Table of Content

15 November 2016, Volume 19 Issue 32

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Correct Understanding of Side Effects of Aspirin

WANG Fang

2016, 19(32):  3897-3901.  DOI: 10.3969/j.issn.1007-9572.2016.32.001

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This paper introduces the side effects related with aspirin and the corresponding prevention and treatment strategies.By having those correct knowledge and taking effective prevention strategies and standardizing use of aspirin,the side effects can be preventable and patients can get maximization of benefits.

Difference Analysis of Service Length of Psychotherapy between Patients with Medically Unexplained Physical Symptoms and Other Patients with Mental Disorders in A General Hospital of Germany

LI Wen-tian, Kurt.Fritzsche, ZHANG Jie

2016, 19(32):  3902-3906.  DOI: 10.3969/j.issn.1007-9572.2016.32.002

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Objective　To explore the differences in the service length of psychotherapy between patients with medically unexplained physical symptoms（MUPS） and other patients with mental disorders in a general hospital of Germany.Methods　8 695 inpatients who referred to the Department of Psychosomatic Medicine and Psychotherapy in the University Medical Center Freiburg from 2006 to 2010 were selected,and 6 720 patients received psychotherapy.According to the reasons of referring to the Department of Psychosomatic Medicine and Psychotherapy,they were divided into three groups——3 886 in problems of coping（Coping） group,2 261 in current psychological symptoms（CPS） group and 573 in MUPS group.The service lengths of psychotherapy of patients were collected by adopting Consultation Liaison-Basic Document（CL-BaDo）,and 10 minutes were taken as a unit.The proportions of each service length of psychotherapy occupied by the patients in the three groups were compared,and the influencing factors of the service length of psychotherapy service were analyzed by general linear model univariate test.Results　In the Coping group,the service lengths of psychotherapy of 392 patients were missed,1 to 6 units,and totally 10 873 units;the service lengths of psychotherapy of 491 patients in CPS group were missed,1 to 6 units,and totally 23 383 units;none in MUPS group missed their service lengths of psychotherapy,1 to 6 units,and totally 2 940 units.There was significant difference in the proportions of each service length of psychotherapy among the three groups（P<0.05）.There was significant difference in the distribution of service lengths of psychotherapy among the three groups（P<0.05）;the proportion of patients with service lengths of psychotherapy less than 9 units and between 10 to 13 units in MUPS group were more than those in Coping group and CPS group（P<0.01）.The results of general linear model univariate test showed that compared with the CPS group,the differences of service lengths of psychotherapy between patients in Coping group and MUPS group were not significantly different（P>0.05）;all the service lengths of psychotherapy had no significant influence on the service length of psychotherapy（P>0.05）;however,in MUPS group,the service length of collecting medical history of mental-related diseases and consultation and discussion had significant influence on the service length of psychotherapy（P<0.05）.Conclusion　It is much easier for the patients with MUPS in the general hospitals in Germany to accept the services of collecting psychological-related medical histories,and this means that although patients with MUPS focus on the feelings of somatic discomfort,they still have inner needs of high potential for obtaining services of psychotherapy.

Howard Berger，Robert Gagnon，Mathew Sermer，Maternal Fetal Medicine Committee

BERGER H, GAGNON R, SERMER M, 等

2016, 19(32):  3907-3908.  DOI: 10.1016/j.jogc.2016.04.002

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This guideline reviews the evidence relating to the diagnosis and obstetrical management of diabetes in pregnancy.The outcomes evaluated were short- and long-term maternal outcomes，including preeclampsia，caesarean section，future diabetes，and other cardiovascular complications，and fetal outcomes，including congenital anomaties，stillbirth，macrosomia，birth trauma，hypoglycemia，and long-term effects.The quality of evidence was rated using the criteria described in the Report of the Canadian Task Force on Preventive Health Care.

Research Progress of Diagnosis and Treatment of Diabetes in Pregnancy

WANG Chen, YANG Hui-xia

2016, 19(32):  3909-3913.  DOI: 10.3969/j.issn.1007-9572.2016.32.003

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Diabetes in pregnancy（DIP） have the following two types:pre-gestational diabetes mellitus（PGDM） and gestational diabetes mellitus（GDM）.DIP is closely related to short- and long-term adverse pregnancy outcomes of the mother and the child.The incidence of DIP in China is increasing year by year,and the age of patients with diabetes during pregnancy is becoming younger.Therefore,it is important to focus on and improve the clinical diagnosis and treatment of DIP.This study introduced the latest research progress on diagnosis and treatment of DIP.Comparisons were made between the diagnostic criteria provided by the World Health Organization（2013） and the International Association of Diabetes and Pregnancy Study Groups（IADPSG,2010） and those in our country.Diet management and exercise intervention need to be carried out throughout the whole treatment process of DIP.Early drug therapy should be provided to patients in need of drug therapy.The importance of postpartum follow-up needs to be emphasized to prevent the occurrence of long-term chronic diseases.In conclusion,treatment should be provided throughout the whole DIP treatment process,which includes pro-gestational planning and preparation,treatment during gestation（including interventions in living habits and drug therapy）,and postpartum follow-ups.

Research Progress of Long-term Effects and Management of Gestational Diabetes Mellitus for Mothers and Offspring

SONG Geng, YANG Hui-xia

2016, 19(32):  3914-3917.  DOI: 10.3969/j.issn.1007-9572.2016.32.004

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Gestational diabetes mellitus（GDM） is defined as glucose intolerance with onset or first recognition during pregnancy,which is one of the most common complications during pregnancy.In this paper,we reviewed the long-term effects of GDM on mothers and offspring,and indicated that GDM could significantly increase the risk of developing the diseases such as type 2 diabetes,obesity,hypertension,metabolic syndrome,and so on.Hence,in order to reduce the risk of suffering the metabolic diseases in the future,we need to pay attention to the long-term follow-up of mothers and offspring,including regular inspection,health education,encouragement of breastfeeding,and lifestyle intervention.

