Table of Content

15 July 2018, Volume 21 Issue 20

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Monographic Research

New Advances in Vitamin D　

ZHANG Ming-jun，YANG Ji-hong*

2018, 21(20):  2395-2399.  DOI: 10.12114/j.issn.1007-9572.2018.00.094

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Vitamin D is well known as an important regulator of bone metabolism.Studies show that vitamin D also involves in the occurrence and development of cardiovascular disease，immune system disease，tumor，metabolic disease and neurological disease.Compared with populations with normal vitamin D，those with vitamin D deficiency are more likely to suffer from the aforementioned diseases.As evidence demonstrates that vitamin D supplementation is beneficial to the prevent and to the improvement of the outcome of these diseases，vitamin D supplementation therapy could be used as a promising regimen.




Novel Developments in the Pathogenesis of Acute Pancreatitis

GUO Zhi-guo*，XIN Yi

2018, 21(20):  2400-2403.  DOI: 10.3969/j.issn.1007-9572.2018.00.076

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Acute pancreatitis is a inflammatory disease of the pancreas manifested by inappropriate activation of trypsinogen，infiltration of inflammatory cells and destruction of pancreatic secretory cells.It can be life-threatening if the progression reaches an advanced stage.Because the pathogenesis is unclear yet，and there is few efficient clinical treatment for severe acute pancreatitis.Trypsin activation is mostly considered to be the factor associated with the pathogenesis of pancreatitis.During the process，pro-trypsinogen activation is associated with imbalance of trypsin-antitrypsin and genetic heterogeneity.In recent years，many studies revealed that pancreatitis is a multifactorial disease：alcohol and tobacco can injure small pancreatic duct and acinar cells，but the incidence of acute pancreatitis in drinkers is not increased significantly；pancreatic duct secretion can reduce pancreatic injury；some of animal models without trypsinogen activation still get acute pancreatitis；cytokines play an increasingly important role in the prediction of acute pancreatitis；cystic fibrosis transmembrane conductance regulator expression is closely related to the occurrence of severe acute pancreatitis；autophagy also plays an important role in the inflammatory reaction of the pancreas.





Advances in the Diagnosis and Treatment of Gastric Epithelial Dysplasia　#br#

ZU Ming，DING Shi-gang*

2018, 21(20):  2404-2408.  DOI: 10.3969/j.issn.1007-9572.2017.00.277

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Gastric epithelial dysplasia is an important precancerous lesion of gastric cancer，which is diagnosed by pathological examination.To standardize the classification and diagnosis of precancerous lesions in the world，Padova，Vienna，and WHO classifications were established.The natural history of low grade gastric dysplasia is still controversial，but the high grade gastric dysplasia is associated with high risk of malignant transformation of gastric cancer.Furthermore，there are histologic discrepancies between the results of endoscopic biopsy and endoscopic resection in the diagnosis of gastric epithelial dysplasia.This article reviews the definition，natural history，diagnosis and treatment of gastric epithelial dysplasia，and puts forward that endoscopic treatment of gastric epithelial dysplasia or regular follow-up is the most reliable strategy for the prevention of early gastric cancer.


Mechanism of New-onset Atrial Fibrillation and Management for Arrhythmia in Sepsis and Septic Shock　

YANG Jian-zhong，TANG Bao-peng*

2018, 21(20):  2409-2413.  DOI: 10.12114/j.issn.1007-9572.2018.00.085

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Sepsis and septic shock often lead to life-threatening multiple organ dysfunction.Atrial fibrillation is one of the most common clinical manifestations in patients with sepsis and septic shock，whose occurrence may be related to factors such as inflammation，autonomic dysfunction，underlying diseases，endotoxin，cardiac dysfunction，and electrolytes，but the internal mechanism is not yet clear，and although there are many medications available for this disease，the particular effective ones are rarely reported in studies.Therefore，new challenges are posed by the pathogenesis of new-onset atrial fibrillation and antiarrhythmic therapy in patients with sepsis and septic shock.


Application of E/e' in Predicting the Prognosis in Sepsis　

LI Zhuan-yun，LI Dan-dan，GAO Ran-ran，YUAN Xin，YANG Jian-zhong*

2018, 21(20):  2414-2419.  DOI: 10.12114/j.issn.1007-9572.2018.00.086

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Objective　 To investigate the value and clinical significance of using the ratio of early diastolic peak velocity and early diastolic flow velocity across the left atrioventricular valve （E/e'） for predicting the prognosis in sepsis.Methods　We selected 157 patients with sepsis enrolled from the First Affiliated Hospital of Xinjiang Medical University from March 2016 to May 2017.In accordance with the outcome within 28 days after the definite diagnosis of sepsis，we divided them into death group （39 cases） and survival group （118 cases）.We collected their clinical data，laboratory findings，acute physiology and chronic health evaluation Ⅱ （APACHE Ⅱ） score，sequential organ failure assessment （SOFA） score，results of echocardiogram performed within 24 hours after admission，E/e' determined by tissue Doppler imaging and so on.Multivariate Cox proportional hazards regression analysis was carried out to explore the associated factors for the prognosis of LVDD in sepsis.ROC curve analysis was implemented to investigate the value of E/e' for the prediction of the prognosis of LVDD in sepsis.Results　Compared with death group，the survival group had higher mean arterial pressure（MAP），oxygenation index（OI），Elat and Ea but less heart rate （HR），respiratory frequency（RF），NT-proBNP，blood lactate，hs-cTnT，PCT，APACHEⅡ score，SOFA score，E/e' sep，E/e' lat，and E/e' （P<0.05）.Moreover，the distribution of left ventricular diastolic function varied significantly between the survivals and the deaths （P<0.05）.Multivariate Cox proportional hazards regression analysis revealed that NT-proBNP〔HR=0.978，95%CI（0.967，0.989）〕，APACHEⅡ score〔HR=1.032，95%CI（1.009，1.054）〕，SOFA score〔HR=1.100，95%CI（1.050，1.153）〕，and E/e'〔HR=2.469，95%CI（2.071，2.867）〕were associated factors for the prognosis of sepsis （P<0.05）.For predicting the prognosis of sepsis，the AUC of E/e'〔AUC=0.887，95%CI（0.829，0.944）〕 was larger than that of NT-proBNP〔AUC=0.821，95%CI（0.743，0.898）〕，APACHEⅡ score〔AUC=0.604，95%CI（0.503，0.706）〕 and SOFA score〔AUC=0.705，95%CI（0.603，0.807）〕 （Z=1.631，P=0.050；Z=4.765，P=0.001；Z=3.057，P=0.001）.Conclusion　The LVDD in the deaths due to sepsis was more severe compared with those survivals.E/e' can be used to predict the prognosis of sepsis，and it is superior to NT-proBNP，APACHEⅡ score or SOFA score.

