclusion criteria.All patients underwent either conventional hemodialysis（CHD），LSHD，or MAC combined with LSHD（M-LSHD） three times a week for 8 weeks，respectively.Changes in blood pressure and the incidence of hypotension were recorded during hemodialysis.Electrolyte（K+，Na+，Ca2+），serum urea nitrogen，serum creatinine，and N-terminal pro-brain natriuretic peptide（NT-proBNP） levels were also measured，and adverse effects were observed before and after the final hemodialysis for each treatment.Results　There was no significant difference in systolic or diastolic blood pressure prior to hemodialysis among the three treatments（P>0.05）．The lowest systolic and diastolic blood pressures during hemodialysis were significantly greater and the incidence of hypotension was significantly lower in patients undergoing M-LSHD compared with CHD or LSHD（P<0.05）．There were no significant differences in serum K+，Na+，Ca2+，urea nitrogen，or creatinine levels between before and after the final hemodialysis for each treatment（P>0.05），but NT-proBNP levels were significantly lower in patients undergoing M-LSHD compared with the other procedures both before and after hemodialysis（P<0.05）．In addition，no patients showed intolerance to low temperature，such as by chilling or shivering，and no palpitation or dizziness occurred following intravenous injection of MCA.Conclusion　M-LSHD may reduce the incidence of IDH by improving cardiac function in hemodialysis patients，with no apparent adverse reactions.These results have important clinical implications.


Feasibility of Rapid Diagnosis of Premature Rupture of Membranes with Amniotic Fluid Monitoring Pad　

HUANG Qian-qian1，2，LUO Pu-ying1，XIONG Yuan-huan2*

2018, 21(15):  1809-1812.  DOI: 10.3969/j.issn.1007-9572.2017.00.256

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Objective　To evaluate the clinical feasibility of rapid diagnosis of premature rupture of membranes（PROM） using amniotic fluid monitoring pad（pad method）．Methods　 We enrolled 90 pregnant women who received treatment in Department of Obstetrics and Gynecology，Jiangxi Provincial People's Hospital during June to December 2016 and divided them into group A（confirmed PROM，n=30），group B（suspected PROM，n=30） and group C（intact fetal membranes，n=30） based on the clinical manifestations and results of speculum examination.Pad method，amniotic fluid crystallization test（crystallization test），and pH determination using pH paper（pH method），and human IGFBP-1 ELISA kit（IGFBP-1 method） were all used to diagnose PROM in all cases.The sensitivity，specificity，Youden index，positive and negative predictive values of the four methods were analyzed comparatively.Results　Concretely，the sensitivity，specificity，Youden index，positive and negative predictive values of the pad method were all higher compared with both the crystallization test and pH method（P<0.05）．Conclusion　Pad method is feasible for clinical rapid diagnosis of PROM because it is simple to use（even can be used at home），owns good specificity and sensitivity，and is inexpensive.


Percutaneous Endoscopic Lumbar Discectomy versus Transforaminal Lumbar Interbody Fusion for Extreme Lateral Lumbar Disc Herniation　

ZHONG Yuan-ming1*，ZHANG Yi-sheng2，LIANG Zi-yang2，LI Jia-lang2，CHEN Zhen2

2018, 21(15):  1813-1817.  DOI: 10.3969/j.issn.1007-9572.2018.00.143

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Objective　To compare the clinical efficacy of percutaneous endoscopic lumbar discectomy（PELD） and transforaminal lumbar interbody fusion（TLIF） for the treatment of extreme lateral lumbar disc herniation（ELLDH）．Methods　Study design was retrospective.45 cases of ELLDH were enrolled based on the inclusion criteria of this study from Department of Orthopedics（Spinal Surgery），the First Affiliated Hospital of Guangxi University of Chinese Medicine from September 2014 to September 2016，including 24 treated by PELD and 21 treated by TLIF．By reviewing the medical records，we collected their demographic characteristics，results of visual analogue scale（VAS） score，Japanese Orthopedic Association（JOA） score and Oswestry Disability Index（ODI） score assessed at 5 time points（before surgery，immediately after surgery，1 week，1 month after surgery，and the last follow-up） as well as clinical response to surgery.Results　Compared with those receiving PELD，the mean duration of surgery，period of bed rest，length of stay，time needed to return to the normal daily life activities and incision length were longer，the mean amount of intraoperative blood loss and hospitalization cost were greater in patients receiving TLIF（P<0.05）．Duration and mode of surgery exerted interaction effects on VAS score and ODI score（P<0.05），but not on JOA score（P>0.05）．Duration and mode of surgery produced main effects on VAS score，JOA score and ODI score（P<0.05）．Compared with baseline，the mean VAS score and ODI score were less and mean JOA score was greater assessed at each time point postoperatively in both groups（P<0.05）．Compared with those treated by PELD，the mean VAS score and ODI score were greater，but mean JOA score was less at immediately after surgery，and at 1 week after surgery in patients receiving TLIF（P<0.05）．Excellent and good response to surgery was achieved in patients receiving PELD rather than those receiving TLIF（P<0.05）．Conclusion　PELD is a safe and effective minimally invasive surgery for ELLDH.Compared with TLIF，using it，the incision length can be less，the postoperative recovery can be rapider，and the length of stay can be shorter.Therefore，it is recommended for wide clinical application.


