Table of Content

05 October 2016, Volume 19 Issue 28

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Improvement of Top-level Design of the Healthcare Reform with the "National Wellbeing" Concept to Promote the Building of Healthy China

XU Guo-ping

2016, 19(28):  3385-3391.  DOI: 10.3969/j.issn.1007-9572.2016.28.001

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China has made progressive development in health care field since the 2009 new healthcare reform implemented.With constant optimization of the health care system and a stage jump in public health capacity,China achieved remarkable improvement in people’ health status.However,the capacity and quality of China’s primary health care are to be significantly improved,outdated core health system is to be radically reformed,health workers’ professional compensation system to be established,and the profit driven public hospitals are to be fundamentally reformed.Chinese president Xi Jinping proposed the new concept "National Wellbeing" at the recent National Health & Wellbeing Conference,and provided strategic guidance and rich context for the perfection of healthcare top-level design.Based on the development experience of advanced healthcare systems at home and abroad,this article explores the concrete elements and key breakthrough points for the building of Healthy China,emphasizes the improvement of the National top-level design of healthcare reform and specific operational policies and regulations,and calls on the creation of a national level integrated health administration body to manage comprehensively health care,health insurance,medicine,medical education and professional health workforce,to reverse the current fragmentation of the health administrative system,and to eliminate various unfavorable factors among government departments that hinder the health care reform.Thus it will promote health care reform to accelerate development of the new national health care system to achieve the goal of Healthy China.

Reflection and Perspective on the Development of Functional Localization of Community Health Services in China

SHI Jian-wei, LU Yuan, ZHANG Han-zhi, WANG Ming-hong, ZHANG Bin, PAN Ying, LIU Rui, YU De-hua, WANG Bo, WANG Zhao-xin

2016, 19(28):  3394-3397.  DOI: 10.3969/j.issn.1007-9572.2016.28.002

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Since 1997,China has vigorously developed community health service for 20 years.Through systematically reviewing the developing framework of community health service,it was found that before the new medical reform,though comparatively complete network system of community health has been built up,there still lacks many talents of general practice so that the community health service is still passive and requires much follow-up measurements.Meanwhile,in the new general era after the new medical reform,despite the fact that the community health is developing towards the direction of the medical path of general practice,the functional localization cannot manifest the advantages of community health,accompanied by the problems that part of the functions were not implemented deeply,as well as the working modes of general practitioners were not explicit,etc.Facing the new challenges of developing general practice,this study concludes lessons from the foreign community health practices involving organizational structure and service function construction,based on which we put forward that the future community health organizations should stick to the principle to cooperate with large hospitals in order to realize the concept of general practice "with precision".

Job Satisfaction and Its Influencing Factors of Community Health Service Workers in Dongcheng District of Beijing

SHEN Qiang, CAO Gui-li

2016, 19(28):  3398-3403.  DOI: 10.3969/j.issn.1007-9572.2016.28.003

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Objective　To understand the job satisfaction of community health service workers in Beijing Dongcheng District,and investigate its influencing factors so as to put forward suggestions of improving their satisfaction degree.Methods　All the on-the-job workers from all the community health service institutions in Beijing Dongcheng District were selected as the research objects by applying cluster sampling method.The questionnaire survey was conducted from September 15th to October 31st in 2015,covering the following major investigation aspects: workers’ basic information （gender,age,educational degree,job title,personnel relation,position,income situation）;workers’ job satisfaction degree （work itself,sense of achievement and honor,working environment,income and welfare treatment,interpersonal relationship,working pressure and workload,loyalty and recommendation of the work,overall satisfaction）.The overall satisfaction degree was divided into 8 dimensions.Divide the total scores of the 8 dimensions by 8 was the comprehensive evaluation scores of satisfaction.738 questionnaires were sent out,and all were recovered with a response rate of 100.0%.Results　The comprehensive evaluation scores of satisfaction of community health service workers in Beijing Dongcheng District was （74.02±13.58）.The respective score of 8 dimensions was shown as follows: work itself （75.28±15.71）,sense of achievement and honor （84.23±15.85）,working environment （69.92±19.84）,income and welfare treatment （62.20±21.20）,interpersonal relationship （81.57±14.87）,working pressure and workload （65.19±13.37）,loyalty and recommendation of the work （70.54±21.26）,and overall satisfaction （83.26±14.45）.Multivariate Logistic regression analysis showed that the satisfaction degree of the work itself,of working environment,of income and welfare and of working pressure and workload significantly influenced workers’ satisfaction （P<0.05）.Conclusion　The satisfaction degree of community health workers in Beijing Dongcheng District remains at an ordinary level.The work itself,working environment,income and welfare treatment,and working pressure workload are the influencing factors of their satisfaction degree.

Experiences and Enforcement Strategies of Hierarchical Diagnosis and Treatment at Home and Abroad

GU Xiao-li, YIN Xuan, QIAN Dong-fu

2016, 19(28):  3404-3408.  DOI: 10.3969/j.issn.1007-9572.2016.28.004

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With literature retrieval,the paper analyzes related problems of hierarchical diagnosis and treatment systematically and summarizes the practical experiences at home and abroad,and deeply analyzes the problems and obstacles in the developing process of hierarchical diagnosis and treatment in our country.Based on above analysis,the paper puts forward the strategies and suggestions for improving the system of hierarchical diagnosis and treatment in our country,including improvement of primary medical and health care services capacity,reform of health insurance mechanism,improvement of performance appraisal and interest coordination mechanism,strengthening of medical informatization construction,perfection of supervision and guidance of the residents to set up good concept of seeking medical treatment.

Current Situation and Thinking of Collaborative Promotion of Competitiveness of Urban and Rural Health Talents under the Circumstance of Hierarchical Diagnosis and Treatment

LIU Heng-yang, JU Yong-he, WANG Jing-cheng

2016, 19(28):  3409-3412.  DOI: 10.3969/j.issn.1007-9572.2016.28.005

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Talent resource is the primary resource,the effective implementation of hierarchical diagnosis and treatment needs a team of urban and rural health talents with service abilities of different focuses and complementary advantages.Collaborative promotion of urban and rural health talents’ competitiveness should reach the difference balance to a certain extent,and thus the competitiveness of health talents in medical institutions at different levels can meet the requirement of hierarchical diagnosis and treatment and guarantee the success of hierarchical diagnosis and treatment system.At present,there are still many problems in collaborative promotion of urban and rural health talents’ competitiveness in China.Based on summarization of the experience of foreign collaborative promotion of urban and rural health talents’ competitiveness under the perspective of hierarchical diagnosis and treatment,the paper analyzes the problems an reasons of collaborative promotion of urban and rural health talents’ competitiveness under the circumstance of hierarchical diagnosis and treatment in China,and puts forward suggestions of path for collaborative promotion.

