Chinese General Practice

Advances in respite care for autism spectrum disorder in children

WU Tao，XIA Haozhi

2020, 23(24): 2991-2999. DOI: 10.12114/j.issn.1007-9572.2020.00.393

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Autism spectrum disorder（ASD）is a serious neurodevelopmental disorder mainly characterized by impaired social interactions，communication disorders，limited interests or repetitive and stereotyped behavior，which can only be alleviated by rehabilitation but not be cured at present.As the primary caregivers for children with ASD，the parents bear a heavy burden induced by long-term care，which decreases their quality of life.Therefore，respite care was put forward abroad to alleviate the caregivers' burden.This paper focuses on the status of family-based respite care for children with ASD abroad，including care pattern，contents，acceptance and acceptance-related factors，as well as effectiveness evaluation indicators of respite care，emphasizing that respite care should be family needs-oriented and personalized，with consideration of family structure in combination with family-based rehabilitation.Besides，this paper also analyzes the current situation of institutional respite care for children with ASD in China，and proposes that the policy and information support of respite care should be improved based on social support theory，and the construction of care team should be strengthened to provide comprehensive multidisciplinary respite care including education and rehabilitation training，and to improve the care quality.

Advances in the Development of Assessment Tools of Adverse Childhood Experiences

WANG Lu，QU Yanhua，ZOU Haiou*

2020, 23(24): 3000-3005. DOI: 10.12114/j.issn.1007-9572.2020.00.305

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The World Health Organization survey shows that more than one third of the global population has had bad childhood experiences.The Centers for Disease Control and Prevention also pointed out in the 2019 report that at least one seventh of the children in the past year have suffered abuse and / or neglect.As a global public health problem，adverse childhood experiences not only damage individual physical and mental health in the short term，but also have a lifelong impact.In recent years，domestic and foreign scholars have explored adverse childhood experiences and formed relevant assessment tools.This paper summarized the widely used assessment tools with good reliability and validity，aiming to provide a comprehensive reference for the evaluation of adverse childhood experiences，and offer insights into related research and interventions in China.

Bullying behaviors among 3-6-year-old children in Guangxi：a cross-sectional survey

ZHANG Tinghui*，YANG Xiuqing，ZHANG Li，SHE Shaohua

2020, 23(24): 3006-3011. DOI: 10.12114/j.issn.1007-9572.2020.00.368

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Background　Available studies about bullying behaviors mainly using primary school and junior high school students as the subjects，but few using 3-6-year-old children.Objective　To survey the bullying behaviors among 3-6-year-old children in Guangxi，providing a reference for better controlling and preventing the bullying behaviors in this population.Methods　This survey was conducted from March to May 2018.By use of cluster sampling，1 054 children were selected from 30 classes of 10 kindergartens〔3 classes were （a junior，a medium and a senior） extracted from each kindergarten〕in Guilin，Liuzhou，Laibin，Nanning and Yulin，Guangxi Province.A self-developed questionnaire named Bullying Behavior Assessment among 3-6-year-old Children was used in the survey，which was filled in by the class teacher for the children according to their reported information，including demographic data，bullying behavior rating scale〔consisting of four subscales：direct forms of being bullied（verbal，physical and property bullying），indirect forms of being bullied，bullying others and responses to bullying〕 settings where bullying occurring．Moreover，on-site videos recorded by the camera were also used to collect relevant bullying data.Results　The questionnaire survey achieved a response rate of 93.2%（982
/1 054）.Among the 982 final participants （518 were male and 464 were female），except 798（81.3%） cases，other 184（18.7%）cases were involved in bullying，including 34 victims of indirect bullying，98 victims of direct bullying，and 52 offenders of bullying.Male children had higher prevalence rate of being victims or offenders of bullying than female children （P<0.05）.The prevalence rates of being involved in bullying，victims of direct bullying differed significantly across junior，medium and senior classes （P<0.05）.Male children had lower prevalence rate of direct verbal bullying and higher prevalence rate of direct physical bullying than female children （P<0.05）.The prevalence rate of direct verbal bullying and rate of victims of indirect bullying differed significantly across junior，medium and senior classes （P<0.05）.The average score of responses to bullying subscale of the victims of bullying was higher than that of those who were not involved in bullying 〔（19.9±4.1） vs （10.3±3.5）〕（t=28.15，P<0.01）.The top three settings where bullying occurring most frequently were activity room 〔76 cases （41.3%）〕，outdoor activity field〔36 cases （19.6%）〕，aisle and hall〔34 cases （18.5%）〕.Prevalence of bullying occurring in outdoor activity field，activity room and kindergarten corner were significantly different across junior，medium and senior classes（P<0.05）.Conclusion　The prevalence of bullying among 3-6-year-old children in Guangxi is high.The prevalence rates of being involved in bullying，offenders of bullying，victims of direct verbal bullying and direct physical bullying differ significantly according to sex.The prevalence rates of being involved in bullying，victims of direct bullying and victims of direct verbal bullying，victims suffering bullying in silence，and settings where bullying occurring differ significantly across junior，medium and senior classes.

Predictive Value of Lipid Accumulation Product for Type 2 Diabetes Risk in Community-dwelling People in Pearl River Delta

HUANG Junxuan，ZHANG Xiaoxia，PENG Xin，XIE Yixian，BAO Xinyu，LIU Yan，CHENG Mengjiao，LI Yusi，GUO Zhuoyuan，MA Jinxiang*

