Objective To study the effect of Sandra Fucile oral stimulation on oral feeding readiness and ability of preterm infants.Methods Sixty-five premature infants were selected in the study.All of the premature infants were recruited randomly in convenience between Jul.and Dec.2012.For a randomized control principle,SPSS 13.0 was performed to achieve complete random design.Objects were divided into control group(receiving routine nursing) and intervention group(on the basis of routine nursing,receiving 15 minutes oral stimulation,1 time/day,for 10 days).Chinese version of Preterm Infant Oral Feeding Readiness Assessment scale(PIOFRA scale-CV) was used when intervention began,and 7 days,10 days,14 days after the start of the intervention.Results PIOFRA-CV scale score was statistically different at different time in both groups(F =169.062,P ＜0.001).The first day ratings were minimum in the 2 groups,after which with an upward trend over time.The control group and intervention group rated a statistically significant difference(F =5.538,P =0.022).Except for no difference on the first day and seventh day (t =1.650,P =0.204 ;t =0.817,P =0.369) between the 2 groups,the intervention group had a higher score than the control group (t =17.339,24.141,all P ＜0.001).Group and time had an interaction effect(F =1 1.561,P ＜0.001).The incidence of vomiting[42.4％ (14/33 cases) vs 34.4％ (11/32 cases)],infection [27.3％ (9/33 cases) vs 9.4％ (3/32 cases)],and gastro-oesophageal reflux[30.3％ (10/33 cases) vs 25.0％ (8/32 cases)] were not significantly different between the 2 groups(x2 =0.445,3.457,0.288,all P ＞ 0.05).Conclusions Saudra Fucile oral stimulation method can significantly promote the development of premature oral feeding ability on the 10 day after the intervention,and will not increase vomiting,gastroesophageal reflux,and infection.It is suitable for clinical application.

Objective To evaluate the safety to perform 23G vitrectomy with scleral incisions at 5.0 mm behind the limbus.Methods This is a prospective uncontrolled case study.The data of 140 consecutive primary 23G vitrectomy patients (145 eyes) were enrolled in this study.There were 56 males (59 eyes) and 84 females (86 eyes),with the mean age of (56.34 ± 9.98) years and axial length of (23.99± 2.57) mm.There were 139 phakic eye and 6 aphakic eyes.All the eyes received 23G pars plana vitrectomy with scleral incisions at 5.0 mm behind the limbus.To measure the normal Chinese adult parameters of anteroposterior axis of the eyeball,lens thickness and scleral distances from the limbus to the plane passing through the lens posterior apex,the head CT scans of 105 patients without eye diseases in our hospital were studied during the same period of time for these vitrectomy surgeries.Pearson correlation analysis was used to analyze the relationship between age,anteroposterior axis of eyeball,lens thickness and scleral distances from the limbus to the plane passing through the lens posterior apex.Results Surgical related complications included retinal tears close to the scleral incision sites (3/145 eyes,2.1％) and lens injury (3/121 eyes,2.5％).No other surgical complications occurred,such as retinal hemorrhage,supra-choroidal expulsive hemorrhage and iatrogenic retinal detachment.Based on CT images,the average scleral distance from limbus to the plane passing through the lens posterior apex,anteroposterior axis of eyeball and lens thickness was (6.72± 0.81),(24.39± 0.97),(4.22 ± 0.47) mm,respectively.The results of Pearson correlation analysis showed that age and lens thickness had statistically significant correlation (r=0.328 9,P=0.000 6).Conclusion Primary 23G pars plana vitrectomy with incisions at 5.0 mm posterior to the limbus is safe.

