Chinese General Practice

Community-based Standardized Management Algorithm of Primary Osteoporosis

Chinese Medical Doctor Association （CMDA）'s General Practitioners Sub-association

2019, 22(11): 1251-1257. DOI: 10.12114/j.issn.1007-9572.2019.00.108

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In order to standardize management of primary osteoporosis in the community，improve the capability of early screening，diagnose，treatment and health management，a community-based standardized management algorithm of primary osteoporosis is formulated by the Chinese Medical Doctor Association （CMDA）'s General Practitioners Sub-association，through a discussion of domestic experts based on the domestic and international latest evidence-based medical evidence，the condition of domestic community health service as well as protocols and guidelines associated with the prevention and treatment of osteoporosis.This management algorithm includes 4 parts，screening，diagnose，management （health records establishment，life-style guidance，health education，the application of bone health basic supplements，medication，fall prevention，follow-up） and referral，design the management flow diagram，standardize the contents and process of management.The release of this management algorithm is of great significance to improve the diagnosis and treatment level and strength the prevention and control of osteoporosis in China.

Current Status and Need of Collaborative Health Management of Diabetes in Community Health Service Centers

ZHOU Yao，GAO Bo，XU Wanshui，QI Guiyou，LU Xiulan

2019, 22(11): 1258-1264. DOI: 10.12114/j.issn.1007-9572.2018.00.456

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Background　Community health service centers （CHSC） shoulder greater responsibility of chronic diseases management as the diabetes incidence in China continues to rise. CHSC，however，can hardly meet the need of diabetes prevention due to its inadequate development. Only by collaborating with higher level hospitals，CHSC can maximize their function of disease prevention and treatment. Objective　To provide reference for improving collaborative health management of diabetes in CHSCs and promoting sound development of family doctor contracted services by virtue of investigation and analysis of current situations，demand and shortcomings of collaborative primary health management of diabetes in CHSC in Wuhou District，Chengdu City. Methods　Six community health service centers in downtown areas and outskirts of Wuhou District，Chengdu City have been selected through purpose sampling method. Medical staff and diabetic patients were randomly selected from each of the six CHSC. The research team conducted a survey in January 2018 with a self-designed questionnaire consisting of questions for medical staff，including implementation of collaborative health service pattern，frequency of use，willingness of use，degree of satisfaction，problems and demand，and questions for diabetic patients，including awareness，satisfaction，necessity，problems of this service and further needs. Results　All selected CHSC conducted two-way referral. Every three centers set up joint specialty-general practice clinics. They implemented periodical assessment，remote consultations and remote group consultations. Among 100 medical staff in these CHSC，two-way referral had the highest frequency of use （67.0%，67/100）；84 （84.0%） medical staff were more willing to choose two-way referral in their daily work；74 （74.0%） medical staff were relatively satisfied with two-way referral. Among 140 diabetic patients in this study，82 （58.6%） of who acknowledged the necessity of and were satisfied with two-way referral；51 （36.4%） patients acknowledged the necessity of and were satisfied with remote consultation service；36 （25.7%） patients acknowledged and were satisfied with periodical assessment；68 （48.6%） patients acknowledged the necessity of and were satisfied with joint specialty-general practice clinics. Conclusion　Most diabetic patients are not clear about collaborative health management of diabetes in CHSCs There are problems such as poor two-way referral process and insufficient service capacity of medical staff. We can better meet the need of patients via improving information platform of the collaborative service，strengthening the coordination between CHSC and higher-level hospitals and enhancing the service capability of staff.

TCM Health Management Services for Type 2 Diabetes Delivered by the Family Doctor Team in Primary Care：a Survey

YE Jingxue，ZENG Qingqiu，QIAN Ning，HUANG Yanli

2019, 22(11): 1265-1269. DOI: 10.12114/j.issn.1007-9572.2018.00.433

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Background　Primary medical institutions play a major role in the prevention and treatment of type 2 diabetes.In recent years，although traditional Chinese medicine（TCM） appropriate techniques have been used extensively in primary medical institutions，the implementation of TCM health management services is unsatisfactory in general，which is partly due to the failure of the family doctor team in playing their due role in delivering such services.Objective　To investigate the TCM health management services for type 2 diabetes delivered by the family doctor team in Wuhou District of Chengdu，providing a reference for tackling problems during the development and promotion of appropriate delivery patterns of such services in primary care.Methods　In December 2017，a questionnaire survey was conducted in all the 13 community health centers in Wuhou District of Chengdu.By use of simple random sampling，5 family doctor teams were selected from each center，and 65 family doctor teams were sampled in total，including 198 team members.The Questionnaire for Design of TCM Health Management Service Model for Diabetes developed by our research team was used in the survey，including basic personal characteristics of the family doctor team members，status of the implementation of TCM health management services for diabetes，frequency and approval level，acceptance level and restrictive factors of delivering TCM health management services by the family doctor team.Results　Among 65 family doctor teams，51（78.5%） had TCM doctors.Among the 198 respondents，171（86.4%） had provided TCM health management services for diabetes，more concretely，the rates of providing identification of body constitution services，and the services using TCM appropriate techniques，were 99.4%（170/171），and 60.2%（103/171），respectively.The delivery frequency of TCM health management services was once a year in 34.5%（59/171） of them，and once every 3 months in 29.8%（51/171）．The services were delivered by 130 cases（76.0%） on the basis of the negotiation between the team members and patient appointments，and by 41 （24.0%） on the basis of cooperation between family doctor teams.Of the 198 cases，180 （90.9%） believed that it was meaningful to carry out TCM health management services for diabetic patients，177 （89.4%） were willing to learn and use TCM health management techniques，and 163 （82.3%） believed that patients were willing to receive TCM services.177 cases completed the survey on the delivery frequency of reasonable and feasible TCM services approved by themselves，and 91 （51.4%） approved the frequency of once in 3 months.In terms of the restrictive factors of delivering TCM health management services，“Having too much workload to deliver TCM health management services for diabetes” ranked the first，with a score of （6.32±2.70），followed by “There are no or lack of adequate criteria for the evaluation of the performance of family doctor team in delivering TCM health management services for diabetes in their community health center”，with a score of （5.10±2.36）．Conclusion　The TCM health management services for diabetes delivered by family doctor teams in Wuhou District of Chengdu are eligible，but limited，and the delivery pattern is simple，with unsatisfactory approval.Therefore，in order to ensure the implementation of such services in an effective and orderly way，healthcare managers should make more efforts and pay more attention to the implementation of such services，and family doctors should improve their service awareness and professional capabilities.

