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Table of Content

    21 September 2019, Volume 40 Issue 5
    Reliability and validity of the Chinese Version Dysfunctional Beliefs and Attitudes about sleep scale
    Xu Bo, Yang Lijuan, Li Zhanjiang
    2019, 40(5):  665-670.  doi:10.3969/j.issn.1006-7795.2019.05.001
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    Objective To evaluate the psychometric characteristics of the dysfunctional beliefs and attitudes about sleep scale. Methods Totally 218 participants who were diagnosed with primary insomnia and insomnia combided with psychiatric disorders according to the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) and 34 good sleepers were recruited. All participants were measured by Dysfunctional Beliefs and Attitudes about Sleep Scale(DBAS), DBAS-16 and Pittsburgh Sleep Quality Index(PSQI).Thirty of them were remeasured by DBAS after two weeks.Results Five factors were extracted in the DBAS-Chinese Version (CV) by the exploratory factor analysis. Total DBAS-CV score was significantly correlated with DBAS-16 (r=0.86,P<0.01) and PSQI(r=-0.48, P<0.01). DBAS-CV scale had a good discriminant validity as well (P<0.01). The Cronbach's coefficient of DBAS-CV was 0.83. The Cronbach's coefficients of five subscales were 0.42-0.78. The test-retest reliability coefficient was 0.94,and coefficient of each subscales ranged from 0.76 to 0.93 (P<0.01). Revised Chinese Version of DBAS scale had a good discriminant validity as well(P<0.01). Conclusion Revised Chinese Version of DBAS showed good reliability and validity, and it could be used to evaluate dysfunctional beliefs in insomniacs.
    Reliability and validity of the whiteley index-Chinese version
    Su Xue, Li Zhanjiang, Long Jing, Zu Si, Zhang Yanbo, Xu Bo
    2019, 40(5):  671-676.  doi:10.3969/j.issn.1006-7795.2019.05.002
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    Objective To the psychometric characteristics of patients bothered by anxiety disorder with the Chinese Version of the scale Whiteley Index (WI-CV). Methods Totally we enrolled 291 patients with somatoform disorders, major depressive disorder, generalized anxiety disorder, panic disorder, and obsessive-compulsive disorder diagnosed with ICD-10 from five hospitals in Beijing, and 190 normal people were enrolled as the control. They were assessed with WI-CV, Chinese Version of Illness Attitude Scale(IAS-CV), Beck Depression Inventory-Ⅱ(BDI-Ⅱ), and Beck Anxiety Inventory(BAI). Results The exploratory factor analysis resulted in 12 items and finally three factors, disease conviction, disease phobia, and bodily preoccupation. The total score of WI-CV was correlated with IAS-CV scores (r=0.69, P<0.01), BAI scores (r=0.50, P<0.01) and BDI-Ⅱ scores (r=0.38, P<0.01). Factor disease convince was correlated with IAS-CV scores (r=0.60, P<0.01), BAI scores (r=0.51, P<0.01) and BDI-Ⅱ scores (r=0.39, P<0.01). Factor disease phobia was correlated with IAS-CV scores (r=0.60, P<0.01), BAI scores (r=0.25, P<0.01) and BDI-Ⅱ scores (r=0.14, P>0.01).Factor bodily preoccupation was correlated with IAS-CV scores (r=0.49, P<0.01), BAI scores (r=0.41, P<0.01) and BDI-Ⅱ scores (r=0.37, P<0.0 1). Patients with somatoform disorders (7.24±2.89) had higher scores than patients with other disorder, such as depression (4.77±2.99), anxiety (5.07±3.05), obsessive compulsive disorder (5.91±2.73), and normal controls (2.52±2.58). Obsessive compulsive disorder had higher scores than other four disorders. Normal controls get the lowest score than other patients. The Cronbach's α coefficients were 0.82 for WI-CV total score and 0.53-0.71 for each subscale. Pearson coefficient measured between total score and factor score were 0.91, 0.76, and 0.76. Split-half coefficient of WI-CV was 0.83, and Split-half coefficient of subscales were 0.59-0.74. Conclusion It suggested that the WI-CV has good psychometric features and it may be trialed in clinical practice and research in China.
