Objective:To investigate the clinical effect of jujube core-shaped tissue resection technique in the treatment of alar reduction.Methods:A retrospective analysis was performed for the clinical data of patients who underwent alar reduction from February 2019 to June 2022. A spindle-shaped incision line was designed along the outer edge of the base of the nasal lobule, with a width of 4-5 mm and a length of 8-12 mm. The incision line was 1-2 mm away from the alar groove, and the inner side of the design line was extended to the inside of the nasal vestibule. After the incision was made, the subcutaneous tissue was undermining dissected with curved sharp scissors, and the shape of the extended excision tissue was similar to that of jujube core. After reduction, the incision was closed with vertical mattress suture. The surgical effect and complications were followed up after surgery, and an independent attending plastic surgeon evaluated the outcome and scarring based on photos before and at the last postoperative follow-up using the global aesthetic improvement scale (GAIS) and the Vancouver scar scale (VSS). GAIS is graded as 1, 2, 3, 4, and 5 points, and the lower the score, the better the improvement(≤3 points as effective improvement). VSS includes four parameters: color (0-3 points), thickness (0-4 points), vascular distribution (0-3 points), and softness (0-5 points). The higher the score, the more significant the scar is.Results:A total of 20 patients were enrolled, including 6 males and 14 females, aged 20 to 33 years, with an average age of 24.9 years. Before the operation, there were different degrees of alar flare and alar hypertrophy. After surgery, 13 patients had mild swelling, ecchymosis, which resolved after 3 days. There were no major complications as infection, incision dehiscence, and delayed healing. After 3 to 16 months of postoperative follow-up, 2 patients gradually developed cartilage deformation and affected the appearance of the nostrils 6 to 9 months after surgery due to the combination of rib-based rhinoplasty, and the satisfactory results were obtained after revision surgery. The symmetry of the nostrils was significantly improved. The GAIS score of 20 patients was (1.20±0.41) points, of which, 16 patients were rated as 1 point and 4 patients were rated as 2 points, all of which met the improvement criteria, and the VSS score was (1.45±0.60) points, in which the average score for color, thickness, vasculature and compliance are 0.60, 0.05, 0.55 and 0.30 points respectively.Conclusion:The application of jujube core-shaped tissue resection technique for alar reduction can increase the amount of tissue removal with the same incision width, which can not only fully narrow the alar effectively but also correct the hypertrophy of the alar tissue.

Objective:To investigate the clinical effect of jujube core-shaped tissue resection technique in the treatment of alar reduction.Methods:A retrospective analysis was performed for the clinical data of patients who underwent alar reduction from February 2019 to June 2022. A spindle-shaped incision line was designed along the outer edge of the base of the nasal lobule, with a width of 4-5 mm and a length of 8-12 mm. The incision line was 1-2 mm away from the alar groove, and the inner side of the design line was extended to the inside of the nasal vestibule. After the incision was made, the subcutaneous tissue was undermining dissected with curved sharp scissors, and the shape of the extended excision tissue was similar to that of jujube core. After reduction, the incision was closed with vertical mattress suture. The surgical effect and complications were followed up after surgery, and an independent attending plastic surgeon evaluated the outcome and scarring based on photos before and at the last postoperative follow-up using the global aesthetic improvement scale (GAIS) and the Vancouver scar scale (VSS). GAIS is graded as 1, 2, 3, 4, and 5 points, and the lower the score, the better the improvement(≤3 points as effective improvement). VSS includes four parameters: color (0-3 points), thickness (0-4 points), vascular distribution (0-3 points), and softness (0-5 points). The higher the score, the more significant the scar is.Results:A total of 20 patients were enrolled, including 6 males and 14 females, aged 20 to 33 years, with an average age of 24.9 years. Before the operation, there were different degrees of alar flare and alar hypertrophy. After surgery, 13 patients had mild swelling, ecchymosis, which resolved after 3 days. There were no major complications as infection, incision dehiscence, and delayed healing. After 3 to 16 months of postoperative follow-up, 2 patients gradually developed cartilage deformation and affected the appearance of the nostrils 6 to 9 months after surgery due to the combination of rib-based rhinoplasty, and the satisfactory results were obtained after revision surgery. The symmetry of the nostrils was significantly improved. The GAIS score of 20 patients was (1.20±0.41) points, of which, 16 patients were rated as 1 point and 4 patients were rated as 2 points, all of which met the improvement criteria, and the VSS score was (1.45±0.60) points, in which the average score for color, thickness, vasculature and compliance are 0.60, 0.05, 0.55 and 0.30 points respectively.Conclusion:The application of jujube core-shaped tissue resection technique for alar reduction can increase the amount of tissue removal with the same incision width, which can not only fully narrow the alar effectively but also correct the hypertrophy of the alar tissue.

