Chinese General Practice

Influenza in Children and Vaccination——Interpretation of AAP Committee on Infectious Diseases Recommendations for Prevention and Control of Influenza in Children（2018—2019）

SUN Shumei

2019, 22(6): 621-626. DOI: 10.12114/j.issn.1007-9572.2019.00.010

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According to the World Health Organization （WHO），about 20% to 30% of children worldwide suffer from seasonal influenza every year.In flu season，the annual infection rate can be as high as 50%.Children aged 5-9 years have the highest infection rate，and children under 5 years have the highest rate of influenza-related hospitalization.Severe flu and death cases often occur in children under 2 years.The American Academy of Pediatrics （AAP） has revised the Recommendations for Prevention and Control of Influenza in Children for several years，focusing on influenza prevention，vaccine use，and antiviral drug prescriptions，and noted that vaccination is the best preventive measure against influenza.This article interpreted the key content of Recommendations for Prevention and Control of Influenza in Children（2018—2019） formulated by AAP Committee on Infectious Diseases.The content included that updated trivalent （including influenza A H1N1，H3N2 and influenza B Victoria） or quadvalent （Influenza B Yamagata） inactivated influenza vaccine （IIV） should be the first choice for children's vaccination during the influenza season from 2018 to 2019；antiviral drugs are important for influenza control，which can be used as an important supplementary means of influenza prevention，but they can not replace influenza vaccine inoculation；influenza-infected children with high risks of influenza are recommended to use antiviral therapy as soon as possible；general practitioners，other health workers should pay attention to vaccine for children before the influenza season arrives，and even during influenza epidemics.

Progress on Clinical Research of Pediatric Psychosocial Oncology

ZENG Zhi，DENG Yaotiao

2019, 22(6): 626-632. DOI: 10.12114/j.issn.1007-9572.2018.00.449

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Diagnosis of pediatric tumor can bring a series of psychosocial problems to the whole family，but it has not received enough attention in clinical practice.It is essential for oncologists，nurses and psychologists to evaluate the psychosocial factors that may affect patients and their families from the diagnosis to the end of treatment and provide appropriate support and intervention to improve their overall quality of life.We briefly described the impact of family financial burden in children with cancer，advances in research on psychosocial needs，assessment and intervention of children and their families，the research on pediatric cancer care and psychosocial education and its significance to the clinical practice.This study aimed to help healthcare providers of pediatric oncology pay attention to psychosocial problems of children with tumor，promote clinical practice and research，meliorate the mental health and quality of life of children and their families.

Comparative Study on Cerebroprotective Effects of Recombinant Huma Interferon α-1b Inhalation at Various Doses and Conventional Antiviral Therapy in Children with Severe Hand，Foot and Mouth Disease

GAO Yi，SONG Chunlan，GUO Caili，CUI Yajie，FU Shuqin，CHEN Yinghua，LI Liping，CHENG Yibing

2019, 22(6): 633-637. DOI: 10.12114/j.issn.1007-9572.2018.00.102

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Background Hand-foot-mouth disease（HFMD）is caused by enterovirus infection. It is characterized by herpes of hands，feet，buttocks and oral mucosa. Few children develop into severe cases with neurological symptoms，such as convulsions. Some children will have neurological sequelae. The current clinical treatment of this disease is routine antiviral therapy and symptomatic treatment.Objective　To compare the cerebroprotective effects，therapeutic efficacy and adverse effects of inhalation of recombinant human interferon alpha-1b（INF-α-1b） at different doses versus intravenous ribavirin infusion in children with severe HFMD complicated by encephalitis.Methods　A total of 120 children with severe HFMD admitted to Henan Provincial Children's Hospital from March 2014 to December 2015 were enrolled and randomized into the control group，the low-dose group and the high-dose group using a random number table，of 40 cases in each group．The subjects in the control group received intravenous infusion of 10 g/kg ribavirin in 5% glucose solution，given in two divided doses，and the cases in the low-dose group were given inhalation of recombinant human INF-α-1b injection at a dose of 2 μg/kg，twice daily for successive 5 days，while the cases in the high-dose group were given inhalation of recombinant human INF-α-1b injection at a dose of 4 μg/kg，twice daily for successive 5 days．The serum levels of C-reactive protein（CRP），neurospecific enolase（NSE） and S-100B protein were measured using enzyme-linked immunosorbent assay（ELISA） 1，3 and 5 days post-treatment．The improvements of clinical features （time of rash disappearance and duration of fever） were observed，and platelet counts and neutrophil counts before and after treatment were recorded.Results There was no interaction between the treatment method and time in terms of the CRP concentration（P>0.05），and there was no significant main effect between the treatment method and time in terms of the CRP concentration（P>0.05）.While an interaction was examined between the treatment method and time in terms of the NSE concentration（P<0.05），and there was a significant main effect between the treatment method and time in terms of the NSE concentration（P<0.05）．Significantly higher NSE levels were detected in the control group than in the low- and high-dose groups，and significantly higher NSE levels were measured in the low-dose group than in the high-dose group 1，3 and 5 days post-treatment（P<0.05）．In addition，there was an interaction between the treatment method and time in terms of the S-100B level（P<0.05），and there was a significant main effect between the treatment method and time in terms of the S-100B concentration（P<0.05）．Significantly higher S-100B levels were detected in the control group than in the low- and high-dose groups（P<0.05），and a significantly higher S-100B level was seen in the low-dose group than in the high-dose group 1，3 days post-treatment（P<0.05），while significantly higher S-100B concentrations were found in the control group than in the low- and high-dose groups 5 days post-treatment（P<0.05）．Moreover，the time of rash disappearance and duration of fever were both shorter in the low- and high-dose groups than in the control group（P<0.05），and the time of rash disappearance and duration of fever were shorter in the high-dose group than in the low-dose group（P<0.05）．Significantly lower neutrophil counts were measured in the low- and high-dose groups than in the control group（P<0.05），and the neutrophil count was significantly lower in the high-dose group than in the low-dose group post-treatment（P<0.05）．Conclusion In the treatment of children with severe HFMD，inhalation of recombinant human INF-α-1b exhibits a greater cerebroprotective effect and clinical efficacy，than intravenous ribavirin infusion for the treatment of HFMD in children.In addition，inhalation of recombinant human INF-α-1b at a high dose exhibits a greater cerebroprotective effect for the treatment of HFMD in children．Therefore，recombinant human INF-α-1b should be given at an appropriate dose according to individual disease conditions and tolerance.

Clinical Study on Acupuncture Combined with Electromyographic Biofeedback Therapy for Severe Hand-foot-mouth Disease Complicated with Dystonia Caused by Central Nervous System Impairment

MENG Bianhong，ZHOU Chongchen，REN Ruiying，GENG Xiangju

2019, 22(6): 638-642. DOI: 10.12114/j.issn.1007-9572.2018.00.355

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Background　Dystonia caused by central nervous system impairment is a common complication of severe hand-foot-mouth disease（HFMD） in children，and its treatment and rehabilitation have become a focus of attention in clinical practice.Objective　To observe the clinical efficacy of acupuncture combined with electromyographic biofeedback therapy for severe HFMD complicated with dystonia caused by central nervous system impairment，so as to provide a reference for clinical treatment of this disease.Methods　70 cases of severe HFMD complicated with dystonia caused by central nervous system impairment who received treatment from Children's Hospital Affiliated of Zhengzhou University from March 2015 to March 2018 were retrospectively analyzed.They were divided into observation group and control group according to the rehabilitation therapy，with 35 cases in each.Both groups received the conventional rehabilitation training，and the observation group additionally received acupuncture combined with electromyographic biofeedback therapy.The intervention lasted for 8 weeks for both groups.Pre-post intervention data about neuroelectrophysiological indicators 〔sensory nerve conduction velocity（SCV），motor nerve conduction velocity（MCV） of femoral，tibial and peroneal nerves〕，grading of muscle tension，scores of exercise and self-care action domains of Comprehensive Functional Assessment for Disabled Children（CFA-DC ） Scale and clinical efficacy were compared between the two groups.Results　After treatment，the SCV and MCV of femoral，tibial and peroneal nerves were much faster than the baseline levels in both groups（P<0.05）.Moreover，intergroup comparison showed that，they were much faster in the observation group compared with those of the control group（P<0.05）.Post-intervention grading of muscle tension improved significantly compared with the baseline level in both groups（P<0.05）.Furthermore，the grading of muscle tension after treatment in observation group was better than that of the control group（P<0.05）.Post-intervention scores of exercise and self-care action domains increased significantly in both groups compared with the baseline levels（P<0.05）.Moreover，intergroup comparison showed that，they were significantly higher in the observation group than those of the control group（P<0.05）.The overall response rate in observation group was significantly higher than that in control group 〔94.3%（33/35） vs 77.1%（27/35）〕（P<0.05）.Conclusion　Acupuncture combined with electromyographic biofeedback therapy for children with severe HFMD complicated with dystonia caused by central nervous system impairment can improve the neuroelectrophysiological indicators，muscle strength and motor function，showing remarkable efficacy.

