[Summary] There is growing awareness of the importance of vitamin D beyond maintenance of musculoskeletal health.Vitamin D has been shown to have extensive biological functions,including modulating immune function,inhibiting cellular proliferation,inducing differentiation,promoting apoptosis.Vitamin D deficiency is highly prevalent in critically ill patients,and it may impact the severity of illness and contribute to lessthan-optimal outcomes.Vitamin D plays an important role in preventing the development of critical illness based on its pleiotropic actions,thus holding a profound prospective with respect to an adjunctive therapy in critically ill patients.

Objective To investigate the prevalence of vitamin D deficiency in medical intensive care unit (ICU) and its relationship with severity of disease and prognosis.Methods A prospective study was performed to evaluate vitamin D status in 216 patients admitted to the medical intensive care unit.The incidence of hypovitaminosis D was observed.Acute Physiology and Chronic Health Evaluation Ⅱ (APACHE Ⅱ) score,days kept in ICU and on ventilator,main laboratory findings,and mortality rate were compared among patients with different serum 25-hydroxyvitamin D [25 (OH) D] levels.Potential risk factors for mortality were analyzed by multivariate logistic regression analysis.Results One hundred and fifty-three patients (70.8％) developed hypovitaminosis D.25 (OH) D deficiency was identified in 95 (44.0％),25 (OH) D insufficiency in 58 (26.8％),and 25 (OH) D sufficiency in 63 (29.2％) patients.APACHE Ⅱ score,positive blood culture,the incidence of multiple organ dysfunction syndrome(MODS),and mortality rate were higher in deficiency group compared with the other two groups [APACHE Ⅱ score:deficiency group 25 (20,28) score,insufficiency group 22 (17,26) score,sufficiency group 19 (18,20) score,P＜0.01 ; positive blood culture:deficiency group 18.9％,insufficiency group 13.8％,sufficiency group 3.2％,P=0.015 ; MODS:deficiency group 48.4％,insufficiency group 43.1％,sufficiency group 25.4％,P=0.025; mortality rate:deficiency group 40％,insufficiency group 24.1％,sufficiency group 15.9％,P =0.003].25 (OH)D levels were negatively correlated with APACHE Ⅱ score and mortality rate (r =-0.325,P＜0.01 ; r=-0.276,P＜0.01,respectively).Analysis by multiple logistic regression demonstrated that 25 (OH) D deficiency (OR =3.005,95 ％ CI 1.321-5.875,P =0.008) was independent risk factor for mortality.Conclusions This study demonstrates that vitamin D deficiency is highly prevalent among patients admitted into ICU.Vitamin D deficiency is associated with disease severity,and seems to be an independent risk factor for mortality.

Objective To explore the clinical outcome of perforator flaps for reconstruction of limb soft tissue defects. Methods In this case series, from 2007 July to 2009 May, 108 cases of perforator flap to reconstruct the defects of the extremities were performed, of these, 98 were free perforator flaps, 10 were pedicled flaps. The perforator flaps included deep inferior epigastric artery perforator flap, anterolateral thigh perforator flap, thoracodorsal artery perforator flap, lateral thigh perforator flap, posterior interosseous artery perforator flap, collateral radial artery perforator flap, medial sural artery perforator flap, posterior tibial artery perforator flap, deep circumflex iliac artery perforator flap and peroneal artery perforator flap. The maximum size of the perforator flap was 44 cmx 9 cm, the minimum size of the perforator flap was 4 em x 2 cm.The donor defect was closed directly. Results Venous congestion occurred in 5 flaps, in 1 case venous congestion was overcomed after released the dressing, 4 flaps requiring reexploration for venous insufficiency,2 had a successful outcome, the other 2 flaps failed . The other 103 flaps were successful. The wounds healed without any infection complications. The follow-up ranges from 6-24 months( 10 months on average). The flaps were of good appearance and not bulky; there were only linear scars on the donor sites, the cosmesis and function of the donor sites were satisfying. Conclusion The muscle, deep fascia and motor nerve are not contained in the flap, the advantages of this type of flap is reducing morbidity of the donor site and its reliable blood supply and suitable thickness for resurfacing, no secondary debuiking is necessary. The perforator flaps can be chosen as the first option to deal with superficial extremity wounds.

OBJECTIVETo study the relationship between sub-health status and the health-promoting lifestyle of employees.