2020, 23(24): 3012-3017. DOI: 10.12114/j.issn.1007-9572.2020.00.017

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Background　Compared with the traditional obesity index，lipid accumulation product（LAP） is a new index that can better predict the risk of type 2 diabetes.In the population in northern China，LAP also shows high accuracy in predicting the risk of type 2 diabetes.However，it is unclear whether LAP also has high accuracy in predicting type 2 diabetes risk in populations in southern China，because the triglyceride（TC） and waist circumstance vary obviously in southern and northern populations due to significant differences in climate，lifestyle and eating habit.Objective　To evaluate the predictive value of LAP for type 2 diabetes risk in community-dwelling people in Pearl River Delta.Methods　By stratified multistage random sampling，828 community-dwelling residents from Pearl River Delta were enrolled from July to September 2017.They received a questionnaire survey，anthropometric tests，and laboratory examinations.According to quartiles of LAP，they were divided into group Q1（LAP<11.22），group Q2（LAP:11.22-22.05），group Q3（LAP:22.06-44.50） and group Q4（LAP>44.50）.Binary Logistic regression models were used to assess the relationship between LAP and type 2 diabetes.Receiver operating characteristic（ROC） curve analysis was used to analyze diagnostic value of BMI，WHR and LAP for type 2 diabetes.Results　Excluding 18 cases of incomplete research data，810 cases were finally included in the survey，including 203 cases in group Q1，202 cases in group Q2，202 cases in group Q3 and 203 cases in group Q4.LAP was positively correlated with fasting blood glucose，and crude prevalence rate of type 2 diabetes（P<0.05）.The risk of type 2 diabetes in group Q4 was 12.22 times higher than that in group Q1〔OR=12.22，95%CI（2.83，52.67），P<0.001〕.When controlling for age，gender，marital status and education level，the risk of type 2 diabetes in group Q4 was 6.65 times higher than that in group Q1〔adjusted OR=6.65，95%CI（1.49，29.77），P<0.05〕.After controlling age，gender，marital status，education level，physical exercise，systolic and diastolic blood pressure，the risk of type 2 diabetes in the group Q4 was 5.04 times higher than that in group Q1〔adjusted OR=5.04，95%CI（1.07，23.64），P<0.05〕.As for the predictive effect，the area under the curve of LAP was superior to that of BMI（Z=-2.210，P=0.027）.The sensitivity of lap to predict the risk of type 2 diabetes was 85.37%，and the best critical value was 25.485.Conclusion　LAP is statistically significant associated with the prevalence of type 2 diabetes in populations in Pearl River Delta.LAP might perform better in predicting type 2 diabetes risk than BMI，but its performance might be similar to that of WHR.

Risk Factors for Pulmonary Embolism in Patients with Chronic Obstructive Pulmonary Disease without Erythrocythemia

SUN Feng，YAN Cunzi，XIA Yu，WANG Zaiyi*

2020, 23(24): 3018-3022. DOI: 10.12114/j.issn.1007-9572.2019.00.797

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Background　The incidence of pulmonary embolism（PE） in chronic obstructive pulmonary disease（COPD） patients is significantly higher than that in the general population，but the mechanism of PE in such patients without erythrocytosis is unclear.Objective　To analyze the risk factors for PE in patients with COPD without erythrocythemia.Methods　A retrospective case-control study was conducted.From January to December 2017，inpatients with COPD whose hemoglobin was no more than 140 g/L were recruited from Respiratory and Respiratory Critical Care Center，the First Affiliated Hospital of Xinjiang Medical University，They were classified as COPD+PE group and COPD group according to the result of multislice spiral CT pulmonary angiography（CTPA）.Data about age，gender，comorbidities，medication history of anticoagulant or antiplatelet agents were collected.Those in the two groups with similar baseline data were screened by propensity score matching using the binary Logistic regression with the principle of 1∶1 k-nearest neighbor，and a calipers value of 0.05.D-dimer level and routine blood test parameters were recorded and compared between the two groups.Factors associated with PE in COPD without erythrocythemia，and the correlation between red blood cell distribution width（RDW） and neutrophil to lymphocyte ratio（NLR） were analyzed.Results　Of the initially selected 339 cases，50 had PE，and other 289 had not.The finally enrolled participants included 50 with PE，and 50 without.Those with PE showed higher mean levels of D-dimer，neutrophil count，RDW，and NLR，but lower mean level of lymphocyte count（P<0.05）.Binary Logistic regression analysis showed that RDW was associated with PE in COPD without erythrocythemia〔OR=1.561，95%CI（1.096，2.225），P<0.05〕.Spearman's correlation analysis showed that RDW was positively correlated with NLR in COPD patients without erythrocythemia（rs=0.225，P<0.05）.Conclusion　In COPD patients with hemoglobin≤140 g/L，increased RDW may increase the risk of complicating with PE，and RDW was positively correlated with NLR.

Relationship between luminal diameter and tortuosity of coronary artery and primary microvascular angina

CUI Jianguo1，LIANG Shuqin2，YANG Qianqian1，SHI Doufei1，XU Wenwen1，QI Jie1，MA Hui1，YAN Xiaohong1，MAO Yanhua1，ZHANG Qingtan1

2020, 23(24): 3023-3028. DOI: 10.12114/j.issn.1007-9572.2020.00.094

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　Background　Microvascular angina（MVA） is a disease that is easy to be ignored in the clinic.At present，there is no clear correlation evaluation index in routine coronary angiography，so it is unable to determine MVA quickly and accurately，and there is no relevant research at home and abroad.Objective　To explore the relationship between the luminal diameter and tortuosity of coronary artery and primary MVA.Methods　From January 2008 to September 2010，a total of 1 361 patients with angina pectoris and underwent coronary angiography were studied in Binzhou Medical University Hospital.The SYNCAX score of each patient was calculated according to the results of coronary angiography.The patients with a score greater than 0 were divided into coronary heart disease （CAD）group，and the patients with a score equal to 0 were divided into MVA group and non coronary heart disease （NCAD） group according clinical diagnosis.Baseline characteristics〔mean age，sex，past medical history，mean erythrocyte sedimentation rate（ESR），hemoglobin，neutrophil /lymphocyte ratio （NLR），blood lipid parameters，renal function parameters，bilirubin，mean luminal diameter of proximal coronary artery，and tortuosity of coronary artery〕 were compared across the three groups.Multivariate Logistic regression model was used to analyze the relationship of baseline characteristics with primary MVA.Results　There were significant differences between MVA group and CAD group in mean age，prevalence of hypertension，diabetes，and tortuosity of coronary artery，mean luminal diameter of proximal coronary artery，ESR，hemoglobin，NLR，TG，LDL-C，HDL-C，Cr and fasting blood glucose（P<0.05）.There were significant differences between MVA group and NCAD group in sex，prevalence of hypertension，diabetes，and tortuosity of coronary artery，smoking history distribution，mean age，mean luminal diameter of artery of proximal coronary，and hemoglobin （P<0.05）.Multivariate Logistic regression analysis showed that，compared with CAD group，mean luminal diameter of proximal coronary artery〔OR=8.279，95%CI（5.459，12.556），P<0.001〕，tortuosity of coronary artery〔OR=6.761，95%CI（3.755，12.174），P<0.001〕，hemoglobin〔OR=1.057，95%CI（1.031，1.083），P<0.001〕，female〔OR=3.019，95%CI（1.379，6.609），P=0.006〕，hypertension〔OR=0.194，95%CI（0.106，0.353），P<0.001〕，diabetes〔OR=0.105，95%CI（0.020，0.548），P=0.008〕and LDL-C 〔OR=0.617，95%CI（0.412，0.914），P=0.019〕 were independent influencing factors of primary MVA.Compared with the non-CAD group，mean luminal diameter of proximal coronary artery〔OR=9.246，95%CI （6.050，14.129），P<0.001〕 coronary artery tortuosity〔OR=4.105，95%CI（2.288，7.363），P<0.001〕，hemoglobin〔OR=1.042，95%CI （1.017，1.068），P=0.001〕，fasting blood glucose〔OR=1.214，95%CI（1.030，1.432），P=0.021〕，hypertension 〔OR=0.282，95%CI（0.154，0.517），P<0.001〕 and diabetes〔OR=0.138，95%CI（0.026，0.745），P=0.021〕 were independent influencing factors of primary MVA.Multivariate Logistic regression analysis showed that primary MVA〔OR=5.150，95%CI（3.366，7.881），P<0.001〕，female〔OR=1.460，95%CI（1.097，1.944），P=0.009〕，hypertension〔OR=1.564，95%CI（1.169，2.094），P=0.003〕 and elevated HDL-C〔OR=1.479，95%CI（1.067，2.050），P=0.019〕 were independent risk factors of tortuosity of coronary artery.Conclusion　Hypertension and diabetes are independently negatively correlated with primary MVA，while hemoglobin，mean luminal diameter of proximal coronary artery，and tortuosity of coronary artery are independently positively correlated with primary MVA.Increase of mean luminal diameter of proximal coronary artery and tortuosity of coronary artery may be secondary manifestations rather than the cause of primary MVA.