Development Status and Suggestions of Primary Medical and Health Institutions under the Circumstance of Hierarchical Diagnosis and Treatment

SHE Rui-fang, ZHU Xiao-li, YANG Shun-xin

2016, 19(28):  3413-3416.  DOI: 10.3969/j.issn.1007-9572.2016.28.006

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Under the circumstance of hierarchical diagnosis and treatment,the functional orientation of primary medical and health institutions includes the following aspects:providing primary health care and basic public health services,of which primary health care is to provide first diagnosis,referral,continuity management services for patients with common diseases of clear and stable conditions,chronic diseases in stabilized phase,acute disease in rehabilitation,geriatric disease and advanced cancer.Currently the quantity and size of the financial aid of primary medical and health institutions in China are increasing continuously,but there are still problems such as lacking of policy guidance,insufficient capabilities of service,poor two-way referral channels,and lagging of information construction.From the perspective of achieving the goal of hierarchical diagnosis and treatment,the paper puts forward the following suggestions:establish effective policy guidance,play the platform function of primary medical and health institutions,establish incentive and restraint system,upper and lower linkage mechanism and integrate regional information systems.

Orientation and Development of General Practice Department of General Hospital in Hierarchical Diagnosis and Treatment Based on Disease Spectrum of Outpatients

WANG Rong-ying, LI Feng, ZHI Xiao, HE Zhen-yin, WANG Yan, ZHAO Wen-wen, WANG Ya-yi, ZHANG Min

2016, 19(28):  3417-3421.  DOI: 10.3969/j.issn.1007-9572.2016.28.007

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Objective　Through analysis of disease spectrum of outpatients in general practice department of general hospital,to explore the orientation and development of general practice department of general hospital in hierarchical diagnosis and treatment.Methods　Patients who received treatment in outpatient clinic of General Practice Department,the Second Hospital of Hebei Medical University from 2014 to 2015 were selected as the research objects.The basic condition and disease information of the patients,including their gender,age,date of visiting,reason of visiting hospital,diagnosis and return visit,were collected and retrospectively analyzed.The data came from the electronic medical record that provided by the information center of this hospital.The standard of disease classification adopted the second edition of International Classification of Primary Care （ICPC-2）.Results　The total number of patients consulting in outpatient clinic was 1 338 500,the number of patients visiting a doctor in outpatient clinic was 111 635,including 54 701 （49.00%） men and 56 934 women （51.00%）;subjects aged from 1 to 99 had an average age of （41.5 ± 24.5）;there were 39 042 （34.97%） referrals from primary care institutions;57 077 （51.13%） were patients of first visit,54 558 （48.87%） patients with repeated visits;61 343 （54.95%） patients had multi-system diseases.After receiving treatment in the outpatient clinic of general practice department,3 552 （3.18%） inpatients were admitted into general practice wards,217 inpatients with clear diagnosis were referred to specialist wards （occupied 6.11% of inpatients number in general practice wards）;2 145 （1.92%） inpatients referred to specialist outpatient for seeking treatment;2 452 （2.20%） patients were directly referred to every specialist ward from outpatient clinic of general practice.The top five diseases of the highest number of visits were hypertension （13 173,11.80%）,coronary heart disease （12 726,11.40%）,diabetes （6 698,6.00%）,cerebrovascular disease （5 917,5.30%）,upper respiratory tract infection （4 912,4.40%）.The top five diseases system of the highest number of visits were circulatory system （23 556,21.10%）,nervous system （14 724,13.19%）,digestive system （12 739,11.41%）,respiratory system （11 721,10.50%）,psychological system （11 164,10.00%）.Conclusion　Most of the diseases of patients in general practice outpatient clinic of general hospital are chronic diseases,common diseases or common symptoms,covering almost all the system diseases,most patients have subsequent visits and less were referred to specialist;the exploration of establishing medical consortium that based on general practice department of general hospital helps to realize two-way referral and hierarchical diagnosis and treatment.

Correlation between Metabolic Syndrome and Carotid Plaque of Middle-aged and Aged People and Its Gender Differences

XIA Ting, LI Juan-sheng, PU Hong-quan, REN Xiao-wei, NIU Yin-ling, YUE Na-na, LIU Jian-zheng

2016, 19(28):  3422-3427.  DOI: 10.3969/j.issn.1007-9572.2016.28.008

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Objective　To investigate correlation between metabolic syndrome and carotid plaque of middle-aged and aged people and its gender differences.Methods　Staffs （aged≥45） who participated in the physical examination for the first time in a company from June 2011 to December 2013 were stratified according to age groups of every 5 years,and 2 180 middle-aged and aged people were selected in proportion from each age group.According to inclusion and exclusion criteria,1 770 middle-aged and aged people were finally selected,813 were male and 957 were female （including 673 postmenopausal cases,284 non-menopause cases）.Carotid ultrasound was used to check whether there was plaque in carotid artery.The international unified standard in 2009 was applied by MS diagnosis （which abdominal obesity using Asian standards）.Results　Among 1 770 middle-aged and aged people,prevalence rate of MS was 40.3% （714/1 770）,detection rate of carotid artery plaque was 25.9% （459/1 770）.There was significant difference in the detection rate of carotid artery plaque among middle-aged and aged males and females and the total population with or without MS （P<0.05）.With the increasing number of components in MS,the detection rate of carotid artery plaque in middle-aged and aged men and women as well as the total population showed an increasing trend （P<0.001）.After adjustment of age,BMI,smoking index,low-density lipoprotein cholesterol （LDL-C）,total cholesterol （TC） and serum uric acid （SUA）,the detection risk of carotid artery plaque of middle-aged and aged men 〔OR（95%CI）=1.53（1.04,2.23）,P=0.030〕 and postmenopausal females 〔OR（95%CI）=1.60（1.08,2.38）,P=0.020〕 increased.Among middle-aged and aged men,blood pressure elevation 〔OR（95%CI）=1.65（1.14,2.37）,P=0.008〕 and blood glucose rising 〔OR（95%CI）=1.93（1.36,2.75）,P<0.001〕 were the components that had great influence on detecting carotid artery plaque after adjustment of age,BMI,smoking index,LDL-C,TC and SUA;among middle-aged and aged women,after adjusting age,BMI,smoking index,LDL-C,TC and SUA and menopause or not,the component that had great effect on detecting carotid artery plaque was blood pressure elevation 〔OR（95%CI）=1.82（1.25,2.65）,P=0.002〕.Conclusion　MS is an independent risk factor of detecting carotid artery plaque in middle-aged and aged men and postmenopausal women;the detection of carotid artery plaque among middle-aged and aged people of different genders was mainly influenced by different components of MS.

