Correlations between depression, sleep quality and dental caries among college students in Chongqing / 中国学校卫生

Objective@#To understand the correlation between depression, sleep quality and dental caries among college students in Chongqing, so as so provide reference basis for targeted health education.@*Methods@#From January to June 2022, a multi stage sampling method was used to select 627 students from six colleges in Chongqing. According to the Fourth National Epidemiological Survey of Oral Health and World Health Organization standards, dental caries were examined and diagnosed. The Self Rating Depression Scale (SDS), Pittsburgh Sleep Quality Index (PSQI) Questionnaire and general situation questionnaire were adopted to investigate depressive symptoms and sleep quality of college students. Correlation analysis was performed to study the correlation between depression, sleep quality and dental caries.@*Results@#The prevalence of dental caries among college students was 42.1%, and there was a statistically significant difference in dental caries prevalence among college students depending on their gender, major, body shape, parental education level, and family sources ( χ 2=14.49, 16.81, 7.82, 15.14, 7.34, P <0.05). The prevalence of depressive symptoms was 13.9%, and there was a statistically significant difference in SDS scores and depression prevalence among students of different body types ( χ 2=10.99, P <0.05). The PSQI score was (4.36±0.94) points, and the rate of poor sleep quality was 26.16%. Furthermore, there was a statistically significant difference in the PSQI score and rate of poor sleep quality among college students of different genders and body types ( χ 2=25.41, 17.59, P <0.05). There was a certain correlation between the occurrence of dental caries and poor sleep quality and depressive symptoms among college students, with contingency coefficients of 0.15 and 0.13, respectively ( P <0.05).@*Conclusion@#The prevalence of dental caries is high among college students in Chongqing. The occurrence of dental caries may be related to depression and sleep quality.

Expert consensus for Jingtong Granules in treatment of cervical radiculopathy in clinical application / 中国中药杂志

With the effects of activating blood and resolving stasis, and moving Qi to relieve pain, Jingtong Granules is widely used in the treatment of cervical radiculopathy in China. Long-term clinical application and related evidence have shown that the prescription has ideal effect in alleviating the pain in neck, shoulder, and upper limbs, stiffness or scurrying numbness, and scurrying pain caused by this disease. However, there is a lack of consensus on the clinical application of Jingtong Granules. Therefore, clinical first-line experts and methodology experts from all over the country were invited to compile this expert consensus. This expert consensus is expected to guide clinicians to use Jingtong Granules in a standardized and reasonable way, improve clinical efficacy, reduce medication risks, and benefit patients. First, according to the clinical experience of experts and the standard development procedures, the indications, syndrome characteristics, clinical advantages, and possible adverse reactions of Jingtong Granules were summarized. Then, through face-to-face interview of clinical doctors in traditional Chinese medicine and western medicine and survey of the clinical application, the clinical problems were summed up, and the consensus was reached with the nominal group method to form the final clinical problems. Third, evidence retrieval was carried out for the clinical problems, and relevant evidence was evaluated. The GRADE system was employed to rate the quality of evidence. Fourth, 5 recommendation items and 3 consensuses items were summarized with the nominal group method. Opinions and peer reviews on the consensus content were solicited through expert meetings and letter reviews. The final consensus includes the summary of evidence on the clinical indications, effectiveness, and safety of Jingtong Granules, which can serve as a reference for clinicians in hospitals and primary health institutions.

Gamma-glutamyl transpeptidase and indirect bilirubin may participate in systemic inflammation of patients with psoriatic arthritis

