Objective To survey the thyroid-hormone changes in gravidas,and to establish the reference intervals for thyroid-hormones in each trimester of normal pregnancy in Pingdingshan.Methods 2 645 gravidas who established documents in our hospi-tal were enrolled,The gravidas were divided to different groups by age (≤30 and >30 years old)and 425 cases of early pregnancy women,1 657 cases of middle pregnancy women and 563 cases of late pregnancy women were collected as research group.4 kinds of thyroid functions in the six groups were detected by electrochemical luminescence.Results FT3 and FT4 gradually reduced as the growth of the pregnancy period,but TSH and TPOAb increased.There is statistical difference in all thyroid-hormones between all trimesters of pregnancy and different age groups.Conclusion There is significant difference in thyroid-hormones for different sta-ges of pregnancy and different age groups.Therefore,establishing reference intervals of thyroid-hormones during different stages of pregnancy may be important for clinical practice.

Objective To explore the curative effect of knee flexion deformity on spastic cerebral palsy treatment method.Methods All of 30 patients with spastic cerebral and knee flexion deformity were randomly divided into two groups:traditional operation group and modified operation group,using the commonly used operation (In 15 cases,with traditional hamstring post surgery) and) modified operation (In 15 cases,with modified hamstring post surgery),two groups of patients were treated with Ilizarov external fixation drafting device in the correction of knee flexion deformity after soft tissue release.Adjustment began 7 days after the soft tissue release operation of external fixation,and stretched approximately 0.2 degrees each time,3 times/d,until knee flexion deformity was corrected to hyperextension for 10 degree and maintained for 3 weeks,and the flexion contracture degree of knee joint was measured every 2 weeks;then the Ilizarov external fixation drafting device was removed.Then wear a walking straight leg brace for more than 3 months,until the knee walking function is good.Clinical evaluation included the joint pain index,walking function index,knee flexion deformity degree and range of joint motion score of Dimeglio standard.Results Flexion contracture deformity of knee joint in 30 cases (60 knees) was corrected when Ilizarov external fixator was removed,knee extension to 0 degrees-5 degrees.The two groups of patients had the knee flexion angle range of-1.2 degrees to 13.3 degrees,with an average of (7.32°±3.41°) after removed of the walking straight leg brace,in which 4 cases (8 joints) got recurrent deformity of 10°-15° at the time of removing of the walking straight leg brace.Knee activity significantly was improved at the end of treatment.60 cases of knee joint activity were close to normal,with flexion of 100 degrees to 135 degrees,extension of 0 degrees to 10 degrees.Two groups of patients were statistically significantly improved before and after surgery.Curative effect comparison:The walking function index of the modified operation group was obviously superior to that of the traditional operation group,there was significant statistical difference.There were no statistically significant differences in pain index,knee flexion,and range of joint motion.Conclusion For the treatment of flexion deformity of the knee joint in spastic cerebral palsy,traditional surgery using the semitendinosus and gracilis,post and semimembranosus lysis,combined with the Ilizarov draft external fixation could improve the walking function of the patients,simplify the surgical incision and reduce trauma.As a result,modified hamstring post surgery is an ideal,effective treatment method.

Objective:To explore the feasibility and precautions of laparoscopic pyeloplasty for children with hydronephrosis combined with renal trauma.Methods:The clinical data of 6 cases with hydronephrosis and renal trauma admitted to the Department of Pediatric Surgery, the First Affiliated Hospital of Zhengzhou University from August 2016 to August 2019, aged from 5 to 11 years old (average age 7 years old) were reviewed.These patients had suffered renal trauma for 1 to 4 days.All patients had the symptoms of pain in the affected kidney, and 4 patients had hematuria.The renal pelvis diameter of all patients was more than 25 mm.The patients underwent laparoscopic pyeloplasty and renal rupture repairment, with the ureteral stent, perirenal drainage tube and catheter placed inside the body during the operation.Results:All operations were completed successfully without any blood transfusion and open surgery.Intrao-perative time was from 2.5 to 3.5 hours.Two cases had renal parenchymal contusion in the front lower pole of kidneys and 4 cases in the lateral lower pole.Five cases had renal cortex and pelvis rupture, and 1 case had renal cortical fracture and subcapsular hematoncus.After the operation, the perinephric drainage tube was pulled out in 3 to 5 days, the catheter was pulled out in 7 to 10 days, and the ureteral stent was removed in 6 to 8 weeks.All children recovered well and hydronephrosis was ameliorated.The glomerular filtration rates and fractional renal function were all improved.Conclusions:One stage laparoscopic pyeloplasty is safe and effective for the treatment of hydronephrosis with renal trauma in children.Renal trauma in children usually occurs at the lower pole of the kidney.Early operation is needed if hydronephrosis is aggravated and symptoms are not relieved after the trauma.Intraoperative impairment of renal parenchymal rupture can be conducted.For intraoperative bleeding in grade 3 renal injury, renal parenchyma suturation and removal of necrotic renal tissue should be adopted to arrest bleeding.

