This case report outlines the treatment of an 11-year-old female who underwent adenotonsillectomy six years ago for snoring but experienced postoperative inefficacy. Her symptoms worsened two weeks before readmission, with increased snoring and sleep apnea, disabling her from lying down to sleep. She was readmitted on December 1, 2023, and diagnosed with severe obstructive sleep apnea hypopnea syndrome and hypercapnia. Automatic BiPAP alleviated her symptoms, with sleep breathing parameters normalizing during treatment. Follow-up at one month showed significant acceleration in her growth and resolution of her hypersomnolence issue.
Humans ; Female ; Child ; Hypercapnia/complications* ; Sleep Apnea, Obstructive/complications* ; Positive-Pressure Respiration ; Noninvasive Ventilation

Objective To observe area of coagulation necrosis after microwave ablation(MWA)of rabbit liver showed on contrast-enhanced ultrasound(CEUS)in comparison with pathological findings.Methods Twenty-five healthy male experimental rabbits were equally randomly divided into L0,M0,H0,M7 and M14 groups.MWA was achieved with different power and time,and then CEUS and pathological examinations were performed,respectively.Four target areas of rabbit liver were ablated under 20 W for 1 min in L0 group,under 30 W for 1 min in M0 group and under 30 W for 3 min in H0 group,and the ablated areas were observed on the same day after MWA,while 2 target areas of rabbit liver were ablated under 30 W for 1 min in M7 and M14 groups,and the ablated areas were observed 7 days and 14 days after MWA,respectively.The ablated foci and ablated foci+edema band(inflammatory reaction band,IRB)showed on CEUS and pathology were compared,and their differences and changes with time going were analyzed.Results On the day of ablation,the extent of ablation foci,ablation foci+IRB as well as IRB in L0,M0 and H0 groups showed on CEUS were all larger than pathological findings under light microscopy(all P＜0.05),and the difference value of the length of the ablation foci between 2 methods increased sequentially among group L0,M0 and H0(all adjusted P＜0.05).Seven days after ablation,the area of ablation foci measured with CEUS in M 7 group was slightly larger than that measured with pathology(adjusted P=0.045),but no significant difference of the length nor the short diameter was found(both adjusted P＞0.05).Fourteen days after ablation,no significant difference of the length,the short diameter nor the area of ablation foci was detected between 2 methods in M14 group(all adjusted P＞0.05).The length,short diameter and area of ablation foci in M0 group measured with CEUS or pathology were all smaller than those in M 7 and M14 groups(all adjusted P＜0.05),while no significant difference was found between the latter 2 groups(all adjusted P＞0.05).Conclusion On the day of MWA of rabbit liver with different power and time settings,the areas of ablation foci,ablation foci+IRB and IRB showed on CEUS were larger than pathological findings.The range of ablation foci showed on CEUS 7 days after ablation was basically in line with pathology,indicating that CUES should be reexamined 7 days after ablation to evaluate the actual extent of coagulation and necrosis of ablation foci.

Objective To observe the impact of cold circulation liquid temperature on ablation focus morphology of microwave ablation(MWA)for in vitro porcine liver tissue.Methods Twenty in vitro fresh porcine liver blocks were randomly divided into ice water circulation group(group A)and normal temperature circulation group(group B),respectively.Ten target ablations in each subgroups in group A and group B,i.e.A1 and B1(50 W,1 min),A2 and B2(50 W,5 min),A3 and B3(60 W,1 min),A4 and B4(60 W,5 min),A5 and B5(70 W,1 min)as well as A6 and B6(70 W,5 min)subgroups were performed using different ablation power(50,60,70 W)and ablation time(1,5 min),respectively.Then the morphology indexes of ablation foci,including longitudinal diameter(LD),transverse diameter(TD),roundness index(RI)and volume(V)were compared between subgroups in group A and B,also among subgroups within group A and B.Results Under the same ablation power and time,LD of ablation foci in subgroups of group A were all smaller than those of group B(all P＜0.05).Significant differences of RI of ablation foci were found between A1 and B1,A2 and B2,A4 and B4,A5 and B5 as well as A6 and B6 subgroups(all P＜0.05),but not between A3 and B3 subgroups(P＞0.05).However,the main effect of cold circulation liquid temperature on ablation focus TD(F=1.125)nor V(F=3.332)was not significant(both P≥0.05).Under the same cold circulation liquid temperature,significant differences of the morphology indexes of ablation foci were detected between A1 and A2,A3 and A4 as well as A5 and A6 subgroups,also between corresponding subgroups in group B(all P＜0.05).Conclusion During MWA for in vitro porcine liver tissue under constant ablation power and time,taken ice water as the cold circulation liquid was benefit to ablation focus shaped spherically.With the extension of ablation time,the larger the ablation focus,the higher the RI.

