Chinese General Practice

Interpretation of 2019 How to Diagnose Heart Failure with Preserved Ejection Fraction from the Heart Failure Association of the European Society of Cardiology　

XU Dingli，ZHANG Hao

2020, 23(11): 1327-1332. DOI: 10.12114/j.issn.1007-9572.2020.00.155

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Currently，heart failure with preserved ejection fraction （HFpEF） accounts for more than 50% of HF cases，but there is lack of available effective drug therapy to improve the prognosis.In 2019，the Heart Failure Association （HFA） of the European Society of Cardiology （ESC） developed a new consensus recommendation，4-step HFA-PEFF diagnostic algorithm:the first step is ＂pre-test assessment＂，and the second step is ＂echocardiographic and natriuretic peptide heart failure with preserved ejection fraction diagnostic score＂，the third step ＂functional testing＂，the fourth step ＂final aetiology＂.In this paper，not only the four-step diagnosis method is introduced in detail，but the comorbidity of HFpEF and community-based management of HF is also discussed.

Advances in Safety of Thyroid Suppression Therapy in Differentiated Thyroid Carcinoma　

LIU Shuhuan，TIAN Haoming，LI Sheyu

2020, 23(11): 1333-1337. DOI: 10.12114/j.issn.1007-9572.2019.00.117

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The differentiated thyroid cancer （DTC） is one of the most common malignancies in adults throughout the world.Thyrotropin （TSH） suppression therapy is recommended as a non-surgical treatment for DTC with promising recurrence-reducing effect by international guidelines.However，little was discussed about the safety of the therapy，especially the long-term ones.We narratively reviewed the potential safety concerns of TSH suppression therapy in the cardiovascular，skeletal，neurological and metabolic systems.
Thyroid neoplasms；Thyrotropin；Atrial fibrillation；Osteoporosis；Review

Comparison of Fitting and Predicting Effects of Models on Mumps in China　

LIU Tian，YAO Menglei，HUANG Jigui，WU Yang，CHEN Qi，TONG Yeqing，CHEN Hongying

2020, 23(11): 1338-1343. DOI: 10.12114/j.issn.1007-9572.2019.00.562

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Background　Mumps is a serious public health concern in China.It is necessary to fully understand the regular pattern of mumps，and then model and forecast the disease to provide the scientific theoretical evidences for its prevention and control.Objective　To evaluate the effect of seasonal autoregressive integrated moving average ( SARIMA ) model，exponential smoothing model，SARIMA- Generalized Regression Neural Network ( GRNN ) combined model and exponential smoothing-GRNN combined model in the fitting and prediction of mumps in China.Methods　The monthly incidence from January 2004 to June 2016 in China was used to fit and train the models，and SARIMA，exponential smoothing model，SARIMA-GRNN combined model and exponential smoothing-GRNN combined model were established respectively.The monthly incidence from July to December 2016 was predicted and compared with the actual value.Four evaluation indicators，such as mean absolute percentage error ( MAPE )，mean error rate ( MER )，mean square error ( MSE )，and mean absolute error ( MAE )，were used to evaluate the fitting and prediction effects of the models.Results　The SARIMA（0，0，2）（0，1，1）12 model was the most appropriate SARIMA model.The Holt-Winters multiplication model was the optimal exponential smoothing model.The SPREAD optimal parameters of the SARIMA-GRNN combined model and the exponential smoothing-GRNN combined model were 0.026 and 0.031，respectively.In the fitting phase，the MAPE，MER，MSE and MAE fitted by SARIMA，exponential smoothing model，SARIMA-GRNN combined model and exponential smoothing-GRNN combined model were 15.350%，14.976%，0.336，0.286；14.346%，14.249%，0.326，0.272；7.390%，6.320%，0.034，0.123；6.952%，5.776%，0.028，0.113，respectively.The MAPE，MER，MSE and MAE predicted by SARIMA，exponential smoothing model，SARIMA-GRNN combined model and exponential smoothing-GRNN combined model were 11.998%，12.260%，0.022，0.138；39.582%，38.462%，0.199，0.432；8.892%，9.677%，0.020，0.109；8.872%，9.672%，0.021，0.109，respectively.Conclusion　The exponential smoothing-GRNN combined model was the optimal model for predicting the incidence of mumps in China with higher accuracy，followed by SARIMA-GRNN combined model.The SARIMA model has poor fitting and prediction accuracy，and the exponential smoothing model has good fitting accuracy，but its prediction accuracy is poor.

Advances in Light Therapy for Patients with Mental Disorders　

SHI Xiuxiu，LI Zheng*

2020, 23(11): 1344-1348. DOI: 10.12114/j.issn.1007-9572.2019.00.381

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SHI Xiuxiu，LI Zheng*
There is no definitive and effective clinical treatment and rehabilitation measures for patients with mental disorders.As a safe，convenient and low-cost non-pharmaceutical therapy，light therapy has attracted extensive attention in the treatment of patients with mental illnesses.At present，there are many foreign studies about light therapy，but few researches about the use of light therapy in psychiatry in China.This paper summarizes the relevant content of light therapy and its application status as well as the effect on patients with mental disorders in order to provide suggestions to promote the rehabilitation of patients with mental disorders.

Hearing Loss is an Early Warning of 3-year Incidence of Cognitive Impairment in Older People　

MA Yajun1，LIU Hui，HU Zhihao，LI Xiaodong，WANG Xiaofeng，JIANG Xiaoyan，LI Shujuan

2020, 23(11): 1349-1354. DOI: 10.12114/j.issn.1007-9572.2019.00.667

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Background　Hearing loss is one of the common health problems among the elderly，which seriously affects their physical and mental health.Previous studies have shown that hearing loss affects cognitive level in older adults.There are few studies on the relationship between hearing loss and cognition in the elderly cohort in China.Objective　To explore the correlation between hearing loss and cognitive impairment in an elderly cohort from Rugao，Jiangsu Province，providing a theoretical basis for delivering early interventions for cognitive impairment prevention via improving hearing loss.Methods　From November 13 to December 21，2014，by use of random stratified sampling，from the name list of 11 198 elderly residents（aged 70-84 years） living in 31 villages of Jiangan Town，Rugao City，Jiangsu Province，provided by Jiangan Town Health Bureau，we selected 1 960 cases，and 1 788 of them were enrolled as the baseline sample.Then we conducted two rounds of surveys with them 1.5 years（from April to June 2016） and 3 years（from November to December 2017） after the baseline survey，respectively.Of the 1 375 cases participating in all the surveys，1 117 with complete self-assessment hearing data evaluated in 2014 and cognitive status evaluated by the MMSE in 2017 were finally enrolled.We collected and analyzed their general information，self-assessment hearing status and cognitive status.Results　Among the 1 117 subjects，916（82.0%） had good hearing，and 201（18.0%） had hearing loss，575（51.5%） had cognitive impairment，and 542（48.5%） had normal cognitive function.Compared with those with normal hearing，hearing-impaired participants showed greater mean age，and lower mean MMSE score（P<0.05）.There were significant differences in sex ratio，distributions of age，occupation，marital status，education level，smoking status，drinking status，self-rated health status，and self-rated hearing status，and proportion of diabetes mellitus between those with and without cognitive impairment（P<0.05）.Logistic regression analysis showed that hearing level was the influencing factor of cognitive impariment〔OR=1.51，95%CI（1.06，2.15），P=0.022〕.Conclusion　Elderly people with hearing loss are more likely to develop cognitive impairment.Timely detection of hearing loss and giving intervention measures may reduce or delay the occurrence of cognitive impairment in the elderly.