Investigation in Prognostic Value of Prognostic Nutritional Index in Patients with Esophageal Adenocarcinoma

WANG Yan, TAO Ren-hai, CAO Yu, GAO Feng, YIN Jin-huan, ZHANG Li-min, ZHOU Jun, LIU Jun-feng

2016, 19(28):  3428-3433.  DOI: 10.3969/j.issn.1007-9572.2016.28.009

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Objective　To investigate the prognostic value of prognostic nutritional index in patients with esophageal adenocarcinoma.Methods　128 cases of esophageal adenocarcinoma treated in Fourth Hospital of Hebei Medical University between January 1st 2008 and December 31st 2010 were retrospectively analyzed.Demographic and clinicopathological data of patients were collected，including gender，age，degree of histological differentiation，tumour location and size，lymphatic metastasis，TNM classification，postoperative exhaust time，postoperative defecation time，diagnosis of stump invasion and tumour thrombus.The calculation of PNI was based on the count data of serum albumin and peripheral blood lymphocytes collected within one week before surgery.The date of surgery was set as starting point，and the date of death or the end date of follow-up（December 31st 2015）as end point.The survival rate was calculated by Kaplan-Meier analysis；the differences between groups were compared using Log-rank test.Cox proportional hazard regression model was used to analyze the factors which may affect the prognosis of the patients.Results　120 out of 128 cases completed follow-up，so that the follow-up rate was 93.8%.Patients were divided into high PNI group（n=41）and low PNI group（n=79）by the average value of PNI（40.82）.The tumour size，lymphatic metastasis，TNM classification and postoperative exhaust time of the patients were compared，and all the differences had statistical significance（P<0.001）.The results of single-factor analysis indicated that there were significant differences in the tumour size，lymphatic metastasis，TNM classification，postoperative exhaust time，postoperative defecation time and PNI（P<0.05）.The results of Cox proportional hazard regression model showed that TNM classification and PNI were the independent factors that affected the prognosis of the patients with esophageal adenocarcinoma（P<0.05）.The patients were divided into young & middle-aged group（n=63）and senior group（n=57）by the average age（61.5 years old）.The results of single-factor analysis indicated that in young & middle-aged group there were significant differences in gender，tumour size，lymphatic metastasis，TNM classification，postoperative exhaust time，postoperative defecation time and PNI（P<0.05）；in senior group，there were significant differences in gender，tumour size，TNM classification，postoperative defecation time and PNI（P<0.05）.The results of Cox proportional hazard regression model showed that TNM classification，postoperative exhaust time and PNI were the independent factors that affected the prognosis of the young & middle-aged patients with esophageal adenocarcinoma（P<0.05）；PNI was the independent factor that affected the prognosis of the senior patients with esophageal adenocarcinoma（P<0.05）.Conclusion　PNI is able to assess the surgical risk for patients with esophageal adenocarcinoma，and it is a valuable clinical marker of preoperative estimation as well as prognosis prediction.

Correlation of Left Atrial Appendage Morphology and Cardioembolic Stroke

KANG Feng-chi, WEI Jiang-man, ZHANG Zheng, JIN Zhi-tao, ZHANG Lian, WU Shu-bin, SHEN Zhang-jun, HU Tao-hong

2016, 19(28):  3434-3438.  DOI: 10.3969/j.issn.1007-9572.2016.28.010

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Objective　To investigate the correlation between left atrial appendage morphology and cardioembolic stroke.Methods　102 patients who had coronary artery CT angiography （CTA） and brain CT or MRI in Second Artillery General Hospital of PLA from December 2014 to August 2015 were enrolled.According to the general clinical diagnosis of specialist physicians,the patients were divided into cardioembolic stroke group of 66 cases and non-stroke group of 36 cases.CT three-dimensional reconstruction was applied to separate left atrial appendage image,and observed its morphology and morphology of its opening,and measured its volume and maximum diameter of its opening.Results　There was significant difference in age,prevalence of diabetes,coronary heart disease prevalence and volume of left atrial appendage between two groups （P<0.05）;while there was no significant difference in gender,prevalence of hypertension,and maximum diameter of left atrial appendage opening （P>0.05）.The morphological distributions of left atrial appendage in two groups were significantly different （P<0.05）;while the morphological distributions of left atrial appendage openings in two groups were not significantly different （P>0.05）.Age,diabetes,coronary heart disease,volume of left atrial appendage,and morphology of left atrial appendage were positively correlated with the occurrence of cardioembolic stroke （values of rs were 0.329,0.291,0.256,0.242,and 0.319 respectively,P<0.05）.Conclusion　Volume and morphology of left atrial appendage are correlated with the occurrence of cardioembolic stroke.

Risk Factors of Nonalcoholic Fatty Liver Disease of Non-overweight People

SU Hui, WANG Cang-hai, WU Jing

2016, 19(28):  3438-3451.  DOI: 10.3969/j.issn.1007-9572.2016.28.013

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Objective　To investigate risk factors of nonalcoholic fatty liver disease （NAFLD） of non-overweight people.Methods　Among 1 337 workers of a company who had taken physical examination in Beijing Shijitan Hospital,Capital Medical University,747 non-overweight people were selected.According to whether people suffered from NAFLD or not,they were divided into NAFLD group （n=210） and control group （n=537）.Blood routine,fasting plasma glucose （FPG）,blood lipids,liver function and serum uric acid （SUA） of all the subjects were detected,and 20 subjects in the two groups were randomly selected to test the levels of plasma interleukin-6 （IL-6）,tumor necrosis factor-α （TNF-α）,granulocyte-macrophage colony stimulating factor （GM-CSF）.Results　There was no significant difference in gender and age between two groups （P>0.05）;while there was significant difference in BMI,waist,white blood cell count （WBC）,direct bilirubin （DBIL）,FPG,triglyceride （TG）,high density lipoprotein cholesterol （HDL-C）,ALT,AST,alkaline phosphatase （ALP） and SUA （P<0.05）.Multivariate Logistic regression analysis showed that waist,DBIL,HDL-C and SUA were the influencing factors of non-overweight people suffering from NAFLD （P<0.05）.Levels of plasma IL-6,TNF-α and GM-CSF in NAFLD group were significantly higher than those in control group （P<0.05）.Conclusion　The risk factors of people suffering from NAFLD are increased waist,elevated level of SUA and lowered level of DBIL and HDL-C;in the meanwhile,multiple inflammatory cytokines may involve in the occurrence and development of the disease.

