Information-Motivation-Behavioral Skills Model Supplemented With the Moderated-Mediation Path: A Framework for Interpreting Patients' Online Medical Services Utilization.

PURPOSE: This study aimed to explore the internal determinants affecting patients' utilization of online medical services (OMS) based on the information-motivation-behavioral skills model from a behavioral perspective. DESIGN: A cross-sectional study. SETTING: This study was conducted in three medical institutions in Jiangsu Province, China. SUBJECTS: 470 internet users were enrolled from patients who came to the outpatient clinics. MEASURES: A self-administered questionnaire with feasible reliability and validity was used to investigate the demographic characteristics and OMS utilization-related information, motivation, behavioral skills, intention, and behavior. ANALYSIS: According to the constructed framework, structural equation modeling was used to test the relationships between those factors and OMS utilization behaviors. RESULTS: All direct paths are established except the path between information and intention. Information and motivation positively affected OMS utilization behavior through behavioral skills and intention (P < .001). Motivation and behavioral skills could positively influence OMS utilization behavior through intention (P < .01). Motivation was found to be the largest predictor of OMS utilization behavior. Moreover, gender played a moderating role in the interpretation of the behavior. CONCLUSIONS: Interventions should be conducted regarding information, motivation, and behavioral skills to promote patients' use of OMS. At the same time, the impact of gender on intervention effectiveness should also be considered.

Online medical services utilization evaluated through the lens of socioecological theory and the information-motivation-behavioral skills model: evidence from China.

Online medical services (OMS) have become increasingly advantageous, but there are still several barriers to utilization among patients. This study aims to explore the factors influencing OMS utilization (OMSU) for patients in micro-, meso-, and macrosystems based on socioecological theory (SET) and from the perspective of the information-motivation-behavioral skills (IMB) model. We selected 1065 participants through multistage stratified cluster random sampling in Jiangsu, China. In microsystems, information and behavioral skills were positively associated with intention (ß = 0.84; ß = 3.21) and actual utilization (OR = 1.69; OR = 1.69). Education level (ß = 0.83) and personal motivation (ß = 1.68) were positively related to intention. Chronic diseases (OR = 2.03) had a positive relationship with actual use. In mesosystems, recommendations from people around the patients (ß = 1.14; OR = 1.99), provision of OMS in the nearest primary medical facility (ß = 0.98; OR = 3.60), and provision of instructional information by medical institutions (ß = 1.01; OR = 1.65) were related to OMSU. The average monthly household income (ß = 0.54) was related to intention. Patients who had information about the OMSU experiences of people around them (OR = 1.73) correlated with actual utilization. In macrosystems, the social medical insurance type (OR = 0.66) was associated with OMSU. This study supports the applicability of the SET and IMB model to interpret patients' OMSU.

The Epidemiological Characteristics of Late-Onset Hypogonadism in Chinese Middle-Aged and Elderly Men: Two Cross-Sectional Studies in the Same Community.

The purpose of this study was to investigate the prevalence and epidemiological characteristics of late-onset hypogonadism (LOH) in middle-aged and elderly Chinese men. Two cross-sectional studies were conducted at 5-year intervals in community-dwelling men living in the same area. A total of 1472 (Study 1, S1) and 944 (Study 2, S2) men aged 40-69 years old were recruited as subjects. Subjects were evaluated through combining serum reproductive hormone levels with the Androgen Deficiency in Aging Males (ADAM) questionnaire and the Aging Males' Symptoms (AMS) scale. A significant difference was found in mean testosterone deficiency (TD) prevalence between S1 and S2, using either serum total testosterone (TT; 14.02% vs. 6.36%) or serum calculated free testosterone (cFT; 43.69% vs. 16.53%) cutoff values. According to the S1 or S2 data, the mean prevalence of LOH was 37.85%/15.47% in the positive ADAM test and 15.42%/9.43% in the positive AMS test (p < .01). According to classifications of TD based on gonadal status, the prevalence of secondary TD (27.34%) was higher than the primary (16.36%) and compensated (15.42%) TD in S1 (p < .01). However, there were significant differences among the prevalence of primary (6.89%), secondary (9.64%), and compensated (27.65%) TD in S2 (p < .05). Different types of testosterone levels, TD cutoff values, and questionnaires influenced the prevalence of TD and LOH. The serum FT cutoff value was an optimal threshold for evaluating and diagnosing TD and LOH, whose prevalence increased gradually with male aging.

