Objective To evaluate the efficacy of ventricle septal defect(VSD) occluder through lower ministernotomy for patients with perimembranous VSD. Methods From January 2007 to August 2008,41 patients with perimembranous VSD(14 male,27 female,weighed 9.0 to 71 kg with a mean of 46.3?16.1) underwent a closure of perimembranous VSD through lower ministernotomy using Amplatzer occluder.Before the operation,all the cases had been confirmed as having a 3-to 8.5-cm perimembranous VSD by transthoracic echocardiography(TTE).Under general anaesthesia,a small incision was made at the lower sternum to expose the right ventricle,and then occluder was placed in the right ventricle.TEE,electrocardiography and chest X-ray were performed before discharge and 1 month after the operation.Results The procedure was completed successfully in all the patients with a mean operation time of(6.2?3.3) hours(ranged from 2.5 to 17 hours).The ICU stay was(15.1?4.3) in average(8-21 hours).The mean drainage volume after the surgery was(80?33) ml(35-210 ml).Follow-up was available in all the cases for(7.9?4.1) months(range,3-15 months).During the period,no A-V block,new AI,occluder displacement,embolization,tricuspid incompetence or residual occurred. Conclusions VSD occluder is feasible and safe for closure of perimembranous ventricular septal defects through lower ministernotomy.

By establishing a series of Dynamic Cervical Implants (DCI) within C5-C6 cervical spinal segments, the biomechanical finite element analysis for DCI with different width and thickness were carried out to investigate the influence of the width and thickness of DCI's curved section on its equivalent stress and range of motion (ROM), so as to provide some theoretical basis for the optimization of DCI's design. The results show that the width of DCI's curved section has more obvious influence on the ROM of lateral bending and torsion, in comparison with the thickness of DCI's curved section. By appropriate reduction in width, the ROMs of lateral bending and torsion increase obviously, i.e. the overall movement function of patients is improved. Furthermore, the increase of equivalent stress could be counteracted by corresponding increase of thickness.
Biomechanical Phenomena ; Cervical Vertebrae ; Finite Element Analysis ; Humans ; Movement ; Neck ; Prostheses and Implants ; Prosthesis Design ; Range of Motion, Articular

Objective To evaluate the clinical characteristics,diagnosis and surgical repair methods of double aortic arch (DAA) associated with complex cardiac anomalies.Methods Retrospectively analyzed the clinical data of the 5 DAA associated with complex cardiac anomalies patients,4 males and 1 female,age from 41 days to 19 years old,weight 4.3-56.0 kg.Accompanied cardiac malformites including 2 cases with TOF,2 cases with DORV,and 1 case with d-TGA.4 cases were diagnosed DAA via MSCT and were surgical treated combined with cardiac malformations at same stage.1 case of DAA associated with d-TGA experienced stubborn pulmonary infection with increased airway resistance and could not tolerate ventilator weaning after aterial switch operation.Then he was diagnosed DAA with left arch atresia through MSCT.So,the patient underwent another surgery to excise the left aortic arch.Results One case worsened postoperatively by the cause of vomiting and aspiration and then died.The other four were survival and discharged with no DAA repair relating complication.Conclusion Double aortic arch can be cured by surgical repair and DAA with cardiac defects can be operated in one stage via median sternotomy.Congenital vascular ring should be considered in patients with stubborn and unexplained respiratory symptoms,who should receive timely imaging examinations for accurate diagnosis and surgical treatment at the early stage.

Objective To evaluate the efficacy of confocal laser endomicroscopy(CLE)for the assessment of the grading of gastric intestinal metaplasia(GIM)in vivo.Methods Patients with known GIM underwent CLE(Pentax EC-3870K).The presence of GIM was indentified immediately by the endoscopist during the procedure.The updated Sydney Classifycation System as reference,GIM was subdivided as mild,moderate and severe according to the area of intestinal metaplasia glands and the number of goblet cells.The histological evaluation remained the gold standard for the final diagnosis of GIM.The presence of the dysplasia and the expression of the Ki67 were examined.Results A total of 151 GIM positive areas were found in 58 patients with mild in 92,moderate in 34.and severe in 25 by CLE. One hundred and forty-six GIM areas were examined histopathologically with positive rate of 96.7%(mild in 82,moderate in 36 and severe in 28).The sensitivity and specificity of CLE were 90.2%and 73.9%in diagnosis of mild GIM,69.4 oA and 92.2%in moderate GIM,71.4% and 95.9%in severe GIM.The kappa coefficient of CLE criteria and the histopathological grading for mild,moderate and severe GIM were 0.65,0.63 and 0.70,respectively.The more severe the GIM,the higher the ratio of incomplete GIM,the ratio of dysplasia and the stronger expression of Ki67.Conclusions CLE may offer an instant and reliable diagnosis for GIM with high accuracy.It is helpful in grading of GIM.