Factors Associated with the Prognosis of Sepsis-induced Myocardial Dysfunction　

YANG Jian-zhong，ZHOU Xian-hui，LU Yan-mei，ZHANG Ling，TANG Bao-peng*

2018, 21(20):  2420-2425.  DOI: 10.12114/j.issn.1007-9572.2018.00.091

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Objective　To explore the factors associated with the prognosis of patients with sepsis-induced myocardial dysfunction （SIMD）.Methods　We enrolled 87 patients with sepsis or septic shock complicating SIMD from the Emergency Resuscitation Room and EICU，the First Affiliated Hospital of Xinjiang Medical University from August 2015 to August 2017.We collected their clinical data，laboratory findings and results of echocardiogram.In accordance with the outcome within 28 days after the definite diagnosis of sepsis，we divided them into death group （56 cases） and survival group （31 cases）.Multivariate Cox proportional hazards regression was used to explore the associated factors for the prognosis of SIMD.Survival analysis was conducted using Kaplan-meier method.Log-rank test was used to compare the survival rate between the groups.Results　Multivariate Cox proportional hazards regression analysis showed that age 〔HR=1.011，95%CI（1.001，1.022）〕，mean arterial pressure （MAP） 〔HR=0.985，95%CI（0.975，0.996）〕，heart rate 〔HR=1.012，95%CI（1.004，1.021）〕，NT-proBNP 〔HR=1.010，95%CI（1.009，1.023）〕，arrhythmia 〔HR=1.875，95%CI（1.415，2.686）〕 were independent factors associated with the prognosis of SIMD patients （P<0.05）.Log-rank test revealed that age equal to or less than 65 years old （χ2=4.973，P=0.027），MAP greater than 65 mm Hg （χ2=8.040，P=0.005），heart rate equal to or less than 104 beats/min （χ2=10.725，P=0.001），and NT-proBNP equal to or less than 1 972 μg/L （χ2=11.426，P=0.001），and without or with arrhythmia （χ2=6.524，P=0.011） were associated with higher survival rate.Conclusion　Age greater than 65 years old，heart rate greater than 104 beats/min，and NT-proBNP greater than 1 972 μg/L，arrhythmia are independent risk factors while MAP greater than 65 mm Hg is a protective factor associated with the prognosis of SIMD patients.PCT and other inflammatory factors showed no association with the prognosis of SIMD patients.


Development of a Cardiac Marker-based Diagnostic Model for Sepsis-induced Left Ventricular Diastolic Dysfunction　

YANG Jian-zhong，LI Zhuan-yun，YIN Fu-kang，LI Dan-dan，TANG Bao-peng*

2018, 21(20):  2426-2431.  DOI: 10.12114/j.issn.1007-9572.2018.00.090

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Objective　To explore the risk factors for sepsis-induced left ventricular diastolic dysfunction （LVDD），and to develop and validate a cardiac marker-based diagnostic model for this disease.Methods　We enrolled sepsis or septic shock from Emergency Department，Emergency Intensive Care Unit，Intensive Care Unit and Respiratory Intensive Care Unit，the First Affiliated Hospital of Xinjiang Medical University from August 2015 to August 2017，including 177 with normal cardiac function was normal cardiac function group，and 66 with sepsis-induced LVDD was sepsis-induced LVDD group.We collected their clinical data and laboratory findings.Co-predictor variable set pre1 （containing the associated variables for sepsis-induced LVDD included in the multivariate Logistic regression model） was used to construct a diagnostic model for sepsis-induced LVDD.Results　Two groups showed significant differences in the age，systolic blood pressure，diastolic blood pressure，mean arterial pressure （MAP），heart rate，respiratory frequency，hemoglobin，INR，partial thromboplastin time （PTT），blood lactate，NT-proBNP，and heart-type fatty acid-binding protein （H-FABP），new arrhythmia （P<0.05）.Multivariate Logistic regression analysis demonstrated that age，INR，PTT，NT-proBNP，H-FABP and new arrhythmia were associated with sepsis-induced LVDD （P<0.05）.Multivariate Logistic regression equation was established：logit（P）=3.231+0.046age-0.344MPA+0.104NT-proBNP+0.065H-FABP+0.744new arrhythmia.Age，NT-proBNP，H-FABP and new arrhythmia were independent factors of sepsis-induced LVDD （P<0.05）.For predicting sepsis-induced LVDD，the AUC of co-predictor variable set pre1 was larger than that of age，MAP，NT-proBNP，H-FABP，new arrhythmia （Z=1.798，P=0.040；Z=3.124，P=0.001；Z=1.894，P=0.032；Z=1.671，P=0.050；Z=1.901，P=0.026）.Eighty patients with sepsis were randomly selected，the sensitivity，specificity，coincidence rate，positive likelihood ratio，and negative likelihood ratio of co-predictor variable set pre1 in predicting sepsis-induced LVDD was 78.12%，89.58%，85.00%，7.49，4.09，respectively.Conclusion　Age，NT-proBNP，H-FABP and new arrhythmia are independent factors of sepsis-induced LVDD.The co-predictor variable set is superior to each of the variable alone in the diagnosis of sepsis-induced LVDD.The cardiac marker-based diagnostic model played a role in predicting sepsis-induced LVDD.


Influence of Different Glucose-lowering Therapies on Colorectal Adenoma Recurrence in Endoscopic Post-polypectomy Type 2 Diabetic Patients

LYU Hong1*，SONG Xiao-hua2

2018, 21(20):  2432-2436.  DOI: 10.3969/j.issn.1007-9572.2018.00.044

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Objective　To analyze the influencing factors of colorectal adenoma recurrence in endoscopic post-polypectomy type 2 diabetic patients treated with different glucose-lowering therapies，providing an evidence-based reference for clinical identification of such cases with recurrence risks.Methods　A total of 273 type 2 diabetic patients with colorectal adenoma who were diagnosed and treated by endoscopic resection of colorectal adenoma in Shenzhen Shekou People's Hospital during January 2006 to June 2016 were included in the cohort and divided into untreated group（n=50），sulfonylureas-treated group（n=94），thiazole-treated group（n=52），metformin-treated group（n=45） and insulin-treated group（n=32） based on the treatment regimen.We obtained the patients' follow-up data. The follow-up period was about 5 years，and the patients who were followed up for less than 5 years were followed up for July 2016. Blood sugar control，hypoglycemic drugs usage，status of aspirin and statins use were recorded.Results　Kaplan-meier curve analysis showed that untreated group，sulfonylureas-treated group，thiazole-treated group and insulin-treated group demonstrated higher colorectal adenoma recurrence rate compared with metformin-treated group（χ2=15.14，18.34，46.83，34.29，P<0.01）．Multivariate Cox regression analysis further demonstrated that history of hypertension〔HR=2.96，95%CI（1.40，6.24）〕，suffering from diabetes for 48 months or longer 〔HR=2.84，95%CI（1.03，7.81）〕，poor glycemic control（fasting plasma glucose>6.1 mmol/L）〔HR=4.97，95%CI（1.74，14.22）〕，more than 20% of the largest adenoma volume was villous adenoma 〔HR=5.73，95%CI（1.86，17.61）〕 and use of sulfonylureas〔HR=3.19，95%CI（1.42，7.14）〕，use of insulin〔HR=3.48，95%CI（1.70，7.13）〕 were risk factors for recurrence of colorectal adenoma，whereas use of metformin could significantly reduce the recurrence〔HR=0.25，95%CI（0.09，0.73），P<0.05〕.Conclusion　Sulfonylureas，metformin and insulin could significantly influence colorectal adenoma recurrence in post-polypectomy type 2 diabetic patients.In view of this，glucose-lowering drugs that can cause lower risk for adenoma recurrence should be used for subsequent treatment as much as possible.


