Chinese General Practice

Interpretation of 2017 AAP Clinical Practice Guideline for Screening and Management of High Blood Pressure in Children and Adolescents and Suggestions for General Practitioners in China　

HU Wenjuan，QI Jianguang

2019, 22(24): 2897-2906. DOI: 10.12114/j.issn.1007-9572.2019.00.339

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With the prevalence of adverse lifestyle behaviors and obesity in children and adolescents，the prevalence of hypertension in children and adolescents is increasing gradually，which affects psychosomatic health in more and more children.In addition，hypertension in children and adolesents increases the development risk of hypertension and metabolic syndrome in adults.In 2017，through reviewing relevant literature，the American Academy of Pediatrics developed this practice guideline to update the 2004 Fourth Report on the Diagnosis，Evaluation，and Treatment of High Blood Pressure in Children and Adolescents.In this guideline，new normative blood pressure（BP） tables based on normal-weight children are created，and it is recommended to measure BP beginning at 3 years of age.Some children with risks for developing hypertension should have BP measured at every health encounter，for otherwise healthy children, however, BP need only be measured annually.Children younger than 3 years should have BP measurements taken at every health check-up if they are at increased risk for developing hypertension.A simplified screening table is created for identifying BPs needing further evaluation. Recommendations on the initial evaluation and management of abnormal BPs are streamlined.In this paper，we interpreted the guideline to provide some advice on hypertension screening，diagnosis and management in Chinese children.

Occurrence of Chronic Complications in Community-dwelling Type 2 Diabetic Patients with and without Hypertension in Beijing after 10-year Standardized Management　

SHAO Jincai，HU Dongming，WAN Gang,LIU Deyuan，CHENG Shuyan，REN Yucui，XIAO Jun，ZHU Yanling，LI Hongfang，GAO Guijuan，SU Liping，MA Lihua，LI Yanfang，ZHANG Wang，HAN Fengrong，WANG Hongjun，et al

2019, 22(24): 2907-2912. DOI: 10.12114/j.issn.1007-9572.2019.00.362

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Background　Type 2 diabetes mellitus（T2DM） has become an important public health problem that seriously affect the physical and mental health of Chinese people.The ultimate goal of T2DM management is to reduce the chronic complications to improve the quality of life and prolong the life-time of patients.Community health centers are the main battlefield for preventing and treating T2DM and its complications.At present，there is no report on the effectiveness of 10-year community-based management of T2DM in China.Zuojiazhuang Community is one of the communities initially participating in the Beijing Community Diabetes Research（BCDS） project.This article is a branch study on the incidence of chronic complications in T2DM patients following 10-year standardized management in the community.Objective　To investigate the incidence of chronic complications in T2DM patients with and without hypertension （HTN） after 10 years' standardized management.Methods　246 patients with T2DM from Zuojiazhuang Community were enrolled from August to December 2008.Among them，those with HTN and without were assigned to T2DM+HTN group，and T2DM group，respectively.Both groups received the unified standardized management required by the BCDS project，including regular follow-up，and referral services.Moreover，they also received review services，which were performed once a year，including physical examination〔BMI，neck circumference，waist circumference，systolic blood pressure（SBP），diastolic blood pressure（DBP）〕，biochemical indicators〔fasting blood glucose（FBG），2-hour postprandial glucose （2 h PG），glycosylated hemoglobin （HbA1c），triglyceride（TG），total cholesterol（TC），high-density lipoprotein（HDL） and low-density lipoprotein（LDL）〕，ALT，blood urea nitrogen，serum creatinine，serum uric acid，and urinary albumin excretion rate （UAER）．All of them were followed up from the enrollment to December 2018.And review results before and after follow-up period were collected.Endpoint events include cardiovascular events，cerebrovascular events，nephropathy，retinopathy and compound endpoint events.Results　After excluding 26 cases（10.6%） who were lost to follow up，220 cases with complete data，including 47 in T2DM group and 173 in T2DM + HTN group，were finally included.At baseline，the levels of waist circumference，SBP，DBP，and TC in T2DM + HTN group were significant higher than those in T2DM group（P<0.05）．At the end of follow-up，the level of 2 h PG in T2DM + HTN group was significant higher than that of T2DM group（P<0.05）．During the period of management，the blood pressure fluctuated slightly in T2DM group，but in T2DM + HTN group，it decreased significantly from 2008 to 2011，and then fluctuated slightly.There were no significant differences in the incidence rates of end-point events between the two groups（P>0.05），including cardiovascular events，cerebrovascular events，nephropathy and retinopathy.But the incidence rate of compound endpoint events in T2DM + HTN group was significant higher than that of T2DM group（P<0.05）．There was a significant difference in the survival curve between the two groups （χ2=4.274，P=0.038）．Cox regression analysis showed that hypertension had no effect on cardiovascular events，cerebrovascular events，nephropathy and retinopathy （P>0.05），but had effect on compound endpoint events（P<0.05）．Conclusion　After 10 years' standardized management，compared with the simple T2DM，the incidence rate of the compound endpoint events significantly increased in T2DM with hypertension.Therefore，more attention should be paid to the intervention for T2DM patients with hypertension.Early detection of complications and timely intervention can reduce the mortality and improve the quality of life.

Anorectal Manometry Analysis of Patients with Functional Constipation by Sex，Age and Accompanying Symptoms　

