ObjectiveTo explore the impact of urinary incontinence on women's quality of life, and the effective measures to improve it.MethodsWe conducted a comprehensive literature review to analyze the present research about quality of life on urinary incontinent women and interventions for improving it.ResultsUrinary incontinence influenced patients' quality of life in many aspects, especially in their physical health, mental health, daily living and sexual life. Regular pelvic floor muscle training could prevent and control the incontinence symptoms and improve patients' quality of life.ConclusionsIt is necessary to carry on a series of activities to propagandize that urinary incontinence can be treated, effective measures should be taken to prevent and manage urinary incontinence in order to improve quality of life in urinary incontinent women.

Objective To evaluate whether an early change in 18F-fluorodeoxyglucose (18F-FDG) uptake can predict tumor response to epidermal growth factor receptor tyrosine kinase inhibitor (EGFR-TKI) and prognosis in patients with non-small cell lung cancer (NSCLC). Methods From August 2009 to April 2015, 22 patients with NSCLC who were eligible to EGFR-TKI treatment were enrolled. PET-CT scan was performed before (baseline) and 1 month after EGFR-TKI administration. Up to 5 hottest single tumor lesions (no more than 2 per organ) were considered to be target lesions. Maximum standardized uptake values (SUVmax) were measured, and post-treatment percentage changes in SUVmax (ΔSUV%) were calculated. PET responses were classified using PET response criteria in solid tumors (PERCIST). Then conventional CT scan was performed every 2 months for follow-up. Kappa statistic was used to compare agreement between the RERCIST recommendations-based therapeutic response evaluation and those based on RECIST1.1 criteria. Fisher exact test was used to compare the probability of disease progression in the early metabolic response and non-response groups. Predictive accuracy of ΔSUV% with respect to response or non-progression at CT scan was evaluated by ROC analysis. Progression-free survival (PFS) was determined by Kaplan-Meier survival analysis, and between-group comparison was performed by log-rank test. Results After 1 month of EGFR-TKI treatment, 12 patients (55%) showed partial metabolic response (PMR), 6 (27%) had stable metabolic disease (SMD), and 4 (18%) had progressive metabolic disease (PMD). There was a moderate agreement(Kappa=0.506,P<0.05) between PET response at 1 month based on PERCIST recommendations and CT response at 3 months according to RECIST 1.1. Non-progression was significantly more frequent in patients with an early PMR (χ2=11.941, P=0.005). Progression had been confirmed later during therapy in all patients with PMD . By using ROC analysis, the area under the curve for prediction of response was 0.906 (95% CI, 0.766—1.000; P=0.002), corresponding to a sensitivity of 88.9% and specificity of 84.6% at a cut-off of 40.36% in ΔSUV%. Using a cut-off value of 25.84% in ΔSUV%, highΔSUV% group (ΔSUV% ≥ 25.84%) had significantly longer PFS than low ΔSUV% group (ΔSUV%<25.84%). Conclusion Early assessment of PET-CT at 1 month of EGFR-TKI treatment could be useful to predict tumor response and clinical outcome in patients with NSCLC.

Objective To analyze the prevalence characteristics of fatty liver in young and middle-aged people,and to explore the risk factors of the disease,so as to provide clinical evidence for the prevention and treatment of fatty liver.Methods In 756 young and middle-aged healthy subjects with age≤50 years old,there were 197 fatty liver cases were diagnosed by ultrasonic test during 2015 year.The prevalence of different characteristics in young and middle-aged fatty liver was analyzed,the difference of blood biochemical index between fatty liver and non fatty liver group was compared,and risk factors of fatty liver was explored by binary logistic regression model.Results The total prevalence rate of fatty liver in young and middle-aged people was 26.1%(197/756),among which 33.1% (119/359) were male and 19.6%(78/397) were female,the prevalence rate of male was significantly higher than that of female(χ2=17.833,P<0.05).The prevalence rate of fatty liver increased with age(χ2=33.296,P<0.05),which in 40-50 years old was 37.1%(111/299) and significantly higher than that in 20 years-(15.0%)(24/160) and 30 years-(20.9%)(62/297).Logistic regression analysis on influencing factors of fatty liver prevalence showed that age,sex,body mass index(BMI),drinking,diabetes and fasting blood glucose(FPG),triglyceride(TG),total cholesterol(TC) were closely related to fatty liver(P<0.05),overweight,obesity,drinking,diabetes increased the risk of fatty liver disease.Biochemical indicators(FPG,TG,TC) in fatty liver group were higher than those in non fatty liver group((7.09±1.47) mmol/L vs.(5.14±1.71) mmol/L,(5.98±1.23) mmol/L vs.(4.95±1.42) mmol/L,(2.03±0.45) mmol/L vs.(1.23±0.67) mmol/L,t=271.905,98.866,278.255;P<0.05).Conclusion The prevalence rate of fatty liver in young and middle-aged people is high,and controlling body weight,give up drinking,active treating diabetes,reducing blood glucose and blood lipids can effectively decrease the prevalence of fatty liver in young and middle-aged people.

