Objective To study the value of lung ultrasonography (LUS) in the diagnosis of pneumothorax in critically ill neonates.Method The neonates admitted to our NICU and suspected to have pneumothorax were prospectively enrolled from June 2017 to December 2018.All eligible infants received both LUS examination and chest X-ray.The characteristics of LUS imaging was analyzed based on the chest X-ray which was used as the golden standard for the diagnosis of pneumothorax.The sensitivity,specificity,positive predictive value and negative predictive value of LUS is computed.The duration of LUS and chest X-ray were compared.The outcome and complications were also observed.Result Fifty neonates with suspected pneumothorax were collected.Among them,pneumothorax was confirmed with chest X-ray in 31 neonates (62.0％).Ultrasound signs of pneumothorax included absence of lung sliding (100％),absence of B lines (100％),stratosphere sign (100％) were observed in all of the 31 neonates.Presence of lung point was also observed in 90.3％ of the patients.The sensitivity,specificity,positive predictive value,negative predictive value and X-ray coincidence rate of LUS in the diagnosis of pneumothorax were 100％.LUS and chest X-ray examination took (5.6 ±5.1) min and (20.1 ± 12.2) min,respectively,the difference was statistically significant (P ＜ 0.05).All 31 infants with pneumothorax survived.15 infants underwent closed thoracic drainage after emergency thoracic puncture or aspiration assisted by LUS.No postoperative complications occurred.Conclusion LUS showed high accuracy,sensitivity and specificity in detecting pneumothorax in critically ill neonates.It is simple to operate and can guide clinical rescue more promptly and quickly.

Objective:To evaluate the gastric emptying of orally administered enzyme-hydrolyzed rice flour solution before surgery in the patients undergoing laparoscopic cholecystectomy and effect on insulin resistance.Methods:One hundred patients, of American Society of Anesthesiologists physical status Ⅰ or Ⅱ, aged 18-64 yr, with body mass index of 19-30 kg/m 2, scheduled for elective laparoscopic cholecystectomy under general anesthesia, were divided into 2 groups ( n=50 each) using a random number table method: water group (group C) and enzyme-hydrolyzed rice flour group (group M). Routine fasting and water deprivation were executed at 1 day before operation in two groups, and 300 ml water in group C or 300 ml enzyme-hydrolyzed rice flour solution in group M were taken orally at 2-3 h before induction on the day of surgery.Bedside antrum ultrasonography was used to calculate the gastric volume (GV) before oral administration (V 0), immediately after oral administration (V 1), and before induction (V 2), and then the ΔGV (GV 1-GV 0) was calculated.Fasting plasma glucose and insulin CONCENTRATIONS were measured on admission to hospital (T 1) and on an empty stomach on 1st morning after surgery (T 2), and then the homeostasis model assessment of insulin resistance (HOMA-IR) was calculated according to HOMA steady-state model formula.Visual analog scale (VAS) scores for subjective comfort (thirst, hunger, fatigue and anxiety) and grip strength were assessed before anesthesia (T 3) and before leaving PACU (T 4). Reflux and aspiration during induction, nausea and vomiting within 24 h after surgery, and anal exhaust time after surgery were recorded. Results:There was no significant difference in GV at V 0, V 1 and V 2 between the two groups ( P>0.05). Compared with the baseline at V 0, no significant was found in the GV at V 2 in both groups ( P>0.05). The fasting plasma glucose and insulin concentrations and HOMA-IR were significantly increased at T 2 than at T 1 in both groups ( P<0.05 or 0.01). Compared with group C, the fasting plasma glucose and insulin concentrations and HOMA-IR were significantly decreased at T 2, VAS scores for hunger, fatigue and anxiety were decreased at T 3, 4, grip strength was increased at T 3, 4, the postoperative anal exhaust time was shortened, and the incidence of nausea was reduced in group M ( P<0.05). No reflux and aspiration happened during induction in either group. Conclusion:The gastric emptying of 300 ml enzyme-hydrolyzed rice flour solution orally administered at 2 h before surgery is normal in the patients undergoing laparoscopic cholecystectomy, which does not increase the risk of reflux and aspiration during anesthesia induction, reduces postoperative insulin resistance, and increases patient′s subjective comfort, and enhances the postoperative recovery of intestinal function.

