SUMMARY Breastfeeding has been recognized as the most natural and nutritious way of feeding babies . Besides the nutritional , immunological and emotional benefits , breastfeeding promotes a healthy stomatog-nathic system .First of all, the nutrients and minerals in maternal milk are easy to be absorbed by the infants, which contributes to the mineralization of the teeth , and suppress the propagation of bacteria on the teeth.Though the jury is still out on whether breastfeeding can prevent Early Childhood Caries (ECC), it is definite that we should pay attention to feeding at night and the oral hygiene of the babies . Secondly , the method of feeding is closely bound up with the development of dentition and jaw .Breast-and bottle-feeding involve different orofacial muscles , which possibly have different effects on the harmo-nic growth of maxilla and dental arches .Meanwhile , breathing , swallowing and mastication should be developing in harmony , and differences exist in the learning of the coordinated movement between breast feeding and bottle feeding children .Bottle feeding had been proved to be closely related with the non-nutritive sucking habits which can cause malocclusion .At last, it should be pointed out that breast fee-ding should be the only feeding source in the first 6 months of life, then supplementary foods should be added .And prolonged bottle feeding should be avoided .We can see that breast feeding is definitely good for the infants , but the reality is not optimistic in our country .

China ; Heart Failure ; epidemiology ; Humans

OBJECTIVE: To explore the clinical characteristics and prognosis of patients with idiopathic sudden sensorineural hearing loss (ISSHL) with vertigo. METHOD: By analyzing the clinical data of 271 ISSHL patients, they were divided into without vertigo group (n = 169) and vertigo group (n = 102). In vertigo group, 34 cases were patients with benign paroxysmal positional vertigo (BPPV) secondary to the ISSHL. All patients received conventional treatment. According to the types of BPPV, patients with secondary BPPV received Epley maneuver or Barbecue roll maneuver. By analyzing the results of the pure tone audiometry test and treatment outcomes of the patients, we summarized the clinical characteristics of ISSHL patients with vertigo. RESULT: The audiometric curves of ISSHL with vertigo group were mainly at high frequency. The degrees of hearing loss of these patients were severe and profound. After treatment, the improvement of hearing threshold for ISSHL with vertigo group was lower than that for ISSHL without vertigo group. What's more, the rate of recovery, success and total effective of audition for ISSHL with vertigo group was also obviously lower than that for ISSHL without vertigo group. Of all the patients with BPPV, 27 cases of posterior semicircular canal and 7 cases of lateral semicircular canal were identified. All patients with BPPV were diagnosed as the same ears as the ISSHL. CONCLUSION ISSHL with vertigo group lost hearing more severely than ISSHL without vertigo group. Also, the improvement of hearing and the effective after treatment were really poor. The symptoms of ISSHL with BPPV group improved and eased significantly than that of ISSHL without BPPV group. The major of BPPV secondary to the ISSHL occurs in the posterior semicircular canal. The canalith repositioning is an effective therapy to the secondary BPPV.
Audiometry, Pure-Tone ; Auditory Perception ; Benign Paroxysmal Positional Vertigo ; complications ; therapy ; Hearing Loss, Sensorineural ; complications ; therapy ; Hearing Loss, Sudden ; complications ; therapy ; Humans ; Patient Positioning ; Prognosis ; Semicircular Canals ; physiopathology ; Treatment Outcome

Objective To evaluate the impact of cerebrospinal fluid drain(CSFD) on the incidence of acute spinal cord injury(SCI) following extensive TAAA repair.Methods From February 2009 to July 2016,153 patients underwent extensive TAAA repairs with a consistent strategy of normal thermia,non-circulatory bypass,sequential aortic cross clamping,aortic-lilac bypass,and intercostal artery reconstruction.The repairs were performed with preoperative CSFD (n =78) or without CSFD (n =75).In the former group,CSFD was inserted after the patient has been anaesthetized and continued for 72 hours after surgery.The target CSF pressure was 10 mmHg or less.Results The mean age of patients was (38 ± 10) years and 108 (70.6％) were male.There were 87 (53.8％) patients with previous aortic surgeries and 33 (22％) with Marfan syndrome.The two groups had similar risk factors for paraplegia.Aortic clamp time,operation time and number of reattached intercostal arteries were similar in both groups.In-hospital mortality rates were 1.3％ (one patient) and 6.7％ (five patients) for CSFD and the group without CSFD,respectively (P =0.086).Ten patients (13.3 ％) in the group without CSFD had paraplegia develop.In contrast,only two patients in the CSFD group(2.6％) had postoperative paraplegia(P =0.013).Stepwise logistic regression analysis identified CSFD had spinal cord protection,P =0.026;OR =0.171;95％ CI:0.036-0.809).No patients occurred CSF catheter related complications.Conclusion This randomized clinical trial showed that preoperative CSFD placement could be an effective strategy in preventing SCI following extensive aortic aneurysm repair.Care should be taken to prevent complications related to overdrainage.

