Chinese General Practice

Interpretation of the European Practical and Patient-Centred Guidelines for Adult Obesity Management in Primary Care —2019　

ZHOU Fangli，LI Sheyu

2019, 22(32): 3905-3909. DOI: 10.12114/j.issn.1007-9572.2019.00.649

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Obesity is an important public health issue worldwide.And its related complications impose heavy burden on society.General practitioners play a central role in the prevention and control of obesity.The European Practical and Patient-Centred Guidelines for Adult Obesity Management in Primary Care released in January 2019，provides systematic recommendations for the management of adult obesity specifically tailored to European general practitioners.This paper interprets the highlights of the guidelines for Chinese general practitioners.

Interpretation of Intrapartum Care for Women with Existing Medical Conditions or Obstetric Complications and Their Babies（NICE 2019）　

LU Hong，ZANG Yu

2019, 22(32): 3910-3914. DOI: 10.12114/j.issn.1007-9572.2019.00.583

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Intrapartum Care for Women with Existing Medical Conditions or Obstetric Complications and Their Babies published by National Institute for Health and Care Excellence（NICE） in 2019 covers care during labor and birth for women who need extra treatment because they have a medical condition or complications in their current or previous pregnancy.This guideline aims to improve outcomes for women and babies，which will be a good reference for the maternity care improvement of mother and babies in China.Its interpretation included the introduction of the contents，the analysis of its advancement and practicality that would provide a new perceptive for the guideline development in China，as well as a practical instruction for Chinese professional health providers in maternal and newborn care.

Correlation between FT3/FT4 and Non-alcoholic Fatty Liver Disease in Patients with Euthyroidism and Hypothyroidism　

FAN Yaofu，CAO Wen，DI Hongjie，ZHANG Huifeng，SUN Hongping，CAO Lin，CHU Xiaoqiu

2019, 22(32): 3915-3920. DOI: 10.12114/j.issn.1007-9572.2019.00.271

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Background　Thyroid hormone is involved in the body's energy balance and lipid metabolism，which may be one of the potential mechanisms leading to the occurrence of non-alcoholic fatty liver disease（NAFLD）．Recently，the correlation between thyroid hormone and NAFLD is becoming a focus of clinical research，but no clear conclusion has been made.Objective　To investigate the correlation between thyroid hormone and NAFLD in patients with euthyroidism and hypothyroidism.Methods　A total of 382 inpatients from the Endocrine and Diabetes Center，Affiliated Hospital of Integrated Traditional Chinese and Western Medicine，Nanjing University of Chinese Medicine were enrolled from March 2015 to March 2018，including 268 with euthyroidism，114 with hypothyroidism；166 with NAFLD，and 216 without.Thyroid hormone indices were collected，and their correlations with NAFLD were explored by using Logistic regression and ROC analysis.Results　Of the 268 cases of euthyroidism，113 had NAFLD，and other 155 had not.NAFLD was associated with higher average levels of waist circumference（WC），total cholesterol（TC），low-density lipoprotein cholesterol（LDL-C），and fasting insulin（FINS），and higher average FT3/FT4 ratio，and homeostatic model assessment of insulin resistance index（HOMA-IR） in euthyroidism patients（P<0.05）．Among the 114 cases of hypothyroidism，53 had NAFLD，and other 61 had not.NAFLD was associated with higher average levels of WC，TSH，TC，LDL-C，and FINS，and higher average FT3/FT4 ratio，and HOMA-IR in hypothyroidism patients（P<0.05）．Multivariate Logistic regression analyses showed that WC〔OR=1.564，95%CI（1.125，2.174）〕，FT3/FT4 ratio〔OR=1.255，95%CI（1.067，1.477）〕and HOMA-IR〔OR=1.922，95%CI（1.194，3.095）〕 were influencing factors for NAFLD in all patients（P<0.05），and WC〔OR=1.233，95%CI（1.056，1.439）〕，FT3/FT4 ratio〔OR=1.628，95%CI（1.381，1.919）〕，TC〔OR=1.168，95%CI（1.014，1.345）〕and HOMA-IR〔OR=1.502，95%CI（1.053，2.142）〕 were influencing factors for NAFLD in patients with hypothyroidism（P<0.05）．ROC curve analysis found that，the AUC of FT3/FT4 ratio was 0.707〔95%CI（0.611，0.809）〕 for predicting the risk of NAFLD in patients with euthyroidism and hypothyroidism，the determined optimal cut-off point was 0.37，with corresponding sensitivity of 78.2%，and specificity of 58.5%.The AUC of FT3/FT4 ratio was 0.746〔95%CI（0.570，0.865）〕 for predicting the risk of NAFLD in patients with hypothyroidism，the determined optimal cut-off point was 0.47，with corresponding sensitivity of 82.4%，and specificity of 61.2%.Conclusion　FT3/FT4 ratio，HOMA-IR and WC are the risk factors of NAFLD in those with euthyroidism and hypothyroidism.For those with hypothyroidism，TC is an additional independent risk factor for NAFLD.

Reasons for Delay in Visit and Initial Diagnosis of Brucellosis　

LI Lin，XU Wenti，SU Cheng，ZHANG Ying

2019, 22(32): 3921-3925. DOI: 10.12114/j.issn.1007-9572.2019.00.260

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Background　Early detection of cases, early diagnosis and early standardized treatment are key to controlling human brucellosis and prevent its chronic development. It is important to study the causes and influencing factors of delayed detection of brucellosis by stages for comprehensive measures, targeted prevention and control of brucellosis. Objective　To study factors influencing delay in visit and diagnosis of human brucellosis, and provide basis for targeted risk control.Methods　Patients with brucellosis reported in Tianjin from 2012 to 2017 were selected as the research object.Self-designed questionnaires were used to collect the data of patients' gender, age, occupation, residence, clinical symptoms and signs, the name of diagnostic disease, the type of preferred hospital, the location of preferred hospital, the clinical stages at the time of consultation, and the first-visit department. According to whether the patient had delay in visit or initial diagnosis, they were divided into the timely visit group, the delayed visit group, the timely initial diagnosis and the delayed initial diagnosis group. Logistic regression was used to analyze the influencing factors of delayed visit and initial diagnosis. Results　A total of 808 cases with brucellosis were investigated. The delayed visit rate was 34.8%（281/808） and the delayed rate of initial diagnosis was 60.9%（492/808）．There were significant differences in fever, preferred hospital type and preferred hospital location between delayed visit group and timely visit group（P<0.05）．Multivariate Logistic regression analysis showed that the type of preferred hospital〔OR=1.70，95%CI（1.48，1.97）〕, the location of preferred hospital〔OR=1.25，95%CI（1.04，1.49）〕were the influencing factors of delay（P<0.05）．There were significant differences in occupation, residence, type of first-visit hospital, location of first-visit hospital, clinical stage and first-visit department between the timely initial diagnosis and the delayed initial diagnosis group（P<0.05）．Multivariate Logistic regression analysis showed that residence 〔OR=1.53，95%CI（1.11，2.10）〕, type of first-visit hospital〔OR=1.37，95%CI（1.24，1.51）〕, first-visit department〔OR=1.55，95%CI（1.39，1.73）〕were the influencing factors of delay in initial diagnosis（P<0.05）．Conclusion　Patients with brucellosis have different degrees of delay in the visit and diagnosis. To reduce the detection delay, we should focus on reducing the first diagnosis delay. Residence, type of preferred hospital and first-visit department may be the factors influencing the delay of first-time diagnosis of brucellosis.