Effects of Glucose Levels at Different Time Points after Oral Glucose Tolerance Test on the Diagnosis of Gestational Diabetes Mellitus and Pregnancy Outcomes

WANG Li-ping, HUANG Jin, YANG Hui

2016, 19(32):  3918-3922.  DOI: 10.3969/j.issn.1007-9572.2016.32.005

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Objective　To evaluate the effects of glucose levels at different time points after oral glucose tolerance test （OGTT） on the diagnosis of gestational diabetes mellitus （GDM） and pregnancy outcomes.Methods　516 pregnant women admitted to Department of Obstetrics in the Second Xiangya Hospital of Central South University for delivery were collected from May to September in 2015.75 g glucose OGTT was performed at 24 to 28 weeks of gestation.GDM was detected in 109 cases.According to the time points for diagnosis of GDM and excluding 13 cases with GDM diagnosed at two or more time points,the patients were divided into 3 groups:35 cases in group diagnosed at fasting blood glucose（group A）,20 cases in group diagnosed at OGTT 1 h blood glucose（group B）,41 cases in group diagnosed at OGTT 2 h blood glucose（group C）.Clinical data of pregnant women with GDM were retrospectively analysed,including:maternal age,pre-pregnancy body mass index（BMI）,body mass growth during pregnancy,neonate birth weight and pregnancy outcomes（premature rupture of membranes,macrosomia,preterm delivery,fetal distress,neonatal pathologic jaundice,gestational hypertension）.Results　In all 516 pregnant women,GDM was detected in 109 cases,the detection rate of GDM was 21.12%.The detection rate of GDM was 6.78% by diagnosed at fasting blood glucose.The detection rate of GDM was 3.88% by diagnosed at OGTT 1 h blood glucose.The detection rate of GDM was 7.95% by diagnosed at OGTT 2 h blood glucose.There were statistically significant difference in the detection rate of GDM according to blood glucose levels at different OGTT time points（χ2=7.80，P=0.02）.The detection rate of GDM by diagnosed at OGTT 1 h blood glucose was lower than diagnosed at fasting blood glucose and OGTT 2 h blood glucose（P<0.01）.There were statistically significant difference in maternal age among the 3 groups（P<0.05）.The maternal age in group A was lower than group B and group C（P<0.05）.There were no statistically significant difference in pre-pregnancy BMI,body mass growth during pregnancy and neonate birth weight among the 3 groups（P>0.05）.There was statistically significant difference in the incidence of fetal distress among the 3 groups（P<0.05）.The incidence of fetal distress in group C was lower than group B（P<0.01）.There were no statistically significant difference in premature rupture of membranes,macrosomia,preterm delivery,neonatal pathologic jaundice,gestational hypertension among the 3 groups（P<0.05）.Conclusion　The detection rate of GDM was 21.12%.There are some differences in the diagnosis of GDM according to blood glucose levels at different OGTT time points.The detection rate at OGTT 1 h blood glucose is lower than fasting blood glucose and OGTT 2 h blood glucose.The incidence of fetal distress is higher in group diagnosed at OGTT 1 h blood glucose.

Root Cause Analysis for the Population with Abnormality of Cerebrovascular Hemodynamics

DING Yi, WANG Yu-shan, WANG Sen-lu, JIANG Yan, GAO Peng-cheng, LI Lian, SHAO Jiang, ZHAN Hao-su, XU Yue, YAO Hua

2016, 19(32):  3923-3927.  DOI: 10.3969/j.issn.1007-9572.2016.32.006

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Objective　To explore the influence factor for the population with abnormality of cerebrovascular hemodynamics,and provide effective evidence for the early intervention.Methods　In this cross-sectional study,we selected 7 032 cases from the population of physical examination who took the cerebrovascular hemodynamics test in the Health Management Center of Xinjiang Medical University from January 2015 to January 2016,and recorded the general information,which included gender,age，nation，body mass index（BMI），overweight or obesity，hypertension，lipid abnormality，diabetes mellitus，heart disease，smoking，alcohol consumption，family history of stroke，and past history of stroke.Abnormality of cerebrovascular hemodynamics index（CVHI） was detected，CVHI≥75 was defined as normal case and CVHI<75 as abnormal case.Abnormal cases were divided into three groups by CVHI:low-risk group with CVHI of 50-74,moderate-risk group with CVHI of 25-49,and high-risk group with CVHI of 0-24.The root causes were analyzed by unconditional multivariate Logistic regression analysis.Results　Among 7 032 cases,there were 5 830 cases（82.91%） with normal of cerebrovascular hemodynamics（control group）,1 202 cases（17.09%） with abnormality of cerebrovascular hemodynamics:622 cases（8.84%） in the low-risk group,331 cases（4.71%） in the moderate-risk group，and 249 cases（3.54%） in the high-risk group.The factors such as gender，age，nation，BMI，overweight or obesity，hypertension，lipid abnormality，diabetes mellitus，heart disease,smoking，alcohol consumption and past history of stroke were significantly different among four groups（P<0.05）.Unconditional multivariate Logistic regression analysis indicated that there were causal relationships between abnormality of cerebrovascular hemodynamics and the factors such as gender，age,nation，overweight or obesity，hypertension，diabetes mellitus，heart disease，alcohol consumption and past history of stroke（P<0.05）.Conclusion　The main risk factors for the population with abnormality of cerebrovascular hemodynamics includ male,aged over 50,the Uyghur or Hui people,overweight or obesity，hypertension，diabetes mellitus，heart disease，alcohol consumption，and past history of stroke,which can provide important evidence and guide for the intervention in the future.