Objective:To investigate the effect of exposure to histological chorioamnionitis(HCA) on premature infants with respiratory distress syndrome(RDS)complicated with bronchopulmonary dysplasia(BPD).Methods:The clinical data of premature infants with gestational age<32 weeks and survival>14 days who were born in the department of obstetrics and admitted into NICU at Qingdao Women and Children′s Hospital from January 2018 to December 2020 were collected.According to placental pathology, they were divided into positive HCA + positive RDS group(observation group)and negative HCA + positive RDS group(control group). T-test, rank sum test and χ2 test were used to analyze the occurrence and clinical characteristics of BPD between the two groups.For premature infants with positive HCA who were diagnosed as BPD, Spearman rank correlation was used to analyze the correlation between HCA stage and BPD severity. Results:There were a total of 162 premature infants with RDS.The average gestational age at birth was 29.29(28.29, 30.43) weeks, and the average birth weight was 1.32(1.13, 1.55)kg; the incidence of BPD was 69.8%(113/162), and the mortality rate of BPD was 2.7%(3/113). There were 114 cases in the observation group and 48 cases in the control group.The incidence of BPD in the observation group was 76.3%(87/114), which was higher than that in the control group(54.2%, 26/48), and the difference was statistically significant( P<0.05). Further study of 87 premature infants with positive HCA who were diagnosed as BPD showed that, the correlation between the stage of HCA and the severity of BPD had not been confirmed( rs=0.062, P=0.571). Serum C-reactive protein before the mother used antibiotics and procalcitonin on the first day after birth in the observation group were higher than those in the control group, and the differences were statistically significant( P<0.05). Among 113 premature infants with RDS who were diagnosed as BPD, the time of antibiotic use, length of stay in intensive care unit and hospitalization cost in positive HCA group were higher than those in negative HCA group, and the differences were statistically significant( P<0.05). Conclusion:HCA exposure will increase the risk of BPD in premature infants with RDS.In addition, HCA also increases the intake period of antibiotics, length of stay and cost of intensive care unit in premature infants with BPD.

Objective:To investigate the correlation between histologic chorioamnionitis(HCA) and periventricular leukomalacia(PVL) in preterm infants less than 34 weeks old.Methods:A total of 287 preterm infants born in Qingdao Women′s and Children′s Hospital from January 2018 to December 2018, whose mothers underwent placental pathological examination and preterm infants transferred to the neonatal intensive care unit for treatment, and whose gestational age was less than 34 weeks old, were selected as the study objects. According to the results of placental pathological examination, the infants were divided into two groups: the positive HCA group(167 cases)and the negative HCA group(120 cases). The incidence of PVL was compared between the two groups. According to the results of placental pathological examination and the stage standard of HCA, the preterm infants who had been diagnosed with PVL(41 cases) were divided into three groups: the non-HCA group, the early HCA group and the middle/late HCA group.The severity of PVL, clinical data, complications were compared in each groups, and the conditions that following up to 6 months were adjusted.Results:PVL was 19.16%(32/167) in the positive HCA group and was 7.50%(9/120) in the negative HCA group.There was significant difference in the incidence of PVL between the two groups( P<0.05). Among the preterm infants with PVL, 21.95%(9/41) was in non-HCA group, 31.71%(13/41) was in the early HCA group, and 46.34%(19/41) was in the middle/late HCA group.The severity of PVL, 1 min Apgar score, white blood cell count at 24 h after birth, the incidence of bronchopulmonary dysplasia, the number of hospital stay, the use of antibiotics, the mental development index(MDI) and psychomotor development index(PDI) at the adjusted gestational age to 6 months were significant differences among the three groups( P<0.05). Moreover, the degree of HCA inflammation was positively correlated with the severity of PVL( r s=0.374, P=0.016). Conclusion:There is a correlation between HCA and PVL in premature less than 34 weeks old.With the increasing of HCA inflammation, the incidence and severity of PVL increase. With the progression of the severity of inflammation, the white blood cell count at 24 h after birth, the incidence of bronchopulmonary dysplasia, the use of antibiotics and the time of hospital stay increase, the MDI and PDI scores at the adjusted gestational age to 6 months decrease.