Objective:To analyze the clinical characteristics and diagnosis and treatment experiences of Langerhans cell histocytosis (LCH) in skull.Methods:Sixteen patients with cranial LCH admitted to our hospital from January 2015 to December 2019 were chosen in our study. Their clinical data, diagnosis and treatment procedures and prognoses were retrospectively analyzed.Results:Among the 16 patients, there were 13 males and 3 females, aged from 1 to 31 years. The clinical manifestations included space-occupying lesions of the skull; and imaging showed bone destruction of the skull, with or without involvement of other bones or organs. All patients were pathologically confirmed to have LCH after surgical total resection of the lesions. Routine whole-body bone scanning was performed after surgery: one was found to have local abnormal metabolic activity and received local radiotherapy; 8 were combined with other bone or organ involvement, and received chemotherapy. All the patients were followed up for 1-5 years, and no recurrence was found, and no one died.Conclusion:Good prognosis can be achieved in cranial LCH patients accepted resection by giving additional treatment according to the results of postoperative reexamination and combination use of standardized radiotherapy and chemotherapy.

Objective:To observe the effects of transcranial direct current stimulation (tDCS) on functional connectivity (FC) in language-related brain regions of patients with picture-naming dysfunction after cerebral infarction by using resting state functional magnetic resonance imaging(rs-fMRI).Methods:Twenty-eight patients with post-infarction picture-naming dysfunction were divided into an acute stage group( n=16) and a recovery stage group( n=12) according to the course of the disease, and 18 middle-aged and elderly volunteers were recruited as the normal control group.The anodic tDCS was applied on the posterior perisylvian region(PPR) of the left sylvian of the patients, 5 days a week for 2 weeks.Before and after the 2 weeks′ treatment, the rs-fMRI and Psycholinguistic Assessment of Chinese Aphasia (PACA)-picture-naming subscale were performed, and FC changes in language-related brain areas were observed. Results:After treatment, the PACA scores of patients in both acute and recovery stage groups were significantly improved after treatment( P<0.05). Compared with normal subjects, FC in multiple brain regions and particularly the Wernicke area was reduced in both cerebral hemispheres among the patient group. It was more severe in the dominant hemisphere.After the tDCS treatment, FC in both frontotemporal lobes and in the Wernicke area was significantly enhanced in both the acute and recovery groups. Further comparison showed that in the acute group FC in both temporo-occipital lobes was significantly enhanced after treatment. In the recovery group, the enhanced FC in the left temporal lobe before the treatment was significantly reduced after treatment. Conclusion:The fMRI technique can evaluate changes in brain connectivity in aphasia patients with picture-naming dysfunction after cerebral infarction accurately and non-invasively.tDCS may improve picture-naming function of stroke patients by enhancing the FC in bilateral language-related brain areas(concentrated in frontotemporal lobes) and Wernicke area.

The paper reports a case of 2,8-dihydroxyadenine (2,8-DHA) crystalline nephropathy caused by mutation of adenine phosphoribosyltransferase ( APRT) gene. The female patient was 60 years old, and sought medical advice due to "foaming urine increased for half a year". Renal biopsy result showed irregular yellowish brown 2,8-DHA crystals with refraction under polarized light. 2,8-DHA crystals were found by urine sediment detection, and homozygous deletion of c.521_523delTCT on exon 5 of APRT gene was found by genetic testing. Finally this patient was diagnosed as 2,8-DHA crystalline nephropathy. Renal function improved after treatment with allopurinol. The case report aims to improve the clinician's understanding of 2,8-DHA crystalline nephropathy. Early recognition, correct diagnosis, and early drug intervention may delay the progression of renal failure and improve the prognosis.

【Objective】 To investigate the positive rate of platelet antibody in pregnant women and analyze the related factors. 【Methods】 A total of 620 pregnant women who underwent antenatal examination from March 2017 to July 2018 were screened for platelet antibodies by solid phase agglutination method. The relationship between platelet antibody positive rate and blood transfusion history, reproductive history and ABO blood group were analyzed, and the profile of disease were alsodiscussed. 【Results】 55 out of 620 pregnant women presented positive platelet antibody, with a positive rate of 8.87%.The platelet antibody positive rate of pregnant women with ahistory of blood transfusion (14.13%) was higher than those never transfused before(6.65%), and the platelet antibody positive rate of pregnant women with a childbirth history (10.46%) was higher than those didn′t bear before(3.52%), showing statistically significant differences (P<0.05). The ABO blood grouphad no correlation with antenatal platelet antibody positive rate(P>0.05). Pregnant women with positive platelet antibodies mainly suffered from diseases such as placenta pravia, scarred uterus, placental implantation and thrombocytopenia. 【Conclusion】 Blood transfusion history, reproductive history and disease type have certain effects on the positive rate of platelet antibody in pregnant women.Screening platelet antibody in pregnant women is of great significance to prevente and reduce miscarriage during pregnancy and the occurrence of neonatal alloimmune thrombocytopenic purpura(NAITP).