    Path analysis on the influence of clinicians' social support,resilience and coping style on their occupational stress
    Dong Rui, Hua Liang, Yu Liling
    2019, 40(5):  677-682.  doi:10.3969/j.issn.1006-7795.2019.05.003
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    Objective To explore the influence mechanism of clinicians' social support, resilience and coping styles on their occupational stress. Methods Random sampling of public hospitals in Beijing, one for each of the second and third grade hospitals, two for the first-level hospitals, a total of 450 doctors and 417 valid questionnaires. Clinician's social support, resilience, coping styles, and occupational stress levels were measured using the Social Support Rating Scale (SSRS), the Connor-Davidson Resilience Scale (CD-RISC), the Coping Style Questionnaire (CSQ), and the Job Stress Scale (JSS). Product moment correlation and path analysis were performed using statistical software. Results The occupational stress and total social support scores(r=-0.416,P<0.01), total scores of resilience(r=-0.387,P<0.01), total scores of positive coping styles(r=-0.357,P<0.01), and total scores of negative coping styles (r=0.203,P<0.01)and their factors were significantly correlated. Social support can directly affect occupational stress. It can also affect occupational stress through the intermediary role of positive and negative coping styles. It can also affect occupational stress through the mediation of resilience and coping style. Conclusion The hospital management should provide effective social support and psychological education for clinicians from the perspective of relieving occupational stress; clinicians should pay attention to the use of multi-channel social support resources, and be good at adopting positive coping styles in order to alleviate occupational stress.
    Mediating effect of resilience between job autonomy and job burnout of pediatrics residents
    Liu Ying, Wei Tongqi
    2019, 40(5):  683-687.  doi:10.3969/j.issn.1006-7795.2019.05.004
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    Objective To explore the relations between job autonomy and job burnout of pediatrics residents and to test the mediating effect of resilience between above two variables. Methods Totally 139 pediatrics residents from a children's hospital in Beijing were assessed by Resilience Scale, Job Autonomy Scale and Marshals Burnout Inventory. Differences between the sample and the norms were detected. Mediation analysis using structural equation modeling was conducted to test the mediating effect of resilience on the relationship between job autonomy and job burnout. Results The three dimensions of burnout are significantly different from the norm(P<0.001). In the relationship between job autonomy and emotion exhaustion and the relationship between job autonomy and performance, resilience played a full mediator role(P<0.01); In the relationship between job autonomy and depersonality, resilience played a partial mediator role(P<0.01) and the mediating effect was 34.65%. Conclusion Job autonomy influenced job burnout through resilience. It is advised to improve the pediatrics residents' resilience in order to reduce their job burnout.
    Analysis of clinical characteristics of catatonia in psychiatric emergency
    He Xiaoxiao, Zhou Fuchun, Wang Chuanyue, Zhu Hui, Ji Xiao, Guan Hongzhi
    2019, 40(5):  688-692.  doi:10.3969/j.issn.1006-7795.2019.05.005
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    Objective To analysis the clinical characteristics of catatonia in psychiatric emergency department. Methods Patients were recruited from the psychotic emergency observation ward in Beijing Anding Hospital, Capital Medical University, between March 2018 and February 2019. The study sample consisted of 123 patients, including 46 catatonic patients and 77 psychotic patients without catatonia features. They were assessed at the admission to determine their catatonia diagnosis and the severity of psychiatric symptoms. Diagnostic and Statistical Manual of Mental Disorders (DSM-5) were used to establish the diagnosis; the Bush-Francis Catatonia Rating Scale (BFCRS) and the Positive and Negative Syndrome Scale (PANSS) were used to determine the severity of catatonic and other psychiatric symptoms, respectively. Results ①The prodromal infection is more common in patients with catatonia (19.6% vs 1.3%). Catatonia patients also had longer stay in hospital[(4.3±2.7) vs (2.1±1.5)]d, higher score on PANSS negative subscale[(26.6±8.6) vs (10.52±5.7)], more urinary incontinence/retention (5.2% vs 1.3%) and incontinence/constipation (58.7% vs 23.4%), higher number of total white blood cells (47.8% vs 26.0%) and higher plasma creatine kinase level (58.7% vs 28.6%). The difference was statistically significant. ② The primary diagnosis included 18 (39.1%) cases of schizophrenia, 10 (21.7%) cases of mood disorder in the group with catatonia, 6 patients (13.0%) with organic catatonia. Negativism, mutism, stupor, agitation, and stereotype were the most common catatonic signs in our sample. Conclusion Patients with catatonia were often brought to psychiatric emergency room as their initial treatment. Catatonia patients presented more severe symptoms, which were often rated as negative symptoms, and were often comorbid with mental and general medical conditions.
    History and future trend of modern psychotherapy
    Song Minjie, Li Zhanjiang
    2019, 40(5):  693-697.  doi:10.3969/j.issn.1006-7795.2019.05.006
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    After experiencing the era that psychotherapy genre was factional and lack of evidence-based support,psychotherapy gradually presents an integrated and compatible situation. The short-term,standardized treatment programs and objective evaluation standards are more in line with evidence-based science and the needs of social policy. In addition,with the rapid development of internet technology,the combination of psychotherapy and information technology such as web platform,virtual reality, and emotional computing is getting more extensive and closer,which provides an effective way to improve the convenience and effectiveness of psychotherapy. The purpose of this paper is to review the origin and history of psychotherapy,summarize the basic methods and deficiencies of the current major psychotherapy genres,and look forward to the development of psychotherapy.