Objective To investigate the relationship between histological chorioamnionitis (HCA),funisitis (FV) and lung injury in preterm infants.Method Data of preterm infants with gestational age of less than 34 weeks,who were born in our Hospital and admitted to the neonatal ward during the period of October 2015 to August 2016 were retrospectively collected.According to reports of placenta pathologies,participants were assigned into three groups,non-infection group,HCA group and HCA + FV group.Demographic and infectious characteristics,duration of respiratory support,partial pressure of oxygen (PaO2) and pulmonary function testing results at corrected gestational age 40 weeks were compared among groups.Result A total of 151 preterm infants were included,with 33 cases in noninfection group,61 cases in HCA group and 57 cases in HCA + FV group.Non-invasive ventilation duration and number of days in room air in HCA + FV groups were both longer than those in the non-infection group [0 (0,66) h vs.0 (0,0) h,65 (0,176) h vs.0 (0,8) h].The duration of invasive ventilation and total ventilation days in HCA + FV group were longer than those of the other two groups [0 (0,4) h vs.0 (0,0) and 0 (0,0) h,0 (0,99) h vs.0 (0,0) and 0 (0,52) h],the differences were statistically significant (P ＜ 0.05).However,there was no significant difference of PaO2 after 0.5 hour respiratory support among the three groups (P ＞ 0.05).Pulmonary functional parameters,such as respiratory frequency,VPEF/TE,VPEF/VE,VPEF and TPEF,gradually decreased with the degree of inflammatory progress,but there was no statistically significant difference (P ＞ 0.05).Conclusion HCA and FV are highly associated with premature lung injury.The worse the placental inflammation is,the longer respiratory support duration will be needed or required.However,HCA and FV may have no significant effect on lung function.

Objective To investigate the significance of interleukin-6 IL-6),interleukin-8 (IL-8) and metal matrix protease-9 (MMP-9) in lung injury caused by intrauterine infection in ueonatal rats.Method Eighteen 18-day-old SD pregnant rats were selected and randomly assigned into 0.6,0.7,0.8,0.9,1.0 mg/kg lipopolysaccharide (LPS) groups and control group.Rats of LPS group were injected intraperitoneally with LPS 0.6.0.7,0.8,0.9,1.0 mg/kg,those of control group was injected with equal volume of sterile saline.After 24 hours of injection,one pregnant rat from each group underwent cesarean seetion and placentae were collected for pathological evaluation.The other pregnant rats delivered spontaneously.When the neonatal rats came to 1,3,and 7 days of age,8 rats were randomly selected from each group.The respiratory frequency,body weight,lung weight,and blood samples for detecting inflammatory factors using enzyme-linked immunosorbent assay were measured among 3-day-old neonatal rats.Lung tissue for hematoxylin-eosin staining and lung pathology score were taken in the 1,3 and 7-day-old neonatal rats.Result (1) The mortality rate of neonatal rats increased gradually with the increasing dose of LPS injection.The mortality rate of neonatal rats in the LPS 1.0 mg/kg group was 20％.The placental pathology score and the frequency of 3-day-old neonatal rats in LPS 0.8,0.9,and 1.0 mg/kg groups were higher than control group and other LPS groups (P ＜ 0.05).(2) The histopathological scores of the neonatal rats in the control group and LPS 0.6,0.7,0.8,0.9,1.0 mg/kg groups on the first day after birth were (0.08±0.08),(0.17±0.11),(1.33±0.19),(1.75±0.33),(1.92±0.36),(2.67±0.14),respectively,and that of the third day after birth were (0.00 ± 0.00),(0.50 ± 0.15),(0.67 ±0.19),(1.33 ±0.36),(2.17 ±0.21),(2.92 ±0.08),respectively.LPS 1.0 mg/kg group on the 1st and 3rd day after birth were significantly different from the other groups (P ＜0.05),LPS 0.8 mg/kg group on the 1st and 3rd day after birth were significantly different from the control group and LPS 0.6 mg/kg group (P ＜ 0.05),and there was significant difference among the LPS 0.9 mg/kg group and the other groups on the 3rd day after birth (P ＜ 0.05).When the concentration of LPS was less than 0.8 mg/kg,there was no significant difference in the pathological scores of the lung tissues between each group (P ＞0.05).(3) The concentrations of IL-6,IL-8,and MMP-9 in the neonatal rats of LPS 0.7,0.8,0.9,and 1.0 mg/kg groups were significantly higher than those in the control group at 3 days of age,and the difference among LPS groups were statistically significant (P ＜ 0.05).Conclusion The intraperitoneal injection of LPS in rats 18 days after gestation can lead to lung injury,pulmonary edema,and increasing level of blood IL-6,IL-8,and MMP-9 in the neonatal rats,and this damage lasts until 7 days after birth which suggests the important meaning for lung diseases caused by intrauterine infection.