Objective To investigate the urinary iodine level and thyroid function during different trimesters of pregnancy in Hangzhou residents and to provide evidence for monitoring iodine nutrition or screening thyroid function. Methods The urinary iodine level and thyroid function of 395 subjects from 5 hospitals in Hanzhou were investigated. The urinary iodine level was measured by arsenic-cerium contact process method. The serum TSH, FT3 and FT4 were measured by chemiluminescence method. Results (1) The urinary iodine median concentration during pregnancy in the 1st, 2nd and 3rd trimesters were 170.3, 170.2, 162.4 μ/L respectively, all significantly lower than that of non-pregnant women (251.9 μg/L, all P < 0.05); (2) The mean value of TSH during the 1st trimester of pregnancy was significantly lower than that of non-preguant women (P < 0.05). The mean values of FT4 and FT3 in the 2nd and the 3rd trimesters of pregnancy were significantly lower than those of the control (P < 0.05); (3) During 2nd trimester, there were 8.7% (9/104, in FT4) and 9.6% (10/104, in FT3) pregnant women below normal lower range while during 3rd trimester, these figures reached 22.7% (22/97) and 17.5% (17/97) resfectively. Conclusions More than half of the pregnant women in Hangzhou have good nutritional status of iodine. There are significant differences in thyroid hormone levels between the non-pregnant and pregnant women as well as between gestation periods. Therefore, it is necessary to establish a trimester-specific reference range of thyroid hormones for normal pregnancy. The screening for thyroid function is recommended for pregnant women besides monitoring routine urinary iodine.

Objective? To evaluate the effect of mobile nursing workstation multimedia module applied to preoperative health education of patients with minimally invasive endoscopic retrograde cholangiopancreatography (ERCP). Methods? By convenience sampling, 100 patients who met the inclusion criteria in-hospitalized in Department of Digestive Medicine, Beijing Chao-Yang Hospital, Capital Medical University from January to June of 2018 were selected and divided into the observation group (n=44) and control group (n=44) according to the random number table. Conventional education approach of oral teaching and distribution of teaching materials was adopted in the control group, besides of that the observation group received the intensive teaching approach through mobile nursing platform multimedia and open communication. The knowledge mastering status, satisfactory degree and anxiety scores were compared between the two groups after health education. Results? In the observation group, the score of knowledge mastering status was (33.00±9.41), satisfactory degree was(23.45±1.18), both higher than the control group [(28.82±7.48),(17.61±1.95)] with statistical difference (P＜0.05); the observation group achieved lower score in anxiety than the control group with statistical difference(P＜ 0.01). Conclusion? The use of mobile nursing platform multimedia teaching method can improve the quality of health education for patients with minimally invasive ERCP treatment and patient satisfaction, alleviate the anxiety of patients.

Objective:To explore the effect of general clinical training on core competence, ICU knowledge and skills of ICU nurses.Methods:Using the convenient sampling method, a total of 32 nurses from various specialties who worked in ICU of Beijing Chaoyang Hospital from February to March 2020 were selected for ICU general clinical practice training. The core competencies of ICU nurses were evaluated by the ICU nurse professional core competencies questionnaire before and 1 month after the training, including the ability to master and apply ICU setting and management, the ability to master and apply critically ill patient care, the ability to master and apply specialized technical skills, and the ability to educate and train. ICU theoretical knowledge and operation skills were assessed by using self-made theoretical knowledge examination papers and operation assessment standards. Paired t test and paired χ 2 test were used for statistical analysis. Results:After the general clinical training, the proportion of 32 nurses who scored good in 16 items in the evaluation of core competence was higher than before (χ 2= 4.571-6.583) . Among the four dimensions of core competence, the score of master and apply ICU setting and management was higher than that before training ( t=-2.442) . The difference was statistically significant ( P<0.05) . After training, theoretical knowledge score of nurses ( t=-9.500) and operational skills score ( t=-2.590) were improved, and the differences were all statistically significant ( P<0.05) . Conclusions:The general clinical training can improve ICU nurses' ability to master and apply ICU setting and management and their knowledge and skills of general intensive care, so as to provide a certain basis for the reserve of general ICU nursing team for future public health emergencies.