Abnormal Deformation of Aorta and Prevention of Abdominal Aortic Aneurysm　

SONG Yujie，PENG Hongmei，ZHANG Dongwei

2020, 23(11): 1355-1360. DOI: 10.12114/j.issn.1007-9572.2019.00.628

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Background　The clinical data shows that the incidence of abdominal aortic aneurysm（AAA） is rising.A large number of studies have found that the cause of AAA is not only the internal cause of blood vessel biochemical properties，but also the external cause of blood hemodynamics.From the point of view of "stress-growth theory" of biomechanics，the abnormal hemodynamic environment will lead to the remodeling of pulmonary vascular structure，causing vascular diseases.Objective　To investigate the effect of internal hemodynamics on the generation and development of AAA in the case of abnormal deformation of the aortic blood vessels.Methods　The clinical CT image data of one case with healthy aortic vessel and two cases with typical AAA aortic vessel lesions in the Department of Neurology，Affiliated Hospital of Inner Mongolia University for Nationalities were collected in this article from 15 June 2016 to 31 July 2017.Three cases of CT data were reconstructed into a three-dimensional vascular structure model consistent with the real blood vessel using medical image three-dimensional reconstruction technology，and the numerical simulation was carried out using computational fluid dynamics software FLUENT 14.5.Based on the calculation results of hemodynamic characteristics in different vascular structure models with the same blood flow entrance velocity，the distribution of different blood wall shear stress，the distribution of blood flow after AAA in vascular and the secondary flow were compared，to explore the changes of hemodynamic characteristics in blood vessels after abnormal bending and distortion，and analyze the reason of hemodynamics caused by AAA.Results　On the premise of the same inlet velocity，and compared with the blood flow in the aorta of healthy person，the velocity and direction of blood flow decreased in the curved aortic arch of two AAA lesion models，and obvious circulation was found in the medial region of curved aortic arch.By calculating the distribution of secondary blood flow in the cross section of AAA model of arterial structure，it was found that the blood flow at the aortic arch appeared vortex flow，and the blood flow was normal after passing through the aortic arch，and the blood flow velocity was relatively low，the blood flow velocity at the bend of AAA increased locally.Compared with the tangential stress distribution of healthy blood vessel model，except for the large tangential stress at each outlet of blood vesselszthe tangential stress of aortic arch segment of human body was smaller，but the wall tangential stress of healthy blood vessel was slightly larger，and the distribution of tangential stress on the wall of blood vessel was more uniform in healthy human body.Conclusion　Compared with healthy human body，the abnormal bending and distortion of blood vessels of AAA are accompanied by secondary flow，and the phenomenon of secondary flow with high-speed and vortex can cause irreversible impact on the vessel wall，and thus causing the generation of AAA and increasing diameter of AAA gradually.

Study on Effects of Community-family-self-management Model on Patients with Early Chronic Kidney Disease　

ZHANG Xiaolei，JIA Hongyan

2020, 23(11): 1361-1367. DOI: 10.12114/j.issn.1007-9572.2019.00.482

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Background　Compared to the mature management of chronic diseases such as hypertension，diabetes，coronary heart disease and cerebral hemorrhage，the management of chronic kidney disease（CKD） is still basically blank.Objective　The effects and significance of this work was analyzed by observing the changes of patients' indicators through the community-family-self-management of early CKD patients for three years.Methods　Using random system sampling method to screen early CKD patients in Fangzhuang Community Health Service Center and its subordinate stations from 10 December 2013 to 9 March 2014，and community-family-self management of these patients was implemented for three years.Physical examination indicators，incidence of urine abnormalities，drug adherence and follow-up compliance，CKD stages，acute eGFR decline events，number of hospitalizations，endpoint events，and short form 36 health survey（SF-36） scores before and after the three-year intervention were compared.Results　In this study，60 patients with CKD were selected，and one patient was lost.A total of 59 patients were included.At six months after the intervention，the levels of systolic pressure，diastolic pressure，HbA1c，TC，LDL-C，Cr，and UA were lower than those before the intervention；the eGFR levels of patients with stage 2 CKD and all patients were higher than those before the three-year intervention（P<0.05）.There were no significant differences in the levels of BUN，the eGFR levels of patients with stage 1 CKD and stage 2 CKD，and the eGFR levels of all patients before and after the three-year intervention（P>0.05）.The levels of systolic pressure，diastolic pressure，HbA1c，TC，LDL-C，TG，Cr，and UA were lower than those before the three-year intervention（P<0.05）.There were no significant differences in the levels of Cr，BUN，the eGFR levels of patients with stage 1 CKD and stage 2 CKD，and the eGFR levels of all patients after the intervention for half a year and three years（P>0.05）.At three years after the intervention，the levels of systolic pressure，diastolic pressure，HbA1c，TC，LDL-C，TG，and UA were lower than those at six months after the intervention（P<0.05）.The incidence of urine abnormalities was statistically significant before and after the intervention（χ2=53.149，P<0.01）.Before intervention，40（67.0%） patients had high drug adherence；21（35.6%） patients had high follow-up compliance.In the first year after intervention，51（86.9%） patients had high drug adherence；48（80.5%） patients had high follow-up compliance.In the third year after intervention，54（92.4%） patients had high drug adherence；50（85.2%） patients had high follow-up compliance.There were 19（32.2%）patients with stage 1 CKD and 40（67.8%） patients with stage 2 CKD before the intervention.There were 26（44.1%）patients with stage 1 CKD，32（54.2%）patients with stage 2 CKD，and 1（1.7%）patient with stage 3 CKD after the three-year intervention.In the six months and one year after the intervention，1（1.7%） patient had an acute eGFR decline and 1（1.7%） patient was hospitalized.No other end point events occurred.The PF，RP，BP，GH，PCS，VT，SF，RE，MH，and MCS scores of patients after the three-year intervention were higher than those before the intervention（P<0.05）.Conclusion　After the management of early CKD patients using community-family-self-management model，the risk factors such as blood pressure，blood sugar，and blood lipids can be effectively controlled，and metabolic indicators such as Cr，BUN and UA also show a declining trend.The standard management improves patients' drug adherence and follow-up compliance，and reduces the acute eGFR decline events.In terms of the incidence of acute eGFR decline events and urine abnormalities，this intervention can reduce kidney damage in the short term and delay the progression of kidney damage in the long term.The community-family-self-management model has a certain effect on the management of patients with early CKD.

