Objective: To evaluate the efficacy of ultrasound-guided caudal epidural block for postoperative analgesia in the infants undergoing lobectomy under general anesthesia. Methods: Sixty American Society of Anesthesiology physical status Ⅱ or Ⅲ pediatric patients of both sexes, aged 1-3 yr, weighing 10-16 kg, scheduled for elective lobectomy under general anesthesia, were divided into 2 groups (n=30 each) using a random number table method: control group (group C) and epidural block group (group E). Caudal epidural block was performed under ultrasound guidance after induction of general anesthesia and at 15 min before surgery in group E. An epidural catheter was inserted at T_{6, 7} interspace, 0.1% ropivacaine 1 mg/kg was injected at 5 min after injecting 1% lidocaine 3 ml, the diffusion of epidural fluid was controlled at T_3-10, and the epidural catheter was then removed.An analgesia pump was connected at the end of the surgery in two groups.Pain was evaluated using Face Legs Activity Cry Consolability scale.When Face Legs Activity Cry Consolability scale score>3, the pump was pressed.When pain was still unrelieved 5 min later, sufentanil 0.1-0.2 μg/kg was intravenously injected.The patients were followed up for 48 h after operation, and the requirement for additional remifentanil and sufentanil, and the occurrence of postoperative nausea and vomiting, respiratory depression, hypoxemia and over-sedation was recorded.The number of pressing times, extubation time and duration of intensive care unit stay were also recorded.Pain at 1 and 2 days after operation was evaluated using the Postoperative Pain Measure for Parents. Results: Compared with group C, the consumption of remifentanil, the number of pressing times and requirement for additional sufentanil were significantly decreased, the incidence of each index of the Postoperative Pain Masure for Patients was decreased at 1 day after surgery, the extubation time and duration of intensive care unit stay were shortened, and the incidence of nausea and vomiting and over-sedation was decreased in group E (P<0.05). Conclusion Ultrasound-guided caudal epidural block provides better efficacy and fewer side effects for postoperative analgesia in the infants undergoing lobectomy under general anesthesia.

AIM: To investigate the oxidative damage effect of povidone iodine on corneal epithelial cells.

METHODS:To study the oxidative damage effect of different concentrations of povidone iodine, the cultured epithelial cells were randomly divided into control group, low concentration group, medium concentration group and high concentration group. To study the oxidative damage effect of disinfection time of povidone iodine, the cultured corneal epithelial cells were randomly divided into control group, short time group, medium time group and long time group. Malondialdehyde(MDA)and superoxide dismutase(SOD)were detected by ELISA, cell viability was detected by CCK-8 method and inverted microscope, and apoptotic rate was detected by flow cytometry.

RESULTS: The higher concentration of povidone iodine was associated with the higher MDA content, the lower SOD content, the lower cell activities and the higher apoptotic rate of the corneal epithelial cells, which was in a dose-independent manner. The differences among four groups were statistically significant(all P<0.01). The longer disinfection time of povidone iodine was related with the higher MDA content, the lower SOD content, the lower cell activities and the higher apoptotic rate of corneal epithelial cells, which was in a time-independent manner. The differences among four groups were statistically significant(all P<0.01).

CONCLUSION: The oxidative damage of povidone iodine on corneal epithelial cells were in a dose independent and time dependent manner.

Biliary atresia is an important reason for neonatal jaundice, and it is also the primary cause of liver transplantation in children. Porto-jejunal anastomosis (Kasai procedure) is an effective method for treating biliary atresia. In this article, the complications after Kasai procedure and long-term outcome were introduced. It is emphasized that the Kasai procedure is the first choice for biliary atresia patients. In addition, this article analyzes the possible influencing factors for surgical outcome, describes the possible problems regarding the long-term survival of autologous liver after the operation for biliary atresia, and proposes the need for more attention to the comprehensive treatment after Kasai procedure and before liver transplantation.