Effect of chronic obstructive pulmonary disease on the severity of coronary artery disease

DU Fei*，ZHANG Li，GONG Ling

2020, 23(24): 3029-3033. DOI: 10.12114/j.issn.1007-9572.2019.00.719

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Background　Systemic inflammation is a pathophysiological link between coronary artery disease（CAD） and chronic obstructive pulmonary disease（COPD）.However，the impact of subclinical COPD on suspected or diagnosed patients with CAD remains largely unknown.Objective　To explore the effect of COPD on the severity of CAD.Methods　210 outpatients and inpatients were recruited from Respiratory Department and Cardiovascular Department，the First People's Hospital of Zunyi between January 2016 and January 2018.All of them were examined by pulmonary function test and coronary angiography or dual-source coronary CTA.Patients were divided into COPD group and non-COPD group.The degree of coronary artery lesions and the correlation of CAD severity with COPD were analyzed.Results　138（65.7%）of the 210 cases received a definite diagnosis of CAD，101 cases （48.1%） were diagnosed as COPD.Compared with those without COPD，COPD patients had higher incidence of CAD，significant stenosis（≥ 50%），3-vessel CAD，multi-vessel CAD，left main coronary artery lesion，and severe CAD（P<0.05）.Severe COPD patients showed higher incidence of CAD and significant stenosis（≥50%） than mild or moderate COPD patients（P<0.05）.Multivarite Logistic regression analysis showed that COPD 〔OR=11.42，95%CI（5.34，24.59），P<0.001〕 was associated with CAD；COPD was associated with CAD with significant stenosis（≥50%）〔OR=4.78，95%CI（2.21，10.34），P<0.001〕.Conclusion　In CAD patients，the severity of coronary lesions is associated with COPD.COPD is associated with CAD and coronary lesions with significant stenosis（≥50%）.

Association of Expression of Human Group X Secreted Phospholipase A2 with Inflammatory Indicators in the Serum in Patients with Bronchiectasis and Infection

XU Lin，LU Ping，YAO Hongmei，ZHANG Yiling*

2020, 23(24): 3034-3039. DOI: 10.12114/j.issn.1007-9572.2020.00.352

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　Background　Bronchiectasis is a common and frequently-occurring respiratory disease，which is mostly caused by infection.Human secreted phospholipase A2 type X（sPLA2-X）plays an important role in accelerating the occurrence and development of an inflammatory response.However，whether serum sPLA2-X and important inflammatory indicators such as procalcitonin（PCT），C-reactive protein（CRP），inducible nitric oxide synthase（iNOS），and interleukin（IL）-6，IL-17，IL-33，are correlated or not in patients with bronchiectasis and infection，has not been reported.Objective　To study the association of serum sPLA2-X with PCT，CRP，IL-6，iNOS，IL-17 and IL-33 in serum in patients with bronchiectasis and infection，and based on this，to further evaluate its association with this disease.Methods　Participants were enrolled from Guizhou Provincial People's Hospital between February 2017 and January 2019，including 47 with bronchiectasis and infection from Department of Respiratory and Critical Care Medicine（case group），and 21 healthy physical examinees from Physical Examination Center（control group）.Demographic data of the two groups were collected and compared.Also，laboratory findings（such as serum sPLA2-X，white blood cell count，PCT，CRP，iNOS，IL-6，IL-17 and IL-33）of the control group（examined on the day of physical examination）were compared with those of the case group measured before treatment（on the day of admission）and after treatment（on the day prior to discharge），respectively.The association of pre-treatment serum sPLA2-X with PCT，CRP，iNOS，IL-6，IL-17 and IL-33 in the case group was analyzed.Results　Compared with the healthy control group，the mean levels of serum sPLA2-X，PCT，CRP，iNOS，IL-17，white blood cell count，IL-6 and IL-33 in the case group before treatment were all significantly higher（P<0.05），after treatment，although the former five were still much higher（P<0.05），the latter three decreased to the levels similar to those of the controls（P>0.05）.The mean levels of the aforementioned eight indicators decreased significantly in the case group（P<0.05）.Serum sPLA2-X was positively correlated with PCT，CRP，iNOS，IL-6，IL-17，and IL-33 in the case group before treatment（r = 0.526 2，0.640 1，0.550 7，0.516 8，0.609 9，0.357 4，
P<0.01）.Conclusion　In patients with bronchiectasis and infection，serum sPLA2-X is elevated and positively correlated with PCT，CRP，iNOS，IL-6，IL-17，IL-33，indicating that it may be associated with the disease，and might be used as an important indicator for evaluating the severity of the disease.