    Lifestyle interventions for physical health conditions in patients with schizophrenia
    Zhuang Wenxu, Zhang Weibo, Zhu Youwei, Zhu Yi, Cai Jun
    2019, 40(5):  698-702.  doi:10.3969/j.issn.1006-7795.2019.05.007
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    The physical health problems in schizophrenia are prominent, especially obesity and metabolic and cardiovascular diseases. Lifestyle interventions including physical activity and dietary adjustment are recommended as non-drug interventions for obesity and other related medical conditions. The paper summarized recent studies on lifestyle intervention in patients with schizophrenia. It has been proved that lifestyle interventions have a significant effect on weight loss but a less obvious effects on blood pressure, glucose and waist-hip ratio control. It may shed light on correlation between physical health problems of patients with schizophrenia and the community management and treatment services of severe mental disorders in China. The influence of lifestyle interventions in the community rehabilitation on the physical health problems of patients with schizophrenia should be concerned.
    Effects of chrysophanol on Beclin1 and Bax protein expressions in mice with focal cerebral ischemia/reperfusion injury
    Fang Yalan, Huang Yuyou, Zhao Yongmei, Shi Wenjuan, Li Jincheng, Duan Yunxia, Gao Li, Luo Yumin
    2019, 40(5):  703-708.  doi:10.3969/j.issn.1006-7795.2019.05.008
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    Objective To study the protective effect mechanism of chrysophanol (CHR) on focal cerebral ischemia/reperfusion mice by regulating the expressions of autophagy-related protein Beclin1 and apoptosis-related protein Bax. Methods A total of 18 male C57BL/B6 mice were randomly (random number) divided into three groups:Sham group (n=6), middle cerebral artery occlusion (MCAO)/perfusion (MCAO group, n=6), and CHR group (n=6). The right MCAO for 45 min was induced by thread embolism and the reperfusion lasted for 14 days. CHR in dose of 0.1 mg/kg was intraperitoneally injected in CHR group mice once a day. On 14 d after reperfusion, the brain tissue was obtained. The positive expressions of autophagy-related protein Beclin1 in the brain ischemic penumbra were observed with immunofluorescent staining. The level of apoptosis-related protein Bax in ischemic brain tissue sections was determined by Western blotting. Results 1) There was little Beclin1 positive cells in Sham group. Compared with Sham group, the number of Beclin1 positive cells in the penumbra of MCAO group obviously increased on 14 d after reperfusion (P<0.05). Compared with MCAO group, the number of positive cells of Beclin1 decreased significantly in the penumbra of CHR group on 14 d after reperfusion (P<0.05). 2) The Beclin1 positive cells were co-localized with NeuN, a general neuronal marker, in the brain ischemic penumbra. 3) Bax protein level was upregulated in the brains of MCAO mice on 14 d after reperfusion. CHR treatment decreased Bax protein level in the ischemic tissue compared with MCAO group (P<0.05). Conclusion CHR may reduce neuronal apoptosis and alleviate excessive activation of autophagy by inhibiting the production of Bax protein and reducing the production of Beclin1 protein, and thus exerts long-term neuroprotective effects on cerebral ischemia-reperfusion injury.
    Regulatory effect of nitric oxide scavenger Carboxy-PTIO on PERK/p-eIF2α pathway in rats with transient focal cerebral ischemia
    Huang Yuyou, Fang Yalan, Shi Wenjuan, Liu Kejian, Zhao Yongmei, Ding Mao, Luo Yumin
    2019, 40(5):  709-714.  doi:10.3969/j.issn.1006-7795.2019.05.009
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    Objective To observe the effect of nitric oxide (NO) remover Carboxy-PTIO (C-PTIO) on cell death mediated by PERK/p-eIF2α pathway in the brain tissues of middle cerebral artery occlusion (MCAO) model rats after 24 hours reperfusion, and to explore the effect of NO production on endoplasmic reticulum stress (ERS)-mediated neuronal apoptosis. Methods Eighteen healthy male Sprague-Dawley rats were divided into sham operation group, MCAO group and MCAO+C-PTIO group (n=6) according to random number table. Rat model of middle cerebral artery ischemia-reperfusion was made by modified suture method, the rats were underwent 90 min of right MCAO, and then reperfusion by withdrawing the filament. The anus temperature of the rats was monitored during the operation. The rats were sacrificed 24 h after reperfusion, and the brain was collected quickly. The expression of p-eIF2α and CHOP in the ischemic penumbra of frozen sections of the brain tissues were detected by immunofluorescence staining. The co-localization of NO-mediated protein damage marker 3-nitrotyrosine (3-NT) with p-eIF2α and CHOP, respectively, was observed with immunofluorescence double labeling. Results 1) No p-eIF2α and 3-NT positive cells were observed in the sham group, while CHOP staining positive cells were occasionally observed. In the MCAO group, the expression of 3-NT, p-eIF2α and CHOP in the ischemic penumbra of the brain tissue increased significantly (P<0.05). 2) Compared with the MCAO group, the expressions of 3-NT, p-eIF2α and CHOP in the penumbra of the ischemia-reperfusion rats were significantly decreased after intraperitoneal injection of C-PTIO (P<0.05). 3) In the penumbra of brain tissue of ischemia-reperfusion rats, 3-NT was co-localized with p-eIF2α and CHOP as observed with immunofluorescence staining. Conclusion NO-mediated oxidative stress damage induces ERS and activates PERK/eIF2α pathway to induce apoptosis during cerebral ischemia-reperfusion. Inhibition of NO production attenuates this process and plays a neuroprotective role.