YAN Xiaoni，YIN Yan，REN Xiaoyang，LYU Jun，YAO Wanxia

2019, 22(24): 2913-2917. DOI: 10.12114/j.issn.1007-9572.2018.00.417

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Background　As a disease with complex etiology and high incidence，functional constipation（FC） has become an important health problem affecting the quality of work and life of people.Anorectal manometry is an important technique for detecting anorectal function in patients with constipation.It can identify，quantify and evaluate the function of anal canal and rectum，providing a basis for the selection of treatment option and evaluation of the treatment efficacy.It has been widely used in the diagnosis and treatment of FC.Objective　To give an anorectal manometry analysis of patients with FC by sex，age and accompanying symptoms，offering evidence for its prevention，diagnosis，and treatment.Methods　We enrolled 95 cases of FC who underwent solid-state high-resolution anorectal manometry from Gastrointestinal Motility Room，the First Affiliated Hospital of Xi'an Jiaotong University during June 2016 to December 2017.All of them were diagnosed according to the Rome Ⅲ diagnostic criteria for FC.We made comparisons between them in terms of sex，age（old people are those who aged 60 or over in accordance with Provisional Guidelines on Standard International Age Classifications），types of stool（assessed by the Bristol Stool Scale） and accompanying symptoms（difficult defecation，incomplete defecation，abdominal distension，abdominal pain），and anorectal manometry parameters〔anal resting pressure，anal canal high-pressure band width，maximum anal squeeze pressure，maximum anal squeeze pressure duration，rectal sensory thresholds（first sensation，desire and urgency to defecate，urgency to defecate，and maximal tolerable volume），rectal pressure and anal residual pressure，anorectal pressure difference，percent anal relaxation〕.Results　There were significant differences between males and females in anal canal resting pressure，maximum anal squeeze pressure duration，anal residual pressure，rectal pressure and percent anal relaxation（P<0.05）．There were no significant differences between males and females in anal canal high-pressure band width，maximum anal squeeze pressure，first sensation，desire and urgency to defecate，maximal tolerable volume，and anorectal pressure difference（P>0.05）．Compared with the elderly group（aged 60 or over），non-elderly group（aged less than 60） had lower anal canal resting pressure，less first sensation，desire and urgency to defecate，percent anal relaxation（P<0.05），but similar anal canal high-pressure band width，maximum anal squeeze pressure，maximum anal squeeze pressure duration，maximal tolerable volume，anal residual pressure，rectal pressure and anorectal pressure difference（P>0.05）．Types of stool，difficult defecation and incomplete defecation were not associated with the values of anal resting pressure，maximum anal squeeze pressure and rectal sensory thresholds（P>0.05）．Abdominal distension and abdominal pain were associated with greater desire to defecate（P<0.05），but not associated with anal resting pressure，maximum anal squeeze pressure，first sensation，urgency to defecate，and maximal tolerable volume（P>0.05）．Male，aged 60 or over，and difficult defecation were associated with higher incidence of paradoxical contraction of the anal sphincter during defecation（P<0.05）．But types of stool，incomplete defecation，abdominal distension，and abdominal pain were not associated with the incidence of paradoxical contraction of the anal sphincter during defecation（P<0.05）．Conclusion　The main anorectal manometry results are pelvic floor dysfunction and inadequate defecatory propulsion in females with FC.Those FC patients aged 60 or over are found with increased prevalence of pelvic floor dysfunction and rectal hyposensitivity，indicating that the two factors are closely involved in the development of FC in old people.Accompanying abdominal distension and pain are closely associated with abnormally increased rectal volume thresholds and decreased rectal sensitivity.FC has complex etiology and high incidence，which severely impairs the quality of people's work and life.FC is associated with abnormal anal canal pressure and sensory function.The anorectal manometry analysis of FC helps to identify，quantify and evaluate the anal and rectal function，and to determine the pathogenesis of FC，offering a reference for the selection of treatment regimen and evaluation of the efficacy.

Serum Vascular Endothelial Growth Factor Levels in Systemic Lupus Erythematosus Patients with or without Antiphospholipid Syndrome：a Comparative Study　

XING Yixi，CHEN Weifei，XU Xiayu，LIN Qianqi，YAO Qicen，LI Jianhong

2019, 22(24): 2918-2923. DOI: 10.12114/j.issn.1007-9572.2019.00.044

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Background　The incidence of antiphospholipid syndrome（APS）is increasing year by year in China，and its coexistence with systemic lupus erythematosus（SLE）is closely related to poor prognosis.Serum vascular endothelial growth factor（VEGF）is a key regulator in the development of vasculitis，and plays an important role in the pathogenesis of SLE and APS.At present，there are few data on the association of serum VEGF with APS and SLE.Objective　The aim of this study was to assess the difference of serum VEGF levels in SLE patients with or without APS and to evaluate the clinical significance.Methods　A total of 84 female SLE patients were selected from Department of Rheumatology，the Second Affiliated Hospital of Hainan Medical University during May 2014 to May 2017，including 37 with APS（APS subgroup）and 47 without（non-APS subgroup）．33 age-matched healthy women（control group）were recruited from the Physical Examination Center of this hospital during the same period.General data，clinical characteristics，therapeutic drugs，disease activity，degree of SLE-induced damage and laboratory results were collected.Results　The serum VEGF level was significantly higher in the SLE patients〔（417.1±410.4）pg/ml vs（76.5±33.01）pg/ml〕than that of the controls（P<0.05）．APS subgroup showed greater age，longer course of SLE，larger dosage of prednisone，higher SLE disease activity index（SLEDAI），Systemic Lupus International Collaborating Clinics Damage index（SLICC DI），erythrocyte sedimentation rate（ESR），hemoglobin，white blood cell count，serum creatinine，rate of proteinuria，rate of positive anti-dsDNA antibodies，IgG anti-cardiolipin antibody（ACL），IgM ACL and VEGF，but demonstrated lower albumin compared with non-APS subgroup（P<0.05）．Serum VEGF level was not linearly correlated with age，duration of SLE，SLICC DI，ESR，hemoglobin，white blood cell count，serum creatinine，proteinuria，IgG and IgM ACL（P>0.05）．Serum VEGF level was positively correlated with prednisone dosage，SLEDAI，positive anti-dsDNA antibody，but negatively correlated with albumin（P<0.05）．Multivariate Logistic regression analysis showed that ESR，white blood cell count，proteinuria，positive anti-ds-DNA antibody，and serum VEGF were the influencing factors of APS in SLE（P<0.05）．The AUC of serum VEGF for the diagnosis of APS in SLE was 0.70〔95% CI（0.56，0.84）〕，with a cut-off value of 126.0 ng/L，72.0% sensitivity，and 60.0% specificity.Conclusion　Serum VEGF level was much higher in SLE patients with APS than that of those without，and it was found to be associated with APS in SLE，so it can be used for the diagnosis of APS in SLE to a certain degree.A SLE patient with elevated serum VEGF level suggests that he may have APS.

Different Concentrations of Ozone Combined with Radiofrequency Ablation in the Treatment of Cervical Spondylotic Radiculopathy：a Comparative Study　

