Chinese General Practice

Clinical Application of New Biologics in Inflammatory Bowel Disease：Current Status and Future Prospect　

WANG Yingde

2021, 24(21): 2629-2633. DOI: 10.12114/j.issn.1007-9572.2021.00.519

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Biologics such as anti-tumor necrosis factor-α agents have been increasingly used to treat inflammatory bowel disease（IBD）in recent years，but their clinical application are limited due to low safety and high rate of secondary loss of response.Currently，the treatment of IBD is entering into a biologics era as new types of biologics are emerging，in which they may become the main option in IBD pharmacological therapies.This paper reviewed the current application，mechanisms of action，therapeutic efficacy，safety and future prospect of new biologics for IBD，including anti-adhesion molecule agents，anti-IL-12/IL-23 agents and Janus kinase （JAK） inhibitors，providing a reference for the standardized and reasonable use of these new biologics in IBD.
Inflammatory bowel diseases；Biological factors；Inflammatory bowel disease；New biologics；Vedolizumab；Ustekinumab；Tofacitinib；Editorial

Application of Histopathological Disease Activity Indices in Ulcerative Colitis　

PENG Ying，XU Lihong

2021, 24(21): 2634-2639. DOI: 10.12114/j.issn.1007-9572.2021.00.550

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At present，the histopathological remission of the intestinal mucosa under the microscope has been widely recognized as a means for evaluating the efficacy and prognosis of ulcerative colitis （UC）.There are a variety of scoring systems that can be used to assess the histopathological status of the intestinal mucosa of UC patients，but it is still controversial that which one is superior to the other in terms of accurately assessing the disease activity and prognosis，and obtaining higher consensus.On this issue，this article reviews the histopathological disease activity indices commonly used in UC，aiming to provide help for clinicians to accurately determine the disease activity and outcome of UC patients.

Recent Developments in the Diagnosis and Treatment of Refractory Irritable Bowel Syndrome　

XIE Xin，CHEN Min，YE Kun，ZHAO Jun，WEI Qingshuang，WU Qiaofeng，LI Zhigang，YU Shuguang

2021, 24(21): 2640-2645. DOI: 10.12114/j.issn.1007-9572.2021.00.546

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Irritable bowel syndrome （IBS） is a functional gastrointestinal disorder that often seen in clinical practice.Monotherapy may not be effective for IBS due to its complex pathogenesis，as a result，some patients' condition is prolonged to become refractory.So far，there are no uniform definition，diagnostic criteria and treatments for refractory IBS.This article summarizes the diagnostic criteria and treatments for refractory IBS worldwide，which will contribute to its clinical diagnosis and treatment，benefiting more patients.

Interpretation of Lipid Management in Patients with Endocrine Disorders：an Endocrine Society Clinical Practice Guideline Issued by The Endocrine Society in 2020　

DENG Chenqian，CHEN Shuchun

2021, 24(21): 2646-2654. DOI: 10.12114/j.issn.1007-9572.2021.00.508

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In recent years，China and many other countries have issued guidelines on lipid management for endocrine disease patients，indicating that lipid management is a very important section in endocrine disease treatment.However，most of previous guidelines only focused on managing lipids in patients with only one endocrine disease，with no systematic elaboration of lipid management in patients with multiple endocrine diseases.The Lipid Management in Patients with Endocrine Disorders：an Endocrine Society Clinical Practice Guideline issued by The Endocrine Society in 2020，is a guideline detailedly elaborates lipid management in patients with endocrine diseases for the first time，which will significantly contribute to lipid management in Chinese patients with endocrine diseases.For this reason，we interpreted the main points of this guideline.

Effects of Dapagliflozin on the Adiponectin Level，Body Fat Distribution and Bone Mineral Content of Overweight Type 2 Diabetes Mellitus Patients　

