Objective: To investigate the risk factors for yersiniosis, so as to provide insights into prevention of yersiniosis. Methods: The patients with yersiniosis admitted to the clinics in the surveillance site of Chengbei Township of Jin'an District and Chengnan Township of Yu'an District in Lu'an City from 2013 to 2021 were included as the case group, and the healthy family members matched to cases were selected as the family control group, while normal residents with a 1︰2 match in the same village, gender, and age difference within 5 years were included in the community control group. Participants' demographics, hand-washing and eating habits, living environment hygiene, poultry and livestock feeding were collected using questionnaire surveys, and factors affecting yersiniosis were identified using a multivariable conditional logistic regression model. Results: There were 43 cases in the case group, with a median (interquartile range) age of 45 (34) years, 91 cases in the family control group, with a median (interquartile range) age of 36 (36) years and 86 cases in the community control group, with a median (interquartile range) age of 46 (34) years. Multivariable conditional logistic regression analysis showed that compared with the family control group, the habit of drinking unboiled water (OR=6.721, 95%CI: 1.765-25.588), and direct consumption of food stored in the refrigerator (OR=7.089, 95%CI: 1.873-26.829) were risk factors for yersiniosis in the case group; and compared with the community control group, not washing hands after contacting with poultry and livestock (OR=50.592, 95%CI: 2.758-927.997), habit of eating raw vegetables and fruits (OR=5.340, 95%CI: 1.022-27.887), direct consumption of food stored in the refrigerator (OR=19.973, 95%CI: 2.118-188.336), and unclean refrigerator (OR=12.692, 95%CI: 1.992-80.869) were risk factors for yersiniosis in the case group. Compared with the family and community control groups, not washing hands after contacting with poultry and livestock (OR=4.075, 95%CI: 1.427-11.637), habit of drinking unboiled water (OR=4.153, 95%CI: 1.331-12.957), habit of eating raw vegetables and fruits (OR=4.744, 95%CI: 1.609-13.993), and direct consumption of food stored in the refrigerator (OR=5.051, 95%CI: 1.773-14.395) were risk factors for yersiniosis in the control group. Conclusion Unhealthy habits such as eating raw vegetables and fruits, drinking unboiled water, direct consumption of food stored in the refrigerator, unclean refrigerator, and not washing hands after contacting poultry and livestock may increase the risk of yersiniosis.

Objective:To evaluate the clinical efficacy of the axillary approach in the treatment of scapular glenoid fracture.Methods:A retrospective analysis was performed of the 12 patients who had been treated for scapular glenoid fracture from November 2019 to April 2021 at Department of Upper Limb Orthopaedics, Zhengzhou Orthopaedic Hospital. They were 4 males and 8 females, aged from 30 to 75 years (mean, 53.5 years). According to the Ideberg classification, there were 2 cases of type Ⅰa, 9 cases of type Ⅱ and one case of type Ⅴa. All cases were treated through the axillary approach. Two patients complicated with anterior shoulder dislocation were treated with manual reduction under anesthesia before operation and the other 10 cases with special plate fixation through the axillary approach. The 3 patients complicated with fracture of greater tuberosity were fixated with a special plate through the lateral shoulder split deltoid approach. Constant-Murley score, visual analogue scale (VAS) and Hawkins grading were used at the last follow-up to evaluate shoulder function, pain and stability after operation.Results:All patients were followed up for 9 to 20 months (mean, 14.4 months). The operation time ranged from 55 to 110 min (mean, 76.3 min), intraoperative bleeding from 60 to 160 mL (mean, 103.8 mL), and hospital stay from 8 to 14 d (mean, 11.1 d). All incisions healed primarily and all scapular glenoid fractures got united 6 months after operation. The last follow-up showed no shoulder instability, neurovascular injury or internal fixation failure. At the last follow-up, the range of motion of the shoulder was 159.2°±26.1° in forward bending, 156.7°±29.6° in abduction, 48.3°± 15.3° in external rotation (neutral position), and 73.3°±12.3° in internal rotation (neutral position), and the Constant-Murley score was (94.0±5.3) points. The range of motion of the shoulder and Constant-Murley score were significantly improved compared with those before operation (10.8°±11.6°, 7.5°±11.4°, 5.8°±10.0°, 42.5°±16.0° and 4.9±4.0, respectively) (all P<0.05). The VAS score was 0 in 11 patients and 2 in one patient at the last follow-up. Conclusion:The axillary approach is feasible for the treatment of scapular glenoid fracture, because it is hidden and less invasive, leading to good clinical outcomes.