Objective To explore the application of adaptive statistical iterative reconstruction (ASIR)scanning technique in low dose pediatric cervical CT, especially in reducing the radiation dose for thyroid. Methods We retrospectivly analyzed 140 pediatric cervical CT. 70 cases of group A scaned with ASIR technology and preseting noise index 12 HU in Discovery CT 750 HD (GE Healthcare), and 70 cases of group B scaned with filtered back projection (FBP) technology and preseting noise index 14 HU in VCT 64 (64 Lightspeed VCT, GE Healthcare). The other scan parameters were same in 2 groups. The distribution characteristics of gender and age were completely consistent between groups. The minimum current, the maximum current, the current of thyroid on CT images and CT dose volume index (CTDIvol), scanning length and dose length product (DLP) on dose reports were all recorded for each child. The noise values of CT images were measured. 4 scores standard was used to evaluate the subjective image quality. The data were analyzed with SPSS 13, Kappa method for the test of consistency and t test for the differences of the measured data. Excel was used for mapping. Results The minimum current, the maximum current, the average current, the current for thyroid of the two groups were respectively (26.8 ± 4.2), (43.2 ± 15.4)mA;(35.8±9.6),(41.8±13.6)mA;(34.6±8.6), (41.0±13.2)mA;(36.8±12.3), (44.7±21.0)mA. The CTDIvol, DLP and the scanning length of the two groups were respectively(1.3 ± 0.3), (1.8 ± 0.6)mGy;(29.0 ± 8.3), (40.3 ± 15.6) mGy·cm and(157.5±20.2), (157.6±21.8)cm. The average current, the thyroid current, CTDI and DLP in group A were 15.8%, 17.9%, 27.3%and 28.4%lower than those in group B (t=-5.50—-0.02, P<0.01). The subjective image quality scores of the two doctors were respectively 3.4 ± 0.9, 3.3 ± 1.0, they were highly consistent (Kappa=0.834, P<0.01). The objective image noise of cancellous bone and neck muscles were respectively (32.5 ± 5.3),(32.9 ± 5.1)HU and (9.2 ± 2.3), (9.1 ± 2.0)HU, there were not statistically difference between the two groups (t=-0.47—0.24, P<0.05). Conclusion Compared with FBP, low dose pediatric cervical CT with 30%ASIR could provide dose reduction for thyroid and the whole neck while maintaining diagnostically acceptable images .

Objective This study was to explore deaf people's needs for a smooth communication with doctors and/or nurses during health consultation in the outpatient department or when being hospitalized and supply reference for compilation of sign language textbooks.Methods Purposive sampling was used and semi-structured interviews were conducted.Six deaf participants who met the inclusion and exclusion criteria were interviewed.It lased for 20 to 40 minutes for each interview.Interviews were recorded digitally and then transcribed and validated.Transcripts were analyzed using a method of thematic analysis.Results Three themes were identified,i.e.needs for sign language interpreters,needs for information and knowledge.and needs for psychosocial and emotional support.Needs for sign language interpreters meant that doctors and nurses were able to communicate with them using simple sign language instead of terminology.The required information and knowledge covered three aspects,i.e.health condition,pharmaceutical therapy,and self-care activity.Conclusions There may exist serious communicative barriers for deaf people during their health consultation in the outpatient department or when being hospitalized.There is a need for healthcare professionals who are competent in sign language to establish the health delivery environment with minimal barriers.

Objective This study aimed to explore issues about dysandia female during pregnancy,peripartum and contraception and to supply reference for their reproductive health improvement. Methods Purposive sampling strategy was used. With the aid of an interview guide, 12 dysaudia women who met inclu-sion and exclusion criteria were invited to be interviewed. Interviews were recorded, validated and then ana-lyzed. Results Four themes were generated, limited knowledge, passive information acquisition, total depen-dence on family and reluctant to talk about contraception. Total dependence on family was noticeable during pregnancy and peripartum. Though little was known about health protection related to pregnancy, peripartum and contraception, participants were passive at seeking for relevant information. Conclusions Deaf women may experience more threats to reproductive health in relation to pregnancy, peripartum and contraception that they require more guidance and assistance.

Objective To investigate students' experiences of learning achieved through the flipped classroom based on Massive Open Online Course(MOOC). Methods Qualitative study in which data were gathered from semi-structured and in-depth interviews conducted with 8 key students from the flipped classroom. The interviews were analyzed using Nancy′s phenomenology 7-step analysis method. Results Four themes emerged from the interviews: personalized learning, active learning, cooperative learning, and the critical role of teacher. Conclusions Overall, our research highlights the efficacy of MOOC-based flipped classroom. The implementation of the flipped classroom in this study improved personalized, active, and cooperative learning, and promoted the positive teacher-student relationship. Further research is needed to continue the investigation into maintaining students′ learning initiatives, controlling teach-learning progression,and strengthening formative evaluation.

