2018年 · 第12卷第05期

In recent years, the incidence of cerebrovascular diseases in China has increased and showed a trend of younger age. Its high disability rate and high mortality rate not only seriously endanger people's health and life, but also bring heavy medical and economic burden to the country and patients' families. This issue organizes a key issue with the theme of "cerebrovascular health management" to discuss the management of cerebrovascular diseases. Wang Wenzhi wrote a review emphasizing that attention should be paid to the risk assessment of the first onset of stroke. Carrying out primary prevention is the fundamental way out of stroke prevention and treatment in China, and the risk assessment of the first onset of stroke is an important method and means to carry out primary prevention. Through risk assessment, it is helpful to identify the high-risk groups of stroke early, formulate individualized stroke prevention programs and countermeasures, and enable high-risk individuals to raise their awareness of stroke risk and consciously take intervention and prevention measures. This paper introduces 8 kinds of stroke risk assessment scales and early warning tools recommended at home and abroad, such as Flemingham Stroke Risk Assessment Scale, Pooled Cohort Equation and Stroke Risk Assessment Mobile Software. If the subject has reached the standard of stroke risk individual, the most important thing is to focus on how to actively intervene, change bad lifestyle, and actively control risk factors according to relevant guidelines, so as to reduce the incidence of stroke, thus achieving the purpose of evaluation and early warning.

In recent years, stroke has seriously endangered the health and life of Chinese residents, causing a heavy burden of diseases. Therefore, it is necessary to increase publicity and advocate early prevention. The risk assessment of the first onset of stroke is an important method and means to carry out primary prevention. Through risk assessment, it is helpful to identify the high-risk groups of stroke early, formulate individualized stroke prevention programs and countermeasures, and enable high-risk individuals to raise their awareness of stroke risk and consciously take intervention and prevention measures. Risk assessment tools help physicians identify those individuals who can benefit from intervention treatment, and play a positive early warning role for those who may be at risk of stroke. The following introduces some scales and early warning tools for stroke risk assessment recommended at home and abroad in recent years^[1]These scales and early warning tools have generally been verified by research in a large sample population, and have good use value.

In recent years, the first cause of death in China is cerebrovascular disease^[1]Stroke is a common acute cerebrovascular disease. 1977 Folstein et al.^[2]After the symptoms of post-stroke depression (PSD) were reported for the first time, PSD gradually attracted the attention of the medical community. PSD refers to the mood disorder with different degrees of depression, loss of interest and fatigue as the main symptoms after stroke, and the symptoms last for more than 2 weeks. It is a common complication after stroke. A large number of studies have found that PSD is closely related to the severity of impaired cognitive function, daily life function and social function of stroke patients, and also affects the neurological recovery of stroke patients, resulting in an increase in stroke recurrence and mortality^[3,4,5]。 Therefore, early detection and timely intervention of PSD are of great significance to the primary, secondary and tertiary prevention of PSD.

Helicobacter pylori is closely related to the occurrence and development of chronic gastritis, peptic ulcer, gastric cancer and gastric mucosa associated lymphoid tissue lymphoma. In 1994, Helicobacter pylori was listed as a class I carcinogen of gastric cancer by the World Health Organization. The occurrence of gastric cancer is closely related to Helicobacter pylori infection, and the eradication of Helicobacter pylori can reduce the incidence of gastric cancer. China is a country with high infection rate of Helicobacter pylori and high incidence of gastric cancer. Helicobacter pylori infection is not only a clinical problem, but also a major health management problem at the public health level. Therefore, this consensus has great practical significance for the prevention and treatment of Helicobacter pylori-related diseases in China.

Colonic polyps are neoplasms that originate from colonic mucosal epithelium and protrude from intestinal mucosa. Their pathological types include inflammatory, proliferative, adenoma and other types. Among them, colonic adenomatous polyps are closely related to the occurrence and development of colon cancer, so colonic adenomatous polyps are regarded as a precancerous lesion.

At present, our country is facing the severe test brought by obesity. In recent years, the number and proportion of overweight and obesity in Chinese adults have shown an obvious upward trend^[1]。 The incidence of various chronic diseases caused by overweight and obesity (such as hypertension, diabetes, hyperlipidemia, coronary atherosclerotic heart disease, stroke, etc.) is also increasing year by year^[2]It has brought a huge economic burden to our residents^[3]。 Obesity can be divided into two types: visceral (centripetal) and subcutaneous (homogeneous), depending on where fat accumulates in the body. Related studies have found that visceral obesity is more closely related to cardiovascular disease and metabolic syndrome than subcutaneous obesity. Even in non-obese people, visceral fat accumulation can lead to atherosclerosis and metabolic disorders^[4]。 Therefore, during physical examination, we should not only pay attention to body mass index (BMI) and body fat rate, but also pay attention to visceral fat area (VFA), which is closely related to metabolic diseases.