Relationship between Physical Activity Patterns and Overweight and Obesity in Community Adult Residents

LI Mi-huan, LI Guo-qiang, JIANG Chong-min

2016, 19(32):  3933-3939.  DOI: 10.3969/j.issn.1007-9572.2016.32.008

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Background　Increasing physical activity is the top measure for promoting health,and its health effects have been observed in the incidence,development,and prognosis of overweight,obesity,and related chronic diseases.However,many sedentary behaviors,separated from levels of medium to high physical activities,can increase the risks of overweight,obesity,and related chronic diseases.Therefore,only focusing on medium to high physical activities or sedentary behaviors is insufficient for evaluating the real relationships between physical activities and obesity.Association between combinations of various physical activities in daily life and overweight and obesity should be taken into consideration.Objective　To explore the relationship between different physical activity patterns and overweight and obesity of adult residents in urban areas.Methods　A total of 756 adult residents in Nanjing and Shanghai were the objects of the study.They were selected through multistage random sampling method from March to October in 2013.Data on gender,age,education level,height,weight,and history of chronic diseases were collected.Physical activity log investigation was used to gather the activity duration time of the objects for consecutive seven days.Factor analysis was applied to analyze the objects’ physical activity patterns.The objects were divided into four groups（Q1,Q2,Q3,and Q4），based on factor scoring of the physical activity patterns with equal interval.Results　Overweight and obesity rates accounted for 33.2%（251/756） and 6.3%（48/756）,respectively.The overweight and obesity rates of male objects were higher than those of female objects（χ2=23.80,8.79；P<0.01）.When the overweight rates of objects among different age groups were compared,the differences were statistically significant（χ2=23.20，P<0.05）.The first four factors were selected as the main factors through factor analysis.The characteristic roots were 2.52,2.00,1.45,and 1.18,with an accumulative contribution rate of 57.5%.The four factors were named as sedentary pattern,the housebound pattern,the balance pattern,and the exercise pattern.The Logistic regression analysis showed that，after correction of confounding factors,the sedentary pattern was the risk factor of overweight and obesity,and the housebound pattern was the protective factor of overweight and obesity（P<0.05）.Association between the balance pattern and overweight and obesity or association between the exercise pattern and overweight and obesity was not found（P>0.05）.When the time percentage of medium intensity activities and high intensity activities between group Q1 and group Q4 in the sedentary pattern were compared,the differences were not statistically significant（P>0.05）.The time percentage of sedentary activities of group Q1 was lower than that of group Q4,the low intensity activities time percentage of group Q1 was higher than that of group Q4,and the total energy consumption of group Q1 was higher than that of group Q4 in the sedentary pattern（P<0.05）.When the time percentage of medium intensity activities and high intensity activities were compared between group Q1 and group Q4 in the housebound pattern,the differences were not statistically significant（P>0.05）.The time percentage of sedentary activities of group Q1 was higher than that of group Q4,the time percentage of low intensity activities of group Q1 was lower than that of group Q4,and the total energy consumption of group Q1 was lower than that of group Q4 in the housebound pattern（P<0.05）.When the time percentage of activities of all intensity levels and total energy consumption were compared between group Q1 and group Q4 in the balance pattern and the exercise pattern,the differences were not statistically significant（P>0.05）.Conclusion　The sedentary pattern dominated by sedentary activities is the risk factor of overweight and obesity.The exercise pattern cannot completely protect individuals from the negative effect of sedentary activities on health.The housebound pattern,in which high amount of energy can be consumed through accumulation of low intensity physical activities,can offset the negative effect of sedentary activities on health.

Clinical Features and Prognosis of Patients with Secondary Epilepsy to Delayed Encephalopathy after Acute Carbon Monoxide Poisoning

ZHOU Yun-peng, ZENG Jiao, GU Jia-peng, ZHANG Xiao-li, ZHANG Ping, WU Qiang, TIAN Song-chao, ZHAO Jian-hua, JIN Mei, PAN Deng, HAN Ya-zhou, ZHAO Guo-you, GU Ren-jun

2016, 19(32):  3940-3945.  DOI: 10.3969/j.issn.1007-9572.2016.32.009

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Background　Previous studies of patients with delayed encephalopathy after acute carbon monoxide poisoning （DEACMP） mainly focused on the symptoms，such as mental retardation，extrapyramidal dysfunction，rather than secondary epilepsy.The investigation of the incidence and clinical features of secondary epilepsy after DEACMP would be beneficial to the aforesaid issues.Objective　To analyze the clinical features of DEACMP patients with secondary epilepsy.To compare the clinical manifestations，the therapeutic effects and prognosis between DEACMP patients with and without secondary epilepsy,in order to provide a basis for predicting the prognosis of DEACMP patients with secondary epilepsy.Methods　450 DEACMP patients admitted to eight hospitals of the Second Affiliated Hospital of Xinxiang Medical University，the First Affiliated Hospital of Xinxiang Medical University，the Third Affiliated Hospital of Xinxiang Medical University，Xinxiang Center Hospital，the First People’s Hospital of Xinxiang，the Second People’s Hospital of Xinxiang，the 371st Center Hospital of PLA and Henan Honliv Hospital from January 2001 to January 2014 were recruited，and 272 of these patients were eligible for inclusion and exclusion criteria and included in our study.The patients’ clinical condition changes，treatment effect and prognosis were recorded through outpatient follow-up and telephone follow-up.Results　In the 272 patients,20 cases（7.4%） got secondary epilepsy，and 17（85.0%） of them epileptic seizures occurred within 6 months after DEACMP.There were no statistically significant differences in gender，age，coma duration，latent phase between DEACMP patients with and without secondary epilepsy （P>0.05），but there was statistically significant difference in severity of illness（P<0.05）. There was statistically significant difference in treatment effect（Z=5.098，P<0.01）.12 cases of DEACMP patients with secondary epilepsy died during the follow up and the mortality was 60.0%,while 52 cases of DEACMP patients without secondary epilepsy died and the mortality was 20.6%.There was statistically significant difference in mortality between the two groups（χ2=15.95，P<0.01）.Conclusion　The DEACMP patients with secondary epilepsy are characteristic of severe condition，poor treatment effect and high mortality.It is important for improving the treatment effect and prognosis of DEACMP patients to prevent the secondary epilepsy，especially epileptic seizure duration.