Guideline-practice Gap and Influencing Factors in the Treatment of Non-ST-Segment Elevation Acute Coronary Syndrome with the Management Mode of Chengdu Chest Pain Center

XU Xueping1，2，WANG Han1，CUI Caiyan1，2，ZHANG Yumei1，2，LI Siyi1，2，ZHU Feng1，2，YE Tao1，CAI Lin1，2*

2020, 23(24): 3040-3046. DOI: 10.12114/j.issn.1007-9572.2020.00.296

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Background　Since 2014，Chengdu has continued to promote the construction of Chest Pain Center to improve the treatment of acute coronary syndrome（ACS）.At present，studies have reported a guideline-practice gap in the clinical diagnosis and treatment of patients with non-ST-segment elevation acute coronary syndrome（NSTE-ACS）.However，there is no research about the guideline-practice gap in the clinical diagnosis and treatment and its influencing factors in Chengdu.Objective　To explore the guideline-practice gap of NSTE-ACS treatment with the management of Chest Pain Center in Chengdu and analyze its influencing factors.Methods　 A multicenter retrospective cross-sectional study was conducted among 1 022 cases of NSTE-ACS receiving inpatient treatment in 11 hospitals with a well-constructed or under construction Chest Pain Center（7 with a primary level center） in Chengdu during 2017 to 2018.General information，treatment strategies，status of percutaneous coronary intervention（PCI）within the recommended time，and discharged medication of these patients were collected from the Chest Pain Center Data Reporting Platform and the electronic medical record system of these 11 hospitals.According to the risk criteria for invasive treatment strategies in the 2016 Chinese Guidelines for the Management of Non-ST-segment Elevation Acute Coronary Syndrome，the patients were divided into low-risk（141 cases ），medium-risk（178 cases），high-risk（668 cases），and extremely high-risk（35 cases） groups.Results　A total of 629（61.5%） cases underwent invasive diagnosis and treatment（388 underwent PCI）.The rate of receiving invasive diagnosis and treatment in low-risk group was higher than that in medium-risk group but was lower than that in high-risk group（P<0.05），and so was that in extremely high-risk group（P<0.05）.Binary Logistic regression analysis showed that NSTE-ACS type and history of coronary heart disease were influencing factors for undergoing PCI within the recommended time（P<0.05）.Compared with medium-risk group or extremely high-risk group，the rates of discharged with aspirin（ASA） and statins were lower in low-risk group but were higher in high-risk group（P<0.05）.The rates of discharged with P2Y12 inhibitors and dual antiplatelet therapy（DAPT）in extremely high-risk group were higher than those in low-risk or medium-risk group，but were lower than those in high-risk group（P<0.05）.The rate of discharged with beta-receptor blockers in medium-risk group was higher than that of low-risk group，and extremely high-risk group，but was lower than that of high-risk group（P<0.05）.The rates of discharged with angiotensin-converting enzyme inhibitors/angiotensin receptor blockers，and optimal medical therapy（OMT）in high-risk group were lower than those in low-risk group，meanwhile higher than those in middle-risk group and extremely high-risk group（P<0.05）.Binary Logistic regression analysis showed that diastolic blood pressure at admission and the level of Chest Pain Center were the influencing factors of OMT as discharge medication（P<0.05）.Conclusion　There are guideline-practice gaps in the invasive diagnosis and treatment rate（61.5%），PCI rate（38.0%），and secondary preventive medication P2Y12 inhibitor（74.0%），ASA（73.4%），and statins（86.7%）in NATE-ACS patients in Chengdu.Patients with unstable angina pectoris and without a history of coronary heart disease are not suggested to undergo PCI within the guideline-recommended time.Elevated diastolic blood pressure at admission and management by the primary Chest Pain Center are factors that promote patients discharged with OMT.

Difference Study of the Atomization Time and Residue Amount after Atomization between the Vibrating-mesh Atomizer and Pressure Jet Atomizer

WANG Huanying，XU Wangmei，CHEN Xiaoli*，SHENG Chunfeng，LI Fan

2020, 23(24): 3047-3050. DOI: 10.12114/j.issn.1007-9572.2020.00.144

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Background　Nebulizers can be divided into pressure jet atomizer，ultrasonic nebulizer and vibrating-mesh atomizer according to their working principle.China has witnessed a recent development in the vibrating-mesh atomizer，but related domestic studies are still rare.Objective　To compare the difference of the atomization time and residue amount after atomization between the vibrating-mesh atomizer and pressure jet atomizer.Methods　From May 19 to June 19，2019，three brands of pressure jet atomizers （named as A，B，and C，respectively） and brand-matched vibrating-mesh atomizers （also named as A，B，and C，respectively） were selected，and were compared in parallel queues in terms of atomizing 6 ml 0.9% sodium chloride solution and residual amount after the atomization.The atomization time and residual amount after atomizing were further compared in the three brands of vibrating-mesh atomizers.Results　Each of the three brands of pressure jet atomizers used longer time to atomize 6 ml 0.9% sodium chloride solution and had more residual amount compared with the same brand of vibrating-mesh atomizer （P<0.05）.Pressure jet atomizers required more time to atomize 6 ml 0.9% sodium chloride solution on average〔（21.35±2.26）min vs （13.55±2.92）min〕（Z=-6.42，P<0.05） and had more average residue amount after atomization 〔（0.47±0.05）ml vs（0.03±0.02）ml〕（Z=-6.67，P<0.05） compared with vibrating-mesh atomizers.Brand A vibrating-mesh atomizer used shorter atomization time compared with other two brands of vibrating-mesh atomizers （P<0.05）.Compared with brand A vibrating-mesh atomizer，brand B vibrating-mesh atomizer had more residue amount after atomization while band C vibrating-mesh atomizer had less（P<0.05）.Conclusion　The vibrating-mesh atomizer required shorter time to atomize 6 ml 0.9% sodium chloride solution and had less residue amount，indicating that its clinical and family applications are worth promoting.

Role of NLRC5 in the Activation of Hepatic Stellate Cells Induced by TGF-β1 and Reversal of Hepatic Fibrosis

