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Objective@#To explore the relationship between anemia and neuropsychological development in various domains among preschool children in China.@*Methods@#Data came from the National Nutrition and Health Systematic Survey for children in China, and 3 261 preschool children aged 2-6 years and their parents from 28 sites across 14 provinces were recruited in this study. Parental and child characteristics were obtained by interview administrated questionnaires. Blood hemoglobin(Hb) concentration was determined by Hemocue method. Neuropsychological development quotients were assessed using the Development Scale for Children Aged 0-6 Years(WS/T 580-2017).@*Results@#The average Hb level was (125.23±11.49)g/L and the overall anemia prevalence was 10.30% among preschool children. After adjusting the confounding factors(sex, age, ethnicity, region, feeding mode, maternal status during pregnancy, etc), developmental quotients of gross motor( β=-2.15, 95%CI =-3.89--0.41), fine motor( β=-2.46, 95%CI =-4.12--0.79), adaptive behavior( β=-2.59, 95%CI =-4.42--0.76), language( β=-3.65, 95%CI =-5.53--1.78), personal social behavior( β=-3.11, 95%CI =-4.94--1.28) and full scale( β=-2.79, 95%CI =-4.10--1.49) among children with anemia were significantly lower than non anemic infants( P <0.05).@*Conclusion@#Anemia was negatively associated with developmental quotient, as well as five domains of gross motor, fine motor, adaptive behavior, language, and personal social behavior in preschool children aged 2-6 years. It is suggested to carry out the work of anemia monitoring and intervention in preschool children to further improve their neuropsychological development.
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Objective@#To explore relationship between screen time and myopia in children aged 11-14 years in China.@*Methods@#The data were extracted from "National Nutrition and Health Systematic Survey and Application for 0-18 Years Old Children". A total of 12 397 children aged 11-14 years old from 14 provinces and 28 districts/counties in seven regions of China were surveyed by using multi stage stratified random sampling method. Daily screen time and visual acuity information were collected through a questionnaire.@*Results@#The myopia rate of 11-14 years old children in China was 45.0%, among which the rate of girls was higher than that of boys, and the rate of urban was higher than that of rural, and it increased with age ( χ 2=178.82,79.25, 495.96 , P <0.01). The daily screen time median of 12 397 children was 40.0 minutes, with boys(40.0 min) longer than girls( 35.0 min ) and urban children(40 min) longer than rural children(33.0 min) ( χ 2=20.86，102.68， P <0.01). The myopia rate of boys ( 42.5 %) with daily screen time greater than or equal to 60 minutes was higher than that of boys (36.4%) with daily screen time less than 60 minutes, and the myopia rate of girls (55.6%) with daily screen time greater than or equal to 60 minutes was higher than that of girls (48.0%)( χ 2=23.62，34.15， P <0.01). After adjusting for age, gender, region, time of medium and high intensity physical activity, intake of sugary food and sugary beverages, daily sleep time, multivariable Logistic regression model showed that girls with daily screen time greater than or equal to 60 minutes ( OR=1.14, 95%CI =1.03-1.27) had a higher risk of myopia than those with less than 60 minutes. After adjusting for confounding factors, there was no correlation between daily screen time and the degree of myopia in boys or girls( P >0.05).@*Conclusion@#Daily screen time greater than or equal to 60 minutes may be a risk factor for myopia in girls aged 11 to 14 years old. Given the complexity of the factors that affect vision, researches are needed to examine the relationship between screen time and myopia.
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Objective:To investigate the values of Ki-67 expression level and 4 molecular types for risk classification of prognosis in patients with medulloblastoma (MB).Methods:A retrospective study of 92 MB patients who underwent surgery and were confirmed by postoperative pathology in the First Affiliated Hospital of Zhengzhou University from January 2009 to January 2018 was performed. The clinical data and survival data of the patients were collected and sorted out. The overall survival (OS) and progression-free survival (PFS) were analyzed by Kaplan-Meier method, and the log-rank test was performed. Risk stratification of prognosis of patients was performed according to the Ki-67 expression level combined with molecular typing, the low-risk group had Ki-67 positive index ≤50% and WNT or SHH subtype, the medium-risk group had Ki-67 positive index ≤50% and GROUP 3 or GROUP 4 subtype, or Ki-67 positive index >50% and WNT or SHH subtype), and the high-risk group had Ki-67 positive index >50% and GROUP 3 or GROUP 4 subtype. The differences in OS and PFS among different risk groups were compared. A multivariate Cox proportional hazards model was used to assess factors affecting the survival of patients.Results:There were 50 cases (54.3%) with Ki-67 positive index ≤50% and 42 cases (45.7%) with Ki-67 positive index >50%. The 5-year PFS rate and OS rate of patients with Ki-67 positive index ≤50% were 46.9% and 63.1%, and patients with Ki-67 positive index >50% were 28.5% and 32.0%, there were statistical differences in PFS and OS between the two groups ( P values were 0.020 and 0.028). There were 16 cases (17.4%) of WNT subtype, 14 cases (15.2%) of SHH subtype, 40 cases (43.5%) of GROUP 3 subtype and 22 cases (23.9%) of GROUP 4 subtype, their 5-year PFS rates were 78.0%, 76.0%, 19.2% and 19.9%, respectively, and their 5-year OS rates were 82.1%, 76.0%, 40.2% and 0, respectively. MB patients with GROUP 3 or GROUP 4 subtype had poorer PFS and OS than patients with WNT or SHH subtype ( P values were 0.003 and 0.039). Ki-67 expression level and molecular typing were combined to