Objective:To investigate the efficacy of fixation with cannulated screws alone via the Kocher approach in the treatment of adult humeral capitulum fractures.Methods:From August 2016 to August 2020, 16 patients with humeral capitulum fracture were treated at Department of Upper Limb Orthopedics, Zhengzhou Orthopaedic Hospital. They were 10 males and 6 females, aged from 36 to 62 years (average, 45 years). The left side was affected in 10 cases and the right side in 6. According to the Ring classification, 3 cases were type Ⅰ, 3 cases type Ⅱ, 6 cases type Ⅲ, and 4 cases type Ⅳ. All patients were treated with the Kocher approach on the lateral side of the elbow. After reduction under direct vision, the fractures were fixated temporarily with Kirschner wires and finally with cannulated screws. On the second postoperative day, the patients started active flexion and extension of the elbow joint and took indomethacin orally to prevent heterotopic ossification. At the last follow-up, the curative efficacy was evaluated according to the Mayo elbow performance score (MEPS). The flexion and extension of the elbow joint and the rotation of the forearm were also recorded.Results:All patients were followed up for 10 to 19 months (mean, 14.3 months) after surgery. Bony union was achieved after 7 to 12 monthes (average, 11.3 monthes) in all the 16 patients, 2 of whom developed heterotopic ossification. By the MEPS evaluation at the last follow-up, 8 cases were excellent, 6 good and 2 fair, scoring an average of 89.5 points (from 73 to 95 points). At the last follow-up, the elbow flexion ranged from 80° to 130° (averaging 113°), extension from 5° to 30° (averaging 15°), forearm pronation from 62° to 75° (averaging 67°), and forearm supination from 50° to 90° (averaging 75°).Conclusion:When the fracture ends are exposed through the lateral Kocher approach, the fracture fragments fixated with cannulated screws only, and the patients encouraged to start elbow joint exercises in the early stage, the treatment of adult humeral capitulum fractures can result in satisfactory curative effects.

To establish the experts consensus on the management of delirium in critically ill patients.A special committee was set up by 15 experts from the Chinese Critical Hypothermia-Sedation Therapy Study Group.Each statement was assessed based on the GRADE (Grading of Recommendations Assessment,Development,and Evaluation) principle.Then the Delphi method was adopted by 36 experts to reassess all the statements.(1) Delirium is not only a mental change,but also a clinical syndrome with multiple pathophysiological changes.(2) Delirium is a form of disturbance of consciousness and a manifestation of abnormal brain function.(3) Pain is a common cause of delirium in critically ill patients.Analgesia can reduce the occurrence and development of delirium.(4) Anxiety or depression are important factors for delirium in critically ill patients.(5) The correlation between sedative and analgesic drugs and delirium is uncertain.(6) Pay attention to the relationship between delirium and withdrawal reactions.(7) Pay attention to the relationship between delirium and drug dependence/ withdrawal reactions.(8) Sleep disruption can induce delirium.(9) We should be vigilant against potential risk factors for persistent or recurrent delirium.(10) Critically illness related delirium can affect the diagnosis and treatment of primary diseases,and can also be alleviated with the improvement of primary diseases.(11) Acute change of consciousness and attention deficit are necessary for delirium diagnosis.(12) The combined assessment of confusion assessment method for the intensive care unit and intensive care delirium screening checklist can improve the sensitivity of delirium,especially subclinical delirium.(13) Early identification and intervention of subclinical delirium can reduce its risk of clinical delirium.(14) Daily assessment is helpful for early detection of delirium.(15) Hopoactive delirium and mixed delirium are common and should be emphasized.(16) Delirium may be accompanied by changes in electroencephalogram.Bedside electroencephalogram monitoring should be used in the ICU if conditions warrant.(17) Pay attention to differential diagnosis of delirium and dementia/depression.(18) Pay attention to the role of rapid delirium screening method in delirium management.(19) Assessment of the severity of delirium is an essential part of the diagnosis of delirium.(20) The key to the management of delirium is etiological treatment.(21) Improving environmental factors and making patient comfort can help reduce delirium.(22) Early exercise can reduce the incidence of delirium and shorten the duration of delirium.(23) Communication with patients should be emphasized and strengthened.Family members participation can help reduce the incidence of delirium and promote the recovery of delirium.(24) Pay attention to the role of sleep management in the prevention and treatment of delirium.(25) Dexmedetomidine can shorten the duration of hyperactive delirium or prevent delirium.(26) When using antipsychotics to treat delirium,we should be alert to its effect on the heart rhythm.(27) Delirium management should pay attention to brain functional exercise.(28) Compared with non-critically illness related delirium,the relief of critically illness related delirium will not accomplished at one stroke.(29) Multiple management strategies such as ABCDEF,eCASH and ESCAPE are helpful to prevent and treat delirium and improve the prognosis of critically ill patients.(30) Shortening the duration of delirium can reduce the occurrence of long-term cognitive impairment.(31) Multidisciplinary cooperation and continuous quality improvement can improve delirium management.Consensus can promote delirium management in critically ill patients,optimize analgesia and sedation therapy,and even affect prognosis.