Abstract Background Previous studies have suggested that systemic metabolic abnormalities are closely related to psoriatic arthritis (PsA). Gamma-glutamyl transpeptidase (GGT) and indirect bilirubin (IBIL), two essential active substances in hepatic metabolism that have been demonstrated as an oxidative and anti-oxidative factor respectively, have been proved to be involved in oxidative stress damage and inflammation in several human diseases. However, their role in PsA remains unclear. Methods In this retrospective comparative cohort study, a case group of 68 PsA patients and a control group of 73 healthy volunteers from the Third Hospital of Hebei Medical University were enrolled. Serum GGT, IBIL, GGT/IBIL ratio and C-reactive protein (CRP), a well applied bio-marker of systemic inflammatory in PsA, were compared between the two groups. Furthermore, the relationship of GGT, IBIL and GGT/IBIL with CRP were explored in PsA patients. Finally, the patients were divided into high inflammation group and low inflammation group according to the median value of CRP. Multivariate logistic regression analyses were used for the association of systemic inflammation level with GGT, IBIL and GGT/IBIL. Results Compared with healthy controls, PsA patients exhibited significantly higher serum GGT, GGT/IBIL, and CRP levels and lower IBIL levels. Serum GGT and GGT/IBIL were positively correlated with CRP, whereas IBIL were negatively correlated with CRP. Binary logistic regression analysis revealed that serum GGT was a risk factor for high CRP in PsA, whereas IBIL was a protective factor. Furthermore, GGT/IBIL was a better indicator of high CRP condition in PsA patients than either GGT or IBIL alone, as determined by the receiver operating characteristic curves. Conclusion GGT and IBIL may participate in the pathogenesis of PsA. Additionally, GGT, IBIL and the balance of the two may reflect systemic inflammation mediated by oxidative stress events related to metabolic abnormalities to a certain extent.

Study of the fibrinolytic activity of serrapeptase and its in vitro thrombolytic effects

Abstract Serrapeptase, a proteolytic enzyme, has been used for the adjuvant treatment of many diseases. However, its fibrinolytic activity is still uncertain. Herein, the fibrinolytic activity of serrapeptase and its in vitro thrombolytic effects were investigated. The results showed that the fibrinolytic activity of serrapeptase was 1295 U/mg, and the specific activity was 3867 U/mg of protein when its proteolytic activity toward casein was 2800 U/mg. The optimum temperature and pH for serrapeptase activity were 37-40°C and 9.0, respectively. At 1 mmol/L, Zn2+, Mn2+ and Fe2+ could activate the fibrinolytic activity of serrapeptase, while K+, Cu2+, sodium dodecyl sulfate (SDS) and ethylene diamine tetraacetic acid (EDTA) inhibited it. In vitro tests showed that serrapeptase could completely prevent blood coagulation at 150 U/mL, and the percentage of blood clot lysis reached 96.6% at 37°C after 4 h at 300 U/mL. These results indicate that serrapeptase has excellent fibrinolytic activity, and can be used as a health food or candidate drug for the prevention or treatment of thrombotic diseases.

Research Progress on Developmental Biology of Sarcosaprophagous Insects / 法医学杂志

Forensic entomology provides a feasible way to estimate postmortem interval (PMI), of which the growth and development of sarcosaprophagous insects is the most widely used indicator in forensic practice. Over the years, forensic entomologists have carried out a large number of studies on the development biology of sarcosaprophagous insects. This paper illustrates the main factors that affect the development of sarcosaprophagous insects, including temperature, humidity, light, food types and poisons. The development indicators of sarcosaprophagous insects were reviewed from the perspectives of morphology, differential gene expression and biochemical characteristics. It is emphasized that future research of development biology on sarcosaprophagous insects should fully absorb and integrate the methods of artificial intelligence and omics, and the research object also needs further expansion in order to establish a more objective and more accurate PMI estimation method.

Identification of Common Sarcosaprophagous Flies in the Yangtze River Delta by COⅠ Gene / 法医学杂志