Human Body Composition Analysis in the Treatment of Heart Failure　

NIE Qiuping，LIU Meixia

2019, 22(32): 3926-3931. DOI: 10.12114/j.issn.1007-9572.2019.00.152

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Background　Heart failure is an unavoidable syndrome in the end stage of heart disease.It has a high mortality and disability rate. Water and sodium retention is the main manifestation of heart failure. Human component analyzer can accurately evaluate the intracellular and extracellular water content of human body. At present, there are few reports about the application of human component analysis in guiding clinical medication in the treatment of heart failure at home and abroad. Objective　To analyze the body fluid distribution and nutritional status of patients with heart failure before and after diuretic treatment. Methods　A total of 33 patients with heart failure（heart failure group） admitted to the Department 4 of Cardiology, Hebei General Hospital and 33 patients without heart failure（non-heart failure group） admitted in the same hospital from January 2017 to January 2018 were selected as the study subjects. White blood cell count（WBC）, hemoglobin（Hb） , albumin（ALB） , aspartate aminotransferase（AST） , alanine aminotransferase（ALT） , creatinine（Cr） , blood potassium, blood sodium, total cholesterol（TC） , total triglyceride（TG） , high density lipoprotein（HDL）, low density lipoprotein（LDL） were measured. Nutrition physicians in our hospital measured extracellular water（ECW） , intracellular water（ICW） , total body water（TBW） , intracellular water/total body water（ICW%） , total body water/body mass （TBW%） , protein content, skeletal muscle content, body fat rate, extracellular water/total body water（ECW%） before and after diuretic treatment in heart failure group and non-heart failure group．The differences between the above indexes before and after diuretic treatment in heart failure group and non-heart failure group were compared. Results　There were no significant differences in sex and age between the two groups（χ2=0.243, P=0.622; t=1.405, P=0.165）．There were significant differences in Hb, ALB and Cr between the two groups（P<0.05）．ICW% before diuretic treatment in heart failure group was lower than that in non-heart failure group, and ECW%（whole body, right upper extremity, left upper extremity, right lower extremity, left lower extremity） was higher than that in non-heart failure group（P<0.05）．After diuretic treatment, ECW%（whole body, right upper extremity, left upper extremity, trunk, right lower extremity, left lower extremity） in heart failure group was higher than that in non-heart failure group（P<0.05）．ICW% increased and ECW%（whole body） decreased after diuretic treatment in heart failure group（P<0.05）．Conclusion　The abnormal water distribution and fluid retention in extracellular fluid in patients with heart failure showed that ECW（whole body, right upper extremity, left upper extremity, right lower extremity, left lower extremity） increased, while ICW% decreased, especially in lower extremity edema.Diuretic treatment could correct the above abnormalities to a certain extent. ECW%（whole body） decreased and ICW%（whole body） increased in patients with heart failure after diuretic treatment, but ECW%（right upper extremity, left upper extremity, trunk, right lower extremity, left lower extremity） had no difference before and after the treatment in heart failure group.

Influencing Factors of Bowel Preparation for Colonscopy in Inpatients　

SUN Chang，HE Wenying，WANG Ce，MA Junji，TIAN Hui

2019, 22(32): 3932-3938. DOI: 10.12114/j.issn.1007-9572.2019.00.206

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Background　With the development of endoscopic diagnosis and treatment technology, colonoscopy has become the gold standard for colon cancer screening. Whether a patient's bowel preparation is adequate is closely related to the success of colonoscopy diagnosis and treatment.At present, there are few domestic and foreign studies on the status, cleanliness level and influencing factors of inpatients' bowel preparation.However, relevant studies have shown that the quality of bowel preparation of inpatients is worse than that of outpatients. Therefore, how to improve the quality of bowel preparation of inpatients remains to be studied, which has received extensive attention from scholars at home and abroad. Objective　To understand the difference in bowel preparation between inpatients and outpatients undergoing colonoscopy, and to analyze the influencing factors of bowel preparation of inpatients. Methods　From January to April 2018, a total of 447 inpatients and outpatients underwent colonoscopy in the Department of Gastroenterology, the Second Hospital of Hebei Medical University were selected by convenience sampling, with the outpatient group of 227 subjects and inpatient group of 220 subjects. Baseline data questionnaire and Activities of Daily Living（ADL） scale were used to understand the general situation of patients. The influencing factors of bowel preparation were studied by using the feedback table of influencing factors of bowel preparation, the bowel preparation quality scored by Ottawa Bowel Preparation Scale（OBPS）, and multiple linear regression was used to analyze the influencing factors of OBPS score in inpatients. Results　The rate of inadequate bowel preparation in the outpatient group was 23.3%（53/227） and in the inpatient group was 49.5%（109/220）. OBPS scores of right colon, transverse colon, left colon, fluid volume and OBPS total score in outpatient group were lower than those in inpatient group（P<0.05）．Nine factors，including the low fiber diet time before two days of colonoscopy, the movement steps from taking compound polyethylene glycol electrolyte powder（PEG） to discharging watery stools, the frequency of bowel activity after taking the PEG, the first bowel activity after taking the PEG, the time interval between bowel preparation and colonoscopy, time for discharging residue after taking PEG, the sleep before the colonoscopy, the temperature of water and the exercise two days before colonoscopy, were significantly different between the two groups（P<0.05）; multivariate linear regression analysis showed that the movement steps from taking PEG to discharging watery stools（β=0，P<0.001）, the frequency of bowel activity after taking the PEG〔β=-0.042，95%CI（-0.078，-0.007），P=0.019〕, time for discharging residue after taking PEG〔β=0.136，95%CI（0.033，0.238），P=0.010〕, the exercise two days before colonoscopy〔β=0.302，95%CI（0.100，0.504），P=0.004〕were influencing factors in OBPS scores of the right colon in inpatients. The steps from taking PEG to discharging watery stools（β=0，P<0.001）was the factor influencing OBPS scores of transverse colon , left colon in inpatients.The steps from taking PEG to discharging watery stools（β=0，P<0.001）, the time interval between bowel preparation and colonoscopy〔β=-0.050，95%CI（-0.090，-0.009），P=0.017〕, time for discharging residue after taking PEG〔β=0.155，95%CI（0.045，0.264），P=0.006〕were the influencing factors in OBPS scores of fluid volume in inpatients.The steps from taking PEG to discharging watery stools（β=0，P<0.001）, the frequency of bowel activity after taking the PEG〔β=-0.105，95%CI（-0.193，-0.017），P=0.020〕, time for discharging residue after taking PEG〔β=0.481，95%CI（0.226，0.736），P<0.001〕and the exercise two days before colonoscopy〔β=0.681，95%CI（0.178，1.184），P=0.008〕were the influencing factors of OBPS total score in inpatients. Conclusion　The movement steps from taking PEG to discharging watery stools, the frequency of bowel activity after taking the PEG, the time interval between bowel preparation and colonoscopy, time to discharge residue after taking PEG and the exercise two days before colonoscopy were the influencing factors of bowel preparation in inpatients. Medical workers should take corresponding measures according to the influencing factors to reduce the impact of inadequate bowel preparation and ensure a smooth progress of colonoscopy diagnosis and treatment.