LIANG Yu，JIAO Xiumin，ZHANG Xingguang，HAO Ping，LYU Xiaofeng

2021, 24(21): 2655-2660. DOI: 10.12114/j.issn.1007-9572.2020.00.591

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Background　It has been identified through background research that obesity and overweight，especially abdominal obesity（central obesity），are a major reason for significant increased prevalence of type 2 diabetes mellitus（T2DM）.Therefore，the clinical goal for T2DM patients should not only target lowering glucose，but also controlling diet and body fat，as well as exercising appropriately.Objective　To investigate the effects of dapagliflozin on adiponectin level，body fat distribution and bone mineral content in overweight T2DM patients.Methods　60 overweight T2DM patients admitted to the Department of Endocrinology，No.7 Medical Center，General Hospital of the People’s Liberation Army from February to August 2019 were selected for this study，and evenly randomized into treatment group （using dapagliflozin with metformin） and control group （using insulin glargine with metformin），treated for 12 weeks.Intergroup comparisons were made in terms of pre- and post-treatment fasting plasma glucose（FPG），glycosylated hemoglobin（HbA1c），blood pressure〔systolic blood pressure（SBP） and diastolic blood pressure（DBP）〕，blood lipid parameters〔triacylglycerol（TG），total cholesterol（TC），high-density lipoprotein cholesterol（HDL-C），low-density lipoprotein cholesterol（LDL-C）〕，adiponectin，BMI，waist-to-hip ratio，body fat （including body fat percentage，body fat mass and lean body mass），whole body bone mineral content for men，A/G ratio，body fat distribution（including both arms and both legs，and trunk） for both fat mass and lean mass，bone mineral content of all body parts and L1-4 bone mineral content of men.Results　Post-treatment FPG，HbA1c，TC，HDL-C and LDL-C showed no significant intergroup differences（P>0.05）.But post-treatment SBP，DBP and TG were lower and post-treatment adiponectin was higher in the treatment group（P<0.05）.Post-treatment lean body mass showed no significant differences between the groups，so did post-treatment whole body bone mineral content for men （P>0.05）.The treatment group showed lower levels of BMI，waist-to-hip ratio，body fat percentage，body fat mass and A/G ratio than the control group at the end of treatment（P<0.05）.Pre- and post-treatment fat mass and lean mass for both arms and legs，and trunk were similar in both groups（P>0.05）.Bone mineral contents for both arms and legs，and trunk and L1-4 for men were similar in both groups either before or after treatment（P>0.05）.Conclusion　While both insulin glargine and dapagliflozin could effectively lower glucose level，dapagliflozin was more superior to insulin glargine in improving blood pressure and blood lipid，reducing abdominal fat accumulation，increasing adiponectin level in over weight T2DM patients，without adverse effects on muscle content and bone mineral content.

Prevalence and Influencing Factors of Fear of Hypoglycemia in Patients with Type 2 Diabetes Mellitus　

LI Shuang，CHEN Yuqing，HU Xu，FANG Li，YUAN Yuan，ZHANG Yu

2021, 24(21): 2661-2668. DOI: 10.12114/j.issn.1007-9572.2021.00.082

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Background　Hypoglycemia is a major barrier to the management of diabetes.Uncomfortable symptoms induced by hypoglycemia can easily result in fear of hypoglycemia（FOH），affecting the disease management.Objective　To analyze the prevalence and influencing factors of FOH in patients with type 2 diabetes mellitus（T2DM）.Methods　This study was carried out from June to October 2019.By use of convenience sampling，T2DM inpatients with a attack history of hypoglycemia within half a year were randomly selected from three tertiary hospitals in Suzhou City and Yangzhou City to attend an onsite survey using a questionnaire consisting of four parts〔demographics，Hypoglycemia Fear Survey-Ⅱ（HFS-Ⅱ），Chinese version of Diabetes Distress Scale（DDS），Summary of Diabetes Self-Care Activities（SDSCA）〕.Researchers with unified survey-related training distributed the questionnaires and collected them after the participants completed.Multiple linear regression analysis was performed to determine the influencing factors of FOH.Spearman rank correlation analysis was used to analyze the correlations of FOH with the degree of distress and self-care activities.Results　The response rate of the questionnaire was 90.2%（258/286）.The average total score of HFS-Ⅱ，Chinese version of DDS and SDSCA was 35.0（27.8，47.0），（36.9±11.0）and（33.2±6.7），respectively，for the 258 respondents.The total score of HFS-Ⅱ among the respondents differed significantly by course of T2DM，therapeutic regimen，understanding of T2DM，number of hypoglycemia attacks within half a year，total average score of Chinese version of DDS and total score of SDSCA，past history of hypoglycemia，severe hypoglycemia，and nocturnal hypoglycemia（P<0.05）.Multiple linear regression analysis showed that，course of T2DM〔B=0.259，95%CI（0.074，0.443）〕，understanding of T2DM〔clear understanding：B=0.362，95%CI（0.003，0.722）〕，number of hypoglycemia attacks within half a year〔3 to 6 times：B=0.737，95%CI（0.428，1.045）；over 6 times：B=0.322，95%CI（0.123，0.520）〕，nocturnal hypoglycemia〔B=0.263，95%CI（0.072，0.454）〕，total scores of Chinese version of DDS〔B=0.711，95%CI（0.600，0.822）〕and SDSCA〔B=-0.019，95%CI（-0.031，-0.006）〕were associated with FOH in patients with T2DM（P<0.05），accounting for 64.3% of the total variants.Spearman rank correlation analysis showed that，in terms of total score，HFS-Ⅱ was positively correlated with Chinese version of DDS（rs=0.749，P<0.01），but was negatively correlated with SDSCA（rs=-0.204，P<0.01）.Conclusion　FOH prevalence is relatively high in patients with T2DM，which is correlated with the levels of distress and self-care activities.Moreover，it is associated with the course and understanding of T2DM，number of hypoglycemia attacks within half a year，nocturnal hypoglycemia，total scores of Chinese version of DDS and SDSCA.Thus，medical workers should pay attention to early psychological screening in such patients and guide them to develop self-management behaviors in an appropriate way.