ZHONG Yuanming，LI Jialang，LI Zhifei，ZHANG Yisheng，CHEN Zhen，LIAO Juncheng

2019, 22(24): 2924-2928. DOI: 10.12114/j.issn.1007-9572.2018.00.379

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Background　Cervical spondylotic radiculopathy（CSR） is the most common type of cervical spondylosis in clinic. Its main symptom is nerve root pain caused by nerve root compression. Ozone combined with radiofrequency ablation is a common interventional therapy for the treatment of Cervical Spondylotic Radiculopathy. However, there is no unified standard on the concentration of ozone injection at home and abroad.Objective　To investigate the early efficacy of different concentrations of ozone combined with radiofrequency ablation in the treatment of CSR．Methods　A total of 45 CSR patients who met the inclusion criteria in Department of Orthopedics from the First Affiliated Hospital of Guangxi University of Traditional Chinese Medicine from January 2016 to January 2017 were selected.They were randomly divided into low concentration group （A group，20 mg/L），moderate concentration group （B group，40 mg/L） and high concentration group （C group，60 mg/L），each with 15 cases.Radiofrequency ablation combined with ozone injection of 20, 40 and 60 mg/L was given to group A, B and C in turn.The visual analogue score（VAS） and neck disability index（NDI） were compared in each group before and at 1 day，
1 month，3 months and 6 months after operation.Results　Treatment method and time had interactive effect on VAS and NDI score （P<0.05），and the main effect of treatment method and time on VAS，NDI score was significant （P<0.05）；VAS and NDI scores of the 3 groups were lower than those before operation at 1 day，1 month，3 months and 6 months after operation （P<0.05）．VAS and NDI score of group B was lower than that of group A at 1 day and 1 month after operation （P<0.05）．The VAS score of group C was higher than that of group A at 1 day，1 months and 6 months after operation，and NDI score at 1 day and 1 month after operation was higher than that of group A （P<0.05）．VAS score of group C was higher than that of group B at 1 day，1 month，3 months and 6 months after operation，and NDI score at 1 day，1 month and 3 months after operation was higher than that of group B （P<0.05）．Conclusion　Moderate concentration （40 mg/L） of ozone combined with radiofrequency ablation is the best treatment method for CSR.

Risk Factors and Prognostic Impact of New-onset Atrial Fibrillation in Patients with Sepsis　

ZHOU Shuqing，SHEN Tao

2019, 22(24): 2929-2932. DOI: 10.12114/j.issn.1007-9572.2019.00.119

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Background　Atrial fibrillation is one of the most common clinical manifestations in patients with sepsis，which can aggravate the severity of the patient's condition，and even cause adverse prognosis.However，there are few studies on new-onset atrial fibrillation in sepsis.Objective　 To identify the risk factors and prognostic impact of new-onset atrial fibrillation in sepsis.Methods　A retrospectively study was conducted on 542 cases of sepsis recruited from the ICU，EICU and RICU of the People's Hospital of Liaoning Province from January 2016 to December 2017，including 82（15.1%）with new-onset atrial fibrillation and 460（84.9%）without.Clinical and prognostic data were collected.And factors associated with new-onset atrial fibrillation were analyzed.Results　 Sepsis patients with new-onset atrial fibrillation showed higher rates of having acute renal injury，heart failure，metabolic disorder，coagulation disorders，respiratory failure，mechanical ventilation，continuous renal replacement therapy（CRRT），and catecholamine use，and higher mean APACHE Ⅱ core compared with those without（P<0.05）．Multivariate Logistic regression analysis demonstrated that，age〔OR=1.038，95%CI（1.013，1.063）〕，acute kidney injury associated with multiple organ dysfunction syndrome〔OR=2.142，95%CI（1.035，4.432）〕，metabolic disorder〔OR=2.071，95%CI（1.083，3.959）〕，coagulation disorders〔OR=7.621，95%CI（3.236，17.945）〕，use of CRRT〔OR=6.567，95%CI（2.306，18.705）〕 and use of catecholamines〔OR=6.683，95%CI（3.224，13.853）〕 were factors associated with new-onset atrial fibrillation in sepsis（P<0.05）．There was no significant difference in 28-day in-hospital mortality between the two groups（P>0.05）．The length of ICU stay was longer in new-onset atrial fibrillation group than that of non-new-onset atrial fibrillation group（P<0.05）．Conclusion　The incidence of new-onset atrial fibrillation in patients with sepsis was high.Old age，acute kidney injury associated with multiple organ dysfunction syndrome，metabolic disorder，coagulation disorders，use of CRRT，and use of catecholamines were independent risk factors for new-onset atrial fibrillation.New-onset atrial fibrillation extended the length of ICU stay，but did not increase the 28-day in-hospital mortality.

Clinical Significance of D-dimer and Intestinal Fatty Acid Binding Protein in Patients with Acute Superior Mesenteric Vein Thrombosis　

WAN Jia，YANG Yong，LI Shanshan，LI Guojian，MA Zhenhuan，YANG Guokai，DU Lingjuan

2019, 22(24): 2933-2936. DOI: 10.12114/j.issn.1007-9572.2019.00.299

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Background　Acute superior mesenteric vein thrombosis is not uncommon in clinical practice.Thromboses can lead to intestinal ischemia and mesenteric necrosis，which can further develop into a severe abdominal infection and eventually cause death.Because the early clinical symptoms of acute superior mesenteric vein thrombosis are not typical，its early diagnosis is difficult.Objective　To investigate the clinical significance of D-dimer and intestinal fatty acid binding protein in the early diagnosis of acute superior mesenteric vein thrombosis.Methods　From January 2015 to December 2016，376 patients with acute abdominal pain and occult blood positive in the Second People's Hospital of Yunnan Province were collected.A total of 21 patients with acute superior mesenteric vein thrombosis diagnosed by abdominal ultrasound，abdominal enhanced CT，angiography and abdominal puncture were classified as the observation group，and the remaining 355 patients were classified as the control group.The D-dimer and intestinal fatty acid binding protein levels were observed at different time points（0，6，12，24，48 h） in the two groups and different clinical features of patients with acute superior mesenteric vein thrombosis were analyzed corresponding to their D-dimer and intestinal fatty acid binding protein levels.Results　At different time points，the levels of D-dimer and intestinal fatty acid binding protein of patients in the observation group were higher than those of patients in the control group（P<0.05）．At admission，the area under the receiver operating characteristic（ROC） curve of D-dimer and intestinal fatty acid binding protein levels in the diagnosis of acute superior mesenteric vein thrombosis were 0.916〔95%CI（0.831，1.000），P<0.001〕and 0.823〔95%CI（0.691，0.955），P<0.001〕respectively.The D-dimer and intestinal fatty acid binding protein levels of patients with severe acute mesenteric vein thrombosis complicated with intestinal necrosis，abdominal infection，sepsis，extensive thrombosis and Acute Physiology and Chronic Health EvaluationⅡ（APACHEⅡ） ≥10 were higher than those of patients with only abdominal pain and occult blood positive（P<0.05）．Conclusion　The D-dimer and intestinal fatty acid binding protein in patients with acute superior mesenteric vein thrombosis were abnormally increased，which may be related to the severity of acute superior mesenteric vein thrombosis and can be used as an important indicator for its early diagnosis.