Empirical Study on Standardized Workload of Diabetes Management in Community Health Service Centers　

JIANG Minmin，GU Wenjuan，CHEN Xubo，WANG Yan，YE Jianhua，LIU Jie，ZHANG Ming，FAN Liangliang，MA Yixin，FAN Qingsong

2019, 22(11): 1270-1276. DOI: 10.12114/j.issn.1007-9572.2019.00.013

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Background　We determined the service content and process of diabetes management through literature review and expert consultation at the early stage.The labor division of medical personnel in community health service centers was defined as well.How to combine the division of labor and practice process of diabetes management in community health service centers to calculate the standardization workload of each diabetes management service in the community，which has become the key to solving the distribution of diabetes management performance in the community.Objective　To calculate the standardization workload of diabetes management services provided by Wujiaochang Community Health Service Center and to lay the foundation for the rational distribution of diabetes management performance in community health service centers.Methods　Fifty five representatives from diabetes management in Wujiaochang Community Health Service Center were selected from April to June，2018.The self-developed e-questionnaire was used through wenjuanxing，an online platform that can be used for questionnaires，exams or voting，to gather the standardization workload measurement data of diabetes management services in communities.The human and time consumption，technical difficulty，risk level，authoritative degree of subjects and similar items between different departments were collected to estimate the standardization workload of various services in diabetes management.The data analysis was carried out under the Excel 2016.Results　There was a total of 29 diabetes management services in the community and each diabetes management service was completed by one person independently，whose occupation types and titles were primary nurse，general practitioner，and laboratory physician.The least time-consuming service was urine sugar qualitative test （4.38 min），and the most time-consuming service was the general outpatient consultation fee （13.33 min）.The service with least technical difficulty was waist measurement，and service with most technical difficulty was medication.The service with the lowest risk was health record （retrieve and recovery），and service with the highest risk was drug treatment.The service with the smallest standardization workload was urine sugar qualitative test，which was 0.25，and the service with the largest standardization workload was the general outpatient examination，which was 1.00.Conclusion　Based on the division of labor and practice processes of diabetes management in community health service centers，the standardization workload of community diabetes management services is measured，which can be used to guide the rational distribution of diabetes management performance in the community.

Effect of Special Disease Outpatient Management on Prevalence and Efficacy of Statin Treatment in Type 2 Diabetic Patients：a Multicenter Community-based Study　

LUO Xiaolu，HUANG Yanli，FENG Shuang，SHA Yu

2019, 22(11): 1277-1282. DOI: 10.12114/j.issn.1007-9572.2019.00.068

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Background　With the implementation of hierarchical medical system，and supportive policies for special disease outpatient management，a great number of type 2 diabetes mellitus （T2DM） patients can obtain management from community health centers （CHCs）．However，it is unclear whether the prevalence of statins treatment and rate of reaching the target low-density lipoprotein cholesterol （LDL-C） in this population can be benefited from such management.Objective　To evaluate the effect of special disease outpatient management on the prevalence and efficacy of statin treatment in T2DM patients in CHCs in Wuhou District，Chengdu.Methods　We conducted this retrospective study in 13 CHCs in Chengdu's Wuhou District from June 15，2017 to June 15，2018.From the electronic patient management （EPM） platform of the CHCs，we enrolled T2DM patients who received family doctor services.We collected their data such as gender，age，body mass index （BMI），hypertension，occupation，education level，special disease outpatient management，statins treatment，and LDL-C level.Multiple linear regression analysis was used to explore the factors affecting LDL-C level with stepping technique.Results　A total of 10 593 cases were included，and 5 184 （48.94%）of them received special disease outpatient management.There were significant differences in gender ratio，average age，prevalence of hypertension，distribution of occupation and education level between those with and without special disease outpatient management （P<0.05）．The prevalence of statins use was 28.00%（2 966/10 593）．The prevalence of statins use was higher in those with special disease outpatient management than that of those without （P<0.05）．Compared with those without special disease outpatient management，those receiving such management had much lower average LDL-C and obviously higher rate of control of LDL-C （P<0.05）．Those receiving both statins treatment and special disease outpatient management had much lower average LDL-C and obviously higher rate of control of LDL-C than those only receiving statins treatment （P<0.05）．Multiple linear regression analysis showed that gender 〔β=-0.077，95%CI（-0.122，-0.032）〕，age 〔β=-0.005，95%CI（-0.007，-0.003）〕，BMI 〔β=0.010，95%CI（0.003，0.017）〕，hypertension 〔β=-0.097，95%CI（-0.145，-0.049）〕，occupation 〔β=0.026，95%CI（0.009，0.042）〕，special disease outpatient management 〔β=-0.160，95%CI（-0.209，-0.111）〕，use of statins 〔β=-0.163，95%CI（-0.217，-0.108）〕 independently influenced LDL-C level in T2DM patients（P<0.05）．Conclusion　The prevalence of special disease outpatient management in T2DM patients from CHCs in Chengdu's Wuhou District is not high.And those with special disease outpatient management showed higher rates of statins treatment and reaching the target LDL-C compared with those without.

Three-year Comprehensive Management of Type 2 Diabetes in Blood Glucose，Blood Pressure and Blood Lipids in Community　

HE Jiao，HUO Rui，WANG Xiaoli，SU Xianghui，CHANG Xiangyun，SUN Kan

2019, 22(11): 1283-1287. DOI: 10.12114/j.issn.1007-9572.2019.00.024

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Background　The integrated management of diabetic patients has become a very important task for chronic disease management in communities. Shihezi is a county-level municipality of Xinjiang Uyghur Autonomous Region and was the headquarter of the Xinjiang Production and Construction Corp. The aging members of the Corp is making the municipal aging problem incrementally severe，and diabetes and its complications are influencing the well-being of citizens there and aggravating the region's economic burden. However，related researches are rare in this area. Objective　To provide basis for the management of type 2 diabetes mellitus in Shihezi community by investigating the levels of blood glucose，blood pressure，blood lipid and joint control rate of them in patients with type 2 diabetes mellitus （T2DM） in comprehensive management of community service centers and tertiary，level A hospitals from 2014 to 2017. Methods　The author selected 300 eligible T2DM patients from 13 communities under the medical coverage of the First Affiliated Hospital of the Medical College，Shihezi University in November 2014 by cluster sampling method. The 300 patients were given a three-year integrated management treatment and observed for dynamic changes of their blood glucose，blood pressure，blood lipid and other indicators. Results　As of November 2017，there were all together 236 patients finished the follow-up survey. From 2014 to 2017，the comparisons of glycosylated hemoglobin （HbA1c） and fasting plasma glucose （FPG） levels showed that the differences were of no statistical significance （P>0.05）． There were significant differences in systolic blood pressure （SBP） and diastolic blood pressure （DBP） among patients （P<0.05）；SBP in 2015 and 2017 was higher than that in 2014，and DBP in 2017 was lower than that in 2014 （P<0.05）． The levels of total cholesterol （TC），triglyceride （TG），high density lipoprotein cholesterol （HDL-C） and low density lipoprotein cholesterol （LDL-C） in patients were significantly different （P<0.05）；TC and HDL-C levels in 2015 were lower than those in 2014，TC and LDL-C levels in 2016，2017 were lower than those in 2014，HDL-C level in 2016 and 2017 were higher than that in 2015，LDL-C level in 2016 and 2017 were lower than that in 2015，and TG level in 2017 was higher than that in 2016 （P<0.05）． From 2014 to 2017，there was no significant difference in blood glucose control rate both male and female patients （P>0.05）． There were significant differences in blood pressure control rate both male and female patients（P<0.05）；both female and male blood pressure control rates in 2016 were higher than those in 2014 and 2015；and the male blood pressure control rate in 2017 was higher than that in 2014 and the female blood pressure control rate in 2017 was higher than that in 2014 and 2015 （P<0.007）．There was no significant difference in blood lipid control rate in male （P>0.05） while that of female showed that the differences were of statistical significance （P<0.05）；and for female，the control rate in 2015 and 2016 were lower than that in 2014，and that in 2017 was higher than that in 2016 （P<0.007）． There was no significant difference in the joint control rate of blood glucose + blood pressure，blood glucose + blood pressure + blood lipid （P>0.05）；there was significant difference in the joint control rate of blood glucose and blood lipid （P<0.05）；and the joint control rate of blood glucose and blood lipid in 2016 and 2017 was higher than that in 2014 and 2015（P<0.007）.Conclusion　After the integrated management，the blood pressure，blood lipid and control rate of the T2DM in patients living in the 13 communities of Shihezi municipality have made obvious progress and the joint control rates related have also achieved improvements，compared with previous conditions of patients.