Objective: To investigate the effect of health education based on Pender′s health promotion theory on life style and living quality of patients with coronary heart disease and undergone percutaneous coronary intervention (PCI). Methods: A total of 124 cases of patients with coronary heart disease, undergone PCI and admitted to hospital from October 2016 to December 2017 were selected as the research objects, and divided into observation group and control group using the random number table method, with 62 cases in each group. All the patients were performed routine nursing intervention including mental intervention, medication guidance, rehabilitation training, complications prevention and follow-up visit after discharge. Besides, patients in control group were performed routine health education, and those in observation group were performed health education based on Pender′s health promotion theory. After 3 months and 6 months of follow-up visit, the healthy life style and living quality of the patients were measured by Pender Health-promoting Lifestyle Profile and Seattle Angina Questionnaire (SAQ). Results: After 3 months of follow-up visit, the scores of self-actualization, sports health, balanced diet, employment security and interpersonal support development in observation group were respectively (3.01±0.41), (2.94±0.43), (3.14±0.37), (3.14±0.43) and (2.75±0.41), which were significantly higher than (2.80±0.43), (2.63±0.37), (2.89±0.46), (2.82±0.49) and (2.43±0.47) in control group, and the differences were statistically significant (t=2.783, 4.403, 3.335, 3.865, 4.040, P<0.05); after 6 months of follow-up visit, the scores of self-actualization, sports health, balanced diet, employment security and interpersonal support development in observation group were respectively (3.52±0.44), (3.45±0.52), (3.60±0.34), (3.56±0.35), (3.36±0.45) and (50.61±5.53), which were significantly higher than (3.12±0.45), (2.86±0.40), (3.15±0.52), (3.12±0.46) and (2.86±0.56) in control group, and the differences were statistically significant (t=5.004, 7.081, 5.703, 5.994, 5.480, P<0.05).After 3 months of follow-up visit, the scores of body confinement degree, angina stability, angina attack degree, treatment satisfaction scale and disease cognition degree in observation group were respectively (69.02±3.98), (62.38±4.59), (66.39±5.24), (81.42±7.73) and (70.41±5.38), which were significantly higher than (65.56±3.57), (57.34±5.37), (62.86±4.28), (74.59±7.28) and (65.32±4.23) in control group, and the differences were statistically significant (t=5.096, 5.618, 4.108, 5.065, 5.856, P<0.05); after 6 months of follow-up visit, the scores of body confinement degree, angina stability, angina attack degree, treatment satisfaction scale and disease cognition degree in observation group were respectively (74.20±8.41), (70.12±7.24), (71.30±7.62), (91.30±8.21) and (75.21±8.52), which were significantly higher than (68.56±8.10), (64.45±7.62), (65.32±7.10), (85.36±7.62) and (69.52±7.65) in control group, and the differences were statistically significant(t=3.803, 4.247, 4.786, 4.176, 3.913, P<0.05). Conclusion Health education based on Pender′s health promotion theory can help promote the formation of healthy life style of patients with coronary artery disease and undergone PCI and improve their living quality.

Objective: To explore the clinical characteristics of multiple magnetic digestive tract foreign bodies ingested by mistake, to review the previous literature and provide reference for clinical treatment. Methods: The clinical data, treatment process and outcome of 8 cases of children with multiple magnetic foreign bodies admitted to Shanxi Children′s Hospital were retrospectively analyzed, and relevant literatures were reviewed. Results: Eight children with multiple magnets were aged 1 to 9 years old, and their medical history ranged from 5 hours to 2 months.Number of magnets ingested was 2-25.During the operation, 6 patients were found with multiple intestinal perforations, 1 with internal fistula and 2 with internal abdominal hernia, with at least 2 perforations and at most 6 perforations.The perforation sites located in the distal esophagus, stomach, duodenum, jejunum, ileum and colon.Seven cases were treated by emergency surgery, and 1 case was removed by colonoscopy and discharged after conservative treatment.One case underwent simple repair, 1 case underwent gastrojejunostomy, intestinal perforation repair; partial intestinal resection was performed in 2 places in 2 cases; partial intestinal resection was performed in 1 place and simple repair in the other places in 2 case; 1 case of fistula in child with intestinal anastomosis laparoscopic exploration, incision bowel resection.Seven cases recovered after surgical treatment.The child with intestinal obstruction after colonoscopy was discharged uneventfully 9 days later by conservative treatment, no complications occurred by followed-up.Combined with experience and literature, we developed a management algorithm for digestive tract magnet foreign body. Conclusion Accidental ingestion of multiple magnets can cause multiple digestive tract perforations, internal hernia, intestinal obstruction and other serious diseases, which should be treated as soon as possible.Therefore, it is necessary to strengthen the understanding of multiple magnet foreign bodies in children, early detection and early treatment.

Several factors can contribute to the formation of aneurysms, including hemodynamic changes, polyarteritis nodosa, bacterial endocarditis, vasculitis, fibromuscular dysplasia, vascular malformation, and cystic medial necrosis.[1,2] Surgery is recommended for splenic artery aneurysms (SAAs) greater than 25 mm in diameter, and several surgical approaches are used, including open surgery, laparoscopic surgery, and percutaneous embolization. Laparoscopic surgery might be associated with an increased risk of pancreatic leakage compared to the open surgery approach. Open surgery without complete aneurysm resection should be preferred for patients with large SAAs in close contact with the pancreas. Here, we report a patient with two splenic artery aneurysms.