Time Series Analysis between Environmental Comfort and Childhood Asthma　

FU Guiqin，LIU Yanxiang，WANG Yakun，JIA Xiaowei，JIANG Ying，XIE Jianhui

2019, 22(24): 2937-2943. DOI: 10.12114/j.issn.1007-9572.2018.00.448

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Background　Asthma is a major global health concern，and changes in environmental and meteorological conditions are its important triggers.Objective　To evaluate the effect of environmental comfort in Shijiazhuang on the outpatient volume of asthma in children.Methods　The data of childhood asthma admissions from 2012 to2015 were collected from Children's Hospital of Hebei Province.The average daily temperature（T），relative humidity（RH），wind speed（F） and air pressure（AP） of Shijiazhuang between 2012 and 2015 were provided by Hebei Meteorological Information Center.And data of average daily concentration of PM2.5，SO2 and NO2 were provided by Hebei Provincial Environmental Protection Bureau.The time-series relationship between environmental comfort and daily outpatient volume of childhood asthma was explored by using Poisson Generalized Additive Model（GAM） with Poisson distribution.The smooth spline function was used to control the annual change，seasonal effect and holiday effect，and to eliminate the mixed effects of air pressure，wind speed and air pollutants（PM2.5，SO2 and NO2） on childhood asthma.Compared to comfort level，relative risk（RR） and 95% confidence interval（95%CI） of other hot/cold discomfort levels with childhood asthma admissions were calculated.The Akaike's Information Criterion（AIC） was used to determine the degree of freedom（df） and optimal lag time of the selected factors.Results　A total of 38 429 children afflicted with asthma were selected;Daily average outpatient volume of childhood asthma was（28.2±18.1），and there were more patients in winter but fewer in summer.The average daily temperature varied widely in winter and summer.Air pollution monitoring from 2013 to 2015 showed a higher concentration of PM2.5 in winter，followed by autumn.Compared with comfort, the increased risk of physical cold for asthma in boys, girls and children aged 0-6 ranks first..RR（95%CI） of extremely hot discomfort on the volume of childhood asthma was 1.01（0.91，1.12），but other thermal discomfort didn't increase the risk.The effect of cold discomfort on the volume of childhood asthma admissions was the largest in the 3-day-lag.The effect of hot discomfort on the outpatient volume of childhood asthma was the strongest in the lag of 3 days.Conclusion　Comfort level has an effect on the daily outpatient volume of childhood asthma，while the main effects was caused by cold discomfort，followed by thermal discomfort.According to the comfort level forecast given by meteorological department，people can take measures to prevent childhood asthma.

Study on the Management Effect of Community Chronic Diseases Active Reservation Health Management Model on Essential Hypertension　

YANG Mei，HU Wei，JIANG Changyong

2019, 22(24): 2944-2948. DOI: 10.12114/j.issn.1007-9572.2018.00.436

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Background　Chronic diseases have become the leading diseases threatening the health of Chinese people，which accounts for 80% of annual total deaths（10.3 million）．If we do not control this issue，the direct cost of treatment and the economic cost caused by the loss of labor force and health will increase the burden of individuals，enterprises and the government.We noted that community healthcare is the main playfield of chronic disease management.Objective　To study the management effect of community chronic diseases active reservation health management model on essential hypertension,and to promote family doctor's contracting work.Methods　In March 2017，450 patients with primary hypertension whose chronic diseases were managed by appointed outpatient follow-up service in Jinyang Community Health Service Center of Wuhou District were randomly selected as the study group，and 450 patients with primary hypertension who signed the contract service in other community healthcare centers in Wuhou District were selected as control group by using stratified randomized sampling method.The study group carried out the health management intervention by active appointments according to different disease grading，while the control group carried out routine management according to hypertension follow-up management standard in the National Basic Public Health Service Standard（the third edition）．Intervention period was from April 2017 to April 2018.The management effect was measured by the self -made questionnaire from 3 dimensions，including general data（gender，age，medical insurance，education，course of disease，complications），the quality of chronic disease management（blood pressure control rate，health expenditure for chronic diseases in past two weeks），patients satisfaction rate and work efficiency of staff（morning visits，average outpatient visits time，and visits in the past month）．Results　The blood pressure control rate before intervention in the study group was lower than that after intervention;the medical cost of chronic diseases in the past two weeks was higher than that after intervention;the satisfaction rates of chronic disease management and contracting service was lower than those after intervention.The morning visiting rate，outpatient visiting time and visits in the past month in the study group were higher than those after intervention（P<0.05）．The satisfaction rates of chronic disease management and contracting service in the control group before intervention were lower than those after intervention（P<0.05）．After intervention，blood pressure control rate in the study group was higher than that in the control group，and the morning visiting rate and the average outpatient visits in the study group were lower than those in the control group（P<0.05）．Conclusion　The community chronic diseases active reservation health management model for chronic diseases can improve blood pressure control rate, patient satisfaction and medical staff work efficiency, and shorten the average time of outpatient visits.

Inner Experience of Postpartum Depression in Women：a Qualitative Study　

LIU Yan，QI Weijing，ZHAO Lixia，ZHANG Ya，HU Jie

2019, 22(24): 2949-2954. DOI: 10.12114/j.issn.1007-9572.2019.00.086

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Background　Postpartum depression（PPD） is a common mental health problem in parturients，which causes pain and produces serious negative effects on parturients and their families.It has attracted wide attention at home and abroad.Objective　To get a deep understanding of the inner experience of PPD in women by a survey，and analyze the causes of PPD.Methods　This qualitative study was based on Edmund & Heidegger's interpretive phenomenology.Participants were 14 consecutive PPD female outpatients recruited from a tertiary grade A hospital in Shijiazhuang City during May to July，2017 by use of convenience sampling.Unstructured interviews were conducted to collect data associated with PPD.Interviews were recorded on site，transcribed，and analyzed with Colaizzi's method.Results　The focus problems extracted from the interviews mainly were relationship between mother-in-law and daughter-in-law，relationship between husband and wife，family economic issues，parenting issues.And the 3 themes identified were relationship between mother-in-law and daughter-in-law，relationship between husband and wife，and lack of parenting experience.Conclusion　Interpersonal relationships，especially family relationships，are the issues concerned most by women with PPD，which also are the major problems that plague their life.In addition，lack of parenting experience also trouble these women to a certain extent.

Rational Application of Antidepressants in Pregnancy　

ZHAI Qian，ZHANG Guofu，FENG Lei

2019, 22(24): 2955-2961. DOI: 10.12114/j.issn.1007-9572.2019.00.182

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The study of drug use during gestation is influenced by many factors other than medical ethics.It is still one of the most easily neglected fields with the slowest development in clinical pharmacology and pharmaceutical research.Due to unique changes in maternal physiology and the vulnerability of fetal development during pregnancy，rational use of drugs in pregnancy has been widely concerned.Depression is a kind of chronic mental disease characterized by high prevalence rate，high disability rate，high recurrence rate，and high suicide rate.Therefore，the safety and necessity of antidepressant use during pregnancy in depressed women has become a major problem in clinical treatment.This paper detailedly discusses the rational application of antidepressants in pregnancy.