A Comprehensive Evaluation of China's TCM Medical Service System: An Empirical Research by Integrated Factor Analysis and TOPSIS.

Objectives: This paper constructs a comprehensive evaluation index of the traditional Chinese medicine (TCM) medical service system and summarizes the development of TCM medical services in China. Methods: We chose 31 provinces' TCM hospitals as research objects. The data were obtained from the Health Statistics Yearbook from 2013 to 2018 and from the National Statistics of Chinese Medicine from 2012 to 2017. The approaches to factor analysis and TOPSIS are used in this paper. It is found that the comprehensive evaluation indexes of the TCM medical service system can be divided into 4 first-level indicators and 14 second-level indicators. Results: The development of the TCM medical service system in China is unbalanced and inadequate. North China and East China are generally superior to Northwest and Southwest China in terms of revenue and expenditure for TCM medical services. The per capita of medical resources in the Southwest and Northwest are stronger than those in Central and South China, but overall medical resources are weaker than those in East China and North China. TCM medical service institutions in East China, South China and Central China have achieved better service results and higher economic benefits with less resource input, which further indicates the efficient allocation of resources and the balanced operation of TCM medical service institutions. Conclusion: The development of China's TCM medical service system shows the imbalance and inadequacy of "East is strong, West is weak" and "South is superior, North is inferior."

Evidence Supporting Predation of 4-m Marine Reptile by Triassic Megapredator.

Air-breathing marine predators have been essential components of the marine ecosystem since the Triassic. Many of them are considered the apex predators but without direct evidence-dietary inferences are usually based on circumstantial evidence, such as tooth shape. Here we report a fossil that likely represents the oldest evidence for predation on megafauna, i.e., animals equal to or larger than humans, by marine tetrapods-a thalattosaur (∼4 m in total length) in the stomach of a Middle Triassic ichthyosaur (∼5 m). The predator has grasping teeth yet swallowed the body trunk of the prey in one to several pieces. There were many more Mesozoic marine reptiles with similar grasping teeth, so megafaunal predation was likely more widespread than presently conceived. Megafaunal predation probably started nearly simultaneously in multiple lineages of marine reptiles in the Illyrian (about 242-243 million years ago).

Age-related changes in serum reproductive hormone levels and prevalence of androgen deficiency in Chinese community-dwelling middle-aged and aging men: Two cross-sectional studies in the same population.

To investigate the age-related nomograms and change trends of reproductive hormones, and prevalence of androgen deficiency (AD) in middle-aged and aging men from 2 studies.Two cross-sectional studies were conducted at 5-year intervals in Chinese community-dwelling men living in the same area. A total of 434 (Study 1, S1) and 944 (Study 2, S2) men aged 40 to 69 years were recruited as subjects and 59 (S1) and 98 (S2) men aged 20 to 39 years as controls to measure serum reproductive hormone levels.Serum total testosterone (TT) levels did not change significantly in S1, whereas TT levels increased in S2 with aging. Serum calculated free testosterone (cFT) levels gradually decreased with aging; however, only men aged 40 to 69 years showed this trend in S2. Serum luteinizing hormone (LH) and sex hormone binding globulin (SHBG) levels gradually increased, and serum testosterone secretion index (TSI) and free testosterone index (FTI) levels gradually decreased with male aging. The mean annual decrease values of serum cFT were 2.705 pmol/l in S1 and 1.060 pmol/l in S2. The cut-off values for AD in S1 and S2 were 9.13 nmol/l and 9.35 nmol/l for TT, and 169.00 pmol/l and 213.90 pmol/l for cFT. Using TT or cFT cut-off values, mean AD prevalence was 14.52% or 44.70% in S1, and 6.36% or 16.53% in S2. Based on cFT cut-off values, prevalence of AD increased gradually with male aging in a range of 25.30% to 61.63% in S1 and 1.20% to 23.03% in S2.The change patterns of serum LH, SHBG, TSI and FTI levels in middle-aged and aging males were consistent; however, there were differences in serum TT and cFT change patterns in S1 and S2 with male aging. cFT cut-off values were the optimal metric to evaluate AD, which can be present a ladder-like change in prevalence of different age groups.

Determination of 5-nitro-2-furaldehyde as marker residue for nitrofurazone treatment in farmed shrimps and with addressing the use of a novel internal standard.