Objective This study aims to analyze midterm survival and to assess the midterm mortality following acute kidney failure (AKF) of patients undergoing surgical treatment of acute type A aortic dissection.Methods Clinical data of the patients who underwent Sun's procedure from February 2009 to March 2015 were collected.Patients with preoperative dialysis were excluded.Data including preoperative cardiovascular diseases,serum creatinine leve1 and CPB time were gathered.The patients were divided into the group of AKF and the group of non-AKF accounting to require dialysis.The group of AKF was follow-up by phone.Midterm mortality was studied with Cox analysis and midterm survival was estimated by Kaplan-Meier analysis.Results 524 patients underwent aortic surgeries which AKF was occurred in 51 (51/524,9.7％) patients.Hospital mortality was 23.5％ (12/51) in AKF group which seven death were strokes,three death were lower-extremity ischemia and two death were low cardio output.There were 2 patients dead with multi organ failure and paraplegia in first year.One reoperation patient because of anastomotic fistula was dead in fifth year.Only diabetes was independently associated with midterm mortality.Midterm survival for patients with AKF was 56％ during a median follow-up of 30.5 months.Survival was equal between the subgroups of Cr ＞ 200 mol/L and Cr ＜ 200 mol/L(P =0.741).Conclusion AKF after acute aortic dissection was a severe complication and the incidence was 9.7％.In patients with AKF,diabetes was associated with increased mortality across follow-up.Five years survival was 56％ not effected by preoperative Cr.

Objective:To design and manufacture mind maps of outpatient pre-examination triage and provide references for the training of outpatient triage nurses.Methods:The mind maps team was set up, and the content of outpatient pre-examination triage was prepared preliminarily by searching literature and combining with clinical practice. The first draft of mind map of outpatient pre-examination triage was established by drawing software, and the final draft was determined after consultation and verification by experts.Results:The final mind maps of outpatient pre-examination triage are composed of three parts: head, neck and chest symptoms, abdominal symptoms and other symptoms. The mind maps of head, neck and chest symptoms and abdominal symptoms both include six modules, and the mind map of other symptoms includes five modules. Each module contains different disease symptoms and departments.Conclusions:This mind map is comprehensive and easily mastering. Meanwhile it can regulate outpatient pre-examination triage and give guidance of nurse training.

Objective:Application Kano model to analyze the nursing service demand of outpatients and promote the improvement of outpatient nursing service quality.Methods:Design a questionnaire for the outpatients’service requirements based on the model of Kano, including 4 parts, service and mental outlook, management and professional duties, health education guidance, outpatient management and convenience Services, composed of 28 items. Using Kano model analysis technology, we can determine the different attributes of outpatient nursing needs, including O expectation attribute, M essential attribute, A charm attribute, R opposite attribute, and Q question answer.Results:The nursing service needs of outpatients were classified by identifying the attributes of each demand. There are 8 items1, 10, 11, 15, 17, 18, 21, 22 attributed to the desired attribute (O). There are 11 items 2, 8, 9, 12, 13, 14, 23, 24, 26, 27, 28 attributed to the mandatory attribute (M). There are9 items 3, 4, 5, 6, 7, 16, 19, 20, 25, 28 attributed to the charm attribute (A) . At the same time, the quadrant diagram of satisfaction and importance of each item is constructed.Conclusion:Using the Kano model to analyze the nursing service demand of outpatients can determine the attributes of each demand, realize the priority of management project improvement, and provide decision-making reference for improving the quality of outpatient nursing service.

OBJECTIVETo investigate the levels of IL-18 in the bone marrow of both normal subjects and patients with hematological diseases and to determine the possible significance of IL-18 in pathogenesis of some hematological malignancies.

METHODSThe IL-18 mRNA levels in the bone marrow of 140 patients with hematological diseases and 15 normal donors were determined by the semi-quantitative reverse transcriptase polymerase chain reaction (RT-PCR). Immunohistochemical method was used to detect IL-18 protein in 12 patients with acute myeloid leukemia (AML). The possible regulation of IL-18 for proliferation of some leukemia cells was investigated using antisense techniques.

