Table of Content

20 July 2018, Volume 21 Issue 21

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Monographic Research

Choice of Antibiotic and Self-care：Interpretation of the 2018 NICE Guideline for Antibiotic Prescription for （Acute） Sore Throat（Ⅰ）　

WEI Xin-fa，WU Hui-li*，RAN Xiao-jun

2018, 21(21):  2521-2524.  DOI: 10.12114/j.issn.1007-9572.2018.00.100

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Sore throat is a common otolaryngological problem mainly treated by antibiotics.Repeated and prolonged use of the same kind of antibiotic lead to antimicrobial resistance or other adverse events.The antibiotic prescription for acute sore throat，its guidance published in January 2018，details the antimicrobial prescribing strategies for acute sore throat，aims at limiting antibiotic use and reducing antimicrobial resistance.Because 60% of the patients cited in the 2014 study reported sore throats，the guideline gives clear recommendations for management and antibiotic treatment of sore throats，which is suitable for ENT doctors and general practitioners.This article reviews the selection of antimicrobial agents and self health care plan for acute sore throat in this guide，combined with relevant literature.


Summary of the Evidence and Committee Discussions：Interpretation of the 2018 NICE Guideline for Antibiotic Prescription for （Acute） Sore Throat （Ⅱ）　

WEI Xin-fa，WU Hui-li*，RAN Xiao-jun

2018, 21(21):  2525-2528.  DOI: 10.12114/j.issn.1007-9572.2018.00.101

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Based on the available evidence provided by more than one hundred studies about the management of acute sore throat published from 2003 to 2014 and experiences of microbiology specialists and infectious disease specialists from Europe，NICE released the latest guideline on antimicrobial prescribing for acute sore throat，offering recommendations for the choice of antibiotic and self-care，which is of great significance for antimicrobial prescribing for acute sore throat among China's ENT doctors and general practitioners under the conditions of lack of a guidance for prescribing for this disease.


A Balanced Diet Is One of the Key Measures to Prevent and Control Hypertension and Concomitant Diseases

HONG Zhong-xin*，DING Bing-jie

2018, 21(21):  2529-2537.  DOI: 10.12114/j.issn.1007-9572.2018.00.075

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Hypertension is the most common cardiovascular disease.The prevalence of hypertension in China is increasing year by year.Among the elderly over 60 years old，one in every two people has hypertension.These patients are also found with diabetes，hyperlipidemia，obesity and other concomitant diseases.Therefore，the prevention and control of hypertension often go hand in hand with the management of concomitant diseases.As a cornerstone for the prevention and control of hypertension，a balanced diet also plays an important role in the management of diabetes，hyperlipidemia，and metabolic syndrome via providing adequate amounts of calories，micronutrients and dietary fiber.Moreover，if taking medications at the appropriate time based on eating a balanced diet，the management effect will be better.Based on the reviewing of relevant studies，we expounded the role of a balanced diet in the management of hypertension and concomitant diseases and discussed properly combined use of medications when necessary.


Effect of Modified Dietary Pattern on Blood Pressure，Body Composition and Blood Lipid Profile in Overweight or Obese Middle-aged and Older People with Hypertension in Zhangfang Village of Beijing's Fangshan District　

WANG Jia，WU Li，WANG Nan，DING Bing-jie，GE Zhi-wen，BI Yan-xia，LI Wei，HONG Zhong-xin*

2018, 21(21):  2538-2546.  DOI: 10.12114/j.issn.1007-9572.2018.00.070

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Objective　To investigate the mechanism of action of nutritional ingredients in blood control based on the study of using modified dietary pattern for improving the blood pressure，body composition and blood lipid profile conducted in overweight or obese middle-aged and older people from Zhangfang Village of Beijing's Fangshan District combined with our previous studies.Methods　This trial was conducted from May 21st to July 1st，2017.From the database of middle-aged and older villagers（245 cases aged 45-75）of Zhangfang Village of Beijing's Fangshan District，54 overweight or obese cases with grade 1 hypertension were selected based on the inclusion and exclusion criteria and were randomized into group A（n=27）eating standardized balanced diet and group B（n=27）eating standardized balanced diet supplemented by anti-atherosclerotic powdered foods.Then，according to the completion status of trial，30（15 in group A and 15 in group B）were included in the final analysis.We collected their data concerning blood pressure〔including systolic blood pressure（SBP）and diastolic blood pressure（DBP）〕，body composition〔including body mass index（BMI），body fat percentage（BFP），body fat mass（BFM），waist-to-hip ratio（WHR）and visceral fat area（VFA）〕，blood lipid profile〔including total cholesterol（TC），triacylglycerol（TG），high-density lipoprotein cholesterol（HDL-C）and low density lipoprotein cholesterol（LDL-C）〕measured before the trial（T0），at the end of the second week（T1），at the end of the fourth week（T2）and total energy intake，food intake（including staple food，leafy vegetables，rhizome vegetables，salt，edible oil，eggs，milk，red meat，white meat，tofu，fruit），nutrient intake/ratio〔including carbohydrates，proteins，fat，dietary fiber，vitamin A（VitA），vitamin B1（VitB1），vitamin B2（VitB2），vitamin C（VitC），calcium，iron，zinc，selenium，magnesium，manganese，cholesterol，nicotinic acid，folic acid，saturated fatty acids（SFA），monounsaturated fatty acids（MUSF）and polyunsaturated fatty acids（PUFA）〕before and after intervention.Results　SBP decreased significantly at T1，and DBP and SBP decreased significantly at T2 in both groups compared with at T0（P<0.05）.Group A showed less BMI，BFM and VFA and higher HDL-C at T1，and demonstrated less BFM，WHR and VFA at T2 compared with at T0（P<0.05）.Furthermore，group A presented less WHR，TC，HDL-C and LDL-C but greater VFA at T2 compared with at T1（P<0.05）.In contrast，group B exhibited less BMI，BFP，BFM，VFA and TG but higher HDL-C at T1，and demonstrated less BMI，BFP，BFM，WHR and VFA，but higher HDL-C at T2 compared with at T0（P<0.05）.Furthermore，group B presented lower HDL-C but greater VFA and higher TG at T2 compared with at T1（P<0.05）.Before and after intervention，both groups showed no significant difference in the average total energy intake（P>0.05）.The average total energy intake after intervention was not significantly different from that before intervention in both groups（P>0.05）.The average intake of edible oil before intervention in group B was higher than that in group A（P<0.05）.Compared with before intervention，except the average intake of salt and edible oil decreased obviously，the average intake of leafy vegetables，rhizome vegetables，eggs，milk，white meat，tofu and fruit increased significantly in both groups after intervention，as did that of protein，dietary fiber，VitA，VitB1，VitB2，VitC，calcium，iron，zinc，magnesium，manganese，cholesterol，nicotinic acid，folic acid，SFA，PUFA and the protein percentage in daily food intake（P<0.05）.The fat percentage in daily food intake declined substantially in group B after intervention（P<0.05）.Compared with group A，the average intake of carbohydrates and selenium was much less but that of protein，magnesium and manganese was much more in group B after intervention（P<0.05）.Conclusion　After eating the balanced diet and modified balanced diet（by adding anti-atherosclerotic powdered foods），the participants developed a comparatively healthy dietary pattern，then，their body composition was improved，blood lipid was stabilized，and the blood pressure was significantly reduced.