Objective To study the relationship of CSF and serum FGF-2 level with clinical parameters in MND patients.Methods Ninety-one MND patients served as a MND group and 40 noninflammtory nervous system disease patients served as a control group.Their CSF and serum FGF-2 level were measured by ELISA.The neurological deficit in ALS patients was assessed according to the modified ALSFRS-r,the progression of MND was assessed according to the DPR.The ALS patients were followed up,during which their survival time was recorded.Results The serum FGF-2 level was significantly higher in MND group than in control group (P＜0.01).The CSF,FGF-2 level were significantly higher in ALS patients of MND group than in those of control group (319.2±105.9 ng/L vs 241.7±34.3 ng/L,P＜0.01).The CSF and serum FGF-2 level were positively correlated with the duration of MND and negatively correlated with the DRP in ALS patients (P＜0.01).Survival analysis of MND patients indicated that the survival time of PMA patients was longer than that of PLS,ALS and PBP patients (P=0.000).The cumulative survival rate of ALS patients with a high serum FGF-2 level was significantly higher than that of those with a low serum FGF-2 level (P=0.002).Conclusion The CSF and serum FGF-2 level are higher in some MND patients and can be used as one of the biomarkers for evaluating the progression and predicting surrival.

Objective To study the clinical significance of serum hs-CRP level in smokers with carotid atherosclerosis (CA) and analyze its difference in subtypes of CA.Methods Two hundred and ninety-eight smokers with CA served as a smoker group and 120 non-smokers with CA served as a non-smoker group,50 healthy smokers without CA served as control group 1 and 50 healthy non-smokers served as control group 2.Their serum hs-CRP level was measured by colloid-enhanced immunoturbidimetry.Smokers were divided into stable plaque group and unstable plaque group.Effect of smoking on serum hs-CRP level in CA patients was analyzed.Results The serum hs-CRP level was significantly higher in smoker group and control group 1 than in non-smoker group and control group 2 (7.26±4.24 mg/L vs 3.56±2.28 mg/L,4.34±2.74 mg/L vs 3.17± 1.68 mg/L,P＜0.05).The smoking index was positively related with the serum hs-CRP level (r=0.395,P＜0.01).The number of daily smoked cigarettes was significantly greater in unstable plaque group than in stable plaque group (P＜0.05).The recurrence rate of ischemic stroke was significantly higher in smokers with a high serum hs-CRP level than in those with a low serum hs-CRP level (11.36％ vs 2.00％,P＜0.01).Conclusion Smoking can increase the serum hs-CRP level in CA patients,which is closely related with the stability of plaques and the recurrence of ischemic stroke.

Hepatocellular carcinoma (HCC) is one of the most common malignant tumors in China with high morbidity and mortality,and its mortality rate is only lower than that of gastric cancer.It poses a serious threat to patients' life,which needs to be given special concerns by clinicians and patients for active implementation of effective treatment methods.Generally,major operation is the mainstay of management.Radiotherapy has gained its popularity when diagnosed have no indications for surgical therapy.An effective radiotherapy plans promote the remission of hepatocellular carcinoma to improve patients condition,prognosis,and survival rate.Therefore,we conducted this study to know the research progress of radiotherapy for hepatocellular carcinoma.