ZHANG Yan*，FAN Xiaoxiang，ZHANG Meiwu，ZHUANG Luhui，MAO Dafeng

2020, 23(24): 3051-3059. DOI: 10.12114/j.issn.1007-9572.2020.00.351

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Background　Liver fibrosis is a pathological change common to various chronic liver diseases.During this process，transforming growth factor-β1（TGF-β1） is significantly increased，which induces the activation of hepatic stellate cells（HSC），promoting process of liver fibrosis.NLRC5，the largest member of NLR family，is an important negative regulator of inflammatory pathway.There is evidence that NLRC5 plays a key role in the development and reversal of liver fibrosis by regulating inflammatory signals and liver fibrosis response.Objective　To investigate the role of NLRC5 in the activation of HSCs induced by TGF-β1 and the reversal of liver fibrosis.Methods　The experiment was implemented from March to July 2018.A total of 24 8-week-old male C57BL/6 mice（body weight 15-20 g） were selected and equally divided into experimental group，normal control group and reversal group using a table of random numbers.After the liver fibrosis model was established in experimental and reversal groups，the mice in all groups were sacrificed，and liver tissues were taken out for measuring liver histological changes with HE staining，Masson trichrome staining and α-smooth muscle actin（α-SMA） immunohistochemistry，respectively.NLRC5 and its mRNA，phosphorylated inhibitor protein αIκBα（P-IκBα），I κ B α，cytoplasmic p65 and nuclear p65 were detected.LX-2 cells were cultured in vitro and were divided into control group，TGF-β1 group and TGF-β1+MDI group.The levels of α-SMA，Col1α1 and Col1α1 mRNA，and NLRC5 and NLRC5 mRNA in LX-2 cells were detected.After being treated with siRNA，activated LX-2 cells were divided into NLRC5-siRNA group，control-siRNA group and normal cell group.NLRC5 and its mRNA，α-SMA，Col1α1，P-IκBα，IκBα，cytoplasmic and nuclear p65 were detected.Results　The detection using HE staining showed that in the normal control group，hepatic cell cords were neat and orderly，without necrotic degeneration and inflammatory cell infiltration，but in the experimental group，potty necrosis，regeneration，steatosis and ballooning degeneration occurred.And in the reversal group，the liver restored ruddy and the structure tended to be normal.The detection with Masson trichrome staining demonstrated that compared with the normal control group，significantly increased blue collagen fibers were observed in the experimental group under the light microscopy，and the increase of blue collagen fibers was also seen in the reversal group but to a lesser degree.The proportion of α-SMA positive cells in the experimental group was higher than that in the normal control group and the reversal group（P<0.05）.The mean levels of NLRC5 and NLRC5 mRNA in liver tissue of experimental group were higher than those of normal control group and reversal group（P<0.05）.The experimental group showed higher mean levels of P-IκBα and nuclear p65 and lower mean level of cytoplasmic p65 in the liver tissue compared with normal control and reversal groups（P<0.05）.The mean levels of α-SMA，Col1α1 and Col1α1 mRNA of LX-2 cells in TGF-β1 group were higher than those in control group and TGF-β1+MDI group（P<0.05）.The mean levels of NLRC5 and NLRC5 mRNA in LX-2 cells of TGF-β1 group were higher than those of control group and TGF-β1+MDI group（P<0.05）.The mean NLRC5 level in the NLRC5-siRNA group was lower than that in the Control-siRNA group〔（0.679±0.045）vs（1.260±0.071）〕（P<0.001）.The mean levels of α-SMA，Col1α1 and Col1α1 mRNA in the NLRC5-siRNA group were lower than those in the Control-siRNA group，but were higher than those in the normal cell group（P<0.05）.Compared to either normal cell group or Control-siRNA group，NLRC5-siRNA group showed higher mean levels of P-IκBα and nuclear p65，and lower mean level of cytoplasmic p65（P<0.05）.Conclusion　NLRC5 can regulate and interfere with key processes related to liver fibrosis by regulating TGF-β1-induced HSC activation and ECM synthesis.It may play a key role in regulating the progression and reversal of liver fibrosis through the NF-κB signaling pathway

Clinical safety of rabeprazole sodium for injection based on the HIS database：a real world study

NING Meiying1，FANG Taiyong2，YIN Zhongpeng3，CHEN Hu4*

2020, 23(24): 3060-3063. DOI: 10.12114/j.issn.1007-9572.2020.00.376

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Background　Rabeprazole is a proton pump inhibitor.Rabeprazole sodium for injection has the characteristics of rapider onset and less irritation of gastrointestinal mucosa compared with oral rabeprazole.At present，the known adverse reactions of rabeprazole sodium for injection mainly come from package inserts，reports from the National Center for ADR Monitoring，China，and available literature reports，but there is a lack of safety evaluation data for a wide range of real world applications.Objective　To evaluate the safety of rabeprazole sodium for injection （Ogamin?） widely used in a population based on real-world research，including the type，severity，and incidence of adverse reactions，with a view to improve the safety and rationality of clinical medication.Methods　An open-label，single-arm，non-interventional，multi-center clinical study with registered cases was conducted.From the hospital information system of 5 hospitals（Cangzhou Central Hospital，Cangzhou People's Hospital，Harrison International Peace Hospital，Second Affiliated Hospital of Fujian Medical University，Xinxiang Central Hospital），electronic medical records of 3 004 eligible inpatients treated with rabeprazole sodium for injection during November 2016 to June 2018 were collected，including the general information，vital signs，clinical diagnosis，medication situation （medication dose，frequency，and duration） and adverse reactions.Results　Of the participants（600 from Cangzhou Central Hospital，385 from Cangzhou People's Hospital，198 from Harrison International Peace Hospital，1 322 from Second Affiliated Hospital of Fujian Medical University，and 499 from Xinxiang Central Hospital），the top four clinical diagnoses（of illness） were hypertension（n=338，11.25%），intestinal tumors（n=258，8.59%），intestinal obstruction（n=254，8.46%），and digestive tract bleeding（n=199，6.62%）.Rabeprazole sodium for injection was administered in a single dose of 10 mg per time in 13 cases（0.43%），20 mg per time in 2 949 cases （98.17%），30 mg per time in 5 cases （0.17%），40 mg
per time in 21 cases （0.77%），and 80 mg per time in one case （0.03%）.And the single dose use information was missed in 15 cases.Rabeprazole sodium for injection was used once daily in 1 924 cases （64.05%），twice daily in 911 cases（30.33%），and three times a day in 23 cases （0.77%）.Administration frequency for other 146 cases was not recorded.Administration duration was no more than 5 days in 1 620 cases（53.93%），6-10 days in 886 cases（29.49%），11-20 days in 405 cases （13.48%），more than 20 days in 80 cases （2.66%），and missed in 13 cases.Adverse reactions occurred in 61 cases（2.03%），among which the incidence rates of decreased white blood cell count，elevated ALT，creatine kinase，systolic and diastolic blood pressure，AST，and γ-GT，decreased neutrophil count，and platelet count were 0.10%-0.50%，but within the reference range in the package insert，the incidence rate of prolonged APTT was 0.03%，which was lower than the reference value （0.10%）.The incidence rate of elevated creatine kinase was 0.30%，but there was no corresponding reference value in the package insert.No rare，new，and unexpected adverse reactions and drug-drug interactions were found.All the adverse reactions were mild，and were dealt with routine clinical treatment.Conclusion　Rabeprazole sodium for injection has mild common adverse reactions，without serious drug-drug interactions，indicating that it has high safety，meeting the clinical safety requirements.