Two Balanced Dietary Patterns with Different Breakfasts for Glycemic and Hypertension Control among Middle-aged and Elderly Hypertensive Patients with Abnormal Blood Glucose：Effects and Possible Mechanisms

DING Bing-jie，BI Yan-xia，WANG Jia，GE Zhi-wen，WANG Nan，LI Wei，HONG Zhong-xin*

2018, 21(21):  2547-2553.  DOI: 10.12114/j.issn.1007-9572.2018.00.078

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Objective　To explore the effects of two balanced dietary patterns with different breakfasts on the blood glucose and blood pressure in middle-aged and elderly hypertensive patients with abnormal blood glucose，and to identify the possible mechanism.Methods　We conducted this test from May 23rd to July 1st，2017.According to the inclusion and exclusion criteria，we enrolled 24 hypertensive cases with abnormal blood glucose from the database of middle-aged and elderly hypertensive villagers of Zhangfang Village of Beijing's Fangshan District and randomized them into group A and group B with 12 cases in each.Both groups received a 4-week balanced diet intervention with the same lunch and dinner but different breakfasts except on the 1st day（T0）and 28th day（T4）of intervention，they ate the same breakfast that we used for OGTT：during the second day to the 27th day of intervention，group A ate steamed bread but group B ate anti-atherosclerotic powdered food，along with a cooked egg，the same amount of milk and salad，for breakfast.We collected their sociodemographic characteristics，and the data regarding fasting blood glucose（FBG）and 2 h-postprandial plasma glucose（2 h PG）after breakfast measured at T0，T1（on the 7th day of intervention），T2（on the 14th day of intervention），T3（on the 21st day of intervention）and T4，2 h PG after lunch measured at T1 and T3，systolic blood pressure（SBP），diastolic blood pressure（DBP），fasting insulin（FIN），angiotensin Ⅱ（AngⅡ），malondialdehyde（MDA），total antioxidant capacity（TAC），Ghrelin and adiponectin（ADPN）measured at T0，T2 and T4.Results　The method and duration of intervention produced interaction effects on 2 h PG after breakfast（P<0.05）instead of FBG（P>0.05）.Intervention duration exerted significant main effects on FBG and 2 h PG after breakfast（P<0.05），but the method of intervention did not（P>0.05）.For more detail，the FBG level at T4 was lower than that at T0，T1，T2，T3 in both groups（P<0.05）.The 2 h PG level after breakfast was lower in group B than that of group A at T1，T2，T3（P<0.05）.Group B showed higher 2 h PG level after breakfast at T0 compared with at T1，T2，T3（P<0.05）.Both groups showed similar 2 h PG level after lunch either at T1 or T3（P>0.05）.2 h PG level after lunch at T1 was similar to that at T3 in both groups（P>0.05）.The method and duration of intervention had interaction effects on TAC（P<0.05）but not on SBP，DBP，FIN，AngⅡ，MDA，Ghrelin and ADPN（P>0.05）.The main effect of the intervention method on SBP，DBP，FIN，AngⅡ，MDA，TAC，Ghrelin and ADPN was not significant（P>0.05）.The main effect of intervention duration on SBP，DBP，TAC，Ghrelin，and ADPN was significant（P<0.05），but that on FIN，AngⅡ and MDA was not（P>0.05）.For more detail，for group A，at T4，SBP，DBP and Ghrelin were lower but TAC and ADPN were higher compared with at T0（P<0.05），and TAC was also higher than that at T2（P<0.05）.For group B，SBP was lower and TAC was higher at T2 compared with at T0（P<0.05），when at T4，SBP，DBP and Ghrelin were lower and ADPN was higher compared with at T0（P<0.05），and TAC was lower compared with at T2（P<0.05）.Conclusion　A balanced dietary pattern helps to achieve glycemic and hypertension control for middle-aged and elderly hypertensive patients with abnormal blood glucose，and its effect（for improving overall health）became better when supplemented by anti-atherosclerotic powdered food.The mechanism may be related to improved postprandial glycemic control，increased TAC and ADPN as well as decreased Ghrelin brought by anti-atherosclerotic powdered food.


Effect of Modified Dietary Pattern on Inflammatory Markers in Overweight or Obese Middle-aged and Older People with Hypertension in Zhangfang Village of Beijing's Fangshan District

WANG Jia，WU Li，WANG Nan，DING Bing-jie，GE Zhi-wen，BI Yan-xia，LI Wei，HONG Zhong-xin*

2018, 21(21):  2554-2560.  DOI: 10.12114/j.issn.1007-9572.2018.00.077

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Objective　To investigate the mechanism of action of modified dietary pattern on reducing the levels of inflammatory markers and hypertension management in overweight or obese middle-aged and older people with hypertension from Zhangfang Village of Beijing's Fangshan District based on our previous studies.Methods　This trial was implemented from May 21st to July 1st，2017.From the database of middle-aged and older villagers（245 cases aged 45-75）of Zhangfang Village of Beijing's Fangshan District，54 overweight or obese cases with grade 1 hypertension were sampled based on the inclusion and exclusion criteria and were randomized into group A（n=27）eating a standardized balanced diet and group B（n=27）eating a standardized balanced diet supplemented by anti-atherosclerotic powdered foods.Then，according to the completion status of trial，30（15 in group A and 15 in group B）were included in the final analysis.We collected the data about the levels of inflammatory markers〔high-sensitivity C-reactive protein（hs-CRP），soluble intercellular adhesion molecule-1（sicam-1），vascular cell adhesion molecule-1（VCAM1），nuclear factor-kappa B（NF-κB），integrin，E-selectin，interleukin-6（IL-6），interleukin 10（IL-10），toll-like receptor 2（TLR2），toll-like receptor 4（TLR4）〕measured before the intervention（T0），during the intervention（T1）and at the end of the intervention（T2）and dietary inflammatory index（DII）at T0 and T2.Results　The DII in group B was lower than that of group A（P<0.05）.The DII in group B decreased significantly at T2 compared with at T0（P<0.05）.The intervention program and duration exerted interactive effects on IL-10（P<0.05）.Intervention program produced significant main effects on NF-κB，integrin and E-selectin（P<0.05）.And intervention duration had main effects on sicam-1，VCAM1，NF-κB，integrin，E-selectin，IL-6 ，and TLR2（P<0.05）.At T0，the levels of NF-κB，integrin and E-selectin were lower in group B compared with group A，when at T2，the levels of NF-κB and integrin were still lower in group B（P<0.05）.For group A，compared with at T0，at T1，only the level of integrin decreased significantly，but at T2，besides integrin，the levels of NF-κB，E-selectin，IL-6 decreased significantly（P<0.05）.Moreover，TLR2 at T2 declined significantly compared with at T1（P<0.05）.For group B，compared with at T0，sicam-1，VCAM1 and integrin decreased significantly at T1（P<0.05），and at T2，besides the above 3 markers，IL-6 also decreased significantly（P<0.05）.Furthermore，sicam-1，NF-κB，E-selectin，and TLR2 were much lower compared with at T1（P<0.05）.Conclusion　After eating a balanced diet and a modified balanced diet（by adding anti-atherosclerotic powdered foods），the middle-aged and elderly overweight or obese patients with hypertension presented reduced levels of inflammatory markers，increased anti-inflammatory capabilities as well as good hypertension management outcome.