Association between Thyroid Peroxidase Antibody Positivity and Pregnancy Event

CHEN Sheng-ping, ZHANG Rui

2016, 19(32):  3946-3949.  DOI: 10.3969/j.issn.1007-9572.2016.32.010

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Objective　To retrospectively analyze the impact of anti-thyroid peroxidase antibody（TPOAb） positivity on pregnancy event.Methods　A total of 2 048 women of first pregnancy with singleton in Beijing Shijitan Hospital，Capital Medical University from December 2012 to December 2013 were included.The pregnant women were conducted OGTT at the sixth week of gestation,and level of blood glucose was detected 2 hours after OGTT.And fasting venous blood sampling were assayed for fasting glucose,ALT,AST,BUN,Cr,TPOAb,FT3,FT4,TSH,and TRAb.The patients of TPOAb positive hypothyroidism and subclinical hypothyroidism,and TPOAb negative hypothyroidism were daily given oral thyroxine tablet treatment with empty stomach.Then the dosage was adjusted according to the TSH level gradually.The events of the pregnancy,including abortion,hypertensive disorder complicating pregnancy,anemia,gestational diabetes,fetal growth restriction,premature birth,and postpartum hemorrhage were recorded.Results　189 cases,9.2% of the subjects were TPOAb positive.There were statistically significant differences in FT3,FT4,TSH,and TRAb levels between TPOAb positive and negative pregnant women（P<0.05）.The incidence of hypothyroidism,subclinical hypothyroidism,and hypothyroxinemia were significantly higher in TPOAb positive pregnant women than those in TPOAb negative pregnant women（P<0.05）.No statistically significant differences in incidence of anemia,fetal growth restriction,premature birth and postpartum hemorrhage between TPOAb positive and negative pregnant women（P>0.05）.The incidence of abortion,hypertensive disorder complicating pregnancy,gestational diabetes were higher in TPOAb positive pregnant women than those in TPOAb negative pregnant women（P<0.05）.Conclusion　TPOAb positive pregnant women have a higher incidence of hypothyroidism,subclinical hypothyroidism,and hypothyroxinemia.TPOAb positivity in pregnancy increase the risk of abortion,hypertensive disorder complicating pregnancy,gestational diabetes.

Screening and Identifying the Target Protein of Blood Activating and Stasis Removing for Lumbar Intervertebral Disk Protrusion

GUAN Peng, YIN Li-jun, XU Jian-wen, WEI Jia-ding, LI Zhi-fei, TAI Zhi-hong, GUI Yu-chang, WEI Yu-lan

2016, 19(32):  3950-3955.  DOI: 10.3969/j.issn.1007-9572.2016.32.011

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Background　Promoting blood circulation and removing blood stasis treatment is the characteric therapy used by traditional Chinese medicine,and it’s also one of the main effective non-surgical therapy for lumbar intervertebral disk protrusion （LIDP） in clinic.In the past,scholars had carried out a great deal of researches from the pathology,imaging,immunology and gene about the disease,but the mechanism of LIDP treated by blood circulation was still unknown.Objective　To obtain the target protein by screening and identifying the differentially expressed proteins before and after promoting blood circulation and removing blood stasis treatment for LIDP patients,using iTRAQ isobaric tags coupled with LC-MS/MS.Methods　30 LIDP patients diagnosed as blood stasis syndrome by Chinese differentiation clinically from July 2013 to December 2014 in the First Affiliated Hospital of Guangxi University of Chinese Medicine were selected as the experiment subjects.Promoting blood circulation and removing blood stasis treatment were given for 4 weeks and clinical efficacy of patients were observed.The serum of the peripheral blood was extracted before and after the treatment.To screen and identify the differentially expressed proteins before and after the treatment through removing the high abundance protein,measuring the protein concentration,enzymatic hydrolysis of proteins,peptide iTRAQ labeling,high performance liquid chromatography and LC-MS/MS analysis.The functional and metabolic pathways of the differentially expressed proteins were analyzed by the combination of gene ontology annotation and KEGG pathway-related bioinformatics.Results　The results showed that 19 cases were clinical controlled,8 cases were excellent,2 cases were effective,1 case was invalid,and the total effective rate of treatment was 96.7%（29/30）.In total,300 non-redundant proteins were identified by using the technique of iTRAQ and LC-MS/MS.There were quantitative information on each channel tag in 209 of these proteins.Twenty differentially expressed proteins were screened out,10 upregulated proteins and 10 downregulated proteins.In this study,the KEGG enrichment results of 20 differentially expressed proteins showed that 9 differential proteins were enriched to 27 related signal pathways.The complement and coagulation cascades were enriched to three differential proteins.PPAR signal pathways,pertussis,trypanosomiasis,staphylococcus aureus infection and systemic lupus erythematosus were enriched to two differentially expressed proteins.11 signal pathway,such as pertussis,trypanosomiasis,staphylococcus aureus infection and systemic lupus erythematosus,et al.were enriched to Complement C3.Nine signal pathways,such as PI3K-Akt signal pathway,focal adhesion,actin cytoskeleton regulation,et al.were enriched to Fibronectin 1.Conclusion　The therapy of promoting blood circulation and removing blood stasis is remarkable on treating LIDP patients with blood stasis syndrome.Apolipoprotein A1,Apolipoprotein M,Apolipoprotein C3,Fibronectin 1 and Complement C3 may be the potential target serum protein of therapy of promoting blood circulation and removing blood stasis for the LIDP patients with blood stasis syndrome.