Objective To analyze the incidence and the risk factors of retinopathy of prematurity (ROP) among the multiple and single gestations births.Methods A prospective control study was applied to the research.The preterm infants were selected that from September 2013 to December 2015 in neonatology department of our hospital.They were divided into multiple gestations group (52 cases) and single birth infants group (600 cases).RetCam Ⅲl retina camera and binocular indirect ophthalmoscope video were used to screening the ocular fundus.The cure rate of the two groups was compared with chi-square test.Results The incidence of ROP in multiple gestations group (32.69％) was higher than single birth infants group (20.83％) (P =0.047).There was significant difference about the multiple and single gestations births in ≤ 30 weeks (P =0.040),and there was no statistically significant difference in ＞ 30 weeks (all P ＞0.05).With the increase of birth weight,the ROP detection rate of two groupa was reduced.There was no statistically significant difference about different birth weight among the two groups (all P ＞ 0.05).The oxygen usage of ＞ 5 days ROP detection rate was higher than 5 days or less in the two groups (P =0.025,0.001).There was no significant difference in ROP detection rate between two groups with ≤5 d oxygen usage.There was significant difference about the multiple and single gestations births in oxygen usage of ＞ 5 days (P =0.020).Multivariate analysis found that multiple gestations and small gestational age were risk factors for ROP.Conclusion The smaller gestational age,the lower birth weight,and the longer oxygen therapy with the preterm infants,the higher the incidence of ROP.The number of different gestational is also the influences factors of ROP.Multiple gestations overall incidence of ROP is higher than the single birth infants.The smaller the gestational age and the longer oxygen usage,multiple gestations incidence of ROP is higher than single gestation in different births.However,there is no relationship in different birth weight among the multiple and single gestations.

Objective To explore the effect of environmental enrichment intervention on spatial memory function,expressions of phosphorylated cAMP response element binding protein (pCREB) and apoptotic regulated genes (Bcl-2 and Bax) in the hippocampus of immature rats with hypoxic-ischemic brain damage (HIBD).Methods Two kinds of raising environments were chosen:standard environment and environmental enrichment.Thirty-two Wistar rats aged 7 days were randomly divided into sham-operated group (n=10),environmental enrichment group (n=11) and standard environment group (n=11).Rats in both environmental enrichment group and standard environment group were induced animal models of HIBD using the way of Rice-Vannucci.Rats in the sham-operated group and standard environment group were raised in standard environment,while rats in the environmental enrichment group were raised in environmental enrichment.After 21 days of environmental enrichment intervention,the escape latency for searching the hidden platform of immature rats was detected by Morris water maze navigation test.The pCREB protein expression was detected by Western blotting;Bcl-2 and Bax expressions in the hippocampus were detected by immunohistochemisty.Results (1) On the fourth and fifth days of Morris water-maze test,the escape latency in the environmental enrichment group was shorter significantly as compared with that in the standard environment group (P＜0.05).(2) As compared with the lesion lateral hippocampus of standard environment group,the expressions ofpCREB (0.435±0.121 vs.0.756±0.101) and Bcl-2 (0.103±0.028 vs.0.165±0.017) in the lesion lateral hippocampus of environmental enrichment group were significantly higher (P＜0.05);however,the expression of Bax in the environmental enrichment group was statistically lower (0.402± 0.028 vs.0.325±0.019,P＜0.05).Conclusion Environmental enrichment intervention can improve the spatial memory ability in the hippocampus after HIBD,which indicates that the effectiveness of environmental enrichment intervention might be through the pathway of CREB-pCREB-apoptotic regulated genes (Bcl-2 and Bax).