Effects of Physical Activity，Social Interaction and Brain Habits on Depressive Symptoms in Elderly Patients with Newly Diagnosed Ischemic Stroke　

GAO Chang1，GAO Ran2，ZHANG Li-li3，LIU Ning4*

2018, 21(21):  2561-2566.  DOI: 10.12114/j.issn.1007-9572.2018.00.004

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Objective　To analyze the influence of fitness activities，social interactions and brain habits on the depressive symptoms of elderly patients with newly diagnosed ischemic stroke.Methods　A total of 916 elderly patients with first-onset ischemic stroke who were treated in the Department of Neurology of the Affiliated Hospital of Jining Medical University between June 2016 and July 2017 and met the inclusion criteria were selected as study subjects.Three months after the onset of the disease，a questionnaire survey was conducted by trained neurosurgical staff.The items in the questionnaire comprised general information including sex，age，ethnicity，marital status，education level，participation in fitness activities（intensive，moderate and leisure fitness activities），social activities（communication frequency with families and friends） and brain habits（reading and playing chess），geriatric depression scale（GDS-15） score，lesion locations（stroke lesion in the left/right or anterior/posterior，as well as specific stroke sites），and NIH stroke scale（NIHSS） score.Univariate and multivariate Logistic regression were used to analyze factors influencing the depression symptoms in elderly patients with newly diagnosed ischemic stroke.Results　A total of 916 questionnaires were distributed，and 764 valid questionnaires were collected.The effective recovery rate was 83.4%.Of the 764 stroke patients，70（9.2%） had depressive symptoms，and 694（90.8%） had no depressive symptoms.Univariate Logistic regression analysis showed that mild leisure fitness activities〔OR=0.451，95%CI（0.253，0.805）〕，the frequency of interaction with families or friends〔OR=0.176，95%CI（0.103，0.301）〕，the stroke position（anterior/posterior）〔OR=2.359，95%CI（1.510，3.562）〕，and the NIHSS score〔OR=1.817，95%CI（1.166，3.358）〕 were the factors associated with depressive symptoms in elderly patients with ischemic stroke（P<0.05）．Multivariate Logistic regression analysis showed that mild leisure fitness activities〔OR=0.503，95%CI（0.277，0.915）〕，the frequency of interaction with families or friends〔OR=0.189，95%CI（0.110，0.326）〕，the stroke position（anterior/posterior）〔OR=2.487，95%CI（1.497，4.134）〕，and the NIHSS score〔OR=1.901，95%CI（1.154，3.130）〕 were the factors associated with depressive symptoms in elderly patients with ischemic stroke（P<0.05）．Conclusion　Participating in mild leisure fitness activities and communicating with friends are protective factors against depressive symptoms in elderly patients with newly diagnosed ischemic stroke.Stroke in the anterior brain and an NIHSS score ≥5 are the risk factors for depression in elderly patients with newly diagnosed ischemic stroke.The relationship between brain habits and depressive symptoms was not significant in the population.


Effects of Three Therapies on Cerebral Hemodynamics in Patients with Non-dementia Cognitive Impairment after Stroke

MI Xiao-kun，WANG Jiao-lan，CUI Peng，LIU Qing-rui，HAN Ying*

2018, 21(21):  2566-2570.  DOI: 10.3969/j.issn.1007-9572.2018.00.185

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Objective　To observe changes in intracranial blood flow in response to three different treatment regimens for non-dementia cognitive impairment（PSCI-ND） after stroke.Methods　The study cohort included 99 patients with PSCI-ND who were admitted to the Department of Neurology of the Fourth Hospital of Hebei Medical University from February 2010 to October 2016 and randomly divided into one of three groups on the basis of conventional drug therapy：a cerebellar fastigial nucleus（FNS） group （n=32），an oxiracetam group（n=32），and a nimodipine group（n=35）．Transcranial Doppler ultrasonography was performed before and after treatment in all three groups to measure and compare the average blood flow velocity（MFV） of the middle cerebral artery（MCA），anterior cerebral artery（ACA），posterior cerebral artery（PCA），and intracranial vertebral artery（IVA） to observe the occurrence of adverse reactions.Results　After treatment，the MFV of the MCA in the FNS group was higher than that of the oxiracetam and nimodipine groups（P<0.05）．After treatment，the MFV of the MCA in the oxiracetam group was not significantly different from that of the nimodipine group（P>0.05）．The MFV of the ACA，PCA，and IVA in the oxiracetam group after treatment was lower than in the FNS and nimodipine groups（P<0.05）．After treatment，the MFV of the ACA was higher in the FNS group than in nimodipine group（P<0.05）．The MFV of the arteries in the FNS and nimodipine groups after treatment was higher than that before treatment（P<0.05）．There was no significant difference in the MFV of each artery before and after treatment in the oxiracetam group（P>0.05）．There was no significant difference in the incidence of adverse reactions among the three groups（χ2=0.730，P>0.05）．Conclusion　FNS and nimodipine generally improved cerebral blood supply in patients with PSCI-ND，but not oxiracetam.


Role of Microalbuminuria in the Prediction of Stroke in Populations with Different Glycometabolic Conditions