Comparison of Consistency and Validity of Fried Frailty Phenotype，FRAIL Scale and Edmonton Frailty Scale for Frailty Screening among Community-dwelling Older Adults　

HAN Jun，WANG Junqiao，XIE Boqin，WANG Yue

2021, 24(21): 2669-2675. DOI: 10.12114/j.issn.1007-9572.2021.00.451

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Background　Due to the increasing aging population，frailty has emerged as a prominent public health issue.Frail older adults have increased risks for falls，disability and death.A good screening tool is needed to early identify frailty among community-dwelling older adults，thereby delivering precise interventions timely.Objective　To compare the consistency and validity of the Fried Frailty Phenotype（FP），FRAIL Scale and Edmonton Frailty Scale（EFS）in screening frailty among community-dwelling older adults.Methods　During July to August 2018，adults aged 75 years or older living in three sub-districts of Xuhui District，Shanghai，were included using the method of convenient sampling.FP，FRAIL Scale and EFS were used to assess the frailty.Activity of Daily Living Scale （ADL） was used as the validity evaluation standard.Correlation analysis，receiver operating characteristic （ROC） curve and Bayes discriminant analysis were used to test the validity and suitability of the three frailty measurements.Results　Of the 2 000 cases included in the study，1 915 completed the measurements，and 1 625 of them（84.9%） who completed effectively were finally enrolled.The prevalence of frailty screened by the FP，FRAIL Scale and EFS was 24.9%（404/1 625），9.2%（149/1 625） and 28.2%（459/1 625），respectively.The Kappa values of FP and FRAIL Scale，FP and EFS，Frail Scale and EFS were 0.371，0.491 and 0.301，respectively （P<0.001）.Congruent validity of FP，FRAIL Scale and EFS with ADL scale were 0.484，0.564 and 0.653 （P<0.001），respectively.The area under the ROC curve （AUC） of FP，FRAIL Scale and EFS for the prediction of activity of dialy living was 0.748，0.736 and 0.787，respectively.The results of Bayes discriminant analysis〔with decline of activity of dialy living as a dependent variable and three frailty screening tools as independent variables〕 showed that the cross validation accuracy of EFS in predicting the decline of activity of dialy living was 75.70%，which was higher than that of FP（63.90%） and FRAIL Scale（67.80%）.Conclusion　FP，FRAIL Scale and EFS play different roles in identifying frailty in community-dwelling older adults.EFS is a good measure for screening the multi-domain frailty；FP may be a better measure for screening physical frailty than the FRAIL Scale.

Correlation of Serum Uric Acid Level and Body Fat Distribution in Individuals by Glucose Metabolism　

XIAO Yuanyuan，JIANG Zhifeng，JIANG Fusong，ZHU Chaoyu，GAO Qingge，WEI Li

2021, 24(21): 2675-2679. DOI: 10.12114/j.issn.1007-9572.2021.00.507

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Background　Hyperuricemia is an important manifestation of metabolic diseases，and a significant risk factor for type 2 diabetes and obesity and so on.However，there are few studies on the correlation between serum uric acid level and body fat distribution in individuals by glucose metabolism.Objective　To investigate the relationship between serum uric acid level and body fat distribution in adult population by glucose metabolism.Methods　A total of 571 adult permanent residents were recruited from Shanghai Nicheng Town Yunsong Community in 2015.According to the 1998 WHO diagnostic criteria for diabetes，they were divided into groups of normal glucose tolerance （NGT），impaired glucose regulation （IGR），and type 2 diabetes mellitus（T2DM）.Hyperuricemia was diagnosed according to the 2010 Chinese Expert Consensus Recommendations for the Diagnosis and Treatment of Asymptomatic Hyperuricemia with Cardiovascular Diseases.Intragroup comparisons of the general demographic information，biochemical and body fat indices by hyperuricemia prevalence were performed to examine the potential association of serum uric acid level and body fat indices.Results　The hypeluricemia prevalence was 12.2%（24/196），21.8%（27/170），and 14.6%（30/205），respectively，in NGT，IGR and T2DM groups，showing no significant statistical difference（χ2=1.042，P=0.594）.In NGT group，those with hyperuricemia had greater mean age，and greater average levels of BMI，triacylglycerol，fasting insulin，trunk fat percentage to leg fat percentage （TFP/LFP） ratio，trunk fat mass to limb fat mass（TFM/LFM） ratio，abdominal fat percentage to hip fat percentage （AFP/HFP） ratio，and lower average level of high-density lipoprotein cholesterol （HDL-C） than those without（P<0.05）.In IGR group，those with hyperuricemia had higher men ratio，waist-to-hip ratio，TFP/LFP ratio，TFM/LFM ratio，and AFP/HFP ratio，and lower average levels of HDL-C，upper and lower limb fat percentages than those without （P<0.05）.In T2DM group，Those with hyperuricemia had greater average age and women ratio，and higher average levels of BMI，total cholesterol，low-density lipoprotein cholesterol，body fat percentage，trunk fat percentage，upper limb fat percentage，and lower limb fat percentage than those without （P<0.05）.Pearson correlation analysis results showed that the level of serum uric acid was positively correlated with TFP/LFP ratio，TFM/LFM ratio and AFP/HFP ratio （P<0.05）in each group；serum uric acid level was positively correlated with waist-to-hip ratio，but negatively correlated with body fat percentage，trunk fat percentage，upper limb fat percentage，and lower limb fat percentage in NGT and IGR groups（P<0.05）.Conclusion　The serum uric acid level and body fat distribution differed significantly among individuals by glucose metabolism，and the serum uric acid level may be closely related to body fat distribution.