OBJECTIVES@#To identify the common sarcosaprophagous flies in the Yangtze River Delta based on mitochondrial cytochrome c oxidase subunit Ⅰ(COⅠ) gene sequence and verify the reliability of this method.@*METHODS@#Seven common genetically stable sarcosaprophagous flies in three families and six genera were collected from large domestic pig carcasses placed in the field and cultured in the laboratory for many generations. The whole genome DNA was extracted and the COⅠ gene fragment was amplified. The forward and reverse sequencing was followed by splicing. The base composition of the amplified fragment and the rate of interspecific evolutionary divergence were analyzed by software such as Mega 7.0.26. The phylogenetic tree of COⅠ gene sequence of common necrophagous flies in the Yangtze River Delta was established by neighbor joining (NJ) method and unweighted pair-group method with arithmetic means (UPGMA) method.@*RESULTS@#The average base composition of different flies was A(30.14%), T(38.23%), C(15.98%), G(15.65%). The rate of interspecific evolutionary divergence ranged from 2.2% to 15.3%, the lowest rate was between Chrysomya megacephala and Chrysomya pinguis, the highest rate was between Muscina stabulans and Boettcherisca peregrina.@*CONCLUSIONS@#COⅠ gene can be used to identify the common necrophagous flies in the Yangtze River Delta.

Eyeglass prescription and refractive examination of grade 4-6 primary school students in Henan / 中国学校卫生

Objective@#To analyze the prevalence of poor vision and eyeglass prescription, refractive examination among primary school students of grade 4-6 in Henan, so as to provide scientific basis for precise interventions for student vision health.@*Methods@#A stratified cluster random sampling method was used to investigate a total of 29 187 students of grade 4-6 from 17 cities in Henan Province. Distant vision examination and questionnaire survey were conducted.@*Results@#The overall prevalence of poor vision for grade 4-6 students in Henan was 63.6%, with girls (69.0%) higher than boys (59.0%),urban students (65.3%) higher than suburban students (62.5%)( χ 2=312.6, 23.6, P <0.01). The prevalence of severe poor vision was 28.5%.With the increase of grade, the detection rate of poor vision and severe poor vision increased( χ 2 trend =278.7, 775.4, P <0.01). Totally 13.2% of pupil did not have a visual examination in the past year. The rate of wearing glasses was 27.0% for students with poor eyesight and 3.2% for students with poor monocular eyesight. Totally 46.8% of the students wearing glasses received mydriatic optometry before wearing glasses.@*Conclusion@#The problem of poor vision among students of grade 4-6 in Henan is prominent, so it is necessary to strengthen eyesight monitoring and eye health education.

Application of Sarcosaprophagous Insects to Estimate the Postmortem Interval in 11 Cases / 法医学杂志

Objective To test the feasibility and accuracy of with sarcosaprophagous insects postmortem interval （PMI） estimation with sarcosaprophagous insects and provide references for estimation practice. Methods Eleven cases confirmed by the detection results, with complete entomological evidence were selected. The insect species, estimation results and true results involved in the cases were statistically analyzed and compared. Results Thirteen species of insects were found at the criminal scene, including Chrysomya megacephala （Fabricius）, Chrysomya rufifacies （Macquart）, Chrysomya nigripes （Aubertin）, Lucilia sericata （Meigen）, Hydrotaea spinigera Stein, Muscina stabulans （Fallén）, Sarcophagid （species were not identified）, Megaselia scalaris （Loew）, Hermetia illucens （Linnaeus）, Saprinus splendens （Paykull）, Creophilus maxillosus （Linnaeus）, Dermestes maculatus （De Geer） and Necrobia ruficollis （Fabricius）. The PMI of all eleven cases was within the range of estimated PMI. The estimated results of 72.73% cases were on the same day of the true results. Conclusion Sarcosaprophagous insects can estimate the PMI simply and conveniently. In cases where the PMI is within the time range of one generation of flies or beetles, the estimation results are relatively accurate. However, the estimation is less accurate when the PMI is beyond the time range.

Nutritional status of students aged 6-16 years of the National Nutrition Improvement Program for Rural Compulsory Education Students in Henan Province from 2012 to 2019 / 中国学校卫生

