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.

Objective:To study the value of coronary flow reserve (CFR) via dynamic single photon emission computed tomography (D-SPECT) in evaluating coronary microcirculation dysfunction (CMD) in patients with heart failure.Methods:A prospective research method was adopted. One hundred and ninety-four patients with heart failure from September 2019 to September 2020 in Zhongshan Hospital, Fudan University were selected. The patients were tested for CFR using D-SPECT, and CFR<2 was defined as CMD. The general data were recorded, including age, gender, body mass index (BMI), blood pressure, heart rate, smoking history, New York Heart Association (NYHA) heart function classification, comorbidities and medication situation. The laboratory test results were recorded, including blood urea nitrogen, blood creatinine, blood uric acid, estimated glomerular filtration rate (eGFR), high-sensitivity C-reactive protein (hs-CRP), cardiac troponin T (cTnT) and N terminal pro B type natriuretic peptide (NT-proBNP). The left atrial diameter (LAD), left ventricular end diastolic diameter (LVEDD), left ventricular end systolic diameter (LVESD), interventricular septal thickness (IVST), pulmonary artery systolic pressure (PASP) and left ventricular ejection fraction (LVEF) were measured by cardiac ultrasound. After discharge, patients were followed up in outpatient or telephone contact, with the primary endpoint event being a composite endpoint consisting of cardiovascular death and heart failure readmission. Multiple linear regression analysis was used to analyze the risk factors of CFR. The Kaplan-Meier survival curve was draw, and the log-rank test was used to evaluate the effect of CFR on prognosis.Results:Among 194 patients, 133 patients had CMD (CMD group), and the incidence of CMD was 68.56%; 61 patients did not have CMD (non-CMD group). There were no statistical differences in gender composition, BMI, smoking history proportion, blood pressure, heart rate, hypertension rate, atrial fibrillation rate, diabetes mellitus rate, renal dysfunction rate, medication situation, LAD, LVEDD, IVST, PASP, blood urea nitrogen, blood creatinine, blood uric acid, eGFR and hs-CRP between two groups ( P>0.05). The age, rate of NYHA heart function classification Ⅲ to Ⅳ grade, rate of myocardial infarction or revascularization history, LVESD, cTnT and NT-proBNP in CMD group were significantly higher than those in non-CMD group: (60.7 ± 14.0) years old vs. (55.9 ± 15.8) years old, 54.89% (73/133) vs. 26.23% (16/61), 22.56% (30/133) vs. 1.64% (1/61), (48.8 ± 13.1) mm vs. (44.6 ± 11.4) mm, 0.023 (0.015, 0.046) μg/L vs. 0.015 (0.010, 0.023) μg/L and 1 591 (751, 3 409) ng/L vs. 1 132 (288, 1 860) ng/L, the LVEF was significantly lower than that in non-CMD group: (40.9 ± 14.2)% vs. (45.5 ± 14.1)%, and there were statistical differences ( P<0.05 or <0.01). Multiple linear regression analysis result showed that the cTnT was an risk factor of CFR ( β = - 0.18, 95% CI - 0.82 to - 0.06, P = 0.025). The median followed up time was 230 (136 to 330) d, 10 patients were lost to follow-up, with 58 patients in CMD group completing follow-up and 126 patients in the non-CMD group. The incidences of primary endpoint event and heart failure readmission in CMD group were significantly higher than those in non-CMD group: 23.02% (29/126) vs. 3.45% (2/58) and 15.87% (20/126) vs. 3.45% (2/58), and there were statistical differences ( P<0.01); there was no statistical difference in incidence of cardiovascular death between two groups ( P>0.05). Kaplan-Meier survival curve analysis result showed that the event free survival rate in CMD group was significantly lower than that in non-CMD group, and there was statistical difference (log-rank χ2 = 11.92, P<0.01). Conclusions:CMD is highly prevalent in patients with heart failure, and it is associated with poor prognosis. Improving CMD for improving coronary microcirculation may be potential targets for the treatment of heart failure.

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

Objective　To determine the prevalence of human herpesvirus 8 (HHV-8) DNA in acute leukemia (AL) patients. Methods　The presence of HHV-8 DNA sequences in peripheral blood mononuclear cells (PBMC) and bone marrow mononuclear cells (BMMC) from 50 AL patients was examined using polymerase chain reaction (PCR). Nine human hematopoietic cell lines and PBMC from 30 normal donors were also included. Results　HHV-8 DNA sequences were detected in one case of acute myelogenous leukemia (AML). The specimens from the bone marrow aspirate, peripheral blood and serum of this patient were all positive. None of the normal donors and human hematopoietic cell lines showed evidence of HHV-8 DNA. Conclusion　The results suggest that the prevalence of HHV-8 is low in AL in China.