We developed a significantly improved ultra-high performance liquid chromatography-tandem mass spectrometry method for determination of 5-nitro-2-furaldehyde (NF) as a surrogate using a novel internal standard for the detection of nitrofurazone. We used 2,4-dinitrophenylhydrazine derivatization and furfural as the internal standard. Derivatization was easily performed in HCl using ultrasonic manipulation for 5 min followed by liquid extraction using ethyl acetate. The samples were concentrated and purified using reverse phase and alumina cartridges in tandem. The derivatives were separated using a linear gradient elution on a C18 column with methanol and water as the mobile phase in negative ionization mode and multiple reaction monitoring. Under the optimized conditions, the calibration curves were linear from 0.2 to 20 µg/L with correlation coefficients >0.999. Mean recoveries were 80.8 to 104.4% with the intra- and inter-day relative standard deviations <15% at spiking levels of 0.1 to 10 µg/kg. The limits of detection and quantification were 0.05 and 0.1 µg/kg, respectively. This method is a robust tool for the identification and quantitative determination of NF in shrimp samples.

[Contamination Characteristics and Safety Risk Assessment of Perflurorinated Alkylated Substances in Aquatic Products from Guangzhou].

To investigate the contamination characteristics of PFASs in aquatic products, 254 samples belonging to 6 species, including fishes, crustaceans, cephalopods, etc., were collected from Guangzhou, and 23 PFASs were determined by UPLC-MS/MS. The total detection rates of the various sample species ranged from 93.5% to 100%, and the concentrations of PFASs were relatively higher in the fishes and crustaceans. 13 PFAS components were detected in the fish samples, but only 6 PFAS components were detected in haliotis samples, and obvious differences were observed among the different species sampled. PFOA and PFOS were the predominant pollutants, with detection rates of 75.6% and 76.8%. The concentrations of PFOS were in the range of 0.19-192.27 µg·kg-1, which were obviously higher than those of the other PFAS components, and their total contamination contribution factor reached the highest percentage of 35.15%. PFOS was a major contributing factor to the PFAS contamination of fishes, crustaceans, siphonopods, and processed products; however, the predominant pollutant in Haliotis samples was PFBA. The results of the risk assessment indicated that the concentrations of PFOA and PFOS would not give rise to timely harm to the consumers.

Association between body mass index and health-related quality of life among Chinese elderly-evidence from a community-based study.

BACKGROUND: This study aimed to explore the effects of (body mass index) BMI on health related quality of life (HRQoL) among the elderly in Jiangsu, China. METHODS: A total of 10,257 community dwelling elderly (≥60 years old) were enrolled in a cross-sectional study. HRQoL was measured via the Eq-5d-3 L. Chi-square tests and one-way ANOVA analyses were used to compare the frequencies and scores of Eq-5d responses among different BMI groups (defined as "underweight", "normal weight", "overweight" and "obese"). Logistic regression analyses were conducted to examine the associations between BMI and HRQoL. RESULTS: Among the subjects, the proportion of "normal weight", "underweight", "overweight" and "obese" were 66.0, 8.3, 23.1, and 2.6%, respectively. The score of the Eq-5d index among total participants was 0.8036 and the Visual Analog Scale (VAS) score was 75.47. For both the responses frequency and scores of Eq-5d-3 L, there were significant differences among BMI groups (P < 0.001). The Logistic regression model showed that both in men and women, underweight elderly were more likely to suffer low HRQoL. The adjusted odds ratio (OR) with a 95% confidence interval (CI) for Eq-5d index/VAS was 2.03 (1.48, 2.79)/1.83 (1.34, 2.50) in men and 1.47(1.09,1.98)/1.52(1.20,1.91) in women. Overweight women more likely to have a low Eq-5d index, while overweight men were less likely to have a low Eq-5d VAS. CONCLUSION: This study shows that underweight is an explicit risk factor of low HRQoL in both the male and female elderly, while the effect of overweight on low HRQoL varies slightly by gender.

Determination of MS-222 in Water Samples by Solid-phase Extraction Coupled with Liquid Chromatography/Tandem Mass Spectrometry.

A practical solid-phase extraction (SPE) method coupled with liquid chromatography/tandem mass spectrometry (LC-MS/MS) has been developed for the determination of the fish anesthetic MS-222 in water. Water samples were concentrated and purified using three SPE cartridges of different specifications. Elution curves of MS-222 were constructed using various methanol-water solutions on the different cartridges, and SPE conditions were optimized in accordance with the elution curves. The mobile phase containing methanol and 0.1% formic acid solution with a linear gradient elution was utilized to separate MS-222 on a C18 column. Detection was carried out by a triple-quadrupole mass spectrometry with an electrospray ion source in positive mode. Recoveries of three MS-222 fortified levels of 0.05, 0.5 and 5 µg/L ranged of 82.6-101% with relative standard deviations (RSDs) below 9.36%. The limit of detection (LOD) and limit of quantification (LOQ) of MS-222 were 0.01 µg/L and 0.03 µg/L, respectively. This method was satisfactorily applied to the determination of MS-222 in actual water samples collected from aquatic product transportation vehicles or from the natural water catchments.