Labor Time in Vaginal Birth after Cesarean Section

JIANG Hai-li, WANG Xin

2016, 19(28):  3439-3443.  DOI: 10.3969/j.issn.1007-9572.2016.28.011

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Objective　To investigate the labor time in vaginal birth after cesarean section（VBAC） so as to get definite evaluating and monitoring points of VBAC.Methods　75 pregnant women who underwent trial of labor after cesarean（TOLAC） in Beijing Obstetrics and Gynecology Hospital,Capital Medical University from January 2012 to June 2015 were selected.Among them,70 cases（VBAC,93.3%） had successful vaginal delivery,5 cases（6.7%） with unsuccessful vaginal trial production underwent cesarean section again.According to the timing of previous cesarean section,70 pregnant women with VBAC were divided into cesarean section after vaginal trial of production group（n=23） and elective cesarean section group（n=47）,and their stages of labor were recorded.Results　The average age and parity of patients in elective cesarean section group were respectively younger and less than those of patients in cesarean section after vaginal trial of production group（P<0.05）;the comparison of gestational age,times of pregnancy,pre-pregnancy BMI,prenatal BMI,thickness of lower uterine segment and premature rupture of membrane through ultrasonic testing,and proportion of gestational diabetes and pregnancy complicated with hypertension among pregnant women in two groups was not significantly different（P>0.05）.There was no significant difference in times of the first stage of labor,the second stage of labor and total stage of labor among pregnant women with no history of vaginal delivery in two groups（P>0.05）;there was no significant difference in times of the first stage of labor,the second stage of labor and total stage of labor among term delivery women with no history of vaginal delivery in two groups（P>0.05）.The amount of postpartum hemorrhage,neonatal weight,neonatal Apgar score,and the proportion of puerperal infection,fetal distress,amniotic fluid Ⅲ,neonatal morbidity,forceps delivery and maternal postpartum hemorrhage among pregnant women in two groups were not significantly different（P>0.05）.Conclusion　There is no effect of VBAC pregnant women with or without trial production in previous delivery on labor time and pregnancy outcome,the persistent progress of labor time is key to the successful vaginal delivery.Risks should be fully evaluated again for patients with labor stagnation or related manifestations,so as to reduce the risk of uterine rupture after cesarean section.

Influence of Malnutrition-inflammatory Complex Syndrome on the Quality of Life of Patients with Maintenance Hemodialysis

DONG Mei, DAI Zheng-yan, WENG Min, LI Shao-hua

2016, 19(28):  3444-3447,3451.  DOI: 10.3969/j.issn.1007-9572.2016.28.012

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Objective　To explore the influence of malnutrition-inflammatory complex syndrome（MICS）on the quality of life of patients with maintenance hemodialysis（MHD）.Methods　The research samples,70 patients who received MHD in the First Affiliated Hospital of Kunming Medical University and Yunnan Kidney Disease Hospital from October 2014 to December 2015 were selected.According to scores of malnutrition-inflammation（MIS）,patients were separated into 3 groups,involving mild group（n=19）,moderate group（n=29）,and severe group（n=22）.The nutrition and inflammatory index of patients in three groups were detected,and short form health survey questionnaire（SF-36） was used to evaluate their quality of life,and the correlations between MIS and patients’ age,nutrition and inflammatory index,and SF-36 scores were investigated.Results　The incidence rate of included patients was 100.0%,average MIS scores of patients in mild,moderate and severe group were（2.7±1.0）,（6.1±0.9）,and（10.9±2.2）.There was significant difference in grip strength,serum ferritin（SF）,high-sensitivity C-reactive protein（hs-CRP）,and tumor necrosis factor α（TNF-α） among patients in 3 groups（P<0.05）;while there was no significant difference in prealbumin（PA） and interleukin-6（IL-6,P>0.05）.Pearson correlation analysis showed that there was a linearly positive correlation between MIS and age,TNF-α（P<0.05）,there was a linearly negative correlation between MIS and grip strength（P<0.05）,and MIS and PA showed no linearly correlation（P>0.05）;Spearman rank correlation analysis presented that MIS was positive correlated with SF and hs-CRP（P<0.05）,and not correlated with IL-6（P>0.05）.There was significant difference in scores of role physical（RP） and total scores of the scale among patients in three groups（P<0.05）;While there was no significant difference in scores of physical function（PF）,body pain（BP）,general health（GH）,energy state（Energy）,social function（SOCF）,role emotional（RE）,emotion well-being（EWB） and physical health（PH）,mental health（MH） score（P>0.05）.Pearson correlation analysis showed that MIS was linearly negatively correlated with PH scores（P<0.05）,and was not linearly correlated with scores of GH and Energy（P>0.05）;Spearman rank correlation analysis manifested that MIS was negatively correlated with PF,RP and total scores of scale（P<0.05）,and was not correlated with scores of BP,SOCF,RE,EWB and MH（P>0.05）.Conclusion　The incidence rate of MICS of MHD patients is high,the more severe MICS is,the more obvious grip strength reduces,the more severe inflammatory state is,the worse overall quality of life is.

Status and Influencing Factors of Type 2 Diabetic Mellitus Patients Combined with Subclinical Hypothyroidism in Xinjiang

TANG Ruo-xi, FAN Yong

2016, 19(28):  3452-3456.  DOI: 10.3969/j.issn.1007-9572.2016.28.014

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Objective　To understand status of type 2 diabetic mellitus（T2DM） patients combined with subclinical hypothyroidism in Xinjiang,and to investigate its influencing factors.Methods　444 patients with T2DM who received treatment in the First Affiliated Hospital of Xinjiang Medical University from January 2013 to December 2014 were collected.Basic situation and laboratory test indicators were retrospectively analyzed,and influencing factors of T2DM patients combined with subclinical hypothyroidism were discussed by Logistic regression analysis.Results　There were 73 patients（16.4%） combined with subclinical hypothyroidism,the combining rate of subclinical hypothyroidism of Uygur patients（27.4%,52/190） was significantly higher than that of the Han nationality（8.3%,21/254,P<0.05）.The comparison of gender,average age,BMI,glycated hemoglobin（HbA1c）,total cholesterol（TC）,triglyceride（TG）,low density lipoprotein cholesterol（LDL-C）,high density lipoprotein cholesterol（HDL-C）,uric acid,ALT,anti-thyroglobulin antibody（TGAb） and thyroid peroxidase antibody（TPOAb） between patients combined with or without subclinical hypothyroidism was not significantly different（P>0.05）;the comparison of Uygur proportion,systolic blood pressure and diastolic blood pressure of patients combined with subclinical hypothyroidism was significantly higher than that of patients combined without subclinical hypothyroidism,the comparison of serum creatinine（SCr） of patients combined with subclinical hypothyroidism was significantly lower than that of patients combined without subclinical hypothyroidism（P<0.05）.Multiple Logistic stepwise regression analysis showed that nationality,systolic blood pressure,diastolic blood pressure,uric acid,SCr significantly influenced T2DM patients combined with subclinical hypothyroidism（P<0.05）.Conclusion　The combining rate of subclinical hypothyroidism of T2DM patients in Xinjiang is rather high,and the rate of Uygur is higher than that of the Han nationality.The influencing factors are nationality,systolic blood pressure,diastolic blood pressure,uric acid and SCr.