Intervention Effects of Routine Physiotherapy Combined with Acupuncture on Motor Dysfunction in Children with Neuromuscular System Dysfunction Caused by Central Nervous System Damage of Severe Hand-foot-mouth Disease

CHEN Fang，ZHOU Chongchen，SONG Chunlan，CHENG Yibing，GENG Xiangju，GAO Guocai，CUI Yajie

2019, 22(6): 643-647. DOI: 10.12114/j.issn.1007-9572.2018.00.227

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Background　Hand-foot-mouth disease （HFMD） is an acute eruptive infectious disease that occurs in infants and young children under 5 years old. It can be caused by more than 20 kinds of enterovirus infections，and its main clinical symptoms are fever and herpes，maculopapule or ulcer in hands，feet，mouth and buttocks，and most can be relieved after treatment without sequelae，but severe HFMD can cause peripheral nerve palsy，central nervous system damage，and even endanger the lives of children patients. Therefore，effective intervention is necessary.Objective　To explore the intervention effects of routine physiotherapy combined with acupuncture on motor dysfunction in children with neuromuscular system dysfunction caused by central nervous system damage of severe HFMD．Methods　A total of 88 children with neuromuscular system dysfunction caused by central nervous system damage of severe HFMD in Children's Hospital Affiliated of Zhengzhou University from June 2014 to December 2017 were selected and randomly divided into control group and observation group，each with 44 subjects.Both groups were given conventional western medicine （including antiviral，anti-infection and promotion of damaged nerve recovery，maintenance of water，electrolytes and acid-base balance），the control group was additionally given routine physiotherapy，and the observation group given routine physiotherapy and acupuncture.The two groups were treated for 1 months.The clinical efficacy，scores of gross motor function measure（GMFM） and Berg balance scale （BBS） before and after treatment，disappearance time of related symptoms （including vomiting，frightening，limb shaking，muscle weakness，somnolence） of central nervous system damage，levels of biochemical indexes〔interleukin-6 （IL-6），high-sensitivity C-reactive protein （hs-CRP），white blood cell count（WBC） and creatine kinase （CK）〕 before and after treatment，occurrence of adverse reactions were compared between the two groups.Results　The clinical efficacy in observation group was significantly higher than that in control group（P<0.05）．After treatment，the scores of GMFM and BBS in observation group were higher than those in control group（P<0.05）．The scores of GMFM and BBS in the two groups after treatment were higher than those before treatment（P<0.05）．The disappearance times of vomiting，frightening，limb shaking，muscle weakness and somnolence in observation group were significantly shorter than those in control group（P<0.05）．After treatment，the levels of IL-6，hs-CRP，WBC and CK in observation group were lower than those in control group（P<0.05）．The levels of IL-6，hs-CRP，WBC and CK in the two groups were lower than those before treatment （P<0.05）．There was no obvious adverse reactions occurred during treatment in the two groups.Conclusion　Routine physiotherapy combined with acupuncture can significantly improve the motor function，shorten course of disease and reduce inflammatory reactions without obvious adverse reactions in the treatment of children with neuromuscular system dysfunction caused by central nervous system damage of severe HFMD.

Effect of “Internet Plus” Model-Based Intervention on Knowledge，Attitude and Practice in Treating Hand，Foot and Mouth Disease of Parents of Infants and Young Children

LIU Li，LIU Hantao，WANG Sumei

2019, 22(6): 648-653. DOI: 10.12114/j.issn.1007-9572.2018.00.088

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Background The hand，foot and mouth disease （HFMD） was the highest incidence of legal infectious diseases among children under 6 years old. Adopting traditional health education models such as lectures and issuance of folding forms for the knowledge attitude and practice（KAP）of infants and young children parents has little effect previously.Objective　To explore the effect of the “Internet Plus” model-based intervention on the KAP in infants and young children parents，to provide scientific evidence for HFMD prevention and control strategies.Methods　Study subjects included parents of infants≤3 years of age who received planned immunization in the Puxing Community Health Center of Pudong New Area between October，2016 and December，2016．The study subjects were divided into a control group and an intervention group through a random number table method．The traditional education model was used in the control group，and the “Internet Plus” model was used in the intervention group．The effects of the two education models of KAP for HFMD were compared，which included the score of HFMD knowledge，awareness of key information，and changes in related attitude and behaviors.Results　In terms of HFMD knowledge，the total score in the intervention group was（88.15±10.44），a value significantly higher than that in the control group （78.40±11.67），P<0.05）．In the intervention group，the scores of 13 items of HFMD knowledge，on the basis of questions including “Have you heard of HFMD?” “What caused the HFMD?” and “Was HFMD once prevalent in China?”，were significantly higher than those in the control group （P<0.05）．In terms of awareness of key information about HFMD，there were statistically significant differences between the two groups regarding items such as “exposed to feces of HFMD patients”“parents chewed food and fed it to children”“take oral antibiotics or anti-inflammatory drugs”“Is HFMD a notifiable disease in China?”“Can HFMD be acquired by contact with animals?”“Adults will not be infected with HFMD”“Adults will not normally be infected but can spread diseases”“Patients with hand，foot，mouth，buttocks will appear rash”（P<0.05）.Regarding changes in relevant attitudes and behaviors regarding HFMD，items including “Would you like to participate in HFMD knowledge training?”“your attention to HFMD”，and “HFMD is a serious disease” after intervention were significantly different between the two groups （P<0.05）．Conclusion　The "Internet Plus" model can improve parents' awareness of HFMD as well as the efficiency of prevention and control of this disease.

Effect of Diabetes Mellitus on the Progression-free Survival in Patients with Lung Cancer

CHENG Xiaolong，HAN Yiping

2019, 22(6): 654-659. DOI: 10.12114/j.issn.1007-9572.2018.00.178

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Background　Lung cancer and diabetes mellitus（DM） are common diseases with age-related increases in incidence.Moreover，clinical coexistence of the two is becoming more common.DM may have an impact on the occurrence and development of lung cancer.Objective　To investigate the effect of DM on the progression-free survival（PFS） in patients with lung cancer.Methods　The clinical information of 189 inpatients with lung cancer with DM（DM group） and 198 inpatients with lung cancer without DM（control group），who were recruited from Department of Respiratory Medicine and Thoracic Surgery，Changhai Hospital，the Second Military Medical University between December 1，2006 and December 31，2016 was collected.Inter-subgroup comparisons were performed in those aged < 65 years and in those aged ≥65 years.The survival curves of patients with different characteristics were drawn and analyzed.And the influencing factors of PFS were analyzed by Cox regression model.Results　Compared with those without DM，lung cancer patients with DM showed much higher proportions of males and older people，higher prevalence of smoking history and commodities （P<0.05）．Moreover，they demonstrated significantly longer mean PFS〔11.0 months，95%CI（8.7，13.3）vs 9.0 months，95%CI（7.8，10.1）〕（χ2=4.197，P=0.040）.In lung cancer patients aged <65 years，those with DM were found with significantly higher proportions of males，prevalence of smoking history and commodities compared with those without （P<0.05）．Furthermore，they presented longer mean PFS〔11.0 months，95%CI（8.5，13.5） vs 7.0 months，95%CI（6.9，9.1）〕（χ2=7.257，P=0.007）.In lung cancer patients aged ≥65 years，the mean PFS in those with DM was equal to or greater than that of those without〔11.0 months，95%CI（6.5，15.5） vs 12.0 months，95%CI（6.0，18.0）〕（χ2=0.058，P=0.809）.Cox regression model analysis showed that age，lung cancer staging and treatment regimen were the influencing factors of PFS in lung cancer patients （P<0.05）；lung cancer staging and DM were the influencing factors of PFS in lung cancer patients aged <65 years （P<0.05）；lung cancer staging and treatment regimen were the influencing factors of PFS in lung cancer patients ≥65 years （P<0.05）．Conclusion　For lung cancer patients，especially those aged <65 years，the prevalence of DM was associated with prolonged PFS.