carry out risk classification of prognosis. There were 12 cases (13.0%) in the low-risk group, 56 cases (60.9%) in the medium-risk group, and 24 cases (26.1%) in the high-risk group . There were statistical differences in PFS and OS among MB patients in low-, medium- and high-risk groups (both P < 0.001). Multivariate Cox regression analysis showed that radiotherapy and risk classification of prognosis as medium risk and low risk were independent protective factors for PFS (radiotherapy vs. no radiotherapy: OR = 0.263, 95% CI 0.124-0.556, P < 0.001; medium-risk group vs. high-risk group: OR = 0.069, 95% CI 0.008-0.581, P = 0.014; low-risk group vs. high-risk group: OR = 0.260, 95% CI 0.131-0.514, P < 0.001); radiotherapy and risk classification of prognosis as low risk were independent protective factors for OS (radiotherapy vs. no radiotherapy: OR = 0.221, 95% CI 0.097-0.503, P < 0.001; low-risk group vs. high-risk group: OR = 0.328, 95% CI 0.150-0.717, P = 0.005). Conclusions:The expression level of Ki-67 and 4 molecular types are related to the prognosis of MB patients. The combination of the two can be used to classify the prognosis risk of MB patients, which has reference significance for the prediction of prognosis of patients and the selection of individualized treatment plans.
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Objective:To identify the risk factors for postoperative early complications of low rectal cancer treated with intersphincteric resection (ISR).Methods:The perioperative data of 82 patients with low rectal cancer undergoing ISR at the General Surgery Department of Shaanxi Provincial People's Hospital between Jan 2017 to Dec 2021 were retrospectively analyzed. Univariate, Logistic regression and multivariate analysis were used to analyze the risk factors for early complications after ISR, and a nomogram prediction model was drawn. Predictive models are validated.Results:There were 22 patients (27%) with complications. Univariate analysis showed that early complications were related to diabetes (0.021), serum albumin (<0.001), nutritional prognosis index (0.003), neoadjuvant chemoradiotherapy (<0.001), and operation time (<0.001). By multivariate analysis, diabetes ( OR=4.853, 95% CI: 1.059-22.241, P=0.042), low serum albumin ( OR=0.672, 95% CI: 0.468-0.966, P=0.032), neoadjuvant chemoradiotherapy ( OR=4.482, 95% CI: 1.117-17.979, P=0.034) and longer operation time ( OR=1.015, 95% CI: 1.001-1.029, P=0.037) were independent risk factors A nomogram prediction model was thus constructed, and the area under the curve of the nomogram prediction model was 0.888 (95% CI: 0.812-0.965). Conclusion:Diabetes mellitus, low serum albumin, neoadjuvant chemoradiotherapy, and longer operation time are independent risk factors of early postoperative complications for low rectal cancer undergoing ISR.
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Objective:To explore the effects of external diaphragm electrical stimulation on the diaphragm thickness and function in mechanically ventilated children.Methods:A randomized controlled trial was conducted in children who were admitted to PICU at Children′s Hospital of Fudan University and received mechanical ventilation between June 2021 and April 2022.The control group was given the routine treatment of mechanical ventilation, and the intervention group was given external diaphragm electrical stimulation in the early stage of mechanical ventilation in addition to routine treatment.Diaphragm thickness was continuously measured by bedside ultrasound every day for one week after mechanical ventilation, and the changing trend of diaphragm thickness was observed, and the diaphragmatic thickening fraction (DTf) and the incidence of ventilator-induced diaphragmtic dysfunction(VIDD) were calculated at the same time.Results:A total of 32 valid samples were included, including 15 cases in intervention group (10 males) and 17 cases in control group (11 males). The median age of the patients was 33 (10, 77) months, and the median duration of mechanical ventilation was 12 (8, 21) days.The reasons for mechanical ventilation in children included respiratory insufficiency in ten cases, brain dysfunction in ten cases, heart failure in eight cases, and postoperative surgery in four cases.The diaphragm end-expiratory thickness (DTe) in intervention group and the control group showed a gradually decreasing trend from the 1st day to the 7th day.The left thickness was reduced by 11% on the 7th day compared to 1st day in intervention group, which was reduced by 18% in control group; the average daily DTe was reduced by 2% per day in intervention group and by 3% per day in control group.The trends on the right and left were similar.The DTe thickness in the intervention group was greater than that in control group, among which, the mean DTe thickness in the left side of the intervention group on the 7th day was (0.110 7±0.023 7)cm, which was greater than that in control group (0.093 5±0.016 9)cm, and the difference was statistically significant ( t=-2.372, P<0.05); On the second day, the mean DTe thickness on the right side in the intervention group was (0.1267±0.0277) cm, which was greater than that in control group (0.104 7±0.018 1)cm, and the difference was statistically significant ( t=-2.688, P<0.05). DTf in the intervention group was lower than that in control group at 7th day, but the difference was not statistically significant(left DTf: adjusted mean difference was -0.117, P=0.088; right DTf: adjusted mean difference was -0.065, P=0.277). The incidence of VIDD in the intervention group was lower than that in control group(33.3% vs.41.2%), but the difference was not statistically significant ( χ2=0.005, P=0.946). Conclusion:External diaphragmatic electrical stimulation may be helpful for alleviating diaphragmatic atrophy in mechanically ventilated children.However, whether the improvement of diaphragm atrophy is beneficial to clinical outcome still needs further study.