Application Effect of Failure Mode and Effect Analysis Management Model in Lowering Risk of Catheter-associated Urinary Tract Infection

ZHANG Yue, TAN Si-yuan, CHEN Yan, XIA Ling, HU Qing, WANG Nian-jian

2016, 19(32):  3956-3960.  DOI: 10.3969/j.issn.1007-9572.2016.32.012

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Objective　To explore the application effect of failure mode and effects analysis（FMEA）management model on preventing the risk of catheter-associated urinary tract infection（CAUTI）in intensive care unit（ICU）.Methods　181 patients who underwent indwelling catheter in ICU of Yancheng City No.1 People’s Hospital from January to May in 2014 and from July to November in 2014 were selected.The before FMEA management group，of which 86 patients underwent indwelling catheter from January to May in 2014，received routine care plan of clinical indwelling catheter；while the after FMEA management group，of which 95 patients underwent indwelling catheter from July to November in 2014，adopted the improving plan that based on risk priority number（RPN）score of FMEA management model to construct CAUTI preventions.The two expert teams RPN score of failure mode，incidence of patients developing CAUTI，time of occurrence，number of days with indwelling catheter，length of stay，strains of urine-cultured pathogenic bacteria and compliance of nurses between two groups were compared.Results　RPN score and incidence of CAUTI in the after FMEA management group were lower than those in the before FMEA management group（P<0.05），the time of occurrence of CAUTI in the after FMEA management group delayed comparing with that in the before FMEA management group（P<0.05）.There was no significant difference in length of stay between the two groups（P>0.05）；number of days with indwelling catheter in after FMEA management group was shorter than that in before FMEA management group（P<0.05）.Hand washing rates before contacting with patients，after contacting with patients，before nursing catheter，after nursing catheter，before collecting urine samples and after collecting urine samples in the after FMEA management group were higher than those in the before FMEA management group（P<0.05），compliance rates of location of urine drainage bags，opening urine drainage bags，perineum situation，changing of urine drainage bags and tube drawing in the after FMEA management group were higher than those in the before FMEA management group（P<0.05）.ConclusionFMEA management mode can lower the risk of CAUTI effectively，improve the compliance of nurses’ preventive behaviors.It is worthy of clinical promotion and application.

Expression and Significance of Smad4 Gene in Papillary Thyroid Cancer

HUANG Ying-rui, CHEN Jie, ZHOU Ling-ling, LIANG Yong

2016, 19(32):  3961-3965.  DOI: 10.3969/j.issn.1007-9572.2016.32.013

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Objective　To explore the expression and significance of Smad4 gene in papillary thyroid cancer（PTC）.Methods　From January to August in 2013，20 cases of PTC admitted to Department of Tumor Surgery of Affiliated Hospital of Taizhou University were enrolled as the PTC group，and 20 patients with nodular goiter accepted surgery in the same period were enrolled as the control group.Surgically resected tissue of PTC in the PTC group and normal thyroid tissue adjacent to nodular goiter in the control group were collected.The positive expression of Smad4 protein in two groups was observed using immunohistochemistry，the expression level of Smad4 protein in two groups was detected using Western blotting and the expression level of Smad4 mRNA using real time-PCR.Results　The positive expression rate of Smad4 protein in PTC group was 35.0%（7/20），which was lower than 90.0%（18/20）in the control group（χ2=10.667，P=0.001）.There was no statistically significant difference in the positive expression rate of Smad4 protein in the PTC patients among gender，age，tumor diameter，lymph node metastases and clinical stage of PTC（P>0.05）.The expression of Smad4 protein in PTC group was（0.352±0.012），which was lower than that in control group（0.722±0.007）（t=46.130，P<0.001）.Smad4 gene expressed in both PTC and control group，the expression level of Smad4 mRNA in PTC tissue was（0.348±0.006） time as much as control group.Conclusion　The expression of Smad4 gene was down-regulated in PTC.The inhibition of TGF-β/Smads signal pathway caused by the loss and down-regulation of Smad4 gene expression might be the possible mechanisms of the occurrence and development of PTC.

Effects and Safety of Magnesium Sulfate Combined with Ligustrazine on Treatment of Pregnancy-induced Hypertension:A Meta-analysis