Objective To investigate pulmonary function in terms of tidal respiration and the influencing factors on it in ＜ 34 weeks premature infants with RDS at corrected gestational age of 40 weeks.Methods A total of 49 of ＜ 34 weeks premature infants with RDS (RDS group) and 36 of ＜ 34 weeks premature infants without RDS (non-RDS group) followed throughout entire twelve months were collected fromn December 2013 to October 2015.Of them,35 RDS patients and 20 non-RDS patients had the pulmonary function examination.A total of 26 full term infants with hyperbilirubinemia (full term group) were recruited for comparison study.The differences in parameters of tidal respiration were compared among the three groups.The RDS patients were further divided into the mild RDS subgroup and severe RDS subgroup according to the severity of illness.Result ①The TPEF [(0.17 ± 0.04) s vs.(0.23 ± O.09) s],VPEF [(6.74±2.70) mLvs.(9.33±2.92) mL],TPEF/TE [(29.06±4.21)％ vs.(38.27± 7.16) ％],VPEF/VE [(32.54 ± 4.43) ％ vs.(39.64 ± 5.88) ％] in RDS group were significantly lower than those in full term group (P ＜0.05).The TPEF [(0.19 ±0.06) s vs.(0.23 ±0.09) s],TPEF/TE [(30.31 ±11.53)％ vs.(38.27±7.16)％],VPEF/VE [(34.39±8.44)％ vs.(39.64±5.88)％] in non-RDS group were significantly lower than those in full termn group (P ＜ 0.05).The TPEF,TPEF/TE,VPEF/VE in RDS group were lower than those in non-RDS group,but the differences were not significant (P ＞ 0.05).②The TPEF,VPEF,TPEF/TE,VPEF/VE in mild RDS group were higher than those in severe RDS group,but the differences were.not significant (P ＞ 0.05).③ Logistic regression analysis indicated that the gestational age was the protective factor of pulmonary function in premature infants with RDS.Conclusions Small airway resistance in ＜ 34 weeks premature infants with RDS is higher than that in full term infants.There was no significant difference in pulmonary function between RDS premature infants and non-RDS premature infants.The gestational age was the influencing factor of pulmonary function in premature infants with RDS.

Objective: To investigate the incidence and pathogen distribution of ventilator-associated pneumonia (VAP) among preterm infants admitted to level Ⅲ neonatal intensive care units (NICU) in China. Method: A prospective study was conducted in 25 level Ⅲ NICU, enrolling all preterm infants <34 weeks gestational age admitted to the participating NICU within the first 7 days of life from May 2015 to April 2016. Chi-square test, t test and Mann-Whitney U test were used for statistical analysis. Result: A total of 7 918 patients were enrolled, within whom 4 623(58.4%) were males. The birth weight was (1 639±415) g and the gestational age was (31.4±2.0) weeks; 4 654(58.8%) infants required non-invasive mechanical ventilation and 2 154(27.2%) required intubation. Of all the mechanically ventilated patients, VAP occurred in 95 patients. The overall VAP rate was 7.0 episodes per 1 000 ventilator days, varying from 0 to 34.4 episodes per 1 000 ventilator days in different centers. The incidence of VAP was 9.6 and 6.0 per 1 000 ventilator days in children′s hospitals and maternity-infant hospitals respectively, without significant differences (t=1.002, P=0.327). Gram-negative bacilli (76 strains, 91.6%) were the primary VAP microorganisms, mainly Acinetobacter baumannii (24 strains, 28.9%), Klebsiella pneumonia (23 strains, 27.7%), and Pseudomonas aeruginosa (10 strains, 12.0%). Conclusion The incidence of VAP in China is similar to that in developed counties, with substantial variability in different NICU settings. More efforts are needed to monitor and evaluate the preventable factors associated with VAP and conduct interventions that could effectively reduce the occurrence of VAP.