Epidemiological Characteristics of Patients with Thoracolumbar Osteoporotic Fracture　

ZHANG Xuefang，YANG Xiaobin，HAO Dingjun，HE Baorong，ZHENG Linhong，LI Hui，GAO Lin，ZHANG Haiping

2019, 22(11): 1288-1292. DOI: 10.12114/j.issn.1007-9572.2018.00.303

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Background　 At present，the epidemiological data on osteoporotic fractures of thoracolumbar spine is insufficient. Therefore，the statistical analysis of big data is urgently needed to provide reference for prevention，clinical diagnosis and treatment of thoracolumbar osteoporotic fracture. Objective　To analyze the epidemiological characteristics of inpatients with thoracolumbar osteoporotic fracture in Honghui Hospital，Xi'an Jiaotong University.Methods　 A total of 4 083 patients with thoracolumbar osteoporotic fracture hospitalized in Honghui Hospital，Xi'an Jiaotong University were included in this study from January 1st 2014 to December 31st 2016.According to age，they were divided into below 60 group（339 cases），60-69 group（1 850 cases），70-79 group（1 421 cases），80-89 group（441 cases），and over 90 group（32 cases）.According to treatment method，patients were divided into minimally invasive surgery group（3 911 cases） and conventional treatment group（172 cases）.Patients' general condition，fracture status and treatment were collected，and T value of bone density and Visual Analogue Scale（VAS） and Oswestry Dysfunction Index（ODI） were evaluated.Results　Male patients with the highest incidence of osteoporotic fracture were in the 70-79 group，and females in the 60-69 group.The incidence among female patients in each group was higher than that in male patients.The greatest incidence difference of osteoporosis fracture between males and females was in below 60 group.The average bone mineral density（T value） of all patients was（-3.2±1.2） SD，including 945 patients（23.14%） with bone density less than -3.5 SD.3 751 patients had at least 1 complication，the most common is cardiovascular diseases（3 278 cases，80.28%），diabetes（645 cases，15.80%），stroke sequelae（529 cases，12.96%）.A total of 245 subjects（6.00%） had high-energy injuries and 3 838 subjects（94.00%） had low-energy injuries.The main cause of fracture is low energy injury.Fractures occurred in 4 953 vertebral bodies.Thoracolumbar fracture segment were unimodal，with the highest proportion at L1（29.09%）；the highest incidence of fracture occurred in thoracolumbar segment（T11~L2），accounting for 77.06%（3 817/4 953） of all vertebrae fracture.Lumbar fracture accounted for 53.46%（2 648/4 953），which was higher than thoracic fracture of 46.54%（2 305/4 953）.There were no spinal cord，nerve and vascular injuries in patients undergone surgeries.Seventy-nine patients had cement leakage but no clinical symptoms.After 3 months of treatment，the T value in the minimally invasive surgery group was higher than that of conventional treatment group；VAS and ODI were lower than those of conventional treatment group；the incidence of deep vein thrombosis and lung infection was lower than that of conventional treatment group and bed time was shorter than that of conventional group（P<0.05）.Conclusion　The incidence of osteoporotic fracture in thoracolumbar spine is higher in female patients than that in males.The main cause of fracture is low energy injury，and mostly occurs in thoracolumbar region.Lumbar vertebrae fracture is more common than thoracic vertebrae fracture.Vertebroplasty or kyphoplasty is the main treatment.

Clinical Effects of Electrical Stimulation，Oxiracetam and Nimodipine on the Cognitive Function of Patients with Post-stroke Cognitive Impairment-with No Dementia　

MI Xiaokun，SHI Jian，LIU Hui，WANG Jiaolan，CUI Peng，HAN Ying

2019, 22(11): 1293-1297. DOI: 10.12114/j.issn.1007-9572.2018.00.269

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Background　Post-stroke cognitive impairment with no dementia（PSCI-ND） mainly is mainly manifested by multiple cognitive impairment.Studies have shown that 6 months，1 year after stroke in patients with cognitive dysfunction improvement rate are 19.6%，13.1% respectively. Different methods have different therapeutic effects in different cognitive fields.Different treatment methods should be chosen for different patients.Objective　To assess the effects of cerebellar fastigial nucleus electrical stimulation（FNS），oxiracetam and nimodipine on different cognitive domains of patients with PSCI-ND．Methods　A total of 96 patients with PSCI-ND admitted to the Department of Neurology，the Fourth Hospital of Hebei Medical University from January 2013 to September 2017 were randomly divided into FNS group，oxiracetam group and nimodipine group，each with 32 cases.With conventional treatment，the FNS group was treated with FNS，1 time/d，30 days of treatment；oxiracetam group was given oxiracetam orally with 0.8 g，3 times/d，30 days of treatment，and nimodipine group was treated with nimodipine with 30 mg，3 times/d，30 days of treatment.Various adverse reactions were monitored and total score and sub-item score changes of Montreal Cognitive Assessment （MoCA） before and after treatment of 3 groups were observed.Results　After treatment，there were no significant differences in scores of attention，language ability，abstract reasoning ability，memory，and orientation ability among three groups （P>0.05）．There were significant differences in visual space，execution ability and total score of MoCA among three groups （P<0.05）．Among them，scores of visual space and executive ability and MoCA total score of oxiracetam group and nimodipine group were lower than those of FNS group，and MoCA total score of nimodipine group was lower than that of oxiracetam group （P<0.05）．After treatment，scores of postoperative visual space and execution ability，attention ability，language ability，memory，orientation ability and MoCA total score in FNS group were higher；scores of postoperative visual space and execution ability，attention ability，language ability，memory，and MoCA total score in oxiracetam group were higher；and scores of language ability and memory in nimodipine group were higher than those before treatment （P<0.05）．The incidence of adverse events was 6.2% （2/32） in FNS group，9.4% （3/32） in oxiracetam group，and 9.4% （3/32） in nimodipine group，with no statistically significant difference （P=1.000）．Conclusion　Cognitive function of PSCI-ND patients can be improved by FNS and oxiracetam，and FNS can improve visual spatial and execution ability，attention ability more significantly.