Prognosis Analysis of Surgical and Non-surgical Treatment for Patients with Pancreatic Neuroendocrine Tumor with Liver Metastasis　

SONG Jiaxin，ZHANG Xianbin，ZHANG Houli，MA Li

2019, 22(32): 3939-3943. DOI: 10.12114/j.issn.1007-9572.2019.00.274

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Background　Pancreatic neuroendocrine tumors（PNETs） are relatively rare，but local lymph nodes，liver，lung and bone metastases can occur during disease progression，and among them liver metastasis is the most common.About 50% of patients are prone to liver metastasis.Treatment method affects the survival of such patients.Moreover，it can also influence the patient's quality of life to a certain degree.Objective　To explore the effect of surgical treatment on the prognosis of patients with pancreatic neuroendocrine tumor with liver metastasis，providing a reference for clinical treatment selection for this disease.Methods　Data about PNETs between 2004 and 2013 were obtained from the SEER database.A total of 476 cases with liver metastasis were enrolled，of whom those receiving surgical treatment for removing the primary tumor，and those receiving non-surgical treatment were assigned to surgical group，and non-surgical group，respectively.Baseline and clinical data were analyzed.The endpoint of the study was overall survival.Results　Of the participants，125（26.3%） received surgical treatment，and other 351（73.7%） did not.The average survival time of the surgical group was longer than that of non-surgical group（χ2=57.649，P=0.001）．Subgroup analysis stratified by T-stage showed that，longer average survival time was found in T1，T2，T3 patients with surgical treatment instead of those without non-surgical treatment，respectively（χ2=5.543，P=0.019；χ2=11.494，P=0.001；χ2=34.240，P<0.001）．Subgroup analysis by lymph node metastasis found that，surgical treatment was associated with longer average survival time either in those with lymph node metastasis（χ2=29.392，P<0.001） or those without（χ2=30.722，P<0.001）．Subgroup analysis by grade of histological differentiation demonstrated that，surgical treatment was associated with longer average survival time in those with gradeⅠ-Ⅱ（χ2=18.513，P<0.001） and also in those with grade Ⅲ-Ⅳ（χ2=11.219，P<0.001）．Multivariate Cox proportional hazards regression analysis revealed that older than 60 years〔HR=1.973，95%CI（1.476，2.637）〕，histological differentiation grade Ⅲ or Ⅳ〔HR=3.864，95%CI（2.279，6.551）；HR=2.801，95%CI（1.278，6.141）〕，and non-surgical treatment〔HR=4.845，95%CI（2.853，8.226）〕were independent risk factors for prognosis（P<0.05）．Conclusion　Surgical resection of the primary tumor improves survival.Lymph node metastasis and T-stage were not associated with the survival，but age and tumor histological differentiation had a significant effect on the survival.For patients younger than 60 years，surgical resection of the primary tumor should be considered a treatment strategy.

Diagnostic and Prognostic Values of Heme Oxygenase-1 in Secondary Phagocytic Syndrome in Children　

WANG Yingchao，LI Zhuangzhuang，ZHU Guiying，YIN Chuyun，WANG Long

2019, 22(32): 3944-3949. DOI: 10.12114/j.issn.1007-9572.2019.00.209

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Background　Hemophagocytic syndrome（HPS） is a kind of serious proliferative disease with high mortality.It can be life-threatening to some children with delayed diagnosis and treatment due to lack of specific diagnostic markers.Heme oxygenase-1（HO-1） is a recently discovered indicator that may be used as a novel diagnostic marker for HPS with higher specificity.However，studies about it are few，so it is important to carry out more evidence-based studies to verify its diagnostic value.Objective　To investigate the diagnostic and prognostic values of serum HO-1 in HPS.Methods　Between September 2015 and September 2017，231 cases from the First Affiliated Hospital of Zhengzhou University were enrolled，including 86 with secondary HPS（HPS group），and 66 infection without HPS（infection group） from pediatric ward，and 70 healthy physical examinees from outpatient department（control group）． Data about sex，age，etiology and laboratory results of all participants，serum HO-1 levels detected with ELISA in HPS group on the admission day，and before treatment，at the end of the 2nd，4th，8th weeks of treatment，and in other two groups on the admission day，and serum HO-1 mRNA levels detected with real-time PCR in all groups on the admission day were collected.Children in HPS group were given a one-year follow-up，during which 63 survived，and 23 died.ROC analysis was performed to investigate the diagnostic values of serum HO-1，ferritin，and the combination of the two in HPS.Outcomes of HPS children were compared by clinical markers.Results　HPS group showed lower average white blood cell count（WBC），hemoglobin（Hb），platelet count（PLT），natural killer（NK）cell percentage and fibrinogen（FIB） levels，and higher average C-reactive protein（CRP），lactate dehydrogenase（LDH） and ferritin levels compared with the infection group（P<0.05）． Serum HO-1 and HO-1 mRNA expression levels differed significantly across the groups（P<0.05）． In particular，they were the highest in HPS group，followed by infection group，and control group（P<0.05）． Serum HO-1 levels of HPS children before treatment，at the end of 2nd，4th，8th weeks of treatment were significantly different（P<0.05）． Serum HO-1 level was positively correlated with ferritin in HPS children（rs=0.661，P<0.001）． For the diagnosis of HPS，serum HO-1 level had a greater AUC than ferritin（Z=1.68，P=0.046）． But the AUC of the combination of the two was greater than that of serum HO-1 or ferritin（Z=1.81，P=0.035；Z=1.98，P=0.023）． The survived HPS children showed much lower average levels of CRP，LDH，ferritin and HO-1 but much higher average PLT level compared with those decreased（P<0.05）． Conclusion　Serum HO-1 level in children with HPS is significantly higher than that of those with other infections，which is closely correlated with serum ferritin level.And the combination of the two showed a higher diagnostic value in HPS，which may serve as a new molecular diagnostic and prognostic marker for HPS in children.