Holistic Integrative Management of Cardiovascular Diseases　

CHEN Guiying，ZHANG Miaomiao，WU Qunhong

2020, 23(11): 1368-1371. DOI: 10.12114/j.issn.1007-9572.2019.00.462

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Cardiovascular disease has become the leading health killer in China with the increasing morbidity and mortality.There is an urgent need for a new chronic disease management program to reduce the morbidity and mortality of cardiovascular disease and improve its cure rate.Therefore，holistic integrative medicine is just the key because it conforms to the modern bio-psycho-social medical model，integrates the advantages of modern multidisciplinary development and comprehensively manages chronic diseases in multi-faceted ways，especially for the management of cardiovascular disease.This article reviews the current situation of holistic integrative medicine in cardiovascular disease management at home and abroad，puts forward the integrated management of cardiovascular disease，and explores the feasible integrated management mode of cardiovascular disease in China.

Value of Plasma and Salivary Cortisol Tests in Generalized Anxiety Disorder　

SHAN Qing，KE Yunqian，WANG Yiming

2020, 23(11): 1372-1375. DOI: 10.12114/j.issn.1007-9572.2019.00.478

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Background　The pathogenesis，pathophysiological changes and early diagnosis of generalized anxiety disorder（GAD） remain unclear.Current research on cortisol concentrations in generalized anxiety disorder is inconsistent.Objective　To investigate whether the changes in plasma and salivary cortisol in GAD are associated with the severity of the disease.Methods　This study was conducted from October 2017 to May 2018 among participants recruited from the Affiliated Hospital of Guizhou Medical University，including 30 GAD outpatients and inpatients（GAD group） from psychological clinic and ward，and 30 healthy people（control group） from physical examination center and consultation clinic.Hamilton Anxiety Scale （HAMA） was used to assess the level of anxiety in GAD group and control group.Plasma and salivary cortisol levels were measured in the morning in all participants.The above indices were measured again in the GAD group after 6 weeks of paroxetine treatment.Analysis was performed to explore the correlation of changes in cortisol levels with the severity of GAD.Results　Mean plasma and salivary cortisol levels as well as mean HAMA score in GAD patients before paroxetine treatment were all higher than those of the controls（P<0.05）.Post-treatment mean plasma and salivary cortisol levels as well as mean HAMA score in GAD patients decreased significantly compared with the baseline levels（P<0.05）.Pearson's correlation analysis showed that plasma and salivary cortisol levels were positively correlated with HAMA score before treatment in the GAD patients（r=0.59，P<0.01；r=0.78，P<0.01）.Conclusion　Plasma and salivary cortisol levels were elevated in GAD，and were positively correlated with the severity of the disease.Detection of salivary and plasma cortisol levels have a certain guiding significance for early identification and severity determination of GAD.

Analysis of Therapeutic Effects of Probiotics on Renal Injury Induced by Hyperuricemia　

XIAO Yuanxun，ZHANG Congxin，ZENG Xianli，YUAN Zhichao

2020, 23(11): 1376-1382. DOI: 10.12114/j.issn.1007-9572.2019.00.479

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Background　The treatment of hyperuricemia with allopurinol is considered to be clinically effective.However，the treatment of renal injury caused by hyperuricemia with allopurinol is still controversial.Most scholars believe that allopurinol can effectively protect the kidney，but its use was limited due to the possible side effects of renal injury.Currently，probiotics have been shown to effectively degrade uric acid（UA）.Objective　Probiotics were screened from traditional pickles to analyze their effects on hyperuricemia with renal injury.Methods　From December 2017 to August 2018，lactic acid bacteria（LAB） were isolated from 18 kinds of pickles collected from different provinces.Firstly，functional LAB with good adhesion，which could degrade nucleosides and were resistant to acid，bile salts，trypsin and pepsin，were selected by microscopic examination after hydrogen peroxide（H2O2） and HE staining.The strains were identified by 16SrDNA sequence analysis and finally applied to the renal injury model of hyperuricemia.A total of 40 rats were divided into normal group（n=10），model group（n=10），S12 strain intervention group（n=10） and allopurinol intervention group（n=10） by random number table method.Levels of UA，serum creatinine（Scr） and urea nitrogen（BUN） were measured on days 0，10 and 20.Results　Fourteen strains of LAB were isolated from 18 kinds of pickles，among which S1，S5，S12 and S14 were used as candidate strains.The purity of S12 strain was the highest，so it was used for animal test.At day 10，Scr level in four groups showed no significantly difference（P>0.05），while the levels of UA and BUN in four groups were significantly different（P<0.05）.UA and BUN levels in the model group，S12 strain intervention group and allopurinol intervention group were higher than those in the normal group（P<0.05）.On the day 20，there were significant differences in the levels of UA，Scr and BUN in four groups（P<0.05）；among them，UA，Scr and BUN levels in the model group，S12 strain intervention group，and allopurinol intervention group were higher than those in the normal group；UA，Scr and BUN levels in the S12 strain intervention group were lower than those in the model group；UA and BUN levels in allopurinol intervention group were lower than those in the model group，while BUN level in allopurinol intervention group was higher than that in the S12 strain intervention group（P<0.05）.Conclusion　Probiotics have a certain degree of protective and therapeutic effects on hyperuricemia with renal injury.