Effects of Transforaminal Lumbar Discectomy via Contralateral Approach on Treatment Sequestered Lumbar Disc Herniation and It's the Expression of MMP-3　

ZHANG Long，CHEN Jia，CAO Can，ZHAI Jin-shuai，HUANG Teng，SHI Li-fang，LI Xi-cheng*

2018, 21(15):  1818-1822.  DOI: 10.3969/j.issn.1007-9572.2018.00.025

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Objective　To investigate the effects of transforaminal lumbar discectomy via contralateral approach on the expression of MMP-3 among patients with sequestered lumbar disc herniation．Methods　One hundred and forty-four cases of sequestered lumbar disc herniation managed in Hebei General Hospital from January 2012 to February 2017 were recruited and randomized into the observation group receiving transforaminal lumbar discectomy via contralateral approach and the control group receiving transforaminal lumbar discectomy via ipsilateral approach with 72 in each.We collected their data about baseline characteristics，value of perioperative indices，Visual Analogue Scale（VAS），MMP-3 expression level，and efficacy evaluation results.Results　Two groups demonstrated no obvious differences in the duration of procedure and intraoperative fluoroscopy times（P>0.05）．The observation group showed lower incidence of complications（cauda equina injury，intervertebral space infection，and dural injury） compared with the control group（P<0.05）．VAS at baseline was similar in both groups（P>0.05），although it was still similar in both groups at 3 months after procedure（P>0.05），it showed a significant decrease in both groups（P<0.05）．At 3 months after procedure，the MMP-3 expression level declined substantially in both groups（P<0.05），and it was much lower in the observation group compared with the control group（P<0.05）．The observation group displayed higher proportion of patients with good to excellent responses to treatment compared to the control group（P<0.05）．Conclusion　For sequestered lumbar disc herniation，transforaminal lumbar discectomy via contralateral approach could improve the outcome by effectively relieving the pain，inhibiting MMP-3 expression level，and reducing the postprocedural incidence of complications without increasing the duration of procedure and intraoperative fluoroscopy times.


Investigation of the Efficacy and Safety of Drainage Tube Placement Using TESSYS Technology during Percutaneous Transforaminal Endoscopic Discectomy in Postoperative Treatment of Lumbar Disc Herniation　

WANG Chong1，JIANG Fei2，SONG Xing-hua1*，XU Lei-lei1，WANG Teng-fei1

2018, 21(15):  1823-1827.  DOI: 10.3969/j.issn.1007-9572.2017.00.228

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Objective　To compare the clinical efficacy and safety of TESSYS technology in the treatment of lumbar disc herniation with and without a drainage tube.Methods　From January 2015 to March 2016，110 patients with lumbar disc herniation，who underwent percutaneous transforaminal endoscopy using TESSYS technology in the Department of Bone Tumor Surgery of the First Affiliated Hospital of Xinjiang Medical University were enrolled and divided into two groups：the no-drainage group with no drainage tube（n=53） and the drainage group with a drainage tube（n=57），according to the random grouping method of region group.The postoperative drainage volume of the drainage group was observed.The operation time，intraoperative blood loss，hospitalization time，incidence of postoperative complications and the postoperative activity time were compared between the two groups.A visual analogue scale（VAS） and the Oswestry Disability Index（ODI） were completed 1 day before operation，1 day after the operation，1，3 and 6 months after the operation，and 1 year after the operation.Results　The postoperative drainage volume of the drainage group was（50±10） ml，and the duration of drainage tube placement of this group was（26.0±2.2） h.There were no significant differences in operative time，intraoperative blood loss and surgical complications between the two groups（P>0.05）．The duration of hospitalization and the time to be able to stand on the groud after the operation of the patients in the no-drainage group were significantly shorter than those of the patients in drainage group（P<0.05）．There were no correlations between treatment methods or time and the VAS score（Finteraction=2.981，P>0.05）．The effect of treatment on VAS was significant（Ftreatment=20.200，P<0.05），but the effect of time on the VAS score was not significant（Ftime=4.241，P>0.05）．The VAS for the drainage group was significantly higher than that for the no-drainage group on the first day after the operation（P<0.05）．There was no correlation between treatment method and time according to the ODI（Finteraction=2.298，P>0.05）．The treatment method and time had no significant effects on the ODI score（Fgroup=1.090，Ftime=4.391，P>0.05）．Conclusion　Use of the TESSYS technology for percutaneous transforaminal endoscopic discectomy treatment in lumbar disc herniation without drainage tube placement does not increase the incidence of complications，indeed it can reduce postoperative pain as well as shortening the duration of hospitalization and improving postoperative activity.