Reliability and Validity of Chinese Revision of the 15-item Version of the Social Production Function Instrument for the Level of Well-being in the Community Elderly

ZHANG Rui-xue, GUO Li-na, FENG Xiao, LIU Kun, SUN Ming-xiu, CHEN Ze-fu

2016, 19(28):  3456-3460.  DOI: 10.3969/j.issn.1007-9572.2016.28.015

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Objective To evaluate the reliability and validity of Chinese revision of the 15-item version of the social Production function instrument for the level of well-being〔SPF-IL(s)-CHI〕in the community elderly.Methods From April to June in 2015,the elderly from three communities of Jining in Shandong Province who volunteered to participate in the survey were selected by adopting convenience sampling method.The elderly were investigated by using SFP-IL(s)-CHI,460 questionnaires were sent out,and 442 were recovered with an effective response rate of 96.1%.The indicators of analyzing the validity of the scale included the correlation between scores of each item and corresponding dimensional scores and total scores,content validity and structural validity;the indicators of analyzing the reliability of the scale included Cronbach′sα coefficient of internal consistency of the scale,Cronbach′sα coefficient of all the dimentsions′internal consistency of the scale,test-retest reliability and split-half reliability.Results Scores of each item were linearly positively correlated with the corresponding dimensional scores and total scores (P＜0.05).The content validity index of items level (I-CVI) was from 0.80 to 1.00,the content validity index of scale level (S-CVI/UA) was 0.80 and content validity index of average scale level (S-CVI/Ave) was 0.96.After exploratory factor analysis,five factors models were got by using principal axis factor extraction method,and the communalities of the items were 0.482～0.878.With confirmatory factor analysis,the degree of freedom of chi-square (CMIN/DF),root mean square error of approximation (RMSEA),goodness-of-fit index (GFI),tall lattei index of non-normalized goodness-of-fit (TLI),incremental fit index (IFI),comparative fit index (CFI),parsimony goodness-of-fit index (PGFI) and standardized regression coefficient were 2.142,0.072,0.907,0.941,0.956,0.955,0.604 and 0.37～0.97 respectively.The Cronbach′sα coefficient of internal consistency of scale was 0.914,Cronbach′sα coefficients of internal consistency of the five dimensions such as emotion, behavioral confirmation, position, comfortable sensation and motivation were 0.779,0.814,0.853,0.938 and 0.690 respectively,the test-retest reliability was 0.902 and the split-half reliability was 0.861.Conclusion The reliability and validity of SPF-IL(s)-CHI is good and can be used for evaluating the well-being status of the elderly in community of our country.

Reliability and Validity of Patient Health Questionnaire in Inpatients with Diabetic Foot Ulcers

ZHOU Chun-lan, LIU Ying, LUO Xiang-rong

2016, 19(28):  3461-3466.  DOI: 10.3969/j.issn.1007-9572.2016.28.016

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Objective　To evaluate the reliability and validity of patient health questionnaire-9（PHQ-9） in inpatients with diabetic foot ulcers（DFU）.Methods　120 inpatients with DFU,who had received treatment in endocrinology department of one top three hospitals in Guangzhou from August 2014 to June 2015,were recruited in this study.We adopted self-designed general information questionnaire to collect the general data of patients;evaluated the depression situation of patients by PHQ-9 and tested the reliability and validity of the questionnaire,including content validity,construct validity,known-group validity,internal consistency reliability and test-retest reliability;verified the evaluated results of PHQ-9 by depression scale of Structured Clinical Interview（SCID） for American Diagnostic and Statistical Manual of Mental Disorders（4th Version）（DSM-IV）,and determined the diagnostic critical value of major depression.Results　PHQ-9 included 9 items totally,the content validity index（I-CVI） of each item was 1.00,1.00,1.00,0.83,1.00,1.00,0.83,1.00,1.00 respectively,and the content validity index of total scale（S-CVI） was 0.96.The average total score of PHQ-9 was（11.7±6.4）,the result of Pearson correlation analysis showed that there was a linear positive correlation between scores of each item and of the total scale（P<0.05）.We got two common factors,they were cognitive-emotion factor and somatic symptom factor,which could interpret 62.1% amount of variability of the scale jointly.Significant difference was found in cognitive-emotion dimension scores among patients with different genders,monthly incomes per person,self-care abilities,Wagner ranks,numerical rating scale scores（NRS） of DFU,and history or risk of limb/toe amputation（P<0.05）;and significant difference was found in somatic symptoms dimension scores among patients with different self-care abilities,NRS of DFU,history or risk of limb/toe amputation（P<0.05）.The Cronbach’s α coefficient of total scale,cognitive-emotion dimension and somatic symptom dimension was 0.88,0.86 and 0.70 respectively;the test-retest reliability coefficient was 0.87,0.89 and 0.83 respectively.The receiver operating characteristics（ROC） showed that there was significant difference in screening depression situation of DFU patients by PHQ-9〔area under the curve（AUC）=0.914,95%CI（0.862,0.967）,P<0.05）〕,the diagnostic critical value of major depression was 10,sensitivity was 0.928 and specificity was 0.804.Conclusion　The PHQ-9 application in DFU patients shows good reliability and validity.The diagnostic critical value of major depression was 10 with rather high sensitivity and specificity.The application of PHQ-9 in screening depression disorders for DFU inpatients was suggested.

Influence of Holding Body on Chronic Diseases Management in Community Health Service Center