Correlation between Cortisol and Clinical Symptoms of Patients with Posttraumatic Stress Disorder　

ZHU Zhihui，XING Wenlong，LU Keke，HU Min，ZHANG Guiqing

2019, 22(11): 1297-1301. DOI: 10.12114/j.issn.1007-9572.2018.00.323

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Background　Cortisol，as the end product of hypothalamus-pituitary-adrenal（HPA）axis，is an important biological indicator of HPA axis function. It has been found that abnormal cortisol secretion exists in posttraumatic stress disorder （PTSD） and that cortisol can improve PTSD symptoms. At present，PTSD clinical symptoms multi-scale evaluation，cortisol and scale correlation analysis，to provide a biological basis for the evaluation of PTSD symptoms. Objective　To investigate the difference of serum cortisol between patients with PTSD and normal population，and the correlation between cortisol and clinical symptoms in patients with PTSD.Methods　Twenty-four patients with PTSD admitted to the First Affiliated Hospital of the Medical College，Shihezi University from December 2016 to December 2017 were selected as PTSD group.Twenty-four healthy persons with similar age，gender and menstrual history were selected as control group.General questionnaires were used to record general information of all subjects.The PTSD group was investigated by using Hamilton Depression Scale （HAMD），the Hamilton Anxiety Scale （HAMA），and the Posttraumatic Stress Disorder Check-list-civilian Version （PCL-C）．Serum cortisol levels were detected in PTSD group and control group.Women in PTSD group and control group were divided into the luteal phase group，the follicular phase group，and the menopause group according to the menstrual cycle in which the blood was collected.Results　The serum cortisol level in PTSD group was 165 （131，181） μg/L，lower than 212 （202，258）μg/L in control group （Z=-5.574，P<0.001）．The serum cortisol level of male patients in PTSD group was 175 （106，193） μg/L，lower than 214 （208，235） μg/L in control group （Z=-2.878，P=0.004）．The serum cortisol level of patients at luteal phase in PTSD group was 138 （72，165） μg/L，lower than 261 （200，333） μg/L of patients at luteal phase in control group （Z=-3.130，P=0.002）．The serum cortisol level of patients at follicular phase of PTSD group was 176 （151，206） μg/L，lower than 261 （200，333） μg/L of patients at follicular phase of control group （Z=-2.193，P=0.028）．The serum cortisol level of patients at menopause in PTSD group was 138（83，186） μg/L，lower than 209（202，229） μg/L of patients at menopause in control group （Z=-2.878，P=0.004）．Cortisol was negatively correlated with HAMD total score，PCL-C total score，and scores of cognitive impairment，day and night change，block，sleep disorder，despair，general symptoms，somatic anxiety，re-experience symptoms，avoidance/numbness symptoms and hyper-arousal symptoms（P<0.05）．Conclusion　Serum cortisol level in patients with PTSD decreased compared with that of normal population.Therefore，it can provide more evidence for assessing symptoms of patients with PTSD.

NLR Combined with GRACE Score for the Prediction of Outcome of ACS Patients　

XU Xiaoting，ZHANG Qiang，YANG Lihong，ZHENG Hongmei，SUN Caihong，FANG Shijie，LIU Ying，LIU Fangfang，XU Huiyan

2019, 22(11): 1302-1306. DOI: 10.12114/j.issn.1007-9572.2018.00.260

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Background　Acute coronary syndrome （ACS） has a higher rate of disability and mortality，and early detection and intervention for high-risk patients with ACS is of great significance to reduce the rate of hospitalization and mortality.At present，the ratio of neutrophil to lymphocyte （NLR），a new inflammatory marker，has important predictive value for the prognosis of cardiovascular diseases.Objective　To explore the associations of NLR，GRACE score with cardiac function indices，and the performance of NLR，GRACE score，according to the occurrence of major adverse cardiac events （MACE） within 6 months，NLR，GRACE score and the combination of the two for predicting the outcomes of ACS patients.Methods　In this retrospective study，we enrolled 284 ACS patients from January 2016 to October 2017 from the Second Affiliated Hospital of Zhengzhou University.We collected their clinical data.Our cohort was divided into low-risk group （n=113，<109 points），medium-risk group （n=71，109 to 140 points），and high-risk group （n=100，>140 points） according to baseline GRACE score，and stratified into high NLR group （n=142，>3.02） and low NLR group （n=142，≤3.02） by the baseline NLR level for investigating the correlations of GRACE score and NLR level with cardiac functions，respectively.ROC analysis was conducted to probe the performance of NLR，GRACE score，and the combination of the two for evaluating the outcome of ACS.Results　Mean age，BMI，heart rate，systolic blood pressure （SBP），diastolic blood pressure （DBP），NLR，N-terminal brain natriuretic peptide（NT-proBNP），left ventricular ejection fraction （LVEF），left ventricular end-diastolic diameter （LVEDD），and incidence of MACE differed significantly between the low-，medium- and high-risk groups （P<0.05）．High NLR group showed greater mean age，higher mean BMI，heart rate，SBP，DBP，GRACE score，NT-proBNP and LVEDD as well as higher incidence of MACE but low mean triacylglycerol （TG），LVEF compared with the low NLR group（P<0.05）．NLR was positively correlated with GRACE score，NT-proBNP and LVEDD （r=0.852，0.417，0.293，P<0.05），while negatively correlated with LVEF （r=-0.416，P<0.05）．GRACE score was positively correlated with NT-proBNP and LVEDD （r=0.445，0.361，P<0.05），but negatively correlated with LVEF （r=-0.508，P<0.05）．The incidence of MACE among all participants was 25.0%（71/284）．For evaluating the outcome of ACS patients，the area under the ROC curve of NLR combined with GREACE score （0.877） was greater than that of NLR alone（0.732）（Z=3.394，P=0.000 7）and GRACE score alone （0.757）（Z=3.045，P=0.002）．Conclusion　Both NLR and GRACE score had correlations with cardiac function indices.NLR combined with GRACE score is more valuable in predicting the outcome of ACS than NLR or GRACE score alone，so it may be used as an auxiliary index for evaluating the outcome.

Predicative Value of Neutrophil-to-lymphocyte Ratio and Platelet-to-lymphocyte Ratio for Disease Activity in Patients with Lupus Nephritis　

LI Hui，MENG Deqian，LIU Yan，LI Ju，LIU Shanshan，WANG Kai，PAN Wenyou

2019, 22(11): 1307-1311. DOI: 10.12114/j.issn.1007-9572.2018.00.280

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Background Lupus nephritis（LN）is an important cause of complications and mortality in systemic lupus erythematosus， and its pathogenesis is very complex. In recent years，neutrophil-to-lymphocyte ratio （NLR），platelet-to-lymphocyte ratio （PLR）as new inflammatory indicators have been used to evaluate many diseases. However，there are few studies on the use of NLR and PLR in evaluating LN disease activity. Objective　To evaluate the predicative value of NLR and PLR for disease activity in patients with LN．Methods　The enrolled 130 participants were all from the Affiliated Huaian No.1 People's Hospital of Nanjing Medical University from March 2013 to March 2018，66 of whom were LN inpatients and other 64 were physical examinees from the Medical Examination Center.LN activity was assessed by systemic lupus erythematosus disease activity index （SLEDAI），and according to the results，16 LN cases were found with inactive LN （SLEDAI≤9） and 50 with active LN （SLEDAI≥10）．Data concerning sex，age，white blood cell count，hemoglobin，platelet count，neutrophil count，lymphocyte count and calculated NLR and PLR of LN patients and controls were collected.Moreover，duration of LN，erythrocyte sedimentation rate （ESR），C-reactive protein，C3 and C4 complements，plasma albumin，serum creatinine，urea nitrogen，uric acid and 24-hour urinary protein of LN patients were collected.Receiver operating characteristic （ROC） curve was performed to explore the value of NLR and PLR in the prediction of LN activity.Results　The mean levels of hemoglobin，platelet count，and lymphocyte counts were significantly lower，however，mean NLR and PLR were significantly higher in LN patients compared to those of the controls （P<0.05）．The mean levels of white blood cell count，platelet count，lymphocyte counts，C3 and C4 complements were significantly lower，but mean NLR and PLR were significantly higher in active LN patients compared with those of inactive LN patients （P<0.05）．NLR was positively correlated with SLEDAI score （rs=0.360，P=0.003）．ROC curve analysis revealed that in the prediction of LN activity，the AUC of NLR was 0.755〔95%CI （0.634，0.876），P=0.002〕，the optimal cut-off value was 4.06，with 68% sensitivity and 75% specificity；the AUC of PLR was 0.698〔95%CI （0.563，0.832），P=0.018〕，the optimal cut-off value was 184，with 64% sensitivity and 75% specificity.Conclusion　NLR and PLR can be used as new inflammatory markers and as potential complementary markers for diagnosing LN disease activity.