Subjective Pain and Food Intake in Patients with Rheumatoid Arthritis　

JIANG Yin，MI Cundong

2020, 23(11): 1383-1388. DOI: 10.12114/j.issn.1007-9572.2020.00.012

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Background　Rheumatoid arthritis （RA） prevalence is increasing，and its diagnosis and treatment are becoming standardized gradually.Pain is the chief complaint.Whether subjective pain is associated with food intake is a generally concerned problem in these patients due to influence of some traditional ideas，and it has been studied rarely in recent studies，leading to insufficient adequate information for conducting effective patient education.Therefore，it is necessary to carry out relevant research.Objective　To investigate the effect of food intake on subjective pain in RA patients，providing evidence for health education for these patients.Methods　The outpatients and inpatients with RA from the First Affiliated Hospital of Guangxi Medical University，and Fourth Affiliated Hospital of Guangxi Medical University were enrolled during December 2014 to October 2016，and were surveyed using a questionnaire covering demographic data，and the influence of food intake on subjective pain（changes in pain level after eating different foods）.Results　A total of 500 cases participated in the survey.Among them，206（41.2%）thought that food intake had effect on subjective pain，but others 〔294（58.8%）〕 did not think so.However，these two groups showed similar severity distribution of disease activity （χ2=2.432，P=0.296）.The top three foods that aggravated subjective pain were poultry 〔45.9%（89/194）〕，red meat 〔30.9%（60/194）〕 and bamboo shoots 〔24.7%（48/194）〕.The top three foods that alleviated subjective pain were Chinese red dates 〔50.0%（21/42）〕，longan 〔28.6%（12/42）〕 and ginger 〔19.0%（8/42）〕.The prevalence of opinions about food intake aggravating subjective pain level was higher in females than that of males （P<0.05）.RA residents in coastal areas were more likely to believe that food intake could alleviate subjective pain compared with those from hilly areas （P<0.05）.Conclusion　The subjective pain level of some RA patients is influenced by food intake.Eating poultry，red meat and bamboo shoots are thought to be aggravating factors for pain level，whereas eating Chinese red dates，longan and ginger are considered to be alleviating factors of the pain.Females are more likely to think that food intake aggravates subjective pain.And those living in coastal areas are more likely to believe that food intake can reduce subjective pain compared with those living in hilly areas.

The Effect of Subglottic Secretion Drainage with Compound Chlorhexidine Gargle on Ventilator-associated Pneumonia　

TAO Shaoyu，PENG Daijiao，LI Wanxia，MING Liangjia，LIU Yuanfei，CHEN Xi

2020, 23(11): 1389-1393. DOI: 10.12114/j.issn.1007-9572.2019.00.750

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Background　The establishment of artificial airway damages the physiological protective barrier of oropharynx and lower respiratory tract.A large number of bacteria accumulating between subglottic and tracheal cannula balloon is an important source of pathogenic bacteria of ventilator-associated pneumonia（VAP）.Compound chlorhexidine gargle could inhibit bacterial adhesion and growth in oral cavity and kill many pathogenic bacteria.Objective　To evaluate the effect of subglottic secretion drainage with compound chlorhexidine gargle on VAP.Methods　It was a prospective randomized controlled study.From January 2016 to August 2018，120 patients receiving mechanical ventilation in EICU and ICU of the Second Affiliated Hospital of Nanchang University were randomly divided into A group and B group（60 patients in each group）.Patients in B group was rinsed with compound chlorhexidine gargle every 6 hours and continuous negative pressure aspiration while patients in A group rinsed with normal saline.The end point of observation was the 14th day after the beginning of mechanical ventilation.Incidence of VAP，lengths of mechanical ventilation，ICU stay，time of using antibiotics，colonies of pathogenic bacteria in subglottic secretion，bacteria and drug resistance in lower respiratory tract of VAP patients between two groups were compared.Results　The incidence of VAP，lengths of mechanical ventilation time，ICU stay and time of using antibiotics in B group were significantly lower than those in A group（P<0.05）.The subglottic secretion bacterial colonies in B group were significantly lower than that in A group on 3，6，9，12 d（P<0.05）.The rate of Gram-negative bacilli of VAP patients in B group was significantly lower than that in A group（P<0.05），in which the MDR，XDR rate of Acinetobacter baumannii was significantly lower（P<0.05）.Conclusion　Subglottic secretion drainage with compound chlorhexidine gargle in patients with mechanical ventilation could significantly reduce the incidence of VAP，lengths of mechanical ventilation，ICU stay，time of using antibiotics，the number of colonies of subglottic secretion and Gram-negative pathogenic bacteria and drug resistance of VAP.It could be used as a preventive and therapeutic measure for VAP.

Screening of Multiple Inherited Metabolic Diseases in 20 307 Newborns of Li Ethnic Group　

ZHAO Zhendong，WANG Jie

2020, 23(11): 1394-1398. DOI: 10.12114/j.issn.1007-9572.2019.00.671

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Background　Although the incidence of a single inherited metabolic disease is low，the total incidence of all inherited metabolic diseases can reach 0.5% in newborns.Hainan is a poor and backward area，and the Li population gather in the poor and remote mountainous areas of Hainan province.Screening inherited metabolic diseases in the newborns of Li ethnic group can provide support for experimental diagnosis of these diseases to Li siblings，prevent birth defects of the Li population，improve population quality，and can play a role in health and poverty alleviation at the same time.Objective　To investigate the incidence of inborn error of metabolism（IEM） of Li ethnic group's newborns in Hainan Province.Methods　A total of 20 307 samples of dried blood samples from Li ethnic group's newborns who were born in Hainan Province from October 2016 to September 2018 were collected.The NeoBaseTM Non-derivatized MSMS kits produced by PE were used.for screening 11 kinds of amino acids，a kind of free carnitine and 30 kinds of acylcarnitines by tandem mass spectrometry.The suspicious samples after primary screening were recalled and screened again，and after second screening，the still abnormal blood samples were sent to Beijing Maikeno gene company for genetic diagnosis.Results　Among the 20 307 newborns，the abnormal cases were 840 in the primary screening，and the abnormal rate was 4.14%（840/20 307）.Among the 840 cases，five patients who were followed up died and 835 patients were recalled.After reexaminnation，770 cases were excluded，65 cases were suspected IEM patients，and 12 cases were diagnosed with IEM by genetic diagnosis，and the incidence was 59/100 000（13/20 307）.Among the 12 cases，5 cases were primary carnitine deficiency（PCD），3 cases were phenylketonuria（PKU），2 cases were 3-methylcrotonyl-coenzyme A carboxylase deficiency（MCCD），1 case was methylmalonic acidemia（MMA），and 1 case was malonic acidemia.3 types of gene mutation were found in 5 cases of PCD patients and among them，1 case was c.760C>T，2cases were c.51C>G and 2 cases were c.338G>A.Three types of gene mutation were found in 3 cases of PKU patients and they were c.1081A>T，c.728G>A and c.764T>C respectively.The gene mutation site of the 2 MCCD patients was c.1331G>A.The gene mutation site of the MMA patient was c.456delT.And the gene mutation site of the malonic acidemia patient was c.541G>A.Conclusion　The incidence of IEM is high（59/100 000） in the newborns of Li ethnic group in Hainan Province，especially PCD of which the incidence is the highest
（1/4 061）.Screening of multiple genetic metabolic diseases by tandem mass spectrometry is of great significance.