Objective@#To understand the changes of students nutritional status in the National Nutrition Improvement Program for Rural Compulsory Education Students (NNIPRCES) of Henan Province, and to provide scientific basis for designating scientific nutritional intervention measures.@*Methods@#About 20%-30% of primary schools and middle schools in the pilot counties in Henan Province were selected to monitor the nutritional status of students. Surveillance data from 2012 to 2019 were analyzed.@*Results@#From 2012 to 2019(no surveillance data were available in 2018), the detection rates of mild thinness were 4.0%, 3.3%, 3.3%, 3.6%, 3.1%, 2.9%, 4.4%, respectively; the detection rates of moderate and severe thinness were 4.5%, 4.5%, 4.4%, 4.6%, 3.9%, 3.6%, 5.1%, respectively; the detection rates of overweight were 9.6%, 12.4%, 12.3%, 12.2%, 12.7%, 13.4%, 11.1%, respectively; and the detection rates of obesity were 3.9%, 6.8%, 6.7%, 6.2%, 7.6%, 7.2%, 5.8%, respectively. The differences were statistically significant (χ 2=1 032.29, 4 771.39, P<0.05). The detection rates of 2019 mild (5.0%, 3.7%) and moderate to severe thinness (5.9%, 4.3%) were the highest for both male and female students, and the highest for primary school students and junior middle school students were the highest for 2019 mild (4.1%, 6.0%) and moderate to severe thinness (5.1%, 4.9%), with statistical significance (χ 2=653.22, 486.46, 919.07, 306.27, P<0.05). The detection rate of overweight was the highest in both males and females (14.8%, 11.8%) in 2017, and the detection rate of obesity was the highest in 2016 (8.3%, 6.9%). The detection rates of overweight and obesity in primary school students were the highest in 2017 and 2016 (13.7%, 8.4%), and the detection rates in middle school students were the highest in 2017 (11.5%, 3.0%), with statistical significance (χ 2=2 391.65, 2 371.74, 4 827.75, 512.64, P<0.05).@*Conclusion@#In the early stage of the implementation of NNIPRCES in Henan Province, malnutrition among students has improved, however, the contem porary malnutrition shows increasing trend, and the co occurrence of malnutrition and obesity calls for targeted nutritional intervention measures.

An Insight of the First Community Infected COVID-19 Patient in Beijing by Imported Case: Role of Deep Learning-Assisted CT Diagnosis / 中国医学科学杂志(英文版)

In the era of coronavirus disease 2019 (COVID-19) pandemic, imported COVID-19 cases pose great challenges to many countries. Chest CT examination is considered to be complementary to nucleic acid test for COVID-19 detection and diagnosis. We report the first community infected COVID-19 patient by an imported case in Beijing, which manifested as nodular lesions on chest CT imaging at the early stage. Deep Learning (DL)-based diagnostic systems quantitatively monitored the progress of pulmonary lesions in 6 days and timely made alert for suspected pneumonia, so that prompt medical isolation was taken. The patient was confirmed as COVID-19 case after nucleic acid test, for which the community transmission was prevented timely. The roles of DL-assisted diagnosis in helping radiologists screening suspected COVID cases were discussed.

Periodontal health knowledge and behavior among adolescents aged 12-15 years in Henan Province / 中国学校卫生

Objective@#To explore periodontal health knowledge and behavior among adolescents aged 12-15 years in Henan Province so as to provide scientific basis for oral health care.@*Methods@#According to the basic methods of the Fourth National Oral Health Survey, 3 786 school adolescents, aged 12-15 years, were selected from 12 middle schools in two district and two country in Henan by multi-stage stratified equal capacity random sampling. Oral examination and a questionnaire survey were performed among these students.@*Results@#The rate of periodontal health was 6.08%, the prevalence of gingival bleeding in these adolescents was 93.92%, its calculus existence was 90.99%. The rate of brushing teeth was 77.79%. However, the rate of brushing teeth twice or more per day was 17.56%, the rate of using fluoride toothpaste was 4.57%. The rate of periodontal health of adolescents who brushing teeth, using fluoride toothpaste were higher than adolescents who did not brush teeth, did not use fluoride toothpaste (χ2=10.81, 5.96, P<0.05). The recognition of oral care knowledge was 62.31%; except for "bacteria can cause dental caries", the awareness rate of other related periodontal diseases is more than 50.00%.@*Conclusion@#The status of periodontal health among adolescents aged 12-15 in Henan Province was not optimistic. Adolescents are lake of knowledge and health behavior towards periodontal health, The promotion of adolescents’s oral health education should be strengthened.