Objective: To assess the exposure levels of lead, cadmium, mercury, arsenic and aluminum in the diets of residents in Henan Province, so as to provide the basis for strengthening food safety supervision. Methods: Six sampling points were selected using stratified random sampling method in Henan Province, including Hebi City, Xiangfu District of Kaifeng City, Jianxi District of Luoyang City, Yuzhou City, Baofeng County and Tanghe County. Food samples were collected and processed into mixed samples of 12 major food categories. The levels of lead, cadmium, mercury, arsenic and aluminum in the samples were measured using inductively coupled plasma mass spectrometry (ICP-MS). Dietary consumption information in Henan Province was collected. The dietary exposure risks of lead, cadmium, mercury, arsenic and aluminum were analyzed using the point estimation method and distribution point estimation method, based on the health guidance values of the Joint FAO/WHO Expert Committee on Food Additives and the margin of exposure (MOE) as the assessment criteria. Results: The dietary exposure level of lead among residents in Henan Province was 41.89 μg/d, which was equivalent to 18.62% of its provisional tolerable weekly intake (PTWI), with cereals and vegetables being the main sources; the MOE values of lead among residents aged 2 to <7 years and 7 to <13 years were both less than 1. The dietary exposure level of cadmium was 10.79 μg/d, which was equivalent to 20.55% of the provisional monthly tolerable intake, with cereals and vegetables being the main sources. The dietary exposure level of total mercury was 0.45 μg/d, which was equivalent to 1.25% of its PTWI, with cereals, vegetables, and water and beverage categories being the main sources; the dietary exposure level of methylmercury was 0.04 μg/d, which was equivalent to 0.28% of its PTWI, and it was entirely derived from aquatic products. The dietary exposure level of total arsenic was 26.65 μg/d, which was equivalent to 0.89% of the daily allowable intake, with cereals and vegetables being the main sources; the dietary exposure level of inorganic arsenic was 8.41 μg/d, which was equivalent to 6.23% of its PTWI, with an MOE value of 22.47. The dietary exposure level of aluminum was 8.27 mg/d, which was equivalent to 45.94% of its PTWI, with cereals and tubers being the main sources; the P90 and P97.5 of dietary aluminum exposure among residents aged 2 to <7 years and 7 to <13 years were both greater than PTWI. Conclusion The overall dietary exposure risks of lead, cadmium, mercury, arsenic and aluminum among residents in Henan Province are relatively low.