Correlation of Nailfold Microcirculation Abnormality with Disease Activity and Osteoporosis in Female Patients with RA　#br#

YU Chun-yan1，ZHANG Lei1*，GAO Zhao-meng1，XU Jian1，LIU Juan2，ZHANG Qi1

2018, 21(20):  2437-2443.  DOI: 10.3969/j.issn.1007-9572.2017.00.204

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Objective　To explore the clinical significance of nailfold microcirculation abnormality in disease activity and osteoporosis in female patients with rheumatoid arthritis（RA）．Methods　This study was conducted in 320 cases selected from Shengli Oilfield Central Hospital，including 240 RA females（case group） who received treatment in Department of Rheumatology and Immunology from August 2015 to March 2017 and 80 healthy females underwent physical examination（control group） in Physical Examination Center during the same period.We collected their clinical data，including erythrocyte sedimentation rate（ESR） result，levels of C-reactive protein（CRP），rheumatoid factor（RF），anti-cyclic citrullinated peptide（anti-CCP） antibodies and antinuclear antibody（ANA），nailfold capillaroscopy score，levels of serum 25-hydroxyvitamin D 〔25（OH）D〕, VEGF and osteoprotegerin（OPG） detected by ELISA，and bone mineral density measured by dual-energy X-ray absorptiometry.Patients in the case group were divided into mild，moderate and high RA activity subgroups according to DAS 28，and mild RA subgroup（48 cases），moderate RA subgroup（136 cases） and severe RA subgroup（56 cases） based on “TIAN Niu's weighted integration method of nailfold microcirculation”.Multiple linear regression analysis was performed to investigate the associated factors for disease activity in patients with RA.Multivariate Logistic regression analysis was conducted to explore the associated factors for osteoporosis.Results　The nailfold capillaroscopy score was markedly higher in the case group than that of the control group 〔（6.1±1.9） vs.（4.7±1.5），t=5.995，P<0.05）〕.The distribution of nailfold microcirculation abnormality between the case group and the control group was significantly different（u=-8.000，P<0.01）．The nailfold capillaroscopy score increased with the severity of RA（P<0.05），namely，the nailfold capillaroscopy score in the high RA activity subgroup was the highest but in the mild RA activity subgroup it was the lowest.The age，course of RA，prevalence of RF and ANA did not differ significantly by degree of nailfold microcirculation abnormality（P>0.05），but the prevalence of abnormal ESR and CRP，levels of VEGF，OPG and 25（OH）D，prevalence of anti-CCP antibodies，DAS 28，prevalence of decreased bone mass and osteoporosis were differed obviously by degree of nailfold microcirculation abnormality（P<0.05）．Compared with the mild RA subgroup，the level of ESR and CRP，prevalence of anti-CCP antibodies，DAS 28 and VEGF，prevalence of decreased bone mass and osteoporosis were higher while the 25（OH）D
and OPG levels were lower in the moderate RA subgroup（P<0.01）．Compared with the mild and moderate RA subgroups，the ESR，CRP，DAS 28，VEGF were higher while 25（OH）D and OPG were lower in the severe RA subgroup（P<0.01）．The prevalence of anti-CCP antibodies，decreased bone mass and osteoporosis was higher in the severe RA subgroup compared with the mild RA subgroup（P<0.01）．Nailfold microcirculation score in the case group was positively correlated with DAS 28（r=0.575，P<0.05），ESR（r=0.529，P<0.05），CRP（r=0.420，P<0.05），the titer of anti-CCP antibodies（r=0.413，P<0.05），but negatively correlated with 25（OH）D（r=-0.595，P<0.05）and OPG（r=-0.538，P<0.05）．Multiple linear regression analysis showed that ESR〔β=0.033，95%CI（0.001，0.065），P=0.043〕，anti-CCP antibodies 〔β=0.008，95%CI（0，0.068），P=0.044〕，nailfold capillaroscopy score 〔β=0.484，95%CI（0.355，0.614），P<0.001〕 was the associated factor of disease activity in female RA patients.Multivariate Logistic regression analysis showed that age 〔OR=1.150，95%CI（1.020，1.291），P=0.025〕 and nailfold capillaroscopy score 〔OR=2.980，95%CI（1.184，7.502），P=0.033〕 were the risk factors for osteoporosis in female RA patients，while 25（OH）D 〔OR=0.005，95%CI（0.003，0.007），P=0.032〕 and OPG 〔OR=0.907，95%CI（0.842，0.977），P<0.001〕 were protective factors for osteoporosis in female patients with RA.Conclusion　Nailfold microcirculation abnormality is associated with disease activity and osteoporosis in female RA patients.As increased nailfold capillaroscopy score is a risk factor for disease activity and the occurrence of osteoporosis，nailfold capillaroscopy examination can be used as a potential tool to predict the occurrence of osteoporosis in female RA patients.


The Application of Annual Hippocampal Atrophic Rate in the Detection of Early Cognitive Decline　#br#

MI Xiao-kun，HAN Ying*

2018, 21(20):  2444-2447.  DOI: 10.12114/j.issn.1007-9572.2018.00.087

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Objective　To investigate the changes in the annual hippocampal atrophy rate in different populations and to explore their value in detecting early cognitive decline.Methods　Study subjects were selected from among healthy people who underwent a physical examination（n=35），patients with amnestic mild cognitive impairment（aMCI）（n=35） and patients with Alzheimer's disease （AD）（n=35），who were treated in the Fourth Affiliated Hospital of Hebei Medical University in 2012.The frequency of follow-up visitation was once per year，the time of follow-up was 5 years.Subjects who did not complete the follow-up for various reasons were excluded.According to the changes in cognitive function during the follow-up period，the subjects were divided into the following four groups：normal（NG，n=23），stable aMCI（aMCI-S，n=25），aMCI progressing to AD（aMCI-AD，n=10） and AD（n=15）.The cognitive function〔evaluated according to the decrease in Mini-Mental State Exam （MMSE） score〕，hippocampal volume（HV） and annual hippocampal atrophy rate were compared among the four groups，and their correlation was analyzed.Results　The MMSE score and HV in the AD group were lower than those in the NG，aMCI-S and aMCI-AD groups（P<0.05）；the decrease in MMSE score in AD group was greater than those in the NG，aMCI-S and aMCI-AD groups（P<0.05）；the decrease in MMSE score in the aMCI-AD group was greater than those in the NG and aMCI-S groups（P<0.05）.The annual hippocampal atrophy rate in the AD group was higher than those in the NG，aMCI-S and aMCI-AD groups（P<0.05），and the annual hippocampal atrophy rate in the aMCI-AD group was higher than those in the NG and aMCI-S groups（P<0.05）.The annual hippocampal atrophy rate was positively correlated with the decrease in MMSE score（r=0.745，P<0.001）.Conclusion　The annual hippocampal atrophy rate accurately reflects the decline in cognitive function in a high-risk aMCI population.Monitoring the annual hippocampal atrophy rate is helpful for early detection and intervention in high-risk patients.