[Serum testosterone reduction and metabolism in aging male rats: correlation and mechanism].

OBJECTIVE: To investigate the mechanism of serum testosterone reduction, its relationship with metabolism, changes in the number and morphology of Leydig cells and endocrine function in aging male rats. METHODS: The levels of serum total testosterone (tT), LH, FSH, HDL, LDL, TG, TC, Glu, INS, IRG and LP were determined in young (9 mo) and aging rats (12, 15, 18 and 21 mo), with 6 in each group. The morphological changes of Leydig cells were observed under the microscope. The concentrations of testosterone secreted from the cultured Leydig cells with the stimulation of hCG and Forskolin were assayed. The apoptosis rates of Leydig cells were detected by TUNEL. The visceral fat was isolated and weighed, and the Lee's index calculated. All the above indexes were recorded and compared among different age groups. RESULTS: The aging rats showed a significant decrease in the levels of serum tT and TSI ([1.26 +/- 0.65] ng/ml and [0.07 +/- 0.65] ng/mIU) as compared with the young rats ([3.24 +/- 0.38] ng/ml and [0.21 +/- 0.01] ng/mIU) (P < 0.01). Obvious differences were found in the morphology of Leydig cells among different age groups. The T secretion of Leydig cells at 24, 48 and 72 h in aging rats was markedly decreased (P < 0.05) while their TUNEL positive rate remarkably increased in the aging rats (17.36% +/- 1.31%) compared with the young ones (7.02% +/- 1.05%) (P < 0.05). There were statistically significant differences between the young and aging rats in all the biochemical parameters including IRG, HDL, LDL, TG, TC and visceral fat content (P < 0.05), except the levels of serum Glu, INS and LP (P > 0.05). CONCLUSION: The serum T level and secreting capacity of Leydig cells are significantly lower in aging rats than in young ones, and the metabolic parameters undergo regular changes with the decreasing level of serum T. The reduction of testosterone in aging male rats may be associated with the decreased secreting capacity and number of Leydig cells and declined function of the pituitary.

[Measurement of brain regional oxygen saturation in neonates in China: a multicenter randomized clinical trial].

OBJECTIVES: To understand the value of measuring neonatal cerebral regional oxygen saturation (rSO2) using near infrared spectroscopy (NIRS) in assessing cerebral oxygenation, to establish the normal range of neonatal cerebral rSO2 and to collect data of the changes of cerebral rSO2 under certain disease status. METHODS: Nine large hospitals participated in the multicenter randomized clinical trial from Jan 2007 to Apr 2008. Using the NIRS human tissue oximeter (TSAH-100) independently developed in China, the cerebral rSO2 of 223 normal full-term and 95 otherwise healthy preterm neonates without any special disease, was detected at 1, 2 and 3 days after birth, respectively. The cerebral rSO2 of 102 neonates with diseases which may affect the cerebral oxygenation, was also detected during the severe phases. The pulse oxygen saturation (SpO2) measured at the finger tip, and also the arterial oxygen saturation (SaO2) measured by blood gas analysis, which could indicate the oxygen supply of the whole body, were obtained simultaneously. The correlations among cerebral rSO2, pulse SpO2 and arterial SaO2 were analyzed. RESULTS: (1) The cerebral rSO2 of the normal full-term neonates was (62+/-2)%. Cerebral hypoxia was defined as rSO2 lower than 58%. The cerebral rSO2 of the normal full-terms was steady at 1, 2 and 3 days after birth respectively, without any significant differences among them (F=0.610, P>0.05). The cerebral rSO2 of the neonates with diseases was (55+/-7)%, which was significantly lower than that of the normal full-term neonates (t=15.492, P<0.05). (2) The cerebral rSO2 was positively correlated with the SpO2 (r=0.74, P<0.01) and the SaO2 (r=0.71, P<0.01). (3) Under some special diseases, the changes of cerebral rSO2 was asynchronous with those of the SpO2: (1) For 18 cases under severe cerebral damages or under relatively low hemoglobin concentration, the cerebral rSO2 was significantly low (50%-58%), but the SpO2 was still normal (above 90%). (2) During the recovery of some critically ill neonates, the increase of cerebral rSO2 was lagged as compared with that of pulse SpO2. Especially, during the severe phases of 6 cases with multi-organ failure, the SpO2 and the cerebral rSO2 were both significantly low (55%-80% for SpO2, and 44%-50% for cerebral rSO2); when the diseases were alleviated, although the SpO2 recovered to above 85%, the cerebral rSO2 was still significantly low (around 50%). (3) In 3 cases, during the severe phases of serious hypoxic-ischemic encephalopathy (HIE), the cerebral rSO2 significantly increased to 70%-72%, which was significantly higher than the normal value (62%). CONCLUSIONS: The range of cerebral rSO2 of the normal full-term neonates was (62+/-2)%. Cerebral oxygenation can be externally indicated by the rSO2 noninvasively and continuously measured by NIRS, which was positively correlated with traditional pulse SpO2 and arterial SaO2. In some special diseases, the rSO2 measured by NIRS can be helpful for clinical diagnoses and treatments.