Clinical Study of Laparoscopic Cerclage Sacrohysteropexy for Treating Moderate to Severe Pelvic Organ Prolapse　

PENG Aizhen，CAO Bianna，GUO Jiubai，LUO Mei

2019, 22(32): 3950-3955. DOI: 10.12114/j.issn.1007-9572.2019.00.163

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Background　Pelvic organ prolapse is a common disease which seriously affects the normal life of women.Surgery is one of the first choice for treatment.In recent years, laparoscopic pelvic floor reconstruction has been paid more and more attention.Many scholars believe that laparoscopic sacrocolpopexy（LSC） is a gold standard operation with minimal recurrence risk.However, there are many disadvantages in traditional LSC operation. Objective　To explore clinical efficacy of laparoscopic cerclage sacrohysteropexy for moderate to severe pelvic organ prolapseon, and to assess its effectiveness and safety. Methods　A retrospective analysis was performed on the clinical data, from December 2016 to March 2018 in Jiangxi Maternal and Child Health Hospital, in a total of 60 patients with severe moderate to severe pelvic organ prolapseon who received LSC, with 30 cases received laparoscopic cerclage sacrohysteropexy（modified group） and 30 cases received traditional LSC（traditional group） selected by random number table method.Diagnosis and grading of pelvic organ prolapse were identified by Pelvic Organ Prolapse Quantification System（POP-Q） . The operation time, blood loss, hospital stay, days of indwelling catheter and complications of the two groups were compared after the operation, and we measured the POP-Q value at every point to assess postoperative pelvic floor function and evaluated preoperative and postoperative quality of life by using the pelvic floor distress inventory（PFDI-20）．The difference between the two groups before and after operation was also compared. Results　All procedures were successfully completed by laparoscopic therapy. The operation time，blood loss of the modified group were significantly less than those of the traditional group（P<0.05）．The follow-up time were 3-14 months after surgery, none of the cases were lost.None of the women had recurrent uterine prolapse at 3 or 12 months after the treatment, with objective cure rate of 100%, and the anatomical cure rate of 100%. The median line of anterior vaginal wall was 3 cm away from hymen margin（Aa） , the reverse fold of anterior vaginal fornix was the farthest from Aa point（Ba） , the median line of posterior vaginal wall was 3 cm away from hymen margin（Ap）, and the measurement value of the farthest point（Bp）of posterior vaginal fornix in the modified group was closer to the physiological state than that of the traditional group（P<0.05）; the POP-Q values at Aa, Ba, the furthest exterior cervical orifice（C）, Ap in the two groups and Bp in the modified group after operation were closer to the physiological state than those before operation（P<0.05）．Before operation, Pelvic Organ Prolapse Distress Inventory（POPDI-6） and Urinary Distress Inventory 6（UDI-6） scores of the modified group were higher than those of the traditional group（P<0.05） . Postoperative PFDI-20, POPDI-6 and UDI-6 scores in the two groups were lower than those before operation, while post-operative Colorectal-anal Distress Inventory 8（CRADI-8）score in the traditional group was lower than that before operation（P<0.05）．Conclusion　The two types of surgery for uterine prolapse are both effective. The laparoscopic cerclage sacrohysteropexy is suitable for patients with moderate to severe pelvic organ prolapse requiring uterus preservation, especially for young women.The mesh placement is lower, and the operation is simpler, with short operation time, short learning curve, small trauma, less bleeding, and faster recovery.The subjective and objective cure rate for patients is high after operation. It is expected to be promoted in clinic.

Effect of Earplugs and Eye Masks on the Incidence of Delirium and Sleep Quality in Intensive Care Patients：a Meta-analysis　

LYU Lulu，ZHANG Xuejing

2019, 22(32): 3956-3961. DOI: 10.12114/j.issn.1007-9572.2019.00.067

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Background　Sleep problem has become a common health issue in critically ill patients.Poor-quality sleep not only increases the level of anxiety in such patients，but also may lead to delirium and other cognitive impairments.Although pharmacologic treatment can improve sleep quality，it also has a series of side effects.So，relieving the conditions via stimulating sensory perception and creating relaxing effects by nonpharmacological interventions is becoming increasingly important.However，whether use of earplugs and eye masks can improve the quality of sleep and reduce the incidence of delirium in this population，the evidence is still insufficient.Objective　To evaluate the effectiveness of earplugs and eye masks on the incidence of delirium and sleep quality in critically ill patients.Methods　We searched the databases of PubMed，Medline，CINAHL，Cochrane Library，CNKI，Wanfang Data Knowledge Service Platform and CBM from inception to March 2018 for articles regarding the improvement of sleep quality in critically ill patients by use of earplugs and/or eye masks.Data extraction and quality assessment were conducted on the eligible articles.Meta-analysis was carried out with RevMan 5.3 software.Results　Twenty articles with a total of 1 364 patients were finally included.The results of meta-analysis showed that the use of earplugs and eye masks significantly reduced the incidence of delirium 〔RR=0.52，95%CI（0.41，0.66），P<0.000 01〕.PSQI score in the experimental group was lower than that of control group 〔MD=-4.63，95%CI（-6.82，-2.43），P<0.000 1〕.The sleep effectiveness score in the experimental group was higher than that of control group 〔SMD=1.54，95%CI（0.48，2.61），P=0.005〕.The sleep disturbance score in the experimental group was higher than that of control group 〔SMD=1.36，95%CI（0.55，2.17），P=0.001〕.There was no significant difference in sleep supplementation score between two groups 〔SMD=1.25，95%CI（-0.34，2.83），P=0.12〕.Sleep duration did not differ significantly between two groups 〔SMD=1.11，95%CI（-0.43，2.65），P=0.16〕.Distribution of sleep duration showed no obvious difference between two groups 〔RR=1.00，95%CI（0.76，1.31），P=1.00〕.Conclusion　Earplugs and eye masks are effective interventions to reduce the incidence of delirium and improve sleep quality of critically ill patients.But it is not certain whether they could improve sleep duration，too.

Suspensory versus Cross-pin Femoral Fixation in an ACL Reconstruction：a Meta-analysis　

LYU Yang，GAO Shihua，LIU Jun，HUANG Junhan，CHEN Haiyun，PAN Jianke，HE Xiangzhong，HE Jingwen