Interpersonal Networks in Healthcare Communication in Pregnant and Postpartum Women　

ZHANG Zhili，LI Rude，CHENG Xiaoyun，PEI Suyun，YUE Zheyu，ZHANG Juan1

2020, 23(11): 1399-1405. DOI: 10.12114/j.issn.1007-9572.2019.00.157

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Background　Adequate social support is necessary for women during pregnancy and childbirth.Information support is an important part of the social support system.Health information accessing can guide pregnant and postpartum women in choosing appropriate maternal healthcare services，and is essential to maintain and promote maternal and child health.Objective　To explore the overall and subgroup characteristics of interpersonal networks in healthcare communication in pregnant and postpartum women in Taiyuan，China，so as to provide a reference for improving the effect of interpersonal communication in maternal health education.Methods　This study was carried out in a sample of pregnant and postpartum women receiving outpatient services in 3 healthcare institutions of different owners and levels（a public provincial maternal and child health hospital，a public township hospital，and a private hospital）from November 2016 to August 2017．A self-made questionnaire was used to collect the general information，and interpersonal network［consisting of most frequently contacted persons（at least 5） for obtaining health information］．The interpersonal networks were analyzed by size，homogeneity，personal familiarity and relationships with the members of the network.Results　A total of 1 100 pregnant and postpartum women participated in the survey，and 863（78.45%） of them responded effectively.Among the respondents，the size，and cultural homogeneity of interpersonal networks were （4.12±1.23）（0.61±0.34），respectively.And their average level of familiarity with the members in the interpersonal networks was （0.68±0.29）．The major members in their interpersonal networks were friends/coworkers（76.66%），mother（48.89%），sister（s）（47.37%），husband（41.31%），and doctors（25.79%）．Correspondence analysis map of their interpersonal networks in healthcare communication showed that，the networks showed low level of homogeneity with medical background，low level of homogeneity without medical background in pregnant and postpartum women with low education level living in urban areas，and those living in counties，towns and villages，respectively.Moreover，for those with high education level living in urban areas，and living in counties，towns and villages，the networks demonstrated high level of familiarity，high level of homogeneity with medical background，and high level of familiarity，high level of homogeneity without medical background，respectively.Conclusion　Most pregnant and postpartum women in Taiyuan had a relatively stable interpersonal network in healthcare communication.They had high-level familiarity with the members in the network，which contained high percentages of relatives，and friends/coworkers，but low percentage of doctors，and had urban-rural differences.

Second-birth Intentions and Mental Health among Women Aged at Least 30 in Their Second Pregnancies during the Implementation of the Universal Two-child Policy in China：a Survey in Small- and Medium-sized Cities of Anhui Province　

LU Xuelei，JIANG Chunxiao，WANG Ling，WU Huabing，NIU Qingshan，ZHANG Chi，ZHONG Qi，HUANG Fen

2020, 23(11): 1406-1410. DOI: 10.12114/j.issn.1007-9572.2019.00.512

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Background　The implementation of the universal two-child policy raises concerns in the whole society about second-birth intentions among women of childbearing age.However，research on associated factors of second-birth intention and mental health among women beyond the optimal age for childbearing is rarely reported.Objective　To explore second-birth intentions and mental health among women aged at least 30 in their second pregnancies from small and medium-sized cities in Anhui Province，providing a reference for further implementation of the universal two-child policy and the improvement of relevant supporting policies.Methods　This study was conducted from April to August 2018.By use of multistage cluster and random sampling，women aged at least 30 in their second pregnancies who had established antenatal healthcare record card in maternal and child health hospitals in three small and medium-sized cities（Tongling，Huainan and Lu'an），Anhui Province，were chosen at random.General demographic data，second-birth intention，fertility-related characteristics，and score of the General Well-being Schedule（GWBS）were collected.Multivariate Logistic regression was used to analyze the influencing factors of second-birth intention and mental health status.Results　Of the 647 women，618 of them answered the questions with a effective response rate of 95.5%.Second-birth intentions among the participants changed significantly according to age，physical health，ideal number of children，fertility status of the surrounding populations，decision-maker for having the child，and expected sex of the second child（P<0.05）．Multivariate Logistic regression analysis showed that age，fertility status of the surrounding populations，decision-maker for having the child and expected sex of the second child were the main factors affecting second-birth intention（P<0.05）．The mean scores of vitality，positive well-being，melancholy or pleasant mood，control over emotion and behavior，relaxation and stress scores，and mean total GWBS score in women who were unwilling to have a second child were lower than those of women who were willing to have（P<0.05）．Different physical health status，second-birth intention，fertility decision-making power and awareness of fertility policies resulted in the differences in total GWBS score（P<0.05）.Multivariate Logistic regression analysis showed that physical health，second-birth intention，and decision-maker for having the child were the influencing factors of GWBS score（P<0.05）．Conclusion　The second-birth intention level is high among women aged at least 30 in their second pregnancies in small and medium-sized cities in Anhui Province.The women's mental health is mainly affected by second-birth intention level.Relevant departments should take comprehensive measures to address the challenges posed by policy changes.

Knowledge of Early Life Nutrition of Mothers with Children 0-2 Years under the Background of Two-child Policy in Anhui Province　

YANG Yucheng，HONG Qian，YANG Shuxinyi，SUN Xingxing，DENG Yuchen，DUAN Shupei，ZHOU Rongjun