Value of Principle of Selective Excitation Technique and Diffusion Tensor Imaging in the Evaluation of Unilateral Lumbosacral Nerve Root Entrapment Caused by Lumbar Disc Herniation　

LI Li-yan1*，GUO Yun-zhi1，HAN Xiao-mei1，CHU Li-juan1，MA Yun-tao1，ZHOU Shun-ke2

2018, 21(15):  1827-1831.  DOI: 10.3969/j.issn.1007-9572.2017.00.239

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Objective　To explore the clinical value of magnetic resonance（MR） principle of selective excitation technique（PROSET） and diffusion tensor imaging（DTI） technique in evaluating L4-S1 unilateral lumbosacral nerve root compression caused by lumbar disc herniation（LDH） locationally and quantitatively.Methods　We enrolled 20 cases of unilateral nerve root compression within L4-S1 innervation area due to LDH diagnosed clinically and treated in Jilin City People's Hospital in 2015.MR PROSET and DTI were performed for localizing the three regions of interest（ROI） respectively at preganglionic nerve root sheath out of dural sac，the ganglion and the anterior branch of the postganglionic nerve expenditure at the external orifice of the intervertebral foramen，and measuring fractional anisotropy（FA） and apparent diffusion coefficient（ADC） value.Meanwhile，diffusion tensor tractography（DTT） was also applied to observe the bilateral L4-S1 nerve roots.Results　There were totally 25 herniated discs among the 20 LDH patients（28 unilateral nerve root compression），including 22 lateral side types（22 unilateral nerve root compression） and 3 intraforaminal types（6 unilateral nerve root compression）．The features of PROSET of each type of LDH：the intraforaminal type showed that the nucleus pulposus pushed the ipsilateral epistatic nerve root outward and upward，and pushed the inferior nerve root inward slightly，while nucleus pulposus only pushed the ipsilateral inferior nerve root inward and backward in lateral side type of LDH.DTT of lumbosacral nerve plexus showed that tract sparsity，narrowing and abrupt break of compressed side nerve root were displayed in all the cases.On the same level of L4-S1 nerve roots，ADC value was significantly higher in the compressed side compared to the normal side nerve root（P<0.05）；the FA value was significantly lower in the compressed side compared to the normal side nerve root（P<0.05）．On the same nerve root，the difference among the three levels was statistically significant（P<0.05）．Conclusion　PROSET，DTI and FT could be used to evaluate the lumbosacral nerve root compression syndrome and locationally and quantitatively assess compressed nerve roots in patients with LDH.


Standardized Nursing Language System Development for Community Home-based Elderly Care　

DU Jia-min，YANG Ru-xia，ZHAO Yuan-ping，XIE Hong*

2018, 21(15):  1832-1838.  DOI: 10.3969/j.issn.1007-9572.2018.00.115

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Objective　To develop a standardized nursing language system for community home-based elderly care（SNLSCHEC），offering a basis for the standardization and data database construction of community home-based elderly care.Methods　From May to August 2017，using convenience sampling，we formulated the final SNLSCHEC through a two-round Delphi consultation among 45 experts from 4 community health stations，4 hospitals and 2 universities in Beijing.Results　45 questionnaires were sent out and 39 were recovered in the first-round expert consultation，the valid response rate was 86.7%；39 questionnaires were sent out and 32 were recovered in the second-round expert consultation，the valid response rate was 82.0%.The authority coefficient，determination coefficient and familiar coefficient for the first round of expert consultation was 0.879，0.913 and 0.846，respectively，and 0.880，0.892 and 0.869 respectively，for the second round of expert consultation.The Kendall's W for both the first and second round of consultation demonstrated statistical significance（P<0.05）．After the modification based on the consensus of the expert panel，the final SNLSCHEC includes 4 first-level indicators，16 second-level indicators and 73 third-level indicators and 4 supplemental indicators.Conclusion　The SNLSCHEC covers the terminologies used in common and important elderly care in community home-based settings.Moreover，it is scientific and reliable.Therefore，it can be used as a reference for the assessment of community home-based elderly care，and as a basis for its standardization and big data development.