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Objective:To summarize the experience of the precise prevention and control strategy of novel coronavirus infection in the pediatric intensive care unit(PICU)during the epidemic of the Omicron variant.Methods:A retrospective analysis was performed on the strategies and management experience of precise prevention and control of novel coronavirus infection in PICU at Pediatric Hospital of Fudan University from March 1 to May 10, 2022.Results:According to the national and Shanghai novel coronavirus infection prevention and control standards, the PICU in our hospital, in accordance with the specialty characteristics of PICU, cooperated with the hospital′s department of infection and medical department to jointly construct a precise ward management strategy for the outbreak of the omicron mutants infection.Precise prevention and control management strategies were formulated from four aspects: the admission process of critically ill children, the division of PICU ward areas and nosocomial infection protection, the reception management system for children′s family members, and the " bubble management" system for PICU staff, and run them for 3 months.During the epidemic, there was no nosocomial infection of novel coronavirus infection in children or medical staff.During the period, a total of 140 critically ill children were admitted, including 87 cases transferred from the general ward in the hospital, 48 cases from the emergency department(non-febrile, 3 cases transferred by the transfer team), four cases from fever clinic, and one case from control ward.Four of the critically ill children had no emergency nucleic acid test report when they were admitted to the PICU.Among the 140 critically ill children, 54 patients received mechanical ventilation, 18 patients received blood purification, and two patients were monitored after liver transplantation.Seventy-eight (55.7%) children had underlying diseases.Conclusion:During the current round of novel coronavirus epidemic in Shanghai, PICU in our hospital formulated the admission and ward management procedures for critically ill children, which ensured the prevention and control of nosocomial infection of novel coronavirus, and at the same time ensured the treatment of critically ill children to the greatest extent.
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Objective:To evaluate the clinical efficacy and safety of oral mifepristone (10 mg/day) versus placebo in the preoperative treatment of uterine fibroids.Methods:This study was a multi-center, randomized, double-blind, placebo, parallel controlled trial. A total of 132 patients with uterine fibroids were randomly divided into study group and control group, with 66 cases in each group. The patients in the study group orally took 1 tablet/day of mifepristone (dose of 10 mg/tablet), the patients in the control group orally took 1 tablet/day of placebo, and both groups were treated for 3 months. The primary efficacy evaluation indicators were the change rate of maximum fibroid volume; the secondary efficacy evaluation indicators included amenorrhea rate, improvement of subjective symptoms and anemia; the safety evaluation indicators included the analysis of adverse events and changes in laboratory biochemical indicators.Results:At the end of treatment, the maximum leiomyoma volume was reduced by 25.97% (95% CI: -34.79%--15.95%) in the study group and reduced by 1.51% (95% CI: -13.03%-11.54%) in the control group. The change rate of the maximum leiomyoma volume before and after treatment in the study group was significantly greater than that in the control group, and the difference in the change rate of the maximum leiomyoma volume between the two groups was -24.84% (95% CI: -36.56%--10.94%), which was much higher than the 10% superiority threshold goal set by this study within the 95% CI interval. At the end of treatment, the complete amenorrhea rate [84% (52/62)], dysmenorrhea elimination rate [98% (61/62)], and menstrual blood loss disappearance rate [87% (54/62)] in the study group were significantly higher than those in the control group (all P<0.05). At the end of treatment, the mean hemoglobin [(131±13) g/L], red blood cell count [(4.5±0.4)×10 12/L] and hematocrit (0.39±0.03) in the study group were significantly increased compared with the baseline, and the differences had statistical significance (all P<0.05); after treatment, the differences in the above three indicators between the two groups had statistical significance (all P<0.01). The serum estradiol level in the study group was significantly lower than that in the control group at the end of treatment, and the difference was statistically significant ( P<0.01). There were no significant differences in follicle-stimulating hormone and cortisol levels before and after treatment between the two groups ( P>0.05). The overall incidences of any adverse event were not significantly different between the two groups (all P>0.05). Abdominal pain was the most common adverse event in the study group [9% (6/65)], but the incidence was not significantly increased compared with the control group [3% (2/64); P>0.05]. Conclusion:Compared with placebo, oral mifepristone 10 mg/day is significantly superior to placebo in reducing the size of uterine fibroids and improving anemia, without significant adverse reactions, and could be used as a drug treatment for patients with of uterine fibroids before surgery.