Objective:To observe the clinical outcomes of continued pregnancy in pregnant women with cesarean scar pregnancy (CSP).Methods:A retrospective analysis was performed on the pregnancy outcomes of 55 pregnant women who were diagnosed with CSP at the Second Affiliated Hospital of Army Medical University during the first trimester of pregnancy from August 1st, 2018 to October 31st, 2021 and strongly requested to continue the pregnancy.Results:Of the 55 pregnant women, 15 terminated the pregnancy in the first trimester, 1 underwent hysterotomy at 23 weeks of gestation due to cervical dilation, and 39 (71%, 39/55) continued pregnancy to the third trimester achieving live births via cesarean section. The gestational age of the 39 pregnant women delivered by cesarean section was 35 +6 weeks (range: 28 +5-39 +2 weeks), of whom 7 cases at 28 +5-33 +6 weeks, 20 cases at 34-36 +6 weeks, and 12 cases at 37-39 +2 weeks. The results of pathological examination were normal placenta in 3 cases (8%, 3/39), placenta creta in 4 cases (10%, 4/39), placenta increta in 9 cases (23%, 9/39) and placenta percreta in 23 cases (59%, 23/39). Among the 36 pregnant women who were pathologically confirmed as placenta accreta spectrum disorders (PAS) after surgery, the last prenatal ultrasonography showed placenta previa in 27 cases (75%, 27/36) and not observed placenta previa in 9 cases. The median intraoperative blood loss, autologous blood transfusion, and allogeneic suspended red blood cell infusion of 39 pregnant women during cesarean section were 1 000 ml (300-3 500 ml), 300 ml (0-2 000 ml) and 400 ml (0-2 400 ml), respectively. The uterine preservation rate was 100% (39/39), and only 1 case received cystostomy due to intracystic hemorrhage. The birth weight of the newborn was 2 580 g (1 350-3 800 g), and 1 case of mild asphyxia. Conclusions:Pregnant women with CSP who continue pregnancy under close monitoring after adequate ultrasound evaluation and doctor-patient communication could achieve better maternal and infant outcomes, but pregnant women with CSP are highly likely to continue pregnancy and develop into PAS. Effective hemostasis means and multidisciplinary team cooperation are needed in perinatal period for ensuring maternal and fetal safety.

