Objective To explore a new surgical treatment for severe inverted nipple and to reduce the possibility of recurrence. Methods Two opposite long six-side polygon de-epithelialized areas were designed within the range of areola on both sides of the nipple. The four sides in lateral portion were dissected and two wedge-shaped dermal and glandular tissue flaps were created, completely releasing the contractive fiber causing nipple retraction while reserving breast ducts. The flaps were reversed 180 degrees through the tunnel bilateral sides of breast ducts to support the nipple. It was tracted for 3-4 weeks by series 7 needle penetrating the nipple basis. Results All the 14 patients were followed up for 3-18 months, and they were satisfied with the appearance and the aesthesia of the nipple and no recurrence was observed, breast-feed function reserved in 2 cases after childbirth. Conclusions This operation is easy to perform with satisfying aesthetic outcome and breast-feed function remaining.It is an ideal method for correcting serious inverted nipple.

OBJECTIVETo investigate the clinical and pathologic characteristics of patients with scleredema.

METHODThe clinical and pathologic data of 67 outpatients with scleredema who were admitted to PUMC Hospital from 1982 to 2008 were retrospectively analyzed.

RESULTSNeck and upper back lesions were detected in all patients, but no hand or foot involvement was noted. Among 54 patients who received serum immunoglobulin examination, 19 (35.2%) showed abnormal serum immunoglobulin results. Among 67 patients, 22 (32.8%) had concomitant diabetes mellitus. Alcian blue staining was performed in 35 patients, among whom 23 (65.7%) had positive results and 12 (34.3%) had negative results.

CONCLUSIONSScleredema may have systemic involvements in addition to skin lesions. Patients with scleredema also tends to have concomitant diabetes mellitus. Alcian blue staining is not sufficient to differentiate scleredema and scleroderma.

Adolescent ; Adult ; Aged ; Child ; Child, Preschool ; Female ; Humans ; Immunoglobulins ; blood ; Male ; Neck ; pathology ; Retrospective Studies ; Scleredema Adultorum ; complications ; diagnosis ; pathology ; Skin ; pathology ; Young Adult

BACKGROUND: Pancreatic damage in critically ill patients is associated with the progressive failure of multiple organs, but little is known about its clinical characteristics. At present, no guidelines are available for the diagnosis and management of pancreatic damage. This study was undertaken to analyze the clinical and pathologic characteristics of pancreatic necrosis in critically ill children, and to find some biological markers of pancreatic damage or pancreatic necrosis. METHODS: We retrospectively reviewed the clinical data, laboratory results, and autopsy findings of 25 children, who were admitted to Hunan Children's Hospital, China from 2003 to 2009, and died of multiple organ failure. The autopsy revealed pancreatic necrosis in 5 children, in whom sectional or gross autopsy was performed. RESULTS: The 5 children had acute onset and a fever. Two children had abdominal pain and 2 had abdominal bulging, flatulence and gastrointestinal bleeding. Four children had abnormal liver function, characterized by decreased albumin and 3 children had elevated level of C-reactive protein (CRP). B-ultrasonography revealed abnormal acoustic image of the pancreas in all children, and autopsy confirmed pancreatic necrosis, which may be associated with the damage of the adrenal gland, liver, lung, heart, spleen, kidney, intestine, thymus, mediastinal and mesenteric lymph nodes and other organs. Children 1 and 2 died of acute hemorrhagic necrotizing pancreatitis (AHNP);children 3-5 died of multiple organ dysfunction syndrome (MODS) due to pancreatic necrosis. CONCLUSION: Pancreatic damage or pancreatic necrosis in critically ill children is characterized by acute onset, severity, short course, multiple organ damage or failure. It may be asymptomatic in early stage, and easy to be ignored.

OBJECTIVETo study risk factors for the occurrence of intra-abdominal hypertension (IAH) in children with sepsis.

METHODSA nest case-control study was employed. According to intra-abdominal pressures (IAP) measured by cystometry, 119 children with sepsis were classified into normal IAP (control, n = 80) and IAH groups (n = 39). Risk factors for the occurrence of IAH were investigated by monovariable and multivariable logistic regression analysis.

RESULTSMonovariable analysis showed that there were significant differences in pediatric critical illness score (PCIS), procalcitonin (PCT) level, PaCO(2), blood lactate level, rates of intestinal or intra-abdominal infection, ascites, gastrointestinal dysfunction, mechanical ventilation, shock and multiple organ dysfunction syndrome (MODS) between the IAH and control groups (P < 0.05). Multivariable logistic regression analysis demonstrated that decreased PCIS, MODS, shock, gastrointestinal dysfunction and ascites were major risk factors for the occurrence of IAH.

CONCLUSIONSChildren with sepsis who have decreased PCIS, MODS, shock, gastrointestinal dysfunction and ascites are at risk for the occurrence of IAH.