Value of Platelet-lymphocyte Ratio in Predicting the Prognosis of Community-acquired Pneumonia

LI Xin，LIU Jianbo，HAN Xiaopeng，LIU Daijian，FU Xiaoxiao

2019, 22(6): 659-663. DOI: 10.12114/j.issn.1007-9572.2018.00.338

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Backgroup　Platelet-to-lymphocyte ratio（PLR） which was described as a new inflammatory marker could be used to predict the severity of community-acquired pneumonia（CAP） in patients.At present，there were few reports about this research in China.Objective　To investigate the clinical value of PLR in predicting the severity of CAP.Methods　According to the inclusion criteria of this study，we retrospectively selected 142 patients with CAP who hospitalized in the Second Affiliated Hospital of Zhengzhou University from January 2013 to March 2018.We collected their Clinical Pulmonary Infection Score（CPIS），and assigned 71 cases with CPIS≤6，71 cases with CPIS>6 to mild group and severe group，respectively.We obtained and compared the clinical data of both groups，including PLR，white blood cell count（WBC），neutrophil-lymphocyte ratio（NLR），C-reactive protein（CRP），procalcitonin（PCT），interleukin 6（IL-6）．Spearman correlation analysis was performed to investigate the correlation of PLR with WBC，NLR，CRP，PCT，IL-6 and CPIS.And the mortality rates within 28 days of being in hospital in both groups were analyzed to evaluate the predictive value of PLR for the prognosis of CAP.Results　The levels of PLR，WBC，NLR，CRP，PCT，and IL-6 in the severe group were higher than those in the mild group（P<0.05）．Spearman rank correlation analysis showed that PLR had no obvious correlation with WBC（rs=0.085，P=0.313），but was positively associated with NLR，CRP，PCT，IL-6 and CPIS（rs=0.488，0.415，0.489，0.490，0.491，P<0.001）．Within 28 days after admission，there were no deaths in the mild group but 5 deaths in the severe group.For predicting the mortality rate within 28 days following admission，the area under the ROC curve was 0.816〔95%CI（0.564，1.000）〕 for PLR，0.843〔95%CI（0.686，1.000）〕 for NLR，0.819〔95%CI（0.730，0.908）〕for CRP，0.781〔95%CI（0.578，0.984）〕 for PCT，0.793〔95%CI（0.708，0.877）〕 for IL-6，and 0.924〔95%CI（0.853，0.994）〕 for CPIS（P<0.05）.Conclusion　PLR is positively correlated with some indicators of inflammation.In other words，it can be used to evaluate the severity of CAP patients.And its predictive value for the prognosis of such patients proves to be valuable.

Diagnostic Value of Cystatin C and Uric Acid for Early Renal Impairment in Kazakh Patients with H-type Hypertension

LI Ruru，CHEN Shaoze，LIU Jingjing，LUO Ruidi，WANG Zhong

2019, 22(6): 664-667. DOI: 10.12114/j.issn.1007-9572.2018.00.035

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Background　Cystatin C （CysC） and uric acid （UA） are closely related to renal impairment in patients with hypertension，and have become a hot research topic in recent years.Objective　To investigate the value of CysC and UA in diagnosis of early renal impairment in Kazakh patients with H-type hypertension.Methods　A total of 318 Kazakh patients with H-type hypertension who participated in the epidemiological investigation in Xinjiang between May 2014 and August 2015 were selected randomly.According to their eGFR levels，the patients were divided into a renal function impairment group〔n=174，eGFR<90 ml?min-1?（1.73 m2）-1〕 and a normal renal function group 〔n=144，eGFR≥90 ml?min-1?（1.73 m2）-1〕.Baseline data were compared between the two groups，and the correlations among CysC，UA and eGFR were analyzed.Factors influencing early renal impairment in Kazakh patients with H-type hypertension，as well as the value of CysC and UA in diagnosis of the condition，were investigated.Results　The indicators age，systolic blood pressure（SBP），diastolic blood pressure（DBP），triglyceride（TG），low density lipoprotein cholesterol（LDL-C），blood urea nitrogen（BUN），creatinine（Cr），homocysteine（Hcy），CysC and UA were higher in the renal function impairment group than in the normal renal function group（P<0.05）.CysC and UA were negatively correlated with eGFR（r=-0.791 and -0.671，P<0.05）.Multivariate Logistic regression showed that LDL-C，CysC，and UA were influencing factors for early renal impairment in Kazakh patients with H-type hypertension（P<0.05）.The areas under the ROC curve（AUC） of CysC and UA in the diagnosis of early renal impairment in these patients were 0.967〔95%CI（0.946，0.989）〕 and 0.875〔95%CI（0.837，0.913）〕.Conclusion　CysC and UA are correlated with early renal impairment in Kazakh patients with H-type hypertension and are a favorable indicator for the diagnosis of early renal impairment.

Relationship between Cognitive Function and Cerebrovascular Reactivity in Asymptomatic Carotid Stenosis Patients

SHI Baolin，ZHANG Shuyun，MIAO Yanxia，SONG Shilei，ZHANG Yueqi

2019, 22(6): 668-672. DOI: 10.12114/j.issn.1007-9572.2018.00.020

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Backgropund　The cognitive status of patients with asymptomatic carotid stenosis （ACS） is still unclear，and its relationship with cerebrovascular reactivity （CVR） is still unclear.Objective　To assess the relationship between cognitive function and CVR in ACS patients.Methods　The participants were enrolled from Weifang People's Hospital from October 2014 to September 2017，including 102 outpatients and inpatients with ACS（ACS group），and 26 healthy cases undergoing physical examination（control group）.We collected the general data in both groups.Transcranial Doppler ultrasound was used for breath-holding test （BHI）to assess CVR in patients with ACS.Based on the assessment results of CVR，ACS patients were divided into normal left CVR（LCVR）group（n=30），impaired LCVR group（n=23），normal right CVR（RCVR）group（n=28），impaired RCVR group（n=21）.Color Doppler ultrasound was used to assess carotid stenosis in ACS patients.The fourth edition of Wechsler Adult Intelligence Scale（WAIS-Ⅳ） was used to assess cognitive function in all participants.Results　There was significant difference in BHI among the 5 groups（P<0.05 ）.The degree of internal carotid artery stenosis did not differ significantly between the normal LCVR group，impaired LCVR group，normal RCVR group and impaired RCVR group（P>0.05）.The vocabulary score of the impaired LCVR group was lower than that of the other four groups（P<0.05）.The impaired RCVR group achieved lower scores of picture completion and visual puzzles compared with other four groups（P<0.05）.There was a positive correlation between the vocabulary score and BHI in the impaired LCVR group（r=0.713，P<0.05）.BHI was positively correlated with the picture completion score as well as the visual puzzles score in the impaired RCVR group（r=0.622，P<0.05；r=0.647，P<0.05）.Conclusion　In patients with ACS，there is a decrease in cognitive function among some patients with reduced CVR. The relevant cognitive domain is associated with the function of the ipsilateral hemisphere of the narrow carotid artery，and the degree of cognitive decline is related to the degree of CVR reduction.

