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Table of Content

    20 June 2018, Volume 21 Issue 18
    Monographic Research
    How do General Practitioners Take Advantage of Guidelines:an Analysis Based on China's Cardiovascular Disease Report 
    DUAN Hong-yan,WANG Yong,LIU Xiao-yu,WANG Liu-yi*
    2018, 21(18):  2143-2147.  DOI: 10.3969/j.issn.1007-9572.2018.00.242
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    China's Cardiovascular Disease Report 2017 indicates that the prevention and treatment of cardiovascular disease(CVD) in China has achieved initial results,but still faces severe challenges such as high morbidity,mortality and medical costs of CVD.Although clinical guidelines or consensuses,can not replace clinical skills,clinical experience,and clinical data,they are summaries of valuable management for specific clinical problems,promoting standardized medical practices.However,in China,guidelines have not gained sufficient attentions from primary care providers(PCPs) and have not been applied satisfactorily in primary care.Moreover,significant differences have been found in the understanding,mastery and application of guidelines between PCPs.In view of this,in order to achieve Healthy China goals,general practitioners are suggested to do the following tasks concerning prevention,management and rehabilitation of CVD with great efforts:improve the professional capabilities by intensified learning and training of CVD guidelines;popularize public education of the essentials of CVD guidelines;value and master the CVD risk assessment in accordance with the CVD guidelines;pay attention to use the knowledge learned from the CVD guidelines in practice(for improving CVD management abilities);develop a high-efficiency and high-quality holistic patient-centered management pattern for CVD;prevent the incidence and progression of CVD effectively by implementing successive interventions.All these contribute to achieving good prevention and control of CVD in China as early as possible.
     
    Interpretation of the Consensus Statement by the AACE/ACE on the Comprehensive Type 2 Diabetes Management Algorithm—2018 
    LI She-yu
    2018, 21(18):  2148-2151.  DOI: 10.3969/j.issn.1007-9572.2018.00.170
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    Type 2 diabetes is one of the top health problems in the world.The Consensus Statement on the Comprehensive Type 2 Diabetes Management Algorithm was updated by American Association of Clinical Endocrinologists and American College of Endocrinology in January 2018,providing recommendations for US diabetes healthcare providers in the context of US.The current manuscript interprets the principles of this clinical practice guideline in the context of Chinese general practice.
    Interpretation of Expert Consensus on Self-management Prescriptions for Type 2 Diabetes in China(2017) 
    ZHANG Xiao-qian1,JIANG Tian1,GAO Ling-ling2,ZHANG Qiu1*
    2018, 21(18):  2152-2155.  DOI: 10.3969/j.issn.1007-9572.2018.00.231
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    Effective diabetes self-management education/support(DSME/S) is the foundation for assisting diabetics in managing and maintaining their own healthy behaviors.Self-management prescription is one of the individualized diabetes education tools.This article describes the development of diabetes education and management in detail and interprets the Expert Consensus on Self-management Prescription of Type 2 Diabetes in China(2017) in order to summarize its main contents and points of implementation.This article points out that DSME/S is a continuous closed-loop of behavior change,and as its implementation and support tool,self-management prescription requires technical support of multiple teams to jointly achieve the standardized and systematic self-management of diabetes.
    Review of Epidemiological Evidences for Association between Air Pollution and Stroke 
    JIANG Bin1,2,3
    2018, 21(18):  2156-2162.  DOI: 10.3969/j.issn.1007-9572.2018.00.169
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    Air pollution not only impairs the environmental quality,but also threatens public health.Increasing evidences show that stroke has a close relationship with air pollution.This paper reviews the possible mechanisms of stroke caused by atmospheric pollution,long-term and short-term effects of air pollution on stroke,stroke burden of disability adjusted of life years and premature deaths attributed to ambient air pollution,discusses the challenges existed in these associated studies,and comments the epidemiological evidences for stroke associated with ambient air pollution,hoping to provide a reference for further researches and prevention and control of stroke.

    Remote Ischemic Postconditioning for Improving the Neurological Function of Patients with Ischemic Stroke 
    WANG Xin-ying1,DING Wen-ting1,BAO Shuang-zhen2,GAO Qian1,WEI Yan1,CUI Yong-jian1*
    2018, 21(18):  2163-2166.  DOI: 10.3969/j.issn.1007-9572.2018.00.193
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    Objective To investigate the effect of remote ischemic postconditioning(IP) on the improvement of neurological function of patients with ischemic stroke.Methods We enrolled 200 cases of ischemic stroke from Department of Neurology,Harrison International Peace Hospital in Hengshui between January 2016 and June 2017.Using random number table,we divided them into the experimental group(n=100) receiving basic drug treatment combined with IP and control group(n=100) receiving basic drug treatment alone.The National Institutes of Health Stroke Scale (NIHSS) scores and the incidence of lateralization were recorded in the two groups before and 12 months after treatment.Results The NIHSS score was similar in both groups before treatment(P>0.05),but it was significantly decreased in the experimental group after 12-month treatment〔(13.3±2.1)scores vs. (15.2±1.8)scores〕(P<0.05).There was no significant difference in the incidence of lateralization between the two groups before treatment (P>0.05),and the incidence of lateralization in the experimental group was higher than that of the control group after 12 months of treatment(P<0.05).Conclusion IP could significantly improve the neurological function and promote the development of collaterals in the cerebral circulation,which is worth popularizing in clinical practice.