    Effect of saxagliptin on cognitive function in patients with type 2 diabetes after ischemic stroke
    Li Sen, Huang Anqi, Guo Jianfei, Bai Jie, Zhang Guangzhen, Wang Ting, Zhao Yongmei
    2019, 40(5):  715-720.  doi:10.3969/j.issn.1006-7795.2019.05.010
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    Objective To investigate the effect of saxagliptin on cognitive function in patients with ischemic stroke and type 2 diabetes.Methods This is a prospective cohort study. A total of 255 new ischemic stroke patients combined with type 2 diabetes were randomly divided into two groups, saxagliptin group and non-saxagliptin group (intervened with gliclazide). Demographic characteristics and basic biochemistry data were collected. The initial cognitive function was evaluated by Montreal Cognitive Assessment (MoCA). The participants with MoCA score below 26 and/or serum glucose disqualified were excluded. Totally 206 patients were screened, and cognitive function assessment was re-evaluated at 1, 3, and 5 months after stroke. The score below 22 points was set as the end point event, which was defined as post-stroke cognitive impairment (PSCI). MoCA scores between the two groups were analyzed with multivariate COX regression analysis.Results Totally 130 cases complete this research. Baseline data were compared between the two groups and no statistical differences were observed. At the end of the observation, 37 patients in the saxagliptin group reached the end point (62 analyzed), with the incidence of PSCI 59.7%, and 50 patients in the non-saxagliptin group reached the end point (68 analyzed), with the incidence of PSCI 73.5%. Multivariate COX regression analysis suggested that the hazard ratio (HR) for saxagliptin intervention was 0.617, with 95%CI 0.388~0.983 and P<0.05.Conclusion Saxagliptin hypoglycemic therapy can reduce the degree of PSCI in patients with ischemic stroke complicated with type 2 diabetes. Conclusion Saxagliptin hypoglycemic therapy can reduce the degree of PSCI in patients with ischemic stroke complicated with type 2 diabetes.
    Influence of interaction between urine 11dehydrothromboxane B2 and other risk factors on disease occurrence in patients with cerebral infarction
    Wang Lingling, Chen Guixin, Wang Zhaohui, Sun Sainan, Sun Boqian, Li Wei
    2019, 40(5):  721-725.  doi:10.3969/j.issn.1006-7795.2019.05.011
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    Objective To analyze the interaction between urine 11 dehydrothromboxane B2(11-DH-TXB2) content and smoking history, drinking history, hypertension history and diabetes history in patients with cerebral infarction, and to clarify the value of 11-DH-TXB2 in the occurrence and prevention of cerebral infarction. Methods Totally 117 patients with cerebral infarction and 50 healthy controls were selected. The general data, smoking history, drinking history, hypertension and diabetes history of the patients were collected, and the content of 11-DH-TXB2 was detected. Statistical analysis was made on the difference between the two groups of 11-DH-TXB2, and the interaction model analysis between 11-DH-TXB2 and other cerebrovascular disease risk factors was carried out. Results There was no statistical difference in general data between the two groups (P>0.05). The urine 11-DH-TXB2 content, smoking history, diabetes history and hypertension history showed statistical significance between the two groups (P<0.05), while drinking history showed no statistical significance between the two groups (P>0.05).In the analysis of interaction additive model, negative interference factor (-/-) was taken as the contrast illuminance, and the OR value was set to 1, the interaction effect index (S) of the increase of 11-DH-TXB2 and smoking history was set to 1.219, the increase of 11-DH-TXB2 and hypertension history S were set to 5.578, the increase of 11-DH-TXB2 and diabetes history S were set to 4.604. Conclusion Urine 11-DH-TXB2 content is correlated with the occurrence of cerebral infarction, and has synergistic interaction with smoking history, hypertension history and diabetes history of cerebral infarction patients. 11-DH-TXB2 can be used as a risk factor for cerebral infarction prevention.