ZHOU Hong-fang，WAN Qin*

2018, 21(21):  2571-2576.  DOI: 10.3969/j.issn.1007-9572.2018.00.181

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Objective　To investigate the role of microalbuminuria （MAU） in the prediction of stroke among populations with different glycometabolic conditions，providing a reference for the prevention of stroke.Methods　The enrolled 3 501 participants over 40 years old were from part of Sichuan's Luzhou who participated in the Risk Evaluation of Cancer in Diabetic Chinese Individuals：a Longitudinal （REACTION） Study initiated by the Chinese Society of Endocrinology from April to November 2011.We collected their baseline characteristics，such as demographic data （sex，age，BMI，family history of diabetes，history of smoking and cardiovascular disease），and laboratory findings〔total cholesterol （TC），triacylglycerol （TG），high-density lipoprotein cholesterol （HDL-C），low-density lipoprotein cholesterol （LDL-C），fasting plasma glucose （FPG），glycated hemoglobin （HbA1c），and MAU〕.We divided them into diabetes mellitus （DM） group，impaired glucose regulation （IGR） group，and normal glucose tolerance （NGT） group based on the status of glucose metabolism.Furthermore，in accordance with the level of MAU，we divided them into NGT with normal MAU subgroup（subgroup A），IGR with normal MAU subgroup（subgroup B），DM with normal MAU subgroup（subgroup C），NGT with increased MAU subgroup（subgroup D），IGR with increased MAU subgroup（subgroup E），DM with increased MAU subgroup（subgroup F）.The occurrence of stroke was recorded during a follow-up visit from April to June 2016.Results　There were 735 cases of DM（458 with normal MAU and 277 with increased MAU），1 212 cases of IGR（837 with normal MAU and 375 with increased MAU），and 1 554 cases of NGT（866 with normal MAU and 688 with increased MAU），accounting for 21.0%，34.6%，and 44.4% of the total participants，respectively.The level of MAU in subgroup C was significantly lower than that of subgroup F but much higher when compared with that of subgroup B（P<0.05）.Subgroup A demonstrated much lower level of MAU compared with subgroups of B，D，E and F（P<0.05）.The follow-up showed that，the incidence of stroke in NGT，IGR，and DM groups was 2.7% （42/1 554），3.1% （37/1 212），
and 5.0% （37/735），respectively，indicating that DM group had the highest incidence （P<0.05）；the incidence of stroke in subgroups of A，B，C，D，E，and F was 1.4% （12/866），1.8% （15/837），3.7% （17/458），4.4% （30/688），5.9% （22/375），and 7.2% （20/277），respectively.Among NGT cases，those with increased MAU having a risk of stroke 3.245 times that of those with normal MAU〔95%CI（1.649，6.386），P<0.05〕.The risk of stroke in IGR cases with increased MAU was 3.415 times that of IGR cases with normal MAU〔95%CI（1.751，6.661），P< 0.05〕.For DM cases with increased MAU，the risk of stroke was 2.019 times that of DM cases with normal MAU〔95%CI（1.039，3.924），P<0.05〕.The incidence of stroke was much higher in the participants with increased MAU compared with those with normal MAU〔5.4%（72/1 340） vs 2.0%
（44/2 161）〕 （P<0.05）.Multivariate Logistic regression analysis showed that elevated MAU was an independent risk factor for stroke in people with different glycometabolic conditions〔OR=1.026，95%CI（1.018，1.033），P<0.001〕.Conclusion　Although people with different glycometabolic conditions have different prevalence of abnormal MAU，elevated MAU is an independent risk factor for stroke for all of them.Therefore，the risk of having stroke could be effectively reduced by early intervention addressing increased MAU in those with glycometabolism disorder.


Significance of the Change of Immune Function in Patients with Sepsis Complicated by Metabolic Syndrome

HUANG Shan，XING Bo *

2018, 21(21):  2577-2581.  DOI: 10.3969/j.issn.1007-9572.2018.00.209

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Objective　To investigate the characteristics of immune status in patients with sepsis complicated by different stages of metabolic syndrome（MS），and their effects on prognosis.Methods　A total of 200 patients with sepsis who were hospitalized in the Department of Emergency ，the Second Affiliated Hospital of Hainan Medical University between January 2014 and June 2017 were prospectively selected and divided into the following four groups according to the presence of MS complication and MS status：MS systemic inflammatory syndrome group（MSS group，50 cases），MS severe sepsis group（MSSS group，50 cases），non-MS systemic inflammatory syndrome group（NMSS group，50 cases） and non-MS severe sepsis group（NMSSS group，50 cases）．A control group included 50 persons who received a health examination in our hospital.Patients with sepsis were also divided into a survival subgroup and a death subgroup.The peripheral blood T-lymphocyte-related immunological indicators（CD3+T，CD4+T，CD8+T，CD4+T/CD8+T） in each group were tested and compared.Results　The Acute Physiology and Chronic Health Evaluation systemⅡ（APACHE Ⅱ） and sequential organ failure assessment（SOFA） scores in the MSSS group were higher than those in the MSS group（P<0.05），and the APACHE Ⅱand SOFA scores in the NMSSS group were higher than those in the NMSS group（P<0.05）．The SOFA score in the MSSS group was higher than that in the NMSSS group（P<0.05）．The percentages of T lymphocytes in the sepsis groups were all lower than that in the control group（P<0.05）．The levels of CD+3T，CD+4T and CD+8T cells were lower in the MSSS group and NMSSS group than the MSS group （P<0.05），and lower in the MSSS group than the NMSSS group（P<0.05）．The MSSS and NMSSS groups had higher mortality than did the MSS and NMSS groups（P<0.05），and the mortality in the MSSS group was higher than that in the NMSSS group （P<0.05）．The APACHE Ⅱ and SOFA scores，and the incidence of MS in the death subgroup were all higher than those in the survival subgroup，and the levels of CD+3T，CD+4T，CD+8T and CD+4T/CD+8 T were lower in the death subgroup than the survival subgroup（P<0.05）．Conclusion　MS aggravates immunosuppression and disease severity in patients with sepsis and affects their prognosis.


Clinical Features and Prognostic Study of Prophylactic Versus Nonprophylactic Hysterectomy in Patients with Lynch Syndrome and Lynch Syndrome-associated Endometrial Cancer　#br#

LI Xue-hui1，SUN Ke-juan1，WANG Na1，GAO Ting1，WEI Han2*

2018, 21(21):  2582-2586.  DOI: 10.3969/j.issn.1007-9572.2018.00.142

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Objective　To explore the clinical features and prognosis of prophylactic hysterectomy （PH） verus nonprophylactic hysterectomy（NPH） in patients with Lynch syndrome（LS）and Lynch syndrome-associated endometrial cancer（LS-EC），with a view to providing a reference for the treatment and prognosis improvement of this disease.Methods　16 patients with LS and 22 patients with LS-EC were involved from the First Hospital of Hebei Medical University from December 2014 to October 2016.Among them，16 voluntarily underwent PH （PH group），and other 22 underwent NPH（NPH group）．The baseline characteristics，results of quality of life assessment，histopathology and gene mutation analysis as well as survival rate of the two groups were collected.Results　Two groups showed significant differences in the time between diagnosis and surgery，and prevalence of symptoms associated with endometrial cancer（EC） （P<0.05）．With regard to histopathological findings，in the PH group，10 were found with abnormal results，including 5 with EC，3 with diffuse endometrial hyperplasia，1 with clear-cell endometrial cancer，and 1 with focal endometrial hyperplasia；the other 6 were found without endometrial cancer，including 3 with mild endometrial hyperplasia，2 with uterine fibroids，and 1 with uterine membrane atrophy；in the NPH group，19 were identified with endometrioid adenocarcinoma，2 with mucinous endometrial adenocarcinoma，1 with serous endometrial cancer；tumor location，status of lymph node metastasis，pathological type，pathological grading of endometrioid adenocarcinoma，and status of uterine muscle layer infiltration were similar in EC patients of both groups（P>0.05），but tumor diameter was less in EC patients of PH group（P<0.05）．Gene mutation analysis revealed that the mutation rates of hMSH2，hMSH6 and hPMS2 were similar in both groups（P>0.05），but mutation rate of hMLH1 was much higher in the PH group（P<0.05）．Up to 2017-03-01，27 survived and 11 died in all patients；PH group had higher survival rate than NPH group （χ2=4.900，P=0.027）．Conclusion　LS patients are usually accompanied by a history of cancer，and from diagnosis to longer operation time，but it can be reduced by PH.