Analysis of Neuroendocrine Causes of Sjogren Syndrome Complicated by Depression　

ZHONG Jing-mei1*，ZHANG Hong2，WU Shao-yuan1，CHEN Hui1，ZHU Yan-qing1

2018, 21(20):  2448-2451.  DOI: 10.3969/j.issn.1007-9572.2018.00.196

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Objective　To explore the causes of Sjogren syndrome （SS） complicated by depression and the relationship with neurologic and endocrine changes.Methods　Two hundred and twenty-five patients with SS who were admitted to the Department of Clinical Psychology and Department of Rheumatology in the First People's Hospital of Yunnan Province from July 2015 to July 2017 were selected.The patients were divided into a depression group，consisting of 59 patients with depressive episodes，and a control group，consisting of 166 patients.Cranial magnetic resonance imaging-weighted and magnetic sensitive-weighted scans were performed on the frontal lobe，temporal lobe，occipital lobe，cerebellum，brainstem，and basal ganglia to detect ischemic cerebrovascular disease，as well as hemorrhagic cerebrovascular disease.Thyroid function，including thyrotropin （TSH），tetraiodothyronine （T4），triiodothyronine （T3），free tetraiodothyronine （FT4），free triiodothyronine （FT3），thyroglobulin antibody （aTG），thyroid peroxidase antibody （TPOAb），was measured.The incidence of liver damage，renal impairment，chronic heart failure，and pulmonary fibrosis was also recorded.Results　The incidence of ischemic cerebrovascular disease in the frontal lobe，temporal lobe，occipital lobe，cerebellum，and basal ganglia was higher in the depression group than the control group （P<0.05）.In the depression group，the incidence of ischemic cerebrovascular disease in the frontal lobe was higher than temporal lobe，the occipital lobe，cerebellum，and brainstem and basal ganglia，and the incidence of ischemic cerebrovascular disease in the temporal lobe and basal ganglia was higher than cerebellum （P<0.05）.The incidence of hemorrhagic cerebrovascular disease in the frontal lobe，temporal lobe，occipital lobe，and basal ganglia was higher in the depression group than the control group （P<0.05）.In the depression group，the incidence of hemorrhagic cerebrovascular disease in the frontal lobe of patients with depression was higher than the occipital lobe，cerebellum，and brainstem （P<0.05）.The levels of TSH，aTG，and TPOAb in the depression group were higher than the control group，while the levels of T3 and FT3 were lower than the control group （P<0.05）.The incidence of pulmonary fibrosis in the depression group was higher than the control group （P<0.05）.Conclusion　SS complicated with depression may be associated with cerebral vascular damage caused by SS，which may be related to cerebral ischemia and bleeding related to emotion.And it may be related to SS causing thyroid dysfunction and complicated vital organ damage，thus affecting the quality of life.


Changes in the Degree Centrality in the Network Node of Resting State Brain Function after Antipsychotic Treatment in Schizophrenia　

YAN Jing1，ZHANG Xiao1，LIU Qi1，YAN Jun1，JIANG Si-si1，CAI Li-wei1，YUAN Hui-shu2，YAN Hao1，LIAO Jin-min1*，ZHANG Dai1*

2018, 21(20):  2452-2458.  DOI: 10.3969/j.issn.1007-9572.2018.00.186

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Objective　To investigate the change in connectivity properties of resting brain function in patients with schizophrenia （SZ） after treatment with a single antipsychotic by using a voxel level degree centrality （DC）-based method.Methods　In this study 38 patients with SZ who were treated as outpatients and inpatients at the Peking University Sixth Hospital from February 2011 to July 2014 were selected as the SZ group.At the same time，31 healthy volunteers from the community were recruited through advertisements and served as the normal control group.Participants were assessed for psychiatric symptoms and cognitive function at baseline and after 6 weeks of follow-up.Positive and Negative Symptom Scales were used to assess the clinical symptoms of the patients.Resting state functional magnetic resonance imaging scans were performed to calculate the total brain DC values.The difference in brain area between the SZ group and the normal control group at baseline，and between at baseline and 6 weeks after treatment with a single antipsychotic drug in the SZ group were detect，and the partial correlation analysis was made with the mental symptoms and cognitive function. Results　At baseline，the DC values in the bilateral central posterior gyrus，right cingulate gyrus，right thalamus，left cerebellum，and bilateral tongue spurs in the SZ group were lower than the normal control group 〔false discovery rate （FDR） correction，P<0.05〕.There was a negative correlation between the DC value in the left postcentral gyrus and the score of positive symptom factors （r=-0.361，P=0.033）.After 6 weeks of treatment，the DC value in the bilateral central posterior gyrus was higher in the SZ group than at baseline （FDR uncorrected，P<0.001）. The DC value in the right central posterior gyrus （z=48 mm） was positively correlated with the age of first onset （r=0.484，P=0.003），and negatively correlated with the total disease duration （r=-0.491，P=0.003）.Conclusion　Antipsychotic treatment can improve the abnormal connectivity of resting state brain function in patients with SZ，and the central posterior gyrus may be an important brain area for antipsychotic.


Expression and Clinical Significance of Early Serum IL-1R1，APC and PCT in Children with Sepsis　

SHI Xiao-na1，XU Mei-xian1，HUO Xi-min1，WANG Xiao-dong1，LIU Gang1，ZHANG Jing2，SUN Su-zhen2*

2018, 21(20):  2459-2462.  DOI: 10.3969/j.issn.1007-9572.2018.00.035

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Objective　To investigate the clinical value of serum interleukin-1 receptor 1（IL-1R1），active protein C（APC），and procalcitonin（PCT） for evaluating the severity of pediatric sepsis.Methods　Sixty-six children，38 with sepsis and 28 with severe sepsis，treated in the ICU of the Children's Hospital of Hebei province in 2015 were included.Thirty healthy children who presented for routine examinations during the study period were the control group.Serum IL-1R1，APC，and PCT were assayed in patients within 24 hours of admission and in controls on enrollment.Receiver operating characteristic（ROC） curve were used to evaluate the significance of IL-1R1，APC，and PCT as markers of sepsis severity.Results　There were significant differences in the IL-1R1，APC，and PCT concentrations（all P<0.05）．IL-1R1 and PCT were higher in the sepsis group than in the control group，and APC was significantly lower（P<0.05）．IL-1R1 was higher，and APC was lower，in the severe sepsis group than in the control group（P<0.05）．APC was higher in the severe sepsis group than in sepsis group（P<0.05）．PCT was higher in the severe sepsis group than in both sepsis and control groups（P<0.05）．The area under the ROC curve（AUC） of the IL-1R1 concentration for diagnosing severe sepsis was 0.597，which was not significantly different from 0.500（P=0.198）．The corresponding AUCs of APC and PCT were 0.686 and 0.817，respectively（both > 0.500；P=0.013 for APC and P<0.001 for PCT）．The AUC of the three combined markers was 0.834，which was significantly higher than 0.500（P<0.001）．Conclusion　Elevated serum PCT and the three biomarkers combined were relatively accurate in evaluating the severity of sepsis and have potential clinical value as a reference of severity.