Comparison of the Value of PET/CT and Multimodal MRI in the Differential Diagnosis of Glioma Recurrence and Radiation Brain Injury　

CHEN Mengda，LI Qiang，WANG Youliang，TONG Hongzhang，SHEN Yao

2019, 22(11): 1312-1318. DOI: 10.12114/j.issn.1007-9572.2018.00.451

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Background　The surgical clearance rate of gliomas is less than 30%.Postoperative combined radiotherapy is widely used in clinical practice，but the proportion of radioactive damage accounts for 20% of the total number of radiotherapy.Glioma recurrence is similar to signs of radiation-induced brain injury，but the treatment direction is quite different.How to accurately identify glioma recurrence and radiation-induced brain injury as early as possible is of great significance for subsequent treatment，and it is also the difficulty and focus of current treatment.Objective　To investigate the value of positron emission computed tomography（PET/CT） and multimodal magnetic resonance imaging（MRI） in the diagnosis of glioma recurrence and radiation-induced brain injury.Methods　From February 2016 to January 2017，153 patients with glioma in the Department of Oncology，Yinzhou Hospital Affiliated to Medical School of Ningbo University who underwent postoperative radiotherapy were recurited.PET/CT and multimodal MRI were performed 3 to 6 months after radiotherapy.The patients were followed up for 12 months after radiotherapy.According to the prognosis，they were divided into a good prognosis group and a poor prognosis group.The clinical data，PET/CT index 〔standard uptake value（SUV），lesion normal ratio（L/N）〕 and multimodal MRI index 〔（local cerebral blood volume（rCBV），mean transit time（rMTT），local cerebral blood flow（rCBF），choline/creatinine ratio（Cho/Cr），Cho/N-acetylaspartate ratio（Cho/NAA），apparent diffusion coefficient（ADC）〕 were compared.The receiver operating characteristic（ROC） curve was used to analyze the value of each index in identifying glioma recurrence and radiation-induced brain injury.Results　After the follow-up，6 patients were lost，and the data of 147 patients were collected.There were 107 patients with good prognosis and 40 patients with poor prognosis，including 21 patients with radiation-induced brain injury and 19 patients with glioma recurrence.There were no significant differences in gender，age，hypertension，diabetes，coronary heart disease，stroke detection rate，rMTT and ADC between the good prognosis group and the poor prognosis group（P>0.05）．The WHO pathological grade，SUV，L/N，rCBV，rCBF，Cho/Cr and Cho/NAA in the poor prognosis group were higher than those in the good prognosis group（P<0.05）．There were no significant differences in gender，age，WHO pathological grade，hypertension，diabetes，coronary heart disease，stroke detection rate，rMTT and ADC between patients with glioma recurrence and radiation-induced brain injury（P>0.05）．SUV，L/N，rCBV，rCBF，Cho/Cr and Cho/NAA in patients with glioma recurrence were higher than those in radiation-induced brain injury（P<0.05）．The AUC of SUV，L/N，rCBV，rCBF，Cho/Cr，Cho/NAA to identify glioma recurrence and radiation brain injury were 0.887，0.837，0.950，0.937，0.865，0.902.The AUC of rCBV for cerebral glioma recurrence and radiation-induced brain injury was higher than L/N and Cho/Cr（Z=4.173，P<0.001；Z=3.261，P<0.001）．The best cut-off point for rCBV to distinguish glioma recurrence and radiation brain injury was 1.442，the sensitivity and specificity was 90.48% and 94.74%，respectively.Conclusion　Among the patients who underwent postoperative radiotherapy，the SUV，L/N，rCBV，rCBF，Cho/Cr and Cho/NAA in patients with poor prognosis are significantly increased.The above indicators in patients with glioma recurrence are higher than those in patients with radiation-induced brain injury.Multimodal MRI is better for distinguishing glioma recurrence and radiation-induced brain injury than PET/CT，especially rCBV，which can provide a basis for clinical treatment.

Clinical Effect of Percutaneous Endoscopic Intercostal Neurectomy in the Treatment of Intercostal Neuralgia after Percutaneous Vertebroplasty for Osteoporotic Thoracic Vertebral Compression Fractures　

WEI Jingchao，GAO Shangju，XING Dong，WANG Qikui，YANG Zhaoxu，DONG Zhijie，ZHANG Long，LI Wenyi

2019, 22(11): 1319-1322. DOI: 10.12114/j.issn.1007-9572.2018.00.304

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Background　The elderly usually suffer from Intercostal neuralgia after percutaneous vertebroplasty for osteoporotic thoracic vertebral compression fractures. There are a variety of treatments，while long treatment period and uncertain effect were the main shortages. Therefore，it is important to discuss a safe and effective treatment method with small trauma and quick recovery. Objective　To discuss the effect of percutaneous endoscopic intercostal neurectomy in the treatment of intercostal neuralgia secondary to percutaneous vertebroplasty for osteoporotic thoracic vertebral compression fractures.Methods　We recruited 6 cases of intercostal neuralgia after percutaneous vertebroplasty for osteoporotic thoracic vertebral compression fractures who were treated with percutaneous endoscopic intercostal neurectomy from Hebei General Hospital from August 2014 to December 2017.We collected the data concerning complications such as nerve injury and local hematoma，and Visual Analogue Scale（VAS）score on the 1st day，at the end of the 1st and 3rd months after treatment.Results　Only 1 case had burning sensation of skin along the intercostal nerve after treatment，but disappeared without special management.The intercostal neuralgia in all cases relieved after treatment.The average VAS score on the 1st day，at the end of the 1st and 3rd months after treatment were 1，0，0，respectively.All the cases were followed up for a mean period of 9 months，during which no recurrence was noticed.Conclusion　Percutaneous endoscopic intercostal neurectomy characterized by small trauma，quick recovery，and short treatment period，is safe and effective for intercostal neuralgia after percutaneous vertebroplasty for osteoporotic thoracic vertebral compression fractures，which achieves high patient satisfaction.