Clinical Features of Herpes Zoster and Its Correlation with Statins Usage　

YUAN Yuan，HUANG Wen-xiang，JIA Bei*

2018, 21(21):  2587-2591.  DOI: 10.3969/j.issn.1007-9572.2018.00.122

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Background　Herpes zoster is a common infectious disease caused by reactivation of varicella zoster virus.This disease may lead to papule blister，and may be accompanied by neuralgia，herpes zoster ophthalmicus，secondary infection，etc，seriously impairing the patient's quality of life.Statins are widely used in clinical practice as a lipid-regulating drug.Several studies have confirmed that herpes zoster is associated with the use of statins.Objective　To analyze the clinical characteristics of herpes zoster and to explore the relationship between herpes zoster and the use of statins.Methods　The enrolled 1 462 inpatients were all from the First Affiliated Hospital of Chongqing Medical University from November 2014 to November 2016，including 731 with herpes zoster（herpes zoster group），and 731 without herpes zoster（control group）．Demographic and clinical data，including gender，age，smoking history，drinking history，body mass index（BMI），lipid levels，comorbidities，and use of statins and antiplatelet aggregation drugs were collected.The prevalence of herpes zoster by gender and age，the relationship of herpes zoster with smoking and drinking history，BMI，lipid level，comorbidities，use of statins and antiplatelet agglutination drugs were analyzed.The herpes zoster patients were divided into≤ 30-year-old subgroup（49 cases），31-60-year-old subgroup（261 cases），and > 60-year-old subgroup（421 cases），then their characteristics were compared.Results　The use rate of statins in herpes zoster group was higher than that of the control group（P<0.05）．Among the herpes zoster patients，there were 446（61.0%） with comorbidities，including 228（51.1%） with multicomorbidities；the most common comorbidities were hypertension〔242 cases（54.3%）〕and diabetes〔134 cases（30.0%）〕.The prevalence of herpes zoster varied significantly by age subgroups（P<0.05）．Herpes zoster patients in > 60-year-old subgroup had higher use rate of statins，higher prevalence of hypertension cardiovascular diseases except hypertension as well as stroke compared with ≤30-year-old subgroup，31-60-year-old subgroup（P<0.05）．Herpes zoster patients in 31-60-year-old subgroup showed higher prevalence of diabetes compared with ≤30-year-old subgroup（P<0.05）．Herpes zoster patients in≤30-year-old subgroup demonstrated higher prevalence of tumor than the other two subgroups（P<0.05）．The prevalence of connective tissue disease was higher in 31-60-year-old subgroup compared with > 60-year-old subgroup，but lower than ≤30-year-old subgroup（P<0.05），and it was higher in≤30-year-old subgroup compared with > 60-year-old subgroup（P<0.05）．Conclusion　The prevalence of herpes zoster may be associated with older age and use of stains.


Prevalence and Epidemiologic Characteristics of Gestational Diabetes Mellitus in Hebei Province，2016

WANG Xiao-xiao1，2，LIU Qing2，3，ZHANG Ying-kui4，LI Jin-hua4，YANG Jie5，WANG Li2*

2018, 21(21):  2592-2596.  DOI: 10.12114/j.issn.1007-9572.2018.00.002

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Objective　To investigate the prevalence and epidemiological characteristics of gestational diabetes mellitus（GDM）in Hebei Province in 2016.Methods　Data were collected from the Monitoring Information Management System for Pregnant and Parturient Women of Hebei Women and Children's Health Center（reported by 22 critical maternal surveillance hospitals in Hebei Province via an internet-based system）from January 1 to December 31，2016.The involved individuals were women discharged from these institutions after delivery in 2016.The prevalence of GDM in 2016 was analyzed.Moreover，epidemiological characteristics of GDM including regional distribution（urban distribution，urban and rural distribution），level of hospitals，age group，onset time（season），and the associated high-risk factors〔pluriparity，multifetation，anemia，hypertensive disorders of pregnancy（HDP），tertiary educational attainment〕in 2016 were explored.Results　64 931 parturient women were included.The overall prevalence of GDM was 5.33%（3 460/64 931）．From a city-specific perspective，the prevalence of GDM in Baoding and Zhangjiakou was 13.99% and 0.06% respectively．In the view of the location of hospital for childbirth，the prevalence of GDM was higher in urban hospitals compared with rural hospitals（7.20% vs 3.51%，P<0.05）．From the point of view of level of hospitals for childbirth，the prevalence of GDM increased successively in primary，secondary and tertiary hospitals（P<0.05）．From the perspective of age group，of the 5 age groups（≤24，25-29，30-34，35-39，≥40），age group of ≤24 possessed the lowest prevalence of GDM（P<0.05），age group of 25-29 had lower prevalence of GDM compared with other 3 older groups（P<0.05），and age group of 30-34 owned lower prevalence of GDM compared with other 2 older groups（P<0.05），indicating that the prevalence of GDM increased with maternal age（fitting equation：y=0.390 5x-5.893，R2=0.692 4）．In terms of onset season，the prevalence of GDM in spring and summer was 5.71% and 4.74% respectively．In addition，by demographic characteristics，higher proportions of women with GDM were found with HDP and tertiary educational attainment compared with those without（P<0.05）．The results of multivariate Logistic regression analysis showed that age，pluriparity，anemia，HDP，education level，level of hospitals，urban and rural distribution，and season were all factors influencing the prevalence of GDM（P<0.05）．Conclusion　The prevalence of GDM in Hebei in 2016 was at an intermediate level of the national norms.Its epidemiological characteristics differed significantly by regions，age groups，and seasons.Therefore，in order to prevent the development of GDM in high-risk populations，raising the level of perinatal health care，targeted preventive interventions should be delivered by regions.


High-risk Pregnancy and Intervention Measures in Chaoyang District of Beijing from 2013 to 2016