    Influencing Factors for Worsening Renal Function and Its Role in Predicting the Short-term Outcome among Very Old Patients with Severe Acute Decompensated Heart Failure 
    YI Shuang-yan,LUO Lei-ming*,FU Shi-hui,ZHAO Shao-pan,SUN Yu-qing,ZHAO Xiao-qian
    2018, 21(18):  2167-2172.  DOI: 10.3969/j.issn.1007-9572.2018.00.213
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    Objective To determine the associated factors for worsening renal function(WRF) in very old patients with severe acute decompensated heart failure(ADHF) and to examine the value of WRF for predicting the short-term outcome of these patients.Methods We enrolled 108 consecutive very old(age ≥ 80,averaged 87.1) inpatients with severe ADHF from Chinese PLA General Hospital between January 2008 and January 2010.We collected their demographic characteristics and clinical data including anti-heart failure drug treatment.WRF was defined as an increase in serum creatinine levels from the first day to the seventh day after admission >0.3 mg/dl or >25%.All-cause mortality was recorded over the follow-up period of 6 months.Influencing factors of WRF and value of WRF in predicting all-cause mortality were then evaluated in all patients.Results 44 were identified with WRF.Multivariate Logistic regression analysis revealed that baseline eGFR,NT-proBNP and coexistence of CKD were independent predictors for WRF(P<0.05).All-cause mortality rates were 70.5%(31/44)in WRF group and 46.9%(30/64)in non-WRF group.Cox regression analysis found that baseline SBP,hemoglobin,BUN and serum potassium as well as WRF were independent predictors for all-cause mortality(P<0.05).Conclusion Coexistence of CKD was an independent influencing factor of WRF,and WRF increased the risk of all-cause mortality in very old patients with severe ADHF.

    Clinical Efficacy of Endovascular Mechanical Thrombectomy with Retrievable Stents for Acute Basilar Artery Occlusion 
    YU Jiang-hua1,SHI Zhi-qin2*,SU Xu-dong1,LI Xin1,CHEN Rui-qing1,ZHAO Li-ming1,YIN Kuo-chang1,LIU Zeng-pin1,TAN Guo-jun1,ZHAO Bo2,ZHU Meng-chu2,FENG Xiao-hong2
    2018, 21(18):  2173-2178.  DOI: 10.3969/j.issn.1007-9572.2018.00.241
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    Objective To investigate the clinical efficacy and safety of endovascular mechanical thrombectomy(EMT) with Solitaire AB stent in patients with acute basilar artery occlusion(ABAO),and to analyze the factors that affect the clinical prognosis.Methods In this retrospective study,we enrolled 16 consecutive cases of ABAO from Department of Neurology,the Second Hospital of Hebei Medical University from March 2015 to December 2017.All of them underwent EMT with the Solitaire AB stent.The recanalization rate and complications of EMT were analyzed.The clinical prognosis within 90 days after EMT was evaluated and its associated factors were analyzed.Results 14 out of 16 patients were successfully treated with EMT.Modified Treatment in Cerebral Ischemia Scale(mTICI) 3 or 2b level was successful achieved in 11 cases(11/16).There was no symptomatic intracranial hemorrhage,whereas 1 case(1/16) of failed endoscopic stent retrieval occurred,and 1 case(1/16) of iatrogenic dissection.The follow-up within 90 days after EMT showed that 5 cases(5/16) died.The Modified Rankin Scale(mRS) score of the survivals was(2.0±1.4).Seven cases(7/16) with mRS score≤ 2 were found with favorable prognosis,but other 9 cases(9/16)(including 4 with mRS score > 2 and 5 deaths) with poor prognosis.Sex,preprocedural NIHSS score,preprocedural pc-ASPECTS,being comatose or hemiplegia in consultation,duration between the onset of stroke symptoms and admission time,duration between the onset of stroke symptoms and recanalization time differed significantly between patients with good prognosis and those with poor prognosis(P<0.05).Conclusion EMT with Solitaire AB stent could achieve a high recanalization rate and improve the clinical prognosis in ABAO patients.

    Plasma BNP Combined with NT-proBNP versus Routine Cardiac Function Parameters for Predicting Postoperative Prognosis in Patients with Heart Valve Replacement Surgery:a Comparative Study 
    TAN Jin1,YU Tao1,HUANG Ke-li1*,LIU Ke1,YANG Qian2
    2018, 21(18):  2179-2184.  DOI: 10.3969/j.issn.1007-9572.2018.00.165
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    Objective To evaluate the clinical application value of plasma brain natriuretic peptide(BNP) combined with N-terminal prohormone of brain natriuretic peptide(NT-proBNP) based on comparing its value for predicting postoperative prognosis of patients with heart valve replacement surgery with that of routine cardiac function parameters.Methods We enrolled 138 patients with rheumatic heart disease undergoing heart valve replacement surgery from Department of Cardiac Surgery,Sichuan Provincial People's Hospital from August 2014 to February 2016 and collected their baseline characteristics,measurement levels of plasma BNP,NT-proBNP and routine cardiac function parameters at 1 week after surgery.They were divided into good prognosis group and poor prognosis group based on the conditions during a 18 month-follow-up initiated at 1 month after discharge.Results Except 14 were lost to follow-up,the other 124 completing the follow-up were included in the final analysis.73 of them were found with good prognosis(good prognosis group),and other 51 with poor prognosis(poor prognosis group),the rate of poor prognosis was 41.1%(51/124).Multivariate Cox regression analysis showed that left ventricular end diastolic diameter(LVEDD)(RR=1.578,P=0.039),plasma BNP(RR=1.935,P=0.013) and NT-proBNP(RR=2.346,P<0.001) were the associated factors of poor prognosis after heart valve replacement surgery.For predicting the patient prognosis,the AUC of LVEDD,plasma BNP,and NT-proBNP were 0.774,0.814,and 0.800,respectively,and the AUC of plasma BNP combined with NT-proBNP was 0.856,with a corresponding specificity of 78.9%,and a sensitivity of 83.6%.Conclusion As its predictive accuracy for the prognosis of patients undergoing cardiac valve replacement surgery,plasma BNP combined with NT-proBNP is expected to be used as one of the clinical parameters for postoperative prognosis prediction of such patients.
     