CHEN Wei, FENG Wen

2016, 19(28):  3467-3471.  DOI: 10.3969/j.issn.1007-9572.2016.28.017

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Objective　To discuss the effects of holding body on chronic disease management in community health service center（CHSC）.Methods　48 CHSC in Haidian District of Beijing were selected as research object in June 2014.18 CHSC were held by college（CHSC held by college）,23 by health administrative department directly（CHSC held by government）,and 7 by hospital（CHSC held by hospital）.Data were collected from CHSC data in 2013 reported directly on network of management center of community health service in Haidian District,including community conditions of residents suffering from chronic,CHSC human resources condition,CHSC chronic disease management situations,and related indicators of CHSC chronic disease management stage.At the same time,directors and deputy directors in charge of medical care of five CHSC（1 CHSC held by college,3 CHSC held by government,1 CHSC held by hospital） were randomly selected to perform one-on-one interview.Results　There was significant difference in the number of community hypertension patients,diabetic patients,community doctors per thousand population and registered nurses per thousand population among CHSC held by different holding bodies（P<0.05）;while the comparison of daily average outpatient number of community doctors per capita was not significantly different（P>0.05）.The annual average community clinic visits of hypertension patients and diabetes patients among CHSC held by different holding bodies（P<0.05）;the annual average community clinic visits of hypertension patients and diabetes patients in CHSC held by college were significantly higher than those in CHSC held by government and hospital（P<0.05）;Organized by different subject CHSC there was significant difference in physical examination rate,management rate of patients with hypertension and of patients with diabetes among CHSC held by different holding bodies（P<0.05）;there was no significant difference in management rate of the elderly aged over 65（P>0.05）.The physical examination rate,management rate of hypertension patients and of diabetes patients,and upward referral rate of CHSC held by college were significantly higher than those of CHSC held by government and hospital,the physical examination rate of CHSC held by government was significantly higher than that of CHSC held by hospital（P<0.05）.Multiple linear regression analysis showed that holding bodies and management rate of hypertension patients significantly affected their annual average community clinic visits（P<0.05）;taking CHSC held by college as a reference,CHSC held by health administrative department significantly affected the annual average community clinic visits of diabetes patients（P<0.05）.The affecting mechanism of holding bodies on community chronic disease management included the following aspects:traditional advantages that CHSC held by college was closely connected with the service of managed objects of chronic disease,service disadvantage of CHSC held by government caused by diversity of residents in the area and disadvantageous status of CHSC among competitive medical and health institutions.Conclusion　In the three stages of chronic disease management,the management condition of CHSC held by college are superior to that of CHSC held by government and hospital;holding bodies and management rate of patients with chronic disease are the influencing factors.

Influence of Practicing Categories of Medical Staff on Community Diabetes Management Effects

LI Yu-dong, ZHAO Lie-bin, TIAN Wen-fei, GONG You-long, YU Jin-ming.

2016, 19(28):  3472-3475,3480.  DOI: 10.3969/j.issn.1007-9572.2016.28.018

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Objective　To investigate the influence of practicing categories of medical staff on community diabetes management effects.Methods　From January 2012 to January 2013,415 diabetes patients who received community management in Wuliqiao Community in Huangpu District of Shanghai were selected.Firstly they were randomly divided into control group and joint management group,and then were divided into general practitioners management group and non general practitioners management group randomly.Finally the grouping results were control group of general practitioners management（n=78） and control group of non general practitioners management（n=122）,joint management group of general practitioners（n=122） and joint management group of non general practitioners（n=93）.Patients in control group applied community conventional management mode,while patients in joint management group adopted joint management mode of general practice-specialist;general practitioners were responsible for the whole management process of diabetic patients in general practitioners management group,nurses and public health practitioners who were currently participated in the follow-up of chronic diseases were responsible for the whole management process of diabetic patients in non general practitioners management group.The management effects of patients in 4 groups were compared,and influence of practicing categories and management mode on management effects were discussed.Results　There was no significant difference in BMI,2-hour postprandial blood glucose（2 hPG）,total cholesterol（TC） and triacylglycerol（TG） of patients in four groups before and after management（P>0.05）;there was significant difference in difference value of waist-hip ratio,systolic blood pressure,diastolic blood pressure,fasting blood glucose（FPG） and glycosylated hemoglobin（HbA1c） before and after management（P<0.05）.The results of multiple linear regression analysis showed that the above indices were not significantly influenced by management mode and practicing categories（P>0.05）.After the general data included in the regression analysis model as a covariate,the results showed that management mode significantly influenced diastolic blood pressure,FPG and HbA1c（P<0.05）;while effectiveness indices were not significantly influenced by practicing categories（P>0.05）.After removing the invalid interaction item in the original mode,the results showed that systolic blood pressure,FPG and HbA1c were significantly influenced by management mode（P<0.05）;while effectiveness indices were not significantly influenced by practicing categories（P>0.05）.Conclusion　The management effects of community diabetes patients is determined by management mode,and practicing categories of medical staffs are not the influencing factors of it.Encourage the staffs with medical working background to be eligible managers of chronic diseases.Relying on the professional support of regional medical association,combining the responsibility system of family doctors and carrying out the community diabetes management by way of team cooperation can help increase the staffing rate of community chronic diseases management.

Service Process and Existing Problems of Community Chronic Disease of General Practitioner Team in Main Urban Area of Guiyang City

LIU Wen-rui, ZHU Yan.

2016, 19(28):  3476-3480.  DOI: 10.3969/j.issn.1007-9572.2016.28.019

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Background　The prevention and control of chronic disease in China is in a severe situation,and chronic disease service at this stage is not optimistic.Objective　To understand service process of chronic disease,find out the existing problems,and provide basis for improving quality of community health services and relevant policies and measures set out by our government authorities.Methods　29 community health service centers in two urban areas of Guiyang downtown were investigated in October 2015,two centers did not cooperate with the investigation,and actually 27 were in the survey.Under qualitative research method,principals of 27 community health service centers and leaders of general practitioner team were interviewed deeply with self-made interview outline.Interview contents included service process and major service contents provided by general practitioner team for community chronic disease patients （including discovery of patients with chronic diseases,screening,follow-up,physical examination,management,treatment,usage of health records,etc.）.Results　Each community health service center in main urban area of Guiyang City had an average of 1 to 2 general practitioner teams,each team was responsible for basic public health services of about 1 500 residents who had signed health service agreements,200 to 300 of them were patients with chronic diseases.General practitioner team members undertook the work of residents’ outpatient service,chronic disease screening,finding and management.Chronic disease management team was mainly responsible for chronic disease management,and it was the branch of general practitioner team.44.4% （12/27） of chronic disease management teams were led by doctors,44.4% （12/27） led by nurses,11.2% （3/27） led by non-medical professionals.Non-clinical professionals such as community nurses were mainly responsible for follow-up of chronic diseases,putting forward lifestyle guidance,and general practitioners for proposing medication guidance.25.9% （7/27） of community health service centers set up specialized community chronic disease clinics,59.3% （16/27） did not and shared with the outpatient clinics of general practice,11.1% （3/27） depended on outpatient medical care of superior hospitals,and another 3.7% （1/27） did not provide clinical outpatient services.Health records in the service process of chronic disease were mainly used for recording follow-up and physical examination information.There were 4 kinds of cooperative ways of general practitioner team in the management process of patients with chronic disease:service principals of chronic outpatient,chronic disease management department,relying on medical services of superior hospitals and lacking of medical care.Conclusion　The chronic disease service processes of general practitioner team basically comply with requirements of national regulations,but phenomena such as the separation between basic medical care and basic public health services,imperfect teamwork mechanism,insufficient effectiveness of health guidance,and lacking of effective use of health records are still existed.

Status and Hot Spots of Resilience Research:A Bibliometric Analysis

SU Pan, ZHANG Jing-ping, ZHANG Jie, WANG An-ni.