Analysis on the influencing factors of school bullying among middle school students in Henan Province / 中国学校卫生

Objective@#To explore the influencing factors of campus bullying among middle school students in Henan province, and to provide evidence for effective intervention measures.@*Methods@#A multi-stage stratified sampling method was used to select 5 407 middle students and implement a questionnaire survey on health status and influncing factors.@*Results@#The overall reported rate of campus bullying among middle school students in Henan Province was 2.2%. Boys reported higher rates of campus bullying in general(3.3%) than girls(1.1%), and the students in the economically poor area (2.9%) reported higher rates of being bullied than those in the economically medium area and the economically better area (2.0% and 1.8%), with statistically significant differences (χ2=30.66，6.02，P<0.05). Different family factors, tobacco and alcohol use, Internet and mobile phone use had different report rates of 6 types of bullying and overall bullying, with statistically significant differences (P<0.05). Multi-variate analysis showed that domestic violence (OR=4.76), alcohol consumption (OR=2.05) and Internet addiction (OR=2.63) were risk factors for campus bullying in middle school students, while girls (OR=0.41) had a lower risk of bullying victimization (P<0.05).@*Conclusion@#Campus bullying is common in middle school students in Henan province. Male students, domestic violence, alcohol consumption and Internet addiction are possible risk factors for bullying victimization. The targeted prevention measures should be taken in combination with multiple departments.

MiR-195 inhibits migration, invasion and epithelial-mesenchymal transition (EMT) of endometrial carcinoma cells by targeting SOX4

MicroRNAs (miRNAs) have been identified as potential biomarkers for endometrial carcinoma (EC) diagnosis, prognosisand therapy. The purpose of the present study was to investigate the detailed role and molecular mechanism of miR-195 inEC metastasis. qRT-PCR assay was performed to assess the expression of miR-195 and SRY-related high-mobility groupbox 4 (SOX4) mRNA in EC tissues and cells. The levels of N-cadherin, Vimentin, E-cadherin and SOX4 protein weredetermined by western blot. SOX4 protein expression in EC tissues was also determined by Immunohistochemistry (IHC)experiment. Transwell assay was used to analyze cell migration and invasion abilities. Dual-luciferase reporter assay andRNA Immunoprecipitation (RIP) assay were performed to confirm the targeted interaction between miR-195 and SOX4.Our data supported that miR-195 was downregulated and SOX4 was upregulated in EC tissues and cell lines. Upregulationof miR-195 inhibited migration, invasion and epithelial-mesenchymal transition (EMT) of EC cells. Moreover, SOX4 was adirect target of miR-195. MiR-195 overexpression-mediated anti-migration, anti-invasion and anti-EMT effects wereantagonized by SOX4 restoration in EC cells. In conclusion, our study suggested that miR-195 inhibited the migration,invasion and epithelial mesenchymal transition (EMT) of EC cells at least partly by targeting SOX4. Our study provided anovel underlying mechanism for EC metastasis and a promising therapeutic target for EC management.

Effective Components and Mechanisms of Drynariae Rhizoma Anti-osteoporosis Based on Network Pharmacology / 中国实验方剂学杂志

Objective:To predict the target of active components of Drynariae Rhizoma by the network pharmacology, map related targets of osteoporosis (OP), and analyze key nodes of interaction topologically, so as to comprehensively explore the pharmacological mechanism of anti-op of osteoclasts. Method:Firstly, the main active components of Drynariae Rhizoma were screened out from TCMSP based on the pharmacokinetic characteristics, and the related targets were predicted by Pubchem and Swiss Target Prediction database according to the Two-dimensional/Three-dimensional(2D/3D)structural similarity. Then, through Online Mendelian Inheritance in Man (OMIM) and Pubmed text, known OP therapeutic targets were mined, based on putative targets, String database was imported to build Drynariae Rhizoma treatment target OP interaction network diagram. With the help of CytoNCA software, the interaction key nodes were topologically identified according to relevant node parameters, and then imported into String database to build the protein interaction network graph. Finally, biological functions and metabolic pathways of key nodes were analyzed through DAVID database. Result:Sixteen active components of Drynariae Rhizoma were screened out, and 118 related targets were predicted according to the target prediction technique. Totally 316 known therapeutic targets for OP were retrieved. The protein interaction network was constructed according to the String network database. A total of 97 key nodes were screened via CytoNCA topology. The enrichment analysis showed that Drynariae Rhizoma may play an anti-osteoporosis role by regulating stem cells, osteoblasts, osteoclasts and immune cells through multiple signaling pathways in aspects of proliferation, differentiation, immunity and oxidative stress. Conclusion:Studies based on network pharmacology have shown that Drynariae Rhizoma may play an anti-op role through direct or indirect targets and multiple major signaling pathways and affect the proliferation and differentiation of multiple types of cells, in order to provid a scientific basis for explaining the material basis and mechanism of Drynariae Rhizoma's anti-osteoporosis effect.