2019, 22(32): 3962-3968. DOI: 10.12114/j.issn.1007-9572.2019.00.098

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Background　Femoral fixation methods for an anterior cruciate ligament（ACL） reconstruction，can be divided into suspensory fixation（indirect fixation） away from the joint and cross-pin fixation（direct fixation） near the joint surface，according to the distance between the fixed point and the joint line.But there is no consensus on which fixation method is more superior.Objective　To perform a comparative meta-analysis of the advantages and disadvantages of suspensory versus cross-pin femoral fixation in an ACL reconstruction.Methods　We systematically retrieved the databases of CNKI，Wanfang Data Knowledge Service Platform，VIP，CBM，PubMed，EMBase and Cochrane Library for RCTs regarding ACL-reconstructed patients with suspensory femoral fixation（experimental group） compared with those with cross-pin femoral fixation（control group） using subject headings combined with free words and key words as of December 1，2017.Quality assessment was conducted on eligible RCTs.Meta-analysis was performed using RevMan 5.3 software.Results　A total of 15 RCTs were included，and 7 of them were initially rated as 1b and other 8 were 2b by the Oxford Centre for Evidence-based Medicine Levels of Evidence，involving 961 cases，of whom 482 with suspensory femoral fixation，and other 479 with cross-pin femoral fixation.Meta-analysis showed that both groups had no significant differences in Lysholm knee score at 12 months after surgery〔MD=-0.42，95%CI（-1.09，0.25），P=0.22〕，KT1000 arthrometer measurements 〔MD=-0.22，95%CI（-0.51，0.08），P=0.15〕 at 12 months after surgery，and KT1000 arthrometer measurements 〔MD=0，95%CI（-0.36，0.36），P=1.00〕 at 24 months after surgery.Moreover，both groups also showed no significant differences in the percentages of normal，nearly normal，abnormal and severely abnormal IKDC scores 〔OR=0.93，95%CI（0.61，1.42），P=0.73；OR=0.91，95%CI（0.60，1.38），P=0.65；OR=1.35，95%CI（0.66，2.73），P=0.41；OR=4.05，95%CI（0.44，37.70），P=0.22〕.In terms of bone tunnel enlargement，descriptive analysis（this method was used due to methods for measuring bone tunnel and statistical results in the RCTs were different） found that，the experimental group had greater enlargement than the control group.And the incidence of complications was similar in both groups〔OR=0.80，95%CI（0.39，1.64），P=0.55〕.Results of postsurgical IKDC score from all studies scattered in the funnel plot，which showed a symmetrical shape，indicating the level of publication bias was low.Conclusion　Suspensory and cross-pin femoral fixation have similar postsurgical outcomes evaluated by indicators such as Lysholm knee score at 12 months after surgery，KT1000 arthrometer measurements at 12 and 24 months after surgery，and IKDC scores as well as the incidence of complications，except the latter produces a greater impact on reducing bone tunnel enlargement due to the movement of graft.In view of the above-mentioned aspects，femoral fixation method should be selected based on an overall consideration of various factors.

Use of Geosocial Networking Smartphone Applications and Associated Sexual Behaviors and Sexually Transmitted Infections among Men Who Have Sex with Men：a Systematic Review　

WANG Haidong，ZHANG Lu，ZHOU Ying，WANG Guoli，WU Jianhui

2019, 22(32): 3969-3974. DOI: 10.12114/j.issn.1007-9572.2019.00.161

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Background　In recent years，a number of global positioning system（GPS）-equipped smartphone applications（App） designed to serve men who have sex with men（MSM） have been developed and achieved great popularity in this population.Increased use of these App may facilitate finding casual sexual partners，resulting in unsafe sexual practices.Objective　The purpose of this systematic review was to summarize the evidence of the use of MSM App and associated sexual behaviors and sexually transmitted infections（STI） in MSM population.Methods　Databases of PubMed，Wanfang Data Knowledge Service Platform and CNKI were searched for articles included between 2005 and 2017 about the use of App and associated sexual health or behaviors in MSM population，and studies concerning sexual behaviors and STI in MSM who use App and those do not.Data about number of male sexual partners，group and unprotected sexual practices，as well as testing and definite diagnosis of STI were extracted from the eligible studies.Results　Twenty-three articles concerning 21 studies were included.App-users were more likely to have more than 5 male sex partners in the past 12 months than non-users.Compared with non-users（8.5%），App-users（10.9% to 13.2%） reported engaging in more group sexual practices in the last 6 months.However，one study found that App-users were less likely to have group sexual practices than non-users in the past 12 months（the prevalence was 8.8% and 10.3%，respectively）．The prevalence of unprotected sexual practices in the past 6 months among App-users ranged from 31.9% to 50.5%，while that of non-users ranged from 26.3% to 35.6%.Compared with non-users（32.6%），App-users（29.9% to 88.6%） were more likely to have lifetime STI testing.The self-reported prevalence of prior diagnosis of STI among App-users ranged from 11.9% to 51.1%，while that of non-users was 23.2%.Conclusion　The increase in MSM using these App may produce more adverse effects on sexual health.

Epidemiological Characteristics from 2008 to 2018 and Trend Prediction of Pulmonary Tuberculosis in Yinchuan City　

LIU Xiaojuan，LI Yan，SHA Xiaolan，LIU Lan

2019, 22(32): 3975-3979. DOI: 10.12114/j.issn.1007-9572.2019.00.556

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Background　Pulmonary tuberculosis（TB） is a public health issue of global concern.Yinchuan is one of the cities with relatively poor economic development in Northwest China in which the prevention and control of TB started late.Objective　To analyze the epidemiological characteristics of pulmonary TB in Yinchuan from 2008 to 2018，and to predict the incidence trend，providing a scientific basis for the prevention and control of this disease.Methods　Descriptive epidemiologic methods and estimated annual percentage change（EAPC） were used for analyzing the surveillance data of pulmonary TB in Yinchuan from 2008 to 2018，and autoregressive integrated moving average model（ARIMA） was used to predict the incidence trend from January 2019 to June 2020．Results　A total of 9 518 cases were reported in Yinchuan from 2008 to 2018.The annual incidence in this period showed a downward trend generally，and the average annual incidence was 42.71/100 000.The male-to-female incidence ratio was 1.39∶1，and the male incidence was significantly higher than that of females（49.34/100 000 vs 35.56/100 000，χ2=25.86，P<0.001）．Pulmonary TB occurred in all age groups，with the highest incidence among the elderly aged 60 and over（119.47/100 000）．Main populations of the TB were farmers 〔40.01%（3 808/9 518）〕.Yongning County had the highest average annual incidence（61.98/100 000），and Lingwu City had the lowest（34.81/100 000）．Most cases occurred in March and April.ARIMA model prediction results showed that the incidence of pulmonary TB in Yinchuan from January 2019 to June 2020 would be lower than that in 2018，showing a downward trend.Conclusion　The incidence of TB in Yinchuan City showed a downward trend from 2008 to 2018.Farmers are key populations in pulmonary TB prevention and control，and attentions should also be paid to the elderly.