GAO Ling-yun，ZHANG Li-ying，CHEN Xiao-jin*

2018, 21(21):  2597-2601.  DOI: 10.3969/j.issn.1007-9572.2018.00.069

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Objective　To investigate the status of high-risk pregnancy in Chaoyang District of Beijing，and based on this，to propose corresponding intervention measures，providing a scientific basis for the reduction of maternal and perinatal mortality rates.Methods　From the Annual Report of Maternal Health Care and Rate of Maternal Health Care Survey Questionnaire reported by the grassroots medical institutions in Beijing's Chaoyang District and Beijing Perinatal Health Care Management Register of Beijing Maternal and Child Health Network Information System，we collected the data about pregnant and lying-in women〔including high-risk pregnant and lying-in women（high-risk group） normal pregnant women（control group）〕 during 2013—2016.We analyzed the high-risk group's management，antenatal care status，high-risk factors，delivery mode，delivery outcome，and maternal mortality status.Results　From 2013 to 2016，the total number of pregnant women was 141 702，and that of high-risk lying-in women was 85 544（60.37%），high-risk management population 85 452（99.89%）．Beijing Maternal and Child Health Records were established before the 13th gestational week for 68 009（79.50%） high-risk pregnant and lying-in women，between the 13th and 27th gestational weeks for 13 434（15.70%） high-risk pregnant and lying-in women，and after the 28th gestational week for 4 101（4.80%） high-risk pregnant and lying-in women.The number of women who are at high risk of not having a birth test decreases year by year， while the number of pregnant women who have had >5 birth examinations increases year by year.Compared with the control group，high-risk group presented higher rates of dead-fetus/stillbirth and early neonatal mortality（P<0.05）．The 3 leading risk factors for high-risk pregnancy and lying-in women in 2013：advanced age，macrosomia，and 2 or more times of abortion.The 3 leading risk factors for high-risk pregnancy and lying-in women during 2014—2016：advanced age，scarred uterus，abnormal glucose metabolism/diabetes.Of the 6 dead pregnant and lying-in women，5 were found with different risk factors for high-risk pregnancy.Conclusion　The number of high-risk pregnant women increases year by year，while the number of pregnant women who >5 birth examinations increases year by year.In order to reduce the maternal and perinatal mortality rates，the incidence of high-risk pregnancy should be decreased by strictly prenatal screening the risk factors for high-risk pregnancy，enhancing the health care and monitoring quality during pregnancy via strengthening the full coverage of the management of pregnant and lying-in women and perinatal monitoring，giving full play to the role of the three-tier dynamic management pattern（community health service organization-district-level maternal and child health care institution-midwifery institution） and advancing the obstetric care quality.


Clinical Comparative Study of Modified Subxiphoid-subcostal Approach and Traditional Transthoracic Approach for the Resection of Thymic Tumors　

MENG Qing-jun*，KONG Fan-yi，SONG Xiang

2018, 21(21):  2602-2605.  DOI: 10.3969/j.issn.1007-9572.2018.00.227

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Objective　To compare the clinical efficacy of modified subxiphoid-subcostal approach with that of traditional transthoracic approach for the resection of thymic tumors（RTT）．Methods　The subjects enrolled in this study were 175 patients undergoing RTT in Department of Thoracic Surgery，Cangzhou Central Hospital from January 2013 to December 2017.95 of them receiving RTT via modified subxiphoid-subcostal approach and 80 via the traditional transthoracic approach were assigned to subxiphoid incision group and chest wall incision group，respectively.The clinical efficacy of these two approaches was compared from the duration of RTT，intraoperative blood loss，duration of postoperative chest tube drainage，length of stay，VAS score assessed on the 1st，3rd days after surgery，and incidence of postoperative complications.Results　Compared with the chest wall incision group，subxiphoid incision group demonstrated much shorter duration of RTT，duration of postoperative chest tube drainage and length of stay，significantly less intraoperative blood loss，obviously lower VAS score on the 1st，3rd days after surgery as well as notable lower incidence of postoperative complications（P<0.05）．Conclusion　RTT via the modified subxiphoid-subcostal approach is more simple to operate，requiring shorter duration.Moreover，it is contributive to smaller incision，lighter degree of postoperative pain，quicker recovery，shorter length of stay as well as lower incidence of postoperative complications among the patients.


Curative Effect of Two Types of Minimally Invasive Surgery on Cholecystolithiasis with Choledocholithiasis：a Comparative Study　

ZHANG Jian-feng，LI Zhi，YANG Fan，CEN Han-jun，ZHOU Xu-kun*

2018, 21(21):  2606-2610.  DOI: 10.3969/j.issn.1007-9572.2018.00.064

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Objective　To compare the curative effect between endoscopic retrograde cholangiopancreatography（ERCP） / endoscopic sphincterotomy（EST） and laparoscopic common bile duct exploration（LCBDE） on cholecystolithiasis with choledocholithiasis.Methods　In this retrospective study，we enrolled 104 cases of cholecystolithiasis with choledocholithiasis who underwent emergency laparoscopic cholecystectomy and LCBDE or ERCP/EST in Hospital of Xinjiang Production and Construction Corps from January 2012 to March 2016 and assigned 52 of them undergoing ERCP/EST to ERCP/EST group，and the other 52 undergoing LCBDE to LCBDE group.We recorded both groups' average common bile duct clearance，average stone residual rate，duration of procedure，total duration of procedure，postoperative length of stay，average incidence of postoperative complications and follow-up results.Results　Compared with ERCP/EST group，LCBDE group presented higher average stone residual rate，longer duration of procedure，and longer postoperative length of stay（P<0.05），but they had similar average common bile duct clearance and total duration of procedure（P>0.05）．Furthermore，the average incidence of postoperative pancreatitis，postoperative bleeding，bile leakage，incision complications，pneumonia and so on did not differ significantly between the groups（P>0.05）．15 cases were lost to follow up，the recorded data of 9 cases were found with errors，and 6 died during the follow-up period.The expected outcome was failed to achieve in 5 cases treated by ERCP/EST，as well as 4 treated by LCBDE.Conclusion　For patients needing emergency laparoscopic cholecystectomy，ERCP/EST is recommended instead of LCBDE，for it can achieve better results with lower stone residual rate.


Quality of Life Clinical Response of Moderate to Severe Facial Acne Patients to Alternating Red and Blue Light Irradiation Generated by Light Emitting Diodes，Mucopolysaccharide Polysulfate Cream and Xihuang Capsule

MA Yue-xian1，WANG Yong-qin2*，YANG Hui-fang3，SUN Jing1，LIU Wei1，XING Hai-ning4，LI Chen4

2018, 21(21):  2611-2615.  DOI: 10.3969/j.issn.1007-9572.2018.00.228

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Objective 　To discuss the clinical efficacy of alternating red and blue light irradiation generated by light emitting diodes（ARBLIGLED），Mucopolysaccharide Polysulfate Cream（MPC） and Xihuang Capsule（XC） for moderate to severe facial acne，and to investigate the degree of improvement in quality of life in these patients.Methods　We enrolled 300 cases of moderate to severe facial acne from the Second Affiliated Hospital of Qiqihar Medical University and Heilongjiang Provincial Hospital from December 2015 to December 2016.Using random number table，we divided them into group A，group B and group C，with 100 in each，treated by ARBLIGLED combined with MPC and XC，ARBLIGLED combined with MPC，ARBLIGLED，respectively.Indicators for clinical efficacy include the number of inflammatory and non-inflammatory skin lesions，and levels of IgG，IgA，IgM，serum complement C3 and C4，IL-2，sIL-2R，and 4 sex hormones（follicle-stimulating hormone，luteinizing hormone，testosterone，estradiol）．Quality of life was assessed by SF-36.Results　After treatment，the number of both inflammatory and non-inflammatory skin lesions decreased significantly in all groups compared with baseline（P<0.05）；levels of IgG，C3，C4 and IL-2 were found to be significantly lower in group A（P<0.05）；the levels of 4 sex hormones were still similar in males or females of all groups（P>0.05）．Compared with other two groups，after treatment，group A achieved better clinical response，which was indicated by much less number of inflammatory and non-inflammatory skin lesions，and significantly lower levels of IgG，C3，C4 and IL-2（P<0.05）．After treatment，group A achieved the highest SF-36 scores，followed by groups B and C（P<0.05）．Conclusion　The combination regimen of ARBLIGLED，MPC and XC has significant effect on moderate to severe facial acne as indicated by much improved immune functions and quality of life.