Effect of Mirror Therapy Combined with Body Weight Supported Treadmill Training on Walking Function in Post-stroke Hemiplegia Patients　

LIU Zhong，LIANG Tianjia

2021, 24(21): 2680-2685. DOI: 10.12114/j.issn.1007-9572.2021.00.482

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Background　Walking dysfunction is a common post-stroke complication，seriously affecting the daily living ability.So it is particularly important to take measures to improve walking function in stroke patients as soon as possible.There are few reports about improving walking function in stroke patients using mirror therapy（MT）combined with body weight supported treadmill training（BWSTT）.Objective　To investigate the effect of MT combined with BWSTT on walking function in post-stroke hemiplegia patients.Methods　A total of 120 post-stroke hemiplegia patients who were hospitalized from May 2019 to September 2020 in Department of Rehabilitation Medicine，the Second Affiliated Hospital of Guangxi Medical University were recruited，and randomly divided into conventional group （n=40），BWSTT group （n=40） and combination group （n=40） by random number table.All groups underwent regular rehabilitation therapy，the BWSTT group underwent BWSTT and combination group underwent MT and BWSTT additionally，for 6 days per week，for a total of 4 weeks.The three groups were evaluated by Fugl-Meyer assessment of lower extremity （FMA-LE），Holden Functional Ambulation Classification（HFAC），Berg Balance Scale （BBS），modified Barthel index （MBI），and 6-minute walking test （6MWT） before and after intervention.Results　The assessment results of FMA-LE，HFAC，BBS，MBI and 6MWT were similar across the groups before intervention （P>0.05）.After intervention，the assessment results of above-mentioned five items improved in all groups（P<0.05），but improved more significantly in BWSTT and combination groups（P<0.05）.Furthermore，the combination group showed better post-intervention assessment results of FMA-LE，HFAC，BBS，MBI and 6MWT than BWSTT group（P<0.05）.Conclusion　Regular rehabilitation therapy with MT and BWSTT may effectively improve the recovery of walking function in post-stroke hemiplegia patients.

Influencing Factors of Polycystic Ovarian Syndrome Patients' Participation in Shared Decision-making　

GUO Xufang，LIU Huan，WU Liping，GAO Chuan，HE Zhong

2021, 24(21): 2685-2690. DOI: 10.12114/j.issn.1007-9572.2021.00.525

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Background　Shared decision-making has become a key initiative for healthcare development along with the advances in healthcare delivery models.Deep understanding of polycystic ovarian syndrome（PCOS）patients' attitude toward and real involvement in decision-making will help the patients to make more satisfactory clinical decisions.Objective　To explore PCOS patients' preferences for participation in shared decision-making and associated factors.Methods　PCOS patients were selected from the gynecological endocrinology center of Peking Union Medical College Hospital，and the reproductive gynecology department of the First People's Hospital of Yunnan from April to June 2020.An investigation was conducted to collect their demographic information，and preferences for participation and real involvement in shared decision-making using a self-developed demographic information questionnaire，and the Chinese version of Control Preferences Scale，respectively.Univariate and multivariate Logistic regression analyses were used to identify the influencing factors of patients' participation in decision-making.Results　A total of 240 cases attended the investigation，and 234（97.5%） of them（including 119 from Yunnan and 115 from Beijing） handed in responsive questionnaires were finally included.The rates of respondents preferring an active role，collaborative role，and passive role in shared decision-making were 5.1%（12/234），65.4%（153/234），and 29.5%（69/234），respectively.The rates of respondents actually playing an active role，collaborative role，and passive role in shared decision-making were 5.6%（13/234），36.3%（85/234），and 58.1%（136/234），respectively.The respondents from Beijing showed significant differences in their preferences for and real involvement in shared decision-making，so did those from Yunnan（P<0.01）.Multivariate Logistic regression analysis showed that education level〔OR=17.840，95%CI（6.175，51.539）〕，average monthly household income〔OR=3.074，95%CI（1.528，6.144）〕influenced PCOS patients' preferences for participation in shared decision-making（P<0.05）.Besides，education level〔OR=4.529，95%CI（2.468，8.311）〕，average monthly household income〔OR=1.461，95%CI（1.045，2.044）〕influenced PCOS patients' actual participation in shared decision-making（P<0.05）.Conclusion　Most PCOS patients preferred taking an active role in their shared decision-making，but showed a low rate of actually participating in shared decision-making.Higher education level and average monthly household income were associated with higher intention to participate in shared decision-making and higher rate of actually participating in shared decision-making.To make more satisfactory treatment decisions and reduce the possibility of having regrets in decision-making，both doctors and patients should correctly understand and use shared decision-making to achieve effective communication.