METHODSA total of 5316 employees in a company in Guangdong were surveyed using sub-health measurement scale version 1.0 (SHMS V1.0) and the health-promoting lifestyle profile (HPLP-II). The former scale included 3 subscales of somatic sub-health, psychological sub-health and social sub-health, and the latter included 6 subscales of self-actualization, healthy responsibility, physical exercise, nutrition, interpersonal sensitivity and stress treatment.

RESULTSThe total healthy rate was 12.86% among the employees, with 76.76% and 10.5% in sub-health and disease states. The mean scores of HPLP-II was 115.95∓21.468 in the total population surveyed, 134.23∓24.72 in healthy employees and 114.69∓19.25 in the patients. There was a significant difference in the grades of health-promoting lifestyle between sub-healthy and healthy employees (P<0.05) as well as in the scores of HPLP-II and the scores of the 6 subscales (P<0.05). An appreciable correlation was found between sub-health status and the 6 subscales, and self-realization, physical exercise and stress management showed significant inverse correlation with sub-health status.

CONCLUSIONSub-health status is related to health-promoting lifestyle, and self-realization, physical exercise and management are the protective factors that influence sub-health status.

Adult ; Cross-Sectional Studies ; Female ; Health Behavior ; Health Promotion ; Health Status ; Humans ; Life Style ; Male ; Surveys and Questionnaires ; Young Adult

Objective To summarize the clinical feature,gene mutations,diagnosis,treatment,and follow-up data of protein-sensitive hypoglycemia,so as to improve the clinical understanding of the disease.Methods Five patients were diagnosed with protein-sensitive hypoglycemia during June in 2015 and December in 2017 from the Department of Pediatric Endocrinology and Inherited Metabolic Diseases,Children's Hospital of Fudan University.Clinical data of 5 cases were summarized,including clinical manifestations,findings of protein sensitivity test,therapy effect and prognosis.The endocrine and metabolic panel was used to investigate the genetic cause of four patients.Related literatures of protein-sensitive hypoglycemia were reviewed,and the phenotypes,genotypes,and therapy effects were summarized.Results Among the 5 patients diagnosed with positive results of protein-sensitive hypoglycemia,three were found to harbor glutamate dehydrogenase 1 (GLUD 1) mutations (c.965G ＞ A,p.R322H:2 cases;c.943C ＞T,p.H315Y:1 case),and another one had complex heterozygous mutations in L-3-hydroxyacyl-CoA dehydrogenase (HADH,c.29G ＞ C,p.R10P;c.89T＞ A,p.V30E).5 patients were euglycemia without any medical support after low protein diet.In 18 literatures retrieved and this study,there were totally 161 cases of protein-sensitive hypoglycemia (149 cases with GLUD1 mutations and 10 cases with HADH mutations).Conclusions When a child was admitted because of hypoglycemia,the diagnosis of protein-sensitive hypoglycemia should be suspected if he or she also had postprandial hypoglycemia,with or without hyperammonemia.Protein sensitivity test is helpful for us to make the diagnosis of protein-sensitive hypoglycemia.

Objective:To investigate the application value and treatment opportunity of single balloon enteroscopy in children with Peutz-Jeghers syndrome(PJS).Methods:A retrospective analysis was conducted on 33 children diagnosed with PJS in Hunan Children′s Hospital from January 2011 to September 2021.The patient′s age, gender, family history, clinical symptoms, enteroscopy examination and treatment, number of polyps, intraoperative and pos-toperative complications, surgical treatment, recurrence of surgery, and follow-up data were analyzed, and the chi- square test was used for statistical analysis. Results:A total of 33 PJS children aged (9.00±3.13) years, including 21 males and 12 females, were included.All of them received at least once single balloon enteroscopy test.The main manifestations of the children were black spots (33 cases) and multiple polyps in the digestive tract (31 cases). In all the 33 cases, black spots were distributed on lips.Some black spots were also found at the end of fingers (3 cases), at the end of foot toes(2 cases), and at the end of finger toes (6 cases). During the operation, 391 polyps were removed, most of which were jejunum polyps (37.08%, 145/391 polyps). Eleven children with PJS has intussusception, of which intestinal intussusception accounted for 90.91% (10/11 cases). Ten cases (30.30%, 10/33 cases) received surgical treatment, and 72.73% (8/11 cases) underwent surgery for acute refractory intussusception.One case had intestinal perforation and 2 cases were bleeding during the operation, and the 3 cases recovered completely after hemostatic clip sealing and surgical treatment.The incidence of hollow ileum polyps and giant polyps in children aged >8 years was higher than that in children aged ≤8 years[92.55% (149/161 polyps) vs.7.45%(12/161 polyps), 96.20%(76/79 polyps) vs.3.80% (3/79 polyps)]. The differences were statistically significant ( χ2=9.854, 8.711, all P<0.05). There was no significant difference in the incidence of intussusception among different age groups ( P>0.05). Among the 33 children with PJS, 57.58% (19/33 cases) had recurrence 1-3 years after operation, and no cases of cancer have been followed up so far. Conclusions:Intestinal polyps are common in children with PJS, and the application of single-balloon enteroscopy in children with PJS is reliable and safe.Children over 8 years old are more vulnerable to empty ileum polyps and giant polyps.Therefore, it is advised that children aged above 8 years with PJS should undergo at least once enteroscopy.