    Clinicopathological Features and Prognosis in Patients with Proliferative and Sclerosing IgA Nephropathy with Anemia 
    CHENG Gen-yang1,2*,WANG Yun1,YUAN Wen-ming1,ZHANG Li-jie1,XIAO Jing1,2,ZHAO Zhan-zheng1,2
    2018, 21(18):  2185-2189.  DOI: 10.3969/j.issn.1007-9572.2018.00.140
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    Objective To analyze the clinicopathological features and prognosis in patients with proliferative and sclerosing IgA nephropathy with anemia.Methods 261 cases of proliferative and sclerosing IgA nephropathy diagnosed by renal biopsy were recruited from the First Affiliated Hospital of Zhengzhou University between January 2012 and June 2016 and divided into anemia group(100 cases with anemia) and non-anemia group(161 cases without anemia)(anemia was determined by the corresponding diagnostic criteria).The demographic data,laboratory findings,histopathological examination results of renal biopsies were collected.All of them were followed up from the date of renal biopsy to June 1,2017.Kaplan-Meier method was used to draw the survival curve.Log-rank test and multivariate Cox proportional hazards regression model were adopted to explore the value of anemia in predicting the prognosis of patients.Results Compared with non-anemia group,anemia group had much lower initial eGFR,serum albumin and calcium levels but higher urea,serum creatinine,phosphorus,24 h urine total protein(UTP) and percentage of glomeruli affected by sclerosis,as well as higher tubular atrophy and interstitial fibrosis levels(P<0.05).The patients had a median follow-up time as 11(6,21)months.Survival analysis showed that patients with anemia had lower cumulative renal survival rate than those without(χ2=30.307,P<0.001).Survival analyses statistically significant difference in the cumulative renal survival rate among patients with CKD3(χ2=22.066,P<0.001).Multivariate Cox hazards regression analysis revealed that anemia〔HR=2.864,95%CI(1.611,5.093)〕,24 h UTP〔HR=1.164,95%CI(1.065,1.272)〕,percentage of glomeruli affected by sclerosis〔HR=3.858,95%CI(1.120,13.290)〕,tubular atrophy and interstitial fibrosis〔HR=1.902,95%CI(1.070,3.383)〕 were risk factors for proliferative and sclerosing IgA nephropathy developing into end-stage renal disease(P<0.05).Conclusion Proliferative and sclerosing IgA nephropathy with anemia patients with anemia showed worse clinicopathological features and lower cumulative renal survival rate compared with those without.Anemia was an independent risk factor for the development of proliferative and sclerosing IgA nephropathy.
     
    Association of Chromosome 8q Copy Number Aberration with Postoperative Overall Survival of Patients with Hepatocellular Carcinoma and Screening of Potential Target Genes 
    ZHAO Kun1,XU Ju-ying2,XU Qing1,3*,ZHU Zhong-zheng3*
    2018, 21(18):  2190-2195.  DOI: 10.3969/j.issn.1007-9572.2018.00.223
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    Objective To investigate the association of chromosome arm 8q copy number aberration (CNA) with postoperative overall survival (OS) of patients with hepatocellular carcinoma (HCC),and to screen for potential target genes in the survival-related CNA(s).Methods A total of 187 HCC patients who received operation in Eastern Hepatobiliary Surgery Hospital,Second Military Medical University from 2007 to 2008 and postoperative follow-up(66 completed the follow-up) were enrolled in the study.We collected their clinicopathological data as well as follow-up data,including the mRNA expression levels of 50 known genes in chromosome 8q24.13-24.3 segment.The associations of the clinicopathological factors and high-frequency CNA(s) (>20%) in chromosome arm 8q with OS were analyzed using the Log-rank test.The confounding factors for OS were analyzed using the Cox proportional hazards model.The survival curves were analyzed using the Kaplan-Meier method.The expression levels between the HCC patients with 8q24.13-24.3 gain and those without were compared by the Mann-Whitney U test.Results Diabetes history,absence of complete tumoral capsule and advanced TNM stage were associated with OS(P<0.05).Univariate Cox analysis showed that chromosome 8q24.13-24.3 gain was associated with OS(P<0.05).Multivariate Cox analysis showed that 8q24.13-24.3 gain,diabetes history,absence of complete tumoral capsule and advanced TNM stage were prognostic factors for OS(P<0.05).Survival analysis showed that the survival rate of the patients with 8q24.13-24.3 gain was lower than that of those without (P<0.05).The mRNA expression levels of 17 genes in 8q24.13-24.3 including C8orf76,ATAD2,WDYHV1,FBXO32,TMEM65,TATDN1,ZNF572,SQLE,KIAA0196,NSMCE2,PVT1,FAM49B,ASAP1,NDRG1,ZFAT,KHDRBS3 and EIF2C2 were significantly increased in patients with 8q24.13-24.3 gain compared to those without (P<0.000 1).Conclusion Copy number gain at 8q24.13-24.3 is a potential prognostic marker for reduced OS for HCC patients,and DNA copy-dependent upregulation of the genes ATAD2,PVT1 and NDRG1 may contribute to the 8q24.13-24.3 gain-related poor prognosis.
     