Clinical Efficacy of Wet Acupuncture Therapy and Home Abdominal Stretching Exercise in the Treatment of Primary Dysmenorrhea

LYU Ya-nan，LI Han，LI Yi-mei*

2018, 21(21):  2616-2621.  DOI: 10.3969/j.issn.1007-9572.2018.00.172

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Objective　To verify the safety and effectiveness of wet acupuncture therapy in the treatment of primary dysmenorrhea （PD） with home abdominal wall stretching exercise and to determine the possible mechanism of analgesia based on the principle of myofascial pain trigger points （MTrPs）．Methods　Thirty patients with PD who were treated in the Outpatient Department of the First Affiliated Hospital of Xinjiang Medical University from November 1，2015 to December 31，2015 were selected as the experimental group，and 30 non-PD controls were selected as the normal control group during the same period.Individuals in the normal control group did not receive any medical interventions and were advised to stay warm during menstrual periods，avoid overwork，cold temperatures and mood swings，and maintain normal daily routines as well as eating habits.The experimental group underwent wet acupuncture therapy to inactivate the MTrPs in the abdominal wall along with abdominal wall stretching exercises，and regular exercise to maintain the therapeutic effect.This group did not receive other therapies during the treatment period and were followed up for 6 months after treatment.The visual analog scale （VAS） was used to evaluate the degree of abdominal pain in patients within 48 h of menstruation before and after treatment.The levels of serum PGF2α and PGE2 were measured in the experimental group within 48 h of menstrual cramps in the month before treatment and in the month after treatment.In addition，the levels of serum PGF2α and PGE2 in the normal control group within 48 h of menstrual cramps in the month after treatment were also measured.Treatment efficacy and adverse reactions were observed and recorded in the experimental group.Results　The VAS score within 48 h of menstrual cramps in the experimental group was lower after treatment than before treatment（P<0.01）．The level of serum PGF2α within 48 h of menstrual cramps the month after treatment was lower than that before treatment in the experimental group，and serum PGE2 levels were higher after treatment than before treatment （P<0.01）．Serum PGE2 levels within 48 h of menstrual cramps after treatment in the experimental group were not statistically different to those in the normal control group （P>0.05）．Serum PGF2α levels within 48 h of menstrual cramps after treatment in the experimental group were lower than those in the normal control group （P<0.05）．The efficacy rates at 1，3，and 6 months after treatment were 80.0% （24/30），83.3% （25/30），and 76.7% （23/30），respectively.In the experimental group，25 cases of musculoskeletal sensation at the puncture site were rapidly relieved by abdominal wall stretching exercise；4 cases of non-menstrual paroxysmal lower abdominal pain and twitching sensation were significantly reduced the month after receiving wet acupuncture therapy and abdominal wall stretching exercise.Conclusion　Treatment with wet acupuncture therapy and home abdominal stretching exercise was effective in patients with PD，and significantly reduced serum PGF2α levels in the experimental group within 48 h of menstrual cramps，increased serum PGE2 levels within 48 h of menstrual cramps，thereby improving discomfort due to menstrual abdominal pain in the experimental group and was safe with few adverse reactions.


Chemical Evaluation of the Mutual Detoxification of the Compatibility of Tripterygium Wilfordii with Lysimachia Christina Based on PCA and GCA Methods

WANG Jun-ming1，2*，LI Jin-hua1，CAI Hong1，LI Jin-yang1，ZHANG Yue-yue1，CHEN Rong-xing1，LI Jun3，CUI Ying1，2

2018, 21(21):  2622-2626.  DOI: 10.12114/j.issn.1007-9572.2018.00.029

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Objective　To investigate the chemical bases and mechanism of mutual detoxification of the compatibility of Tripterygium wilfordii （TW） with Lysimachia christina （LC）.Methods　This study was conducted in October 2015.Dry extracts of ethyl acetate extract （EAE），4/1 EAE，2/1 EAE，1/1 EAE，1/2 EAE，and 1/4 EAE were prepared，and then the corresponding test solutions were made up.After the linearity of triptolide （TP） and celastrol （CEL），the precision of the instrument，the stability of the test solutions，and the good reproducibility of the methods were determined，the contents of TP and CEL were calculated based on their standard curves，respectively，and the HPLC chemical characteristics （characteristic peaks） before and after compatibility of TW and LC were identified.The TP and CEL contents of each group before and after compatibility，and the peak area integral values of the unknown differential characteristic peaks were calculated by the PCA method to obtain the Z value of the chemical score.The GCA method was used to analyze the grey correlation between the peaks of TP，CEL and other chemical differences and the Z value of chemical scores，and ranked according to the gray correlation coefficient.The degree of influence of each chemical characteristic peak on the chemical score was compared.Results　A total of 12 distinctive peaks were identified under the TP and CEL conditions，naming as TP，CEL，and 1-10 peaks.After being dimensionally reduced by PCA，two principal components were produced.Then the weighted content of TP-CEL was obtained by weighting the TP and CEL content based on the extracted information，that is，the common factor variance.The TP-CEL of 4/1 EAE，2/1 EAE，1/1 EAE，1/2 EAE，and 1/4 EAE was lower than that of EAE （P<0.05）；the TP-CEL of 2/1 EAE was lower than that of 4/1 EAE，1/1 EAE and 1/2 EAE （P<0.05）；the TP-CEL of 1/4 EAE was lower compared with that of 4/1 EAE，2/1 EAE，1/1 EAE，and 1/2 EAE （P<0.05）.The Z value of the chemical scores of 4/1 EAE，2/1 EAE，1/1 EAE，1/2 EAE，and 1/4 EAE was lower than that of EAE （P<0.05）；the chemical score Z of 2/1 EAE was lower compared with that of 4/1 EAE，1/ 1 EAE and 1/2 EAE （P<0.05）；1/4 EAE group had lower chemical score Z than 4/1 EAE，2/1 EAE，1/1 EAE and 1/2 EAE （P<0.05）.Based on the GCA analysis performed on the differential characteristic peaks and the Z value of the chemical scores，the gray correlation coefficients of the characteristic peaks were obtained and ranked according to the grey correlation coefficient.Ranked No.1 was No.3 characteristic peak，and TP and CEL were ranked as No.8 and No.9 of the 12 characteristic peaks，respectively.Conclusion　The 12 differential chemical components found were the main chemical basis for the mutual detoxification of the compatibility of TW with LC.The mass ratio of 4/1 to 1/4 can be used to attenuate the toxicity by reducing the chemical score，and especially 1/4 is the best ratio，and its attenuation may be related to the combined effects of the chemical constituents of TP，CEL，No.1-10 characteristic peaks，in particular，the No.3 characteristic component has the greatest influence.