Levels of HMGB1，TLR2 and TLR4 in Serum and Their Clinical Significance in Patients with Mild Traumatic Brain Injury Combined with Mild Cognitive Impairment

ZHANG Xuyang，WANG Xinjun，FU Xudong，ZHOU Shaolong，MA Jian，LIU Feifei，MENG Enping

2019, 22(6): 673-677. DOI: 10.12114/j.issn.1007-9572.2018.00.242

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Background　Traumatic brain injury（TBI）often leads to cognitive impairment in varying degrees.The morbidity is 20%-50%，which seriously affects the quality of life.However，its pathogenesis is still unclear and basic research is relatively scarce.High-mobility group box-1（HMGB1）is a proinflammatory factor，which acts on Toll-like receptor 2（TLR2）and Toll-like receptor 4（TLR4）to activate nuclear factor kappa B（NF-κB），and its abnormal expression is associated with cognitive impairment.The expression of serum HMGB1，TLR2 and TLR4 in patients with cognitive impairment after TBI has rarely been reported.Objective　To detect the serum HMGB1，TLR2 and TLR4 levels of patients with mild traumatic brain injury（mTBI）combined with mild cognitive impairment（MCI）and analyze their clinical significance.Methods　In this prospective study，seventy-five patients whose mTBI scored 13 to 14 in Glasgow Coma Scale（GCS）admitted to Department of Neurosurgery，the Fifth Affiliated Hospital of Zhengzhou University from June 2016 to December 2017 were determined as mTBI group（GCS scored 14 had 38 cases，GCS scored 13 had 37 cases，including 53 cases without MCI and 22 cases with MCI），meanwhile 20 normal subjects as control group were enrolled in this prospective study.Fasting peripheral venous blood was collected in the morning to detect the levels of HMGB1，TLR2，TLR4 in serum.The serum levels of HMGB1，TLR2 and TLR4 were compared between the two groups.The serum levels of HMGB1，TLR2 and TLR4 between GCS scored 13 and GCS scored 14 patients were analyzed.The serum levels of HMGB1，TLR2 and TLR4 between patients with MCI and patients without MCI were also analyzed.The correlations of HMGB1，TLR2 and TLR4 in serum of patients with mTBI combined with MCI were analyzed.Results　Levels of HMGB1，TLR2 and TLR4 in serum in mTBI group were significantly higher than those in control group（P<0.05）．There was no significant difference in serum levels of HMGB1，TLR2 and TLR4 between patients with GCS scored 14 and those with GCS scored 13 in mTBI group（P>0.05）．HMGB1，TLR2 and TLR4 levels in serum of patients with mTBI combined with MCI were significantly higher than those in patients with mTBI without MCI（P<0.05）．Levels of TLR2 and TLR4 in serum of patients with mTBI combined with MCI were both positively correlated with HMGB1 level〔Y=0.438X-0.858（r=0.615，P=0.014）；Y=0.494X+0.158（r=0.846，P<0.001）〕，and the level of TLR2 was not correlated with TLR4 in patients with mTBI combined with MCI〔Y=0.687X-0.178（r=0.372，P=0.055）〕.Conclusion　The serum levels of HMGB1，TLR2 and TLR4 were higher in patients with mTBI combined with MCI，and the high serum expression levels of HMGB1，TLR2 and TLR4 might be related to the occurrence and development of MCI in mTBI patients.

Effects of Non-selective β Blockers on Hemodynamics and Hepatorenal Syndrome in Cirrhosis Patients with Esophageal-gastric Varices

WU Rui，LIU Chuntao，WU Jing，TIAN Hongfei，FU Xiaoqing，LIU Shourong

2019, 22(6): 678-682. DOI: 10.12114/j.issn.1007-9572.2019.06.012

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Background　Non-selective β receptor blockers（NSBBs） can reduce portal vein pressure in patients with decompensated cirrhosis，so they are widely used in cirrhosis patients with esophageal-gastric varices. However，the influence of NSBBs on hemodynamics and the incidence of hepatorenal syndrome （HRS） in these patients has rarely been reported.Objective　To explore the effects of NSBBs on hemodynamics and the incidence of HRS in cirrhosis patients with esophageal-gastric varices.Methods　Clinical data were collected from 215 cirrhosis patients with complications of esophageal-gastric varices who were admitted to the Department of Hepatology of Xixi Hospital of Hangzhou between 2012 and 2016.According to esophageal-gastric variceal bleeding，the patients were divided into group A（only having varicose veins，n=155） and group B（having varicose veins with bleeding，n=60）.Each group was further divided into two subgroups according to whether the subjects were taking propranolol：subgroup A1（not taking propranolol，n=56） and subgroup A2（taking propranolol，n=99），as well as subgroup B1（n=25） and subgroup B2（n=35）.Indices including sex；age；laboratory tests including total bilirubin（TBiL），albumin（ALB），platelet count（PLT），international normalized ratio（INR） and creatinine（Cr）；and hemodynamic parameters including basal heart rate，arterial systolic pressure（SAP），mean arterial pressure（MAP） and incidence of HRS among the above subgroups were compared.Results　There were no significant differences in sex，age，TBiL，ALB，PLT，INR and Cr between subgroups A1 and A2（P>0.05）.The basal heart rate，SAP and MAP were higher in subgroup A1 than in subgroup A2（P<0.05）.The incidence of HRS in subgroup A1 was 7.1%（4/56），and that in subgroup A2 was 2.0%（2/99）；this difference was not significant（χ2=1.334，P=0.248）.The six HRS cases in group A all survived 90 days after the first diagnosis of HRS；among them，three patients had a Child-Pugh score（CPS） of grade C（two patients in subgroup A1 and one in subgroup A2）.There were no significant differences in sex，age，TBiL，PLT，INR，Cr，SAP and MAP between subgroups B1 and B2（P>0.05）.ALB was lower and basal heart rate was higher in subgroup B1 than in subgroup B2（P<0.05）.The incidence of HRS in subgroup B1 was 4.0%（1/25），and that in subgroup B2 was 5.7%（2/35）；this difference was not statistically significant（χ2=0.090，P=0.754）.Three patients with HRS in group B died within 90 days after the first diagnosis of HRS，of whom two had CPS grade C（one in subgroup B1 and one in B2）.Conclusion　NSBBs may have negative effects on hemodynamics in cirrhosis patients with esophageal-gastric varices，but whether the drugs increase the incidence of HRS still requires further study to verify.

Effect of Prophylactic Antivirus Therapy on Hepatic Impairment and Hepatitis B Virus Surface Antigen in Lung Cancer Patients with Hepatitis B Virus Infection

WANG Wanmin，HAN Yiping

2019, 22(6): 683-686. DOI: 10.12114/j.issn.1007-9572.2018.00.327

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Background　Due to the high prevalence of primary bronchogenic carcinoma （lung cancer） and hepatitis B virus infection in China，lung cancer patients infected with HBV are common.Some studies found that lung cancer patients who infected with HBV have higher rates of liver damage and hepatitis B virus reactivation（HBVR）than those without HBV.Objective　To investigate the effect of prophylactic antiviral therapy on hepatic impairment and hepatitis B virus reactivation（HBVR） in lung cancer patients with hepatitis B virus surface antigen（HBsAg） infection.Methods　According to the inclusion and exclusion criteria，from Changhai Hospital during 2015 to 2017，we enrolled 61 lung cancer inpatients with positive HBsAg test result（HBsAg-positive group），including 29 who received prophylactic antiviral therapy（intervention subgroup） and 32 who did not（control subgroup），and other 61 lung caner inpatients without HBsAg infection（HBsAg-negative group）．The incidence of hepatic impairment was compared between the intervention subgroup，control subgroup and HBsAg-negative group.And the incidence of HBVR was compared between the intervention subgroup and the control subgroup.Results　The incidence of hepatic impairment in the control subgroup was higher than that in the HBsAg-negative group at the first third hospitalization（P<0.05）．At the first hospitalization，the incidence of hepatic impairment in the HBsAg-negative group was lower than that in the intervention subgroup（P<0.05）．At the first third and fifth hospitalizations，there was no significant difference in the incidence of hepatic impairment between the intervention subgroup and the control subgroup（P>0.05）．There was no significant difference in the incidence of HBVR between the intervention subgroup and the control subgroup（P>0.05）．Conclusion　HBV infection can significantly increase the risk of hepatic impairment in lung cancer patients during antitumor therapy.But the absolute risk of hepatic impairment in this population during antitumor therapy can be reduced by prophylactic antiviral therapy．

Influencing Factor Analysis of Signing a Contract with a Family Doctor among Residents in Hongkou District，Shanghai

HUANG Jiaoling，LIANG Hong，ZHANG Weisheng，ZHANG Jianmin，WANG Chao，CHEN Xiang，LIU Shanshan，HE Rongrong，ZHANG Yimin