Objective:To establish and validate a predictive model for chronic hydrocephalus in patients with acute cerebral infarction after thrombolytic therapy.Methods:The clinical data of 288 patients with acute cerebral infarction admitted to Linfen People′s Hospital from January 2020 to December 2022 were retrospectively collected, based on whether the patients had chronic hydrocephalus or not, they were divided into the hydrocephalus group (62 cases) and the control group (226 cases). The clinical characteristics of the two groups were compared, and the risk factors for chronic hydrocephalus in patients with acute cerebral infarction after thrombolysis treatment were analyzed by multivariate Logistic regression. Based on relevant risk factors, the predictive model for chronic hydrocephalus in patients with acute cerebral infarction after thrombolytic therapy were established and validated it by R4.0.3 software.Results:The age, rate of diabetes mellitus and massive cerebral infarction in the hydrocephalus group were higher than those in the control group: (70.81 ± 10.34) years old vs. (63.46 ± 10.34) years old, 50.00%(31/62) vs. 16.81%(38/226), 38.71%(24/62) vs. 15.93%(36/226), there were statistical differences ( P<0.05). The results of multivariate Logistic regression analysis showed that the age>65 years old, diabetes mellitus and massive cerebral infarction were the risk factors of chronic hydrocephalus after thrombolytic therapy for acute cerebral infarction ( P<0.05). A prediction model and randomly divided the dataset into a training set (202 cases) and a validation set (86 cases) by R4.0.3 software, the area under curve (AUC) of the receiver operating characteristic curve in the training set was 0.774 (95% CI 0.694 - 0.855), and the AUC of the validation set was 0.807 (95% CI 0.664 - 0.950). In the validation set, the model was subjected to the Hosmer-Lemeshow Goodness-of-Fit test, χ2 = 8.35, P = 0.400, indicating that the model had good reliability. Conclusions:The present predictive model has high value in predicting chronic hydrocephalus in patients with acute cerebral infarction after thrombolytic therapy, and can be used to identify patients at high risk of chronic hydrocephalus.

Objective: To explore the relationship between fathers′ nursing time and maternal parenting stress of children with autism spectrum disorder(ASD). Method: Mothers of 98 ASD children who were first diagnosed in the department of Child Health Care, Children′s Hospital of Fudan University during June 2015 to January 2016 were included in the ASD group, with mothers of 92 typical children from a Community Maternal and Child Health Hospital and a kindergarten in the control group. The evaluation of parenting stress, parents′ nursing time and other related factors were cross-sectionally analyzed. Interview was conducted with the following tools: Parental Stress Index-Short Form(PSI-SF)for maternal parenting stress, and self-made General Parenting Information Questionnaire for nursing time of both parents and other related factors. The relationships were analyzed by Multiple Linear Regression analysis and Wilcoxon Rank-Sum test. Result: Maternal parenting stress of ASD children had a significant negative correlation with father′s nursing time in total score of parenting stress, PCDI domain and PD domain (t=-2.76, -2.98, -2.79; P=0.007, 0.004, 0.006), within which PD domain also included family annual income and mothers′ nursing time (R²=0.22, 0.24, 0.25); while no such correlation was found in control group in terms of father′s nursing time(P=0.22, 0.42, 0.06). Wilcoxon Rank-Sum test showed that in 62 (63.3%) double-income ASD families and 72(78.3%) double-income typical families, there were significant differences between ASD fathers′ and ASD mothers′and typical fathers′nursing time(2.0(0.5, 2.1)vs. 3.5(2.4, 6.0)vs. 3.0(2.0, 4.7)h, t=-86.32、-49.65, all P<0.01). Conclusion Lack of fathers′ involvements was common in ASD children′s families. Increasing these fathers′ nursing time, as well as their enthusiasm and initiative in the family intervention could relieve maternal parenting stress and improve the intervention pattern of ASD children.

Objective: To assess the nutritional supply status of school meals for primary and secondary school students in Henan Province, so as to provide a basis for scientific guidance of school meals. Methods: During 2021-2023, 115 lunch and dinner samples were collected from 25 primary and secondary schools in Zhoukou, Anyang and Luoyang of Henan Province by a direct selection method, and 13 nutrients were determined for each sample. The nutrient supply was evaluated based on Nutrition Guidelines of School Meals and Reference Intake of Dietary Nutrients for Chinese Residents (2023 Edition). Mann-Whitney U test was used to compare the differences of nutritional supply between urban and rural schools. Results: The median values for energy (709.77 kcal,1 kcal=4.18 kJ), fat energy supply ratio (0.27) and carbohydrate energy supply ratio (0.55) in the 66 lunches and dinners from primary school were within the recommended range. The supply of protein (28.39 g) and sodium (1 464.59 mg) was excessive. The median values of zinc (2.62 mg) and dietary fiber (5.19 g) were lower than the reference values. No statistically significant differences were observed in the supply of 13 nutrients between urban and rural primary schools( U = 427.00 -633.00, P > 0.05 ). Among 49 samples from secondary schools, the median value of energy supply (930.02 kcal), carbohydrate energy ratio ( 0.54 ) and fat energy supply ratio(0.25) were within the recommended range; and the median values of protein (38.82 g) and sodium (2 556.80 mg) were higher than the standard; and the median values of calcium (250.32 mg) and vitamin B1 (0.16 mg) were lower than the standard. Additionally, the differences in the level of vitamin B2 ( U =372.00) and zinc ( U =375.00) between the urban and rural secondary schools were statistically significant ( P <0.05). Conclusion Nutrient supply of primary and secondary school meals in three cities of Henan Province is inadequate and imbalanced, and the recipe need to be further optimized and improved.