Reliability and Validity of the Chinese Version of the 10-item Connor-Davidson Resilience Scale in Chinese Cancer Patients　

YE Zeng-jie1，WANG Zhen-yu1，LIANG Mu-zi2，Knobf Tish3，Dixon Jane3，SHE Ying4，HU Qu1，ZENG Zhen1，HU Guang-yun1，ZHU Yun-fei1，QIU Hong-zhong1*

2018, 21(15):  1839-1844.  DOI: 10.3969/j.issn.1007-9572.2018.00.107

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Objective　This study was designed to examine the psychometric properties of the Chinese version of 10-item Connor-Davidson Resilience Scale（CD-RISC-10） in a sample of Chinese patients with cancer.Methods　This study was conducted between December 2015 and July 2016.The psychometric properties of Chinese version of CD-RISC-10 were tested in a randomly selected sample of 520 cancer cases from the First Affiliated Hospital of Guangzhou University of Chinese Medicine，Sun Yat-Sen University Cancer Center and Guangdong Provincial Hospital of Chinese Medicine.The participants were also surveyed by other 2 scales〔Chinese version of Hospital Anxiety and Depression Scale（HADS） and Chinese version of Strategies Used by People to Promote Health（SUPPH）〕 to test their associations with the CD-RISC-10 and get the cut-off point of the CD-RISC-10.424（81.5%） responded to the survey positively，and 50 of them were randomly selected based on a Microsoft Excel-based algorithm and were resurveyed by the Chinese version of CD-RISC-10 two weeks later.The unidimensionality for the Chinese version of CD-RISC-10 was investigated by a two-parameter item response analysis，item analysis was performed using GRM.Furthermore，its convergent validity and retest reliability and cut-off point were analyzed.Results　The Chinese version of CD-RISC-10 retained its original undimensional structure，which could explain 58.06% of the total variance.The item separation index（ISI） was 0.914.The item difficulty was ideally normal，discrimination ability ranged from 1.17 to 1.82 and fit residual value of every item was within the range of -2.5-2.5.There existed no disordered threshold among all the items and the step of thresholds varied from 1.08 to 3.17 logits.The Chinese version of CD-RISC-10 was negatively associated with the Chinese version of HADS and its anxiety and depression subscales but positively associated with the Chinese version of SUPPH and its subscales in terms of scoring（P<0.05）．The retest reliability coefficient，cut-off point，sensitivity and specificity for the Chinese version of CD-RISC-10 was 0.855，21.5，0.735，0.833，respectively.Conclusion　The Chinese version of CD-RISC-10 has a stable undimensional structure with good monotonicity，ideally normal item difficulty，reasonable distribution of step of thresholds，as well as good reliability and external validity，so it is suitable to be adapted in clinical settings for assessing the psychological status of Chinese cancer patients.



Reliability and Validity of Sub-health Measurement Scale Version 1.0 for Evaluating the Sub-health Status of Anhui Urban Residents　