Objective: To investigate the incidence rate of parastomal hernia(PH) among patients who have received laparoscope radical cystectomy and ileal conduit diversion and to discover the risk factors for PH. Methods: Data of 162 patients who underwent surgery of laparoscope radical cystectomy and ileal conduit diversion for bladder cancer between Jan 2012 and Dec 2017 were studied. The patients who had suffered other tumors before surgery or without follow-up data were excluded. At last, 148 patients were enrolled in this retrospective study. According to the occurrence of PH, the patients were divided into two groups: PH group and non-PH group. There were 21 patients (12 males and 9 females) in PH group. The mean age was (66.5±8.6) years old, and mean body mass index (BMI) was (33.4±5.2) kg/m². 11 patients with synchronous disease and 10 patients without synchronous disease before operation in PH group. Postoperative T stage 3 in 17 cases, ≥T₃ in 4 cases. 4 Cases received neoadjuvant chemotherapy and 5 cases received adjuvant chemotherapy. Tumor recurrence was found in 6 cases. 16 cases had hypoproteinemia. Ileal conduit was made through abdominal incision in 9 cases, and 12 cases was made with laparoscopy. After the surgery, there was severe cough in 7 cases and abdominal distension in 7 cases. 3 cases had previous abdominal operation, and 5 cases had history of glucocorticoid use. The mean size of the stoma was (3.0±0.6) cm. The mean length of the outflow tract was (11.2 ±1.3) cm. We did trans-rectus stoma in 4 cases, and para-rectus stoma in 17 cases. There were 127 patients (82 males and 45 females) in non-PH group. The mean age was (71.4 ±7.4) years, and the mean BMI was (28.8±4.1)kg/m². 60 patients with synchronous disease and 67 patients without. Postoperative T stage 3 in 96 cases, ≥T₃ in 31 cases. 29 patients received neoadjuvant chemotherapy and 39 cases received adjuvant chemotherapy. Tumor recurrence was found in 38 cases. 66 cases had hypoproteinemia. Ileal conduit was made through abdominal incision in 55 cases, under laparoscopy in 72 cases. There was severe cough in 34 cases and abdominal distension in 38 cases. 21 cases had previous abdominal operation, and 35 cases had history of glucocorticoid use. The mean size of the stoma was (2.3±0.4) cm. The mean length of the outflow tract was (12.2±1.6) cm. 4 cases had trans-rectus stoma, and 17 cases had para-rectus stoma. Postoperative rate of PH was estimated using the Kaplan-Meier methods. Chi-square test were used for the univariate analysis between group of PH and the normal one. Multivariate Logistic regression analysis was used to judge the independent risk factors of PH. Results: Patients were followed up for 24 months. PH occurred in 21 cases, the 1, 2, 5 year cumulative incidence of PH was 9.9%, 5.4% and 16.7% respectively. Clinical characteristics, including age at surgery(χ²=4.018, P=0.045), obesity(χ²=3.949, P=0.047), perioperative hypoproteinemia(χ²=4.279, P=0.039), chronic constipation(χ²=5.416, P=0.020), stoma location(χ²=6.464, P=0.011), stoma size(χ²=3.915, P=0.048), were significantly different between the PH group and the normal group(P<0.05). Multivariate Logistic regression analysis shows that obesity(OR=1.326, 95%CI=1.102-1.548, P=0.043), stoma location(OR=0.892, 95%CI=0.854-0.931, P=0.028), stoma size(OR=1.365, 95%CI=1.089-1.631, P=0.028) were the independent risk factors for PH. Conclusion We demonstrated that most of PH usually develop in 2 years after undergoing radical cystectomy with ileal conduit diversion. Obesity, stoma location and stoma size are independent risk factors. Preoperative counseling and preventative measures regarding PH formation should be emphasized, particularly in those patients with risk factors.