Management Model for Intravenous Medication Safety Developed Based on Informatization

ZHOU Sai1，MA Hongli2*，RUAN Wenzhen1

2020, 23(24): 3064-3069. DOI: 10.12114/j.issn.1007-9572.2020.00.207

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Background　Intravenous medication has become an important administration means because of its clear and rapid effect.A small mistake in the process of intravenous administration may lead to serious consequences.So ensuring the safety of medication is the basis of today's medical safety.Objective　To develop a management model for intravenous medication safety using information technology，safeguarding the medication safety of patients.Methods　This study was carried out in Shaoxing People's Hospital during March to September 2019.Participants were randomly recruited from 3 clinical departments（No.2 Hepatobiliopancreatology，Hematology and Cardiothoracic Surgery ）using the original intravenous medication management model during March to May（control group，consisting of 41 537 subgroups），and from other clinical departments（No.1 Hepatobiliopancreatology，No.1 Respiratory Medicine and GI Medicine）using the new management model for intravenous medication safety（developed using the information technology，namely，adding a warning module in the computerized physician order entry system，limiting or reminding the amount of glucose to be used in diabetic patients or allergic drugs to be used in patients，and adding a scanning segment at the end of infusion，realizing the traceability of the whole process of infusion）during July to September（observation group，consisting of 39 132 subgroups）.The overall incidence of the possibilities of making intravenous medication errors（approximate errors in glucose use and drug allergy intervention）and the completion rates of intravenous infusion process based on traceability were compared between the two groups.Results　The overall incidence of approximate errors in glucose use and drug allergy intervention in the observation group was lower than that in the control group（0.02% vs 0.56%，0.03% vs 0.32%，respectively，P<0.05）.The completion rates of intravenous infusion process based on traceability in the control group and observation group were 0 and 97.34%，respectively.Conclusion　Our management model for intravenous medication safety developed based on informatization may reduce the potential unsafe risk factors of intravenous medication，and the possibilities of making intravenous medication errors.Moreover，the traceability of whole process of intravenous infusion may be realized，by which individual responsibility for errors may be distinguished.Furthermore，the application of the model is conducive to enhancing scientific and rational drug use，ensuring the safety of patients，and improving the medical quality continuously.

Antibiotics strategies for the perforated appendicitis in children based on the transition of bacterial drug resistance pattern

SHOU Tiejun，CHENG Xiaoqiang，GONG Sheng，SONG Lei，LI Yong*

2020, 23(24): 3070-3074. DOI: 10.12114/j.issn.1007-9572.2020.00.372

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Background　Drug resistance of bacteria has always been a global problem.The resistance of bacteria related to perforated appendicitis in children to commonly used antibacterial drugs is consistently changing，which influences the therapeutic effect and poses challenges to clinical drug selection.Objective　To explore the transition of bacterial drug resistance in children with perforated appendicitis and analyze the changes of antibacterial drug regimens in order to give advice rationally on clinical antibiotics strategy.Methods　The clinical data of 461 children with perforated appendicitis treated in Ningbo Women and Children's Hospital from January 2013 to December 2018 were retrospectively collected.According to the time they were admitted to the hospital，children were divided into Group 1（G1，from January 2013 to December 2015）（n=214） and Group 2（G2，from January 2016 to December 2018）（n=247）.The results of bacterial culture and drug susceptibility test of abdominal pus from appendicitis surgery，and antibacterial drug regimens were analyzed.Results　Of the 461 patients，451 cases had bacterial cultures of abdominal pus，and 10 cases had no bacterial cultures（the reason was that the perforated appendix pus was too few to collect）.Among the bacterial culture results，the number of detected strains of Escherichia coli，Pseudomonas aeruginosa，and Streptococcus anginosus were the top three in both G1 and G2，accounting for 60.8%（129/212），10.4%（22/212），and 6.1%（13/212）in G1，respectively，and 59.5%（163/274），12.0%（33/274），and 4.7%（13/274）in G2，respectively.The resistance of Escherichia coli to cefazolin，maxipime，and macrodantin in G1 and G2 was statistically significant（P<0.05）.There were no significant differences in the resistance of Escherichia coli to ampicillin sulbactam，aztreonam，gentamicin，cotrimoxazole，ceftriaxone，ampicillin，ciprofloxacin，ertapenem，amikacin，cefotetan，imipenem，tobramycin，piperacillin tazobactam，ceftazidime，and levofloxacin between G1 and G2（P>0.05）.The resistance of Pseudomonas aeruginosa to ampicillin sulbactam，cotrimoxazole，ceftriaxone，and ampicillin in G1 and G2 was statistically significant（P<0.05）.There were no significant differences in resistance of Pseudomonas aeruginosa to cefazolin，ciprofloxacin，cefotetan，macrodantin and imipenem between G1 and G2（P>0.05）.Among the anti-bacterial strategies，the top three in G1 were ceftriaxone sodium+meroxicillin sodium/sulbactam sodium，cefodizime sodium+piperacillin sodium and sulbactam sodium needle+metronidazole sodium chloride，and ceftriaxone sodium+meroxicillin sodium/sulbactam sodium+metronidazole disodium phosphate，while the top three in G2 were ceftazidime+metronidazole disodium phosphate，imipenem/cisastatin sodium+metronidazole disodium phosphate，and cefotiam needle+azlocillin sodium for injection.Compared with the G1，the use of ceftriaxone decreased in G2，while the use of carbapenems（imipenem） increased.Conclusion　The problem of drug resistance of bacteria should not be ignored.Ceftriaxone and other drugs have been questioned as the first choice for empirical antibiotics in the treatment of perforated appendicitis，while imipenem is increasingly being used widely as a third-line drug.The drug susceptibility test result is meaningful for guiding the empirical drug application，as well as the dynamic transition of drug resistance.