WEI Xiao-hong, ZHANG Yu-jiao, LI Ai-ling, FU Xiao-dong

2016, 19(32):  3966-3972.  DOI: 10.3969/j.issn.1007-9572.2016.32.014

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Objective　To analyze and evaluate the effects and safety of magnesium sulfate combined with ligustrazine on treatment of pregnancy-induced hypertension compared with monotherapy of magnesium sulfate by meta-analysis,and to provide evidence for clinical medication decisions.Methods　A computer-based retrieval of CNKI,CBM,Wanfang Data,VIP,China Dissertation Database,Cochrane Library,PubMed,EMBase,OVID,EBSCO were made,and relevant literatures of research group adopting magnesium sulfate combined with ligustrazine,and of control group only using magnesium sulfate in treating pregnancy-induced hypertension were screened.The searching period was from the time of database building to December 2015.The abstracts of literatures were read and literatures were screened of the full text,and necessary data were extracted and induced,including the first author,publishing time,sample size,intervening measures,courses of treatment,outcome indicators,as well as random method,allocation concealment and blinding methods,and other sources of bias;the quality of the included literatures was assessed according to the standard form of quality assessment of Cochrane Handbook for Systematic Reviews of Interventions（5.1.0 version）.The total effective rate，incidence of postpartum hemorrhage，incidence of neonatal asphyxia，incidence of fetal distress，and incidence of adverse reactions between the two groups were analyzed using RevMan 5.3 software.Results　A total of 16 literatures were enrolled,including 1 369 patients,of which 683 in control group and 686 in research group.13 literatures were randomly divided into groups,of which only one had mentioned the method of blinding in observing and evaluating outcome indicators;allocation concealment were not reported in all the included literatures,and no lost to follow-up and selective reports results were found,and research data were completely provided.The results of meta analysis were shown as follows:compared with control group,the total effective rate of research group was higher〔RR=1.19,95%CI（1.13,1.25）〕,incidence of postpartum hemorrhage〔RR=0.38,95%CI（0.25,0.58）〕,incidence of neonatal asphyxia〔RR=0.35,95%CI（0.21,0.58）〕,and the incidence of fetal distress in uterus〔RR=0.42,95%CI（0.26,0.66）〕,and incidence of adverse reactions〔RR=0.30,95%CI（0.15,0.57）〕 were lower.ConclusionMagnesium sulfate combined with ligustrazine in the treatment of pregnancy-induced hypertension is superior to using magnesium sulfate alone in terms of the following aspects:improving overall clinical efficiency,and reducing rates of postpartum hemorrhage,neonatal asphyxia,fetal distress in uterus,and adverse reactions.

Effect of Probiotic Yogurt on Body’s Blood Plasma Lipid Levels：A Meta-analysis

LIU Rui-fang, ZHAO Hua, LI Jian-hua, CHENG Qing-hong

2016, 19(32):  3973-3978.  DOI: 10.3969/j.issn.1007-9572.2016.32.015

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Objective　To systematically evaluate the effect of probiotic yogurt on plasma lipid in adults.Methods　Databases including the Cochrane Library，Web of Science，PubMed，EMBase，VIP，CNKI，CBM and Wanfang Database from January 1999 to February 2016 were searched by computer.Randomized control trial on the relationship between probiotic yogurt and lipid metabolism were included.Two reviewers independently screened literature according to the inclusion and exclusion criteria，then extracted data and evaluated biased risk of the included literature.The effect of probiotic yogurt on total cholesterol（TC），high-density lipoprotein cholesterol（HDL-C），low-density lipoprotein cholesterol（LDL-C）and triglyceride（TG）were analyzed using RevMan 5.3 software.Results　A total of 13 studies in the 12 literatures were included，including 606 subjects（305 in the probiotic yogurt group and 301 in the traditional yogurt group）.The results of meta-analysis showed that the levels of TC〔MD=-8.43，95%CI（-10.28，-6.58），P<0.001〕,LDL-C〔MD=-6.34，95%CI（-10.06，-2.62），P<0.001〕 and TG〔MD=-6.10，95%CI（-10.32，-1.87），P<0.001〕 in the probiotic yogurt group were significant lower than those in traditional yogurt group.There was no statistically significant difference in the HDL-C level between probiotic yogurt group and traditional yogurt group〔MD=1.29，95%CI（-0.67，3.25），P=0.20〕.There were significant statistical heterogeneity about the levels of HDL-C and LDL-C between the two intervention methods in the different literatures.The longer observation time and possible heterogeneity literatures were deleted using sensitivity analysis.The result showed that there were statistically significant difference in the levels of HDL-C and LDL-C between the probiotic yogurt group and traditional yogurt group〔MD=1.50，95%CI（1.12，2.87），P<0.001；MD=-4.73，95%CI（-8.97，-0.48），P=0.03〕.The funnel plot of the literatures about HDL-C was roughly symmetrical and indicated that there was less possibility of publication bias.Conclusion　Compared with the traditional yogurt，probiotic yogurt can effectively improve the level of blood plasma lipids.However，due to the influence of quality and quantity of the included literatures，this conclusion still needed high-quality experiments to further confirm.

Occurrence Status and Root Cause Analysis of Low Birth Weight and Fetal Macrosomia of Beijing in 2014

HUANG Li-li, JIA Zhao-xia, ZHAO Yong-xian, WANG Zhao, WANG Jun-hua, JIANG Jing-wei, WU Ming-hui

2016, 19(32):  3979-3983.  DOI: 10.3969/j.issn.1007-9572.2016.32.016

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Background　Neonatal birth weight is an important index to measure the growth and development of fetus in the uterus,and it plays an important role in predicting the health condition,growth and development of the newborn in childhood.There are many studies exploring the risk factors of low birth weight and macrosomia,however,there are few studies collecting data in large cities like Beijing.Objective　To investigate the distribution of neonatal birth weight in Beijing,and analyze the risk factors that affect the incidence of low birth weight and macrosomia.Methods　We selected the infants born in 2014 with certificate of live birth from medical birth information database of Beijing maternal and child health information system,and extracted their medical information,including newborn’s gender,birth weight，gestational age at birth,region of birth,and mother’s maternal age,fetal number and place of household registry.Results　We collected 269 609 cases of newborns’ medical information.The average birth weight of the newborn boys was （3 398±489）g,and that of girls was （3 294±471）g.There were 10 753 （3.99%） cases of newborns with low birth weight and 21 685（8.04%） cases with macrosomia.The incidences of low birth weight and macrosomia between different newborn’s gender,gestational age at birth and region of birth were significantly different （P<0.05）;the incidences of low birth weight and macrosomia between different mother’s maternal age,fetal number and place of household registry were also significantly different （P<0.05）.The results of multivariate Logistic regression analysis indicated that girl,premature infant,born in urban area,maternal age below 25 years old and multiple fetuses were the risk factors for low birth weight;boy,postmature infant,born in suburb or exurb,maternal age over 34 years old,single fetus and non-Beijing household registrant were the risk factors for macrosomia（P<0.05）.Conclusion　The incidence of low birth weight is relatively low,whereas that of macrosomia is relatively high in Beijing for the year 2014.Newborn’s gender,gestational age at birth,region of birth，mother’s maternal age and fetal number are the root causes for newborn’s abnormal birth weight.