2020, 23(11): 1411-1415. DOI: 10.12114/j.issn.1007-9572.2019.00.472

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Background　Nutrition early in life affects not only the average growth and development of a person in fetal and childhood，but also in their adult and even whole life.Under the background of two-child policy，the newly-born population is increasing，so it is essential to improve the correct cognition of mothers' nutrition knowledge in early life.Objective　To understand the current situation of knowledge of early life nutrition of mothers with children 0-2 years of age in Anhui Province under the comprehensive two-child policy，and to provide scientific basis for targeted health intervention in the future.Methods　From January 2015 to January 2016，a multi-stage stratified cluster sampling method was used to select mothers with children aged 0-2 years in Hefei，Wuhu，and Fuyang of Anhui Province to conduct a questionnaire survey to understand their knowledge of pregnancy and childbirth nutrition，post children's nutritional needs，primary sources of nutritional knowledge after delivery，and comparison of differences between three regions.Results　Of the 1 050 mothers with children aged 0-2 years，1 019 of them answered all the questions with a effective response rate of 97.0%.The average score of nutrition knowledge during pregnancy was（23.3±7.4），the total pass rate was 40.3%（411/1 019）.There were significant difference in the awareness rates of the normal and reasonable dietary requirements，the reasonable nutritional needs during pregnancy，the folic acid supplement in early pregnancy，the calcium supplementation in mid and late-pregnancy，the appropriate growth range of body weight during pregnancy，and the risk of overweight gain during pregnancy of mothers in three regions（P<0.05）.The average score of children's nutritional needs after childbirth was（21.9±8.8），and the total pass rate was 36.6%（373/1 019）.There were significant differences in the awareness rates of that breastfeeding can provide balanced nutrition，enhance resistance，easy digestion and absorption，and promote mother-child emotions communication，promotion of post-partum recovery，exclusive breastfeeding time，breast milk can be fed to 2 years，increase trace element iron if have anemia in three regions（P<0.05）.The primary sources of nutrition knowledge of children after childbirth were medical workers，QQ/WeChat，and other online platforms and professional books.There was significant difference in the proportion of sources of nutrition knowledge in mothers after delivery in three regions（P<0.05）.Conclusion　The early life nutrition knowledge level of mothers with children 0-2 years of age needs to be further improved.It is suggested to strengthen the publicity of pregnancy nutrition and breast-feeding knowledge，provide postpartum visits for the lying-in women，take targeted measures for different regions，explore new ways of online publicity and education，and set up professional lectures to promote maternal and infant health.

Use of WeChat among Elderly Patients with Chronic Diseases in Central District of Shanghai　

WEI Wei，LE Jiayi，MA Longfei，WANG Xuling，LU Yuan

2020, 23(11): 1416-1420. DOI: 10.12114/j.issn.1007-9572.2019.00.563

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Background　Chronic diseases have become major risk factors affecting the health of the population and WeChat has been applied to multiple researches to explore the innovative model of chronic disease management.As the fundamentals of implementing WeChat-effective intervention，researches on the usage of WeChat in related population，especially the elderly are few.Therefore，correlated studies were performed in this research，offering targeted support for WeChat-based chronic disease management.Objective　To investigate the WeChat usage ability in elderly patients with chronic diseases in central urban area and explore the management path of WeChat chronic disease management.Methods　Clinical diagnosis statistics in Ruijin'erlu Community Health Service Center of Huangpu District，Shanghai from October 2017 to September 2018 were retrieved and top 5 diseases with over three-month disease course were chosen.By considering the actual situation of daily management of chronic diseases in this community，patients with hypertension，diabetes，hyperlipidaemia，coronary heart disease and cerebral infarction were selected as research objects.In October 2018，1 010 elderly patients from Ruijin'erlu Street of Huangpu District，Shanghai were selected and surveyed to check WeChat usage.Random sampling method was used to select 160 patients from the elderly patients who use WeChat for questionnaire in which general information，access channel and motivation of using WeChat，daily operation capabilities of WeChat and application evaluation of WeChat functions.Results　Among 1 010 patients，there were 557 patients using WeChat（55.15%） and utilization rate of WeChat aged from 60 to 70 was 71.68%（405/565），higher than that of patients aged 71 years or over〔25.62%（114/445）〕（χ2=211.443，P<0.001）．For questionnaires surveyed in 160 patients，there were 158 valid questionnaires and valid return rate was 98.75%.Distribution of beginning time of using WeChat was quite balanced and the earliest began in 2011.Nearly 80% of patients installed WeChat through introduction by their children，relatives as well as friends and colleagues.Source and type of friends were mainly children and relatives.Adding strangers to be friends was quite rare and their number of friends were few.When coming across with difficulties，they often turned to their children and relatives for help.Daily use of WeChat among patients was quite frequent and about 90% of patients logged on WeChat almost every day for communication with their sons and daughters，friends and colleagues.Patients paid more attention to articles on health care.Nearly 90% of patients were willing to communicate with physicians or ward mates through WeChat.Meanwhile，only about 20% of patients had used WeChat to communicate with physicians.About 50% of patients had used WeChat to communicate with ward mates.State of illness，diseases prevention and self management were major contents for patient communication.When using WeChat，visual fatigue was main adverse effects and false information and ads were major issues they met.Conclusion　Over half of elderly patients with chronic diseases in central district use WeChat.The elderly patients could use most functions of WeChat skillfully and they have strong willing for physician-patient communication through WeChat.Setting up WeChat group based on medical units and diseases for management of chronic diseases is a direction for application.

Job Preferences of Nurses from Township Health Centers in Poverty-stricken Areas：a Discrete Choice Experiment-based Study

LIAN Dongqing，LI Yueping，LU Ruoyan

2020, 23(11): 1421-1424. DOI: 10.12114/j.issn.1007-9572.2019.00.792

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Background　As an important part of health resources，nurses play a key role in ensuring the quality of health services.In township health centers in poverty-stricken areas of China，nurse resources are insufficient with high mobility and serious drain.So finding out job preferences of them from township health centers in poverty-stricken areas，and exploring measures to attract and retain them are of great significance to rural health development.Objective　To analyze job preferences in nurses working at township health centers in poverty-stricken areas.Methods　Participants were nurses who were on duty on survey days（from March 21 to March 26，2017） in 5 township health centers randomly selected from two poverty counties（Changting County and Wuping County） of Longyan City，Fujian Province.They were surveyed with a self-developed questionnaire for collecting their sociodemographic features and job evaluation.A discrete choice experiment was used to identify their work priorities.The Mixed Logit model was used for regression analysis of the data.Results　Of the 145 cases receiving the survey，122（84.1%） responded effectively.The overall preferred characteristics of a job were staffing，high salary，providing good conditions for employees' children，long expected working life，and short time stipulated for professional title promotion.The aforementioned five job attributes had heterogeneous in preference，for instance，89% of the respondents preferred a job with long working years，while the other 11% did not.Educational conditions provided for employees' children had the highest monetary value of 4 109 yuan per month.The proportion of respondents choosing this job would increase by 47.90% when the salary raised from 2 000 yuan to 8 000 yuan per month.Conclusion　Priorities should be given to the improvement of the income and children's educational conditions of nurses working at township health centers in poverty-stricken areas，and incentives for them should be formulated scientifically.