Objective To study the changes of serum markers of hepatic fibrosis in patients with fatty liver,and to provide clinical diagnosis and treatment for patients with fatty liver.Methods Three hundred and sixty-one patients with fatty liver were divided into light,medium and heavy three degrees according to the intrahepatic echo and structure.Serum markers of hepatic fibrosis-hyaluronic acid (HA),laminin (LN),procollagen Ⅲ (PC Ⅲ) and type Ⅳ collagen (C-Ⅳ) were examined by enzyme linked immunosorbent assay (ELISA),and the ordinal logistic regression model was used to analyze,regarding the grade of fatty liver as dependent variable.Results The levels of serum fibrosis markers HA,LN,PC Ⅲ and C-Ⅳ in patients with mild,moderate and severe fatty liver were (94.53 ± 16.21),(101.38 ± 20.42),(127.34 ± 26.54) μg/L,(107.25±22.63),(117.38±24.84),(136.62±32.27) μg/L,(110.27±23.15),(121.55±27.36),(138.62± 30.62) μg/L,(72.61 ± 15.46),(82.06 ± 18.28),(92.96 ± 21.35) μg/L respectively,there was significant difference in serum fibrosis markers among mild,moderate and severe fatty liver patients (F =675.719,398.771,303.960,840.570;P＜0.05),while the markers of patients with severe fatty liver were higher than normal.The ordinal logistic regression model showed that the serum fibrosis indexes of HA,LN,PC Ⅲ and C-Ⅳ had significant effects on the grading of fatty liver(P＜0.05),whose odds ratio were 1.322,1.229,1.899,3.935,that was the higher the HA,LN,PC Ⅲ,C-Ⅳ,the more severe fatty liver.Conclusion There were liver fibrosis trend in patients with severe fatty liver.Detection of serum markers of hepatic fibrosis can be used as an important basis for monitoring and diagnosis of fatty liver disease.

ObjectiveTo analyze the characteristic of the T peak-end interval (Tpe) in dilated cardiomyopathy(DCM) patients with heart failure and its significance in evaluation of global dispersion of ventricular repolarization.MethodsFifty-three inpatients were enrolled in this study,which included 28patients with DCM and heart failure (DCM group),and 25 patients with supraventricular tachycardia and without structural heart disease (control group).The Tpe and the dispersion of QT interval (QTd) from the 12-lead surface electrocardiogram(ECG) were acquired and measured,and consequently the corrected numerals of the average of Tpe (Tpe-AVEC),the maximal Tpe (Tpe-MAXC) were acquired.ResultsThe levels of Tpe-AVEC,Tpe-MAXC and QTd in DCM group were significantly higher than those in control group [ ( 106.31 ±26.34) ms vs.(82.72 ± 10.01 ) ms,(234.05 ± 69.75) ms vs.( 119.15 ± 11.55 ) ms,( 119.17 ± 67.62) ms vs.( 39.74 ± 17.04 ) ms ] ( P ＜ 0.05 or ＜ 0.01 ).ConclusionsThe global dispersion of ventricular repolarization is significantly increased in patients with DCM and heart failure.The Tpe-AVEC and Tpe-MAxc are recommended to be used for evaluating the dispersion of ventricular repolarization as the prognostic index in patients with DCM and heart failure.