    Investigation of the Prognostic Factors in Malignant Peritoneal Mesothelioma 
    LIANG Yu-fei1,ZHENG Guo-qi1*,LI Chun-ying1,SUN Ning-ning1,GUO Zhong-jian2
    2018, 21(18):  2196-2200.  DOI: 10.3969/j.issn.1007-9572.2018.00.135
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    Objective To investigate the effect of histopathology and common clinical indices on the prognosis of patients with malignant peritoneal mesothelioma(MPeM).Methods This study consisted of 72 cases diagnosed with MPeM in Cangzhou Central Hospital from 2012 to 2015.Patient data including gender,age,BMI,pathological type,TNM stage,Eastern Cooperative Oncology Group(ECOG) score,Charlsoncomorbidity index(CCI) and peritoneal carcinoma index(PCI) were obtained,and the associations between these indices and patients prognosis were analyzed.Results MPeM lacks specific clinical manifestations.In this cohort,bloat was a common symptom followed by abdominal pain.Fifty-two cases had stage Ⅰ-Ⅱ and 20 cases had stage Ⅲ-Ⅳ disease.Sixty-eight cases had diffuse MPeM and four cases had localized MPeM.With regard to pathological type,69 cases had epithelial carcinoma and 3 cases had sarcomatoid mesothelioma.Forty-two patients received intra-peritoneal chemotherapy.Histopathological type,TNM stage,ECOG score,PCI and whether undergoing chemotherapy were significantly associated with cumulative survival(P<0.05).Cox regression analysis showed that TNM stage 〔hazard ratio(HR)=2.105,P=0.015〕,ECOG score(HR=1.930,P=0.038),and chemotherapy(HR=0.457,P=0.005) were independent prognostic factors for MPeM.Conclusion MPeM patients in the earlier stages with better performance status have a better prognosis.Early examination and diagnosis are of great significance for improving the survival of MPeM patients.

    Development and Regional Performance Examination of a Kano Model-based Service Pattern for the Stroke Population:an Exploratory Study 
    GU Jing-chun,LI Qin*,GU Yi-qin
    2018, 21(18):  2201-2208.  DOI: 10.3969/j.issn.1007-9572.2018.00.216
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    Objective To investigate the healthcare demands and level of satisfaction with healthcare among community-dwelling individuals with high risk of stroke with a Kano model-based questionnaire survey,providing a reference for the development of service patterns for such populations.Methods This survey was conducted in a sample of community-dwelling individuals with high risk of stroke receiving outpatient healthcare in West Zhijiang Road Community Health Service Center from June 12th to September 5th,2017 with a self-developed Kano model-based questionnaire for collecting the demographic characteristics and attitude toward the community-based services for populations with high risk of stroke.And an analysis of the survey results was carried out.Results All the participants(202) responded positively to the survey,with a response rate of 100.0%.For all of them,western medicine therapy had attractive quality;the 4 services winning high level of satisfaction and self-rated significance were measurement of 3 indicators(blood pressure,blood lipids,fasting blood glucose),referral service,western medicine therapy and physical rehabilitation,in particular,western medicine therapy won the highest level of satisfaction and self-rated significance among all the services.From the perspective of those without a history of stroke,referral service had attractive quality,and it won the highest level of satisfaction and high level of self-rated significance;measurement of 3 indicators,Chinese medicine therapy,acupuncture therapy,western medicine therapy,physical rehabilitation and exercise rehabilitation were of high level of self-rated significance despite winning low level of satisfaction,in particular,physical rehabilitation had the highest level of self-rated significance of all the services.In the view of individuals with a history of stroke,western medicine therapy possessed attractive quality;measurement of 3 indicators,western medicine therapy and physical rehabilitation gained high level of both satisfaction and self-rated significance,in particular,western medicine therapy achieved the highest level of satisfaction and self-rated significance.In the opinion of those with stroke onset times less than 3,western medicine therapy had attractive quality,and it won the highest level self-rated significance,but public education of stroke-related data achieved their highest level of satisfaction;measurement of 3 indicators,referral service,western medicine therapy and physical rehabilitation gained high level of both satisfaction and self-rated significance.In the eyes of those with stroke onset times≥3,intensive education of stroke-related data had attractive quality,dietary therapy was of attractive quality or indifferent quality,but Chinese medicine therapy was of reverse quality,western medicine therapy had attractive quality or must-be quality;western medicine therapy won a high level of satisfaction and the highest level of self-rated significance,intensive education of stroke-related data achieved the highest level of satisfaction,exercise rehabilitation won high level of self-rated significance despite gaining low level of satisfaction.Conclusion Western medicine therapy was evaluated as a service with an attractive quality in all the participants.However,the assessed service with an attractive quality differed significantly between participants by onset times of stroke.The community-based preventive services for stroke was not valued by the participants,which demonstrates that the community health center should further intensively publicize such preventive services and make these services be more attractive,guiding such a population to change the quality attributes given to the needed services.In addition,the community-based services delivered should be different from person to person.
     