Objective: To explore the application value of endoscope in probing the chronic wound with sinus tract in clinic. Methods: Twenty-eight chronic wounds with sinus tracts from 27 patients conforming to the inclusion criteria admitted to Outpatient Department of Wound Healing Center of Ruijin Hospital from December 2017 to March 2018 were investigated in a prospective and self-controlled trial. After being cleaned, the diameter of the opening of sinus tract was measured with a rule. A probe was used to measure the depth of a sinus tract according to the touch from the probe extremity in operation, and to measure the depth of a sinus tract that could be observed with naked eyes with the help of a pair of hemostatic forceps. Five minutes later, a probe was inserted deeply into the sinus tract to measure the depth under the endoscopic view combined with touch from the probe extremity in operation. Afterwards, the sinus tract was observed with endoscope, and the depth of the tract which could be observed under the endoscopic view was measured using a probe inserted deeply into the sinus tract. After completion of the above exploration, the sinus tract was infused with contrast agent Omnipaque 350 and scanned by computed tomography (CT) later to obtain its depth. The following indicators were calculated: the ratio of the depth of the sinus tract measured by CT to the diameter of the opening of the sinus tract (hereinafter referred to as the depth/diameter ratio of the sinus tract), the deviation rate comparing the depth of the sinus tract measured by conventional method (measured by probe only) and by endoscope (measured by probe under the endoscope view) with the depth of the sinus tract measured by CT (hereinafter referred to as the deviation rate of the measured depth of the sinus tract), the deviation rate comparing the depth of the sinus tract that could be observed measured by conventional method and by endoscope with the depth of the sinus tract measured by CT (hereinafter referred to as the deviation rate of the depth of the sinus tract that could be observed). Data were processed with paired t test. Pearson correlation analysis was applied to analyze the correlation between the depth/diameter ratio of the sinus tract and the deviation rate of the measured depth of the sinus tract and the deviation rate of the depth of the sinus tract that could be observed by conventional method and by endoscope. Results: The depth/diameter ratio of the sinus tract of this group of wounds was 1-32 (8±7). The deviation rate of the measured depth of the sinus tract and the deviation rate of the depth of the sinus tract that could be observed by conventional method were (19±14)% and (79±18)%, respectively, both obviously larger than (9±9)% and (25±25)% by endoscope (t=3.837, 13.626, P<0.01). Positive correlation existed between the depth/diameter ratio of the sinus tract and the deviation rate of the measured depth of the sinus tract by conventional method, and between the depth/diameter ratio of the sinus tract and the deviation rate of the depth of the sinus tract that could be observed by conventional method and by endoscope (r=0.514, 0.585, 0.651, P<0.01). However, there was no obvious correlation between the depth/diameter ratio of the sinus tract and the deviation rate of the measured depth of the sinus tract by endoscope (r=0.113, P>0.05). Conclusions Compared with the conventional method, application of endoscope is able to get more accurate data of chronic wounds with sinus tracts and observe the wounds with wider range.

The correct thoughts and principles of diagnosis and treatment of chronic refractory wounds need to be formulated. Through the relevant domestic and international consensus and based on clinical experience, the Thoughts and principles of diagnosis and treatment of chronic refractory wounds in China is proposed. It is considered that in the diagnosis and treatment of chronic refractory wounds, in the case of fully understanding the patient′s medical history, the following thoughts and principles should be complied in order. (1) Pay attention to the cleanliness of the wound after being cleaned. (2) Reasonably perform debridement to avoid being " excessive" or " not thorough". (3) Reasonably perform examination, diagnosis, and differential diagnosis of pathogenic factors. (4) Treat according to etiology. (5) Find comorbidities and prevent adverse outcomes. (6) Select the correct wound treatment method reasonably and timely. When the conservative wound care treatment is considered, pay attention to embodying the concept of etiological treatment, treat the wound according to the principles of safety, phase, selectivity, and effectiveness, and make a reasonable choice of continuing conservative treatment or surgical treatment in time after completing the preparation of the wound bed. When surgical treatment is considered, pay attention to the selection of reasonable surgical method and donor site, pay attention to the healing rate of surgical wound site and the outcome of donor site, and give reasonable protection to the wound site after surgery. (7) Carry out rehabilitation treatment after wound healing and related health education.