Cognition on Exercise of Pregnant Women between Primiparas and Multiparas during Pregnancy and Their Prenatal Physical Activities

LI Jing, ZOU Fang-liang, HUANG Shu-rong, ZHAI Jin-guo, CAI Wen-zhi

2016, 19(32):  3983-3986.  DOI: 10.3969/j.issn.1007-9572.2016.32.017

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Objective　To investigate the cognition of pregnant women between primiparas and multiparas on exercise during pregnancy and their prenatal physical activities status.Methods　Pregnant women who had underwent prenatal examination in Traditional Chinese Medicine Hospital of Wuyi from April to August in 2015 in Jiangmen city were investigated by convenience sampling method.The questionnaire was designed by the researchers themselves based on “health belief model” to understand beliefs and attitudes of pregnant women towards exercise during pregnancy；Pregnancy Physical Activity Questionnaire（PPAQ）of Chinese version was applied to investigate the energy expenditure of pregnant women in physical activities of different fields，and the energy expenditure of physical activities of different intensities.Results　637 questionnaires were sent out and 612 valid questionnaires were recovered with an effective response rate of 96.1%，including 365（59.6%）primiparas and 247（40.4%）multiparas.There was no significant difference in cognitive scores of maternal-fetal disease susceptibility caused by no exercise between two groups（P>0.05）；the scores of cognition of severity，cognition of behavior benefits，cognition of behavior disorder，self-efficacy and the total score of health belief of primiparas were significantly higher than those of multiparas（P<0.05）.The energy consumption of high intensity physical activity，traffic travel，professional activity,exercise and total energy consumption between two groups were not significantly different（P>0.05）；energy consumption of sedentary behavior of primiparas was significantly higher than that of multiparas，while their energy consumption of low intensity physical activity，moderate intensity physical activity and household activities were significantly lower than those of multiparas（P<0.05）.Conclusion　The health belief of exercise during pregnancy of primiparas is stronger than that of multiparas，while their active degree of physical activity is lower than that of multiparas.This indicates that exercise behaviors are affected by multiple factors，belief is not equivalent to action.The simply adoption of a theoretical model cannot explain and predict exercise behavior well.

Clinical Features and Prognosis of Patients with Atrial Fibrillation and Slightly Elevated Troponin I Level during Emergency Treatment

WANG Ya-yun, CHEN Man-hua

2016, 19(32):  3987-3990.  DOI: 10.3969/j.issn.1007-9572.2016.32.018

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Objective　To compare the clinical features and prognostic differences of patients with atrial fibrillation and distinct troponin I level during emergency treatment,and to provide references for treatment of such patients.Methods　A total of 503 cases diagnosed with atrial fibrillation in the Central Hospital of Wuhan from 2008 to 2014 were selected as the subjects.Medical history,treatment history,laboratory examination,and clinical symptom of these patients were collected.Troponin I level of these patients during emergency treatment were measured.According to the troponin I level,all the patients were divided into two groups:the observation group（0.01-0.03 μg/L,220 cases） and the control group（<0.01 μg/L,283 cases）.In the follow-up for one year,survival information of the patients was gathered through return visits,telephone,E-mail,or examinations in community hospitals.Results　Differences of gender,atrial fibrillation history,hypertension,OSA detection rate,pacemaker implantation,ICD treatment ratio,Cr,and ventricular rate between the two groups were statistically significant（P<0.05）.Difference of incidence of dyspnea,chest pains,and vertigo between the two groups were not statistically significant（P>0.05）;the incidences of palpitation and fatigue of the observation group were higher than those of the control group（P<0.05）.During the follow-up,five（1.8%） cases in the control group and four（1.8%） cases in the observation group were lost.The total mortality and MI-related mortality of the observation group were higher than those of the control group（P<0.05）.Conclusion　The patients with atrial fibrillation and slightly elevated troponin I level mostly have atrial fibrillation history;the MI-related mortality and total mortality of these patients increase within one year.

Small Cell Neuroendocrine Tumor of the Urinary System：An Overview of Clinicopathological Characteristics and Diagnosis and Treatment

LIU Fei, SHI Jian, YUAN Meng

2016, 19(32):  3990-3994.  DOI: 10.3969/j.issn.1007-9572.2016.32.019

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Neuroendocrine tumor（NET）belongs to a group of heterogeneous tumor，it originates from neuroendocrine system and can occur anywhere on the body，but NET which originates from the urinary system is relatively rare.Small cell NET is a kind of NET with poor differentiation.In this article，the clinicopathological features，diagnosis and differential diagnosis，treatment and prognosis of small cell NET of the urinary system were reviewed，thus the understanding and treatment level of this disease can be improved.

Cerebral Infarction Caused by Cerebral Proliferative Angiopathy：A Case Report and Literature Review

YUAN Zheng-zhou, ZHOU Yan-li, LI Jing-lun, ZHANG Shu-jiang, XIAO Zheng-yuan, ZHOU Fan, LI Zuo-xiao

2016, 19(32):  3995-3998.  DOI: 10.3969/j.issn.1007-9572.2016.32.020

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Atherosclerosis,which resulted in cerebral vascular stenosis or even occlusion,is the most common cause of cerebral infarction.Here we reported a case of cerebral infarction caused by cerebral proliferative angiopathy（CPA）.There were more blood vessels in cerebral infarction area than normal brain tissue in the patient.Through the literature review,we discussed clinical manifestations,imaging and digital subtraction angiography appearances,pathological features,pathogenesis,treatment,and prognosis of CPA.Only few cases of cerebral infarction caused by CPA have been described in the world literature till now.CT angiography imaging could demonstrate unusually abundant blood vessels in the lesion.Treatment should be adapted to the patient specific characteristics,while the prognosis of CPA is hard to predict.