Association of Fat-1 Gene Polymorphism and Spinal Tuberculosis Susceptibility　

SHEN Jian*，SHI Shi-yuan，LAI Zhen，JIN Yang-hui

2018, 21(20):  2463-2468.  DOI: 10.3969/j.issn.1007-9572.2017.00.255

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Objective　To find and explore new candidate genes associated with spinal tuberculosis susceptibility.Methods　A total of 193 patients with spinal tuberculosis，who were treated in Hangzhou Red Cross Hospital from June 2013 to December 2015，were selected as the case group.A further 207 healthy subjects who came for physical tests in the same hospital during the same period were selected as the control group.We used high-throughput sequencing to analyze DNA from six patients and used bioinformatics to determine candidate genes associated with tuberculosis. Results　showed that the gene polymorphism，Fat-1（rs1280098，c.8798A > C，p.Q2933P），was associated with the occurrence of spinal tuberculosis.Subsequently，the Sanger sequencing method was used to verify this mutation loci in both the control group and case group.Expression of
Fat-1 was subsequently detected using real-time fluorescent reverse transcription polymerase chain reaction（qRT-PCR）．
In addition，the levels of interleukin（IL）-12 and interferon gamma（IFN-γ），as well as other biochemical indicators were detected. Results　There were 129（66.8%） AA genotypes，33（17.1%） AC genotypes，and 31（16.1%） CC genotypes in the case group，while there were 157（75.8%） AA genotypes，35（16.9%） AC genotypes，and 15（7.3%） CC genotypes in the control group.There was a significant difference between the two groups in the distribution of Fat-1 genotype（χ2=7.885，P=0.019）． Logistic regression analysis of different genetic models showed that，in the additive model，CC homozygous mutation genotypes were correlated with increased incidences of spinal tuberculosis，while AC heterozygous mutation genotypes were associated with normal incidences of spinal tuberculosis（P>0.05）． In the dominant model，AC+CC mutation genotypes were correlated with increased incidences of spinal tuberculosis（P<0.05）；in the recessive model，CC homozygous mutation genotypes were correlated with increased incidences of spinal tuberculosis（P<0.05）；and the minor allele C of the polymorphism locus was related to the incidence of spinal tuberculosis（P<0.05）． The expression of Fat-1 in peripheral blood was lower in the case group than in the control group，while the levels of serum IL-12 and IFN-γ were higher in the case group compared with the control group（P<0.05）. The levels of lipoprotein A，C-reactive protein，erythrocyte sedimentation rate，and eosinophil counts in the case group were higher than those in the control group，while albumin level in the case group was lower than that in the control group（P<0.05）． Conclusion　The gene polymorphism，Fat-1，is associated with the occurrence of spinal tuberculosis.In addition，the mutation of the Fat-1 gene results in reduced levels of Fat-1 gene transcription，as well as increased levels of the inflammatory cytokines，IL-12 and IFN-γ，in serum.These test results provide a molecular mechanism for the early diagnosis of spinal tuberculosis.


Factors Associated with Prehospital Delay among Patients with Acute Myocardial Infarction in Rural Areas of Liaoning Province　

HUANG Dong-hui1，2，ZHANG Wen-liang3，SUN Hao1，SHI Jing-pu1*

2018, 21(20):  2469-2474.  DOI: 10.3969/j.issn.1007-9572.2017.00.261

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Background　Prehospital delays in acute myocardial infarction（AMI） patients in rural areas are common，but this issue has not been studied well in China.Objective　To investigate the characteristics and associated factors of prehospital delay in rural areas AMI patients in Liaoning province，providing theoretical evidences for delivering targeted interventions.Methods　From August 2010 to February 2012，we enrolled a total of 822 AMI inpatients who received treatment in 15 county-level hospitals of Liaoning province by convenience sampling and surveyed them with a self-developed questionnaire for collecting the following data：sex，age，history of smoking and drinking，medical history（hypertension，hyperlipidemia，diabetes mellitus，stroke，angina and myocardial infarction），history of revascularization treatment，self-treatment for chronic diseases，attack time of AMI（onset season，circadian rhythm），departure time for seeking treatment，arrival time at the hospital，hospital level，prehospital transfer，mode of transport and causes of delay in seeking treatment.Ordinal Logistic regression model was used to analyze the association between these aforementioned factors and prehospital delay.Results　Prehospital delay time in rural areas AMI patients was 140（220） min.In the analysis of ordinal Logistic model，history of diabetes mellitus〔OR=2.368，95%CI（1.501，3.734）〕 and self-treatment for chronic diseases〔OR=0.596，95%CI（0.398，
0.894）〕，circadian rhythm in AMI onset〔6：00-11：59：OR=0.314，95%CI（0.193，0.511）；12：00-17：59：OR=0.458，95%CI（0.276，0.761）〕，departure time for seeking treatment〔6：00-11：59：OR=3.035，95%CI（1.876，4.908）；12：00-17：59：OR=2.189，95%CI（1.326，3.612）〕，prehospital transfer〔indirect transfer with medical measures：OR=4.015，95%CI（2.176，7.407）； indirect transfer without medical measures：OR=3.554，95%CI（1.793，7.044）〕，the mode of transport except ambulance，taxi，vehicle，walking and manual handing〔OR=1.695，95%CI（1.004，2.861）〕，causes of delay in seeking treatment〔way far away：OR=0.083，95%CI（0.058，0.119）； poverty：OR=0.352，95%CI（0.161，0.770）；others：OR=0.584，95%CI（0.393，0.868）〕 were independent associated factors of prehospital delay（P<0.05）．Conclusion　The rural areas AMI patients in Liaoning province have long prehospital delay，which is associated with many factors，such as insufficient recognition of AMI，poor sense of seeking treatment，and relative lack of medical resources.In view of this，greater efforts should be made to publicize the knowledge about this disease and interventions should be taken to improve the poor medical status.


De-escalation Strategies for Emergency Treatment of Elderly Patients with Craniocerebral Injury　

GU Yu-hui*，CHEN Xiao-yan，SHI Hui，ZHANG Ming-xiang，ZHOU Shui-xin，JIANG Hui，GU Yu-dan，XU Xi-de

2018, 21(20):  2475-2478.  DOI: 10.3969/j.issn.1007-9572.2018.00.114

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Objective　To explore the effect of de-escalation strategies for emergency treatment of elderly patients with craniocerebral injury.Methods　The participants were 132 elderly patients with craniocerebral injury，including 67 enrolled from July 2015 to July 2016 treated by the conventional emergency treatment（conventional group），and 65 enrolled from August 2016 to August 2017 treated by emergency treatment with de-escalation strategies（research group）．The emergency treatment duration，outcome（survival rate，mortality，status of recovery of the survivals，prevalence of developmental disabilities） and patient satisfaction with emergency treatment were compared between the two groups.Results　Compared with the conventional group，the research group had much shorter emergency treatment duration（t=21.843，P<0.05），significantly higher survival rate（χ2=6.453，P<0.05），and notable lower case fatality rate（χ2=6.872，P<0.05），higher score of Glasgow coma scale（t=7.924，P<0.001），but substantially lower prevalence of severe developmental disabilities（χ2=8.786，P<0.05），and much higher level of patient satisfaction with emergency treatment（χ2=14.678，P<0.001）．Conclusion　De-escalation strategies used in the emergency treatment of elderly patients with craniocerebral injury can significantly shorten the emergency treatment duration，reduce the case fatality rate，improve the prognosis as well as the patient satisfaction with emergency treatment，so it is worthy of clinical promotion.