    Recurrent Health Expenses in Primary Healthcare Institutions in Beijing 
    ZHAO Xuan1,JIANG Yan2,MAN Xiao-wei2,ZHAO Li-ying2,XIE Qi-xin1,CHENG Wei2*
    2018, 21(18):  2209-2215.  DOI: 10.3969/j.issn.1007-9572.2018.00.221
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    Objective To investigate the financing and components of recurrent health expenses in primary healthcare institutions in Beijing,providing evidence for the formulation of relevant health policies.Methods This study was conducted between July 2016 and June 2017.The data concerning Beijing health expenses in 2015 were derived from China Statistical Yearbook 2016,Beijing Statistical Yearbook 2016,Beijing Municipal Government Healthcare Subsidies Monitoring System,Beijing Public Health Information Center,2015 Beijing Healthcare Expenditure Report and so on.The sharing coefficient was calculated based on the data of the individual cases from Beijing Healthcare Price Monitoring Platform and sample survey results of Beijing's medical institutions.Using the System of Health Accounts(SHA) 2011,the basic status,financing schemes and components(including recurrent health expenses of treatment and preventive services) of 2015 total recurrent health expenses for Beijing's primary healthcare institutions were analyzed.Results The recurrent health expenses for Beijing's primary healthcare institutions in 2015 was 13.811 billion yuan.The inputs were mainly from medical insurance reimbursement programs and Beijing municipal government subsidies(accounting for 56.14% and 27.20% respectively).The healthcare expenses of treatment and preventive services accounted for 86.96%,13.04% of the total healthcare expenses of 2015.In terms of treatment,the healthcare subsidies were mainly spent on chronic non-communicable diseases(accounting for 70.90%) if analyzed based on the GBD classification,circulation system disease(accounting for 25.88%) if analyzed in accordance with the ICD-10 standards,and patients of 50-69 years old if analyzed according to the age group.When it comes to the preventive services,the healthcare subsidies were mainly spent on the implementation of state-sponsored immunization programs,chronic disease prevention and control,elderly health management,resident's health record management,accounting for 24.86%,13.33%,10.37%,10.05%,respectively.Conclusion The healthcare inputs for primary healthcare institutions in Beijing are mainly from public funding.Our study results indicates that the recurrent health expenses in these institutions is consistent with the role in delivering medical care and with the key actor in offering preventive services.
     
    Status and Associated Factors of Quality of Life in Children with Allergic Rhinitis #br#
    LI Ke-qiong1,LI Jing1,ZHANG Ling-ling2,YUAN Ke2*
    2018, 21(18):  2216-2222.  DOI: 10.3969/j.issn.1007-9572.2018.00.161
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    Objective To investigate the quality of life in children with allergic rhinitis(AR) and its influencing factors in Chongqing,providing scientific advice for the improvement of quality of life in such patients and prevention of AR in children.Methods 348 children confirmed with AR were enrolled from Department of ENT,Children's Hospital of Chongqing Medical University from April 2014 to June 2015.A modified Chinese version of Pediatric Rhinoconjunctivitis Quality of Life Questionnaire (PRQLQ-C) with a Cronbach's α of 0.897 and a split-half reliability of 0.872 was used to assess the quality of life.A survey with Associated Factors for Children with AR Questionnaire was conducted for collecting the data related to quality of life.Analyses were performed to investigate the status and associated factors for children with AR in Chongqing.Results 332 returned responsive questionnaires,achieving a response rate of 95.4%.The overall PRQLQ-C score showed that 91 of them (27.4%) had excellent or good quality of life,162(48.8%) had fair quality of life,and other 79 (23.8%) had poor or poorer quality of life.Male children scored higher in the overall PRQLQ-C,eye symptoms domain,and emotional function domain than female children (P<0.05).Children from suburban counties scored higher in non-nose/eye symptoms domain and emotional function domain compared with those from urban districts(P<0.05).The overall PRQLQ-C score,non-nose/eye symptoms domain score and emotional function domain score differed significantly by age(P<0.05),and increased with age(r=0.158,P=0.004;r=0.256,P<0.001;r=0.111,P=0.043).Stepwise multiple linear regression analysis revealed that the main associated factors of quality of life included age,the nasal symptoms daily cumulative time,duration of nasal symptoms,history of contact dermatitis and the impact of family economy(P<0.05);the history of birth asphyxia,raising pets at home had impact on sleep domain score(P<0.05);age,nasal symptoms daily cumulative time,raising pets and the impact of family economy had impact on non-nose/eye symptoms domain score(P<0.05);age,nasal symptoms daily cumulative time,duration of nasal symptoms,exclusive breastfeeding and the impact of family economy had impact on the practical problems domain score(P<0.05);nasal symptoms daily cumulative time,duration of nasal symptoms,history of contact dermatitis and the impact of family economy had impact on nasal symptoms domain score (P<0.05);nasal symptoms daily cumulative time,history of allergic conjunctivitis and family history of AR had impact on eye symptoms domain score(P<0.05);home locationz,nasal symptoms daily cumulative time,history of contact dermatitis,history of allergic conjunctivitis and raising pets at home had impact on emotional function domain score(P<0.05).Conclusion AR could seriously impair the patient's quality of life,which was mainly affected by age,nasal symptoms daily cumulative time,duration of nasal symptoms,history of contact dermatitis and the impact of family economy.AR prevention should be considered from multi-aspects.
     