Objective To observe any effect of intensive training on the degree of depression and the expression of Kalirin-7 in the hippocampus of rats modeling with post-stroke depression,and to investigatc possible mechanisms.Methods Forty male Wistar rats were randomly divided into a post-stroke depression (PSD) group,a routine training group,an intensive training group and a sham-operation group (n =10 for each group).All except the sham-operation group were given the middle cerebral artery occlusion using the intraluminal thread method,and chronic mild stress was applied.The PSD group and the sham-operation group were not given any training.The routine training group was trained oncc a day,and the intensive training group was trained twice a day.The sucrose preference test,open field test and forced swimming test were conducted at the outset and after 14 and 28 days of training.The expression of Kalirin-7 in the left hippocampus was detected using Western blotting.Results After 14 days of training,significant differences were found in the test results of the sham-operation group compared with the other groups (P＜0.05).There were also significant differences in the average results on all 3 tests among all of the groups except the sham-operation group.At both 14 and 28 days after training,the average expression of Kalirin-7 in both the routine and intensive training groups was significantly higher than in the PSD group (P＜0.05),and that of the intensive training group was significantly higher than that of the routine training group at the same time points (P＜0.05).Conclusion Intensive training can relieve depression and increase the expression of the Kalirin-7 in the hippocampus,at least in rats.

Objective To observe the effect of intensive training on lower extremity motor function and depression after stroke.Methods Thirty patients with post-stroke depression were randomly divided into an intensive training group and a control group,each of 15.Both groups received conventional anti-stroke and antidepressant drug therapy,and rehabilitation training.The intensive training group,however,was additionally provided with lower extremity motor function training each day.Hamilton Depression Rating Scale,the Fugl-Meyer assessment (FMA),10-meter maximum walking speed test (10MWT) and the Holden functional ambulation categories (FAC) were conducted before treatment,and 2 and 4 weeks after the treatment.The level of human β-endophin (β-EP) and brain derived neurotrophic factor (BDNF) in the serum were also detected.Results After 4 weeks of treatment,the FAM,10MWT,BDNF and β-EP were significantly improved in both groups compared to those before the treatment (P＜ 0.05).No significant differences,however,were found between the 2 groups in the above measurements after 2 weeks of treatment (P＞0.05).After 4 weeks of treatment,the FAM (20.67±6.79),10MWT [(0.48±0.22)m/s],BDNF [(10.81±2.33)μg/L] and β-EP [(164.02±42.15)ng/L] of the intensive training group were significantly improved compared to those of the control group (P＜0.05).Both after 2 weeks and 4 weeks treatment,the HAMD scores of the intensive training group (16.33±6.74 and 12.13±5.44) were significantly better than those of the control group (P＜ 0.05).However,there was no significant difference in terms of FAC between the two groups either after 2 weeks or 4 weeks of treatment (P＞0.05).Conclusion The intensive training can improve motor function and relieve poststroke depression of stroke survivors.It is worth promoting and applying in clinical practice.

Objective To observe the effects of early exercise on the expression of synaptophysin pro-tein and Nissl bodies in the hippocampus after hypoxic-ischemic brain damage( HIBD) , and to investigate possi-ble mechanisms. Methods A total of 35 neonatal Wistar rats aged 7 days were randomly divided into a train-ing group of 13, a control group of 11 and a sham-operation group of 11. HIBD was induced in the rats of the training and control groups, while those in the sham-operation group had the left common carotid artery separa-ted, but without ligation. Seven days after successful modeling, the training group began swimming training for 10 min every day lasting for 14 days, while the other groups were not trained. Western blotting was used to detect the expression of synaptophysin in the affected hippocampus of the brain based on the ratio of the gray band val-ues for synaptophysin and beta. Nissl staining was applied to observe the number of Nissl bodies and the morphol-ogy of the neurons in the hippocampus. Results The average expression of synaptophysin in the sinistrocere-bral hippocampus of the rats in the control group was significantly lower than that in the sham-operation group, but significantly higher than that of the training group. The control group had significantly fewer Nissl bodies than the sham-operation group, but significantly more than the training group. Conclusion Early training can in-crease the expression of synaptophysin and the number of Nissl body in the hippocampus after hypoxic-ischemic brain damage.