Effects of Iodine Deficiency in Pregnancy and Iodine Supplementation on Neurointellectual Development of Offspring　

ZHANG Le，BAI Yu，ZHAI Xiaodan

2019, 22(24): 2962-2966. DOI: 10.12114/j.issn.1007-9572.2019.00.231

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Iodine is a necessary trace element for the synthesis of thyroid hormone，which is crucial for human brain development and physical growth.Due to increased physiological demand for iodine during pregnancy，iodine deficiency is a common problem of malnutrition during pregnancy，which has attracted much attention.During pregnancy，especially in the first trimester，even mild and moderate iodine deficiency may cause irreversible damage to neurointellectual development and cognitive function of the offspring.However，the necessity and timing of iodine supplementation are still controversial.On the basis of literature review，we summarized recent advances in the impact of iodine deficiency during pregnancy，especially mild and moderate iodine deficiency during pregnancy on neurodevelopment in children，and in iodine supplementation，and concluded that iodine supplementation therapy should be used mainly for preventing iodine deficiency rather than curing，and maintaining optimal iodine nutrition status in pregnancy is crucial to the prevention of brain development injury of offspring.

Interpretation of Immunohistochemistry for Mismatch Repair Proteins in Colorectal Cancer：Misjudgment and Solution　

JIANG Wu，LING Yihong，WU Xiaodan，CAI Muyan，ZHANG Huizhong，LIN Yuzhu，DING Peirong，PAN Zhizhong，WAN Desen

2019, 22(24): 2967-2970. DOI: 10.12114/j.issn.1007-9572.2019.00.105

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Background　Mismatch repair（MMR） status of colorectal neoplasms is a biomarker for tumor screening and clinical management.It is routinely tested in pathological examination.Objective　To explore the problem and solution in the interpretation of immunohistochemistry （IHC） for MMR protein.Methods　A total of 3 357 patients received MMR IHC test in Sun Yat-sen University Cancer Center between November 2010 and December 2015 were enrolled.A retrospective analysis of IHC test for MMR protein was carried out and reassessment was made to screen out the cases with irregular and controversial interpretation，and summarized and reinterpret their test results.Results　One hundred and three patients with irregular interpretation were controversial：（1） IHC results in percentage form，such as MLH1 （80%+），were reported in 25 cases；（2） IHC results were described in semi-quantitative form，i.e.weak +，focal +，partial +，individual + and others.A total of 75 staining indexes in this form were obtained from 65 patients；（3） 14 staining index from 13 patients were fuzzy expression as +/-.After reevaluating，the results were as follows：（1） IHC results in 25 cases described in percentage form were all stained positive．（2） Among 75 semi-quantitative IHC results，69 were stained positive after reinterpretation，5 were stained negative，and one was still undecidable （loss of tumor tissue，no re-staining）．（3） Among 14 IHC results vaguely expressed as +/-，13 indexes were positive，and one index was negative after reinterpretation.Three patients showing four MMR proteins deficiency were also reevaluated.One patient resulted in four MMR proteins positive；another two patients showed MSH6 negative and paired MLH1-PMS2 negative，respectively.Conclusion　The reasons for the controversy in interpreting the results of immunohistochemistry of MMR proteins are mainly that the IHC results are described in percentage form，semi-quantitative form，fuzzy expression as +/- and negative staining of four MMR proteins.It should be noted that the results of immunohistochemistry of MMR proteins are only negative and positive，and there are very few missing expressions of all four proteins.Review of questionable staining results will help to improve the accuracy of interpretation.

Clinical Analysis of Children with Incomplete Kawasaki Disease　

NIE Ying，XU Huifu，CHEN Changjian，QIAO Jing

2019, 22(24): 2970-2974. DOI: 10.12114/j.issn.1007-9572.2019.00.120

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Objective　To summarize the clinical features and laboratory results of incomplete Kawasaki disease （IKD） in children，providing evidence for early clinical recognition，diagnosis and prognosis improvement of this disease.Methods　We enrolled 94 children with IKD who received inpatient treatment in Department of Pediatrics，Wuhan No.1 Hospital from July 2016 to July 2018 in accordance with the inclusion criteria of this study，including 53 with typical KD（typical KD group），and 41 with atypical KD（IKD group）．Through the His system of the hospital，we collected and retrospectively analyzed their clinical data，including sex，age，clinical manifestations（fever interval before diagnosis，bulbar conjunctival congestion，chapped lips，strawberry tongue，fingernail and toenail shedding，perianal desquamation，rash，cervical lymphadenopathy，redness and swelling of the BCG vaccination scar），laboratory results during the acute stage of KD 〔erythrocyte sedimentation rate，C-reactive protein （CRP），white blood cell count，hemoglobin，neutrophil percentage （N%），platelet count，serum albumin，A/G ratio，AST，ALT，CK-MB 〕，and results of etiology detection，echocardiography and electrocardiogram（ECG）．Results　Two groups had no significant differences in sex ratio （χ2 =0.106，P>0.05） and age distribution（Z=-1.760，P>0.05）．Compared with typical KD group，IKD group demonstrated longer average fever interval before diagnosis，lower rates of chapped lips，fingernail and toenail shedding，perianal desquamation，rash，and cervical lymphadenopathy，higher rate of redness and swelling of the BCG vaccination scar，and lower average levels of CRP and N% at the acute stage of KD（P<0.05）．Among the typical KD group，there were 19 cases （35.9%） with clear etiologies，including 6 cases of viral infection，5 cases of bacterial infection，5 cases of Mycoplasma infection and 3 cases of mixed bacterial and viral infection，and in IKD group，there were 22 cases （53.7%） with clear etiologies，including 9 cases of Mycoplasma infection，6 cases of bacterial infection，5 cases of viral infection，and 2 cases of mixed bacterial and viral infection，indicating there was no significant difference in the incidence of pathogenic infection between the groups （χ2 = 2.981，P>0.05）．The incidence of coronary artery dilatation in IKD group was higher than that of typical KD group （P<0.05）．Conclusion　IKD was associated with longer fever interval，higher possibilities of having redness and swelling of the BCG vaccination scar，and coronary artery dilatation，but not associated with noticeable clinical manifestations.If children are found with the above-mentioned symptoms，IKD should be suspected，and inflammatory marker test should be performed as soon as possible，in order to obtain a definite diagnosis early.