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Objective:To explore the value of the model based on multi-sequence magnetic resonance imaging (MRI) radiomics and clinical features in predicting molecular subtypes of pediatric medulloblastoma (MB).Methods:MRI imaging data and clinical data of 100 children with primary MB admitted in the First Affiliated Hospital of Zhengzhou University from January 2011 to January 2020 were analyzed retrospectively.Fifty children with primary MB were allocated to training cohort, and those of the other 50 were allocated to testing cohort by using simple random sampling method.In the training cohort, there were 5 cases of WNT-activated MB (Wingless, WNT), 5 cases of SHH-activated MB (Sonic hedgehog, SHH), 28 cases of non-WNT/non-SHH medulloblastoma Group3 (Group3), 12 cases of non-WNT/non-SHH medulloblastoma Group4 (Group4). The testing cohort included 11 cases of WNT, 3 cases of SHH, 24 cases of Group3 and 12 cases of Group4.The robust and non-redundant features were selected from 5 929 three-dimensional radiomic features extracted from the manually delineated tumor area, and Boruta algorithm was used to further select the optimal features.Based on the selected features, a random forest prediction model was constructed using the training cohort (50 cases), which was further used to evaluate the testing cohort (50 cases). Combined with radiomic features and clinical features, a joint random forest prediction, clinical-radiomic model was constructed.Results:A radiomic model containing 13 optimal radiomics features was used to predict molecular subtypes of MB.The area under curve(AUC) of receiver operating characteristic (ROC) curve for WNT, SHH, Group3 and Group4 MB cases in the testing cohort was 0.923 1, 0.673 7, 0.519 2 and 0.705 0, respectively.Incorporating clinical features into the radiomic model improved AUC for WNT and SHH at 0.944 1 and 0.819 1, respectively.Conclusions:The multi-sequence clinical radiomic model has a high predictive value for pediatric MB with the molecular subtypes of WNT and SHH, which provides decision-making supports for individualized diagnosis and treatment of pediatric MB.
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Objective:To probe into the causes, reconstructive strategies, and repair outcomes of asymmetric eyelid configuration after blepharoplasty.Methods:All 73 patients (14 males and 59 females) with asymmetric double eyelid after blepharoplasty were recruited between July 2013 and June 2018 from Department of Plastic and Burns Surgery, West China Hospital, Sichuan University. The patients aged from 18 years to 42 years with the median age of 27 years. The new double eyelid line was designed pre-operation. Releasing subcutaneous adhesion of upper eyelid entirely, trimming inferior orbicularis oculi, adjusting and comparing the attachment position of bilateral levator aponeurosis were performed during surgery. Patients and surgeons marked the appearance of double eyelid both before and after repair operation, results of which were analyzed by t-test.Results:All 73 patients obtained improved double eyelid with primary healing. During follow-up from 8 to 12 months, repaired double eyelid showed satisfactory configuration with smooth natural double eyelid line and symmetric bilateral double eyelid. Of the 73 patients, 3 (4.1%) complaint rough double eyelid line, for whom re-fixation through small incision were adopted and no complication was observed during follow-up time. Scores by patients and surgeons were both significantly better after surgery.Conclusions:Analyzing the causes of asymmetric eyelid after double-eyelid blepharoplasty and repairing it contribute to aesthetic pleasing reconstructed double eyelid.
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Objective:To investigate the status of Corona Virus Disease 2019 (COVID-19) health literacy and associated factors in Inner Mongolia Autonomous Region.Methods:Based on the multi-stage stratified sampling method, the questionnaire survey of health literacy of COVID-19 were carried out in 55 599 local residents from12 prefecture-level cities of Inner Mongolia Autonomous Region between March 10 and 15, 2020. The questionnaire in details included not only knowledge, attitude and behavior, but also mental health, their scores were calculated using Decimal method. A ≥80% of the correct answer rate of the survey content was regarded as qualified for health literacy. There were 51 722 (93.0%) valid questionnaires, according to the ratio of medical staff to non-medical staff, 32 529 questionnaires were selected for analysis. The health literacy level was defined according to the proportion of qualified people.The credibility and availability of the questionnaires were evaluated by Cronbach′s α coefficient and KMO test. The associated factors were analyzed by Pearson χ 2 test and logistic regression. Results:In Inner Mongolia Autonomous Region, the whole level of health literacy of COVID-19 was 85.7%, and their scores were (26.30±2.48). Knowledge, attitude, and behavioral literacy levels were 61.6%, 95.6%, and 96.8%, respectively. Compared with the population of 15-25 years old, the health literacy level of 46-65 years old was the highest ( OR=2.00, 95% CI: 1.78-2.24). The health literacy level of medical staff group ( OR=2.54, 95% CI: 1.30-4.95) was far higher than the non-medical staff group; the population with college or above education level ( OR=10.22, 95% CI: 9.19-11.36) was significantly higher than the population with education level below college. The degree of anxiety was negatively correlated with education level. Conclusions:The health literacy level of COVID-19 in residents in Inner Mongolia Autonomous Region is relatively high, but the level of knowledge literacy needs to be improved. The main factors affecting the health literacy of COVID-19 among Inner Mongolia residents are age, occupation and education level.