    Study of tissue distribution of paraquat in rats
    Li Pengfei, Fan Jiaming, Liu He, Zhang Xi, An Zhuoling, Liu Lihong
    2019, 40(5):  726-730.  doi:10.3969/j.issn.1006-7795.2019.05.012
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    Objective To study of the tissue distribution of paraquat in rats. Methods Thirty-six male rats were divided into nine groups:the pre-administration group, the 0.5, 1, 3, 6, 10, 24, 48 and 72 hours after administration. The pre-administration group did not give paraquat, and the tissues were directly taken. The post-administration group was given 90 mg/kg paraquat by single administration, and the tissues and plasma were taken at the corresponding time points. Heart, liver, lung, kidney, brain, cerebellum, stomach were taken for homogenate extraction, and paraquat concentration in tissues and plasma was determined by liquid chromatography-tandem mass spectrometry (LC-MS/MS). Results The highest concentration of paraquat in stomach, kidney, lung and liver was more than 30 μg/g, and the highest concentration of paraquat in heart, brain and cerebellum was less than 10 μg/g. The highest concentrations were found in stomach and lung at 1 hour (205.5±69.5) μg/g and (35.5±28.0) μg/g, respectively. The highest concentrations were found in kidney and liver at 3 hours (124.8±146.9) μg/g and (30.9±42.1) μg/g, respectively. Most of the concentration in tissues and plasma varied more than 50% individually, showing higher individual differences. Conclusion The distribution of paraquat in vivo is highly similar with the damage location and degree of target organs after poisoning. The plasma concentration of paraquat can only indirectly reflect of the paraquat in vivo, but can not represent the level of poisons in injured organs. We should pay attention to the damage and failure of target organs in clinical practice, and timely intervention and treatment.
    Building a prediction model of brain tissues gene expression based on whole blood gene expression profiles
    Xu Wenjian, Li Wei
    2019, 40(5):  731-737.  doi:10.3969/j.issn.1006-7795.2019.05.013
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    Objective Gene expression analysis is a powerful tool for explaining biological phenotypes and assisting disease diagnosis. It is difficult, risky and expensive to collect the samples of gene expression experiment of brain tissue. It is urgent to find an alternative method to detect the expression profiles of brain tissue from other available samples. Methods Using the whole blood gene expression profiles matched with brain tissue samples from GTEx (Genotype-Tissue Expression) database as input features and 13 brain tissue expression profiles as targets, we mined many-to-many correlations between the gene expression level in whole blood and that of specific brain tissue. Then we construct a predictive regression model of gene expression level of unavailable brain tissue based on the expression level of whole blood gene expression profiles. Results A new low-dimensional feature dataset for each gene in each brain tissue was constructed by extracting 15 most relevant gene expression features from whole blood, and a linear regression prediction model for all gene in 13 brain tissues was constructed. The mean absolute error (MAE) of the prediction model is between 0.406 and 0.542, and the root mean square error (RMSE) is between 0.558 and 0.941. Conclusion A prediction model of gene expression in brain tissues based on whole blood gene expression profile is proposed. It is proved that the gene expression in unsampled brain tissue can be predicted relatively accurately only by using whole blood expression profile data. It is possible that the surgical sampling of brain tissue samples can be avoided in transcriptome research, thus providing an alternative for the study of gene expression profiles of brain tissue-related diseases.
    Extraction process and determination of caffeine and catechins from tea
    Shao Jianqun, Li Qingyuan, Wang Yuji, Zhang Feng
    2019, 40(5):  738-743.  doi:10.3969/j.issn.1006-7795.2019.05.014
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    Objective Research on heating and ultrasonic method optimum extraction technology of caffeine (CAF),epigallocatechin gallate (EGCG), epicatechin gallate (ECG),epicatechin (EC) in tea. Methods The amounts of effective components from tea were determined by high performance liquid chromatography (HPLC) and the ethanol concentration, extraction time and solid-liquid ratio as the factors affecting were studied. Results Heating extraction process was ethanol concentration of 65%, solid-liquid ratio of 1:25 and extraction for 30 min at 85℃. Ultrasonic extraction process was ethanol concentration of 65%, solid-liquid ratio of 1:25 and ultrasonic for 60 min at room temperature. Conclusion The results showed that two kinds of extraction technology had the same extraction efficiency and four kinds of effective components in the extract content from the high to the end order were EC, EGCG, CAF and ECG. Catechin material in EC, EGCG and ECG in green tea and scented tea were significantly higher than that of black tea and puer tea.