Laboratory Test Indices and Survival Status in Patients with Advanced Cancer　

YU Wenkai，CHEN Jianlin，WANG Jianfang，NI Xiaorong，LIU Deng，PAN Jumei，SHI Yongxing

2021, 24(21): 2691-2695. DOI: 10.12114/j.issn.1007-9572.2021.00.515

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Background　Accurate assessment of expected survival in patients with advanced cancer is important to improve their quality of life.However，current tools for predicting the survival of these patients need to be improved.Objective　To explore the relationship between laboratory test indices and survival status of advanced cancer patients.Methods　Totally 175 advanced cancer patients were recruited from Hospice Ward，Linfen Community Health Center，Shanghai's Jing'an District，from 2018-11-01 to 2019-06-31.Admission laboratory test results were collected，including white blood cell count，hemoglobin，lymphocyte count，neutrophil count，platelet count，C-reactive protein，serum albumin，neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio.The follow-up was conducted until September 30，2019.The end point for follow-up was death.Cox regression analysis was used to examine the association of each laboratory indicator with the survival status.Results　Of the 175 cases，150 died in hospital，with a median survival of 8 days（range，1-29 days），other 25 were lost to follow-up after discharge，with a median length of stay of 67.5 days（range，30-167 days）.Univariate Cox regression analysis showed that high white blood cell count，neutrophils count and C-reactive protein，and low lymphocyte count，platelet count，and serum albumin were associated with the survival status of advance cancer patients（P<0.05）.Multivariate Cox regression analysis showed that lymphocyte count 〔low：HR=1.498，95%CI （1.035，2.170），P=0.032；high：HR=8.490，95%CI （1.894，38.057），P=0.005〕，neutrophil count 〔high：HR=2.227，95%CI （1.478，3.357），P<0.001〕，platelet count 〔low：HR=2.185，95%CI （1.418，3.366），P<0.001〕，and C-reactive protein 〔high：HR=1.478，95%CI （1.005，2.201），P=0.047〕 were independently associated with the survival status of advance cancer patients.Conclusion　Lymphocyte count，neutrophil count，platelet count and C-reactive protein are independently associated with survival status of patients with advanced cancer，may have a certain value in assessing the survival status.

Dual Antiplatelet Therapy for Mild Stroke or Transient Ischemic Attack：from Clinical Guidelines to Real-world Evidence　

REN Jing，WANG Yongle，LIU Tingting，NIU Xiaoyuan

2021, 24(21): 2696-2700. DOI: 10.12114/j.issn.1007-9572.2021.00.545

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Patients with mild ischemic stroke or high-risk transient ischemic attack （TIA） have higher risk of recurrent stroke or other vascular events in the early stage of onset.Evidence from recent large-scale randomized controlled trials（RCTs） about stroke has provided new understandings of early use of antiplatelet therapy in patients with mild ischemic stroke or high-risk TIA.The 2019 BMJ guidelines recommended the dual antiplatelet therapy with aspirin and clopidogrel for acute high-risk TIA and mild ischemic stroke.However，the indications for the use of this therapy are still controversial，and have not been more extensively tested in the real world.We analyzed the protocols and results of recent RCTs and clinical practice using aspirin and clopidogrel for mild stroke or high-risk TIA to find the discrepancy between guideline recommendations and clinical practice，aiming at discussing patient compliance to and benefits from wider application of the dual antiplatelet therapy.