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Objective:To investigate the effect of peripheral blood neutrophil to lymphocyte ratio (NLR) and platelet distribution width (PDW) on the clinical prognosis of childhood medulloblastomaMethods:Clinical data and survival data of 76 pediatric patients who were diagnosed as medulloblastoma by post-operative pathology in the First Affiliated Hospital of Zhengzhou University from January 2009 to December 2016 were collected. Kaplan- Meier method was used to calculate the overall survival(OS) and progression free survival(EFS) rates, Log- rank test was employed to compare the survival rates of different groups, and Cox proportional hazards regression model was used for multivariate analysis. Results:The log- rank test revealed that 5-year PFS rate and OS rate (22.2%, 22.2%) in the high NLR group (NLR>4.94) were significantly lower than those in the low NLR group (NLR≤4.94) (45.6%, 55.7%), and the differences were statistically significant(PFS: P=0.009, OS: P=0.001), and the 5-year PFS and OS (52.3%, 66.5%) of the high PDW group (PDW>15.90) were significantly higher than those in the low PDW group (PDW ≤ 15.90) (27.1%, 32.5%), and the differences were statistically significant(PFS: P=0.032, OS: P=0.039). Univa-riate analysis showed that the extent of resection (PFS: P=0.006, OS: P=0.009), and postoperative radiotherapy (PFS: P=0.011, OS: P=0.001) and postoperative radiotherapy(PFS: P=0.011, OS: P=0.001) were the factors influencing the prognosis of children with medulloblastoma.Multivariate Cox proportional hazards regression model analysis suggested that no postoperative radiotherapy (PFS: P=0.048, OS: P=0.008), NLR>4.94 (PFS: P=0.023, OS: P=0.003) and PDW≤15.90 (PFS: P=0.028, OS: P=0.006) were the independent risk factors for the prognosis of childhood medulloblastoma. Conclusions:Increased NLR and decreased PDW indicate unfavorable prognosis of the childhood medulloblastoma.Therefore, preoperative NLR and PDW may be the potential prognostic markers for childhood medulloblastoma.
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Objective@#To study the effect of sinus tarsi approach in patients with calcaneus fracture combined with high risk factors of incision complications.@*Methods@#The clinical data of 18 patients with calcaneus fracture combined with high risk factors of incision complications in Jinzhou Center Hospital from July 2015 to July 2017 were retrospectively analyzed. In all patients, combined diabetes mellitus was in 8 cases, long-term smoking history was in 13 cases, combined diabetes mellitus and smoking was in 3 cases. Active and passive smoking were prohibited in hospital, and fasting and postprandial blood glucose were monitored and controlled. In order to reduce swelling, plaster fixation, limb elevation and cold compression were performed. After the blood glucose was stable and local swelling was reduced, surgery was performed via the sinus tarsi approach. After 1 to 2 weeks of postoperative gypsum fixation, the non-weight-bearing function exercise was allowed. After early activities and late loading, the weight-bearing function exercise began at least 12 weeks after surgery.@*Results@#All patients were followed up for 12 to 20 months (mean 14.3 months). No skin necrosis and infection occurred. All fractures healed, and fracture healing time was 11 to 16 weeks, with mean time of 13.5 weeks. The American Orthopaedic Foot and Ankle Society Ankle Hindfoot score was used to evaluate the curative effect. Six cases were excellent, 10 cases were good, and 2 cases were passable.@*Conclusions@#Treatment of calcaneal fracture via tarsal sinus approach has little interference with soft tissue. It is especially suitable for the patients with high risk factors of incision complications, which can effectively avoid the occurrence of incision complications. At the same time, the postoperative functional recovery is satisfactory. It is a good approach in patients with calcaneal fracture combined with high risk factors of incision complications.
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Objective: To summarize clinical experience and curative effect in applying three-dimensional mechanical equilibrium concept to cartilage scaffold construction in total auricular reconstruction. Methods: Between June 2015 and June 2017, ninety-seven microtia patients (102 ears) were treated with total ear reconstruction by using tissue expanders. The patients included 43 males and 54 females and their age ranged from 7 to 45 years with an average of 14 years. There were 92 unilateral cases (45 in left side and 47 in right side) and 5 bilateral ones. There were 89 congenital cases and 8 secondary cases. According to microtia classification criteria, there were 21 cases of type Ⅱ, 67 cases of type Ⅲ, and 9 cases of type Ⅳ. Tissue expander was implanted in the first stage. In the second stage, autogenous cartilage was used to construct scaffolds which were covered by enlarged flap. According to the three-dimensional mechanical equilibrium concept, the stable ear scaffold was supported by the scaffolds base, the junction of helix and inferior crura of antihelix, and helix rim. The reconstructed ears were repaired in the third stage operation. Results: All patients had undergone ear reconstruction successfully and all incisions healed well. No infection, subcutaneous effusion, or hemorrhage occurred after operation. All skin flaps, grafts, and ear scaffolds survived completely. All patients received 5- to 17-month follow-up time (mean, 11.3 months) and follow-up time was more than 12 months in 61 cases (64 ears). All reconstructed ears stood upright, and subunits structure and sensory localization of reconstructed ears were clear, and the position, shape, size, and height of bilateral ears were basically symmetrical. Mastoid region scar hyperplasia occurred in 3 patients, which was relieved by anti-scar drugs injection. No scaffolds exposure, absorption, or structural deformation occurred during follow-up period. Conclusion: Application of three-dimensional mechanical equilibrium concept in cartilage scaffold construction can reduce the dosage of costal cartilage, obtain more stable scaffold, and acquire better aesthetic outcomes.