【Objective】 To investigate the frequency of antibiotic antibodies in hospitalized patients with anemia and analyze the yieldingresults. 【Methods】 The blood samples of 358inpatients with anemia, whohad taken antibiotics for 3 days or more, were selected. The drug-coated red blood cell method and drug addition method were used for the detection of antibodies toantibiotic drug, and the relevant clinical data were consulted for comprehensive analysis of the experimental results. 【Results】 Among the 358 blood samples, antibiotic antibodies were detectedin 12 by drug-coated red blood cell method, with ayielding rate of 3.35%(12/358). 6 out of 284 samples subjected to cephalosporin antibodies testing were positive, with a positive rate at 2.11%(6/284), and6 out of 74 samples subjected to non-cephalosporins antibodies testing were positive, with a positive rate at 8.11%(6/74), showingstatistical significance between the above two positive rates(P<0.05). No significant difference was notable among the 12 patients with positive antibioticantibody by gender, age, operation andnon-operation(P>0.05). No antibiotic antibodies were yielded in blood samples bydrug addition method. 【Conclusion】 The corresponding antibodiesagainst antibiotic could be produced insome patientsafter takingantibiotics.Therefore, enhancing the clinical attentionto antibiotic antibodies is of great significance to the effective application of clinical antibioticsand the accuracy of blood transfusion therapy.

Objective: To analyze the mortality and years of life lost (YLL) trends of cervical cancer in Tianjin, and provide references for the research and prevention programs of cervical cancer. Methods: Mortality rate, standard mortality rate, cumulative rate (0-74 years-old) and truncated rate (35-64 years-old) of cervical cancer from 1999 to 2015 were calculated. The annual percentage change of the mortality rate and YLL rate were analyzed by using Joinpoint regression analysis, and the trend in different age-groups were analyzed. Results: From 1999 to 2015, 1 741 cases died of cervical cancer in Tianjin, the average crude mortality rate was 2.15/100 000. The average age-standardized rate of (ASR) China and ASR world were 1.47/100 000 and 1.50/100 000 respectively. The average YLL was 3 347.97 person-years. Deaths occurred in those aged 0-34 years, 35-64 years and 65 years and over accounted for 3.10%, 57.84% and 39.06% of the total, respectively. The mortality rate of cervical cancer in urban area was higher than that in rural area, with a ratio of 1.37∶1 between urban area and rural area. The age-specific mortality rate of cervical cancer during 1999-2015 increased with age. Two peaks of mortality rate were observed in those aged 50 years and aged 75 years, during 2014-2015. From 1999 to 2011, the mortality rate of cervical cancer was stable (APC=-0.2%, P=0.80), but there was a rapid increase from 2011 to 2015 (APC=21.6%, P<0.01). But group aged 20-49 years, it showed an upward trend from 1999 to 2015 (APC=6.9%, P<0.01). For group aged 50-69 years, it showed a downward trend from 1999 to 2007 (APC=-9.2%, P<0.01), and an upward trend from 2007 to 2015 (APC=14.5%, P<0.01). For group aged 70 years and over, it showed a downward trend from 1999 to 2009 (APC=-10.2%, P<0.01), but the difference in the mortality were not significant from 2009 to 2015 (APC=7.8%, P=0.10). Since 2008, the YLL rate of cervical cancer in group aged 50-70 years had exceeded that in group aged >70 years and the gap gradually widened. Conclusions: There had been a rapid increase trend of cervical cancer mortality since 2011 in Tianjin. Women aged 50-70 years were the main group of life loss.
Adolescent ; Adult ; Aged ; China/epidemiology* ; Female ; Humans ; Incidence ; Middle Aged ; Mortality/trends* ; Regression Analysis ; Residence Characteristics ; Survival Rate/trends* ; Uterine Cervical Neoplasms/mortality* ; Young Adult

Objective: To explore the clinical and genetic characteristics of primary coenzyme Q10 deficiency caused by coenzyme Q4 (COQ4) variants. Methods: Clinical data were collected, while COQ4 gene was sequenced. Results: Here were reported a boy of 3 months old who came to our hospital presented with feeding difficulties, repeated respiratory infections, convulsions for 3 months. He was subsequently diagnosed as cerebral atrophy, and growth retardation. All exons were sequenced.c.211G>A(p.A71T, maternal), c. 436T>A(p.F146I, paternal) were detected. After treatment with coenzyme Q10, the convulsive symptoms improved significantly. Literature review revealed that totally 14 cases with primary coenzyme Q10 deficiency caused by COQ4 gene mutation were reported. The onset age varies from neonatal to 18 years old, and the clinical manifestations are heterogeneous, including cardiomyopathy, epilepsy, ataxia, cerebellar atrophy, respiratory insufficiency, and growth retardation. Conclusion For cases with atypical clinical manifestations of primary coenzyme Q10 deficiency, gene detection is helpful for an early diagnosis and treatment.