Efficacy and Safety of Paiteling in Treating Patients with Persistent High-risk HPV Infection　

WANG Yan，HE Liqing，CAI Xuzi，WANG Xuefeng

2019, 22(11): 1323-1327. DOI: 10.12114/j.issn.1007-9572.2018.00.166

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Background　Nearly 90% of cervical intraepithelial neoplasia（CIN） and 99.7% of cervical cancer tissues have high-risk human papillomavirus （HR-HPV） infection, but there is no clear and effective treatment for persistent HR-HPV infection.Objective　To investigate the efficacy and safety of paiteling in the treatment of patients with persistent HR-HPV infection.Methods　We collected the clinical data of 123 participants who were recruited from Department of Obstetrics and Gynecology，Zhujiang Hospital of Southern Medical University from August 2015 to December 2016，including 80 with persistent HR-HPV infection and negative results of TCT（group A），15 with persistent HR-HPV infection and CIN grade 1（group B） and 28 with persistent HR-HPV infection after cervical cancer surgery and CIN grade 2-3（group C）． Paiteling treatment was given to all of them，and the response and safety were analyzed.Results　Spearman's correlation analysis showed that white blood cell count，hemoglobin，prothrombin time，thrombin time，fibrinogen，D-dimer，triacylglycerol，low density lipoprotein cholesterol and high density lipoprotein cholesterol levels increased with the progression of CIN among the patients with persistent HR-HPV infection（P<0.01）． The negative conversion rate differed significantly between groups A〔87.5% （70/80）〕，B（15/15），and C〔57.1% （16/28）〕（P<0.001），but the cumulative negative conversion rate {group A〔91.2% （73/80）〕 vs group B（15/15） vs group C〔89.3% （25/28）〕} did not （P>0.05）． 2 cases without response were found to be infected with subtypes HR-HPV 52 and 58 by a re-examination.The follow-up revealed that among all the participants，vaginal and vulvar stinging and burning were the most common short-term adverse reactions within a 6-month treatment，and no long-term adverse reactions such as cervical adhesion，cervical erosion，as well as cervical stenosis were found during 1 to 2 years of treatment.Conclusion　Paiteling is effective and safe for the treatment of persistent HR-HPV infection.

Association between Benign Paroxysmal Positional Vertigo and Osteoporosis/Osteopenia：a Meta-analysis　

HE Lingling，LI Xiaoqiong，LI Xinyi

2019, 22(11): 1328-1333. DOI: 10.12114/j.issn.1007-9572.2018.00.306

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Background　Benign paroxysmal positional vertigo （BPPV） is the most common type of vertigo.While its etiology is not clear，a growing number of studies have shown that BPPV is closely associated with osteoporosis/osteopenia.Osteoporosis/osteopenia may be a risk factor of BPPV，but there is no definite conclusion yet.It is important to clarify the relationship between BPPV and osteoporosis/osteopenia for the etiology and the prevention and treatment of BPPV.Objective　To systematically evaluate the association between BPPV and osteoporosis/osteopenia.Methods　Relevant studies from home and abroad on the relationship between BPPV and osteoporosis/osteopenia were identified by searching PubMed，EMBase，Cochrane Library，ScienceDirect，Web of Science，Wanfang Data Knowledge Service Platform and CNKI from the founding of each database to March 2018.RevMan 5.3 software was used for meta-analysis.Pooled odds ratios（OR） and 95% confidence intervals（CI） were used to assess the combined effect.Results　A total of 9 studies involving 1 982 individuals were included，which were all case-control studies.The results of meta analysis showed that both the incidence of osteoporosis 〔OR=3.22，95%CI（2.08，4.97），P<0.000 01〕 and osteopenia 〔OR=1.72，95%CI（1.11，2.67），P<0.000 1〕 in BPPV groups were significantly higher than those in control groups.The results of subgroup analysis showed that the incidence of osteoporosis in female 〔OR=2.74，95%CI（1.93，3.89），P<0.000 01〕 and xanthoderm BPPV patients 〔OR=3.75，95%CI（2.87，4.90），P<0.000 01〕 were higher than those in control groups，and the incidence of osteopenia in female 〔OR=1.68，95%CI（1.04，2.70），P=0.03〕 and xanthoderm BPPV patients 〔OR=1.54，95%CI（1.00，2.36），P=0.05〕 were higher than those in control groups.Conclusion　BPPV patients are more likely to have osteoporosis/osteopenia，especially in female and xanthoderm patients，suggesting that osteoporosis/osteopenia may be a risk factor of BPPV.

Incidence of Major Adverse Events Associated with Cardiac Pacemaker Implantation：a Meta-analysis　

TAO Qingmei，SUN Xinghe，GAO Le，ZHAI Wei，LIANG Wei，SUN Feng

2019, 22(11): 1334-1340. DOI: 10.12114/j.issn.1007-9572.2018.00.257

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Background　Implantable cardiac pacemakers have been applied to clinical use for 50 years，saving tens of thousands of lives.At present，this number has increased by 15% each year.Because of this，the adverse events of pacemakers are concerned by people.However，full scaled surveys with large samples on the incidence of adverse events associated with cardiac pacemaker implantations are still insufficient.Objective　To systematically assess the incidence of adverse events of cardiac pacemaker implantation.Methods　We searched the databases of SinoMed，CNKI，VIP，Wanfang Data Knowledge Service Platform，PubMed，EMBase，Cochrane Library，ClinicalTrials.gov for studies concerning the adverse events 〔including 10 major adverse events （pocket infection，premature battery depletion，electrode dislocation/displacement，electrode fracture，electrode perforation，elevation of the pacing threshold，diaphragmatic stimulation，skin ulceration or redness and swelling，under/over-sensing and death） and other adverse events〕 related to cardiac pacemaker implantation from their inception to November 1，2016 using the subject headings and free-text terms of “ implantable cardiac pacemaker” plus “adverse event” or “adverse reaction” or “safety”，and “植入式心脏起搏器” plus “不良事件” or “不良反应”or“安全性”.Meta-analysis was performed with SPSS 16.0 and statistical software for meta-analysis.Subgroup analyses were conducted according to the follow-up period，publication year，and type of pacemaker.Results　The most commonly reported adverse event was death 〔6.6%，95%CI（4.8%，8.9%）〕，followed by other adverse events 〔4.5%，95%CI（4.0%，5.2%）〕，skin ulceration or redness and swelling 〔3.6%，95%CI（1.8%，7.0%）〕，electrode dislocation/displacement 〔3.4%，95%CI（2.9%，4.0%）〕，elevation of the pacing threshold 〔2.9%，95%CI（1.9%，4.5%）〕，under/over-sensing〔2.6%，95%CI（1.8%，3.8%）〕，premature battery depletion 〔2.3%，95%CI（1.4%，4.0%）〕 and so on.The overall incidence of major adverse events was 〔7.5%，95%CI（6.7%，8.4%）〕.Conclusion　The available evidence indicates that the incidence of major adverse events of cardiac pacemaker implantation is high，in particular，the death，skin ulceration or redness and swelling，electrode dislocation/displacement etc.，so patients with cardiac pacemaker implantation should be monitored and followed up closely as long as possible.