Objective To investigate the regulatory effect of branched chain amino acids (BCAA) on the expression of apoptosis related proteins after cerebral ischemia reperfusion injury and the protective effects of BCAA on ischemic brain injury in rats.Methods 40 male SD rats were randomly divided into normal diet group (n =20) and branched chain amino acid (BCAA) group (n=20) according to the random number table,and each group was randomly divided into control group (n=6),sham operation group (n=6) and model group (n =8) which used suture method to make ischemia reperfusion model.After modeling,modified Neurological Severity Scores (mNSS) was used to access the neurological impairment degree of 2,6,24,48 and 72 h in each group.The expression of apoptosis related proteins (Cleaved,Bax/Bcl-2) after 72 h was detected by the method of immune protein imprinting (Caspase3) and compared between normal diet group and BCAA group.Results Compared with the normal diet rats,the mNSS of BCAA diet rats after modeling at 2,6,24,48,72 h decreased (11.35±2.78 vs.7.15±2.41,P=0.019;9.35±1.75 vs.5.82±1.17,P=0.002;6.11±1.16vs.4.39±1.46,P=0.048;5.87±1.32vs.3.55±1.94,P=0.036;4.98±2.24vs.2.09±1.33,P=0.022).The expression of cleaved caspase3 protein and the ratio of Bax/Bcl-2 decreased in BCAA group.Conclusion BCAA can alleviate the apoptosis of rats after ischemia and reperfusion,reduce the damage of nerve function,and has a positive protective effect on ischemic brain injury.

Objective To evaluate a therapeutic strategy using aromatase inhibitors and TAM in postmenopausal Luminal B breast cancer patients. Methods The clinical data of 733 primary breast cancer cases receiving postoperative endocrine thempy from July 2002 to Mar 2005 in Tianjin Cancer Hospital were retrospectively analyzed.Diagnosis was confirmed by pathology in all the cases.All patients were post-menopausal and ER-positive.501 patients were given tamoxifen(TAM 2.5 mg qd,po),232 patients were given aromatase inhibitors(Letrozole 10 mg bid,po).The follow-up time ranged from 36 to 90 months.Median follow-up time was 46 months.Results The disease-free-survival(DFS)rate of Luminal B breast cancer patients in aromatase inhibitors(AIS)group was higherthan that in TAM group(90.6% vs.88.6%,P=0.038).In TAM group,subgroup analysis showed 3-year DFS of node-positive with HER2(+)is lower than that of node-positive with Her-2-negative(88.2% vs.90.4%,P=0.037);3-year DFS of ER+/PR+ group in HER2(+) patients was higher than that of ER+/PR-group(90.8% vs.89.5%.P=0.032).In AIs group,in spite of the axillary lymph node status,there was no significant difference of 3-year DFS between HER2(+)patients and HER2(-)ones(P>0.05).3-year DFS of ER+/PR+with HER2(+) patients was higher than that of ER+/PR-ones with HER2(+)(91.9% vs.90.5%,P=0.029).Hot flush,vaginal bleeding and thromboembolics in AIS group is less frequent,but muscle pain and bone fracture is more common than that in TAM group(P<0.05).Conclusion Compared to TAM, AIs is more effective and safer with postmenopausal Luminal B patients,and the effect is independent on node stams.

Objective: To investigate the association of iron with stress hormones and insulin resistance in patients with gestational diabetes mellitus (GDM). Methods: Seventy-five pregnant women diagnosed as GDM during 24-28 weeks were collected from January to November 2015 in Yantai Yuhuangding Hospital, and 75 normal pregnant women were used as control group. Blood glucose, insulin, stress hormones and iron metabolism related indexes were detected. Homeostasis model assessment for insulin resistance (HOMA-IR) was used to evaluate insulin resistance, and the correlation of iron metabolism with stress hormones and insulin resistance was analyzed. Results: Compared with control group, norepinephrine (NE) and epinephrine (E) levels were higher in GDM group (both P<0.05), but there was no significant difference in cortisol level between two groups (P>0.05). Serum ferritin (SF), serum iron, and transferrin saturation levels were higher in GDM group than those in control group(all P<0.01). Multivariate logistic analysis showed that cortisol, E, and NE levels were positively correlated with SF level in GDM group (all P<0.05). Cortisol and E levels were positively correlated with transferrin saturation (both P<0.05). SF and transferrin saturation were positively correlated with HOMA-IR in two groups (P<0.05 or P<0.01). Conclusion Iron overload may involve in dysfunction of stress adaptation and insulin resistance in patients with GDM. (Chin J Endocrinol Metab, 2018, 34: 563-566)