Clinical Features，Diagnosis and Treatment of Six Cases with Infantile Fibrosarcoma：a Single-center Study　

LI Shuo，ZHAO Weihong，HUA Ying，GAO Yangxu，SUN Qing，XIE Yao，WU Penghui，LU Xintian

2019, 22(24): 2975-2979. DOI: 10.12114/j.issn.1007-9572.2019.00.252

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Objective　To retrospectively analyze the clinical features，treatment and outcome of 6 children with infantile fibrosarcoma（IFS） who were hospitalized in the Peking University First Hospital，in order to provide evidence for a universal protocol of this very rare childhood tumor nationwide.Methods　From September 2012 to February 2018，six children with IFS were admitted to the Hematological Oncology Ward，Department of Pediatrics of Peking University First Hospital.The clinical data of IFS patients were collected，including age，gender，tumor size，primary site，pathology and results of ETV6-NTRK3 fusion gene test.The clinical data，disease staging，treatment protocol，efficacy evaluation and follow-up of chemotherapy were reviewed retrospectively.Results　The disease occurred in very young patients（all under the age of two years），predominantly in males（5∶1），and mainly in limbs（4/6）．ETV6-NTRK3 transcript was present in two patients.Postoperative staging was as follows：two patients were classified as IRS stage Ⅰ，two as IRS stage Ⅱ，one as IRS stage Ⅲ and one as IRS stage Ⅳ.Two patients had initial surgery and postoperative chemotherapy，one of who received radiotherapy；four received adjuvant chemotherapy and delayed operation.Two cases underwent direct surgical resection of the tumors，and the remaining four cases received preoperative chemotherapy，all with response，with the volume of tumors decreased by 66% to 93%.After a median follow-up of 35 months（range 13-77），all patients survived disease-free.Conclusion　Overall prognosis of IFS is favorable.Conservative surgery remains the mainstay treatment.When the initial operation fails to completely remove the tumor，patients should receive adjuvant chemotherapy and delay the surgery after tumor reduction.Adjuvant chemotherapy combined with conservative surgery approach is effective and feasible without significant long-term functional or cosmetic impairment.

Clinical Features of Critically Ill Patients with Severe Fever with Thrombocytopenia Syndrome　

MAO Xuelan，DENG Baocheng

2019, 22(24): 2979-2984. DOI: 10.12114/j.issn.1007-9572.2018.00.432

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Severe fever with thrombocytopenia syndrome virus（SFTSV） is a newly identified hemorrhagic fever virus.The clinical manifestations of patients infected with this virus include fever，leukocytopenia，thrombocytopenia，and multiple organ failure.From 2010 to October 2016，the national average mortality rate of SFTSV infection was 5.3%，and that of critically ill infected patients reached 25%.There are no drugs particularly effective for SFTSV.To reduce the mortality effectively，the key lies in early diagnosis，and early identification of critically ill infected patients，and timely application of support treatment.We reviewed the clinical features of critically ill patients with severe fever with thrombocytopenia syndrome，in order to help clinicians identify such patients as early as possible to improve the prognosis，and reduce the mortality，

Analysis and Prediction Research of Death and Premature Death by Chronic Obstructive Pulmonary Disease in Rural Areas of Liaoning Province from 2009 to 2016　

TIAN Peiru，ZHANG Simeng，NI Pin，AI Con，LIU Xiaobing，SUN Qiuhong，SHI Jingpu

2019, 22(24): 2985-2990. DOI: 10.12114/j.issn.1007-9572.2018.00.330

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Background　Chronic obstructive pulmonary disease （COPD） is one of the most severe diseases affecting people's health in the world.Hundreds of millions of people suffer from the pain and harm caused by COPD every day.In the background of high incidence，mortality and disability rate around the globe，COPD mainly affects rural areas in the north of China，but there are few comprehensive reports of COPD death and premature death in these areas.Objective　To analyze the trend of death and premature death caused by COPD in rural areas of Liaoning Province from 2009 to 2016，and make effective prediction，so as to provide a scientific basis for COPD prevention and control.Methods　The death data of Zhangwu Center for Disease Control and Prevention and Fengcheng Center for Disease Control and Prevention from 2009 to 2016 and the population data of Zhangwu County and Fengcheng City from public security departments were collected.The mortality rate，standardized mortality rate，total mortality rate，standardized total mortality rate，premature mortality rate，standardized premature mortality rate，premature death probability，total premature mortality rate，standardized total premature mortality rate，total premature death probability and the annual percentage change（APC）were calculated.COPD mortality rate，standardized mortality rate，total mortality rate，standardized total mortality rate，premature mortality rate，standardized premature mortality rate，premature death probability，total premature mortality rate，standardized total premature mortality rate，total premature death probability were analyzed and predicted by using Joinpoint regression and grey model GM（1，1）．Results　 In rural areas of Liaoning Province from 2009 to 2016，the number of deaths from COPD was 1 912，and the number of premature deaths was 389，accounting for 20.35% of deaths from COPD.The mortality and standardized mortality rates of COPD were significantly higher in females than those in males（P<0.001）．From 2009 to 2016，the standardized mortality rate and the standardized total mortality rate in females decreased by year（P<0.05） and premature mortality and standardized total premature mortality in males showed a downward trend by year（P<0.05）．The total premature death probability of COPD decreased from 0.83% in 2009 to 0.77% in 2016.There was a gap of 0.58% between the data of 2016 and the control target of 2030（1.00%）in terms of the probability of premature death in men，and the probability of premature death in women is 0.28% higher than the control target of 2030（1.12%）．The results of GM（1，1） prediction showed that the total mortality of COPD and the total premature mortality of COPD decreased by year（P<0.001）．The MAPE of each model was from 1.18% to 8.76%.Conclusion　In the rural areas of Liaoning Province，the mortality and premature mortality of COPD decreased from 2009 to 2016，but future predictions showed that the mortality and premature mortality rate in men and the total mortality of COPD increased by year.Therefore，targeted preventions should be taken to reduce residents' exposure to risk factors and reduce the harm caused by COPD.

Characteristics of Thyroid Autoantibodies and Influencing Factors among Adult Population in Hefei Area　