2016, 19(28):  3481-3485.  DOI: 10.3969/j.issn.1007-9572.2016.28.020

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Objective　To retrieve and analyze the status and hot spots of resilience research.Methods　We made a retrieval in PubMed for literature with subject terms or key words concerning resilience published from January 1 2010 to September 15 2015.BICOMS was applied to conduct biliometric analysis on retrieval results including publishing time,source journals,subject terms,etc.According to the changing curve of accumulated times of subject terms,we found high-frequency subject terms by interception and obtained a subject term matrix.Then gCLUTO 1.0 software was applied to conduct two-way cluster analysis,by which we made curves of subject term cluster,a matrix of subject term cluster,and a tree diagram of subject term cluster.At last,specific papers were referred to find research status and hotpots.Results　A total of 3 241 pieces of literature relevant with resilience were collected,and there were 36 subject terms with frequency ≥40.We found 4 research hot spots through analysis,including the role of resilience on posttraumatic stress disorder（PTSD）,the relation between resilience and mental health of the elderly,the resilience of caregivers for the patients,and the biochemistry mechanism of resilience in the aspect of stress coping.Conclusion　In recent years,the academic circle in China and abroad attaches increasingly more importance on the research of resilience.The research emphasis is the effect of resilience on PTSD and the relation between resilience and mental health of the elderly.These subjects can be considered in further research,in order to find effective intervention scheme on resilience.

Effect of Leisure Participation of Rural Left-behind Junior Middle School Students on Resilience and Its Gender Difference

HU Bing-zheng.

2016, 19(28):  3486-3490.  DOI: 10.3969/j.issn.1007-9572.2016.28.021

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Objective　To explore the effect of leisure participation of rural left-behind junior middle school students on psychological resilience and its gender difference.Methods　From March to May in 2014,with cluster random sampling method,left-behind students in two rural junior middle schools in west He’nan Province were selected as the research objects.Self-made questionnaire of leisure participation of rural left-behind junior middle school students and healthy kids resilience scale （HKRA） were applied in this study.After excluding non left-behind students,380 questionnaires of left-behind students were recovered,and 340 were valid questionnaires with a response rate of 89.5%.Results　There was no significant difference in scores of leisure participation in 9 activities among rural left-behind junior middle school students of different genders （P>0.05）;while there was significant difference in scores of leisure participation in the rest 11 activities and scores of resilience characteristics and external protection （P<0.05）.For the overall,leisure participation degree of the four activities-interest activity groups,playing chess and cards,playing video games and farmland activities had significantly predictive effects on resilience characteristics factors （P<0.05）,and the total predictive power was 18.7%;playing video games had negatively predictive effects on resilience characteristics factors and the predictive power was 6.1%.Leisure participation degree of the four activities-interest activity groups,playing chess and cards,handcrafting and voluntary workers/volunteers activities had significantly predictive effects on external protection factors （P<0.05）,and it was positively predictive effect with a total predictive power of 15.0%.For boys,leisure participation degree of farmland activities and playing video games had significantly predictive effects on resilience characteristics factors （P<0.05）,the total predictive power was 18.8%;playing video games had negatively predictive effects on resilience characteristics factors and the predictive power was 10.6%.For girls,leisure participation degree of interest activity groups and playing chess and cards had significantly predictive effects on resilience characteristics factors （P<0.05）,and it was positively predictive effect with a total predictive power of 15.7%;leisure participation degree of playing chess and cards,voluntary workers/volunteers activities and joining a party had significantly predictive effects on external protection factors （P<0.05）,and it was positively predictive effect with a total predictive power of 25.8%.Conclusion　Extracurricular leisure participation affects resilience level of rural left-behind adolescents,the more deeply interactive leisure participation,the more beneficial to the enhancement of psychological resilience level of rural left-behind female adolescents.

Mediating Effects of Emotional Resilience on Relationship between Family Socioeconomic Status and Borderline Personality Level of Adolescents

CHEN Tao, XIANG Jin-jing, XING Yi-lun, PEI Huan-chang, WANG Peng-chong, LUO Jie.

2016, 19(28):  3491-3494,3499.  DOI: 10.3969/j.issn.1007-9572.2016.28.022

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Objective　To investigate mediating effects of emotional resilience on relationship between family socioeconomic status and borderline personality level of adolescents.Methods　From September to November in 2013,by applying cluster sampling method,683 middle school students from three middle schools in Beijing were enrolled with the class as the unit.After deleting malingering data in questionnaire of personality diagnosis and samples of information,509 cases were finally included in the sample size of this study.The sub-scale of borderline personality disorder （BPD） in questionnaire of personality diagnosis was used to assess the borderline personality level of adolescents;the questionnaire of adolescents’ emotional resiliency was used to measure their emotional resiliency;and self-made demographic questionnaire was used to assess their socioeconomic status.Taking educational levels of their parents as the measurement index,adolescents whose parents’ educational level was college degree or above belonged to high family socioeconomic status group （n=294）,while adolescents whose parents’ educational level was below college degree belonged to low family socioeconomic status group （n=215）.Results　Adolescents’ borderline personality level in high family socioeconomic status group was significantly lower than that in low family socioeconomic status group,while its scores of positive emotion and total scores of emotional resilience were significantly higher （P<0.05）;the difference of scores of emotional recovery in two groups was not significantly different （P>0.05）.Family socioeconomic status was negatively correlated with borderline personality level of adolescents （rs=-0.10,P<0.05）,and positively correlated with the total score of emotional resilience （rs=0.11,P<0.05）.The total score of emotional resilience was negatively correlated with borderline personality level of adolescents （rs=-0.47,P<0.01）.Adolescents’ emotional resilience played a completely mediating role in the relationship between family socioeconomic status and level of borderline personality level of adolescents;the mediating effect occupied 39.7% of the total effects.Conclusion　The emotional resilience plays a fully mediating effect on the relationship between family socioeconomic status and borderline personality level of adolescents.

Clinical Effects of Lingguizhugan Decoction in the Treatment of Hypoxic Pulmonary Hypertension

YANG Li-li, ZHANG Zheng-yi, JIANG Hua, GUAN Xiao-li, AN Hong-jin.