2019, 22(6): 687-691. DOI: 10.12114/j.issn.1007-9572.2018.00.340

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Background　Family doctor system has been given new connotations in the new round of grassroots health service reform，and have become the significant measurement for realizing the health of the whole people.At the same time, it is very important to understand the acceptance of family doctors and the main influencing factors of their contracting behavior.Objective　To analyze the influencing factors of signing a contract with a family doctor among residents in Shanghai's Hongkou District，providing theoretical basis and empirical evidence for primary care reform.Methods　This study was conducted between December 2015 and January 2016.By use of multi-stage cluster sampling，the permanent residents in Shanghai's Hongkou District were enrolled.Through the individual face-to-face interview，the status of signing a contract with a family doctor was collected，and recorded.Implementation Evaluation of the Family Doctor System in Shanghai's Hongkou District，a questionnaire designed by our research group，was used to conduct a survey among the residents，which is mainly composed of demographic data，health status（whether have chronic diseases），habit of seeking first-contact care（the preferred medical institution），overall level of satisfaction with the contracted family doctor services（CFDSs），and awareness of the CFDSs （favorable items）．Multiple Logistic regression was adopted to analyze the influencing factors of signing a contract with a family doctor among these residents.Results　Of the 900 residents，614 effectively responded to the questionnaire，giving a response rate of 68.22%.Among the respondents，401（65.31%） had signed a contract with a family doctor，but other 213（34.69%） had not.Compared with the non-contracted residents，the contracted ones had older average age，higher rates of having Shanghai hukou and chronic diseases，higher average overall level of satisfaction with CFDSs，and higher average awareness level of CFDSs，but lower retirement rate （P<0.05）．Educational level，average income per month and habit of seeking first-contact care were all significantly different between the two groups （P<0.05）．Multiple Logistic regression analysis showed that educational level，habit of seeking first-contact care，overall level of the satisfaction with CFDSs and awareness level of CFDSs were influencing factors of signing a contract with a family doctor （P<0.05）．Conclusion　Educational level，habit of seeking first-contact care，overall level of the satisfaction with CFDSs and awareness level of CFDSs are influencing factors for signing a contract with a family doctor among residents.

Analysis on the Difference of Expectation and Actual Value of Contracted Services among Residents and Its Countermeasures in Datuan Community Health Service Center

CAI Liqiang，HOU Jin，LU Xinjian

2019, 22(6): 691-695. DOI: 10.12114/j.issn.1007-9572.2018.00.390

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Background　As a platform for the government to provide basic medical and public health services to the people，the efficient and orderly service of community health service centers will improve the operational efficiency of family doctors' contracted services and meet the basic health needs of residents.Objective　To analyze the difference between the expected value and the actual value of contracted services among residents in Datuan Community Health Service Center，and understand the operation status of the Center，so as to put forward countermeasures against existing problems.Methods　Contracting residents of Datuan Community Health Service Center were selected from April to June 2017 using a simple random sampling method.Self-designed Survey on the Evaluation of Expectations and Actual Values of Community Health Services by Contracting Residents were used during face-to-face interviews with contracting residents.The questionnaire consisted of 25 entries in 3 dimensions.Dimension 1 was the evaluation of 4 projects：visiting environment，service attitude，doctor's diagnosis and treatment skills，and construction of auxiliary functional platform of the health service center（including expected and actual values）；dimension 2 was the evaluation of environment，service attitude，diagnostic and therapeutic skills in different departments （actual value）；dimension 3 was the evaluation of operational service items，clinical laboratory items，radiation/echocardiography/electrocardiogram examinations，and drug supply（actual values）．Results　A total of 400 questionnaires were distributed，396 were recovered，and 390 valid questionnaires were collected，with an effective recovery rate of 97.50%.Among 390 contracted residents，206（52.82%）indicated that they concerned“doctors' diagnosis and treatment skills” the most，75 （19.23%）indicated that they focused on the“construction of auxiliary functional platform”.Visiting environment's expectation score was（8.34±1.27） points，actual value score was（8.23±1.34） points，service attitude expectation score was （8.49±1.17） points，the actual value score was （8.22±1.29） points，doctor's diagnosis and treatment skills expectation score was （8.59±1.06） points，and actual value score was （8.14±1.24） points，auxiliary function platform expectation score was （8.25±1.27） points，and actual value score was （7.97±1.33） points.Contracted residents evaluated the departments and top three highest actual value departments were general practice clinic〔（8.42±1.25） points〕，outpatient lobby〔（8.37±1.23） points〕，and outpatient department of Traditional Chinese Medicine〔（8.28±1.32） points〕.The actual value of doctors' operational service items in the community health service center was （7.95±1.40） points；clinical laboratory items was （7.92±1.33） points；radiation/echocardiography/electrocardiogram examinations items was（8.01±1.23） points；drug supply was （7.66±1.38） points.209（53.59%）contracting residents thought that there was an urgent need to improve the“drug supply”.Ninety-eight （27.22%）thought it was urgent to improve“perational service items”.Conclusion　Contracting residents are most concerned about the diagnosis and treatment skills of doctors in community health service centers.The gap between the expected value and the actual value is large.The evaluation of doctors' operation items is low，and the supply of drugs can not meet the demand.Under the guidance of the government，we suggest to establish Family Doctor Studio，introduce internal competition mechanism，change performance appraisal standards，and speed up the construction of talent team.Through the“system+science and technology” management model，the function of community health service centers can be improved.

Current Status of Hospital-at-home for Oncology Patients Delivered by Dongshi Central Hospital during 2015—2017

HUANG Yayu，CHEN Yuzhang，LIN Jianguang，ZHANG Changmao，DAI Yijun，DAI Yangbin，ZHAO Aiyue，XU Tianwen

2019, 22(6): 696-700. DOI: 10.12114/j.issn.1007-9572.2018.00.220

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Background　Although the incidence of cancer continues to rise in China，and the number of cancer patients admitted by grade A tertiary hospitals is limited due to insufficient beds，hospital-at-home，providing hospital-level care in a patient's home，can be used as an appropriate substitute for hospital care for end-stage cancer patients.Objective　 To investigate the status of hospital-at-home delivered by Department of Oncology，Dongshi Central Hospital，and to analyze the hospitalization expenses and use of opioid analgesics of the patients，providing a basis for the development of hospital-at-home schemes.Methods　 We enrolled 225 cancer patients who received hospital-at-home delivered by Department of Oncology，Dongshi Central Hospital during April 2015 to December 2017.We conducted a retrospective analysis of the establishment of hospital-at-home，the general clinical data of patients，participation in medicai hospitalization（total expenses，individual payment excluding reimbursement，individual payment ratio，reimbursement ratio），and use of opioid analgesics.Moreover，we carried out telephone follow-ups to collect the data concerning the patient's survival and satisfaction with hospital-at-home.Results　 The numbers of cancer patients receiving hospital-at-home from April to December 2015，in 2016 and insurance and payment methods，2017 were 66，68，91，respectively.Compared with 2015（from April to December），the number of patients receiving hospital-at-home showed 103.03%，and 137.88% development speed in 2016，2017，respectively，increasing by 3.03%，37.88%，respectively.Of these totaled 225 patients，men outnumbered women〔85.3%（192/225） vs 14.7%（33/225）〕；and 38.2%（86 cases） aged 60 years or younger.216 out of 225 patients in hospital-at-home participated in the new rural cooperative medical insurance and reimbursed according to the prescribed proportion.Within this period，average individual payment excluding reimbursement，average total hospitalization expenses，and average reimbursement ratio，were 195.34 yuan，3 824.24 yuan，65.37%，respectively.The doses of morphine tablets，and OxyContin used showed an increase year after year，conforming to the principle of the WHO's three-step analgesic ladder.89.1% （114/128）of the patients or their family members were fully satisfied with hospital-at-home.Conclusion　By use of hospital-at-home，these cancer patients obtained high reimbursement ratio and decreased hospitalization expenses，so the financial burden for them was reduced.Moreover，as the treatment was conducted at home，a place being more appropriate than hospital for spending the last days of life，the qualities of life of the patient and his family members were improved.In addition，their satisfaction with care was increased.