    Value of SYNTAX score Ⅱ to predict no-reflow of prior percutaneous coronary intervention in patients with ST-segment elevation myocardial infarction
    Hao Peng, Feng Siting, Zhen Lei, Wang Xiao, Wang Chunmei, Nie Shaoping
    2019, 40(5):  744-748.  doi:10.3969/j.issn.1006-7795.2019.05.015
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    Objective To assess the value of SYNTAX score and SYNTAX Ⅱ score to predict no-reflow of primary percutaneous coronary intervention (pPCI) in patients with acute ST-segment elevation myocardial infarction (STEMI). Methods A total of 384 STEMI patients who were diagnosed by coronary angiography within 12 hours were enrolled in the Emergency Critical Care Center of Beijing Anzhen Hospital from January 2016 to January 2017 in this study. No-reflow group (76 cases) and normal blood flow group (308 cases) are divided by reflux phenomenon. SYNTAX score and SYNTAX Ⅱ score were calculated,and the clinical features and laboratory data were collected to compare the differences between groups. Logistics regression analysis was assessed of no-reflow factors,and receiver operating characteristic (ROC) curve analysis was compared the SYNTAX score with SYNTAX Ⅱ score in predictive value of no-reflow phenomenon in STEMI patients. Results Through univariate analysis,SYNTAX score and SYNTAX Ⅱ score were all correlated with no reflow of coronary arteries,but only SYNTAX Ⅱ score was correlated with no reflow of coronary arteries in multivariate analysis. With high SYNTAX Ⅱ score,the risk of coronary non-reflow increased. ROC curve analysis showed that the area under curve of SYNTAX score Ⅱ was larger than SYNTAX score,and the difference was statistically significant (0.905 vs 0.818,P<0.001). Furthermore,the sensitivity and specificity of predicting no reflow were higher than SYNTAX score. Conclusion The SYNTAX Ⅱ score was an independent risk factor of no-reflow and had a better predictive value of no-reflow than the SYNTAX score in STEMI patients.
    Clinical effects of postoperative application of glucocorticoids in total knee arthroplasty
    Zhang Bo, Wang Jinjun, Wang Zhiwei, Ren Shixiang, Lin Yuan
    2019, 40(5):  749-753.  doi:10.3969/j.issn.1006-7795.2019.05.016
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    Objective To investigate the clinical efficacy of the short-term intravenous glucocorticoid after primary total knee arthroplasty and to evaluate the security of the patients. Methods From March 2016 to March 2018,348 cases (496 knees) who met the inclusion criteria had received primary total knee arthroplasty (TKA) in our hospital. All of the patients were divided into two groups according to whether glucocorticoid was used after operation-regular group (186 patients,266 knees) and hormone group (162 cases,230 knees). Observation indexes include:visual analogue scale (VAS) and range of motion 1 to 7days after the operation,hospital for special surgery scores at the first week after the operation and the postoperative complications rate,include nausea,vomiting,wound healing and joint infection. Results The VAS and range of motion (ROM) after surgery of the Hormone group was significantly better than the normal group,also relate to the HSS score,with significant difference between these two groups. Furthermore,the incidence of nausea and vomiting in the hormone group was significantly lower than that in the normal group,and there was no significant difference in the incidence of wound healing and infection. Conclusion Short-term intravenous application of glucocorticoid hormones can significantly reduce postoperative pain patients,reduce postoperative nausea and vomiting,promote the knee function recovery,at the same time does not increase complications such as poor wound healing,infection of joint after replacement.
    Risk assessment and management of human immunodeficiency virus (HIV) patients with teeth extraction perioperative period
    Wang Kaili, Chen Shizhang
    2019, 40(5):  754-757.  doi:10.3969/j.issn.1006-7795.2019.05.017
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    Objective To evaluate the perioperative immune status of human immunodeficiency virus (HIV) patients,and explore the clinical treatment methods to prevent infection and reduce the risk of postoperative infection.Methods Analysis the clinical data of 246 HIV-infected patients for tooth extraction from May 2008 to July 2018. They were divided into three groups according to the level of CD4+T lymphocytes before operation,and given corresponding anti-infection treatment. To summarize related perioperative process in each group,and analyze the changes of CD4+T lymphocytes for seventh day and 1 month after the operation were done. Results According to the different immune status of patients,we adopted the corresponding anti-infection treatment scheme to ensure the medical safety and achieve the ideal therapeutic result. The results showed that:the CD4+T lymphocyte of the patients were significantly reduced 7 days after the operation (P<0.05,with statistical difference),but it could be restored to the preoperative level 1 month after the operation. Conclusion We can determine the operation time,evaluate the operation risk and give corresponding preventive intervention treatment according to CD4+T lymphocytes which can reflect the immune status of HIV-infected patients. Reasonable anti-infection treatment can improve the immune status of HIV-infected patients. Meanwhile,the perioperative psychological management and diet management cannot be ignored.