OBJECTIVE To further improve the rational drug use control mechanism based on performance appraisal， explore new paths of pharmaceutical care and promote the rational clinical drug use management to deepen development. METHODS The reform of pharmaceutical management system in our hospital was performed through implementing the “ten-point system of prescription behavior management”， supplemented by the two carriages of “strengthening prescription review” and “standardizing clinical medication”. By implementing a number of auxiliary measures such as man-machine integration pre-prescription review， improving pharmacists’ prescription review ability， optimizing prescription review mechanism in real time， regulating physicians’ off-label drug use behavior， and improving drug evaluation mechanism， pre-control and in-process intervention were completed. The evaluation results were incorporated into performance assessment by referring to the “ten-point system of prescription behavior management”， so as to realize multi-dimensional and fully closed-loop rational drug use management. The effects of management were evaluated by comparing the statistical results of related indexes before and after the management. RESULTS Compared with before management， irrational rate of prescriptions and medical orders in our hospital in 2022 decreased significantly， compared to the same period in 2020； the irrational rate of inpatient medical orders decreased from 5.00% in 2020 to 2.69% in 2022， and that of outpatient prescriptions decreased from 4.59% to 2.48%； the frequency of communication between clinical pharmacists and physicians increased； the times of clinical consultations increased from 16 to 58， and doctors’ acceptance of intervention for irrational drug use had improved from 52％ to 87％ ； physicians had a deeper understanding and recognition of clinical pharmaceutical care， the awareness of clinical rational drug use had been significantly improved. CONCLUSIONS The rational drug use control mechanism guided by performance appraisal further standardizes the issuance of prescriptions and medical orders， and makes physician-pharmacist cooperation more prominent， so as to realize the closed-loop pharmaceutical management of “pre- review， in-process supervision and post-evaluation”， and promote rational drug use in clinical practice.

Objective:To analyze the gene variants in patients with primary distal renal tubular acidosis (dRTA), and explore the correlation between the genotype and phenotype.Methods:The Sanger direct sequencing or whole-exome sequencing was used to identify causal variants and the variation pathogenicity was evaluated according to 2015 American College of Medical Genetics and Genomics (ACMG) standards and guidelines in 44 dRTA patients (37 families) diagnosed in the Affiliated Qingdao Municipal Hospital of Qingdao University and the Affiliated Hospital of Qingdao University from April 2010 to September 2020. The clinical features of the patients were summarized, and the correlation between the genotype and phenotype was investigated.Results:Seven variants of SLC4A1 gene, 17 variants of ATP6V0A4 gene, and 15 variants of ATP6V1B1 gene were identified in 44 patients with dRTA, and of which 11 variants were new ones. According to ACMG guidelines, the pathogenic, likely pathogenic, benign variants among the 39 variants were 22, 16 and 1, respectively. Nine patients were autosomal dominant hereditary dRTA caused by SLC4A1 gene mutation, 4 patients with autosomal recessive hereditary dRTA complicated with Southeast Asian ovalocytosis and anemia were caused by SLC4A1 gene mutation, and 14 patients caused by ATP6V0A4 gene mutation and 8 patients caused by ATP6V1B1 gene mutation were autosomal recessive hereditary dRTA; Two children with dRTA were found to carry one monoallelic defect in ATP6V1B1, and no causal gene mutation was identified in 7 patients. One patient showed incomplete dRTA, and the other 43 patients showed complete dRTA. The prevalence of sensory neural hearing loss caused by ATP6V0A4 and ATP6V1B1 mutation were 2/14 and 6/10 respectively. The frequency of chronic kidney disease in adults, children and infants were 4/4, 2/4, and 1/36, separately. After the drug treatment based on potassium citrate and sodium citrate, the growth and development (28/40) and electrolyte disturbance (41/44) of most patients were significantly improved. Conclusions:The present study has identified 39 variants of SLC4A1, ATP6V0A4 and ATP6V1B1 genes in 44 patients with dRTA, including 11 novel ones. There is a close relationship between genotype and phenotype in dRTA patients and most patients' conditions were improved after proper treatment. This study enriches the human gene mutation database and provides valuable references for diagnosis, treatment and genetic counseling in patients with dRTA.