Regulating Effects of Kidney-nourishment and Blood-activation Recipe on Annexin A2 and Toll-like Receptor 4 of Peripheral Blood and Decidua in Patients with Recurrent Spontaneous Abortion and Positive Antiphospholipid Antibody

FENG Xiaoling，CHANG Zhuo，ZHANG Xuan，CHEN Lu，WANG Wei，ZHAO Xiaoxuan，ZHAO Yan

2019, 22(6): 701-706. DOI: 10.12114/j.issn.1007-9572.2018.00.382

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Background　Recurrent spontaneous abortion（RSA） is one of the common diseases in pregnancy，and anti-cardiolipin antibodies（ACA） are closely related to the occurrence of the disease.Previous studies have found that the Toll-like receptor 4 （TLR4） /NF-κB pathway in the decidua of ACA（+） RSA is activated，suggesting that the changes in factors in this pathway and pathway may be important mechanisms for the occurrence of ACA（+）RSA，so the pathway and interventions with related factors may have an impact on the pregnancy outcome of ACA（+）RSA.Because ACA（+）RSA has a tendency to thrombosis，which is consistent with the syndrome of kidney deficiency and blood stasis in Chinese medicine，so use the method of reinforcing kidney and activating blood，Kidney-nourishment & Blood-activation Recipe prepared according to the treatment method have also been obtained good effect in long-term and large-scale clinical application.Objective　To observe the effect of Kidney-nourishment and Blood-activation Recipe on peripheral blood and decidual Annexin A2 （ANXA2），TLR4 in patients with RSA and positive ACA，and then to explain the efficacy and action mechanism of Kidney-nourishment and Blood-activation Recipe in fetus protection for ACA （+） RSA patients.Methods　Thirty-one patients admitted to the outpatient and inpatient departments of First Affiliated Hospital， Heilongjiang University of Chinese Medicine from March 2015 to March 2016 were selected.Among them 16 cases had pregnancy failures and needed complete curettage of uterine cavity，and 15 patients performed normal abortion at the outpatient department.A total of 31 decidua were collected and patients were divided into test group 1 （n=16） and control group 1 （n=15）．One case was excluded from the test group 1 because of chromosome abnormality in the abortion tissue.Eleven patients were selected as test group 2 with ACA（+）RSA who asked for a fetus protection andadmitted to the outpatient and inpatient departments of First Affiliated Hospital to Heilongjiang University of Chinese Medicine from March 2015 to March 2016，and 13 patients who received a normal pregnancy test at the outpatient department were selected as control group 2.A total of 24 serum samples were collected.Four cases were excluded from the study，as one case in the test group 2 had spontaneous abortion，and 3 cases in the control group 2 quitted the study.The levels of ANXA2 mRNA and TLR4 mRNA in decidua of patients in the control group 1 and test group 1 were detected with RT-qPCR method.The test group 2 was given Kidney-nourishment and Blood-activation Recipe，and the control group 2 was not given intervention.Their venous blood was taken before and after treatment.The levels of serum progesterone，β-HCG，ANXA2，and TLR4 of control group 2 and test group 2 were detected using the ELISA method.Results　The level of ANXA2 mRNA in the abortion decidual tissue of the control group 1 was higher than that of the test group 1 and its TLR4 mRNA level was lower than that of the test group 1 （P<0.05）．There were significant differences in levels of serum progesterone，β-HCG，ANXA2 and TLR4 between the control group 2 and the test group 2 before the treatment （P<0.05）．After the treatment，the differences in serum progesterone，β-HCG、ANXA2 and TLR4 between the control group 2 and the test group 2 was not statistically significant （P>0.05）．The levels of serum progesterone，β-HCG，ANXA2 of the test group 2 were all significantly higher than those before treatment ，level of serum TLR4 of the test group 2 was significantly lower than that before treatment（P<0.05）．Conclusion　The occurrence of ACA（+）RSA may be associated with low expression of ANXA2 and high expression of TLR4.Kidney-nourishment and Blood-activation Recipe can improve hypercoagulability and inflammation and in turn improve the pregnancy outcome by up-regulating ANXA2 and down-regulating TLR4.

Effects of Preventive Acupuncture at the Fenglong Acupoint on Obesity Prevention and PPAR-γ Expression Level in Rats Fed a High-fat Diet

WU Jiajing，ZHU Wenyan，SUN Yinong，ZHU Shipeng

2019, 22(6): 707-711. DOI: 10.12114/j.issn.1007-9572.2018.00.290

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Background　At present，disease medicine is gradually changing to health medicine，and the time point of medical intervention is gradually getting earlier. Preventive treatment of disease is an important manifestation of TCM preventive medicine，and preventive acupuncture and moxibustion is one of its important means.Objective　To observe the effect of preventive acupuncture at the Fenglong acupoint on obesity prevention and PPAR-γ expression level in rats fed a high-fat diet.Methods　This study was implemented during May to July 2016.Twenty-four four-week-old male SPF male rats were randomly divided into blank group，model group and preventive acupuncture group，with eight in each.All groups received a 12-week intervention，during this period，the blank group received a normal diet plus being taken and fixed at the self-made fixator（three times a week），the model group received a high-fat diet plus being taken and fixed at the self-made fixator（three times a week），and the preventive acupuncture group received a high-fat diet plus preventive acupuncture treatment（bilateral needling of the Fenglong acupoint after being fixed at the self-made fixator，three times a week）；body weight was measured once a week.When the intervention ended，the rats were scarified and perirenal fat weight was measured，morphology of the adipocyte area was observed，serum leptin and PPAR-γ expression levels in the adipose tissue were measured.Results　At the end of the 8th week of intervention，the blank group showed much lower body weight than the model group（P<0.05）．At the end of the intervention，the body weight was much lower in the blank group than that of the model group and preventive acupuncture group（P<0.05）；the preventive acupuncture group demonstrated significantly decreased body weight compared with the model group（P<0.05）.The blank group exhibited significantly decreased perirenal fat weight compared with other two groups （P<0.05）．The perirenal fat weight of the preventive acupuncture group was much lower than that of the model group（P<0.05）．Compared with the model group，both the blank group and preventive acupuncture group showed much less newly generated adipocytes and much smaller adipocyte areas.The average area of adipocytes in model group was larger than that in blank group and preventive acupuncture group （P<0.05）.The model group had significantly higher serum leptin level compared with other two groups（P<0.01）.The PPAR-γ expression level in the adipose tissue in the model group was obviously higher than that of the blank group and preventive acupuncture group （P<0.05）．Conclusion　Preventive acupuncture at the Fenglong acupoint can effectively prevent obesity in rats and improve the abnormal state of fat metabolism.The mechanism may be related to the improvement of leptin resistance and the regulation of PPAR-γ expression level in the adipose tissue.

Efficacy and Safety of New Ultrasound-guided Hydrostatic Reduction vs Conventional Pneumatic Reduction for Intussusception in Pediatric Patients

WANG Dengliang，KANG Quan，WANG Haoming，DAI Xiaoke，ZHANG Mingman

2019, 22(6): 712-714. DOI: 10.12114/j.issn.1007-9572.2018.00.264

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Background　The conventional pneumatic reduction of an intussusception is associated with a risk of perforation and considerable ionizing radiations.Objective　To compare efficacy and safety of new ultrasound-guided hydrostatic reduction and conventional pneumatic reduction in treating pediatric intussusception.Methods　A total of 60 patients with primary intussusception meeting inclusion criteria admitted to Children's Hospital of Chongqing Medical University from 10 May 2016 to 2 August 2016 were enrolled.Subjects were divided into hydrostatic reduction group and pneumatic reduction group by random numbers generated by computers，each with 30 patients.The pneumatic reduction group received new ultrasound-guided hydrostatic reduction，and the hydrostatic reduction group received conventional pneumatic reduction.The success rate of reduction，rate of recurrence，duration of reduction，and enema pressure were recorded.Results　No significantly statistical differences were found in terms of success rate of reduction and recurrence rate between the two groups（P>0.05）.The duration of reduction in hydrostatic reduction group was significantly longer than that in pneumatic reduction group，and the enema pressure in hydrostatic reduction group was significantly higher than that in pneumatic reduction group（P<0.001）.No perforation and delayed intestinal necrosis were found in two groups. Conclusion　The new ultrasound-guided hydrostatic reduction and conventional pneumatic reduction have similar success rate of reduction and recurrence rate in the treatment of pediatric intussusception.The new ultrasound-guided hydrostatic reduction is of great use of value as its pressure is controllable，although it has longer duration of reduction and higher enema pressure.