To enhance the spatial resolution of vibro-acoustography,an improved vibro-acoustography system is constructed using a large-angle dual-frequency focused transducer.Based on this system,mimicking phantoms are used as the experimental objects to explore the spatial resolution of vibro-acoustography,and test the vibro-acoustography results of mimicking phantoms with different acoustic characteristics.Additionally,the effects of the position of hydrophone and difference frequency on the vibro-acoustography results are studied,and the effects of transducer component distribution on vibro-acoustography results are analyzed with a simulation model established with k-Wave.The research results indicate that the vibro-acoustography system with a large-angle dual-frequency focused transducer has higher spatial resolution,contrast and specificity in imaging mimicking phantoms with different acoustic characteristics.The choice of difference frequency is critical for the imaging quality,but the position of the hydrophone and transducer component distribution have trivial effects on vibro-acoustography results.The study is expected to provide new ideas for the development of vibro-acoustography technology,and to promote its further practical application.

Objective:To exlplore the association between the baseline luteinizing hormone/follicle stimulating hormone (LH/FSH) ratio of polycystic ovary syndrome (PCOS) and in vitro fertilisation-embryo transfer outcomes.Methods:This was a retrospective cohort study. A total of 2 868 PCOS patients were enrolled, all of the participants were patients in The First Affiliated Hospital of Anhui Medical University Hospital from October 2015 to October 2021. Propensity score matching (1∶2.5) was conducted to regulate the non-random allocation of patients. Data were extracted from the hospital′s medical records. Patients with baseline LH/FSH ratio>2 were deemed as study group, patients with baseline LH/FSH ratio≤2 were deemed as control group. Single factor analysis was applied to compare the differences of pregnancy outcomes between two groups.Results:After propensity score matching (1∶2.5), there were no statistically significant differences in baseline data between the two groups (all P>0.05), indicating that the data were comparable. In the study group, the total dose of gonadotropin (Gn) and duration of Gn were lower than those of the control group ( t=4.989, P<0.001; t=3.267, P=0.001), the rate of in vitro maturation was higher than that of the control group ( χ2=4.938, P=0.026), the number of retrieved oocytes and cleavage were higher than those of the control group ( t=-2.305, P=0.021; t=-2.816, P=0.005), but there were no differences in the number and rate of high-quality embryos between the two groups ( t=-1.636, P=0.102; t=-0.123, P=0.902). The incidence of moderate to severe ovarian hyperstimulation syndrome in the study group was significantly higher than that in the control group ( χ2=17.277, P<0.001). Regardless of fresh embryo transfer or frozen-thawed embryo transfer cycles, the incidences of gestational diabetes mellitus in the study group were higher than those in the control group ( χ2=9.174, P=0.002; χ2=4.204, P=0.040) of singleton pregnancy. In the fresh embryo transfer cycle, the clinical pregnancy rate [30.30% (20/66) vs 47.75% (53/111)] and delivery rate [30.30% (20/66) vs 46.85% (52/111)] in the study group were lower than those in the control group ( χ2=5.198, P=0.023; χ2=4.695, P=0.030). In the frozen-thawed embryo transfer cycle, the delivery rate in the study group was higer than that in the control group [59.41% (423/712) vs 55.04% (1 053/1 913); χ2=7.526, P=0.023]. The clinical pregnancy rate and delivery rate of fresh embryo transfer cycle in the study group were significantly lower than those of frozen-thawed embryo transfer cycle ( χ2=21.308, P<0.001; χ2=20.871, P<0.001), but there were no significant differences in the control group (all P>0.05). Conclusions:PCOS patients with a higher basal LH/FSH ratio are more likely to develop moderate to severe ovarian hyperstimulation syndrome after controlled ovarian stimulation and have a higher incidence of gestational diabetes mellitus. Better pregnancy outcome could be obtained by frozen-thawed embryo transfer.