Relation between aspirin resistance and thrombosis in high-risk pediatric patients following cardiac surgery: A prospective cohort study / 中国胸心血管外科临床杂志

@#Objective To determine the prevalence of aspirin (ASA) resistance in pediatric patients with congenital heart disease and evaluate whether postoperative thrombosis is associated with aspirin resistance. Methods A total of 52 patients undergoing high-risk congenital cardiac surgery were recruited in a prospective cohort study at Fuwai Hospital from August 2016 to December 2017. There were 29 males and 23 females with a median age of 8 months (6 d to 13 years). The response to aspirin was determined using the thromboelastography with platelet mapping (TEG-PM) system several days after administration. According to the arachidonic acid (AA) inhibition< 50% or not, they were divided into an ASA resistance group (n=14) and an ASA sensitivity group (n=38). Risk factors of ASA resistance were identified using univariate and multivariate analysis. Patients were monitored prospectively for three months for the development of a thrombosis event. Results Of 52 children analyzed, 14 (26.9%) were ASA resistance. The prevalence of thrombosis after ASA antiplatelet therapy was 5.9%. Dose escalation based on aspirin testing was performed in 3 of 14 patients, and the ASA sensitivity was observed in 1 patient. No correlation was found between ASA resistance and postoperative thrombosis (r=0.04, P=0.80). Conclusion Postoperative thrombosis is not associated with aspirin resistance in these patients. Our findings also suggest that resistance may be due to lack of aspirin doses, monitoring of aspirin therapy and consideration of dose adjustment or alternative agents for unresponsive patients.

Prognosis of the complete transposition of great arteries with left ventricular outflow tract obstruction after intraventricular repair / 中国胸心血管外科临床杂志

@#Objective     To compare the clinical characteristics and prognosis of patients who received two different intraventricular repair. Methods     We retrospectively analyzed the clinical data of 24 complete transposition of the great arteries (TGA)/left ventricular outflow tract obstruction (LVOTO) patients who all received intraventricular repair. The patients were allocated into two groups including a REV group and a Rastelli group. There were 13 patients with 9 males and 4 females at median age of 25.2 (6, 72) months in the REV group. There were 11 patients with 10 males and 1 female at median age of 47.9 (14, 144) months in the Rastelli group. Results     The age at operation (P=0.041), pulmonary valve Z value (P=0.002), and LVOT gradient (P=0.004), rate of multiphase operation between the REV group and the Rastelli group was statistically different. The mean follow-up time was 17.3 months. And during the follow-up, 1 patient had early mortality, 2 patients had early reintervention, 7 patients had postoperative RVOTO, and received Rastelli and larger VSD inner diameter were associated with postoperative RVOTO. Conclusion     As the traditional surgery for TGA/LVOTO patients, the intraventricular repair has a low early mortality and low early reintervention. Modified REV is associated with postoperative peripheral pulmonary vein isolation (PVIS). Patients who received Rastelli operation and with larger VSD inner diameter are more likely to have postoperative RVOTO, but the reintervention for PVI and   RVOTO during follow up is very low.