LIN Yuan-qi1，XU Jun1*，LI Wen-yuan2，WU Wei-xuan1，XIA Cong1

2018, 21(15):  1845-1851.  DOI: 10.3969/j.issn.1007-9572.2018.00.146

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Objective　To analyze the reliability and validity of Sub-health Measurement Scale Version 1.0（SHMS V1.0） in measuring the sub-health status of urban residents in Anhui Province.Methods　We carried out this study from November 2016 to March 2017.The 1 150 urban residents（selected based on male to female ratio of 1∶1） enrolled in accordance with the inclusion and exclusion criteria of the study，were from a stratified random sample of 3 prefecture-level cities of Anhui Province（400 from Hefei，400 from Tongling，and 350 from Fuyang）．We used a self-designed Sub-health Questionnaire（consisting of Urban Resident Demographic Questionnaire and SHMS V1.0） for collecting the data about sub-health.Psychometric properties of SHMS V1.0 including the reliability（internal consistency reliability and split-half reliability），content validity（item-dimension correlation，correlation between dimension and subscale，Cronbach's ɑ for each dimension，dimension-total correlation） and structural validity（exploratory factor analysis and confirmatory factor analysis） were assessed.Results　A total of 1 078（93.74%） residents returned responsive questionnaires.The Cronbach's ɑ for SHMS V1.0，physiological sub-health scale（PS），mental sub-health subscale（MS），and social sub-health subscale（SS） was 0.928，0.847，0.875 and 0.857，respectively.The Spearman-Brown coefficients for them were 0.847，0.749，0.809 and 0.742，respectively.The Guttman coefficients for them were 0.847，0.745，0.807 and 0.731，respectively.The item-to-own-dimension correlation coefficients of SHMS V1.0 ranged from 0.711 to 0.901（P<0.05）．The correlation coefficients of dimension to its corresponding subscale were 0.642-0.906（P<0.05）．The Cronbach 's ɑ of each dimension is greater than the correlation coefficients of this dimension with other dimensions or the SHMS V1.0（P<0.05）．The KMO of SHMS V1.0=0.901，the Bartlett's spherical test χ2=8 753.858，and the degrees of freedom was 595（P<0.001），indicating that it was suitable for factor analysis.Totaled 8 common factors were extracted from exploratory factor analysis，explaining 63.319% of the total variance，and each item had a large loading value on one of the common factors（>0.400）．Confirmatory factor analysis confirmed that the fitting effect of the final model was ideal：the degrees of freedom ratio（CMIN/DF）=2.009，the normed fit index（NFI）=0.858，the relative fit index（RFI）=0.835，the incremental fit index（IFI）=0.907，tucker-lewis index（TLI）=0.891，comparative fit index（CFI）=0.906，root mean square error of approximation（RMSEA）=0.055.Conclusion　SHMS V1.0 could accurately，reliably and sensitively measure the sub-health status of Anhui urban residents，demonstrating its good reliability and validity，so it can be used for further study of the status and associated factors of sub-health among this population.


 

Peritoneal Perfusion with Kailaite Injection and Cisplatin for Gastric Cancer of Spleen Deficiency and Dampness Retention Syndrome with Malignant Ascites　

ZHANG Feng-bin1，WANG Ying-nan1，WU Chen-si1，LIU Xiao-yan2，ZHANG Rui-xing1*

2018, 21(15):  1852-1856.  DOI: 10.3969/j.issn.1007-9572.2018.00.130

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Objective　To investigate the effectiveness and safety of peritoneal perfusion with Kailaite Injection and cisplatin for gastric cancer of spleen deficiency and dampness retention syndrome（SDDRS） with malignant ascites.Methods　We enrolled 82 inpatients with gastric cancer（adenocarcinoma of the stomach） of SDDRS with malignant ascites from Department of GI Medicine，Fourth Hospital of Hebei Medical University from January 2013 to June 2016 and divided them into combination group receiving peritoneal perfusion with Kailaite Injection and cisplatin and cisplatin group receiving peritoneal perfusion with cisplatin by block randomization method.The effectiveness and safety of treatment regimen were evaluated after 2 courses of treatment by the volume of ascites and response maintenance duration，quality of life，adverse events and TCM syndrome score.Results　Compared with the cisplatin group，combination group achieved better response（P=0.008），significantly improved quality of life and TCM syndrome score（P<0.05），and had obviously less nausea/vomiting events（P<0.05）．However，no significant difference was found in disease control rate between these two groups（P=0.364）．Conclusion　Peritoneal perfusion with Kailaite Injection and cisplatin can enhance the clinical response，improve the control rate of malignant ascites due to gastric cancer and TCM syndrome score，as well as reduce the adverse events.



Boguzhuyu Granules Developed by the Zhuang People for Early Treatment of Simple Thoracolumbar Compression Fractures：a Clinical Observational Study　

LIANG Zi-yang1，ZHONG Yuan-ming2，LI Zhi-fei2*，ZHANG Jia-li2，FU Shuan-hu2，LU Da-han2