OBJECTIVE: To explore the clinical application of the peripheral totally implantable venous access port(TIVAP) in breast cancer chemotherapy patients,and to understand the clinical applicability and safety of peripheral TIVAP.METHODS: The clinical data of 201 cases using peripheral TIVAP of multi-course chemotherapy in the First Affiliated Hospital of Chongqing Medical University from March 2017 to June 2018 were analyzed retrospectively.The difference of composition ratio of various complications,and difference between the conventional pressure bandaging method and the modified pressure bandaging method for incision hemorrhage,the conventional implantation method and the improved implantation method for catheter ectopic and the difference of the catheter ectopic after left/right peripheral vein TIVAP placement were compared.RESULTS: There were 50 cases(24.9%) of postoperative complications,15 cases(7.5%) of incision hemorrhage,4 cases(2.0%)of catheter-related thrombosis,3 cases(1.5%) of base exposure,4 cases(2.0%) of sack infection,15 cases(7.5%)of primary catheter ectopic,7 cases(3.5%) with no blood withdrawal,2 cases(1.0%) with catheter-related upper limb movement limitation.Using the goodness of fit test(equal ratio) to compare the composition ratio of various complications,χ~2=30.520,P<0.001,the proportion of complications was not obeyed,and the proportion of incision hemorrhage and catheter ectopic was the highest.The conventional pressure bandaging method(78 cases) and the modified pressure bandaging method(123 cases) showed incision bleeding,and the difference was statistically significant [11 cases(14.1%) vs.4 cases(3.3%),χ~2=6.642,P=0.010];the conventional implantation method(90 cases) and the modified implantation method(121 cases) were compared with catheter ectopic,and the difference was statistically significant [9 cases(10.0%) vs.3 cases(2.4%) χ~2=4.131,P=0.042];there was no statistically significant difference in catheter ectopic position after left(106 cases)/right(95 cases) peripheral TIVAP implantation [8 cases(7.5%) vs.7 cases(7.3%),χ~2=0.020,P=0.962].CONCLUSION: The complication of peripheral TIVAP can be effectively controlled through safe management,close observation and active treatment.TIVAP is still a safe and effective intravenous infusion channel for long-term clinical use if there is no contraindication.

Objective To investigate the characteristics of coronary vessel re-endothelialization after placement of drug-eluting stents (DES), and to provide clinical evidence for the double anti-platelet treatment. Methods Optical coherence tomography (OCT) was performed in 43 patients in 1 year after DES implantation. Characteristics of re-endothelialization and percentage of neointimal coverage of stent struts were evaluated by OCT. Results The rate of stent struts intimal coverage was 90.70%, and the remain was lack of endothelial coverage; The ratio of neointimal thickness (NIT) between 0-99, 100-199 and above 200 microns was 19.92%, 37.55% and 42.53%, respectively. The rate of neointimal coverage was higher and the degree of neointimal hy-perplasia was more extensive in patients with DM and in patients with ACS than those of patients without DM and of patients with stable angina pectoris. Conclusion One year after stent placement, most of the stent struts were covered with neointima and few struts obtained poor coverage of endothelial. DM and ACS may be impact factors for the progress of re-endothelialization after DES placement.

Objective: To compare the percutaneous transluminal septal myocardial ablation (PTSMA) and percutaneous transluminal septal tunnel myocardial ablation (PTSTMA) on cardiac function in experimental canines.
Methods: According to CAG determined coronary septal branches, a total of 25 hybrized canines were divided into 2 groups:PTSMA group, n=13 canines with the bigger septal branches and PTSTMA group, n=12 canines with the smaller or uneven septal branches. Alcohol ablation model was established. Electrocardiograph (ECG) at before and after the operation, biomarkers for myocardial injury, echocardiography and hemodynamic changes were recorded. The animals were scariifes at 1 week after operation, the pathological changes in ventricular septal were observed by HE and Masson staining.
Results: Myocardial infarction (MI) could be induced by either PTSMA or PTSTMA and the thickness of septal was decreased. LVEDd, LVEF and hemodynamic indexes were similar between 2 groups. The alcohol volume used in operation, EKG and echocardiography ifndings were similar between 2 groups, P>0.05. Pathological staining indicated that there was a well-demarcate between the ablation focal and normal myocardium, merging area had neutrophiles invasion, infarcted cells were partially having the ghost cell sample and they were gradually replaced by ifbrous tissue. There was nest-like necrosis in ablated lumen and the normal vessel wall disappeared. PTSMA group had vessel lumen conifguration in septal branch and the necrosis limited inside the lumen;while in PTSTMA group, the vessel wall of was discontinued and some necrosis materials move out to from lumen.
Conclusion: Both PTSMA and PTSTMA were effective for alcohol septal ablation in different coronary septal branches, the impacts on cardiac function and hemodynamic changes were similar in experimental canines.