Epidemiological Analysis of Syphilis in Songjiang District of Shanghai from 2007 to 2017　

MA Jilin，ZHANG Xueping

2019, 22(32): 3980-3984. DOI: 10.12114/j.issn.1007-9572.2019.00.276

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Background　Syphilis is a global public health problem.Primary syphilis is closely associated with HIV infection and can promote the infection.Moreover, it increases the risk of transmission of acquired immunodeficiency syndrome by 3 to 5 times. The number of recently reported cases of syphilis in China is increasing rapidly. It ranks third among Class A and B infectious diseases in terms of incidence, and has become an important public health and social problem. Objective　To investigate the epidemiological characteristics of syphilis, a common sexually transmitted disease, in Songjiang District of Shanghai from 2007 to 2017, to provide scientific evidence for the development of targeted prevention and control measures.Methods　Data of reported and monitored syphilis cases in Shanghai's Songjiang District from 2007 to 2017 were collected and descriptively analyzed. Results　A total of 8 546 cases of syphilis were reported in Songjiang District of Shanghai from 2007 to 2017, with an average annual incidence rate of 48.23/100 000. The average annual incidence rates of primary, secondary, and latent syphilis were 14.14/100 000, 9.66/100 000 and 24.33/100 000, respectively. During this period, the overall incidence of syphilis showed a U-shaped upward trend.It peaked（68.17/100 000） in 2016. The incidence of syphilis decreased by 6.13/100 000 per year from 2007 to 2010, but increased by 5.64/100 000 annually from 2010 to 2017.The characteristics of this group of syphilis were: latent syphilis accounted for 51.84%（4 430/8 546）; the reported cases peaked from June to September; local residents made up a large majority of the total〔57.65%（4 927/8 546）〕; male-female ratio was 1∶1.06; persons aged 20 to 59 accounted for 81.24%（6 943/8 546） of the total．Subgroup analysis by place of hukou and gender showed that, local males outnumbered females, with a male-female ratio of 1.30∶1 in general, and a male-female ratio of 1.73∶1 among the primary or secondary syphilis cases.However, among nonlocal cases, males were less than females, showing a male-female ratio of 0.60∶1 in general.Subgroup analysis by gender and age group found that females of 20-49 years accounted for 74.75%（3 289/4 400） of all the female cases, and males of 20-49 years accounted for 56.82%（2 356/4 146） of all the male cases, indicating that younger females were associated with increased risk of syphilis. Subgroup analysis by stage of syphilis and gender revealed that, the prevalence of primary syphilis was higher in males than that of females〔35.50%（1 472/4 146）vs 20.98%（923/4 400）〕. But the prevalence of secondary syphilis was lower in males than that of females〔19.83%（822/4 146）vs 20.02%（881/4 400）〕, and the prevalence of latent syphilis was also lower in males than that of females〔44.40%（1 841/4 146）vs 58.84%（2 589/4 400）〕.Most local syphilis cases were 30-59 years old〔59.06%（2 910/4 927）〕, but most nonlocal syphilis cases were 20-49 years old〔85.24%（3 085/3 619）〕. Conclusion　The incidence of syphilis in Songjiang District is increasing year by year. To control the transmission and dissemination of syphilis, the following measures are recommended: strengthening the monitoring of syphilis and standardizing the treatment according to specific syphilis features, enhancing syphilis screening in females（including local and nonlocal）and local older people, intensifying the propaganda of sexually transmitted diseases prevention and treatment, and advocating safer sex behaviors.

Efficacy and Biomechanical Recovery of Locking Plate in the Treatment of Proximal Humeral Fractures with Different Neer Classifications　

ZHAO Hongbin，SONG Yang，HUANG Mingguang，ZENG Qiutao，MIAO Xudong，RUAN Zhangtao

2019, 22(32): 3985-3989. DOI: 10.12114/j.issn.1007-9572.2019.00.433

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Background　 Proximal humeral fractures are divided into unstable fractures and stable fractures.With the progress and development of social science and technology，it is still controversial to choose surgical or conservative treatment for different Neer classifications of proximal humeral fractures.Compared with traditional treatment，locking plate therapy has advantages such as angular fixation，less rotator cuff injury and early rehabilitation exercise.Objective　 To study the efficacy and biomechanical recovery of locking plate in the treatment of proximal humeral fractures with different Neer classifications.Methods　 A total of 49 patients with proximal humeral fractures who were treated in Shunde Hospital of Southern Medical University from July 2012 to May 2018 were selected.Diagnosed by X-ray，there were 16 cases of Neer type Ⅱ，16 cases of Neer type Ⅲ and 17 cases of Neer type Ⅳ.The operation time，intraoperative bleeding volume，fracture healing time and postoperative complications were recorded.The shoulder function was evaluated by Constant-Murley shoulder function score six months after operation，and the limb function was evaluated by Neer shoulder function score.Results　The operations were completed smoothly.There was no significant difference in operative time and incidence of complications between patients with different Neer classifications of proximal humeral fractures（P>0.05）；however，there were significant differences in blood volume and healing time in patients with different Neer classifications of proximal humeral fracture（P<0.05）.There was significant difference in Constant-Murley shoulder function score between patients with different Neer classifications of proximal humeral fractures 6 months after operation（P<0.05）；among them，Constant-Murley shoulder function score in patients with Neer type Ⅲproximal humerus fracture was lower than that of patients with Neer typeⅡ fracture，and Constant-Murley shoulder function score of patients with Neer type Ⅳ proximal humerus fracture was lower than that of patients with Neer type Ⅱ and type Ⅲ fracture（P<0.05）．There was no significant difference in Neer shoulder function score among different Neer classifications of proximal humeral fractures（P>0.05）．Pearson correlation analysis showed that Neer classification was positively correlated with intraoperative bleeding volume and fracture healing time（r=0.894，P<0.001；r=0.783，P<0.001），and was negatively correlated with Neer shoulder function score（r=-0.431，P<0.001）．Conclusion　The proximal humeral locking plate in the treatment of Neer type Ⅱ，Ⅲ，Ⅳof humerus fracture has better clinical efficacy and safety.Clinically，we recommend locking plate treatment，but the previous damage directly affects the patient's blood volume，postoperative fracture healing time and Constant-Murley shoulder function score.Therefore，postoperative treatment and rehabilitation should be taken according to the damage，so as to improve the rate of shoulder joint healing.

A Clinical Study on External Application of Honey in the Treatment of Anal Fissure in Children　

YU Ting，XUE Minmin，CHEN Xinghua，XIE Minning，CHEN Lei，HU Chunlan

2019, 22(32): 3990-3992. DOI: 10.12114/j.issn.1007-9572.2019.00.155

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Background　In recent years，many children have constipation or/and anal fissure due to eating formula milk and picky eating.Clinical visits due to anal fissure in children are gradually increasing.However，this disease is often ignored because there are few studies or reports about pediatric anal fissure，and children's relatives have insufficient understanding of this disease and even do not know the appropriate specialty to seek healthcare.Objective　To explore the clinical efficacy of external application of honey by analyzing relevant therapeutic indices，and discuss its simplicity of use，providing a new scheme for the treatment of this disease.Methods　This study was implemented from October 2017 to December 2018 in 140 children with anal fissure selected from anorectal outpatients of Jinshan Hospital Affiliated to Fudan University，and from physical examinees of Jinshan Industrial Park Community Health Center，Jinshan Shihua Community Health Center，Caojing Community Health Center，and Jinshanwei Community Health Center.Participants were equally divided into the control group and treatment group by a random number table，70 cases in each group，treated with adjusting the diet，adjusting the diet with application of the honey on the fissure using cotton swabs every evening.The intervention lasted for 2 weeks.Intervention outcome was evaluated by the hematochezia score，FLACC score and fissure healing status.Results　The average hematochezia scores of the treatment group on the 7th and 14th day of treatment was lower than that of the control group（P<0.05）.There were no significant differences in average FLACC score between the two groups before treatment and on the 7th day of treatment（P>0.05）.The average FLACC score of the treatment group on the 14th day of treatment was lower than that of the control group（P<0.05）.The treatment group showed higher fissure healing rate than the control group on the 7th day of treatment〔8.6%（6/70）vs 0〕（χ2=4.353，P=0.037） as well as on the 14th day of treatment〔68.6%（48/70） vs 34.3%（24/70）〕（χ2=16.471，P<0.001）.Conclusion　External application of honey is highly effective for reducing the hematochezia and pain，and promoting the healing of anal fissure，manifesting the features of simple，convenient，effective and inexpensive.