Free tissue flaps in head and neck reconstruction: clinical application and analysis of 93 patients of a single institution / Retalhos livres de tecido para reconstrução em cirurgias de cabeça e pescoço: aplicação clínica e análise de 93 pacientes de uma única instituição

Abstract Introduction Reconstruction with a free flap is routine in head and neck surgery because of better functional outcomes, improved esthetics, and generally higher success rates. Objective To evaluate the clinical outcomes in patients undergoing different microvascular free flap reconstructions. Methods This was a retrospective study of 93 patients undergoing reconstructions with free flaps from 2007 to 2015. Four types of free flap were performed: anterolateral thigh (76.3%), radial forearm (16.1%), fibula (4.3%) and jejunum (3.3%). Patients' demographic data were collected, and the outcomes measured included flap survival and complications. Postoperative functional and oncological outcome were also analyzed. Results The patients included 73 men and 20 women, with a mean age of 56.1 years. The most common tumor location was the tongue. Squamous cell carcinoma represented the vast majority of the diagnosed tumors (89.2%). The most common recipient vessels were the superior thyroid artery (77.4%) and the internal jugular vein (91.4%). Nine patients required emergency surgical re-exploration and the overall flap success rate was 90.3%. Venous thrombosis was the most common cause for re-exploration. Other complications included wound infection (5.4%), wound dehiscence (1.1%), partial flap necrosis (9.7%), fistula formation (10.8%), and 1 bleeding (1.1%). The majority of patients had satisfactory cosmetic and functional results of both donor site and recipient site after 46.7 months of mean follow-up. Conclusion Microsurgical free flap is shown to be a valuable and reliable method in head and neck surgery. It can be used safely and effectively with minimal morbidity in selected patients. The reconstruction can be performed by appropriately skilled surgeons with acceptable outcomes. Success rate appears to increase as clinical experience is gained.

Resumo Introdução Reconstrução com retalhos livres é um procedimento de rotina nas cirurgias de cabeça e pescoço devido aos melhores resultados funcionais e estéticos e às taxas de sucesso geralmente maiores. Objetivo Avaliar os desfechos clínicos de pacientes submetidos a diferentes reconstruções microvasculares com retalhos livres. Método Estudo retrospectivo de 93 pacientes submetidos à reconstruções com retalhos livres, de 2007 a 2015. Foram utilizados quatro tipos de retalho livre: coxa anterolateral (76,3%), antebraço radial (16,1%), fíbula (4,3%) e jejuno (3,3%). Os dados demográficos dos pacientes foram coletados e os parâmetros avaliados incluíram sobrevida e complicações. Os resultados funcionais e oncológicos pós-operatórios também foram analisados. Resultados Os pacientes incluíram 73 homens e 20 mulheres, com idade média de 56,1 anos. O local mais comum para o tumor foi a língua. O carcinoma de células escamosas representou a maioria dos tumores diagnosticados (89,2%). As artérias receptoras mais comuns foram a artéria tireóidea superior (77,4%) e a veia jugular interna (91,4%). Nove pacientes necessitaram de reexploração cirúrgica de emergência e a taxa de sucesso global do retalho foi de 90,3%. A trombose venosa foi a causa mais comum da reexploração. Outras complicações incluíram infecção da ferida cirúrgica (5,4%), deiscência da ferida (1,1%), necrose parcial do retalho (9,7%), formação de fístula (10,8%) e sangramento (1,1%). A maioria dos pacientes apresentou resultados estéticos e funcionais satisfatórios, tanto no local doador quanto no receptor, após 46,7 meses de seguimento médio. Conclusão O retalho livre microcirúrgico mostrou ser um método valioso e confiável na cirurgia de cabeça e pescoço. Pode ser usado de forma segura e eficaz, com morbidade mínima em pacientes selecionados. A reconstrução pode ser feita por cirurgiões adequadamente qualificados com resultados aceitáveis. A taxa de sucesso parece aumentar à medida que a experiência clínica é adquirida.

