BACKGROUND: Functional constipation (FC) might exert great influence on children in body and mental health, social-psychological development and long-term life quality. At present, there is not precise definition, clear classification, unite diagnostic standards and practicable systematic treatment project for FC in children. As a non-traumatic diagnostic means for chronic transiting constipation, gastrointestinal transit time (GTT) is considered as one of the objective indexes for dynamically observing gastrointestinal transit function, and has significance in the diagnosis of abnormal gastrointestinal dynamics, etiological investigation and therapeutic effect assessment.OBJECTIVE: To investigate the difference of GTT between constipation children and normal healthy control, so as to elicit its significance in assessing the dynamics of whole gastro-intestine and each segment.DESIGN: Case control comparative study based on FC children and healthy children.SETTING: Department of Pediatrics, Guangdong Provincial General Hospital, Chinese People's Armed Police Forces.PARTICIPANTS: This study was carried out at Pediatric Department of Guangdong Provincial General Hospital, Chinese People' s Armed Police Forces. Totally 28 children with confirmed FC in the General Hospital of Armed Police took part in the experiment, and 68 healthy children from a certain kindergarten and an elementary school in Guangdong province were selected as normal controls.METHODS: Whole gastrointestinal transit time(GTT), mouth-intestine transit time and colon transit time(CTT) were determined with plain abdominal photograph at 12 hours, 24 hours and 48 hours after orally administrated of radio-opaque markers.MAIN OUTCOME MEASURES: Whole GTT, mouth-intestine transit time and CTT, as well as right colonic transit time, left colonic transit time, rectosigmoid transit time.RESULTS: 50% whole gastrointestinal transit time, mouth-intestine transit time and CTT were[(23.6±1.6) vs (80.4±2.1) hours], [(9.9±1.4)vs(20.7±0.6) hours] and[(14.8±0.8) vs (59.9±2.3) hours] in constipation and healthy group respectively, with significant difference between them( P < 0.01 ) . Moreover there was statistical difference in right colon transit time, left colon transit time and rectosiqmoid transit time between two groups( P < 0.01).CONCLUSION: GTT of constipation children is obviously different from that of healthy children; it can be used for assessing the dynamics of whole gastrointestine and each segment, thereby possess practical significance in the diagnosis and therapeutic effect assessment of FC in children.Yang M, Wang BX, Wang MG. Determination of gastrointestinal transit time in functional constipation in children.

Objective To evaluate the efficacy of transverse thoracic muscle plane-thoracic nerve block combined with general anesthesia when used for modified radical mastectomy. Methods Sixty female patients, of American Society of Anesthesiologists physical statusⅠ or Ⅱ, aged 45-63 yr, weighing 48-72 kg, scheduled for elective modified radical mastectomy, were divided into 3 groups ( n=20 each) using a random number table method: thoracic nerve block-general anesthesia group ( group P+G ) , transverse thoracic muscle plane-thoracic nerve block-general anesthesia group ( group T+P+G) and general anesthesia group ( group G ) . Anesthesia was induced with midazolam, propofol, fentanyl and cisatracurium and maintained with sevoflurane, fentanyl and cisatracurium. Thoracic nerve block typeⅠ and Ⅱ was per-formed after implanting laryngeal mask airway in group P+G. Transverse thoracic muscle plane block was performed after performing thoracic nerve block typeⅠandⅡin group T+P+G. Flurbiprofen 50 mg was in-travenously injected after operation as a rescue analgesic to maintain the Visual Analogue Scale score≤3. The consumption of opioids, emergence time and time for removal of the laryngeal mask airway were recor-ded. Ramsay sedation score was recorded at 10 min after removal of the laryngeal mask airway. The require-ment for rescue analgesia, time of passing flatus and development of nausea and vomiting within 24 h after operation were recorded. Results Compared with group G, the emergence time, time for removal of the laryngeal mask airway and time of passing flatus were significantly shortened, and the Ramsay sedation score, consumption of fentanyl and requirement for rescue analgesia were decreased in P+G and T+P+G groups ( P<0. 05) , and the incidence of nausea and vomiting was significantly decreased in group T+P+G ( P<0. 05) . Compared with group P+G, the time for removal of the laryngeal mask airway and time of pass-ing flatus were significantly shortened, the consumption of fentanyl was decreased ( P<0. 05) , and no sig-nificant change was found in the requirement for rescue analgesia or incidence of nausea and vomiting in group T+P+G ( P>0. 05) . Conclusion Transverse thoracic muscle plane-thoracic nerve block combined with general anesthesia can provide satisfactory perioperative analgesia and is helpful in improving prognosis for the patients undergoing modified radical mastectomy.