Research Progress in Brain Imaging and Nuclear Brain Imaging Technology of Depression　

WANG Xinyuan，LIU Yan，TAN Xi

2021, 24(21): 2701-2706. DOI: 10.12114/j.issn.1007-9572.2021.00.441

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Because of high prevalence，recurrence，misdiagnosis and suicide rate，depression can cause heavy burden for the families of patients and even the whole society.The developments of neuroscience and brain imaging technology have provided new methods and ideas for the identification，diagnosis，pathogenesis and treatment for depression in recent years，and also the scientific basis for the development of physical therapy of depression.Current imaging studies of depression mainly contain brain imaging and nuclear brain imaging technology.This paper mainly reviewed the latest research progress of the two technologies mentioned above and analyzed the advantages，disadvantages and existing problems of the two technologies，in order to provide a reference for better diagnosis and treatment of depression.

Self-perceived and Objective Recurrence Risk of Stroke in Rural Patients with Ischemic Stroke：Consistency Analysis and Countermeasures　

GUO Yunfei，ZHANG Chunhui，ZHANG Zhenxiang，LIN Beilei，XUE Lihong，LIU Xiao，LIU Qingxuan

2021, 24(21): 2707-2716. DOI: 10.12114/j.issn.1007-9572.2021.00.404

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Background　Although the self-perceived recurrence risk of diseases has received much attention abroad，there is lack of studies about self-perceived recurrence risk of stroke in China.Objective　To explore the consistency between self-perceived and objective recurrence risk of stroke in rural patients with ischemic stroke and put forward countermeasures.Methods　This study was carried out from May to August 2020.Participants were 295 rural neurology inpatients with ischemic stroke selected from People's Hospital of Hua County，Anyang.A survey using a self-developed questionnaire was conducted to collect related information，mainly including demographic characteristics，fear of recurrence，disability degree，objective and self-perceived recurrence risk of stroke.Results　Of the participants，the number of patients who were evaluated with low，medium and high recurrence risk of stroke by Essen Stroke Risk Score（ESRS）was 144（48.8%），151（51.2%），and 0，respectively.And the number of patients who subjectively evaluated themselves with self-perceived low，medium and high recurrence risk of stroke was 152（51.5%），47（15.9%），and 45（15.3%），respectively；other 51 cases（17.3%）could not evaluate their risk clearly.Compared to the evaluation by the ESRS，69 cases（23.4%）underestimated their risk，115（39.0%）accurately assessed their risk，60（20.3%）overestimated their risk，51（17.3%）could not perceive their risk distinctly.The self-perceived recurrence risk of stroke and consistency analysis result were significantly different from those evaluated by the ESRS（P<0.05）.Spearman rank correlation analysis demonstrated that the assessment result of the ESRS was negatively correlated with the consistency analysis result（rs=-0.498，P<0.001）.Multivariate Logistic regression analysis results showed that，gender，BMI，occupation，number of combined disease and fear of recurrence were influencing factors of underestimating the recurrence risk of stroke in the consistency analysis in rural patients with ischemic stroke，while BMI，occupation，main caregiver and fear of recurrence were influencing factors of accurately assessing the recurrence risk of stroke（P<0.05）.Conclusion　The consistency between self-perceived and objective recurrence risk of stroke was relatively low in rural patients with ischemic stroke.And there were significant differences of the self-perceived recurrence risk of stroke and consistency analysis result in patients with different objective recurrence risk of stroke.Gender，BMI，occupation，number of combined disease，monthly household income per capita and fear of recurrence were associated with underestimating the recurrence risk of stroke in the consistency analysis in rural patients with ischemic stroke，while BMI，occupation，main caregiver，monthly household income per capita and fear of recurrence were associated with accurately estimating.

Analysis and Reflection on Hospital-based Rehabilitation and Postdischarge Community-based Intelligent Cloud Rehabilitation Mode for Spinocerebellar Ataxia Type 2 in a Child　

QIAN Xue，ZHUANG Ren，HE Jun，YANG Ling

2021, 24(21): 2717-2720. DOI: 10.12114/j.issn.1007-9572.2020.00.609

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Background　Childhood onset of spinocerebellar ataxia type 2（SCA-2）is very rare.Currently，in addition to symptomatic drug treatment，active rehabilitation treatment is the key to possibly maintaining the self-care ability and improving quality of life in SCA-2 patients.Objective　To analyze the hospital-based rehabilitation and postdischarge community-based intelligent cloud rehabilitation for a child with SCA-2，to provide a reference for the delivery of rehabilitation treatment for such patients.Methods　Retrospective analysis was conducted on the clinical data，hospital-based rehabilitation treatment strategies and effect of postdischarge community-based intelligent cloud rehabilitation treatment for a child with SCA-2 who was admitted to the Rehabilitation Center of Changzhou Dean Hospital in 2018.Results　After 30 days of in-hospital systematic rehabilitation treatment，the child showed significant improvement in coordination，balance，feeding ability and other functions，indicating that he could take care of himself basically.After 1 year of postdischarge community-based intelligent cloud rehabilitation treatment，the child’s memory and attention showed a declining trend，but there was no significant decline in his coordination，balance，transfer，feeding and walking abilities，and he was able to complete the indoor 10-meter walk，take care of himself basically，and manage to attend school normally.And family and social supports for him are continuing to improve.Conclusion　This pediatric case of SCA-2 presented significant improvement in coordination，balance，eating and walking abilities and could basically take care of himself after in-hospital systematic rehabilitation treatment delivered based on precise assessment，and postdischarge community-based intelligent cloud rehabilitation treatment.Postdischarge community-based intelligent cloud rehabilitation mode may be as a new mode of continuing rehabilitation by community physicians to deliver home-based rehabilitation trainings and to deliver rehabilitation treatment for patients with lifelong diseases.