    Gene Polymorphisms of Nitric Oxide Synthase in Endothelial Cells of Umbilical Cord Vessels and Major Complications among Han Premature Infants of ≤34 Weeks' Gestational Age 
    CHANG Shao-hong1*,LUAN Bin2,ZHANG Wei-xing1
    2018, 21(18):  2222-2226.  DOI: 10.3969/j.issn.1007-9572.2018.00.159
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    Objective To examine the association of gene polymorphisms of nitric oxide synthase(NOS) in endothelial cells of umbilical cord vessels and major complications among Han premature infants of ≤34 weeks' gestational age in Xinxiang.Methods This study was conducted in a cohort of preterm infants(n=231) with a gestational age of ≤34 weeks delivered in Xinxiang Central Hospital from February 2014 to December 2016.Allele and genotype frequencies at 3 single nucleotide polymorphisms(rs2070744,rs1799983 and rs61722009) of eNOS in endothelial cells of umbilical cord vessels(extracted at the delivery).We collected the clinical data of the preterm infants.The association of gene polymorphisms of eNOS with the development of bronchopulmonary dysplasia(BPD),necrotizing enterocolitis(NEC),stage Ⅲ-Ⅴ retinopathy(ROP),stage Ⅲ-Ⅳ periventricular-intraventricular hemorrhage(PIVH),neonatal respiratory distress syndrome(RDS) requiring mechanical ventilation(MV) and death.Results The frequency of C allele of rs2070744 polymorphism,and T allele of rs1799983 polymorphism was 0.145,0.188,respectively,which was similar to that proposed in the studies collected in Ensembl genome database(χ2=0.875,P=0.646;χ2=3.541,P=0.173).The a allele of rs61722009 polymorphism was identified to be 0.159.Univariate analysis found that rs2070744 TC+CC genotypes(crude OR=0.370,P=0.003) and rs1799983 GT+TT genotypes(crude OR=0.484,P=0.030) were associated with the development of BPD.Multivariate Logistic regression analysis revealed that rs2070744 TC+CC genotypes were independent risk factors for BPD(OR=1.875,P=0.020),and synchronized appearance of rs61722009 aa+ab and rs1799983 GT+TT genotypes were independent risk factors for stage Ⅲ-ⅤROP(OR=2.961,P=0.041).Conclusion The eNOS gene polymorphisms are associated with the major complications of Han preterm infants in Xinxiang.Genotyping may be helpful to identify patients with higher risk of BPD and stage Ⅲ-ⅤROP.
    Clinical Features of Hemorrhagic Fever with Renal Syndrome:an Analysis of 55 Cases 
    DONG Xin,SUN Tong-wen*,LI Ya-hui,YU Yan-wu,WAN You-dong,DING Xian-fei
    2018, 21(18):  2227-2230.  DOI: 10.3969/j.issn.1007-9572.2018.00.084
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    Objective To summarize the clinical features of hemorrhagic fever with renal syndrome(HFRS),in order to improve the understanding of this disease of healthcare providers,by which the probability of missed diagnosis can be reduced.Methods The 55 participants were enrolled from the First Affiliated Hospital of Zhengzhou University.All patients were diagnosed with HFRS and treated from January 2010 to December 2016.We retrospectively analyzed their demographic data,clinical manifestations,laboratory findings,prevalence of complications,treatment methods and outcomes,and discussed the factors associated with the prognosis of HFRS.Results Clinical manifestations:53(96.4%) with fever,48(87.3%) with gastrointestinal symptoms(abdominal pain,abdominal distension,nausea,vomit),28(50.9%) with oliguria,27(49.1%) with dermahemia and mucosa bleeding,21(38.2%) with lumbago,20(36.4%) with headache,11(20.0%) with shock,9(16.4%) with courbature and 4(7.3%) with orbital pain.Laboratory findings:48(87.3%) with thrombocytopenia,45(81.8%) with leukocytosis,45(81.8%) with proteinuria.Prevalence of complications:49(89.1%) with renal insufficiency,49(89.1%) with liver damage,17(30.9%) with coagulopathy,2(3.6%) with pancreatitis,1(1.8%) with cerebral hemorrhage.2(3.6%) died.Univariate Logistic regression analysis revealed that the duration of shock was the risk factor for the prognosis of HFRS〔OR(95%CI)=2.078(1.008,4.282),P=0.047〕.Conclusion HFRS patients have less typical clinical manifestations,and they are prone to various degrees of injury in the liver,kidney and blood system.Moreover,the duration of shock is the risk factor for the prognosis of HFRS.