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Objective To study the effect of sinus tarsi approach in patients with calcaneus fracture combined with high risk factors of incision complications. Methods The clinical data of 18 patients with calcaneus fracture combined with high risk factors of incision complications in Jinzhou Center Hospital from July 2015 to July 2017 were retrospectively analyzed. In all patients, combined diabetes mellitus was in 8 cases, long-term smoking history was in 13 cases, combined diabetes mellitus and smoking was in 3 cases. Active and passive smoking were prohibited in hospital, and fasting and postprandial blood glucose were monitored and controlled. In order to reduce swelling , plaster fixation, limb elevation and cold compression were performed. After the blood glucose was stable and local swelling was reduced, surgery was performed via the sinus tarsi approach. After 1 to 2 weeks of postoperative gypsum fixation, the non-weight-bearing function exercise was allowed. After early activities and late loading, the weight-bearing function exercise began at least 12 weeks after surgery. Results All patients were followed up for 12 to 20 months (mean 14.3 months). No skin necrosis and infection occurred. All fractures healed, and fracture healing time was 11 to 16 weeks, with mean time of 13.5 weeks. The American Orthopaedic Foot and Ankle Society Ankle Hindfoot score was used to evaluate the curative effect. Six cases were excellent, 10 cases were good, and 2 cases were passable. Conclusions Treatment of calcaneal fracture via tarsal sinus approach has little interference with soft tissue. It is especially suitable for the patients with high risk factors of incision complications, which can effectively avoid the occurrence of incision complications. At the same time, the postoperative functional recovery is satisfactory. It is a good approach in patients with calcaneal fracture combined with high risk factors of incision complications.
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Objective: To observe the clinical manifestations of cervical esophageal webbed stenosis in the patients with Plummer-Vinson syndrome(PVS) and analyze its relationship with hypopharyngeal carcinoma, and to raise the clinicians' awareness of the disease. Methods: The diagnosis and treatment process of one patient with PVS complicated with hypopharyngeal carcinoma was summarized, and its clinical characteristics were analyzed in combination with relevant literatures.Results: A 39-year-old patient with PVS as a complaint by "dysphagia" was diagnosed as hypopharyngeal carcinoma by electronic laryngoscope and pathological biopsy. A lot of intraepithelial papillary capillary loops (IPCL) were seen on narrow band imaging(NBI) of the mucosa extending downward from the posterior and lateral walls of the hypopharynx to the upper part of the esophageal web. The hypopharyngeal mucosa with dense IPCL was found to have moderate to severe dysplasia. After 2 courses of induction chemotherapy for hypopharyngeal carcinoma, the symptoms disappeared and the tumor volume was significantly decreased.Conclusion: The occurrence of hypopharyngeal carcinoma is related to the mucosal changes of PVS. NBI technique is helpful for early diagnosis of hypopharyngeal and esophageal mucosal degeneration in the PVS patients.
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Objective To investigate the changes of serum retinol binding protein 4 (RBP4) concentration in peripheral blood of normal gravidas at different stages during pregancy and the differential expression of serum RBP4 in gravidas with fetal growth restriction (FGR) in second trimester.Methods This study enrolled 80 gravidas who received routine prenatal examination and delivered in the Beijing Luhe Hospital Affiliated to Capital Medical University from January 2014 to January 2015,Forty gravidas were classified to FGR group as the birth weight of their fetuses was below two standard deviations or below the 10th percentile for the corresponding gestationas and same sex,or less than 2 500 g after 37 weeks.The other 40 gravidas who delivered newborns with normal birth weight (2 500 g ＜ birth weight ＜ 4 000 g) were used as control group.Levels of serum RBP4,plasma albumin,fasting blood glucose,triglyceride,total cholesterol,low density lipoprotein-cholesterol (LDL-C),hemoglobin,fasting insulin and vitamin A were determined before pregnancy and at 12-16,20-24,28-32 and 36-40 weeks of gestation.Homeostasis model assessment-insulin resistance (HOMA-IR) was calculated.Independent sample t test or analysis of variance,Chi-square test or Fisher exact test was used for statistical analysis.Pearson correlation was used to analyze the relationship between peripheral blood RBP4 level and neonatal birth weight at 20-24 weeks.Results (1) Serum RBP4 levels in normal gravidas were (24.65± 10.02),(29.86±23.40),(56.10± 12.28),(65.80±20.56) and (53.71 ±24.17) μg/ml before pregnancy and at 12-16,20-24,28-32 and 36-40 weeks of gestation,respectively,showing a gradually increasing trend with gestational week until a peak at 28-32 weeks and then followed by a decrease (F=14.173,P＜0.001).(2) The body mass index and placental weight of gravidas in FGR group were lower than those in control group [20.7±3.3 vs 22.9±2.1,(401.3±56.2) vs (501.3±64.7) g;t=22.590 and 2.487,both P＜0.05].(3) The fasting blood glucose,fasting insulin,HOMA-IR,RBP4 and plasma albumin in FGR group were lower than those in control group [(4.06± 0.4) vs (4.38 ± 0.4) mmol/L,(21.84± 15.2) vs (31.76 ± 1.5) μ U/ml,0.5 ± 0.2 vs 0.7±0.2,(41.78± 12.8) vs (65.80±20.5) μg/ml,(35.1 ±2.7) vs (36.5±2.3) g/L;t=3.419,2.355,3.419,6.263 and 2.462,all P＜0.05].Maternal serum RBP-4 at 20-24 weeks of normal gravidas and FGR gravidas were positively correlated with the birth weight of newborns (r=0.717 and 0.748,both P＜0.05).Conclusions Serum RBP4 of gravidas may be associated with the occurrence of FGR.