Objective To explore the effects of airway peak pressure (Ppeak)guidance on the minimum laryngeal mask airway (LMA)intracuff pressure (ICP)setting during general anesthesia. Methods Sixty patients,aged 18-65 years,ASA physical status Ⅰ or Ⅱ,scheduled for elective gy-necological laparoscopic operation under general anesthesia were enrolled.The patients were randomly divided into pressure-regulated group (group P)and control group (group C)with 30 cases in each group.Size 4 Supreme LMA was inserted in after general anesthesia induction.Air was injected into the cuff to make ICP achieve 60 cm H2O.Volume-controlled ventilation was selected and Ppeak was recorded.In group P,all the gas in the LMA cuff was sucked out,and then air was injected in during expiration phase to make ICP achieve the level of Ppeak.If air leakage occurred,ICP was increased by 5 cm H2O each time until no gas leaked from the oropharynx.After pneumoperitoneum,the cuff was inflated to make ICP achieve 60 cm H2O and Ppeak was recorded once more.Then all the gas in the LMA cuff was sucked out,and air was injected into the cuff to make ICP achieve the level of Ppeak as the above method till the end of operation.In group C,ICP was maintained at 60 cm H2O.Ppeak, ICP and the intracuff gas volume were recorded before and after pneumoperitoneum.ICP during in-spiratory phase in the two groups was measured.Tidal volume during inspiration(Vti)and expiration (Vte)in the two groups were recorded,and the air leakage fraction (LF)was calculated as [(Vti-Vte)/Vti×100%].Laryngopharyngeal complications of all the patients in 24 hours after surgeries were also recorded.Results The intracuff gas volume before and after pneumoperitoneum and ICP were decreased significantly in group P compared with group C (P<0.05).There was no difference in LF between the two groups.Compared with group C,there were fewer patients with postoperative throat pain and swallow discomfort in group P (P<0.05).Conclusion ICP at the level of Ppeak plus 0-5 cm H2O during LMA ventilation can provide better sealing effect and less laryngopharyngeal com-plications.

Objective:To explore the clinical efficacy of lenalidomide combined with second-line immunochemotherapy as a salvage regimen in the treatment of relapsed/refractory diffuse large B-cell lymphoma (DLBCL).Methods:The clinical data of 37 relapsed/refractory DLBCL patients receiving lenalidomide combined with second-line immunochemotherapy as a salvage regimen who had recurrence after autologous hematopoietic stem cell transplantation or who were not eligible for transplantation or had no intention to transplant between January 2016 and December 2020 in the First Affiliated Hospital of University of Science and Technology of China were retrospectively analyzed. Among 37 patients, 6 cases with primary central nervous system (CNS) lymphoma and 3 cases with secondary CNS lymphoma. The short-term efficacy after treatment was evaluated. Kaplan-Meier method was used to analyze the overall survival (OS) and progression-free survival (PFS), and log-rank test was used for subgroup comparison.Results:The median follow-up time of 37 patients was 20.4 months (2.7-37.0 months). At the end of treatment, the overall response rate (ORR) of all patients was 64.9% (24/37), the complete response (CR) rate was 45.9% (17/37), and the median duration of response (DOR) of 24 patients who responded to treatment was 17.7 months (3.6-33.6 months). The median PFS time of all patients was 11.2 months, and the 1-year PFS rate was 48.6% (95% CI 32.5%-64.7%). The median OS time of all patients was not reached, and the 1-year OS was 67.6% (95% CI 52.5%-82.7%). Among 24 responding patients, 17 cases who received lenalidomide maintenance therapy after remission tended to have a better response compared with 7 cases who did not receive lenalidomide maintenance therapy after remission, although there was no significant difference in OS and PFS between both groups (both P > 0.05). Additionally, neutropenia was the most common adverse reaction with an incidence of 81.1% (30/37). Conclusions:Lenalidomide combined with the second-line immunochemotherapy may be an effective salvage therapy for patients with relapsed/refractory DLBCL, especially for patients with CNS involvement. The patients achieving remission after salvage therapy continue to receive lenalidomide maintenance therapy and could have a better prognosis.

Objective To understand the spatial distribution of incidence of hand foot and mouth disease (HFMD) at scale of township and provide evidence for the better prevention and control of HFMD and allocation of medical resources.Methods The incidence data of HFMD in 108 counties (district) in Shandong province in 2010 were collected.Downscaling interpolation was conducted by using area-to-area Poisson Kriging method.The interpolation results were visualized by using geographic information system (GIS).The county (district) incidence was interpolated into township incidence to get the distribution of spatial distribution of incidence of township.Results In the downscaling interpolation,the range of the fitting semi-variance equation was 20.38 km.Within the range,the incidence had correlation with each other.The fitting function of scatter diagram of estimated and actual incidence of HFMD at country level was y=1.053 1x,R2=0.99.The incidences at different scale were consistent.Conclusions The incidence of HFMD had spatial autocorrelation within 20.38 km.When HFMD occurs in one place,it is necessary to strengthen the surveillance and allocation of medical resource in the surrounding area within 20.38 km.Area to area Poisson Kriging method based downscaling research can be used in spatial visualization of HFMD incidence.

Humans ; Hematopoietic Stem Cell Transplantation ; Transplantation, Autologous ; Lymphoma, Non-Hodgkin/drug therapy* ; Aminopyridines/therapeutic use* ; Antineoplastic Combined Chemotherapy Protocols