At present, the "serological biopsy" indicators of gastric mucosa, which are widely used in clinical practice, mainly include pepsinogen (PG) Ⅰ, PG Ⅱ, Gastrin 17 (G17) and Helicobacter pylori (Hp) antibody (immunoglobulin G, IgG), also known as gastric function, which are used to evaluate the secretion status, functional changes and infection of gastric mucosa in different parts. Epidemiological studies show that gastric mucosal "serological biopsy" plays a very important role in the early screening of gastric cancer and precancerous lesions. These four functional indicators can play a preliminary early warning, efficacy evaluation and long-term monitoring role for gastric mucosal lesions. According to whether the results are normal or not, it can assist clinicians to judge whether the subject needs to undergo electronic gastroduodenoscopy in the next step^[1]。 In previous clinical studies, more attention was paid to PGⅠ and PGⅠ/PGⅡ ratio, but PGⅡ was neglected, which was often considered as an auxiliary marker. In fact, PGⅡ is a marker of gastric epithelial cell differentiation and maturation, and its level changes can reflect the differentiation degree of gastric mucosa, which can be used as an observation index to reflect the changes of gastric diseases^[2]。 We analyzed the expression of serum PGⅡ level in different gastric diseases and its relationship with Hp infection in people who underwent routine physical examination at the Health Management Center of the First Affiliated Hospital of China Medical University from January 2013 to October 2017, and explored its application value as a screening index of gastric diseases in prevention and early diagnosis in health management of physical examination population.

At present, type 1 diabetes (T1DM) is showing a significant upward trend in the world. According to the latest epidemiological survey, the number of T1DM patients under the age of 15 in China has increased significantly compared with 20 years ago, and the incidence of T1DM in adults has gradually increased^[1]。 Cardiovascular disease (CVD) is an important complication of T1DM and one of the leading causes of death^[2]。 Compared with normal subjects, patients with T1DM develop arteriosclerosis earlier and more severely, so it is crucial to monitor the progression of arteriosclerosis early and explore the related influencing factors^[3]。 Bilirubin is a tetrapyrrole pigment produced by heme metabolism, which has various physiological activities such as improving oxidative stress, inhibiting inflammation and regulating glucose and lipid metabolism^[4]。 Several studies have confirmed that mildly elevated bilirubin levels are of great significance for the prevention and treatment of coronary atherosclerotic heart disease (CHD), diabetes, obesity and other diseases^[5]。 Recent studies show that bilirubin is closely related to the development of arteriosclerosis in patients with type 2 diabetes (T2DM)^[6]。 In this study, carotid intima-media thickness (C-IMT) was used as an assessment index of subclinical atherosclerosis^[7]To explore the correlation between serum total bilirubin (TBIL), direct bilirubin (DBIL) and indirect bilirubin (IBIL) levels and arteriosclerosis in patients with T1DM, in order to provide reference for the prevention of CVD.

Hypertension is the most common disease in the elderly. It is the main cause of stroke, coronary atherosclerotic heart disease (CHD), and cardiorenal failure. It has become the leading cause of death and disability in the elderly, and its incidence is increasing year by year. However, the awareness rate, treatment rate and control rate of hypertension are at a low level^[1,2,3]Doing a good job in the health management of hypertension has become an urgent problem to be solved. This paper discusses the effect of chronic disease management mode on hypertension patients by implementing chronic disease management for hypertension patients.

According to the 2010 diagnostic criteria for gestational diabetes mellitus (GDM) developed by the International Association of diabetes and Pregnancy Research Groups, the global prevalence of GDM is estimated to be 9.8% to 25.5%, with 9.3% to 18.9% in China^[1]。 GDM increases the short-term and long-term health risks of mothers and infants through changes in the uterine environment and epigenetics: such as premature birth, macrosomia, neonatal hypoglycemia, respiratory distress syndrome, type 2 diabetes and other diseases are at higher risk. Studies have shown that prevention or intervention of GDM can effectively improve pregnancy outcomes^[2]。 This survey was conducted retrospectively by using a questionnaire method, from food frequency table, eating habits, physical activity, nutrition class participation during pregnancy, etc., to explore the effects of body mass index (BMI) before pregnancy, diet during pregnancy, sedentary activity and physical activity on weight gain and GDM during pregnancy. In order to better carry out nutritional guidance during pregnancy, prevent GDM and improve pregnancy outcome to provide reliable reference basis.

"Important abnormal results" in physical examination are abnormal conditions found in physical examination and have important clinical significance. They need to be reexamined immediately, further examined or referred to clinical specialty for diagnosis and treatment^[1]。 The physical examination institution has established a reporting system and processing process of "important abnormal results". On the one hand, it can timely find subjects who may be on the verge of life-threatening state, quickly take intervention measures and give clinical treatment in time; On the other hand, it can also reduce and avoid the medical risks of medical examination institutions. The Health Management Center of Tianjin Medical University General Hospital has carried out the management of important abnormal results of health examination since 2012. After years of work exploration, it has gradually optimized and improved the management process of important abnormal results during and after examination, which has not only improved the quality of physical examination service, ensured medical safety, but also improved the satisfaction of physical examination customers. The handling process and quality management and control of important abnormal results are summarized as follows.

Living near sports facilities such as gymnasiums and swimming pools is strongly associated with lower body mass index (BMI), body fat content, and smaller midlife waist circumference, according to a British study^[1]。 The study also suggests that obesity is somewhat associated with living near fast food restaurants.

The notion that moderately obese people live longer is popular, but a new study suggests this is false^[1]。

A recent large study on the association between a sitting lifestyle and colorectal cancer found that men who watch TV for 4 hours or more a day are more likely to develop colorectal cancer^[1]。

A large-scale observational study has found that testing for human papillomavirus (HPV) in women with abnormal cervical exfoliative cytology can diagnose cervical lesions more quickly and rarely miss diagnoses^[1]。