【Objective】 To establish an intelligent management system of surgery blood (IMSSB) and explore its effectiveness in promoting rational and timely blood transfusion in surgical patients. 【Methods】 IMSSB was constructed based on the hospital closed-loop blood transfusion information management system, clinical transfusion mobile nursing APP system, and the Internet of Things blood bank forward management system to dynamically guide, supervise and evaluate the whole process of perioperative blood transfusion management. Blood management data of 100 patients undergoing cardiac vascular surgery before( from May to October, 2018) and after (from November 2018 to April 2019) the application of IMSSB were selected and compared to evaluate the role of the system in the management of surgical blood. 【Results】 Time, from blood application to transfusion, during surgery was shortened(30 minutes before vs less than 2 minutes after). The proportion of patients with Hb over 110g/L after intraoperative blood transfusion decreased significantly from 30.5%(25/82) to 8.5%(4/47)(P<0.01). The incidence of surgical blood transfusion decreased from 82.0%(82/100) to 47.0%(47/100)(P<0.01). 【Conclusion】 IMSSB, as an innovation of clinical blood management mode for surgical patients, can promote timely and rational blood transfusion during operation, which is of great significance to improve operation safety.

【Objective】 To explore and evaluate the application of blood intelligent management platform (scheme) based on the Internet of Things(IoT)in the clinical blood management for hospitals. 【Methods】 Based on radio frequency identification technology (RFID), smart blood refrigerators, IoT blood shipping containers, automated blood bank systems, smart blood management software, etc. were developed and integrated as an IoT blood intelligent management platform (scheme). The blood storage, management software and hardware systems were organically combined, and the blood storage equipment was moved forward to the clinical departments to solve the concerns of clinicians. 【Results】 The in-depth integration of IoT technology, RFID and refrigeration technology has built an RFID-based IoT blood management solution, which integrates blood storage, transfusion, and quality control management, also realizes the entire process of supervision and traceability of clinical blood transfusion. The forward movement of blood bank to the clinical departments and the implementation of electronic cross-matching streamlined and optimized the clinical blood flow. The waiting time of patient′s for blood transfusion was shortened from (40±10) min to less than 2 min. The whole process of cold chain logistics ensured the storage quality of blood products issued, so that the clinical departments can return the untransfused blood and Blood Transfusion Department can reissue it to other hospitals. 【Conclusion】 IoT blood intelligent management based on RFID realizes the intelligent management of clinical blood transfusion and blood information traceability. The forward movement of blood bank to the clinical departments improves the efficiency of clinical blood transfusion, avoids the waste of blood source, and ensures the safety of blood transfusion. It is worth promoting in the whole process of blood transfusion.

Objective: To explore the correlations relating functional MRI (fMRI) and diffusion tensor imaging (DTI) parameters with pre-operative neurological status and post-operative outcomes for patients with cervical spondylotic myelopathy (CSM). Methods: Eighty-seven CSM patients treated with surgical decompression and 38 healthy counterparts were enrolled as the CSM and control groups respectively. DTI and fMRI of the cervical spine were performed while the subjects performed a finger-tapping task with their right hands before the operation and 6 months later. The control group was evaluated only when they were enrolled. All of the patients were given systematic rehabilitation treatment after the surgery. The Japanese Orthopaedic Association (JOA) scoring system for CSM was used to evaluate neurological status, and a JOA recovery rate <50% was defined as a poor recovery. Results: Compared with the healthy controls, the pre-operative patients showed significantly higher volume of activation (VOA) in the left precentral gyrus (PrCG), but that had decreased significantly 6 months after the surgery. Before the surgery, the patients′ fractional isotropy (FA) was significantly less than that of the controls, but it had increased significantly 6 months after the operation. There was no difference in VOA in the left postcentral gyrus (PoCG) between the CSM patients and the controls before the surgery. The VOA ratio (PrCG/PoCG), VOA-PrCG, VOA-PoCG and FA were significantly correlated with both the JOA scores and recovery rates. Receiver operating characteristic (ROC) curve analyses were performed for the predictive ability with respect to surgical outcomes. The largest area under the ROC curve was observed for the VOA ratio (0.805), followed by FA (0.740), and the VOA-PrCG (0.715). The fMRI and DTI showed better potential for predicting functional outcomes than with standard MRI parameters. Multivariate logistic regression revealed that the VOA ratio and FA were independently associated with poor outcomes. Conclusions fMRI and DTI parameters may be more valuable than conventional MRI results for neurological assessment and prognosis with CSM patients. They can also provide references for making up rehabilitation plans.