Objective: To investigate the lens and ora serrata safety during 23G vitrectomy with sclera incisions at 5.0 mm or 4.0 mm posterior to the limbus. Methods: A prospective case-controlled study was adopted. From April 2016 to January 2018, 290 consecutive primary 23G vitrectomy patients (300 eyes) with vitreoretinal disease in Department of Ophthalmology of Subei People’s Hospital Affiliated to Yangzhou University were enrolled in this study. Among them, 146 patients (150 eyes) received 23G pars plana vitrectomy (PPV) with scleral incisions at 5.0 mm posterior to the limbus (5.0 mm group), and 144 patients(150 eyes) at 4.0 mm (4.0 mm group). No statistically significant difference was found in age, axial length(t=−1.324, 0.867; P=0.186, 0.387) and in gender, right/left eyes, proportion of indications (χ²=1.366, 2.615, 10.195; P=0.242, 0.106, 0.070) between the two groups. The incidence rate of complications between the two groups were comparatively observed, such as lens injury, retinal tears close to the scleral incision, retinal hemorrhage, supra-choroidal expulsive hemorrhage and iatrogenic retinal detachment. Independent sample t test and χ² test were performed for comparison between the two groups. Results: Lens injury was observed in 4 eyes(2.67%) and 14 eyes (9.33%) respectively in the 5.0 mm and 4.0 mm group during surgery (χ²=5.910, P=0.015). Retinal tears close to the scleral incision sites were observed in 5 eyes (3.33%) and 6 eyes (4.00%) respectively in the 5.0 mm and 4.0 mm group during surgery (χ²=0.094, P=0.759). The mean time of removing the vitreous base was 6.17±2.76 min and 10.03±5.56 min respectively in the 5.0 mm and 4.0 mm group (t=7.599, P <0.01). No other surgical complications occurred in any group, such as retinal hemorrhage, supra-choroidal expulsive hemorrhage and iatrogenic retinal detachment, etc. Conclusion In primary 23G PPV, the safety of ora serrata with incisions at 5.0 mm posterior to limbus is similar to that at 4.0 mm, but the safety of lens and the efficiency of vitreous resection is higher with incisions at 5.0 mm.

Objective: To observe the outcomes of 23G pars plana vitrectomy (PPV) and air tamponade for non-inferior rhegmatognous retinal detachment (RRD). Methods: A prospective case series study. From August 2017 to April 2018, 39 consecutive RRD patients (39 eyes) in Department of Ophthalmology of Subei People’s Hospital Affiliated to Yangzhou University were enrolled in this study. There were 20 males(20 eyes) and 19 females (19 eyes), 23 right eyes and 16 left eyes, with the mean age of 55±11 years. There were 30 eyes with lens and 9 eyes without lens or IOL. There were 21, 14 and 4 eyes with 1, 2 and equal or greater than 3 retinal tear respectively. All patients underwent 23G PPV which performed preretinal proliferative membranes and vitreous cortex removal, photocoagulation around the breaks with 3-5 rows, and filtered air tamponade. The follow-up was more than 2 months. The retinal reattachment, visual acuity and complications were observed. Pearson correlation analysis was used to analyze the correlation between BCVA and disease course. Chi-square test was performed for comparison among retinal reattachment rate and different clinical factors before operation. Results: At 2 months after the PPV, 35 eyes' retina reattached, the rate of reattachment was 89.8%. In 2-3 weeks, 4 eyes were re-detached, all of them performed silicone oil tamponade. One eye was secondary to pre-macular membrane. The logMAR BCVA before and after PPV were 1.15±0.78 and 0.41±0.31, respectively (t=6.589, P=0.0001). Correlation analysis results showed that BCVA after surgery was positively correlated with BCVA before surgery(r=0.544, P=0.001). Twelve of 30 eyes with crystalline lens suffered cataract. The rate of reattachment vary in the number of the breaks (χ²=9.181, P=0.010). Conclusion PPV with air tamponade may be an optimal treatment of non-inferior RRD with better success rate and security.