Retrievable Inferior Vena Cava Filter Placement for the Prevention of Perioperative Pulmonary Embolism in Patients with Deep Venous Thrombosis after Lower Extremity Fracture

XIE Yinli，ZHANG Dachun，ZHI Xingxing，ZHU Rui，WENG Gaojie，ZHOU Feng，YANG Li，XU Qian，ZHOU Shi

2019, 22(6): 715-719. DOI: 10.12114/j.issn.1007-9572.2018.00.367

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Background　Pulmonary embolism （PE）is the main risk factor for perioperative mortality in patients with lower limb fracture complicated with deep vein thrombosis（DVT）. For such high-risk population，retrievable inferior vena cava（IVC） filter can prevent the occurrence of pulmonary embolism and recover it when not needed.Objective　To investigate the clinical value of retrievable IVC filter replacement for the prevention of perioperative PE in patients with DVT following lower extremity fracture.Methods　We conducted this study among the patients with DVT following lower extremity fracture who received treatment in Liupanshui People's Hospital from January 2001 to December 2007.All were confirmed by Doppler ultrasonography of the lower extremity arteries.Among them，of the 1 711 cases treated during January 2008 to January 2017，after excluding 231 with permanent IVC filter replacement，we assigned 843 receiving retrievable IVC filter replacement to the retrievable IVC filter replacement group，and other 637 without IVC filter replacement to No. 1 control group，respectively.Furthermore，all the 1 062 cases who were treated but were not given IVC filter replacement during January 2001 to January 2017（because this treatment has been carried out in this hospital since 2008） were assigned to No. 2 control group.The incidence of PE，mortality，and anticoagulant therapy were compared between the 3 groups.And IVC filter placement and complications secondary to this treatment were compared between the retrievable IVC filter replacement group and No. 1 control group.Results　Compared with the two control groups，the retrievable IVC filter replacement group had lower overall incidence of PE，lower incidence of PE in those receiving anticoagulant therapy，lower incidence of PE in those with contraindications for anticoagulation therapy，and lower overall mortality（P<0.05）．Retrievable IVC filter replacement was implemented successfully in the 843 cases，and the filters were placed in the correct position.The prevalence of filter tilt was 28.94%（244/843） in the follow-up period.700 patients（83.04%） who had no contraindications to anticoagulant therapy were treated with LMWH after surgery.25 patients（3.92%） in No.1 control group refused to place the filter because of contraindications to anticoagulation therapy，and no anticoagulant therapy was given to them during the perioperative period.In No. 2 control group，924 patients （87.01%） received anticoagulant therapy.In the retrievable IVC filter replacement group，1 case had pneumothorax associated with surgery，2 cases had puncture site haematoma，and no arteriovenous fistula occurred.For 6 cases had retrievable IVC filters tilting towards the heart，the filters were removed.During the removal process，3 had vena cava injuries，2 of them had a incision less than 2 cm in the vena cava，other 1 had IVC perforation with an area about 3 cm in diameter with leaked contrast media，and no PE occurred.In 251 patients（29.8%），the embolus was found before the removable filter was removed.Among them，122（14.47%） had large emboli（diameter>1 cm） and 129（15.30%） had smaller emboli；19 patients had IVC blocked by a large number of emboli.Of the 219 cases using Optease? filters，except for one case，a large embolus was found on the filter by vena cava angiography，the filters of other cases were removed according to the course of treatment.The filter was placed for 10 to 17 days with an average of（13.9±4.8） days.Of the 625 cases using Celcet filters，the filters of 578 were removed，and the removal was successfully implemented in 566 cases（97.92%）．The retention time of the retrievable filters was 12 to 52 days，with an average of（15.8±12.1） days.Conclusion　Retrievable IVC filter replacement may be a safe and effective treatment for preventing perioperative symptomatic or fatal PE in lower extremity fracture patients with DVT.

Dynamic MRI in Evaluation of Levator Ani Structure Changes in Post Radical Hysterectomy Patients　

CHEN Shuozhen，LIU Ping，CHEN Chunlin，CHEN Lan，PENG Cheng，HUANG Lu，GONG Shipeng，SU Guidong，QIAO Wenjun，TANG Lian，CHEN Jinyang

2019, 22(6): 720-725. DOI: 10.12114/j.issn.1007-9572.2018.00.246

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Background It has been reported that the changes of pelvic floor after radical hysterectomy is one of the most important reason for postoperative pelvic floor dysfunctions. However，there are few reports on the changes in postoperative levator ani muscles.Objective　To evaluate the changes in levator ani muscle before and after radical hysterectomy with reconstruction of 3D dynamic MRI，providing a theoretical reference for the understanding of postoperative pelvic floor disorders.Methods　According to the inclusion criteria，33 cases underwent radical hysterectomy due to stageⅠA2-ⅡA2 squamous carcinoma of the cervix in Nanfang Hospital，Southern Medical University during September 2015 to September 2017 were enrolled.The structures of levator ani muscle observed with MRI during static breath holding and a maximal breath hold within 2 weeks before the operation and 1 year after the operation were collected and 3D image reconstruction of the pelvis and levator ani muscle was performed.The morphological changes in iliococcygeus，puborectal muscle and the attachment of the muscle to pubic symphysis were evaluated using the 2D model and those in the volume of the levator ani muscle，the levator ani muscle plate angle，levator hiatus width and length，and the distance between the pectineus muscle attaching to pubis and the inferior border of pubic symphysis were evaluated using the 3D model.Results　The following changes occurred postoperatively：（1）2D MRI images showed that the iliococcygeus changed to funnel shape in 11 cases（33.3% of the total），puborectal muscle changed to the shapes of “U”“O”or“irregular” in 10 cases（30.3% of the total）the attachment of the muscle to pubic symphysis changed to wave shape and defected shape in 19 cases（57.6% of the total）.（2）3D MRI images demonstrated that，the volume of the levator ani muscle decreased by 3.81 cm2；the levator ani muscle plate angle presented an increase of 4.13°；the distance between the pectineus muscle attaching to pubis and the inferior border of pubic symphysis exhibited an increase of 0.94 mm；levator hiatus width and length changed insignificantly.Conclusion　According to the postoperative changes in some parameters closely associated with the support function and morphology of levator ani muscle，we can infer that levator ani muscle's power decreased postoperatively.It provides a theoretical basis for early clinical rehabilitation of pelvic floor.

Relationship between Functional Magnetic Resonance Imaging and Swallowing Function in Patients with Dysphagia after Cerebral Infarction　

LONG Yaobin，LI Weixiong，HUANG Yalin，HUANG Fuling

2019, 22(6): 726-730. DOI: 10.12114/j.issn.1007-9572.2018.00.337

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Background　Dysphagia has become an independent risk factor affecting the prognosis of stroke patients. There are few reports about the recovery mechanism of dysphagic patients after stroke using resting state functional magnetic resonance imaging（rsfMRI）．Objective　To analyze the relationship between functional magnetic resonance imaging and swallowing function in patients with dysphagia after cerebral infarction，so as to explore the probable mechanism of dysphagia after cerebral infarction.Methods　Twenty patients who were hospitalized from March to December 2016 in Department of Neurology，the First Affiliated Hospital of Guangxi Medical University were recruited.Meanwhile，twenty healthy volunteers who underwent a health checkup were included，serving as the controls.Both groups were performed cranial magnetic resonance imaging（MRI） and rsfMRI examinations.Amplitude of low frequency fluctuations （ALFF） was analyzed by DPARSF software.The video fluoroscopy swallowing study （VFSS），as well as the rosenbek penetration and aspiration scale were carried out among patients，in order to evaluate swallowing function.Those regions with lower ALFF values among patients were reviewed as the regions of interest （ROI）．Then the relationship between ROI and Rosenbek penetration/aspiration grade was analyzed.Results　After the exclusion of unqualified subjects，twelve patients and eighteen healthy controls were included finally.Compared to the controls，ALFF values of left anterior central gyrus，precentral gyrus，insular lobe and putamen were all lower among patients （ P<0.05），while ALFF values of right anterior cingulate，insular cortex，visual center and primary auditory cortex were all higher （ P<0.05）．The ROIs of left central anterior，central posterior，insular lobe and putamen of patients were marked as ROI1，ROI2，ROI3 and ROI4，respectively.The results of Pearson correlation analysis revealed that ROI1，ROI2，ROI3 and ROI4 were all positively correlated with Rosenbek osmotic/aspiration grade （rROI1=0.45，P=0.006；rROI2=0.34，P=0.017；rROI3=0.24，P=0.035；rROI4=0.18，P=0.043）．Conclusion　The ALFF value of patients with dysphagia after cerebral infarction is positively correlated with Rosenbek penetration/aspiration grade.The abnormality of brain function may be one of the probable mechanisms underlying dysphagia.