2018, 21(15):  1857-1861.  DOI: 10.3969/j.issn.1007-9572.2018.00.125

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Objective　To explore the clinical effectiveness of Boguzhuyu Granules in the early treatment of simple thoracolumbar compression fractures.Methods　We enrolled 180 cases of thoracolumbar compression fractures from Department of Orthopedics，the First Affiliated Hospital of Guangxi University of Chinese Medicine from June 2013 to April 2016，and divided them into the observation group and control group by block randomization method.Based on the treatment with a soft and thin protective padding covering the fracture site and back extension exercise，the observation group orally took Boguzhuyu Granules after mixing it with lukewarm boiled water，while the control group orally took Mannitol Injection.The outcome was evaluated by pain status assessed by Visual Analogue Scale（VAS），defecation after medication as well as clinical response.Results　There was no significant difference between two groups with respect to VAS score before the treatment（P>0.05）．However，VAS score decreased significantly in the observation group after treatment（P<0.05）．The defecation status after medication was similar in both groups（P>0.05）．The observation group demonstrated much better clinical response（P<0.05）．Conclusion　Boguzhuyu Granules developed by the Zhuang people is simple，convenient and safe for clinical treatment of thoracolumbar compression fractures，which can effectively reduce the post-fracture pain and improve the quality of life.



Mechanism of Aqueous Extract from Wenyanglishui Decoction in Protecting Mouse Podocytes from Injury Caused by Serum from IMN Patients with Syndrome of Spleen and Kidney Yang Deficiency　#br#

LU Huan，TANG Shui-fu，CHEN Gang-yi，SU Bao-lin，ZHAN Dong-xiang，WU Xing-bo，WANG Chao，LUO Yue-zhong*

2018, 21(15):  1862-1868.  DOI: 10.3969/j.issn.1007-9572.2018.00.129

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Objective　To explore the protective mechanism of aqueous extract from Wenyanglishui Decoction（WD） on mouse podocyte injury caused by serum from idiopathic membranous nephropathy（IMN） patients with syndrome of Spleen and Kidney Yang deficiency（SSKYD）．Methods　The 58 participants were enrolled from Nephropathy Department，the First Affiliated Hospital of Guangzhou University of Chinese Medicine from February to March 2015，including 28 anti-PLA2R positive cases of IMN（diagnosed by initial renal biopsy） with SSKYD and 30 controls. Fasting venous blood samples were taken from both groups simultaneously early in the morning.The mouse podocyte injury models caused by serum from IMN patients with SSKYD were established in vitro. CCK-8 kit was applied to evaluate the influence of different concentrations（5%，7.5% and 10%） of serum from IMN patients with SSKYD on the proliferation ability of immortalized mouse podocytes cultured in vitro.Based on the testing results of CCK-8，5 groups including normal control，model，2 mg/ml，4 mg/ml，8 mg/ml aqueous extract from WD were divided，treated with 10% of serum from controls + RPMI-1640 culture medium，10% of serum from IMN patients with SSKYD + RPMI-1640 culture medium，10% of serum from IMN patients with SSKYD +RPMI-1640 culture medium + 2 mg/ml aqueous extract from WD，10% of serum from IMN patients with SSKYD +RPMI-1640 culture medium + 4 mg/ml aqueous extract from WD，10% of serum from IMN patients with SSKYD + RPMI-1640 culture medium + 8 mg/ml aqueous extract from WD，respectively.F-actin cytoskeleton of podocytes of the 5 groups was examined by immunofluorescence microscopy，and Caspase-3 mRNA was detected by qRT-PCR at 24 h and 48 h after incubation，respectively.Results　There were no significant differences between RPMI-1640 culture medium groups and RPMI-1640 culture medium + aqueous extract from WD groups in optical density（t=1.937，P>0.05）．The optical density in 0 mg/ml aqueous extract from WD group was higher than that of 20，40，60，80 and 100 mg/ml groups（P<0.05）．The optical density of 10 % serum of IMN patients group was lower than that of the control group，5% and 7.5% serum of IMN patients groups（P<0.05）．10 % serum of IMN patients destroyed the cytoskeleton of podocytes，down-regulated the expression of F-actin，and the filaments were redistributed inconsistently with the direction of the axis of the cells.Moreover，part of the filaments broken and cell bodies retracted.After 24 h and 48 h incubation，however，F-actin filaments showed up-regulated expression，and improved broken conditions and disordered arrangement in aqueous extract from WD groups when compared to model group.The relative expression level of Caspase-3 mRNA in model group was higher when compared to control group after 24 h incubation（P<0.05）．After 48 h incubation，the expression level of Caspase-3 mRNA in model group was higher than that of control group，2 mg/ml and 8 mg/ml aqueous extract from WD groups（P<0.05）．Among three decoction groups，the expression level of Caspase-3 mRNA was the lowest in 8 mg/ml group and showed a significant difference when compared with 2 mg/ml as well as 4 mg/ml groups（P<0.05）．Conclusion　The aqueous extract from WD can ameliorate the rearrangement of podocyte cytoskeleton F-actin injured by serum from IMN patients with SSKYD.This mechanism may be related to the inhibition and down-regulation of Caspase-3 mRNA expression，therefore the podocytes apoptosis is alleviated.