Status and Influencing Factors of the Fear of Cancer Recurrence in Breast Cancer Survivors　#br#

ZHANG Yang1，CHENG Chun-yan2，CUI Pan-pan2，CHEN Chang-ying1，2*

2018, 21(20):  2479-2483.  DOI: 10.3969/j.issn.1007-9572.2018.00.075

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Objective　To explore the status and influencing factors of the fear of cancer recurrence（FCR） among breast cancer survivors.Methods　By convenience sampling，280 breast cancer patients who received postoperative chemotherapy in the First Affiliated Hospital of Zhengzhou University from September 2016 to March 2017 were enrolled.A self-developed sociodemographic data questionnaire，Chinese version of the Fear of Progression Questionnaire-Short Form
（FoP-Q-SF），Chinese version of the Hospital Anxiety and Depression Scale（HADS） and Chinese version of the Perceived Social Support Scale（PSSS） were used to survey them for collecting the sociodemographic characteristics，status of FCR，anxiety and depression，and social support.Results　A total of 280 questionnaires were handed out，and 270 responsive ones were returned.The effective recovery rate was 96.4%.The mean score of FoP-Q-SF was（36.8±10.7），171 cases（63.3%） had a FCR score≥34 and the mean score was（19.3±5.5） for physical health，and（17.5±6.2） for social and family.The mean score was（16.6±7.4） for HADS，（8.9±4.3） for anxiety subscale and（7.8±3.9） for depression subscale.The mean score of PSSS was（59.9±13.9），the family support score was（21.7±5.1），and the score of external support of family dimension was （38.2±9.8）．The mean FoP-Q-SF score varied significantly by age，marital status，employment status，average household monthly income，cancer stage and treatment response（P<0.05）．FoP-Q-SF score of breast cancer patients was positively correlated with HADS score（r=0.665，P<0.01），but negatively correlated with PSSS score（r=-0.464，P<0.01）．Multiple linear regression analysis revealed that age（t=-3.908），marital status（t=-3.218），HADS score（t=11.327），and the score of PSSS（t=-4.672）were associated factors of FoP-Q-SF score of breast cancer patients（P<0.05）．Conclusion　The prevalence rate of FCR was high among breast cancer survivors，which was significantly affected by age，marital status，anxiety，depression and social support.


Relationship between Loneliness and the Image of Ageing：Chain Mediating Effects of Anxiety and Perceived Social Support　

LIN Zhong-yong1，WAN Peng-yu1，YANG Xin-guo2*

2018, 21(20):  2484-2488.  DOI: 10.3969/j.issn.1007-9572.2018.00.137

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Objective　To explore the chain mediating effect of anxiety and perceived social support on the relationship between loneliness and the image of ageing.Methods　In this study conducted from May to June 2017，we surveyed a random sample of 320 students from Guangxi Nanning University for the Elderly with the Chinese version of Image of Ageing Scale（IAS），Chinese version of Perceived Social Support Scale（PSSS），Chinese version of Anxiety Scale（AS） and Chinese version of Loneliness Scale（LS）．AMOS 20.0 was used to construct the structural equation modeling for analyzing the mediating effect of anxiety and social support on loneliness and images of ageing.Results　293 respondents returned responsive questionnaires，with a response rate of 91.56%.The average score for IAS，PSSS，AS，and LS was（57.6±7.7）（22.8±4.0）（10.9±4.5） and 1（0，2），respectively.Elderly people with poor economic status scored much lower for IAS compared with those with fair economic status（P<0.05）．Correlation analysis showed that perceived social support was positively correlated with image of ageing and anxiety（P<0.05），loneliness was negatively correlated with the image of ageing and perceived social support（P<0.05），and anxiety was positively correlated with loneliness（P<0.05）．Path analysis with multiple mediators demonstrated that loneliness had a positive effect on anxiety（β=0.16，P=0.01），but a negative effect on perceived social support（β=-0.40，P<0.001）；anxiety positively affected perceived social support（β=0.18，P=0.006） as well as the image of ageing（β=0.30，P=0.003）．Mediation analysis with Bootstrapping indicated that in the path of “loneliness→ perceived social support→ the image of ageing”，the estimated value of perceived social support was -0.353 5〔95%CI（-0.685 6，-0.126 8）〕，stating that perceived social support produced partial mediating effects on loneliness and the image of ageing；in the path of “loneliness →anxiety→ perceived social support →the image of ageing”，the estimate value of “anxiety → perceived social support” was 0.028 4〔95%CI（0.004 9，0.088 9）〕，exhibiting that perceived social support and anxiety exerted chain-mediated effect on loneliness and the image of ageing.Conclusion　Anxiety and perceived social support play a chain mediating effect on the relationship between loneliness and the image of ageing.Loneliness indirectly affects the image of ageing through the mediating role of perceived social support，and ultimately predicts it via the mediating effects of anxiety and perceived social support.


Associated Factors for the Adherence to Prescribed Chinese and Western Medications in Patients with Chronic Kidney Disease：a Delphi Consultation Study

TAN Jiao-wang1，ZHANG Min1，HUANG Qiong1，YE Mei-qin1，LUO Li1，ZHANG Ding-jun1，JIE Xi-na2，FU Li-zhe2，LUN Long-wei2，WU Yi-fan2*

2018, 21(20):  2489-2492.  DOI: 10.3969/j.issn.1007-9572.2018.00.024

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Objective　To explore the associated factors for the adherence to prescribed Chinese and Western medications in patients with chronic kidney disease（CKD） by using the Delphi consultation.Methods　In this study carried out between April and September 2017，we recruited 23 experts in the field of Chinese and Western medicine nephrosis，and conducted a three-round Delphi expert consultation for investigating their appraisal of each item in our pre-designed knowledge-belief-behavior based questionnaire.Results　Total 44 items were formed after three-round expert consultation.The knowledge part comprises 18 items（e.g.curative effects，side effects，naming and methods of administration），each of them achieved over 90% recognition rate.Nineteen items（e.g.harmonious interaction，clear mind，and relaxed mood due to medication） constitute the belief part，and 12 out of them（e.g.richer energy，lower likelihood of hospitalization，and relaxed mood after medication） won over 90% recognition rate.The behavior part consists of 7 items（e.g.missing medication，overlooked medication，medication cessation against prescription after symptomatic relief），5 of which（e.g.missing medication，overlooked medication，medication cessation against prescription after symptomatic relief） gained over 90% recognition rate.Conclusion　The factors affecting the compliance of CKD patients include the degree of patients' understanding of daily medication, the understanding of  decocting of Chinese medicine and the acceptance of the taste of traditional Chinese medicine, the self feeling after taking the medicine, the effect and prognosis of the treatment, and the influence of daily life on the medicine.Patient education focusing on significant associated factors for medication adherence to boost positive medication belief and avoid negative medication belief may improve medication adherence in patients with CKD and clinical benefits.