Differential Diagnosis of Intracranial Hyperdensity after Interventional Procedure for Acute Cerebral Infarction by Spectral CT　

SUN Rui，GE Yinghui

2019, 22(6): 731-734. DOI: 10.12114/j.issn.1007-9572.2018.00.124

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Background　There are a few patients with hemorrhagic transformation after interventional procedure for acute cerebral infarction.However，on conventional CT，hemorrhagic transformation and contrast exudation used in interventional procedure are hyperdensity，which can not be identified effectively in time，and the study on the identification of the two by Spectral CT is rarely reported.Objective　To evaluate the value of differential diagnosis of intracranial hyperdensity after interventional procedure for acute cerebral infarction by spectral CT.Methods　The hyperdensity CT images which immediately obtained in 21 patients with acute cerebral infarction in Henan Traditional Chinese Medicine Hospital between May 2015 to October 2017，after interventional procedure were analyzed retrospectively.According to the results of conventional CT 24 hours after interventional procedure，21 cases were divided into two groups：contrast exudation group（n=11） and hemorrhagic transformation group（n=10）．CT value，iodine （water） and water（iodine） based value，and relative value between these values and the value of periventricular normal-appearing white matter were measured in each group，and the difference between the two groups were compared.Results　There was no significant difference in the CT value of intracranial hyperdensity between the two groups （P>0.05）．Water （iodine） value in exudation group was lower than that in hemorrhage group，and the iodine （water） value in exudation group was higher than that in hemorrhage group（P<0.05）．There was no significant difference in CT indexes between the two groups（P>0.05）．There was no significant difference in the relative value between the two groups （P>0.05），and CT density images showed similar high density．The relative value of the water（iodine） in exudation group was lower than that of the hemorrhage group（P<0.05）．On the water（iodine） images，the contrast extravastion showed low density，and the hemorrhage showed high density．The relative value of iodine（water） value of the contrast extravasation group was larger than that of hemorrhage group（P<0.05）．On the iodine （water） images，the contrast extravasation showed high density，and the hemorrhage showed low density.Conclusion　The spectral CT can be used to differentiate intracranial abnormal high density after interventional procedure of acute cerebral infarction in a timely and effective manner.

Characteristics Analysis of Subclinical Synovitis Measured with Ultrasound in Rheumatoid Arthritis　

CHEN Guangyao，HU Qi，XU Yuan，MA Xiao，LUO Jing，TAO Qingwen

2019, 22(6): 735-738. DOI: 10.12114/j.issn.1007-9572.2018.00.369

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Background　Subclinical synovitis refers to synovitis found under ultrasound or nuclear magnetic resonance，and no signs of joint swelling are found in clinical physical examination. Studies have shown that subclinical synovitis joints in patients with rheumatoid arthritis （RA） still have radiological progression of bone erosion，suggesting that subclinical synovitis joints are still in disease activity.Objective　To investigate the clinical features of subclinical synovitis measured with ultrasound in RA.Methods　In this clinical trial，a total of 132 outpatients and inpatients with RA receiving treatment from Department of TCM Rheumatology，China-Japan Friendship Hospital from April 2017 to May 2018 were enrolled.We used clinical physical examination and ultrasound to evaluate 28 joints including the metacarpophalangeal joints，proximal interphalangeal joints，wrist joints，elbow joints，shoulder joints and knee joints.The joints that showed no swelling in physical examination，but were detected with subclinical synovitis by ultrasound （i.e. subclinical synovitis joints） were recorded.The number of joints affected with subclinical synovitis in RA patients were analyzed by gender，age，erythrocyte sedimentation rate （ESR），C-reactive protein （CRP），rheumatoid factor （RF），and anti-cyclic citrullinated peptide （CCP） antibody.Results　Among the 132 cases，14 were male and 118 were female；37 were 18-44 years old，53 were 45-59 years old，42 were 60-75 years old；ESR：43 normal cases，89 abnormal cases；CRP：45 normal cases，87 abnormal cases；RF：34 negative cases，56 cases of low titer，42 cases of high titer；anti-CCP antibody：33 negative cases，17 cases of low titer，82 cases of high titer.Number of joints with subclinical synovitis：106 patients were found with subclinical synovitis and other 26 without.Gender，age，levels of ESR，CRP and RF were not associated with the number of joints with subclinical synovitis in RA patients（P>0.05）．High titer of anti-CCP antibody was associated with more joints affected with subclinical synovitis while negative and low titer of anti-CCP antibodies were not（P<0.05）．Conclusion　High titer of anti-CCP antibody is associated with subclinical synovitis in RA to various degrees，suggesting that in addition to clinical physical examination，ultrasound examination is needed for RA patients with high titer of anti-CCP antibody in order to assess the disease activity of RA intensively.

Clinical Analysis of Pregnant Women with Perinatal Intrauterine Infection　

WANG Huiying，ZHANG Rui，YU Shasha，LI Nan

2019, 22(6): 739-743. DOI: 10.12114/j.issn.1007-9572.2018.00.380

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Objective　 To analyze the relationship between perinatal intrauterine infection and adverse outcomes of mother and fetus.Methods　We retrospectively analyzed the clinical data of 46 pregnant women with perinatal intrauterine infection who delivered from January 2011 to July 2017 in Beijing Shijitan Hospital，Capital Medical University.Pathogenic bacteria，main causes and routes，and clinical manifestations of intrauterine infection and maternal and infant outcomes were analyzed by clinical data.Results　Among 46 cases with intrauterine infection during the study period，29 cases were infected by Escherichia coli，5 cases by group B streptococcus，3 cases by cytomegalovirus，2 cases by Listeria monocytogenes，1 case by staphylococcus aureus，1 case by Enterococcus faecalis，1 case by Klebsiella pneumoniae and 4 cases by other causes.Intrapartum Escherichia coli infection was mainly associated with multiple vaginal examinations during childbirth or history of uterine cavity operation，premature rupture of membranes and unclean diet Escherichia coli infection was the main cause of intrauterine infection.The main clinical symptoms of perinatal intrauterine infections were fever.Perinatal intrauterine infections caused by Escherichia coli and Listeria bacteria produced clinical manifestations of high fever and shivering.Perinatal intrauterine infections caused by group B Streptococcus and cytomegalovirus had no obvious fever symptoms.Thirty-eight out of 46 cases（82.6%） with perinatal intrauterine infection were accompanied by fever.Perinatal intrauterine infection caused by Escherichia coli resulted in postpartum high fever，sepsis in 12 pregnant women.There were 7 perinatal deaths，including 3 cases of cytomegalovirus infection，2 cases of Escherichia coli infection and 2 cases of Listeria infection；3 cases by infectious pneumonia.Conclusion　Perinatal intrauterine infection is closely related to intestinal bacterial infection.It is one of the main reasons leading to poor maternal and fetal outcomes.The main clinical symptoms of parturient women are fever，and neonatal infection can lead to toxic shock and death.We should do disinfection measures during childbirth and minimize unnecessary vaginal operations to reduce intrauterine infection in perinatal period.

Analysis of the Diagnosis and Treatment of a Chronic Obstructive Pulmonary Disease Case　

DUAN Jing，LI Fan，SUN Huifen

2019, 22(6): 744-746. DOI: 10.12114/j.issn.1007-9572.2018.00.092

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In this paper，we analyzed the clinical data of a patient with chronic obstructive pulmonary disease，discussed the effects of diagnostic accuracy and normative treatment on patient prognosis，and reviewed the differences in diagnosis，treatment，and management strategies regarding chronic bronchitis and chronic obstructive pulmonary disease．The cause of the patient's disease progression was analyzed to improve the standardization of diagnosis and treatment of this disease by community practitioners.

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