Use of Antithyroid Drugs in Pregnancy and Lactation——Recent Developments　

DING Jing-ya，QIN Lu-dan，XU Yong*，ZHOU Lu-ping

2018, 21(15):  1869-1873.  DOI: 10.3969/j.issn.1007-9572.2018.00.066

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Normal maternal thyroid function plays an important role in fetal growth and development.However，hyperthyroidism during pregnancy，an endocrine disorder，is frequently seen.Moreover，its treatment during lactation is associated with the recovery of maternal and neonatal thyroid function.We introduced the mechanisms of action and adverse reactions of antithyroid drugs（ATDs），such as methimazole（MMI） and propylthiouracil（PTU），briefly described the effects of treatment with different doses of ATDs at different time points during pregnancy and lactation on maternal，fetal and neonatal thyroid functions，and based on this，we recommended PTU for treatment during first trimester，MMI for treatment during second and third trimester.Furthermore，we encouraged mothers to receive the treatment with ATDs during lactation，and low- to medium-dose MMI was suggested for first-line treatment，and PTU for second-line treatment.In addition，we suggested that appropriate treatment with ATDs during pregnancy and lactation could not significantly affect fetal and neonatal physical and intelligence development（including thyroid function）．


Analysis of Initial Pharmacotherapy in Patients with Parkinson's Disease　

ZHAO Xue-jun，WU Lei*，DING Xiao-ling*，NIU Xi-yuan，YOU He-yang，LU Ya-nan

2018, 21(15):  1874-1876.  DOI: 10.3969/j.issn.1007-9572.2018.00.138

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Background　There are few reports regarding the initial pharmacotherapy for newly-diagnosed Parkinson's disease（PD） patients in China.Objective　To understand the current status of pharmacotherapy for PD patients by investigating the choice of initial drugs for PD patients.Methods　One hundred fifty-six patients who were initially hospitalized in Anhui Provincial Hospital Affiliated to Medical University of Anhui between September 2015 and April 2017 were selected as study subjects.Patient gender，age of disease onset，symptoms，time from disease onset to definite diagnosis，initial drugs，and drug types were collected and analyzed.Results　The initial drugs chosen by the patients included the following：levodopa（LD） alone（n=92）；LD plus dopamine agonist（DA）（LD+DA，n=30）；LD plus other anti-PD drugs（LD+X，n=3）；DA plus other anti-PD drugs（DA+X，n=23）；and non-LD/non-DA drugs（n=8）．Gender，age of disease onset，and disease symptoms did not affect patient choice for initial drugs（P>0.05），while time from disease onset to definite diagnosis did not significantly affect choice for initial drugs（P<0.05）．Conclusion　LD is a first-choice drug for most PD patients.Patients who initially use DA，monoamine oxidase inhibitors，and other anti-PD drugs are relatively fewer in number.


Somatostatin Versus Terlipressin or Octreotide in Combination with Endoscopic Variceal Ligation for Esophagogastric Variceal Bleeding：a Cost-effectiveness Analysis　

WANG Gui-liang，QIU Ping，XU Lin-fang，HAN Ming，WEN Ping，GONG Min，CHEN Wei-guo，WEN Jian-bo*