RESULTSIL-18 mRNA levels were obviously higher in the patients with leukemia or other malignant hematological diseases (OMHD) than in normal donors. However, no significant difference was found in the level of transcription between patients with iron deficiency anemia (IDA) and normal controls. Immunohistochemical method confirmed the presence of IL-18 protein in 10 out of 12 AML cases with positive transcription. By 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyl tetrazolium bromide (MTT) assay, IL-18 antisense oligodeoxynucleotides (ASON) clearly inhibited the growth of J6-1 and HL-60 cells (42% and 12% inhibited, respectively) in a dose-dependent manner.

CONCLUSIONSIL-18 was detected at elevated levels in the bone marrow of patients with some hematological malignancies, and might be involved in the proliferation of certain leukemic cells in vivo through an autocrine mechanism.

Adolescent ; Adult ; Bone Marrow ; metabolism ; Cell Division ; drug effects ; Dose-Response Relationship, Drug ; Female ; Humans ; Immunohistochemistry ; Interleukin-18 ; analysis ; antagonists & inhibitors ; genetics ; Leukemia ; drug therapy ; metabolism ; pathology ; Male ; Middle Aged ; Oligonucleotides, Antisense ; pharmacology ; RNA, Messenger ; analysis

Continuing medical education for general practitioners is an important measure to upgrade the quality of primary health care services in China, which is still facing various challenges and need to be further developed and improved. This article analyzes the status quo and existing problems of continuing medical education for general practitioners in China, and proposes suggestions based on the concept of people centered and integrated health care (PCIC), including faculty development, training contents, assessment methods, and experience learning, to provide references for the improvement of continuing medical education for general practitioners.

Objective : To investigate the effect of different decontamination methods, including photodynamic therapy, sandblasting and titanium curette, on titanium surface morphology and bacterial adhesion for the treatment of peri-implant disease. Methods: Porphyromonas gingivalis (Pg) and Fusobacterium nucleatum (Fn) were inoculated on the surface of polished titanium specimens, and titanium specimen surfaces were treated with different decontamination methods after incubation. The titanium specimens were divided into a no-treatment control group, photodynamic group, sandblasting group and titanium curette group according to different decontamination methods. The changes in titanium surface roughness were observed by atomic force microscopy (AFM), and the remaining bacteria on the titanium surface were observed by scanning electron microscopy (SEM) and live/dead bacteria staining tests. After reinoculation of Pg and Fn, bacterial readhesion was observed on the surface of decontaminated titanium specimens. Results : The AFM results showed that the surface roughness of the titanium curette group was significantly higher than that of the no-treatment control group, photodynamic group and sandblasting group (P<0.05), and there was no statistically significant difference between the no-treatment control group, photodynamic group and sandblasting group (P>0.05). The results of contact angle measurement showed that the surface contact angle of each treatment group was smaller than that of the no-treatment control group (P<0.05). The SEM results obtained after the titanium specimen surface was decontaminated showed that the number of bacteria on the no-treatment control group surface was higher and the bacteria were relatively concentrated. The bacteria on the surface of the photodynamic group, sandblasting group and titanium curette group were scattered and distributed in small numbers, and most bacteria on the surface of the photodynamic group were ruptured. The results of the live/dead bacteria staining experiment showed that the percentage of dead bacteria on the surface of the photodynamic group was significantly higher than that of the no-treatment control group, sandblasting group and titanium curette group (P<0.05). The remaining bacteria on the surface of the sandblasting group and titanium curette groups were mainly live bacteria. The remaining bacterial adhesion on the surface was significantly reduced for the sandblasting group compared to the no-treatment control group and the photodynamic and titanium curette groups (P<0.05). SEM and live/dead bacteria staining results of bacterial readhesion on the surface of titanium specimens showed that there was an aggregation of Pg on the surface of the titanium curette group, and its surface bacterial adhesion was significantly higher than that of the no-treatment control group, photodynamic group and sandblasting group. Conclusion In mechanical decontamination, sandblasting machines are a better option than photodynamic therapy and titanium curettes; however, sandblasting does not remove all bacterial contamination. For sterilization, photodynamic therapy is more effective than sandblasting and titanium curettes. A combination of sandblasting and photodynamic therapy methods for the treatment of peri-implant disease may be considered in clinical practice.