Child ; Child, Preschool ; Critical Illness ; Female ; Humans ; Infant ; Intra-Abdominal Hypertension ; etiology ; therapy ; Male ; Multiple Organ Failure ; complications ; Risk Factors ; Sepsis ; complications ; mortality

OBJECTIVETo study the role of N-methyl-D-aspartate-receptor (NMDAR) expression in the development of hearing damage in neonatal rats with hyperbilirubinemia.

METHODSSixty seven-day-old Sprague-Dawley rats were randomly injected with bilirubin of 100 microg/g (low-dose treatment group) or 200 microg/g (high-dose treatment group) or normal saline (control group). Auditory brainstem response (ABR) was examined. The concentrations of bilirubin in blood and brain were measured. NMDAR expression in the cochlear nucleus slices was examined by immunohistochemistry assay.

RESULTSABR reflecting threshold obviously increased, and I, II and III wave latency as well as I-II, II-III and I-III interval were more prolonged in the two bilirubin treatment groups when compared with the control group. The NMDAR expression in the cochlear nucleuse in the two bilirubin treatment groups was obviously lower than that in the control group. The NMDAR expression in the cochlear nucleuse was negatively correlated with the brain bilirubin content and the ABR reflecting threshold in the two bilirubin treatment groups.

CONCLUSIONSAn increased NMDAR activity may play an important role in hearing damage following hyperbilirubinemia.

Animals ; Animals, Newborn ; Bilirubin ; analysis ; Cochlear Nucleus ; chemistry ; Evoked Potentials, Auditory, Brain Stem ; Female ; Hearing Disorders ; etiology ; Hyperbilirubinemia ; complications ; metabolism ; Immunohistochemistry ; Male ; Rats ; Rats, Sprague-Dawley ; Receptors, N-Methyl-D-Aspartate ; analysis

Objective To explore the new thought of developing the open management of "parent-child caregiving" in department of neonatology to provide a reference for perfecting the nursing management. Methods The "parent-child caregiving" was carried out in the closed neonatal ward without caregivers in a class III grade A children′s hospital. A total of 274 pediatric patients were admitted in the non-caregiving area of department of neonatology from December 2015 to February 2016. At the time, a total of 66 pediatric patients was admitted to the "parent-child caregiving" area. The hospital day, hospital expense, nosocomial infection incidence, and satisfaction of the parent or guardian of pediatric patients were compared between two groups.Results The median of the hospital day of pediatric patients with pneumonia in the area of "parent-child caregiver" was 6.5 d which was statistically lower than that in the area without caregivers (Z=-4.672, P<0.01). The hospital expense (18902.68 yuan) in the area of "parent-child caregiving" was higher than that in the area without caregivers (Z=-6.985,P<0.01). There was one case with nosocomial infection in the area without caregivers. The satisfaction with the medical staff of the parent or guardian of pediatric patients was 95.98% and 97.29% before and after carrying out "parent-child caregiving".Conclusions The development of the open "parent-child caregiving" which is based on the family centered care mode can help to meet requirements of pediatric patients and their parents or guardians under different circumstances and has immeasurable effects on pediatric patients and their families. The method is worth spreading.

OBJECTIVETo understand the perception on roles of gender and decision-making regarding family affairs among married women and its impact on the utilization of perinatal care.

METHODSClustering sampling was conducted to select 1227 married women with at least a child aged from 0 to 7 years old, from Hebei, Hubei and Sichuan provinces. All women were interviewed using a uniform questionnaire during Nov.-Dec. 2004.

RESULTSThe overall proportion of women who had relatively poor perception of gender role was 65.1%. 59.3% of the women agreed that "husband's health is more important than wife's in the family" versus 39.7% of interviewed women agreed that "man is more suitable for leadership than woman". In 46.2% of the families, wife and husband shared the responsibility of decision making on family affairs. In 16.2% of the families women played a decisive role, while 67.1% of interviewed women had to get the approval of her husband when spending money on daily necessities. When there were different opinions between the couples, husband usually made the final decision in 20.5% of all the families versus 17.4% of families where wife made the final decision. In total,the proportion of women who had somehow rights on family affairs was 64.1%. The coverage rate of antenatal care was 91.0%, and 65.3% women who received antenatal care got the first antenatal visit during the first trimester and the proportion of women who had at least five antenatal visits was 39.7%. The institutional delivery was 59.3% among all the women. Perception of gender role was not a predictor for antenatal care utilization, but it was predictive of institutional delivery. Education was quite a significant predictor on perinatal care utilization.

CONCLUSIONEfforts should be strengthened to improve women's awareness and to increase their perception on gender role in the families so that more women could achieve quality perinatal care.