Overview of Systematic Reviews on Efficacy and Safety of Mindfulness Meditation on Post-traumatic Stress Disorder　

TAN Xiangyi，YANG Yiling，ZHAO Jiubo，WANG Ning，SHI Lei

2021, 24(21): 2721-2728. DOI: 10.12114/j.issn.1007-9572.2021.00.456

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Background　Mindfulness meditation has been widely used in the treatment of post-traumatic stress disorder（PTSD） due to easy availability，low cost，simplicity，wide popularization，and less conversational exposure.However，clinical evaluations of its effectiveness and safety vary.Objective　To evaluate the quality of methodological and outcome indicators in studies included in systematic reviews/Meta-analyses of the efficacy and safety of mindfulness meditation in the treatment of PTSD.Methods　CNKI，Wanfang Data，VIP，CBM，PubMed，Web of Science，EMBase，ScienceDirect，Wiley Online Library，OVID LWW，JBI Database，and Cochrane Library were searched from inception to November 28，2019，and the systematic reviews /Meta-analyses of the efficacy and safety of mindfulness meditation on PTSD were collected.Two researchers screened the literature and extracted data independently.AMSTAR 2 was applied to evaluate the methodological quality.GRADE system was used to evaluate the outcome indicators.Results　Totally 11 systematic reviews /Meta-analyses were included，thereinto only 1 of which was of high methodological quality，7 were low，and 3 were very low.The major methodological flaws were lack of a preliminary design plan，poor description of the included study design，and lack of explanation of the research funding sources.GRADE system evaluation results showed that there were 7 outcome indicators altogether，with a total of 28 evidence bodies：4 were of moderate quality，20 were of low quality，and 4 were of very low quality.Conclusion　Mindfulness meditation has a partially stable effect on alleviating the symptoms，improving sleep quality，and raising the level of mindfulness of PTSD patients，with fewer adverse reactions.But further research on trauma-sensitive mindfulness is needed.However，the methodological quality and reliability of outcome indicators for the systematic reviews/Meta-analyses of the efficacy and safety of mindfulness meditation on PTSD are mostly low.It is recommended to improve the study design，use higher quality clinical evidence，and conduct systematic evaluation studies strictly following the procedures and standardize the reporting of study results.

Influencing Factors of Postpartum Post-traumatic Stress Disorder：a Meta-analysis　

CHEN Ying，QIAN Hongyan，ZHU Yuting，WANG Yuanyuan，QIAN Lihua，KONG Xiang

2021, 24(21): 2729-2733. DOI: 10.12114/j.issn.1007-9572.2021.00.470

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Background　Postpartum post-traumatic stress disorder （PTSD） is a serious threat to maternal and child health due to its complex influencing factors.Therefore，it is essential to conduct a Meta-analysis of its influencing factors.Objective　We explored the influencing factors of postpartum PTSD through a Meta-analysis，to provide scientific evidence for screening and preventing such diseases in the future.Methods　Foreign databases （PubMed，EMBase，Cochrane Library，Web of Science，PsycINFO and Scopus） and domestic databases （CNKI，Wanfang Data，VIP，CBM） were searched systematically from inception to September 2020 for cross-sectional studies and cohort studies on the influencing factors of postpartum PTSD.Snowballing was used to search for the references of the included studies.Literature enrollment and data extraction were performed by two researchers separately according to the literature inclusion and exclusion criteria.AHRQ methodology checklist was used for assessing the quality of cross-sectional studies.The Newcastle-Ottawa Scale was used for assessing the quality of cohort studies.Meta-analysis was performed using Stata 16.0 and RevMan 5.3.Results　Finally，6 cross-sectional studies and 6 cohort studies were included，with moderate or high methodological quality.The Meta-analysis found that psychological problems during pregnancy （depression，anxiety）〔OR=10.73，95%CI （4.91，23.45）〕，pregnancy complications〔OR=4.80，95%CI（1.91，12.03）〕，traumatic delivery experience 〔OR=3.57，95%CI（2.20，5.80）〕，cesarean section 〔OR=3.46，95%CI（2.82，4.24）〕，emergency cesarean section 〔OR=3.05，95%CI （2.11，4.41）〕，instrumental delivery 〔OR=2.47，95%CI（1.65，3.69）〕，low level of psychological consistency 〔OR=2.27，95%CI （1.64，4.51）〕，and epidural anesthesia 〔OR=1.55，95%CI （1.19，2.02）〕 were associated with increased risk of postpartum PTSD （P<0.05）；satisfaction with childbirth services〔OR=0.30，95%CI （0.21，0.44）〕，early mother-infant skin-to-skin contact 〔OR=0.20，95%CI （0.16，0.25）〕，and social support 〔OR=0.13，95%CI （0.03，0.48）〕were associated with decreased risk of postpartum PTSD （P<0.05）.The combined results are relatively stable in the sensitivity analysis except for the emergency cesarean section and with no publication bias.Conclusion　Postpartum PTSD is associated with various factors，whose occurrence probability may increase with psychological distress during pregnancy （depression，anxiety），pregnancy complications，traumatic birth experience，cesarean section，instrumental delivery，low level of psychological consistency，and epidural anesthesia.