Use of Electronic Devices and Chronic Headache among College Students in China

CHEN Jin-yuan1，2，ZHAI Yue1，2，LIU Ze-yu1，2，YAN Yi-rui2，XIA Jia-yang1，3，DENG Guo-ying1*

2018, 21(21):  2627-2632.  DOI: 10.3969/j.issn.1007-9572.2018.00.118

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Background　Chronic headache severely impairs people's quality of life.It can be caused by inappropriate use of electronic devices.College students are a population with high-frequency use of electronic devices and high prevalence of chronic headache.However，few studies have evaluated the use of electronic devices and chronic headache among this population in China.Objective　To evaluate the relationship between the use of electronic devices and prevalence of chronic headache among college students in China based on a survey concerning the use of electronic devices.Methods　From March to June 2017，using a self-developed questionnaire，we conducted a survey among the 6 000 students from 127 universities 29 provinces（except Taiwan，Qinghai，Xizang，Ningxia，Xinjiang） of China for collecting the data about demographic characteristics，use of electronic devices，psychological status（spirit state during learning，role of electronic devices in life） and prevalence of chronic headache.Univariate Logistic regression analysis was performed to investigate the relationship between use of electronic devices and prevalence of chronic headache.Results　Of the 6 000 questionnaires administered，5 622（93.7%） were returned，and 4 848 were responsive，achieving a response rate of 80.8%（4 848/6 00）．The prevalence of chronic headache was 29.3%（1 420/4 848）.Of the 4 848 final participants，the longest duration of computer use for one time daily is mainly>4 h，
neck and shoulder discomfort after long period of computer use to 58.3% of them，eye-to-screen distance while using mobile terminals is mainly 10-20 cm，time spent on using a mobile device per day is mainly >4 h，neck and shoulder discomfort after prolonged use of a handheld mobile terminal to 46.8% of them，posture of using an electronic device when sitting in the seat of a vehicle is mainly figure 1 B，the longest time for using electronic devices with the same posture sitting at the table is mainly 1-<2 h，using electronic devices in bed to 87.6% of them，duration for using electronic devices with the same posture in bed for one time is mainly 0.5-<1.0 h.Which was significantly associated with gender，major，the longest duration of computer use for one time daily，neck and shoulder discomfort after long period of computer use，eye-to-screen distance while using mobile terminals，time spent on using a mobile device per day，neck and shoulder discomfort after prolonged use of a handheld mobile terminal，posture of using an electronic device when sitting in the seat of a vehicle，the longest time for using electronic devices with the same posture sitting at the table，using electronic devices in bed，duration for using electronic devices with the same posture in bed for one time，spirit state during learning，and role of electronic devices（P<0.05）．Conclusion　The longest duration of computer use for one time daily or time spent on using a mobile device per day is mainly >4 h of college students.Neck and shoulder discomfort after ong period of computer use or prolonged use of a handheld mobile terminal is in the majority of college students.The prevalence of chronic headache among college students is significantly associated with gender，major，use of electronic devices，and psychological stress.Female，engineering，agriculture，foreign literature，or science majors，inappropriate use of electronic devices，as well as great psychological stress obviously increase the risk for chronic headache.With the increasing popularity of electronic devices，the prevalence，treatment and control of chronic headache among college students in China deserve more attention and interventions.


Analysis of the Determinants of Life Satisfaction among Elderly People Living in High Buildings without Elevators in Shanghai City：a Survey in the Jing'an District of Shanghai City　#br#

LUO Wei1，LIU Deng1，AI He-ling2*，HU Min1，ZHU Yu1，CHEN Qi1

2018, 21(21):  2632-2637.  DOI: 10.3969/j.issn.1007-9572.2018.00.109

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Objective　To identify factors influencing life satisfaction among elderly people who live in high buildings without elevatorsin the Jingan District of Shanghai City.Methods　In March 2017，224 elderly people（≥80 years of age） living in high buildings without elevators on Linfen Road，Pengpu New Village and Pengpu Town of the Jing'an District of Shanghai City were randomly selected as study subjects to complete a questionnaire.The questionnaire was self-designed and covered items，such as life satisfaction，general information，health status，living conditions，acknowledgment of nursing service，and alone time per week.Factors which potentially affected the life satisfaction of the subjects were analyzed.Results　A total of 224 questionnaires were distributed and 218 valid questionnaires were recovered，for a valid recovery rate of 97.3%.The respondents who rated their life satisfaction as "OK（neither satisfied nor dissatisfied）" accounted for the greatest percentage of study subjects（39.0%）．Satisfaction in the respondents with different living conditions，self-rated health status，number of chronic diseases，self-rated visual acuity and hearing，living status，ability to go downstairs，economic pressure for nursing service，acknowledgment of nursing service，and alone time per week was significantly different（P<0.05）．Multivariate Logistic regression analysis showed that factors influencing the satisfaction of respondents included self-rated health status，self-rated visual acuity，living status，the ability to go downstairs freely，economic pressure for nursing service，and alone time per week（P<0.05）．Conclusion　Elderly people living in high buildings without elevators do not have high life satisfaction.Many factors influence the life satisfaction of elderly people.The present study is valuable for further improving the care services for elderly people and enacting associated policies.


Multiple System Atrophy Misdiagnosed as Idiopathic Parkinson's Disease：Report of One Case and Diagnostic Ideas　

YIN Shun-xiong1*，TANG Yan-yan1，MIN Lian-qiu2　

2018, 21(21):  2638-2642.  DOI: 10.3969/j.issn.1007-9572.2018.00.041

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The mode of onset，clinical symptoms and signs of multiple system atrophy（MSA） are similar to those of idiopathic Parkinson's disease（IPD），so it is very difficult to differentiate them.In order to improve the clinicians' awareness level of MSA and to reduce the probability of misdiagnosis and mistreatment，we reported one case of MSA misdiagnosed as IPD and reviewed related literature，summarized the clinical features，diagnosis and treatment，the causes of misdiagnosis of MSA and proposed preventive measures.


A Case Report of Bardet-Biedl Syndrome with Recurrent Urinary Tract Infection and Literature Review　

LIN Bao-hua，YANG Xiao-qing*，SHEN Tong

2018, 21(21):  2643-2646.  DOI: 10.3969/j.issn.1007-9572.2018.00.108

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Bardet-Biedl syndrome（BBS） is a rare autosomal recessive genetic disease with an occult onset.The features of BBS include polydactylism，obesity，progressive retinopathy，mental retardation，renal in sufficiency，and gonadal dysgenesis.BBS also has a high disability rate.We report a patient diagnosed with BBS and review the clinical features，laboratory test results，and diagnostic criteria to raise awareness of BBS.We recommend genetic testing for patients suspected to have BBS to establish the diagnosis and initiate treatment early，and to avoid misdiagnosis，which will improve the prognosis.