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Objective To investigate the efficacy of conventional laparoscopy and mini-laparoscopic surgery in the treatment of endometriosis(EM). Methods From September 2015 to November 2016, 35 cases of endometriosis were treated with mini-laparoscopic surgery(mini group,15 cases)or conventional laparoscopic surgery(conventional group,20 cases)in Beijing Huafu Women&Children's Hospital.The peri-operative parameters,incidence of complications, and symptom relief rate were observed in both groups. Results The operation time was(68.2 ±2.1)min in the mini group,which was significantly shorter than that in the conventional group[(78.4 ±2.3)min,t=13.468,P=0.000].The intraoperative blood loss was significantly less in the mini group (12.1 ±6.7)ml than that in the conventional group[(21.4 ±7.8)ml, t=-3.703, P =0.000].The recovery time of gastrointestinal function was significantly lower in the mini group(21.5 ±7.6)h than that in the conventional group[(28.6 ± 7.4)h,t=-2.777, P=0.009].The hospital stay was significantly shorter in the mini group(2.7 ±1.1)d than that in the conventional group[(3.7 ±1.1)d,t=-2.662,P=0.012].The incidence of postoperative complications was 6.7%(1/15)in the mini group,which was significantly lower than that in the conventional group[40.0%(8/20), Fisher exact test, P =0.048]. Postoperative pathology:the mini group had 6 cases of deep infiltration type EM, 9 cases of pelvic EM, and 7 cases of ovarian chocolate cysts; the traditional group had 13 cases of deep infiltration type EM, 7 cases of pelvic EM, and 10 cases of ovarian chocolate cysts.The follow-up time was 3-9 months,including 15 cases in the mini group for(6.2 ±2.8)months and 20 cases in the conventional group for(6.8 ±2.6)months.There was no significant difference between the two groups in symptom relief rate[93.3%(14/15)vs.85.0%(17/20)]and the recurrence rate[20.0%(3/15)vs.20.0%(4/20), Fisher exact test, P=0.619 and 1.000]. Conclusion Mini-laparoscopic surgery for EM has advantages of small incision, shorter hospital stay, and less postoperative complications,being worthy of clinical promotion.
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Objective To evaluate whether arm equilibrium pressure (Parm) is helpful to predict the effect of fluid load in improving oliguria in intensive care unit(ICU) patients.Methods Hemodynamically stable patients [mean artery pressure (MAP)＞65 mmHg (1 mmHg=0.133 kPa),heart rate (HR)＜120 beats/min,lactic acid＜2 mmol/L] with urine output (UO)＜0.5 ml· kg-1· h-1 for 3 consecutive hours were enrolled.The fluid loading was performed by infusion of ringer's lactate 500 ml within 30 minute after baseline hemodynamic data were recorded.The positive renal response was defined as UO increased more than 0.5 ml· kg-1 · h-1 1 hour after fluid challenge,otherwise was negative.Results A total of 30 oliguric ICU patients were enrolled including 17 males and 13 females with median age (54.2±16.3) years.After fluid load,patients' HR decreased[(84± 13)beat/min vs.(80± 10) beat/min,P＜0.01],central venous pressure (CVP) increased[(7.0±2.4)mmHg vs.(8.8±2.6) mmHg,P＜0.01],30s Parm [(33.4±5.3) mmHg vs.(35.4±5.8) mmHg,P＜0.01] and 60s Parm [(26.9±4.5) mmHg vs.(28.7±5.0) mmHg,P＜0.01] increased,and UO [(18.5±8.8)ml/h vs.(64.1±38.3)ml/h,P＜0.01] increased significantly,while MAP and lactic acid did not change (P＞0.05).There were eighteen renal responders and 12 patients did not response.In responding group,MAP[(78.1 ±10.7) mmHg vs.(91.2±11.7) mmHg,P＜0.01],30s Parm[(30.4±3.8) mmHg vs.(38.0±3.7) mmHg,P＜0.01]and 60s Parm [(24.3±2.5) mmHg vs.(30.8±4.0) mmHg,P＜0.01] before fluid load were lower than those in negative group.HR,CVP,lactic acid,age and body weight were comparable between two groups (P＞0.05).After volume loading,MAP,30s and 60s Parrn in positive group were still lower than those in negative group (P＜0.05),while HR,CVP and lactic acid were similar (P＞0.05).Correlation analysis showed that baseline 30s Parm (r=-0.75,P＜0.01),60s Parm (r=-0.69,P＜0.01),and MAP (r=-0.46,P＜0.05) were negatively correlated with 1 h UO after fluid load,but HR and CVP were not (P＞0.05).The receiver operating curve (ROC) showed that 30s Parm had the largest area under curve (AUC) of 0.94 (95％ CI 0.84-1.05,P＜0.01),which 35.5 mmHg was the best threshold with sensitivity 94.4％ and specificity 91.7％(likelihood ratio 11.37).Conclusion In hemodynamically stable oliguric ICU patients,if Parm is lower than normal reference value,volume expansion is more likely to increase UO.Thus Parm can be used to predict the effect of fluid loadon UO.