Recent Progress in Immune Dysfunction of Neutrophils in Patients with Cirrhosis　

ZHANG Guoyuan，TIAN Caiyun，HU Han，LIN Shide

2021, 24(21): 2734-2743. DOI: 10.12114/j.issn.1007-9572.2021.00.457

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Patients with cirrhosis are susceptible to concurrent infection，which is largely due to immune dysfunction.As the main effector cells of innate immunity，decreasing and dysfunction of neutrophils play a critical role in immune dysfunction of patients with cirrhosis.The dysfunction of neutrophils includes defects of chemotaxis and respiratory bursting，depression of phagocytosis，and the formation and release deficiencies of neutrophil extracellular traps.We reviewed recent developments in the causes and mechanisms of neutrophil dysfunction as well as some treatments in patients with cirrhosis，providing new insights into further exploration of the mechanism and treatment of this disease.

Recent Advances in Molecular Mechanism of Metformin against Gastrointestinal Cancer in Type 2 Diabetics　

TAN Zhiqiang，HE Li，JIANG Yanxia

2021, 24(21): 2744-2748. DOI: 10.12114/j.issn.1007-9572.2021.00.513

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The morbidity and mortality rates of gastrointestinal cancers are increasing with the aging of population in China，such as esophageal cancer，gastric cancer，pancreatic cancer and colorectal cancer，seriously endangering people's health.Metformin has been used for type 2 diabetes since 1995，and has become a first-line drug for type 2 diabetes for its safe and stable anti-hyperglycemic and cardiovascular protective effects favored by endocrinologists.Meanwhile，epidemiological and clinical studies at home and abroad have confirmed that metformin can reduce the incidence rate of various tumors and improve the prognosis in type 2 diabetics，suggesting that chemoprophylaxis of gastrointestinal cancer may be a breakthrough obtained in cancer chemoprophylaxis.In this paper，the molecular mechanism of metformin against gastrointestinal cancer in diabetics was reviewed.

Hypohidrotic Ectodermal Dysplasia Caused by a Novel Mutation of the EDA Gene：a Case Report and Literature Review　

QI Jing，PEI Yuying，LU Jun

2021, 24(21): 2749-2751. DOI: 10.12114/j.issn.1007-9572.2021.00.168

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Ectoderm dysplasia is a group of rare congenital diseases that mainly affect organs originating in the ectoderm，such as nails，teeth，hair，and sweat glands，causing abnormalities in their structure and function.EDA gene is the pathogenic gene of hypohidrosis ectodermal dysplasia（HED）.Children with HED are prone to high fever，and even severe fever that can cause death.We summarized the clinical features and gene mutation characteristics of HED caused by a novel c.852T>A mutation in the EDA gene，and reviewed relevant literature to improve clinicians' awareness of this rare disease.

Hypertriglyceridemic Pancreatitis Caused by Lipoprotein Lipase Gene Mutation in Children：a Case Report and Literature Review　

XU Jinping，BAI Haitao，YAO Yonghua，CHEN Xianrui

2021, 24(21): 2752-2756. DOI: 10.12114/j.issn.1007-9572.2020.00.610

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Hypertriglyceridemic pancreatitis（HTGP）often occurs in patients with dyslipidemia（including types Ⅰ，Ⅳ and Ⅴ） or secondary to other diseases.Although the clinical symptoms of HTGP are similar to those of acute pancreatitis caused by other etiologies，HTGP is often associated with more severe clinical symptoms and complications，thus it is necessary to improve the awareness of this disease.In this paper，we reported a child with HTGP caused by lipoprotein lipase gene mutation and reviewed relevant studies，and recommended that genetic testing should be performed early for patients with suspected HTGP，to provide a reference for clinical early diagnosis and treatment，as well as the improvement of prognosis of this disease.

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