Construction of a Comprehensive Health Assessment for Community In-home Elderly in Beijing Based on Modified Delphi Methods　

ZHU Kaiyi，TAO Hong

2019, 22(11): 1341-1345. DOI: 10.12114/j.issn.1007-9572.2018.00.279

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Background　During the “Twelfth Five-Year Plan” period，Beijing proposed a new model of community home care for the elderly. Therefore, faced with the surge in the elderly population，the increase in medical burden and the shortage of nursing home，it is urgent to establish a comprehensive health assessment for community in-home elderly and quantitative technology which is suitable for China's national conditions and culture in the transition from medical science to bio-psycho-social medicine. Objective　To develop a comprehensive health assessment for community in-home elderly in Beijing based on modified Delphi method，and to provide reference for new model of community home care for the elderly.Methods　Twenty experts worked on clinic medicine，psychology，nutrition，nursing，education and management of health，and statistics were invited from December 2017 to March 2018.According to the modified Delphi method，the evaluation index system for community in-home elderly （version 1） was designed on the basis of comprehensive geriatric assessment.In two-rounds of consultation，the expert consultation tables were delivered by E-mail and face-to-face conversation.The significance of the indexes，the extent of familiarity and the basis for judgment were graded by the experts.The active coefficient，the degree of expert authority，the significance of each index，the coefficient of variation and the degree of expert coordination of the all indexes were calculated according to the results of the consultation.Results　Twenty consultation forms were issued in each round，and 20 copies were recovered，with a recovery rate of 100%.The extent of familiarity for the first round was 0.73 and the second round was 0.74，and the basis for judgment were both 0.89.The degree of expert authority were 0.81 and 0.82，respectively.In the first round，average points of the significance were 3.80 to 4.80，the coefficient of variation 0.09 to 0.37 and the degree of expert coordination 0.341 （χ2=132.778，P<0.05）；in the second round，average points of the significance were 4.05 to 4.80，the coefficient of variation 0.09 to 0.23 and the degree of expert coordination 0.410 （χ2=132.329，P<0.05）．According to expert consultation，six indexes were deleted and two indexes were added in the first round of consultation，and no index was revised in the second round.Finally，the comprehensive health assessment covered 5 items and 12 indexes.Conclusion　The result of the comprehensive health assessment for community in-home elderly in Beijing based on modified Delphi method is satisfied，which could provide reference for in-home elderly assessment.

Development of the Self-supporting Ability Rating Scale for the Elderly　

MEI Yangyang，PANG Shuqin

2019, 22(11): 1346-1350. DOI: 10.12114/j.issn.1007-9572.2018.00.119

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Background　As the population is aging，China，as a developing country to age before it gets rich，has social and family modes of care for the aged .However，due to insufficient social supporting resources and limited family support capability，the elderly care quality is difficult to be guaranteed.To tap the potential of self-care and realize self-supporting has become a research hotspot.Therefore，relevant evaluation tools are important to improve old-age self-care ability.Objective　To establish a scientific，systematic and easy-to-use Self-supporting Ability Rating Scale for the Elderly （SSARSE） in China.Methods　We conducted this study from May to June 2016.Based on literature review and the results of semi-structured interviews with older people and geriatric specialists，we formed the initial SSARSE consisting of 3 first-level indicators，7 second-level indicators and 90 third-level indicators．Then the initial SSARSE was modified （including the determination of the weights of the indicators） in accordance with the results of two rounds of face-to-face or email Delphi survey among 19 experts in geriatric care and other related fields.Results　The response rates of the two rounds of Delphi survey were 78.95% and 100.00%．The expert authority coefficient （Cr） was 0.87．The final SSARSE consists of 3 first-level indicators，7 second-level indicators and 56 third-level indicators．The Kendall's W increased from 0.262 to 0.364 （P<0.01）．Conclusion　The SSARSE is domestic-oriented，scientific，reliable and pragmatic.

Reliability of the Patient Reported Outcomes Scale for Coronary Heart Disease　

ZHANG Chuanmeng，WAN Chonghua，YANG Zheng，HUANG Zhiwen，WU Bin，XU Chuanzhi

2019, 22(11): 1350-1354. DOI: 10.12114/j.issn.1007-9572.2018.00.209

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Background　Coronary heart disease is difficult to cure，and the course of which is long.Traditional evaluation indexes （such as mortality and cure rate） cannot evaluate the health status and treatment effect on patients.Patient reported outcome is the direct evaluation of patients' own health status without interpretation of medical professionals.The key to the assessment of patient reported outcome is to develop an appropriate measurement scale and evaluate it accordingly．Objective　To evaluate the reliability of the Patient Reported Outcome Instruments for Chronic Disease （PROISCD-CHD）．Methods　To evaluate the reliability of PROISCD-CHD by classical test theory （CTT） and modern test theory （Generalizability Theory，GT），a total of 189 patients with coronary heart disease who were literate and volunteered were investigated at the time of admission and 75 of them were randomly selected for the second survey after one day interval.The correlation coefficients of the first and second measurements were used to evaluate the test-retest reliability while Cronbach's α coefficients were used to evaluate internal consistency.The source of the patient's reported outcome score was explored in G-study and the suggested number of items was given based on their G-coefficient （Ep2） and indexes of dependability （φ） in D-study．Results　Coefficients of physiological health，mental health，social health，spirit/belief health，common modules，specific modules and total score of PROISCD-CHD scale were 0.89，0.84，0.75，0.86，0.88，0.89，0.71，respectively （P<0.001），and Cronbach's α coefficients of each item were 0.71，0.75，0.75，0.69，0.88，0.78，0.89，respectively.G-study showed that the biggest source of variation was the interaction between the patients and items，and the smallest was the item.D-study revealed that G-coefficients of all domains were greater than 0.70，except for the domain of spirit/belief health，which had the same result with the reliability analysis of classical test theory.And according to Ep2 andφ，the optimal number of items was also given．Conclusion　PROISCD-CHD can be used to assess patient-reported outcome for patients with coronary heart disease with good reliability.

Effects of Task-oriented Training Combined with Electromyographic Biofeedback on the Intelligence in Children with Cerebral Palsy　

CHEN Cai*，ZHOU Yuanjing，TANG Lingjian，HONG Fangfang

2019, 22(11): 1355-1359. DOI: 10.12114/j.issn.1007-9572.2018.00.258

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Background　The incidence of cerebral palsy（CP） in China is 2.48‰，with an increasing growth due to rising number of older mothers and environmental pollution.Children with CP are often accompanied by mental retardation，the incidence of which is 40%-65%.In clinical study of CP，task-oriented training and electromyographic biofeedback mainly focus on motor function，but few on intelligence．Objective　To explore the effects of task-oriented training combined with electromyographic biofeedback on the intelligence in children with CP．Methods　We enrolled 69 children with CP from Affiliated Hospital of Guilin Medical University from December 2013 to February 2017 and divided them into the control group （n=34） and observation group （n=35） by a random number table，receiving a 3-month task-oriented training，a 3-month task-oriented training combined with electromyographic biofeedback，respectively.The intelligence quotient （IQ） of both groups before and after intervention was assessed by the Chinese Binet-Simon Intelligence Handbook （CBIH，fourth edition） and Chinese Wechsler Young Children Scale of Intelligence （C-WYCSI）．Results　Except for 5 cases of dropouts and exclusion，the other 64 （including 31 from the control group and 33 from the observation group） who completed the intervention were included in the final analysis.Before intervention，the mean IQ scores assessed by CBIH and C-WYCSI were similar in both groups （P>0.05）．After intervention，they increased significantly in both groups （P<0.05）．Moreover，greater increases were found in the observation group rather than the control group （P<0.05）．Conclusion　Task-oriented training combined with electromyographic biofeedback can better improve the intelligence level in children with CP.