Survey on the Awareness and Prevention of Diabetic Retinopathy among Patients with Diabetes Mellitus and Impaired Glucose Tolerance in the Huamu Community of Shanghai City　

SU Jia-li*，ZHANG Yi，XU Ying

2018, 21(20):  2493-2498.  DOI: 10.3969/j.issn.1007-9572.2018.00.136

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Objective　To understand the current status of knowledge of the prevention and treatment of diabetic retinopathy（DR） in a community population and to provide a reference for DR prevention and treatment.Methods　The study subjects consisted of 501 patients with diabetes mellitus（DM） or impaired glucose tolerance（IGT） who were treated in the Youyou service station of the Huamu Community Health Service Center between January 2016 and January 2017.A self-designed questionnaire was used for the survey.Items included the subjects' knowledge of DR（items 1-7），current status of prevention and treatment of DR and willingness to take related measures（items 8-10）．Results　There was a significant difference in knowledge in item 2（the cause of DR），item 3（that DR can be prevented and controlled），item 5（that DM patients need regular fundus examination） and item 6（the way to understand DR） between DM patients and IGT patients（χ2=4.217，χ2=13.198，χ2=15.721，χ2=25.168，P<0.05）．The difference in the distribution of control behavior of item 9（the time of recent ophthalmology examination） and item 10（regular fundus examination） between DM patients and IGT subjects were statistically significant（u=2.156，χ2=4.474，P<0.05）．The difference in item 10 between male and female IGT subjects was statistically significant（χ2=7.250，P=0.007）．DM patients of different ages showed a significant difference in items 9 and 10（H=9.614，P=0.022；χ2=23.449，P<0.001），the difference in item 9 between DM patients <60 years old versus 70-79 years old was statistically significant（P<0.05），and the proportion of DM patients <60 years old who chose "receive regular examination" was higher than that of DM patients 60-69，70-79，≥80 years old（P<0.05）．In addition，DM patients 60-69 years old and 70-79 years old comprised a higher proportion who choose "receive regular examination" than did DM patients ≥80 years old（P<0.05）．DM patients with different disease courses differed regarding item 8（DR knowledge lecture） and item 10（χ2=10.539，P=0.005；χ2=6.353，P=0.042），among them，DM patients with a disease course >10 years had a higher proportion who choose "once took DR knowledge lecture" than did those with a disease course <5，5-10 years.Moreover，DM patients with a disease course <5 years comprised a higher proportion who choose "receive regular examination" than did those with a disease course 5-10，>10 years.DM patients with a disease course 5-10 years also had a higher proportion who choose "receive regular examination" than did those with a disease course > 10 years（P<0.05）．Conclusion　The awareness of DR in the residents of this community is relatively low，and people with IGT have less awareness and fewer prevention behaviors than those with DM.Therefore，it is necessary to provide health education to provide DR-related knowledge to the community.


Common Sites of Short-term Interventricular Premature Beats in Patients with Atrial Fibrillation　

XIONG Yu-qin1，LIU Geng-xing1，LIN Min1，FANG Ding-fen1，HUANG Wei-bin2*

2018, 21(20):  2499-2502.  DOI: 10.3969/j.issn.1007-9572.2018.00.156

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Objective　To determine the occurrence of short-term interventricular premature beats and ventricular anatomical position in patients with atrial fibrillation （AF）．Methods　A retrospective analysis of the 24 h dynamic electrocardiograms of 323 patients with AF and ventricular premature beats treated at the First Affiliated Hospital of Xiamen University in 2016 was performed.The Lorenz scatter plot was used to measure the point of the shortest conjugation among the ventricular premature beats in patients with AF，and the origin of the premature ventricular contractions was determined using the reverse technique.Results　The measurements of short-term intervals of ventricular premature beats which originated from the left ventricular apex and right ventricular apex were the shortest〔（380 ± 55） ms and （394 ± 58） ms〕，respectively.There was no significant difference between the two groups （P> 0.05）．The measurements of short-term intervals of ventricular premature beats was lower in the left ventricular apex than left ventricular inflow tract，left ventricular outflow tract，right ventricular inflow tract，and right ventricular outflow tract（t=4.89，P<0.01；t=5.61，P<0.01；t=3.90，P<0.01；t=5.99，P<0.01，respectively）．The measurements of short-term intervals of ventricular premature beats was lower in the right ventricle apex than left ventricular inflow tract，left ventricular outflow tract，right ventricular inflow tract，and right ventricular outflow tract（t=2.18，P=0.03；t=3.09，P<0.01；t=2.07，P=0.04；t=3.11，P<0.01，respectively）．Conclusion　The apical level in patients with AF is prone to short-term interventricular premature beats，which may be related to pathophysiology，apical structure and function.


Postoperative Application of Self-made Bandage in Patients with Modified Radical Mastectomy　

CHEN Yong，WEI YANG-hui*，HUANG Yao

2018, 21(20):  2502-2505.  DOI: 10.3969/j.issn.1007-9572.2018.00.152

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Objective　To investigate the clinical value of self-made bandage via postoperative use of it in patients with modified radical mastectomy.Methods　The enrolled participants were 60 patients undergoing modified radical mastectomy by the same group of surgeons in Thyroid and Breast Surgery，the Eighth Affiliated Hospital，Sun Yat-sen University between May 2010 and October 2016.Using block randomization method，they were allocated into group A and group B.For binding up the wound postoperatively，normal elastic bandage was used for group A，while self-made bandage was adopted for group B.The incidence of postoperative skin flap necrosis，incidence of subcutaneous effusion，rate of grade Ⅰ wound healing，the average extubation time，average daily drainage volume，average length of stay（LOS） and postoperative reported comfort were compared between the groups.Results　Compared with group A，group B demonstrated lower postoperative incidence of skin flap necrosis〔6.7%（2 cases） vs 26.7%（8 cases）〕（χ2=4.32，P=0.038），lower incidence of subcutaneous effusion〔6.7%（2 cases） vs 30.0%（9 cases）〕（χ2=5.46，P=0.020），but higher rate of grade Ⅰ wound healing〔93.3%（28 cases） vs 73.3%（22 cases）〕（χ2=4.32，P=0.038）． Moreover，group B showed shorter average extubation time（insertion sites of armpit and protothorax），and LOS，as well as less average daily drainage volume（P<0.001）． In addition，group B had lower rate of injection of analgesic drugs〔10.0% （3 cases） vs 33.3% （10 cases）〕（χ2=4.81，P=0.028），lower rate of respiratory limitations〔6.7%（2 cases） vs 26.7%（8 cases）〕（χ2=4.32，P=0.038），and lower rate of being confined passive position〔6.7%（2 cases） vs 30.0%（9 cases）〕（χ2=5.46，P=0.020） than group A.Conclusion　Using self-made bandage for binding up the wound postoperatively，can reduce the incidence of subcutaneous effusion，decrease the incidence of skin flap necrosis，increase the rate of grade Ⅰ wound healing，shorten the extubation time and LOS，decline the daily drainage volume and improve the postoperative comfort，so it is worthy of clinical promotion.