[Comparison of the effect of Angelica polysaccharide, platelet-derived growth factor and thrombopoietin on megakaryocytopoiesis].

OBJECTIVE: To investigate the effect of Angelica polysaccharide (APS), platelet-derived growth factor (PDGF) and thrombopoietin (TPO) on the proliferation and apoptosis of human megakaryocytic cell line M-07e. METHODS: Cell count and the viability testing of M-07e cells (trypan blue exclusion assay) were performed at 24 hours, 48 hours and 72 hours after treatment with APS, PDGF or TPO. Three apoptosis related flow cytometric assays including Annexin V, Caspase-3 and JC-1 were performed to determine apoptotic rate of each group at 72 hours after the treatment. RESULTS: After the incubation, the number of M-07e cells in the APS, PDGF and TPO group increased and the viabilities of the three groups were significantly higher than the control group (P < 0.05). The dead cells in the APS, PDGF and TPO group were (19.41 +/- 7.59)%, (21.38 +/- 7.25)% and (18.77 +/- 8.00)%, respectively by flow cytometry using Annexin V method, which were significantly lower compared to the control group (34.33 +/- 5.46)%. The expression of the activated caspase-3 in the group of APS, PDGF and TPO were (12.27 +/- 5.18)%, (12.39 +/- 6.26)% and (13.75 +/- 8.25)%, the APS and PDGF group decreased significantly compared to the control group (18.92 +/- 6.09)%. The ratio of total cell deaths in the APS, PDGF and TPO group were (23.64 +/- 6.69)%, (28.00 +/- 10.05)% and (27.99 +/- 8.99)%, the ratio in APS group decreased significantly compared to the control group (39.48 +/- 11.86)% by JC-1 method. Differences between APS and PDGF groups and between APS and TPO groups were not statistically significant. CONCLUSION: APS, PDGF and TPO have similar effect in stimulating proliferation and inhibiting serum-free-culture induced apoptosis of M-07e cells.

[Examination of cerebral electrical admittance plethysmogram in healthy newborns].

OBJECTIVE: Cerebral electrical admittance plethysmography is a novel noninvasive technique for evaluating cerebral hemodynamics. This study aimed to measure the reference values of cerebral electrical admittance plethysmogram in healthy newborns. METHODS: Bilateral cerebral electrical admittance plethysmography was performed in 40 healthy newborns. RESULTS: The values of various indexes of cerebral electrical admittance plethysmogram in 40 newborns were obtained by this technique. The index of Admittance Differential Loop (ADL) I+II at the third and fourth days after birth was significantly higher than that at the first day of life (P < 0.05). There were significant differences in the index of ADL I+II and the ratio of Hs to b-S (Hs/ b-S) among different birth weight groups (P < 0.05). No significant differences were found in all the indexes of cerebral electrical admittance plethysmogram between the left and right brain of newborns. Gender and parturition mode had also no effects on these indexes. CONCLUSIONS: The research reported the reference values of cerebral electrical admittance plethysmogram in healthy newborns. The postnatal age and birth weight are influencing factors for the cerebral electrical admittance plethysmogram.

[Regional cerebral oxygen saturation in neonates with meconium aspiration syndrome].