    Application of the critical-care pain observation tool for pain assessment in intracranial tumor patients after craniotomy
    Yang Yanlin, Chen Guangqiang, He Xuan, Shi Zhonghua, Xu Ming, Zhou Jianxin
    2019, 40(5):  758-763.  doi:10.3969/j.issn.1006-7795.2019.05.018
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    Objective To evaluate the reliability and validity of the critical-care pain observation tool (CPOT) for pain assessment in intracranial tumor patients after craniotomy. Methods This prospective study was enrolled intracranial tumor patients after craniotomy undergoing mechanical ventilation in the intensive care unit (ICU). Nociceptive and non-nociceptive operations were performed in a random crossover manner. Two researchers completed CPOT evaluation before and after the operation, and another researcher performed pain evaluation after the operation. Patients were divided into two groups according to whether they could self-report pain. The intraclass correlation coefficient (ICC) was used to compare the reliability of CPOT between the two researchers. By using self-reported pain as the reference, the receiver operating characteristic (ROC) curve of CPOT and vital signs was drawn, and the area under the curve (AUC) and 95% confidence intervals (CI) were calculated. Changes in CPOT and vital signs before and after different operations were compared in patients without self-reported pain. Results A total of 243 patients were enrolled, 171 (70.4%) were able to complain self-report pain. It was maintained in 151 (88.3%) and 34 (19.9%) patients complained pain during nociceptive and non-nociceptive operations, respectively. The ICC range of patients with self-reported pain or not before and after different operations was between 0.790 and 0.945. For patients with self-reported pain, the AUC and 95% CI for CPOT were 0.805 (0.759-0.852) (P<0.001). For patients without self-reported pain, CPOT was increased significantly after nociceptive operation. Conclusion CPOT has good reliability and validity for pain assessment in intracranial tumor patients after craniocerebral craniotomy. It could also distinguish the differences between nociceptive and non-nociceptive operations in patients without self-report pain.
    Investigation and intervention of donor-derived infection of renal transplantation
    Shan Hui, Zhang Xin, Gu Li, Tang Ziren, Zhang Xiaodong
    2019, 40(5):  764-768.  doi:10.3969/j.issn.1006-7795.2019.05.019
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    Objective To summarize the experience of donor selection and receptor therapy in the face of potential donor infection, which improves the quality of the use of donor organs, reduces the risk of postoperative infection and the loss of transplant kidney and recipient mortality. Methods This study used a retrospective analysis of 59 kidneys from 31 donors and corresponding recipients from April 2017 to March 2018. Results The pathogenic culture of only 10 donors in 31 donors were totally negative, accounting for only 32%. Two receptors whose donor's blood culture was positive for Acinetobacter baumannii were treated with cefoperazone sulbactam sodium and tigecycline; two receptors whose donor's phlegm culture was positive for Acinetobacter baumannii were treated with cefoperazone sulbactam sodium; for the donor whose phlegm culture was positive for Candida albicans, the responding recipient whose urine culture was positive for the same pathogenic bacteria was treated with fluconazole; none of the above recipients experienced serious adverse events caused by donor-derived infections after targeted anti-infective treatment. Conclusion Although it is quite common for the donor to have an infection before the organ is acquired, we could improve prognosis of the patients and reduce the serious adverse events caused by donor-derived infections through a package of measures, such as target and preventive application of appropriate and prophylactic antibiotics to the corresponding donors, closely detecting changes in infection indicators, and adjusting medications timely.
    Clinical imaging characteristics of magnetic resonance neurography of normal lumbar nerve root
    Ding Yi, Yang Jincai, Zhang Liming, Yang Zaisong, Yin Peng, Liu Chang, Xu Chunyang
    2019, 40(5):  769-775.  doi:10.3969/j.issn.1006-7795.2019.05.020
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    Objective Magnetic resonance neuroimaging (MRN) was used to measure the imaging anatomical parameters of normal adult lumbar nerve roots and adjacent structures, providing an important anatomical reference for clinical transforaminal approach. Methods Thirty healthy adults were chosen(15 males and 15 females, aged 24.3±2.1 years old).Through a thin layer continuous lumbosacral magnetic resonance scan(the sequence was FATSAT fat suppression),the following parameters were measured:the position of origin of the nerve root, the distance from the ganglion to the pedicle, the size of the ganglion, the length and area of the Kambin triangle. Results The L1-L5 nerve roots of these 30 healthy adults were well displayed by thin-layer MRN scanning technique, and there was no difference in the parameters of the two sides. With the lumbar segment moving down, the longest diameter of the L1-L5 ganglion was (6.34±0.47) mm to(11.25±1.52)mm, and the shortest diameter was (4.93±0.36)mm to (6.19±0.62)mm. The distance between the ganglion and the lower edge of the upper vertebral pedicle was (7.91±1.94) mm to (-3.13±2.54) mm, and the distance between the ganglion and the upper edge of the lower vertebral pedicle was (9.41±1.87)mm to (7.14±1.79) mm. The distance from the L1-L5 nerve root from the dural sac to the lower edge of the vertebral body was (8.89±2.89) mm to (19.96±3.70)mm, and the distance from the origin of the nerve root to the ganglion was (7.43±2.34)mm to (12.98±3.31) mm. The angle between the nerve root and sagittal plane of the L1-L5 was (39.53±3.97)° to (27.56±4.45)°. The area of safety triangle of Kambin was (153.73±37.34) mm2 to (193.19±36.15)mm2. Conclusion As the lumbar segment moves toward the tail end, the position of the origin of the nerve roots gradually increases, moreover, the distance between the nerve root and the ganglion and the area of the ganglion gradually increases. The distance between the ganglion and the vertebral pedicle of the lower vertebral body gradually decreases. Besides, the angle between the nerve root and the dural sac decreases gradually. The area of the Kambin triangle gradually increases. The above parameters provide an important anatomical references for the transforaminal approach.