Objective:To evaluate the therapeutic characteristics of laparoscopic repair in children with ure-terovesical junction malformation through internal or external bladder.Methods:From February 2018 to August 2019, 29 cases of hydronephrosis combined with ureter expansion treated in the First Affiliated Hospital of Zhengzhou University, with 17 boys and 12 girls confirmed through the preoperative examinations.Inspection results revealed 15 cases of ureteropelvic junction obstruction, 12 cases of vesicoureteral reflux, and 2 cases of single ectopic ureter.Totally, 21 cases were treated by pneumovesical laparoscopic Cohen means, including 17 unilateral cases and 4 bilateral cases, 5 cases of ureterocele, and 8 cases of ureteral clipping.A total of 8 cases were treated by laparoscopic Lich -Gregoir surgical treatment, including 7 unilateral cases and 1 bilateral case.Meanwhile, 4 cases of ureteral clipping were performed among them.There was 1 case of duplex kidney with the ectopic upper ureter outside iliac blood vessels, 1 case of bilateral cryptorchidism and 1 case of unilateral cryptorchidism.Ureteral stents were implanted for those with ureteral tailoring.The catheters were removed 7 days after operation, and the indwelling ureteral stents were removed by cystoscope under general anesthesia after about 6 weeks.Results:All the cases with hydronephrosis and ureteral dilatation were completed in laparoscopic surgery, without open surgery or blood transfusion, 21 cases were treated by pneumovesical laparoscopic Cohen means, with the average time being 1.8 hours in unilateral side and 2.8 hours in bilateral sides.At the same time, 8 cases were treated by laparoscopic Lich-Gregoir means, with the unilateral average time being 1.7 hours and bilateral time being 3.0 hours.All cases were followed up at an average month of 9 (4-20 months), and all children underwent voiding cystourethrography 4 months after the operations.The voiding cystourethrogram(VCUG) of all the cases was confirmed successfully, with only 1 case of vesicoureteral reflux in level Ⅲ, and their hydronephrosis were relieved.There was no vesicoureteral reflux in the others.The short-term urinary retention occurred in 1 patient with bilateral ureteral reimplantation in Lich-Gregoir group, and the symptom disappeared after 1 week of indwelling catheterization.Among them, 1 patient in Cohen group had hematuria that disappeared gradually for 4 days after surgery.There were no significant differences in operation time and postoperative recovery between the two groups.The length of hospital stay in laparoscopic Lich -Gregoir group was slightly longer than that in pneumovesical laparoscopic Cohen group.Conclusions:As for children with ureterovesical junction malformation, laparoscopic Lich-Gregoir surgery is suitable for the ectopia of ureter opening, overexpansion of ureter, and other abdominal malformation complicated and expansive ureter without tortuosity.Pneumovesical laparoscopic Cohen surgery is suitable for hydronephrosis and ureteral expansion with ureterocele, especially with the symptom of dysuria, and ureteral tortuosity obviously.The two ways are safe and reliable, and the advantages and disadvantages should be weighed before being chosen.