    Clinical Characteristics of Pituitary Metastasis with Diabetes Insipidus as the Initial Manifestation 
    WANG Nuo-jin,ZHANG Nan,DENG Da-tong,TANG Song-tao,ZHANG Qiu*
    2018, 21(18):  2231-2237.  DOI: 10.3969/j.issn.1007-9572.2018.00.026
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    Objective To analyze the clinical characteristics of pituitary metastasis(PM) with diabetes insipidus as the initial manifestation,so as to improve clinicians' capabilities in the differential diagnosis of this disease from diabetes insipidus,avoiding the incidence of misdiagnosis and missed diagnosis.Methods In November 2016,one male patient was admitted to Department of Endocrinology,the First Affiliated Hospital of Anhui Medical University due to pituitary metastasis from lung cancer with diabetes insipidus as the initial manifestation.Meanwhile,using the search terms(“pituitar*/hypophys*” “metasta*” combined with “diabetes insipidus” or “垂体” “转移” combined with“尿崩症”),we searched PubMed,ISI Web of Knowledge,CNKI,and Wanfang Data Knowledge Service Platform for studies about PM with diabetes insipidus as the initial manifestation published between January 1990 and October 2017.We conducted a retrospective analysis of the clinical data of the cases involved in the included studies and the male case treated by us.Results Thirty-one articles were included,involving 41 cases.So totaled 42 cases enrolled after adding our case,and the data of them were summarized as follows:distribution of sex:24 males and 18 females;mean age:(56.6±12.7) years old;primary disease:malignant tumor;diagnostic pathway:41 patients by pathological examination,the other 1 by the combination of chest CT and serum tumor markers;main clinical manifestations:polyuria,polydipsia,and headache;imaging findings:lesions in sellar region were identified in 41 cases,and the tumor had metastasized to more than 2 sites in 29 cases;laboratory findings:insufficient secretion of hormone in the anterior pituitary was found in 26 cases,and electrolyte disorders in 11 cases;outcome:all showed poor outcome,with a median survival time of 6.0 months,1-year cumulative survival rate of 22.1%,and 3-year cumulative survival rate of 17.7%.Conclusion PM is a rare tumor-related complication with poor prognosis.Diabetes insipidus could be the initial manifestation and even the only symptom of these patients.Therefore,for a middle-aged or elderly patient with new-onset diabetes insipidus,diagnosis should be performed based on identifying the primary disease,and considering the effect of systemic disease as well as PM.
     
    Clinical Analysis of 9 Cases of Pediatric Williams-Beuren Syndrome 
    HUANG Qin-rong,XIAO Nong*,CHEN Yu-xia,LIU Ling,JIANG Wei,HOU Xue-qin,FENG Ying,ZHANG Ting
    2018, 21(18):  2238-2241.  DOI: 10.3969/j.issn.1007-9572.2018.00.060
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    We retrospectively analyzed the clinical data from 9 children with Williams-Beuren syndrome who were admitted to the Children's Hospital of Chongqing Medical University from March 2016 to February 2017.The risk factors for pediatric Williams-Beuren syndrome included cold in pregnancy,amniotic fluid abnormalities,MLBW infants,long pregnancy,cesarean section,placentaprevia.All 9 patients had a special appearance,and the growth and development of intelligence andmotor and language abilities were slow.There were 4 cases with dystonia,4 with epilepsy and 3 with hypercalcemia.Seven cases were complicated with congenital heart disease.Two cases had abnormal head magnetic resonance imaging(MRI) findings,and abnormal lumbosacral MRI occurred in 1 case.Moreover,1 case had digestive system abnormality,cranial suture early closure was found in 8 cases,and 6 cases showed abnormal behavior.Therefore,pediatric Williams-Beuren syndrome is associated with multiple risk factors,and patients exhibit diverse clinical features.The disease should be given adequate attention.