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<p><b>OBJECTIVE</b>To investigate the safety and feasibility of 3D laparoscopic surgery via transrectal extraction of specimens without abdominal incision in the treatment of slow transit constipation (STC).</p><p><b>METHODS</b>From May 2015 to January 2017, 8 STC patients (6 females and 2 males) with informed consent were selected to receive subtotal colectomy with 3D laparoscopy as the no-incision incision group, in which the initial part of ascending colon and rectum were end-to-end anastomosed directly after extraction of the specimen through the rectum. Twelve STC patients (9 females and 3 males) undergoing traditional subtotal colectomy with 3D laparoscopy were selected as the traditional group by case matching method (gender, age, BMI, the difference of receiving operation time less than 12 months, same surgeon team). Perioperative parameters (operation duration, intraoperative blood loss, exhausting time, postoperative hospital stay, complications, postoperative pain score and additional pain management), inflammation index at postoperative day 1 and day 3 (leukocyte, procalcitonin, interleukin 6, C-reactive protein), postoperative peritoneal infection, wound healing, short-term and long-term efficacy, patient satisfaction evaluation (subjective hundred-mark system) at postoperative one year were compared between two groups.</p><p><b>RESULTS</b>There were no significant differences between two groups in operation duration, intraoperative blood loss, exhausting time, postoperative hospital stay and morbidity of complication (all P>0.05). Significantly lower pain scores at postoperative 6-hour (median 3.0 vs. 4.5, U=23.0, P=0.042), lower ratio of additional analgesic at postoperative day 1(1/8 vs. 7/12, P=0.040) were found in the no-incision group. Leukocyte level at postoperative day 1 was significantly lower in the no-incision group [(11.0±3.5)×10/L vs. (14.7±3.6)×10/L, t=-2.281, P=0.035]. C-reactive protein concentration at postoperative day 3 was not significantly different between two groups but with different trend [median 78.1(0.1 to 154.0) mg/L vs. 22.0 (7.0 to 55.9) mg/L,U=33.0, P=0.047]. There were no significant differences of interleukin-6 and procalcitonin between two groups(all P>0.05). All the patients had follow-up for 14-31 months. Subjective effectiveness score was 90±9 in the no-incision group and 94±6 in the traditional group without significant difference(t=-1.099, P=0.286). No long-term complications associated with abdominal infection was observed in the no-incision group.</p><p><b>CONCLUSION</b>3D laparoscopic subtotal colectomy via transrectal extraction of specimens without abdominal incision in the treatment of STC has similar short-term and long-term efficacies compared with traditional laparoscopic assisted surgery, and does not increase the probability of abdominal contamination.</p>
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Colectomy , Methods , Constipation , General Surgery , Female , Humans , Laparoscopy , Length of Stay , Male , Operative Time , Rectum , Treatment OutcomeABSTRACT
Objective@#To investigate the helping role of Kangfuxin liquid on early enteral nutrition in craniocerebral injury patients with mechanical ventilation, and the indirect effect on mechanical ventilation.@*Methods@#60 craniocerebral injury patients with mechanical ventilation and early enteral nutrition were selected, and they were randomly divided into treatment group and control group according to the digital table, 30 cases in each group.All patients were given conventional treatment and nutritional support, the patients in the treatment group were given Kangfuxin liquid.Before and 7 days after treatment, the levels of albumin(ALB), pre albumin(PA) and totalprotein(TP) were tested.The incidence of abdominal distension, reflux and aspiration in 7 days were recorded.The time of mechanical ventilation and the stay time in ICU were recorded.The mortality rate in 28 days was recorded.@*Results@#7 days after treatment, the levels of ALB[(33.47±4.82)g/L vs.(30.47±4.64)g/L], PA[(206.21±41.87)mg/L vs.(185.62±38.94)mg/L]and TP[(57.82±5.96)g/L vs.(54.47±6.17)g/L]in the treatment group were higher than those in the control group(t=2.456, 2.338, 2.139, all P<0.05). The incidence rates of abdominal distension(20.00% vs.53.33%), reflux(16.67% vs.43.33%), time of mechanical ventilation[(11.76±2.02)d vs.(13.02±1.96)d]and the stay time in ICU[(13.74±2.31)d vs.(15.43±2.14)d]in the treatment group were lower than those in the control group(χ2=7.177, 5.07, t=2.452, 2.940, all P<0.05). There was no statistically significant difference in 28-day mortality rate (P>0.05).@*Conclusion@#Kangfuxin liquid has helping role on early enteral nutrition in craniocerebral injury patients with mechanical ventilation.And it is helpful to shorten the time of mechanical ventilation.