OBJECTIVE: This study examined the changes of regional cerebral oxygen saturation (rSO2) by noninvasive near infrared spectrophotometry in neonates with meconium aspiration syndrome (MAS). METHODS: Seventy-three full neonates with MAS were divided into three groups by respiratory symptoms: asymptomatic group (group 1, n=38), common group (group 2, n=28) and severe group (group 3, n=7). Near infrared spectrophotometry was used to measure the cerebral rSO2 on days 1, 3, 5 and 7 after birth. Thirty healthy full-term newborns served as the Control group. RESULTS: The cerebral rSO2 of group 1 decreased significantly compared with that of the Control group between days 1 and 3 (P < 0.05). The cerebral rSO2 of group 2 or group 3 was significantly lower than that of group 1 and the Control group on days 1, 3 and 5 (P < 0.05). The MAS patients with mild hypoxic-ischemic encephalopathy (HIE) had significantly higher brain rSO2 levels than those with medium or severe HIE on days 2, 3 and 5 (P < 0.05). CONCLUSIONS: The cerebral rSO2 decreased in neonates with MAS. The values for rSO2 correlated with the severity of HIE in MAS patients.

[Spectral diagnosis of dielectric barrier plasma discharge at atmospheric pressure and its application to surface modification of materials].

The spectral lines of air and argon plasma emission at atmospheric pressure were recorded and analyzed. Plasma parameters such as discharge current, discharge gap and electron temperature were measured. The purpose of the study is to control the process of materials' surface modification promptly. The experimental results indicate that a critical discharge gap is an important parameter to improve the quality of materials' surface modification, and spectral diagnosis has been proved to be a workable method by choosing a suitable discharge gap.

[Evaluation of laryngotracheal stenosis with spiral CT three-dimensional images and clinical application].

OBJECTIVE: To study the use of spiral computed tomography three-dimensional images (SCT-3DI) in the evaluation of patients with laryngotracheal stenosis. The value and utility of SCT-3DI compared with actual endoscopy were also investigated in terms of accuracy of diagnosis and validity of treatment. METHODS: Eight patients with laryngotracheal stenosis were underwent SCT-3DI and regular endoscopy examination preoperatively. Of eight patients, Five had traumatic causes, two with tracheal narrowing due to tracheal granulomas, one with too much scar tissue of unknown etiology in the subglottic area. The location, extent and contour of the stenosis were identified and compared with actual endoscopy findings, and confirmed by surgical procedures. RESULTS: SCT-3DI evaluation was accurate in assessing the length, width and shape of all the laryngotracheal stenosis in our study. The results of SCT-3DI were best correlated with actual endoscopy findings and those found in the surgery. Based on the SCT-3DI, five patients were treated by open surgical techniques including laryngotracheal reconstruction procedures and dilation methods with hyoid grafts or stents. Two undertaken endoscopic treatment with CO2 laser excision of scar tissue or granulomas, one accepted no surgical procedures. All eight patients were successfully decannulated with improved voice and satisfied airway after 6-month postoperative follow-up. CONCLUSIONS: Evaluation of the upper airway with SCT-3DI is useful in the diagnosis, measurement, and definition of the laryngotracheal stenosis. Objective data obtained from SCT-3DI is very helpful for operative scheme. Patients treated with appropriate procedures best suited for every stenosis have reached satisfactory clinical results.

[Treatment of severe subglottic laryngotracheal stenosis using hyoid graft with sternohyoid muscle flap].

OBJECTIVE: To evaluate the possibility and reliability of the hyoid-sternohyoid graft transfer in the correction of server subglottic laryngotracheal stenosis, and delineate the operation skills and clinical results. METHODS: Seven patients with severe subglottic stenosis underwent laryngotracheal reconstruction using the hyoid grafts with sternohyoid muscle flaps (HG-SHMF). Five of these patients had traumatic subglottic stenosis, one with scar tissue of unknown etiology arising in the subglottic region, another with tracheal narrowing caused by inhalation of hydrochloric acid. RESULTS: All seven patients were successfully decannulated with moderate good voice. The average time from reconstruction to decannulation was 15.4 months. The stent was endoscopically removed with a range of 3 to 22 months; the mean time required for stenting was 9.6 months. Two patients who received additional salvage reconstruction procedures because of graft or stent displacement were extubated with improved voices and satisfactory airway. CONCLUSIONS: The HG-SHMF transfer was a single-stage reconstruction, relatively simple procedure that can restore an adequate airway and a good voice. Patients undergoing laryngotracheal reconstruction with HG-SHMF must have regular, long-term follow-up since graft displacement and recurrent granulation tissue or scar reformation can cause restenosis after an initially successful surgery. This procedure should be used in a large number of patients to further test its reliability.