2018, 21(15):  1877-1881.  DOI: 10.3969/j.issn.1007-9572.2018.00.105

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Objective　To perform a cost-effectiveness analysis of somatostatin versus terlipressin or octreotide in combination with endoscopic variceal ligation（EVL） for esophagogastric variceal bleeding（EVB）．Methods　150 EVB inpatients were enrolled from Jiangxi Pingxiang People's Hospital from January 2009 to July 2017 and were divided into 4 groups by the random number table，EVL group（n=40，undergoing EVL），EVL plus somatostatin group（n=34，undergoing EVL plus somatostatin pump intravenous），EVL plus terlipressin group（n=40，undergoing EVL plus terlipressinintravenous injection） and EVL plus octreotide group（n=36，undergoing EVL plus octreotide pump intravenous）．The hemostasis rate at 24 h，1 week after treatment，length of stay（LOS） after treatment，cost of hospitalization，cost-effectiveness ratio of the treatment regimen，incremental cost-effectiveness（ICE） ratio of the treatment regimen，sensitively analysis of the treatment regimen，incidence of complications and incidence of side effects were compared between the 4 groups.Results　EVL group in particular，demonstrated much lower hemostasis rate compared with other 3 groups（P<0.05）．EVL group in particular，presented much longer LOS compared with other 3 groups（P<0.05）．In terms of cost of hospitalization，EVL plus terlipressin group spent the most of all the groups（P<0.05）．Cost-effectiveness analysis results revealed that EVL group had higher cost-effectiveness ratio than both EVL plus somatostatin and EVL plus octreotide groups（P<0.05）；EVL plus terlipressin group presented the highest cost-effectiveness ratio（P<0.05）．ICE analysis demonstrated that ICE ratio of EVL plus octreotide group was lower than that of EVL plus terlipressin group（P<0.05）．Sensitivity analysis showed the following results：EVL group demonstrated higher cost of hospitalization than EVL plus octreotide group（P<0.05）；EVL plus terlipressin group had the highest cost of hospitalization of all the groups（P<0.05）．EVL group showed higher cost-effectiveness ratio compared with EVL plus somatostatin group and EVL plus octreotide group（P<0.05）；EVL plus terlipressin achieved the highest cost-effectiveness ratio（P<0.05）．ICE ratio of EVL plus octreotide group was lower than that of EVL plus terlipressin group（P<0.05）．There were no significant differences in the incidence of complications as well as the incidence of side effects between the 4 groups（P>0.05）．Conclusion　EVL is an effective treatment for EVB，and the use of it in combination with somatostatin，terlipressin or octreotide can increase the treatment efficacy.Although the 3 combination therapies show similar treatment efficacy，EVL plus terlipressin is the most expensive，followed by EVL plus octreotide，then EVL plus somatostatin.Therefore，EVL plus somatostatin is an ideal regimen for EVB.


Etiology Analysis of 372 Cases of Fever of Unknown Origin

　LI Jun-rui1*，JIANG Hui2，HE Guo-li1，KANG Rui-na1

2018, 21(15):  1882-1885.  DOI: 10.3969/j.issn.1007-9572.2018.00.027

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Objective　To investigate the causes of fever of unknown origin（FUO），in order to benefit the clinical diagnosis and treatment of this disease.Methods　In this retrospectively study，we enrolled 372 cases of FUO according to the diagnostic criteria from Tangshan Gongren Hospital from July 2014 to June 2017.We collected their data about baseline characteristics，diagnostic methods，classification of causes of FUO and outcome.Results　The clinical data of these patients are as follows：distribution of sex：184 males and 188 females；mean age：（48.0±18.3） years；number of patients without identified causes of FUO：85（accounting for 22.8% of the total）；number，diagnostic pathway and classification of causes of FUO of patients with identified causes of FUO：287 were found with identified causes，accounting for 77.2% of the total，138（48.1%） by clinical features and/or treatment response；86（30.0%） of them were diagnosed by pathogenic or serological examination，50（17.4%） by imaging examination，and 13（4.5%） by pathological or bone marrow examination，181（63.1%） of them were caused by infectious disease〔121（66.9%） by bacterial infectious disease，and 60（33.1%） by viral infectious disease〕，57（19.9%） by connective tissue disease〔including 14（24.6%） by adult onset Still's disease〕，17（5.9%） by neoplastic disease〔including 10（58.8%） by hematological tumor〕，and 32（11.1%） by other diseases〔including 15（46.9%） by subacute thyroiditis〕．Conclusion　Infectious diseases，especially brucellosis and tuberculosis，were the most common causes of FUO．Furthermore，the characteristics of the region that the patient comes from，features of the hospital that the patient treated in，patient'atmedical history，results of meticulous physical check-up，clinical characteristics，results of auxiliary and invasive examinations are all contributive to the identification of the causes of FUO.


Malignant Neurilemmoma of the Lung：a Case Report and Literature Review　#br#

LIU Zi-shan1，YANG Hai1*，ZHANG Dao-chun1，CHEN Chu-yue2

2018, 21(15):  1886-1890.  DOI: 10.3969/j.issn.1007-9572.2018.00.043

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Due to lack of clinical and imaging features，the diagnosis of malignant neurilemmoma of the lung（MNL） needs to be performed in accordance with the results of imaging exanimation combined with immunohistochemistry and other examinations.Based on the diagnosis and management of one MNL case of ours and review of other 55 MNL cases reported in domestic and international studies，we summarized the diagnosis and treatment of MNL，with a view to increasing clinicians' awareness level of this disease.