Objective:To explore the family resilience resources in parents of children with congenital pseudarthrosis of the tibia (CPT) , so as to provide a reference for formulating nursing intervention to improve their family resilience.Methods:From December 2020 to January 2021, purposive sampling was used to select 13 father or mother of children with CPT in the Department of Orthopedics of Hunan Children's Hospital as the research object. Semi-structured interviews were conducted with parents of children with CPT using the phenomenological method in qualitative research. Colaizzi 7-step method was used to organize, summarize, analyze and refine the data.Results:The family resilience resources of parents of children with CPT were reflected in three aspects, namely, personal resources, family resources and social resources.Conclusions:Family resilience interventions should make full use of their own resources when implemented in parents of children with CPT. Individualized continuous intervention should be provided by taking into account the learning ability and psychological state of the children's parents and in combination with specific needs. The intervention target should include as many family members as possible, and strengthen the establishment of a diversified support system to help parents of children with a large number of social resources.

Objective To investigate the effect of early physical training on long-lasting neurological function,pathology changes,spatial learning and memory abilities,sensorimotor function and ultrastructure changes in neonatal rats with hypoxic-ischemic brain damage (HIBD).Methods Ninety 7-day-old sprague-dawley rats were randomly divided into three groups:a group that was subjected to left carotid ligation followed by 2 hours hypoxic stress (vehicle group),a group that received physical trainings (grabbing,rotation,walking and balance) 1 weeks after HIBD event (trained group) and a sham-operated group that was subjected to a sham-operation without ligation and hypoxic stress (n=30).Following four weeks of physical trainings,neurological scale was performed on all the rats; the number of neurons in the CA1 region of hippocampus and cortex forehead was measured by Nissl count; the expression levels of synaptophysin and c-fos were examined; Morris water maze tests and cortex sensorimotor tests were performed to detect the spatial learning and memory abilities and sensory functions; transmission electron microscope was employed to observe the synapses and neuronal ultrastructure.Results As compared with those in the vehicle group,the neurological scale scores were significantly increased in the trained group and the sham-operated group 14,21 and 28 days after trainings (P＜0.05).As compared with those in the vehicle group,the number of neurons in the left hippocampal CA1 area and cortex increased in the trained group and sham-operated group (P＜0.05).The expressions of synaptophysin and c-los in the trained group increased significantly as compared with those in the vehicle group (P＜0.05).As compared with those in the vehicle group,the spatial learning and memory abilities and sensorimotor functions in the trained group were significantly increased (P＜0.05).The ultrastructure of the left hippocampus and cortex was remarkably abnormal in the vehicle group by the transmission electron microscopy,while no obvious abnormality was observed in the trained group.Conclusion Early physical training can restrain neuron damage in the hippocampus and cortex and enhance synaptic plasticity to ameliorate the long-term neurological function after HIBD; the strong expression of synaptophysin and c-fos in the hippocampus and cortex caused by early physical training may be one of the improvement mechanisms.

Background:For Chinese patients with hepatocellular carcinoma (HCC),surgical resection is the most important treatment to achieve long-term survival for patients with an early-stage tumor,and yet the prognosis after surgery is diverse.We aimed to construct a scoring system (Shanghai Score) for individualized prognosis estimation and adjuvant treatment evaluation.Methods:A multivariate Cox proportional hazards model was constructed based on 4166 HCC patients undergoing resection during 2001-2008 at Zhongshan Hospital.Age,hepatitis B surface antigen,hepatitis B e antigen,partial thromboplastin time,total bilirubin,alkaline phosphatase,γ-glutamyltransferase,α-fetoprotein,tumor size,cirrhosis,vascular invasion,differentiation,encapsulation,and tumor number were finally retained by a backward step-down selection process with the Akaike information criterion.The Harrell's concordance index (C-index) was used to measure model performance.Shanghai Score is calculated by summing the products of the 14 variable values times each variable's corresponding regression coefficient.Totally 1978 patients from Zhongshan Hospital undergoing resection during 2009-2012,808 patients from Eastern Hepatobiliary Surgery Hospital during 2008-2010,and 244 patients from Tianjin Medical University Cancer Hospital during 2010-2011 were enrolled as external validation cohorts.Shanghai Score was also implied in evaluating adjuvant treatment choices based on propensity score matching analysis.Results:Shanghai Score showed good calibration and discrimination in postsurgical HCC patients.The bootstrap-corrected C-index (confidence interval [CI]) was 0.74 for overall survival (OS) and 0.68 for recurrence-free survival (RFS) in derivation cohort (4166 patients),and in the three independent validation cohorts,the CIs for OS ranged 0.70-0.72 and that for RFS ranged 0.63-0.68.Furthermore,Shanghai Score provided evaluation for adjuvant treatment choices (transcatheter arterial chemoembolization or interferon-α).The identified subset of patients at low risk could be ideal candidates for curative surgery,and subsets of patients at moderate or high risk could be recommended with possible adjuvant therapies after surgery.Finally,a web server with individualized outcome prediction and treatment recommendation was constructed.Conclusions:Based on the largest cohort up to date,we established Shanghai Score-an individualized outcome prediction system specifically designed for Chinese HCC patients after surgery.The Shanghai Score web server provides an easily accessible tool to stratify the prognosis of patients undergoing liver resection for HCC.