Unplanned re-intervention within 30 days after pediatric cardiac surgery / 中国胸心血管外科临床杂志

@#Objective     To recognize the risk factors of unplanned re-interventions within 30 days after pediatric cardiac surgery and evaluate the outcome of re-interventions. Methods     We retrospectively analyzed the clinical data of 202 children in Fuwai Hospital between January 1, 2015 and August 31, 2017. There were 115 males and 87 females at average age of 32.4 months with range of 3 days to 14 years. Results     There were 202 children who underwent unplanned re-intervention during 30 days post-operation, including 54 re-adjustments of pulmonary blood flow, 34 re-corrections for residual cardiac abnormalities, 28 cardiopulmonary resuscitations, 38 for coagulation problems, 19 pericardial drainages, 11 palliative re-operations to deliver heart load and 6 diaphragmatic folds and 12 others. The mortality rate among children who underwent unplanned re-inventions after cardiac surgery was 10.9% (22/202). It was much higher than those free from re-interventions (0.7%). Time of mechanical ventilation was 284.3 (11–2 339) h, and mean ICU stay was 17.7 (1–154) d, significantly longer than those free from re-interventions at the same period. Conclusion     Unplanned re-interventions after pediatric cardiac surgery is associated with higher mortality rate and longer recovery time. Early identifying risk factors and re-intervention can reduce the complications and improve the prognosis.

Application of pulmonary surfactant in the treatment of severe acute respiratory distress syndrome in different age baby with congenital heart diseases / 中国胸心血管外科临床杂志

@#Objective To evaluate the efficacy of pulmonary surfactant (PS) on severe acute respiratory distress syndrome (ARDS) in different age baby with congenital heart disease. Methods We divided 43 baby patients into two separate groups including a little baby group (12 patients with age less than 3 months) and an infants group (31 patients with age of 3 months to one year). Both groups of patients were treated with intratracheal PS at the same time. The clinical data were collected and analyzed. Results The little baby group had lower body weight. There was no statistical difference in the cardiopulmonary bypass (CPB) time, operation blocking time, mechanical ventilation time, ICU stay time between the two groups (P>0.05). Before treatment, arterial partial presurre of oxygen (PaO2), fractional oxygen concentration in inspire gas (FiO2), the ratio of arterial PO2 to the inspired oxygen fraction (P/F) and arterial-alveolar N2 difference or gradient (a/A) had no difference between the two groups (P>0.05). After treatment, PaO2 and P/F of both groups were significantly lower than before (P<0.05), and FiO2 and P/F were significantly higher than before (P<0.05). After 24 h of treatment, PaO2 and P/F of the little baby group was significantly higher than that of the infants group (P<0.05), and FiO2 and P/F were significantly lower than those of the infants group (P<0.05). Conclusion PS treating severe ARDS in little baby with congenital heart disease has better effect than infants.

Percutaneous occlusion of major aortopulmonary collaterals in children after cardiac surgery / 中国胸心血管外科临床杂志

@#Objective     Tho evaluate the outcomes of early percutaneous occlusion of these residual major aortopulmonary collateral arteries after heart surgery. Methods     This was a retrospective review of children undergoing early percutaneous embolization of major aortopulmonary collateral arteries after cardiac surgery. From January 2013 to February 2017, 52 consecutive patients with postoperative residual major aortopulmonary collateral arteries were treated with percutaneous embolization (38 males, 14 females; median age of 10.0 months, interquartile range 14.0 months; median weight 8.6 kg, interquartile range 4.4 kg). Fifty-one patients were cyanotic and 1 patient was acyanotic. Forty-nine patients underwent corrective surgery and 3 patients underwent B-T shunt. Results     Typical symptoms and signs of major aortopulmonary collateral arteries included: elevated left atrial pressure; focal lung infiltration, pink or blood-stained frothy sputum. The median time interval from cardiac surgery to percutaneous occlusion of major aortopulmonary collateral arteries was 5 (9) d, median duration of mechanic ventilation support since occlusion was 72 (159) h, mechanic ventilation support was 239 (480) h and median duration of intensive care unit was 19 (29) d. There was no death in this group. Conclusion     Angiocardiography could be able to demonstrate the existence of postoperative major aortopulmonary collateral arteries. The early percutaneous occlusion appears to be simple, safe and effective.