Investigation on the nutritional status of the elderly in some nursing home and its influencing factors in Beijing

YUAN Min1，2，HUANG Yafang3，HAO Lixiao4*，JIA Jianguo2，5*

2020, 23(24): 3075-3080. DOI: 10.12114/j.issn.1007-9572.2020.00.118

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　Background　Under the social background of increasing aging population，the function of family to support the elderly has been weakened，and nursing institutions are becoming an inevitable trend in the future.It is reported that the elderly in many old-age care institutions suffer from unreasonable nutritional status，which seriously affects their health status and quality of life.Objective　By investigating the nutritional status and its related factors of the elderly in some nursing home in Beijing，in order to provide a theoretical basis for the nutrition education of general practitioners and the improvement of the quality of life of the elderly.Methods　This survey was implemented from October 2014 to December 2015.Using a convenient cluster sampling method，seven nursing home were selected in Beijing，and we conducted a face-to-face questionnaire survey on senior individuals who met the inclusion and exclusion criteria.The questionnaire included the general situation，Mini Nutrition Assessment（MNA），the Barthel Index（BI） and the Geriatric Depression Scale（GDS）.The influencing factors of nutritional status of the elderly were analyzed by binary Logistic regression.Results　The effective response rate of questionnaire was 100%（258/258）in this study.Among the 258 elderly people who were surveyed，there were 75 individuals with malnutrition or at a risk of malnutrition，accounting for 29.1%.The differences were statistically significant in nutritional status of the elderly with different age，gender，marital status，body mass index（BMI），payment methods of medical expenses，daily activity capacity and mental state（P<0.05）.Binary Logistic regression analysis showed that age〔OR（95%CI）=2.349（1.070，5.156）〕，BMI〔OR（95%CI）=0.092（0.036，0.239）〕，payment methods of medical expenses〔OR（95%CI）=0.208（0.083，0.522）〕，daily activity capacity〔OR（95%CI）=10.214（3.099，33.669）〕，number of comorbidities〔OR（95%CI）=2.682（1.248，5.763）〕and mental state〔OR（95%CI）=4.822（2.005，11.600）〕 affected the nutritional status of the elderly（P<0.05）.Conclusion　The elderly in nursing home of Beijing are facing health threats of malnutrition and at a risk of malnutrition.Advanced age，low BMI，depression，multiple comorbidities，low daily activity capacity and lacking of medical insurance are independent risk factors.The personalized nutrition education and nutritional treatment for the elderly need to be strengthened.

Evaluation of application effect of Malnutrition Risk Assessment of the Aged in long-term care facilities in Beijing and Tianjin

ZHU Dan1，ZENG Ping2，HAN Feng3，XIE Hong1*

2020, 23(24): 3081-3085. DOI: 10.12114/j.issn.1007-9572.2020.00.217

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Background　Nutrition screening and assessment is the basis for the development of standardized nutrition support.There have been no reports on the reliability and validity of the evaluation tool before and after the issuance of the industry standard WS/T 552-2017 Malnutrition Risk Assessment of the Aged.Objective　To assess the reliability and validity of Malnutrition Risk Assessment of the Aged among the elderly in representative long-term care facilities in Beijing and Tianjin.Methods　Using convenient sampling method，a questionnaire survey was conducted among 444 old people from seven long-term care facilities in Beijing and Tianjin from May to June，2019.The reliability and validity of Malnutrition Risk Assessment of the Aged were evaluated by critical ratio，correlation coefficient between each item and the total score，exploratory factor analysis，Cronbach's α coefficient，and split-half reliability coefficient.Results　The effective response rate of questionnaire was 93.7%（444/474）.The critical ratio of each item in Malnutrition Risk Assessment of the Aged ranged from -1.992 to 13.272，and the correlation coefficient between each item and the total score ranged from -0.051 to 0.566.Eight common factors were extracted by exploratory factor analysis，and the cumulative explained variation was 62.069%．The factor loading of four items was <0.40 and failed to meet the standard.The Cronbach's α coefficient was 0.323 and split-half reliability coefficient was 0.531.The Cronbach's α coefficient of the eight common factors ranged from -0.542 to 0.649，and the split-half reliability coefficient ranged from -0.424 to 0.637.Conclusion　When applied among the elderly in long-term care facilities，a few items of Malnutrition Risk Assessment of the Aged had poor item discrimination and homogeneity，and the construct validity and internal consistency of Malnutrition Risk Assessment of the Aged are not very ideal.When screening and assessing the nutritional status of the elderly in long-term care facilities，it is necessary to further consider the items of Malnutrition Risk Assessment of the Aged，in order to evaluate the nutritional status of the elderly in a more efficient and effective manner.

Clinical，endothelial，hemorheological and immune responses in patients with early diabetic nephropathy to the treatment with Compound Xiancao Granules（a Zhuang Medicine）

HUANG Yalan1，HUANG Guodong2*，CAI Linkun1，HUANG Qionghe1，GAN Jiali1，XUE Hanyu1

2020, 23(24): 3086-3093. DOI: 10.12114/j.issn.1007-9572.2020.00.243

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Background　At present，the application of Western medicine treatment alone is not very effective in patients with early diabetic nephropathy（DN），especially in microcirculation disturbance，abnormal endothelial function，hemorheology and immune function.Moreover，after such treatment，the disease is easily recur.Therefore，it is particularly important to find a more effective treatment for early DN.Objective　To explore the clinical，endothelial，hemorheological and immune responses in patients with early DN to the treatment with Compound Xiancao Granules，a Zhuang Medicine.Methods　From July 2018 to April 2019，60 patients with early DN were selected from Department of Nephrology，Ruikang Hospital Affiliated to Guangxi University of Chinese Medicine and were randomly and equally divided into control group and observation group.Both groups were treated with routine treatment combined with intravenous administration of alprostadil injection，the observation group additionally orally administered Compound Xiancao Granules.The treatment course lasted for 4 weeks.Clinical response，renal function parameters〔24 h urinary albumin excretion rate（UAER），serum creatinine（Scr） and cystatin C（Cys C）〕，microcirculation and endothelial function parameters 〔thromboxane-B2（TX-B2），nitric oxide（NO），endothelin-1（ET-1），von Willebrand factor（vWF） and thrombomodulin（TM）〕，whole blood viscosity at high shear rates（ηbH），whole blood viscosity at medium shear rates（ηbM），whole blood viscosity at low shear rates（ηbL），plasma viscosity（ηp），fibrinogen（FIB），and erythrocyte aggregation index（AI），and immune parameters〔CD4+ helper T cells，CD8+ T suppressor cells，and CD4+/CD8+ 〕 were compared between the two groups before and after treatment.Results　The overall clinical response of the observation group was better than that of the control group（P< 0.05）.After treatment，the mean levels of UAER，Scr，Cys C and TX-B2 of the observation group were significantly lower than those of the control group（P<0.05）.The observation group showed higher NO but lower mean ET-1，vWF and TM compared with the control group（P<0.05）.Moreover，mean post-treatment ηbH，ηbM，ηbL，ηp，FIB and erythrocyte AI of the observation group were significantly lower than those of the control group（P<0.05）.Furthermore，the observation group showed higher mean CD4+ and CD4+/CD8+ but lower mean CD8+ after treatment（P<0.05）.Conclusion　Compound Xiancao Granules in combination with Western medicine achieves good response in treating deficiency of spleen and kidney，and damp-heat and blood stasis syndrome in early DN patients，mainly manifesting as alleviating the microcirculation disturbance，improving renal，endothelial，hemorheological and immune functions.