Evaluation of the Value of Transrectal Ultrasonography in Diagnosing Male Infertility　#br#

LIU Gui-mei1，2，GE Hui-yu1*，RAN Wei-qiang1，CHEN Wen1，MENG Xiu-feng2

2018, 21(20):  2506-2510.  DOI: 10.3969/j.issn.1007-9572.2018.00.175

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Objective　To explore the value of transrectal ultrasound in diagnosing male infertility.Methods　We summarized and analyzed the sonographic features of the ejaculatory duct，the seminal vesicles，and the terminal part of the vas deferens in patients with non-sexual dysfunction infertility who were treated at the Peking University Third Hospital between January 2014 and February 2016.Results　Ultrasound examination revealed an abnormality rate of 49.29% （836/1 696） in the ejaculatory duct，seminal vesicle，and terminal vas deferens.The incidence of abnormalities in the ejaculatory duct was 31.72% （538 cases），including 458 cases（27.00%） of ejaculatory duct cysts，35 cases（2.06%） of ejaculatory duct calcification or stones，28 cases（1.65%） of ejaculatory duct cysts accompanied by stones，8 cases（0.47%） of ejaculatory duct expansion accompanied by stones，7 cases（0.41%） of ejaculatory duct expansion，and 2 cases（0.12%） of ejaculatory duct wall thickening.The incidence of seminal vesicle abnormalities was 32.02%（543/1 696），including 290 cases（17.10%） of congenital deficiency of the seminal vesicle，127 cases（7.49%） of congenital dysplasia of the seminal vesicle，81 cases（4.78%） of seminal vesicle expansion，25 cases（1.47%） of seminal vesicle stones，11 cases（0.65%） of seminal vesicle cysts，and 9 cases（0.53%） of seminal vesicle wall thickening.The rate of abnormalities in the terminal vas deferens was 8.20% （139/1 696），of which 109 cases（6.43%） had congenital deficiency or dysplasia of the vas deferens，11 cases （0.65%） had expansion of the terminal vas deferens，11 cases （0.65%） had vas deferens calcification or stones，8 cases（0.47%） had vas deferens wall thickened.Conclusion　Transrectal ultrasound examination of male infertility can be used to diagnose patients with congenital and acquired lesions of the ejaculatory duct，seminal vesicles，and terminal vas deferens，thus providing clear diagnostic value and a basis for disease treatment.


Diagnosis of Thyroid Nodules through Ultrasound-guided Fine Needle Aspiration and Effects of Nodule Size on Bethesda Classification

CHEN Li-bin1*，ZHANG Sheng-min1，XU You-feng1，JIANG Yue-ming-ming1，GUO Min-hua1，ZHANG Tao2

2018, 21(20):  2511-2515.  DOI: 10.3969/j.issn.1007-9572.2018.00.177

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Objective　To evaluate the value of ultrasound-guided thyroid fine needle aspiration （FNA） in the differential diagnosis of benign and malignant thyroid nodules，and to investigate the effect of nodule size on Bethesda classification.Methods　We retrospectively analyzed the clinical data of patients who underwent ultrasound-guided thyroid FNA of thyroid nodules in the Ningbo First Hospital in 2015 and 2016，as well as the pathological results according to the Bethesda reporting system.Histopathology was used as the gold standard to judge the value of thyroid FNA in differentiating benign from malignant nodules，and the effect of nodule size on Bethesda classification was also analyzed.Results　A total of 743 patients were included，and 755 nodules were analyzed.The nodule diameter was （10.4±7.1）mm.The FNA pathological results of 755 thyroid nodules were classified according to the Bethesda reporting system：there were 81（10.7%） nodules with unsatisfactory specimens，342（45.3%） benign nodules，80（10.6%） nodules with atypia of undetermined significance （AUS），3（0.4%） follicular neoplasms，91（12.1%） suspicious malignant nodules，and 158（20.9%） malignant nodules.The rate of satisfactory specimens was 89.3%（674/755）.There were no significant differences in the rates of unsatisfactory samples，AUS and malignant nodules between ≤10 mm and >10 mm nodules （P>0.05）.There were no significant differences in the rates of unsatisfactory samples and AUS between ≤5 mm nodules and >5 mm nodules （P>0.05）.The malignant rate was lower in ≤5 mm thyroid nodules than >5 mm nodules （P<0.001）.Among 202 nodules with surgical pathological results，FNA obtained consistent results in 173 nodules.The sensitivity，specificity，accuracy，positive predictive value，and negative predictive value of FNA in the diagnosis of thyroid nodules were 94.3%（150/159），85.7%（12/14），93.6%（162/173），98.7%（150/152），and 57.1%（12/21），respectively.Conclusion　Ultrasound-guided thyroid FNA has substantial value in differentiating benign and malignant thyroid nodules，with a very high positive predictive value；nodule size does not significantly affect Bethesda cytopathological classification，and the rate of satisfactory specimens is affected by the degree of proficiency.


Clinical Characteristics and Prognosis of 45 Patients with Late-onset Myasthenia Gravis　

XIA Chun-feng1，ZHAO Yan-jun1，ZHANG Jun2，LIU Gang3，ZHANG Yue-qi4*

2018, 21(20):  2516-2520.  DOI: 10.3969/j.issn.1007-9572.2018.00.167

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Objective　To analyze the clinical manifestations and prognosis of patients with late-onset myasthenia gravis （LOMG）.Methods　Forty-five patients with LOMG undergoing treatment at Weifang People's Hospital，Qianfoshan Hospital of Shandong，and Xuanwu Hospital，Capital Medical University between January 2015 and January 2017 were selected as the study subjects.The patient general information，clinical symptoms，complications，laboratory tests，treatment，and follow-up data were collected and retrospectively analyzed.The clinical data of patients with different ages of onset and prognosis were compared.Results　The 45 LOMG patients included 28 males and 17 females，with an average age of onset of （73.4±9.7） years.The initial symptoms included ocular muscle involvement 〔38 cases （84%）〕，ball palsy 〔31 cases （69%）〕，and difficulty raising the head 〔6 cases （13%）〕.According to the Osserman classification，there were 10 type Ⅰ，27 type Ⅱ，and 8 type Ⅲ early-stage cases，and 7 type Ⅰ，15 type Ⅱ，21 type Ⅲ and 2 type Ⅳ acme-stage cases.Eighteen patients （40%） had myasthenia gravis associated autoimmune dysfunction and 41 patients （91%） had at least one medical complication.Among the 43 patients who underwent AchR-Ab testing，39 （91%） were positive.Among the 33 patients who underwent cholinesterase inhibition testing，31 （94%） were positive.Abnormalities in neuromuscular electrophysiologic examinations existed in 20 （61%） of 33 patients.An increase in 1 or more autoantibodies occurred in 10 patients；there were 7 patients （17%） with abnormal thymus imaging among 42 patients who underwent chest imaging.Forty-two patients （93%） were treated with anti-cholinesterase inhibitors，36 patients （80%） received conventional immunosuppressive therapy，and 10 patients （22%） had thymectomies.The incidence of ball palsy，the Osserman classification in the early stage，and the mortality rate were significantly different among patients with different ages of onset （P<0.05）.The Osserman classification in the acme-stage among patients who died was significantly higher than in survivors.The incidence of cancer and the number of hospitalizations during the follow-up period in the patients who died were also significantly higher than in survivors （P<0.05）.Conclusion　Patients with LOMG have clinical features，such as involvement of laryngeal muscles，diverse clinical manifestations，complications of autoimmune diseases，and poor response to thymectomy.Such patients should be followed closely with early diagnosis and treatment.