Objective:To explore the reasons for the retention of long time testicular torsion and the surgical selections of contralateral testis in children.Methods:The data of children with acute scrotal emergencies treated by the First Affiliated Hospital of Zhengzhou University from August 2016 to August 2019 were retrospectively analyzed.All the testicular torsion was included in the study sequence to summarize the clinical characteristics of the testicle that could be saved and different treatment methods adopted in the contrary side according to the anatomy of testes.Results:A total of 80 children with testicular torsion were included in the study.The onset time ranged from 2 hours to 15 days.All patients came to the hospital with unilateral scrotal pain or inguinal pain, including 74 cases of unilateral testicular torsion and 6 cases of cryptorchidical testicular torsion.All the children were treated with surgery.Orchiectomy was performed in 69 cases of testicular necrosis, and 11 cases were saved, among which 4 cases took a long time for testicular torsion, the main reason for the retention was the longer spermatic cord in the tunica vaginalis.Of the 80 healthy testes, the adhesion of the testis to tunica vaginalis was normal in 63 cases and abnormal in 17 cases.There were 20 children (including 5 children with abnormal anatomy) were routinely treated with partial removal of the tunica vaginalis and orchiopexy.Among the remaining 60 cases, 12 cases with abnormal adhesion of the testis to tunica vaginalis underwent partial removal of the tunica vaginalis and orchiopexy, and the other 48 cases with normal anatomy received the testis examination and the original incision closure.During the follow-up of 80 cases, 5 cases of the 11 children with the testis preserved returned to normal, 6 cases of them showed atrophy to varying degrees, and no discomfort such as torsion or pain was found in all the healthy testes.Conclusions:The long spermatic cord in the tunica vaginalis is the reason for long time testicular torsion in children with the testis saved.It buys time for the rescue of their testes.Orchiopexy is not necessary for those who have normal anatomy of the healthy testes, while partial removal of the tunica vaginalis and orchiopexy are recommended for patients with bell clapper anomaly.

Objective This study aimed to observe the effect of Jiang Tang San Hao Formula(JTSHF)on systemic and intestinal inflammation,as well as on the NLRP3 inflammasome in type 2 diabetic mice(T2DM),and to elucidate its anti-diabetic molecular mechanisms.Methods Four-week-old male C57BL/6 N mice were used to establish the T2DM model using a high-fat diet combined with streptozotocin injection.The diabetic mice were randomly divided into the model,metformin,and JTSHF groups.A control group was also set to provide baseline comparisons.Each group of mice was orally administered with the corresponding medication daily.The metformin group was orally administered with 0.20 g/kg metformin,the JTSHF group was orally administered with 4.26 g/kg JTSHF,and the control group and model group were orally administered with an equal amount of sterile water continuously for 8 weeks.After an 8-week drug intervention via gavage,the lipopolysaccharide(LPS),tumor necrosis factor-alpha(TNF-α),interleukin 1 beta(IL-1β),and interleukin 6(IL-6)serum and colon levels were quantified using an enzyme-linked immunosorbent assay(ELISA).The pathological morphology of the colon was observed using hematoxylin and eosin staining.NOD-like receptor protein 3(NLRP3),apoptosis-associated speck-like protein containing a caspase recruitment domain(ASC),caspase-1,zonula occludens-1(ZO-1),occludin,and G-protein coupled receptor 43(GPR43)protein expression in the colon were assessed using immunohistochemistry.The mRNA expression levels of NLRP3,ASC,caspase-1,ZO-1,Occludin,and GPR43 in the colon were detected using Real-time PCR.Results The ELISA data revealed significant differences in inflammatory markers among the groups.Compared with the model group,the JTSHF group exhibited notably reduced LPS,TNF-α,IL-1β,and IL-6 levels(P<0.05).Moreover,compared with the model group,JTSHF treatment upregulated ZO-1,occludin,and GPR43 protein and mRNA expression in the colon and downregulated NLRP3,ASC,and Caspase-1 protein and mRNA expression(P<0.05).Conclusion The inflammatory reaction of T2DM mice is apparent.JTSHF effectively alleviates the systemic and intestinal inflammatory response of T2DM mice by inhibiting the NLRP3 inflammasome and repairing the intestinal mucosal barrier,highlighting the potential molecular mechanisms of the anti-diabetes effects of JTSHF.