    Does the left atrial appendage morphology correlate with the risk of thrombus and transient ischemic attack in patients with atrial fibrillation?
    Zhang Yang, Ma Zhanhong, Jiang Tao
    2019, 40(5):  776-780.  doi:10.3969/j.issn.1006-7795.2019.05.021
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    Objective To investigate the relationship between left atrial appendage morphology and thrombus formation and transient ischemic attack (TIA) in patients with atrial fibrillation. Methods Totally 687 patients with atrial fibrillation scheduled for radiofrequency ablation from August 2013 to June 2017 were selected and divided into left atrial thrombosis group and non-thrombosis group according to esophageal ultrasonography. All patients received pre-operative pulmonary vein and left atrium enhancement scans. All CT scans were reconstructed by post-processing image reconstruction and left atrial appendage anatomical classification. The Pearson χt est was used for comparison among the enumeration data groups, and the unconditional Logistic regression model was used for multivariate analysis. Results 687 patients were enrolled, 135 patients (19.65%) were cactus type, 275 patients (40.03%) were chicken wing type, 80 patients (11.64%) were windsock type and 197 patients (28.68%) were cauliflower type. Univariate and multivariate analysis showed that chicken wing left atrial appendage was a protective factor for thrombosis (OR=0.323) and TIA (OR=0.254) (P<0.05); cauliflower left atrial appendage was a risk factor for thrombosis (OR=3.116) and TIA (OR=2.391) (P<0.05). Conclusion The morphological characteristics of left atrial appendage can be divided into four types:cactus type, chicken wing type, windsock type and cauliflower type. The proportion of chicken wing type is the highest, while the risk of thrombosis and TIA is the lowest. Cauliflower type is the risk factor of thrombosis and TIA. Therefore, the detection of left atrial appendage morphology may have certain clinical significance in evaluating the possibility of thrombosis and TIA, guiding treatment and evaluating prognosis.
    Clinical application value of prenatal diagnosis of placenta implantation by transabdominal three-dimensional ultrasound
    Zhang Xuejuan, Wu Jing, Zhang Wenping, Zhou Qi, Yang Jingchun
    2019, 40(5):  781-785.  doi:10.3969/j.issn.1006-7795.2019.05.022
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    Objective To explore the application value of the abdominal three dimensional (3D) ultrasound in the prenatal diagnosis of the placenta implantation. Methods Retrospective analysis of 34 cases with placental implantation risk factors in our hospital were selected, 31 of them received prenatal 3D ultrasound and magnetic resonance imaging (MRI) examination. The imaging findings and diagnostic value were analyzed. Results The results showed that the sensitivity 77.8%,specificity 68.8% and accuracy 74.2% of 3D ultrasound were slightly superior to the sensitivity 50.0%,specificity 60.0% and accuracy 54.8% of MRI,3D ultrasound was consistent with the standard of surgery or pathological diagnosis(Kappa=0.617),moreover,the ultrasonic characteristics of the hypoecho area disappeared behind the placenta(77.8%)and increased blood flow at the base of the placenta(66.7%)were more common in the case of placental implantation.The accuracy of the combined diagnosis of placenta implantation by 3D and MRI was 87.1%,which was significantly higher than that by 3D ultrasound (74.2%) and MRI (54.8%). Conclusion 3D ultrasound has significant advantages in the diagnosis of the placenta implantation.Combined MRI examination can significantly improve the diagnostic accuracy of placental implantation.
    Hypoxia inducible factor: a weight to balance the oxygen homeostasis—introduction of Nobel Prize in Physiology or Medicine 2019
    Jiao Shiyu, Yu Baoqi, Qu Aijuan
    2019, 40(5):  805-809. 
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    On October 7, 2019, Beijing time, the Karolinska Institute of Sweden announced in Stockholm that the 2019 Nobel Prize in Physiology or Medicine was awarded to American scientists William G. Kaelin, Gregg L. Semenza, and the British scientist Peter J. Ratcliffe in recognition of their contribution in understanding cellular perception and adaptation to oxygen changes.