ZHANG Yaqin，CHEN Mingwei，WANG Youmin，DENG Datong，CHEN Tingting，YANG Fang

2019, 22(24): 2991-2995. DOI: 10.12114/j.issn.1007-9572.2018.00.437

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Background　Iodine is one of the important raw materials for the synthesis of thyroid hormones in the thyroid.Previous studies have shown that excessive iodine intake induces the production of anti-thyroid antibodies.Our previous survey results show that excessive iodine intake is frequently seen in 8-10-year-old school-age children in Hefei，but the characteristics of urinary iodine levels and thyroid autoantibodies in adult population in this area are still unclear.Objective　To investigate the characteristics of thyroid autoantibodies and influencing factors among adult population in Hefei area.Methods　A cross-sectional survey was carried out in a cluster sample of 2 593 permanent residents aged over 18 years who lived in Baohe District，Hefei for at least 6 months and were eligible for the study during January to February 2017.Physical parameters such as height，body weight，waist circumference，systolic blood pressure，and diastolic blood pressure were measured，and body mass index was calculated.Laboratory parameters such as fasting plasma glucose，2-hour postprandial plasma glucose，triacylglycerol，total cholesterol，high-density lipoprotein cholesterol，low-density lipoprotein cholesterol，glycated hemoglobin，thyroid-stimulating hormone（TSH），thyroid peroxidase antibody（TPOAb），thyroglobulin antibody（TgAb），urinary iodine，thyroid volume（TV） were also measured.According to the TPOAb and TgAb levels，they were divided into autoantibody double-positive group（both TPOAb and TgAb were positive，n=177），autoantibody single-positive group（positive TPOAb with negative TgAb or negative TPOAb with positive TgAb，n=231），and autoantibody double-negative group（both TPOAb and TgAb were negative，n=2 185）．The rate of positive thyroid autoantibodies in the participants was analyzed by sex and age.And physical and laboratory parameters were compared by both TPOAb and TgAb levels.Multivariate Logistic regression analysis was used to investigate the influencing factors for positive thyroid autoantibodies.Results　The prevalence of positive TPOAb，positive TgAb，positive TPOAb and TgAb，positive TPOAb with negative TgAb or negative TPOAb with positive TgAb，and negative TPOAb and TgAb was 9.6%（248/2 593），11.8%（307/2 593），6.8%（177/2 593），8.9%（231/2 593），84.3%（2 185/2 593），respectively.Females had higher prevalence of positive TPOAb and TgAb compared with males（P<0.05）．Females had higher percentages than males in autoantibody double-positive group and autoantibody single-positive group（P<0.001），but had lower percentage than males in autoantibody double-negative group（P=0.002）．Autoantibody single-positive group had a greater average age than autoantibody double-negative group（P=0.001）．Autoantibody double-positive group had higher average TSH and TV levels than other two groups（P<0.05）．The TSH levels and TV in autoantibody single-positive group were significantly higher than those of autoantibody double-negative group（P<0.05）．Multivariate Logistic regression analysis showed that sex，TSH levels，and TV were influencing factors for positive thyroid autoantibodies（P<0.05）．Conclusion　The median urinary iodine for adults in Hefei was 208.59μg/L，indicating that most of them took too much iodine.The prevalence of positive thyroid autoantibody，positive TPOAb，and positive TgAb was 29.4%，9.6% and 13.0%，respectively in adults in this area，which basically coincide with those of the adult populations in central and eastern of China.Females were associated with higher prevalence of positive TPOAb，and positive TgAb.Sex，TSH and TV were the influencing factors of positive thyroid autoantibody.

Age-specific Cut-off Point for the Determination of Populations of Late-onset Hypogonadism：a Study Conducted in Community-dwelling Middle-aged and Older Males in Chengdu　

YANG Fan，JIANG Xiaobo，CAO Hongyi，TANG Yi，YANG Jing，REN Xin，KANG Jun，WAN Haiyan

2019, 22(24): 2996-2999. DOI: 10.12114/j.issn.1007-9572.2018.00.318

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Background　Male late-onset hypogonadism （LOH）is a clinical and biochemical syndrome associated with aging.It will severely affect the quality of life and bring adverse effects on multiple organs .At present，there is no unified diagnostic criteria at home and abroad，and the incidence of LOH varies in different regions.Objective　To investigate the prevalence of LOH and identify age-specific cut-off point for the determination of LOH among community-dwelling middle-aged and older males in Chengdu.Methods　By use of stratified sampling，we selected 800 males aged 30-70 from the fixed populations living in Chengdu Banknote Printing Company Community in Chengdu's Wenjiang District during May to August 2017，and 709 of them including 231（32.6％） aged 30-39，168（23.7％） aged 40-49，178（25.1％） aged 50-59，and 132（18.6％） aged 60-69 were finally enrolled according to the exclusion criteria.The Androgen Deficiency in Aging Males（ADAM） questionnaire was used to screen LOH.Serum total testosterone was measured to identify LOH.Chi-square test was used to compare the prevalence of LOH among different age groups.Spearman rank correlation analysis was used to explorethe relationship between age and the prevalence of LOH.ROC curve analysis was performed to determine the age-specific cut-off point for the determination of high risk population of LOH．Results　The prevalence of LOH in all participants assessed by ADAM score，serum TT level，and ADAM score combined with serum TT level was 67.1%，19.0%，17.9%，respectively.The prevalence of LOH assessed by ADAM score，serum TT level，and ADAM score combined with serum TT level differed significantly between the four age groups（P<0.05）.The prevalence of LOH in all participants assessed by ADAM score，or ADAM score combined with serum TT level increased with age（rs=0.238，0.231，P<0.05）．The optimal age-specific cut-off points for the identification of LOH by ADAM score，serum TT level，and ADAM score combined with serum TT level were 42.5，50.5，53.5，respectively.Conclusion　The prevalence of LOH in community-dwelling middle-aged and older males in Chengdu is high，and it correlates with age.The age-specific cut-off point of LOH is 40-55 years old，but it needs to be further verified.

Value of a Combination of Ultrasound Examinations in Preoperative Diagnosis of Neck Lymph Node Metastasis in Papillary Thyroid Cancer　

FANG Chao，WU Tingting，ZHOU Yingying，XUE Jun，YANG Weiwei

2019, 22(24): 3000-3004. DOI: 10.12114/j.issn.1007-9572.2018.00.428

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Background　The degree of diagnostic accuracy of cervical lymph node metastasis of papillary thyroid cancer（PTC） can influence the surgical approach and patients' prognosis.Ultrasound is often used to determine the prevalence of lymph node metastasis，but it is not accurate enough.Recently，contrast-enhanced ultrasound and ultrasound elastography are expected to improve the accuracy of diagnosis of lymph node metastasis.Objective　To explore the value of conventional ultrasound in combination with contrast-enhanced ultrasound and elastography in the preoperative diagnosis of cervical lymph node metastases in PTC.Methods　We recruited 124 cases of PTC from Jing'an District Zhabei Central Hospital，Shanghai from December 2015 to December 2017 and divided them into metastasis group（n=53） and reactive group（n=71） according to the postsurgical pathological findings for cervical lymph node.The routine ultrasound features〔anteroposterior diameter（S） and transverse diameter（L） of cervical lymph nodes，and L/S ratio（L/S score > 2 or ≤2），marginal morphology of cervical lymph nodes（regular/irregular），prevalence of lymphatic hilum，echo degree of cervical lymph node cortex （hypoechoic，isoechoic，hyperechoic），prevalence of cervical lymph node calcification and liquefaction，blood flow distribution pattern（central，peripheral，mixed），and blood flow grade（0-2）〕，contrast-enhanced ultrasound〔peak intensity（PI），time to peak（TP），area under the time-intensity curve （AUC），enhancement pattern（homogeneous or uneven），prevalence of perfusion area，and boundary condition （unclear or clear）〕，and elastography data〔real-time elastography（RTE）〕were collected and compared.Logistic regression was used to investigate the influencing factors for cervical lymph node metastasis of PTC.And AUC analysis was performed to test the diagnostic accuracy of different combinations of ultrasound tools.Results　Compared with the reactive group，metastasis group had greater L/S ratio，better marginal morphology，higher prevalence of lymphatic hilum，better blood flow distribution pattern and enhancement pattern，higher PI value and RTE score（P<0.05）．L/S ratio，marginal morphology，lymphatic hilum，blood flow distribution pattern，PI value，enhancement pattern，and RTE score had significant influence on the occurrence of cervical lymph node metastasis in PTC（P<0.05）．The AUC of the PI value，RTE score，lymphatic hilum，combined with L/S ratio for the diagnosis of cervical lymph node metastasis in PTC was greater than that of PI value alone（Z=6.183，P<0.001）．The fitting equation for the combined diagnosis was Logit（P）=-13.168+2.888×L/S ratio+4.232×lymphoid hilum +0.159×PI value+3.029×RTE score.Conclusion　Conventional ultrasound combined with contrast-enhanced ultrasound and elastography can effectively improve the accuracy of PTC cervical lymph node metastasis diagnosis.