2016, 19(28):  3495-3499.  DOI: 10.3969/j.issn.1007-9572.2016.28.023

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Objective　To investigate the clinical effects of Lingguizhugan decoction in the treatment of hypoxic pulmonary hypertension（HPH）.Methods　96 HPH patients who received treatment in Lanzhou University Second Hospital from May 2013 to August 2015 were selected and divided into control group（n=44） and experimental group（n=52） by using random number table method.The control group was treated with conventional therapy,based on which the experimental group took Lingguizhugan decoction.The average time of therapy of patients in two groups was（12±2） d.Serum N-terminal pro brain natriuretic peptide（NT-proBNP） level,hearts and lungs function indices,blood gas analysis,TCM symptom scores,and efficacy of TCM syndrome and occurrence of adverse reactions among patients in two groups before and after treatment were compared.Results　Serum NT-proBNP levels of patients in two groups before treatment were not significantly different（P>0.05）;after treatment,serum NT-proBNP level of patients in experimental group was significantly lower than that in control group（P<0.05）;serum NT-proBNP levels of patients in two groups after treatment were significantly lower than those before treatment（P<0.05）.There was no significant difference in cardiac output（CO）,left ventricular ejection fraction（LVEF） and pulmonary artery pressure of patients in two groups before treatment（P>0.05）;after treatment,CO and LVEF of patients in experimental group were significantly higher than those in control group,while pulmonary artery pressure in experimental group was lower than that in control group（P<0.05）;both CO and LVEF of patients in two groups after treatment were significantly lower than those before treatment,while pulmonary artery pressure after treatment was lower than that before treatment（P<0.05）.pH,partial pressure of blood oxygen（PaO2） and arterial partial pressure of carbon dioxide（PaCO2） of patients in two groups before treatment were not significantly different（P>0.05）.pH of patients in two groups was not significantly different（P>0.05）;PaO2 of patients in experimental group was significantly higher than that in control group,while PaCO2 was lower than that in control group（P<0.05）.pH of patients in two groups after treatment and before treatment was not significantly different（P>0.05）;PaO2 in two groups was significantly higher than that before treatment,PaCO2 was significantly lower than that before treatment（P<0.05）.There was no significant difference in TCM symptom scores of patients in two groups before treatment（P>0.05）;after treatment,TCM symptom scores of patients in experiment group were significantly lower than those in control group（P<0.05）;TCM symptom scores of patients in two groups after treatment were significantly lower than those before treatment（P<0.05）.Efficacy of TCM syndrome of patients in experiment group was better than that in control group（P<0.05）.Patients in two groups had no obvious adverse reaction.Conclusion　Conclusion Lingguizhugan decoction has precise clinical effects on the treatment of HPH,and can remit patients’ hypoxic condition.It benefits prognosis of patients.

Clinical Effects of Tacrolimus Combined with Jiaweihuangqichifeng Decoction on Treatment of Old Patients with Idiopathic Membranous Nephropathy

ZHANG Chen, WANG Mei-ling, MA Hua, ZHANG Yu.

2016, 19(28):  3500-3505.  DOI: 10.3969/j.issn.1007-9572.2016.28.024

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Objective　To evaluate clinical effects of tacrolimus combined with Jiaweihuangqichifeng decoction on treatment of old patients with idiopathic membranous nephropathy（IMN）.Methods　57 old patients with IMN who received treatment in outpatient or ward of Zhengzhou Jiaotong Hospital from June 2011 to June 2014 were selected.They were divided into control group（n=20） and observation group（n=37） according to treatment plan.Patients in control group were treated with tacrolimus combined with methylprednisolone orally,while patients in observation group took oral tacrolimus combined with Jiaweihuangqichifeng decoction.24 h urine protein quantitation,serum albumin,red blood cell in urinary sediment,blood glucose and lipids levels,hepatic and renal function parameters of patients in two groups before treatment and after treatment of 8 weeks,12 weeks and 24 weeks were detected respectively;and clinical effects of 24-week treatment and adverse reactions during treatment were recorded.Results　24 h urinary protein quantitation and red blood cell in urinary sediment of patients in two groups were significantly different（P<0.05）;the comparison of different time points was significantly different（P<0.05）;therapeutic method and time had interactive effects on 24 h urinary protein quantitation and red blood cell in urinary sediment（P<0.05）.The serum albumin of patients in two groups was not significantly different（P>0.05）;the comparison of different time points was significantly different（P<0.05）;therapeutic method and time had interactive effects on serum albumin（P<0.05）.Fasting plasma glucose（FPG）,total cholesterol（TC）,low density lipoprotein（LDL） and high density lipoprotein（HDL） of patients in two groups were significantly different（P<0.05）;the comparison of different time points was significantly different（P<0.05）;therapeutic method and time had interactive effects on FPG,TC,LDL and HDL（P<0.05）.Serum creatinine（SCr） and ALT of patients in two groups were not significantly different（P>0.05）;the comparison of different time points was significantly different（P<0.05）;therapeutic method and time had no interactive effects on SCr and ALT（P>0.05）.The comparison of uric acid（UA） of patients in two groups was significantly different（P<0.05）;the comparison of different time points was significantly different（P<0.05）;therapeutic method and time had no interactive effects on UA（P>0.05）.Estimate glomerular filtration rate（eGFR） and gamma glutamyl transpeptidase（GGT） of patients in two groups were not significantly different（P>0.05）;the comparison of different time points was significantly different（P<0.05）;therapeutic method and time had no interactive effects on eGFR and GGT（P>0.05）.The clinical effects of patients in two groups were not significantly different（P>0.05）.The incidence of adverse reactions of patients in observation group was significantly lower than that in control group（P<0.05）.Conclusion　Tacrolimus combined with Jiaweihuangqichifeng decoction and tacrolimus combined with hormone have similar curative effects on treatment of old patients with IMN.With good patient tolerance,it is suitable for clinical treatment of IMN old patients with glucocorticoid contraindication.

Research Progress of Mechanism of Inflammatory Bowel Disease Patients with Irritable Bowel Syndrome-like Symptoms during Remission

CAO Ming-wei, LIU Yu-lan, MA Jing-jing, DONG Wei-guo.

2016, 19(28):  3506-3509.  DOI: 10.3969/j.issn.1007-9572.2016.28.025

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Inflammatory bowel disease（IBD） is a chronic nonspecific inflammatory bowel disease with not very clear causes,IBD during remission（IBDR） patients often have irritable bowel syndrome（IBS）-like symptoms.The presence of IBS-like symptoms leads to reduced quality of life of patients,and influences assessment of disease and choice of treatment strategies of doctors.Therefore,the paper reviews the mechanism of IBDR patients with IBS-like symptoms,and concludes that IBDR with IBS-like symptoms was related to intestinal low-grade inflammation and nerve remodeling,and may also have combined IBS for IBD.

Research Progress on the Optimal Exercise Prescription of Metabolic Syndrome and Its Mechanism

LIN Le-tao, DONG Ai-mei.

2016, 19(28):  3509-3512.  DOI: 10.3969/j.issn.1007-9572.2016.28.026

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Metabolic syndrome (MS) is a group of clinical symptoms,including central obesity,high blood sugar,high blood pressure and dyslipidemia,which influenced human health seriously.Exercises can improve the expression level of adipocytokines,promote the glucose metabolism and secretion function of skeletal muscles,and improve the repairing capacity of damages in vascular endothelium,so as to effectively prevent and improve the metabolic syndrome.Based on recent studies,this paper summarized the most proper exercise prescription for MS from the form of exercise,the frequency and duration of exercises,and intensity of exercises.Future direction was further clarified to provide reference for clinical treatment and relevant scientific research for MS.