Clinical study of Gandou Decoction combined with copper removal therapy for balance disorder in patients with interior retention of damp-heat Wilson disease

FANG Xiang1*，JING Shan1，YANG Wenming1，CHEN Huaizhen1，FU Yayu2

2020, 23(24): 3094-3098. DOI: 10.12114/j.issn.1007-9572.2020.00.241

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Background　Wilson disease（WD）is an autosomal recessive inherited disorder of copper metabolism，and its pathologlical basis is the deposition of a large amount of copper due to copper metabolic disorder caused by ATP7B gene mutation，and common features of this disease include progressive liver disease and neurological symptoms.Western medicine treatments have no significant therapeutic effects on such patients，so many scholars explore the treatment with integrated traditional Chinese and Western medicine in order to improve the efficacy．Objective　To study the efficacy of Gandou Decoction combined with copper removal therapy in the treatment of balance disorder in patients with interior retention of damp-heat WD.Methods　We enrolled 60 cases of WD with interior intention of damp-heat syndrome and balance disorder who received inpatient treatment in Encephalopathy Center，the First Affiliated Hospital of Anhui University of Chinese Medicine from 2017 to 2018，and divided them into the observation group and the control group with 30 in each based on a random number table.Removing copper with intravenous drip of Sodium Dimercaptopropionate Injection was given to both groups，and oral administration of Gandou Decoction was additionally given to the observation group，for 32 days〔4 courses of treatment（8-day treatment was defined as a course）〕．Pre- and post-treatment balance function were assessed by the Berg Balance Scale（BBS），pre- and post-treatment TCM syndrome score and 24-hour urinary copper excretion were collected.Results　After treatment，the mean score of BBS was significantly higher than that before treatment in both groups（P<0.05），especially in the observation group（P<0.05）.The mean TCM syndrome score was significantly lower than that before treatment in both groups（P<0.05），especially in the observation group（P<0.05）.The mean 24-hour urinary copper excretion in both groups was significantly higher than that before treatment（P<0.05），especially in the observation group（P<0.05）.Conclusion　Gandou Decoction combined with copper removal therapy may significantly improve the balance disorder，relieve the clinical symptoms and improve the quality of life in patients with interior retention of damp-heat WD.

Combination therapy in chronic active Epstein-Barr virus infection with multiple organs involvement：a case report and literature review

XU Lingling，LIN Hongrong，BA Hongjun，KE Zhiyong，TANG Wen*

2020, 23(24): 3099-3103. DOI: 10.12114/j.issn.1007-9572.2020.00.143

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Chronic active Epstein-Barr virus infection（CAEBV） is an insidious disease with clinical manifestations and severity varying according to the site of involvement.Therefore，clinical management may be challenging.Currently，there is no universally acknowledged effective therapy for this disease.We reported a Chinese boy with CAEBV infection with intestinal，vascular，and neurological involvement using a treatment protocol including thalidomide and propranolol，ganciclovir and glucocorticoid.After treatment，the patient demonstrated a marked improvement in clinical symptoms，and was successfully cured.Literature review was also carried out.The report，together with the review may improve clinicians' understanding of CAEBV.Our treatment protocol shows promise as a safe and effective therapeutic approach for the disease.

Report of MELAS Type Mitochondrial Encephalomyopathy：Four Cases in the Second Generation of a Familymelas

NIU Huiyan1*，LIU Juan1，WANG Hai1，PENG Chaoying2，JIA Weiquan2

2020, 23(24): 3104-3108. DOI: 10.12114/j.issn.1007-9572.2019.00.799

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Mitochondrial encephalomyopathy is a rare maternally inherited disease.Four patients of a familymelas with MELAS type mitochondrial encephalomyopathy were analysed in this paper whose main clinical features were stroke-like episodes，headache，epilepsy，hyperlactatemia，muscle intolerance fatigue，advanced intelligence decline，hearing loss and short stature.The diagnosis was confirmed by characteristic imaging changes，gene detection and muscle biopsy.By reviewing literature and characteristics of mt-DNA? transmission only from daughter to the next generation，we summarized and analyzed the clinical characteristics of MELAS type mitochondrial encephalomyopathy，to help clinicians understand the disease and improve the diagnosis rates.

Advances in research on acute intermittent hematoporphyria

LI Pingping1，HU Yiting2，ZHAGN Jian2，WANG Yuzhen2*

2020, 23(24): 3109-3113. DOI: 10.12114/j.issn.1007-9572.2019.00.574

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Acute intermittent porphyria（AIP） is an autosomal dominant disease，and it is a group of metabolic diseases caused by the overproduction of porphyrins or porphyrin precursors due to congenital or acquired defects of porphobilinogen deaminase in the pathway of heme biosynthesis.The clinical manifestations of AIP are complex and diverse，and repeated episodes are prone to multiple complications.Currently treatment methods of AIP include arginine heme，liver transplantation，intrasplenic hepatocyte transplantation，and so on，among which gene therapy，a new therapy，is expected by AIP patients both at home and abroad.This article introduces the latest advances in research on the pathogenesis，diagnosis，clinical manifestations，complications and treatment strategies of AIP，to improve clinicians' understanding of AIP and to provide more treatment options for AIP patients.

Causes and Countermeasures for Anorectal Stenosis after Hemorrhoidectomy

XIAO Xiaolong1，FAN Wenbin2，HE Ping1*

2020, 23(24): 3114-3118. DOI: 10.12114/j.issn.1007-9572.2019.00.424

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Anorectal stenosis is manifested clinically as thin stool shape or difficult defecation，anal pain or abdominal distension，and even intestinal obstruction.Anorectal stenosis can be congenital，primary or secondary，among which secondary anorectal stenosis，which is mainly caused by hemorrhoidectomy，is the most common.Anorectal stenosis after hemorrhoidectomy is a serious complication，which is difficult to treat and brings serious social and medical problems.The factors influencing the occurrence of the disease include severity of the disease，surgical approach，surgical skills，postoperative management and so on.So more attention should be paid to clinical prevention of the disease.Current treatments include surgical and non-surgical regimens，but there are no guidelines for the regimen selection.This article discussed the causes，prevention and clinical strategies of anorectal stenosis after hemorrhoidectomy，to provide help for primary care physicians to prevent and treat the disease.

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