Long Time Use of CPR Appliance for CPR:One Case Report and Literature Review

PAN Ling-ai, SHANG Kai-xi, HUANG Xiao-bo

2016, 19(32):  3999-4001.  DOI: 10.3969/j.issn.1007-9572.2016.32.021

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High efficiency cardiopulmonary resuscitation（CPR） is one of the most important factors to improve the rescue success rate of CPR.In recent years,CPR appliance have been used in clinical practice,this paper introduces a case of using CPR appliance for 5 hours and reviews of the relevant literature,so that clinicians can use these new technologies better,improve the successful rate of first aid.

Coexistence of Thyroid Dysfunction and Malignant Struma Ovarii:One Case Report and Literature Review

ZENG Jia-ling, ZHANG Hong

2016, 19(32):  4002-4008.  DOI: 10.3969/j.issn.1007-9572.2016.32.022

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Objective　To explore the clinical manifestation and laboratory test results of patients with thyroid dysfunction and malignant struma ovarii,to enhance the understanding of the disease.Methods　A patient with thyroid dysfunction and malignant struma ovarii was admitted to the Fourth Affiliated Hospital of Guangxi Medical University on 29 April 2015,the data of the case were analyzed retrospectively.To further understand coexistence of thyroid dysfunction and malignant struma ovarii by literature retrieval.Results　Struma ovarii is more common in perimenopausal women and on unilateral side，and most of them are benign,multiple metastases are rarely seen.The onset age of this case is identical with the onset age recorded in literatures,the lesion is highly malignant and multiple metastases are observed,and the case is clinically very rare because of the existence of thyroid dysfunction.Conclusion　Struma ovarii can cause hyperthyroidism,possible sources of thyroxine:high functional ovarian thyroid tissue,high functional thyroid and struma ovarii,thyroid tissue secretion combined with non functional ovarian goiter;for hyperthyroidism caused by struma ovarii,the iodine uptake rate in pelvic cavity should be high and the iodine uptake rate in the neck should be low;the diagnosis of struma ovarii combined with hyperthyroidism is relatively difficult,the disease always is paid more attention to due to repeated recurrence of hyperthyroidism,non functional struma ovarii is more likely to cause missed diagnosis;functional ovarian thyroid is similar to ectopic thyroid gland hyperactive adenoma,and can secrete thyroid hormone,thus can inhibit thyroid function,but struma ovarii secrets triiodothyronine（T3） mainly,the abnormal thyroid function performance such as increased levels of TT3 and FT3,and decreased levels of TSH,TT4 and FT4 may exist,all of these findings warrant further research.

Preventive Position of Ventilator-associated Pneumonia and Its Compliance

XU Gui-ru, WANG Yan, LI Li, LI Ying-lan

2016, 19(32):  4009-4013.  DOI: 10.3969/j.issn.1007-9572.2016.32.023

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Supine position is one of the independent risk factors of ventilator-associated pneumonia（VAP） in any patient who is mechanically ventilated.Changing positions can markedly prevent VAP.This review summarizes the advantages and disadvantages of common preventive positions for VAP，such as <30° semi-recumbent position，30°-45° semi-recumbent position，continuous lateral rotation therapy and etc，meanwhile analyzes the medical care personnel compliance and influencing factors of semi-recumbent and other positions.We sum up existing problems and make recommendations in order to provide strategy for prevention of VAP.

Research Prognosis of Application of Mesenchymal Stem Cells in the Tissue Repair of Rheumatoid Arthritis

ZHANG Xiang-mei, TANAKA Yoshiya, SHAN Bao-en

2016, 19(32):  4014-4018.  DOI: 10.3969/j.issn.1007-9572.2016.32.024

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Rheumatoid arthritis（RA） is an autoimmune disease characterized by synovitis and articular injury due to synovitis.The current available treatments for RA mainly control synovitis,but have little effects on articular destruction repair.Mesenchymal stem cells（MSC） have effects on immunological regulation,and have the ability of multiple differentiation potential,so MSC have the potential to control synovitis and repair articular destruction.Until now,some researchers have reported the application of MSC in the treatment of RA patients or RA animal models,while these studies lead to different conclusions,and few studies focused on the effects of articular destruction.The studies on application of MSC in the tissue repair of RA are summarized in this article,which may provide the reference for clinical treatment.

Research Progress of Twist Gene in Ovarian Cancer

HONG Li, YANG Jiang, XING Hui

2016, 19(32):  4019-4022.  DOI: 10.3969/j.issn.1007-9572.2016.32.025

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Ovarian cancer is a gynecologic malignant tumor with morbidity in the third place after endometrial cancer and cervical cancer,its fatality rate ranks first in gynecologic malignant tumors.Twist in the transcription factor of basic helix-loop-helix （bHLH） family is highly expressed in ovarian cancer tissues,and its abnormal expression plays an important role in the process of occurrence,development and deterioration of the ovary.After silence processing of Twist gene,proliferation and migration of ovarian carcinoma cells will be obviously affected.By combining recent research results at home and abroad,the paper outlines the latest mechanism of Twist gene in the occurrence and development of ovarian cancer.

Scientific Statement on the Correct Understanding of Cholesterol

Branch of Non-communicable Chronic Disease Prevention & Control, Chinese Preventive Medicine Association, Branch of Nutrition and Non-communicable Chronic Disease Prevention & Control, Chinese Nutrition Society, Chinese Society of Cardiology, Chinese Association of Cardiovascular Health

2016, 19(32):  4023-4024.  DOI: 10.3969/j.issn.1007-9572.2016.32.026

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Scientific statement on the correct understanding of cholesterol［J］.Chinese General Practice，2016，19（32）：4023-4024.