Influence of Social Resilience on Professional Self-identity in Family Doctors　

JIANG Maomin，GUO Peipei，YE Jun，LU Yanyan

2020, 23(11): 1425-1430. DOI: 10.12114/j.issn.1007-9572.2020.00.168

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Background　Doctor turnover is becoming increasingly common.As to family doctors，the health stewards of the community，turnover may influence their professional development，and may be detrimental to the implementation of national health promotion program.Currently，the duties of domestic family doctors are implemented mainly by general practitioners in primary care.They need to deliver home-based services besides hospital services，leading to increased risk of job burnout.Strengthening their professional self-identity is essential to avoid the turnover.Objective　To explore the impact of social resilience on the professional self-identity in family doctors，with a view to providing high-quality medical services for patients in primary care via improving professional self-identity in family doctors，and promoting the sustainable development of the family doctor system.Methods　This cross-sectional study was conducted in Zhejiang Province between October 2018 and June 2019.Participants were 2 500 family doctors from 321 primary health centers selected by development level from 8 cities （Hangzhou，Ningbo，Wenzhou，Jinhua，Huzhou，Zhoushan，Taizhou and Lishui） sampled by both administrative division and economic development level.A survey was implemented to collect participants’ data concerning demographics and professional self-identity using a questionnaire consisting of demographic part and Family Physician Professional Self-identity Scale （FPPSS）.Stepwise multiple linear regression was adopted to analyze the association of social resilience with dimensions of the FPPSS.Results　Among the 2 319 cases returning the questionnaire，2 261 were found to be appropriate respondents，indicating that the survey obtained a response rate of 90.44%.The mean scores of the FPPSS and its 5 dimensions，professional expectation，professional sense of belonging，professional value，professional perception，and professional behavior were （3.6±0.7），（3.0±1.0），（3.4±1.3），（4.1±1.2），（3.5±1.0），（4.1±1.1），respectively.Stepwise multiple linear regression analysis showed that innovation capacity，psychological resilience，community tolerance，equal opportunity，and social support were associated with professional self-identity（P<0.05）.And these 5 factors were also associated with professional sense of belonging （P<0.05）.Innovation capacity and equal opportunity were found to be associated factors for professional expectation（P<0.05）.Psychological resilience，community tolerance，equal opportunity，and social support were associated with professional value （P<0.05）.Innovation capacity，community tolerance，and social support were associated with professional perception （P<0.05）.Innovation capacity，psychological resilience，and community tolerance were associated with professional behavior （P<0.05）.Conclusion　In Zhejiang Province，the overall level of professional self-identity in family doctors is above the average，but there is still room for improvement.The professional self-identity level may be influenced by social resilience，including innovation capacity，psychological resilience，community tolerance，equal opportunity，and social support，with equal opportunity as the foremost.

The Clinical Characteristics of Type B Insulin Resistance　

ZHAO Linlin，WANG Shoujun

2020, 23(11): 1431-1435. DOI: 10.12114/j.issn.1007-9572.2019.00.485

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Objective　To summarize the clinical characteristics of Chinese patients with type B insulin resistance （B-IR） to improve their diagnosis and treatment.Methods　We searched the databases of CNKI，Wanfang Data Knowledge Service Platform and PubMed with the keyword “type B insulin resistance” from January 2000 to January 2019.Literatures reported Chinese patients were selected in PubMed database.According to the inclusion criteria，13 articles and 15 patients were included.The clinical manifestation，laboratory examination，treatment and follow-up were summarized.Results　Among 15 cases，the mean age of three male patients was （46.3±17.0） years，and the mean age of twelve female patients was （45.3±11.4） years；the age of all patients ranged from 24 to 63 years，and the mean age was （45.6±11.6） years.All patients （15/15） were accompanied with autoimmune diseases （AID），and 12 of them （12/15） with single AID，three of them （3/15） with more than two AIDs，nine cases（9/15） with systemic lupus erythematosus.Fourteen patients began with hyperglycemia and the mean value of HbA1c was （11.9±2.7）%，while one patient began with hypoglycemia with the value of HbA1c about 7.6%.There were 11 patients （11/15） whose fast serum insulin level were higher than 300 μU/ml and 5 patients（5/15） with hypertestosteronemia.Among the 15 patients，7 （7/15） were positive for anti-insulin receptor antibodies （AIRA），6 （6/15） were positive for 13C breath test，four of who were positive and two were negative.The combination of glucocorticoids and immunosuppressant drugs was the main treatment programs.There were 4 cases （4/15） starting with a program of pulse glucocorticoids therapy （methyprednisolone ≥250 mg/day for 3 days）．The remaining 11 patients （11/15） started with a program of methyprednisolone 20-40 mg/day or prednisone 40-60 mg/day.Twelve patients （12/15） were treated with low-dose glucocorticoid （methylprednisolone 4-8 mg/d，prednisone 2.5-10.0 mg/d） for maintenance therapy.As for the initial use of immunosuppressive drugs，8 patients （8/15） were treated with cyclophosphamide，0.4-0.6 g/week at the beginning，generally for 1-3 weeks.The time limit for blood glucose control was from 2 weeks to 1 year.One patient had no follow-up record，the others were followed up for 2 months to 7 years.Conclusion　B-IR is a rare disease，which has typical clinical characteristics including severe blood glucose disorder，hyperinsulinemia and autoimmune diseases.The treatment program mainly includes the combination of glucocorticoids and immunosuppressant drugs，and it is vital to have close follow-up in order to improve the prognosis.

Clinical and Pathological Characteristics of Fundic Gland Polyps：an Analysis of 1 200 Cases　