Objective To explore self-care abilities and current status of fatigue and loneliness in peritoneal dialysis patients, and to determine the correlation between their self-care and fatigue & loneliness. Methods Totals of 237 cases with peritoneal dialysis followed up by Nephrology Department in the First Affiliated Hospital of Zhengzhou University were selected and surveyed by General patient information questionnaire, Exercise of Self-Care Agency Scale ( ESCA) , Multidimensional Fatigue Inventory-20 ( MFI-20) , and UCLA Loneliness Scale ( Chinese version ) . Results Scores of self-care ability in peritoneal dialysis patients were ( 92. 18 ± 15. 23) points, in the level above the average. Scores of fatigue in peritoneal dialysis patients were (61.24±11.72) points, and of loneliness (46.28±5.34), both higher than norm (P<0.01). Self-care ability of peritoneal dialysis patients showed a negative correlation with level of fatigue and loneliness ( P<0. 01) . It was revealed in multiple stepwise regression analysis that influencing factors of self-care abilities in peritoneal dialysis patients included comprehensive fatigue, less activity, physical fatigue and loneliness. Conclusions When making nursing measures for peritoneal dialysis patients, their fatigue and loneliness should be assessed. Targeting measures should be intervened to eliminate their fatigue and loneliness, so as to improve their self-care ability and quality of life.

With the increasing incidence and mortality of coronary heart disease (CHD) in China, the prevention and treatment of CHD is no time to delay. Since Professor Gruentzig completed the first human case of percutaneous transluminal coronary angioplasty (PTCA) in 1977, percutaneous coronary intervention (PCI) had reached to a new page. After three decades of development and change, PCI has been improved and matured gradually from the early PTCA to the current stent era. With the advent of stents, the rate of restenosis after PCI was significantly reduced from 30%-50% to 10%-20%. But stent restenosis was still with no total cure. The issue of how to prevent the stent restenosis has become a long-term major issue for the exploration in both clinical and preclinical medicine. Therefore, this paper reviewed the etiology, pathology, related risk factors, latest diagnosis methods, prevention and treatment of stent restenosis by integrative medicine.

This study was aimed to observe the safety and effectiveness ofShugan Jieyu Capsules in the treatment of vasovagal syncope (VVS) with mild-to-moderate depression and anxiety, and to compare the effect with Flupentixol and Melitracen Tablets. A total of 89 VVS cases with mild-to-moderate depression and anxiety were randomly divided into 3 groups, which were group A (Shugan Jieyu Capsules group), group B (Flupentixol and Melitracen Tablets) and group C (control group). Based on the conventional therapy of VVS treatment, treatments were given to all three groups for 8 weeks. And the negative conversion ratio of VVS in each group was observed. Hamilton Depression Scale (HAMD 24 items) and Hamilton Anxiety Scale (HAMA) were evaluated for the calculation of reductive rate. Treatment emergent symptoms scale (TESS) was used in the evaluation of adverse reactions of both medications during the treatment. In the 12-month follow-up after treatment, the recurrence rate of syncope was observed in each group. The results showed that compared with pretreatment, HAMD-24 and HAMA scores of group A and group B after treatment were significantly reduced (P < 0.05). Compared with group C, the heat-up tilt testing-negative rate, HAMD-24 and HAMA reductive rate of group A and group B after treatment were significantly increased (P < 0.05). Compared with group B, the negative rate, HAMD-24 and HAMA reductive rate of group A were more significant (P < 0.05). After treatment, scores for TESS of group A was significantly lower than group B (P< 0.05). In the 24-month follow-up, the recurrence rate of syncope of group A and group B was significantly lower than group C (P < 0.05); and group A was obviously better than group B (P < 0.05). It was concluded thatShugan Jieyu Capsules can be used in the treatment of VVS with mild-to-moderate depression and anxiety. Its effectiveness and safety may be better than Flupentixol and Melitracen Tablets.