    Comparison of Low-kiloelectron Volt Monochromatic Images and Low-tube-voltage Images at Indirect Computed Tomography Venography with Dual-source Dual-energy CT 
    ZHANG Bin1,LU Hai-hua2*,ZHOU Yu-qi2,ZHANG Ling-fang2,CAO Yu-lin2
    2018, 21(18):  2242-2245.  DOI: 10.3969/j.issn.1007-9572.2018.00.082
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    Objective To investigate the differences of vascular enhancement and image quality between low-kiloelectron volt monochromatic images and low-tube-voltage images at indirect CT venography(ICTV) with dual-source dual-energy CT.Methods In this retrospective study,50 consecutive patients suspected to have pulmonary thromboembolism(PTE) underwent multislice spiral CT pulmonary arteriography(CTPA) and ICTV by a dual-source dual-energy CT at Tongde Hospital of Zhejiang Province.Two radiologists evaluated 50 kiloelectron volt(keV) monochromatic images(group A) and 80 kVp images(group B) for vessel enhancement,image quality,image noise in the distal inferior vena cava(IVC),right femoral vein(at the level of the inguinal ligament),and right popliteal vein(in the popliteal fossa).Results Of the 50 patients,11 were found with venous thromboembolism,and 9 of them had PTE(including 3 also had DVT),2 had isolated DVT.Mean intravascular CT attenuation within the deep vein was significantly higher in group A than in group B(P<0.05).Although the images of group A had significantly higher image noise than that of group B(P<0.05),there were no significant differences in image quality between the two groups(P>0.05).Conclusion Similar image quality with substantially higher venous attenuation was provided by 50 keV monochromatic images from dual-energy CT venography acquisition compared with 80 kVp images.
    CT and MRI Features of Intestinal Lymphangiectasia:an Analysis of 3 Cases 
    PAN Hai-peng1,2,LAO Qun2,FEI Zheng-hua3,LAI Can1*
    2018, 21(18):  2246-2251.  DOI: 10.3969/j.issn.1007-9572.2018.00.086
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    Objective To investigate the CT and MRI manifestations of intestinal lymphangiectasis(IL) in children,improving the diagnostic accuracy of this disease by these two imaging techniques.Methods In this retrospective study,we enrolled 3 participants who received treatment in the Children's Hospital,Zhejiang University School of Medicine from January 2016 to June 2017.They were diagnosed with IL based on the results of gastroscopy,pathological examination and imaging examination.No.1 case underwent unenhanced CT scan and contrast-enhanced CT scan of the abdomen,No.2 case underwent unenhanced CT scan and contrast-enhanced CT scan of the abdomen as well as unenhanced MRI scan of the abdomen,and No.3 case underwent unenhanced MRI scan and contrast-enhanced MRI scan of the abdomen.We analyzed their clinical and imagining data and reviewed the related literature.Results No.1 case:part of the upper jejunal wall was diffusely thickened and obviously enhanced after enhancement.The superior mesenteric artery and its branches were covered with flaky and striped water-like low-density shadows,which were not enhanced after enhancement.No.2 case:unenhanced CT scan and contrast-enhanced CT scan showed that the volume of the liver increased significantly,and the hepatic veins dilated;part of the small intestinal wall was diffusely thickened and obviously enhanced after enhancement.The superior mesenteric artery and its branches were covered with flaky and striped water-like low-density shadows without enhancement.Abdominal unenhanced MRI scan showed that the duodenum and part of the jejunal wall were thickened,MIP reconstructed images of heavy T2WI showed that the lymphatics in retroperitoneal and mesenteric regions expanded extensively with reticular changes,and the proximal thoracic duct was twisted and dilated.No.3 case:the retroperitoneal region and the area around the superior mesenteric artery and its branches appeared as lump-shaped shadows of long T1 and T2 with clear boundary,the superior mesenteric artery was completely covered without significant pressed and flattened appearance.Moreover,the MIP reconstructed images of the heavy T2WI showed that the lymphatics in the bilateral waist areas and mesenteric region expanded extensively with reticular changes.Conclusion The extensive reticular lymphatic expansion in the retroperitoneal and mesenteric regions on the MIP reconstructed image of the heavy T2WI is the characteristic of IL.CT scan or contrast-enhanced MRI scan of the abdomen can be used for non-invasive diagnosis of IL,since either of them can clearly show superior mesenteric artery and its branches covered by flaky and striped water-like low-density shadows without enhancement and partly thickened small intestinal wall.
     
    Recent Advances in the Prognosis and Associated Risk Factors in Uremic Patients with Maintenance Hemodialysis
    GU Hui,DU Xiao-gang*
    2018, 21(18):  2252-2257.  DOI: 10.3969/j.issn.1007-9572.2018.00.086
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     Maintenance hemodialysis(MH) is the most important form of renal replacement therapy in patients with end-stage renal disease(ESRD).Despite many improvements in medical technology have been achieved in recent years,the mortality rate of ESRD patients with MH is still high.In this paper,based on the review of domestic and abroad articles published recently in which the prognosis and associated risk factors in uremic patients with MH were studied,we summarized the predictive factors for poor prognosis in such patients,including older age,prevalence of diabetes mellitus,dyslipidemia and disorders of calcium and phosphate metabolism,poor hypertension management,and so on.In general,there are many risk factors for poor prognosis of uremic patients,which not only involves the disease itself,but also the treatment and follow-up management.
    Advances in the Association of Helicobacter Pylori Strain Specificity with Gastric Cancer #br#
    XU Jia-sheng,WANG Biao,XIE Chuan*
    2018, 21(18):  2258-2262.  DOI: 10.3969/j.issn.1007-9572.2018.00.120
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    Gastric cancer is one of the most common malignancies,whose incidence ranks the second among all cancers in China.Many factors participate in the development of gastric cancer,of them,Helicobacter pylori is regarded as the most important carcinogen by WHO.We reviewed the recent studies concerning gastric cancer and Helicobacter pylori strain specificity,in particular,examined the internal relationship of gastric cancer with several Helicobacter pylori proteins(CagA,VacA,outer membrane protein,dupA) based on analyzing in vitro studies and animal model studies.Our findings suggest that the specificity of Helicobacter pylori strains in different regions may lead to the geographical differences in the incidence of gastric cancer.
    Recent Advances in the Influence of Patient Navigation on the Adherence to Diagnosis and Treatment among Low-income Cancer Patients 
    ZHANG Jing,LIU Dong-ling*
    2018, 21(18):  2263-2268.  DOI: 10.3969/j.issn.1007-9572.2018.00.162
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    The burden of cancer is expected to continually grow worldwide due to the growth and aging of the population.Because of family,financial factors or other reasons,the adherence to diagnosis and treatment among low-income cancer patients are poor,which can seriously impair the prognosis and quality of life.Patient navigation (PN) is a new type of continuous cancer care model to improve the accessibility and timeliness of medical resources.Studies show that PN can improve the adherence to diagnosis and treatment among low-income cancer patients significantly.However,there are few related studies in China.Therefore,we reviewed the concept,development process,practice model of PN and its influence on the adherence to diagnosis and treatment among low-income cancer patients,with a view to increasing the relative adherence in such a population as well as the domestic cancer care level.