Animal Experimental Study of Acoustic Radiation Force Impulse Imaging in the Assessment of Liver Fibrosis Severity　

TONG Jin，CAO Chunli，MA Ting，LIU Shanshan，KANG Yanfei，XU Lihong，DU Tingting，LI jun

2019, 22(24): 3005-3010. DOI: 10.12114/j.issn.1007-9572.2019.00.273

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Background　Hepatic fibrosis is a precancerous lesion of cirrhosis and hepatocellular carcinoma.Early treatment can delay the progress of fibrosis.At present，the main diagnostic methods of liver fibrosis include liver biopsy and serological markers，but each method has its own defects.Objective　To evaluate the accuracy of acoustic radiation force impulse imaging（ARFI） in the determination of liver fibrosis severity in a rabbit model of liver fibrosis.Methods　This experiment was conducted between April and October 2015.A total of 44 healthy New Zealand rabbits were selected and randomly divided into 2 groups，36 for the experimental group，and 8 for control group.The experimental group were subcutaneously injected with CCl4 with the initial dose of 0.3ml/kg，0.4ml/kg from the 4th week，and 0.5ml/kg from the fifth week，which was also the maintenance dose till the end of 16-week intervention.The control group received the same amount of normal saline.At the 4th，6th，8th，10th，12th，14th，16th weeks of intervention，3-6 rabbits in the experimental group were randomly selected to be examined by ARFI technology in vitro and in vivo liver tissue to obtain the stiffness parameters of transverse shear wave velocity（SWV，SWV1），respectively.After each examination，the rabbits were killed by air embolization，and.liver tissues were sampled.H&E and Masson's trichrome staining were used to determine the pathological stage of liver fibrosis.The diagnostic efficiency of the ARFI in liver fibrosis stages was evaluated according to the area under the curve（AUC） of the receiver operating characteristic curve（ROC）．Results　By the 16th week of intervention，the rabbit liver fibrosis models were successfully established at different stages.Pathological examination showed that the control group had normal results and there was no fibrosis.In the experimental group，rabbit models were successfully established in all cases except 4 deaths（6 in stage F1，10 in stage F2，8 in stage F3 and 8 in stage F4）．The rate of successful models was 88.9%（32/36）．The SWV and SWV1 of the control group were less than those of the rabbits with stage F1-F4 fibrosis in the experimental group（P<0.05）．In the experimental group，the SWV and SWV1 successively increased with the severity of liver fibrosis（P<0.05）．SWV1 was greater than SWV either in rabbits of the control group or in rabbits with stage F1-F4 fibrosis in the experimental group（P<0.05）．The AUC of SWV for the diagnosis of stage ≥F2，≥F3，F4 liver fibrosis were 0.901，0.939，0.945，respectively（P<0.001）．When the cut-off points of SWV were selected as 2.21m/s，2.29 m/s，2.36 m/s，the sensitivity were 80.8%，87.5%，87.5% and the specificity were 83.3%，87.5%，79.3%，respectively.The AUC of SWV1 in diagnosing stage ≥F2，≥F3，F4 liver fibrosis were 0.901，0.901，0.958，respectively（P<0.001）．When the cut-off points of SWV1 were selected as 2.58 m/s，2.92 m/s，3.26 m/s，the sensitivity were 80.8%，81.3%，87.5%，and the specificity were 83.3%，87.5%，95.8%，respectively.Conclusion　 ARFI may be used as an effective tool for the evaluation of liver fibrosis severity in rabbits.The AUC of ARFI parameters，SWV and SWV1，in the determination of liver fibrosis in rabbits was larger than 0.9，indicating high accuracy，so they may be used for the evaluation of liver fibrosis severity.

Recent Advances in Internet-based Management of COPD　

YANG Zhenjiao，CUI Miaoling，TAN Guirong，BAI Jing，ZHANG Xiaofang

2019, 22(24): 3011-3015. DOI: 10.12114/j.issn.1007-9572.2018.00.441

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Chronic obstructive pulmonary disease（COPD） is one of the multiple chronic diseases with a high mortality in China，which seriously affects the quality of life in patients.The application of Internet technologies in healthcare delivery upgrades the traditional delivery patterns of medical services，realizing the family-hospital seamless connection in disease management.We reviewed the articles about the application forms and areas of the Internet technologies in COPD management，and analyzed the problems during the Internet-based management，with a view to providing a reference for COPD management in China.

Advances in the Diagnosis and Treatment of Functional Constipation　

WANG Dongdong，WU Xiangbai

2019, 22(24): 3016-3022. DOI: 10.12114/j.issn.1007-9572.2019.00.062

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Functional constipation（FC） is a disease with a high prevalence commonly encountered in clinical settings，which can seriously impair human physical and mental health.This article reviews the latest progress in the diagnosis and treatment of FC. It mainly includes that the exact etiology and pathogenesis of FC are not yet clear. The diagnosis of FC mainly depends on the symptoms of patients, and constipation caused by intestinal and systemic organic causes should be excluded.Clinical examination methods for FC usually include colorectal transit time measurement，anorectal manometry，balloon expulsion test，defecography and dynamic MRI defecography.The treatments mainly include general management，pharmacotherapy，biofeedback therapy，traditional Chinese medicine treatment，psychological treatment and surgical management.Pharmacotherapy plays a greater role in treating FC than other therapies.Surgical management is only used for those with very serious conditions and without response to medical treatment.Moreover，indicators for surgical intervention should be strictly assessed.Although the surgical intervention can be performed based on individual conditions，the incidence of postoperative complications is high.At the same time, this paper also introduces some new FC therapies which have been gradually applied in clinic in recent years, such as ssacral neuromodulation and fecal bacteria transplantation，and some clinical effects have been achieved. Therefore, this article aims to provide new ideas for the future treatment of FC.

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