Efficacy of Cinobufacin Capsule Combined with Fentanyl Transdermal Patch in the Treatment of Moderate and Severe Cancer Pain with Bone Metastasis　

YANG Sen，ZHAO Huaxin，WANG Zhaoxin，GE Xuhua，LU Yuan，JIN hua，BO Xiaojie，ZHANG Hanzhi，MA Le，PAN Ying，YU Dehua

2019, 22(32): 3993-3996. DOI: 10.12114/j.issn.1007-9572.2019.00.269

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Background　Bone metastasis is a common complication among patients with advanced tumors and a difficult issue to treat in clinic.At present，three-step analgesia treatment has achieved a certain effect，but the long-term use of opioid drugs can lead to addiction，constipation and other toxic side effects，which will affect patients' compliance and treatment results seriously.Objective　To evaluate the efficacy and safety of cinobufagin capsule and fentanyl transdermal patch in the treatment of cancer pain from bone metastasis.Methods　A total of 298 patients with bone metastasis diagnosed by pathology and imaging were selected from Yangpu Hospital，Tongji University and Shanghai Dermatological Hospital from April 2016 to June 2018.A double blind randomized controlled trial was used to divide them into two groups：observation group（147 cases） and control group（151 cases）．The observation group was treated with cinobufagin capsule and fentanyl transdermal patch，while the control group was treated with oral placebo and fentanyl transdermal patch.The visual analogue scores（VAS），24 h estazolam usage，quality of life（QoL） score before treatment and at 7，14，30 days after treatment，pain relief rate at 7 days after treatment and side effects during treatment were compared between the two groups.Results　On the 7th，14th and 30th day after treatment，the VAS and the dosage of estazolam in the observation group was lower than those in the control group（P<0.05）．Meantime，the quality of life score in the observation group was higher than that in the control group（P<0.05）．On the 7th day of treatment，the effective rate in the observation group was 72.1%（106/147），which was higher than that in the control group 〔49.7%（75/151）（χ2=15.729，P<0.001）〕.There was no significant difference of the incidence of toxic and side effects between the two groups，which was 12.2%（18/147） in the observation group and 11.9%（18/151） in the control group（χ2=0.007，P=0.932）．In both groups，there were no significant abnormality of the blood test，urine test，fecal test and electrolytes of liver and kidney function before and after treatment.Conclusion　The combination of cinobufagin capsule and fentanyl transdermal patch in the treatment of moderate/severe cancer pain from bone metastasis is more effective and safer than fentanyl transdermal patch solely used in the treatment.

Clinical Effect of Transcuataneous Electrical Nerve Stimulation in the Treatment of Opioid Analgesic Insufficiency of Bone Metastases Cancer Pain　

DU Weibin，BAO Guanai，SHEN Fuxiang，HU Huahui，CHEN Rongliang，QUAN Renfu

2019, 22(32): 3997-4001. DOI: 10.12114/j.issn.1007-9572.2019.00.078

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Background　Moderate and severe cancer pain has become one of the reasons for the decline in the quality of life of cancer patients.Although strong opioids represented by morphine are effective for it, there are 40% to 60% of patients still cannot adequately control their cancer pain, and the way in which transcutaneous electrical nerve stimulation（TENS） assists drugs in the treatment of cancer pain has been gradually recognized by scholars. Objective　To explore the effect of TENS on the efficacy and safety of opioid analgesic insufficiency in bone metastatic cancer pain. Methods　A total of 48 patients with bone metastatic cancer pain in Jiangnan Hospital Affiliated to Zhejiang Chinese Medicine University and Zhejiang Cancer Hospital from September 2017 to May 2018 were selected and then divided into the opioid group（24 cases） who treated with opioid only and the combined treatment group（24 cases） who treated with TENS combined with opioid according to the random number table method.The pain was assessed by Brief Pain Inventory; the 24-hour equivalent morphine dosage, the number of breakthrough pain and adverse drug reactions for 24 hours were recorded before treatment, 2 weeks and 4 weeks after treatment.The differences between the two groups were compared. Results　The most severe pain, average pain and current pain scores after 2 weeks and 4 weeks of treatment in the combined treatment group were lower than those in the opioid group（P<0.05） . The most severe pain and average pain after 2 weeks and 4 weeks of treatment in the two groups were significantly lower than those before treatment in the same group（P<0.05）．The equivalent morphine dosage after 2 weeks and 4 weeks of treatment was higher than that before treatment in two groups（P<0.05） , and the dosage of the combined treatment group was significantly lower than that of the opioid group in the same period（P<0.05）．The number of breakthrough pain episodes after 2 weeks and 4 weeks of treatment in two groups was less than that before treatment（P<0.05） , and the reduction was more obvious in the combined treatment group than that in the opioid group （P<0.05）．During the treatment period, the adverse reactions of opioids in the two groups mainly included nausea, vomiting, constipation, dizziness, and pruritus, without any adverse reactions such as drowsiness and respiratory depression. The incidence of nausea, vomiting and constipation in the combined treatment group was lower than that in the opioid group（P<0.05）．Conclusion　Combined with opioid therapy, TENS can effectively alleviate bone metastatic cancer pain, slow down opioid dosage process in patients with cancer pain, and reduce the incidence of adverse reactions, with relatively higher efficacy and safety.