Adult ; Child, Preschool ; China ; Decision Making ; Family Health ; Female ; Gender Identity ; Humans ; Infant ; Infant, Newborn ; Male ; Marriage ; Perinatal Care ; utilization

Iron-doped titanium dioxide nanosheets was prepared by hydrothermal method using tetrabutyl titanate (C16H36O4Ti) and iron trifluoride (FeF3) and modified on ITO electrode.ITO/Fe : TiO2/CdS photoelectrochemical sensor was fabricated by successive ionic layer absorption and reaction(SILAR) method for determination of copper ion.The band gap of electode material was narrowed by iron doped TiO2 nanosheets,which made its absorption red-shifted and its response range of light was magnified.Based on the sensitization effect of CdS,the absorption and utilization of visible light of sensor was significantly enhanced and the photoelectric signal was amplified via reducing the recombination of electrons and holes.The sensor displayed excellent analytical performance for detection of copper ion with linear range of 0.2-4.0 μmol/L and 4.0-80.0 μmol/L and with the detection limit of 85 nmol/L.The sensor was used to detect copper ion in tap water,drinking water and Yongjiang river water with recoveries ranging from 94% to 111%.

OBJECTIVETo analyze the characteristics of children with acute pancreatitis and provide the basis of early diagnosis and treatment.

METHODSTotally 121 children with acute pancreatitis admitted to Hunan Children's Hospital between March 2003 and December 2009 were enrolled in this retrospective study. The data of clinical manifestations, biochemical examinations, imaging and prognosis were summarized and statistically analyzed.

RESULTSOf the 121 cases, preschool and school-age children were the main groups, and the prevalent months were May and June. Abdominal pain (88.4%) and vomiting (61.2%) were the major initial symptoms of pancreatitis in children, but none of children under the age 1 year complained of abdominal pain; 70.2% had signs of abdominal tenderness, accompanied by abdominal rigidity, distension, hepatomegaly, jaundice, etc. Severe patients developed shock, convulsions, coma and so on. Serum amylase concentration increased to above the upper reference limit in 114 children (94.2%) when they admitted within 24 hours after admission. Urine amylase elevation was noted in 77 children (79.4%). The amylase concentration decreased after 3 days, but not all returned to normal 14 days afterward. Children with sustained serum amylase elevation or serum amylase level ≥ 3 times upper limit of normal range more likely to have fever, vomiting, abdominal distension, and pancreatic abnormalities at ultrasonography or CT which showed that the echo of pancreas decreased or enhanced, pancreas edema, pancreatic duct expanded, etc. Abdominal ultrasonography and CT showed that 75 cases (62.0%) had other organ damage besides pancreatitis, liver (25.3%) and intestinal (16.0%) damages were very common, while liver and myocardial damages were seen frequently in the laboratory examinations, which complicated with serum ALT/AST, total bilirubin, blood glucose elevation and myocardial enzyme abnormalities. Several gastroscopic examinations showed mucosal hyperemia and edema, sheet-like erosion, etc. Except for one case who underwent laparotomy, all the remaining children were treated with non-operative comprehensive treatment. Of them 119 were cured or improved, 2 died and 5 had recurred disease later.

CONCLUSIONSGastrointestinal symptoms were the main clinical manifestations of acute pancreatitis in children, often complicated with extrapancreatic damage. The younger the patient was, the less complaint of abdominal pain they had. This indicates that acute pancreatitis should be considered when children suffered from acute abdominal pain and vomiting which had no known cause or could not be explained. It is important to do take serial monitoring of serum amylase, and imaging procedures.

Adolescent ; Amylases ; blood ; Child ; Child, Preschool ; Female ; Humans ; Infant ; Male ; Pancreatitis, Acute Necrotizing ; blood ; diagnosis ; Prognosis ; Retrospective Studies

OBJECTIVETo analyze the pathological reports and clinical data of the cases with pancreatic damage in critically ill children, and summarize the clinical features and biological markers of critically ill children with pancreatic damage or pancreatic necrosis so as to provide the basis for early diagnosis and treatment in children complicated with pancreatic damage.

METHODSThe clinical data of 13 patients treated in our hospital from 2003 to 2009 whose autopsy confirmed pancreatic damage existed and the pathological results of all organs were collected and analyzed.

RESULTSAll the cases had acute onset; 7 cases had fever, 2 had abdominal pain, the other cases had abdominal distention, hepatosplenomegaly, hypoactive bowel sounds, ascites, intestinal obstruction and gastrointestinal bleeding, etc. All these cases had abnormal liver function, especially elevated ALT or AST level and significantly decreased albumin, 9 cases had abnormal blood glucose, 5 cases had elevated C-reactive protein (CRP). In abdominal B-mode ultrasonography, no case showed abnormal pancreas acoustic image. Autopsy confirmed that 7 cases had varying degrees of necrosis of the pancreas, other 6 cases showed edematous, hemorrhagic or inflammatory changes, which may be associated with adrenal gland, liver, lung, heart, spleen, kidney, intestine, thymus, mediastinal and mesenteric lymph nodes and other damage. All these children died within 36 hours after the patients' conditions worsened.

CONCLUSIONSPancreatic damage or necrosis in critically ill children had acute and ferocious onset, short course and were prone to multiple organ damage or failure to which all pediatric clinicians should have high alert.

Child ; Child, Preschool ; Critical Illness ; Female ; Humans ; Infant ; Infant, Newborn ; Male ; Pancreas ; pathology ; Pancreatitis, Acute Necrotizing ; diagnosis ; pathology ; therapy ; Retrospective Studies