Pelvic Floor Biofeedback Therapy for Postoperative Dysuresia among Middle-aged and Elderly People with Cervical Spinal Cord Injury　

LIU Liangle，DAI Minghai，YE Xiuzhi，ZHONG Xiqiang，WANG Juncheng，TANG Chengxuan

2019, 22(11): 1359-1363.

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Background　Cervical hyperextension injury is a common disease in middle-aged and elderly patients，and dysuria is one of the main complications. In recent years，pelvic floor electrobiofeedback method has been used to treat dysuria，and has been gradually promoted in clinical practice. However，the effect of using only a single physical or pharmaceutical method to treat dysuria in middle-aged and elderly patients is often unsatisfactory. Objective　To evaluate the effect of pelvic floor biofeedback therapy （PFBT） on postoperative dysuresia in middle-aged and elderly people with cervical spinal cord injury （CSCI）．Methods　We enrolled 82 middle-aged and elderly patients with postoperative dysuresia following CSCI surgery from the Third Affiliated Hospital of Wenzhou Medical University from May 2012 to May 2015.We divided them into control group （n=42） and treatment group （n=40） by random number table，receiving bladder training，bladder training combined with PFBT，respectively.The treatment effect was evaluated by the duration of indwelling urethral catheter and the rate of successful spontaneous voiding measured during the active voiding trial，and urodynamic parameters （including the residual urine volume，maximum capacity of the bladder，maximum urinary flow rate，average urinary flow rate，detrusor pressure at the end of filling） measured after treatment.Results　All patients were followed up for an average of 4.5 months.The average duration of indwelling urethral catheter in the treatment group was significant less than that of the control group〔（24.5±3.9） d vs （45.6±5.5） d，t=19.950，P<0.001〕.Spontaneous voiding recovery was achieved in 37 （92.5%） in the treatment group，and 28 （66.7%）in the control group including 13 demonstrated different degrees of dysuresia after the removal of the urethral catheter，indicating that the treatment group had a higher rate of successful spontaneous voiding （χ2=8.329，P=0.004）．After treatment，the maximum capacity of the bladder，maximun arinary flow rate，and the average urinary flow rate significantly increased while the residual urine volume decreased，and the detrusor pressure at the end of filling dropped obviously in both groups compared to the baseline （P<0.05）；the treatment group demonstrated substantially less residual urine volume and detrusor pressure at the end of filling and significantly increased maximum capacity of the bladder and average urinary flow rate compared with the control group （P<0.05）．Conclusion　PFBT can effectively improve the postoperative voiding function and shorten the duration of indwelling urethral catheter in middle-aged and elderly patients with CSCI，which is worthy of clinical application.

Application Effect of Otago Exercise Program and Xiao's Double C Nursing in Elderly Patients with Hemiplegia Following Cerebral Infarction　

XIE Jing

2019, 22(11): 1364-1368. DOI: 10.12114/j.issn.1007-9572.2019.00.069

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Background　The incidence of hemiplegia following cerebral infarction is increasing，which has a great impact on the quality of life and physical and mental health of the population in the world.In the past，Otago exercise program was often used to intervene such patients，which can achieve certain effects，but the overall effect is not satisfactory.Xiao's double C nursing is an intervention of important clinical significance，which can make patients reach various comfort levels，improve the quality of comprehensive care，and promote the patients' recovery as early as possible.Objective　To investigate the effect of Otago exercise program and Xiao's double C nursing in patients with hemiplegia induced by cerebral infarction.Methods　Eighty four cases of cerebral infarction following hemiplegia were recruited from Henan Provincial Chest Hospital from November 2015 to May 2017，and were equally randomized into the control group （n=42） and study group （n=42），receiving 2-month conventional nursing and Otago exercise program，2-month conventional nursing，Otago exercise program and Xiao's double C nursing，respectively.At baseline，and the end of the 1st，and 2nd months of intervention，sensorimotor recovery was assessed by Fugl-Meyer Assessment （FMA） scale，level of activities of daily living was assessed by Barthel index，and quality of life was assessed by 30-item QOL scale，respectively.Adherence to rehabilitation training and satisfaction with nursing were also measured at the end of intervention.Results　Intervention methods and duration had significant interactive effect on FMA score，Barthel index and 30-item QOL score （P<0.05）．And they produced obvious main effect on FMA score，Barthel index and 30-item QOL score （P<0.05）．Compared with baseline，FMA score，Barthel index and 30-item QOL score increased significantly in both groups at the end of the 1st and 2nd months of intervention （P<0.05）．Intergroup comparisons found that although FMA score，Barthel index and 30-item QOL score were similar in both groups at baseline （P>0.05），and FMA score，Barthel index and 30-item QOL score increased significantly in the study group at the end of the 1st and 2nd months of intervention （P<0.05）．Moreover，the adherence to rehabilitation training and satisfaction with nursing in the study group were all better than those of the control group （P<0.05）．Conclusion　Conventional nursing in combination with Otago exercise program and Xiao's double C nursing，can effectively recover the level of activities of daily living，improve the sensorimotor recovery and quality of life，adherence to rehabilitation training，and enhance satisfaction with nursing in elderly patients with hemiplegia following cerebral infarction.

Panicked Patient and Family Members：a RICE Skills-based Consultation Case Study in Primary Care Practice　

JIN Feng，WEI Xiao-lin

2019, 22(11): 1369-1371. DOI: 10.12114/j.issn.1007-9572.2018.00.204

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When encountering a panicked patient with metoclopramide-induced extrapyramidal reactions accompanied with family members，we used RICE （Reason-Idea-Concern-Expectation） skills，namely，detailedly analyzing the reasons for healthcare seeking，thoughts of the patient，concerns and expectations of the patient and her family members.By treatment based on this type of consultation，the anxieties and symptoms of the patient were relieved in a short period of time.Limited by the conditions of community health organizations （CHOs），general practitioners shall learn to solve problems in practice with simple methods，and improve the level of people's trust in the care delivered by CHOs with knowledge，technology and moral quality.
RICE inquiring；Metoclopramide；Extrapyramidal reaction；General practitioners

Multiple Myeloma with Hyperamylasaemia：a Case Report and Literature Review　

GUO Maodong，DING Jin，CHEN Yanping，WANG Qunying，WENG Xiang，YE Xiaohua

2019, 22(11): 1372-1376. DOI: 10.12114/j.issn.1007-9572.2018.00.256

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Multiple myeloma （MM） is a terminally differentiated B-cell malignancy with clinical presentations of osteolytic bone lesions，impaired renal function，and pathological secretion of monoclonal immunoglobulin.Hyperamylasemia is a presentation mostly found in acute pancreatitis.Hyperamylasaemia associated with MM appears to be a fairly unusual phenomenon.We reported a case of MM with hyperamylasemia with a detailed description of the diagnosis and treatment process.Moreover，we investigated the clinical manifestations，treatments，prognosis and pathological mechanisms of this disease on the basis of the review of the related studies.The study can deepen clinicians' understanding of this disease.

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