Efficacy and Safety of Apatinib in the Treatment of Advanced Gastric Cancer with Multiple Line Failure of Chemotherapy：42 Cases　

SAIFUDING·Keyoumu，WANG Bin，TANG Yong

2019, 22(32): 4002-4005. DOI: 10.12114/j.issn.1007-9572.2019.00.096

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Background　With the discovery of research，the occurrence and development of tumors is mainly about neovascularization.Tumor angiogenesis is one of the important causes of carcinogenesis.Apatinib，as a target drug of tyrosine kinase inhibitor of vascular endothelial growth factor developed in China，is also the first oral anti-angiogenesis drug for advanced gastric cancer in the world.Objective　To observe the clinical efficacy and toxicity of apatinib in the treatment of advanced gastric cancer with multiline chemotherapy failure.Methods　A total of 42 patients with advanced gastric or gastro-esophageal junction adenocarcinoma treated in the Affiliated Tumor Hospital of Xinjiang Medical University from January 2015 to November 2016 were selected.According to Eastern Cooperative Oncology Group（ECOG） score，42 patients with advanced gastric cancer were given different doses of apatinib and apatinib combined with tegafur therapy.Follow-up ended at 1 January，2017，and the efficacy，adverse reactions and overall survival rate of patients during medication were observed and recorded.Results　As of 1 January，2017，31 patients（73.8%） died and 11 patients（26.2%） survived.The survival time was 5.53〔95%CI（4.20，6.86）〕 months.Forty-two patients had different degrees of toxicity and side effects in targeted therapy.Among them，there were 16 cases（38.1%） of nausea and vomiting，16 cases（38.1%） of fatigue，8 cases（19.0%） of elevated blood pressure，8 cases（19.0%） of leukopenia and thrombocytopenia，4 cases（9.5%） of elevated transaminase and 11 cases（26.2%） of other symptoms.The symptoms of fatigue，hypertension and other symptoms in patients were improved by reducing the dosage of apatinib properly，and patients could continue to tolerate treatment.Conclusion　Apatinib has a significant effect for the treatment of advanced gastric carcinoma and gastro-esophageal junction cancer with multiple line failure of chemotherapy，but it still needs further study by clinical workers.

Anti-NMDA Receptor Encephalitis Secondary to Tubercular Meningitis：a Case Report and Diagnostic Ideas　

CHEN Dan，ZHANG Yun，ZHOU Baotong，GUAN Hongzhi，ZENG Xuejun

2019, 22(32): 4006-4010. DOI: 10.12114/j.issn.1007-9572.2019.00.267

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A novel case of anti-N-methyl-D-aspartate（NMDA） receptor encephalitis following tuberculous meningitis was reported to improve the management of autoimmune encephalitis secondary to infection.A diagnosis of possible anti-NMDA receptor encephalitis secondary to tubercular meningitis was made after multidisciplinary discussion.After standardized anti-tuberculosis treatment，and active anti-infection treatment with methylprednisolone and intravenous immunoglobulin，clinical remission was achieved，and anti-NMDA receptor encephalitis was controlled during the prodromal stage.This case was really benefited from the multidisciplinary diagnosis and treatment approach although the diagnosis was difficult to make due to old age，atypical clinical symptoms，multiple complications，and rapid changes in conditions.

Infection Caused by Tick Bites in Children：Report of Three Cases and Literature Review　

HUANG Ruiou，ZHOU Kai，CAO Liming，LIU Hao，SHAN Mingfeng

2019, 22(32): 4011-4014. DOI: 10.12114/j.issn.1007-9572.2019.00.141

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Objective　To investigate the injury，treatment and prevention secondary to infection from tick bites.Methods　Based on literature review，the clinical data（sex，age，symptoms，signs，laboratory examination，treatment） of 3 children with tick bite infection admitted to the Children's Hospital of Nanjing Medical University were analyzed from July 6 2018 to July 19 2018.Results　Among the 3 cases，1 was male and 2 was female；three children were aged 1 year and 7 months，5 years and 3 months and 15 years and 6 months，respectively.Three patients all had fever with body temperature exceeding 38.5 ℃.
In one of the cases，the biting tick was removed by surgery followed by debridement of the wounded area.This case had a good outcome with short course and low medical expenses.The other two cases were siblings without findings of specific site of the biting ticks.These two patients presented with fever，and were diagnosed with severe fever with thrombocytopenia syndrome virus（SFTSV） infection by the center for disease control and prevention subsequently.The little brother bacame better after conventional therapy.The big sister with worse condition became better as well after treating with ribavirin and r-globulin of 2 g/kg.Conclusion　Removing the ticks in time is of good efficacy.For patients who can not find the bite site，if fever occurs，white blood cell count and platelet count decrease，their blood should be sent to the center for disease control and prevention in time to identify the cause，receive early treatment as soon as possible to reduce complications.

Research Progress on High Cholesterol and Osteoarthritis　

HAN Guangtao，LI Haohuan，CAI Weisong，ZHANG Yubiao

2019, 22(32): 4015-4019. DOI: 10.12114/j.issn.1007-9572.2019.00.178

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Studies have shown that osteoarthritis is not only affected by aging，but also affected by a variety of other factors.One of the risk factors may be high cholesterol level in the body.Although high cholesterol has been shown to promote cardiovascular diseases，its role in musculoskeletal disorders，especially osteoarthritis，is unclear.This paper will discuss how high cholesterol affects osteoarthritis and the molecular mechanisms by which it affects.This will be a new research direction and will provide a new strategy for the prevention and treatment of osteoarthritis.

Adipose Tissue Inflammation in Aging　

DAI Huoxiang，ZHANG Xin，SHEN Jun，HUANG Lihong

2019, 22(32): 4020-4026. DOI: 10.12114/j.issn.1007-9572.2019.00.050

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Adipose tissue has traditionally been viewed as an endocrine organ in studies of obesity and diet-associated metabolic disorders.However，as studies reveal the role of white adipose tissue as energy storage，lipid metabolism site，and adipokine secretor，it has become recognized as an important organ for metabolic health in both young obese people and old obese people.Senolytics has taken the spotlight in the aging research，where the clearance of senescent cells has shown the effect of attenuating age-related disorders.More interestingly，anti-aging studies have also revealed that these senescent cells，specifically p16（Ink4a） positive senescent cells，accumulate within adipose tissue，skeletal muscles，and eyes.These results implicate the importance of adipose tissue in aging and broaden the scope of research on the effects of senescent cells on life span and health across immune and non-immune cell pathways.

Progress in Diagnosis and Treatment of the Calcaneonavicular Coalition　

QIAN Huijie，HAN Shufeng，JIA Erlong

2019, 22(32): 4027-4030. DOI: 10.12114/j.issn.1007-9572.2019.00.125

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The calcaneonavicular coalition is a malformed condition between calcaneus and navicular. There are three forms of coalition: bone, cartilage and fibrous.At present, the mainstream view is that the calcaneonavicular coalition is the result of the differentiation failure of mesenchymal cells during the embryo. The 45° oblique radiographic view of hind foot is conducive to the diagnosis of calcaneonavicular coalition.Computed tomography（CT） scan and magnetic resonance imaging（MRI） are of great value in the identification of coalition.Conservative treatment, such as non-steroidal anti-inflammatory drugs（NSAIDs） and short leg cast, can effectively relieve the symptoms of calcaneonavicular coalition, and patients who failed in conservative treatment can be treated by traditional open operation and minimally invasive surgery. By consulting the relevant literature, we reviewed the etiology, diagnosis and treatment of the calcaneonavicular coalition, so as to enhance the clinicians' understanding and improve the diagnostic rate.

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