ObjectiveTo analyze the risk factors of hemorrhage during cesarean section in multiparous women with advanced delivery age， and provide a theoretical basis for the prevention and treatment of hemorrhage during cesarean section. MethodsWe retrospectively analyzed the clinical data of 1 838 women with advanced maternal age undergoing cesarean section in the First Affiliated Hospital of Sun Yat-sen University from January 2015 to December 2019. According to whether the intraoperative blood loss of the parturient is ≥ 500 mL， they were divided into hemorrhage group and non-hemorrhage group. The correlations of various factors such as basic maternal data， intraoperative factors， placental factors and intraoperative hemorrhage， and obtain the results by multi-factor binary logistic regression analysis independent risk factors were analyzed. ResultsLogistic regression analysis showed that operation time ［OR=1.069， 95% CI： （1.050， 1.089）， P<0.001］， placenta delivery method ［OR=3.131， 95%CI： （1.259， 7.782）， P=0.014］， fetal distress ［OR=4.727， 95% CI： （1.191， 18.763）， P=0.027］， surgical grade ［OR=21.494， 95%CI： （6.031， 76.611）， P<0.001］， anesthesia method ［OR=2.904， 95%CI： （1.158， 7.281）， P=0.023］ and weak uterine contractions ［OR=7.255， 95%CI： （4.413， 11.927）， P<0.001］ were independent risk factors for intraoperative hemorrhage. ConclusionsOperation time， fetal distress， operation level， anesthesia， uterine weakness， and placental delivery are the main influencing factors for bleeding during cesarean section in elderly women who have undergone cesarean section. Clinical measures should be taken to reduce the risk of hemorrhage during cesarean section.

OBJECTIVE: To evaluate the characteristics of severe periodontitis with various number of tooth loss during 4-year natural progression, and to analyze the factors related to higher rate of tooth loss. METHODS: A total of 217 patients aged 15 to 44 years with severe periodontitis were included, who participated in a 4-year natural progression research. Data obtained from questionnaire survey, clinical examination and radiographic measurement. Tooth loss during 4-year natural progression was evaluated. The baseline periodontal disease related and caries related factors were calculated, including number of teeth with bone loss > 50%, number of missing molars, number of teeth with widened periodontal ligament space (WPDL), number of teeth with periapical lesions and etc. Characteristics of populations with various number of tooth loss and the related factors that affected higher rate of tooth loss were analyzed. RESULTS: In 4 years of natural progression, 103 teeth were lost, and annual tooth loss per person was 0.12±0.38. Nine patients lost 3 or more teeth. Thirty-four patients lost 1 or 2 teeth, and 174 patients were absent of tooth loss. Molars were mostly frequent to lose, and canines presented a minimum loss. The number of teeth with WPDL, with periapical lesions, with intrabony defects, with probing depth (PD)≥7 mm, with PD≥5 mm, with clinical attachment loss≥5 mm, with bone loss > 50% and with bone loss > 65% were positively correlated to number of tooth loss. Results from orderly multivariate Logistic regression showd that the number of teeth with bone loss > 50% OR=1.550), baseline number of molars lost (OR=1.774), number of teeth with WPDL (1 to 2: OR=1.415; ≥3: OR=13.105), number of teeth with periapical lesions (1 to 2: OR=4.393; ≥3: OR=9.526) and number of teeth with caries/residual roots (OR=3.028) were significant risk factors related to higher likelihood of tooth loss and multiple tooth loss. CONCLUSION In 4 years of natural progression, the number of teeth with bone loss > 50%, baseline number of missing molars, number of teeth with WPDL, baseline number of teeth with periapical lesions and number of teeth with caries/residual roots were significantly related to higher risk of tooth loss and multiple tooth loss among Chinese young and middle-aged patients with severe periodontitis in rural areas.
Humans ; Tooth Loss/etiology* ; Periodontitis/complications* ; Tooth ; Periodontal Diseases ; Molar