SHI Xiaoxiao，YU Dehua，ZHENG Songbai

2020, 23(11): 1436-1439. DOI: 10.12114/j.issn.1007-9572.2019.00.486

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Objective　To investigate the epidemiological，and endoscopic features as well as pathogenesis-related factors of fundic gland polyps（FGPs）．Methods　This study was carried out following a retrospective design.Participants were recruited from Gastroscopy Center，Huadong Hospital Affiliated to Fudan University during October 2014 to June 2016.All of them were initially found with gastric polyps by gastroscopy，and were diagnosed with FGPs by pathologic results of biopsies or resection specimens.Clinical，endoscopic and pathological data were collected.Some of the patients were selected by a random number table，and were given a telephone follow-up.Treatment with proton pump inhibitors （PPIs） was surveyed via the telephone，including the name and dose of the PPI，as well as the course of treatment （≤3 months，4-6 months，7-12 months，>12 months）．Results　Altogether，1 909 of the 29 309 cases undergoing gastroscopy were found with gastric polyp，including 1 200 cases of FGPs，the prevalence of FGPs was 4.09%（1 200/29 309）．In FGPs cases，male-to-female ratio was 1∶1.91.FGPs mainly grew in the stomach body 〔692 cases （57.7%）〕 and fundus 〔464 cases （38.6%）〕 with diameters ranging from 1 to 5 mm 〔1 082 cases （90.1%）〕.Single FGP was found in 797 cases （66.4%），and multiple FGPs were found in 403 cases （33.6%）．The prevalence of FGPs with reflux esophagitis，FGPs with active gastroduodenal ulcer，FGPs with bile reflux，FGPs with intestinal metaplasia in gastric antral mucosa，and FGPs with atrophy in the antral mucosa was 15.2%（183 cases），5.6%（67 cases），4.1%（49 cases），19.3%（232 cases），and 14.8%（178 cases），respectively.A total of 322 cases received the telephone follow-up，among whom 179 （55.6%） received PPIs treatment，and the duration of PPIs treatment was ≤3 months for 97 cases （54.2%），4-6 months for 31 cases （17.3%），7-12 months for 28 cases （15.7%），and longer than 12 months for 23 cases （12.8%）．61 cases（34.1%） were treated with omeprazole，85（47.5%） with rabeprazole，20（11.2%） with pantoprazole，4（2.2%） with lansoprazole，and 9（5.0%） with esomeprazole.The type of PPIs used in the patients differed significantly by the duration of PPIs treatment （χ2=35.083，P<0.05） as well as age group （χ2=31.829，P<0.05）．Conclusion　FGPs are common intragastinal lesions，which are more common in women clinically.Most FGPs occur in the fundus and the body of the stomach，mainly single，with a diameter of 1-5 mm.Endoscopic examination shows that FGPs are often associated with reflux esophagitis，peptic ulcer，bile reflux，etc.For FGPs patients applying PPIs，the choice of PPIs should be determined by the patient's age and duration of treatment.

Diagnosis and Treatment of Tibial Plateau Fracture with Soft Tissue Injury　

LI Shuaijie，CAI Long，LIU Xiaohu，XIANG Chuan

2020, 23(11): 1440-1444. DOI: 10.12114/j.issn.1007-9572.2019.00.443

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Background　Tibial plateau fracture is often associated with soft tissue injury around knee joint.Early diagnosis and treatment of tibial plateau fracture combined with soft tissue injury on the basis of correct and timely treatment can not only help patients alleviate pain，but also help patients recover limb function to the greatest extent and improve their quality of life.Objective　To explore the strategy of diagnosis and treatment of tibial plateau fracture with soft tissue injury.Methods　A total of 82 patients with tibial plateau fracture and soft tissue injury who were hospitalized in the Second Hospital of Shanxi Medical University from April 2014 to September 2017 were selected as the study subjects，and were divided into six groups according to Schatzker classification.The preoperative general data，perioperative indicators，soft tissue injury distribution and multiple soft tissue injuries were recorded and compared.Results　The incidence of delayed diagnosis and missed diagnosis was 30.5%（25/82）．The operation time of types Ⅲ，Ⅴand Ⅵ fracture was longer than that of types Ⅰ，Ⅱand Ⅳ fracture，and the bleeding volume of type Ⅵ fracture was more than that of types Ⅰ，Ⅱ，Ⅲ，Ⅳand Ⅴ fracture （P<0.05）．There were 40 cases with multiple soft tissue injuries（2 or more），and there was no significant difference in the rate of multiple soft tissue injuries（P=0.574）between Schatzker types Ⅰ，Ⅱ，Ⅲ，Ⅳ，Ⅴ and Ⅵ.Bone healing occurred 4 to 8 months after operation，and line of gravity of lower limbs was basically normal.Knee Joint Score of Hospital for Special Surgery（HSS）：26 cases were excellent，29 cases were good，26 cases were acceptable，1 case was poor，with the excellent and good rate was 67.1%.Conclusion　The delayed diagnosis and missed diagnosis rate of tibial plateau fracture complicated with soft tissue injury is high.Great attention should be paid to early diagnosis and treatment of soft tissue injury，so as to avoid serious consequences such as limb movement，sensory disturbance and even amputation.

EBV-associated Hemophagocytic Syndrome：a Case Report and Literature Review　

WANG Jiangya，SUN Meng，ZHENG Youning

2020, 23(11): 1445-1448. DOI: 10.12114/j.issn.1007-9572.2019.00.480

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Hemophagocytic syndrome is a rare histocyte disease in children.Due to lack of specific clinical manifestations in the early stage，it is very easily misdiagnosed，delaying the appropriate treatment.We retrospectively analyzed the clinical data and treatment of one child with EBV-associated hemophagocytic syndrome，and reviewed available studies about the disease，to help clinical workers identify hemophagocytic syndrome at an early stage，by which the survival opportunities in such patients can be increased.

Pheochromocytoma Combined Familial Adenomatous Polyposis with Ectopic ACTH Syndrome: a Case Report and Literature Review　

ZHANG Min，CHEN Jingyan，ZHANG Li，ZHANG Lu，CHEN Ping

2020, 23(11): 1449-1454. DOI: 10.12114/j.issn.1007-9572.2019.00.469

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Background　Ectopic adrenocorticotropic hormone syndrome（EAS） refers to a series of clinical syndromes caused by the secretion of adrenocorticotropic hormone（ACTH） or other proopiomelanocortin （POMC） derived peptide by tissues outside the pituitary gland，which stimulates adrenocortical hyperplasia and makes it secrete excessive glucocorticoid.EAS caused by pheochromocytoma is very rare.Objective　To describe the clinical features of a case of pheochromocytoma combined familial adenomatous polyposis（FAP） with EAS，and to investigate its diagnosis and treatment approaches.Methods　The patient was admitted to Sichuan Provincial People's Hospital on June 12，2014 because of "recurrent consciousness disorder，fatigue，headache，palpitation，excessive sweating and insomnia for one month".The patient was diagnosed with pheochromocytoma combined FAP with EAS，and the clinical data of this patient were retrospectively reviewed and the literature was reviewed.Results　The patient had typical manifestations of pheochromocytoma such as paroxysmal headache，palpitations，blurred vision，excessive sweating and large blood pressure fluctuations，accompanied by clinical manifestations of EAS such as hyperglycemia，fatigue，insomnia，and ematiation，while the early clinical manifestations of FAP had been hidden.Conclusion　EAS has a variety of clinical manifestations and is easily misdiagnosed and mistreated.When the patients experience clinically the severe hypertension，hypokalemia，arrhythmias and secondary diabetes，the Cushing's syndrome should be considered，especially the possibility of EAS.It requires a combination of clinical features，biochemical and hormone secretion，imaging，and pathology results for a comprehensive judgment.Early clinical manifestations of FAP are non-specific，the family investigation and colonoscopy screening for populations at risk are important ways to detect patients with FAP early.

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