Objective To comprehensively evaluate the resuscitation effect of endotracheal intubation (ETI) ventilation and laryngeal mask airway (LMA) for out-of-hospital cardiac arrest (OHCA). Methods Databases such as Cochrane Library, PubMed, Embase, Ebsco, Elsevier, OVID, Springer, Proquest, and China biomedical literature database (CBMdisc), CNKI, Wanfang database, Chinese Science and Technology Journal Full-text Database, VIP Chinese biomedical journal database were searched from the establishment of literature database to December 2017 to study the difference of effects between ETI and LMA for patients with OHCA. The effect determination indexes included the return of spontaneous circulation (ROSC) rate, 1-month survival and 1-month neurological recovery. After evaluation of the quality of included studies and extraction of the data, the software of RevMan 5.3 was used to analyze those outcomes. Results A total of 9 articles, including 7 English, 2 Chinese;5 prospective studies and 4 retrospective studies were included. All of the literatures had high quality, and the Newcastle Ottawa scale (NOS) scored 7-9 points. The Meta-analysis showed that ETI was significantly more beneficial than LMA in improving the rate of ROSC [odds ratio (OR) = 1.51, 95% confidence interval (95%CI) = 1.42-1.62, Z = 12.35, 1 < 0.01], and 1-month survival (OR = 1.16, 95%CI = 1.06-1.26, Z = 3.41, 1 < 0.01), and there was no significant difference in 1-month neurological recovery (OR = 1.13, 95%CI = 0.96-1.32, Z = 1.49, 1 = 0.14). Conclusion ETI has higher recovery success rate and survival rate than LMA for the rescue of OHCA adult patients, but the improvement of the nervous system is unclear.

Objective: To explore the correlation between screen time, exposure time to different screens and psychology behaviors of preschool children. Methods: A total of 2 582 children from kindergartens in urban Xuzhou areas were recruited to perform the physical examination, a cluster sampling method being explored. Parent questionnaires were performed to understand the time of screens and children’s psychology behaviors. Multi-linear regression and Logistic regression models were also used to analyze the correlation between them in preschool children. Results: The prevalence of abnormal internalization behavior of preschool children in Xuzhou City was 3.8%, the detection rate of abnormal externalization behavior was 22.4%, and the detection rate of prosocial behavior abnormality was 20.9%. The time spent by the preschool boys on TV time, learning day screen time and one-week video time is significantly higher than the girls (P<0.05). After adjusting for age and gender, the results of multiple linear regression analysis showed that the longer the average screen time, the more serious the problem of internalizing and externalizing problems; and the longer the average screen time of the weekend and the week, the worse the prosocial behavior of children (P<0.05). After correcting multiple covariates, it was found that the average screen time was positively correlated with children’s internal and external behavioral problems (P<0.05). Logistic regression analysis showed that after adjusting for age and gender, the average screen time of study day, weekend and week was a risk factor for preschool children’s internal and external behavior problems, and the average weekly screen time was a protective factor for prosocial behavior (P<0.05). After adjusting for multiple covariates, the learning day and the average weekly screen time were risk factors for children’s internal and external behavior (P<0.05). In addition, the results of association analysis between different types of video time exposure and psychological behavior showed that after adjusting for age and gender, all types of video exposures affected the internal and external behaviors of patients (P<0.05); after correcting multiple covariates The association was still statistically significant (P<0.05). Logistic regression analysis showed that after adjusting for age and gender, the exposure time of each type of video screen was a risk factor for children’s internal and external behavior problems (P<0.05). After correcting multiple covariates, all types of video exposure were internalized behavior problems. The risk factors, and the video time of other electronic products were risk factors for externalization behavior problems (P<0.05). Conclusion Average screen time has a significant positive correlation with psychological behavior, and the exposure time of screens such as TV and mobile phone could increase the incidence of psychological behaviors in preschool children.

Objective:To study a deep learning-based dual-modality fundus camera which was used to study retinal blood oxygen saturation and vascular morphology changes in eyes with branch retinal vein occlusion (BRVO).Methods:A prospective study. From May to October 2020, 31 patients (31 eyes) of BRVO (BRVO group) and 20 healthy volunteers (20 eyes) with matched gender and age (control group) were included in the study. Among 31 patients (31 eyes) in BRVO group, 20 patients (20 eyes) received one intravitreal injection of anti-vascular endothelial growth factor drugs before, and 11 patients (11 eyes) did not receive any treatment. They were divided into treatment group and untreated group accordingly. Retinal images were collected with a dual-modality fundus camera; arterial and vein segments were segmented in the macular region of interest (MROI) using deep learning; the optical density ratio was used to calculate retinal blood oxygen saturation (SO 2) on the affected and non-involved sides of the eyes in the control group and patients in the BRVO group, and calculated the diameter, curvature, fractal dimension and density of arteriovenous in MROI. Quantitative data were compared between groups using one-way analysis of variance. Results:There was a statistically significant difference in arterial SO 2 (SO 2 -A) in the MROI between the affected eyes, the fellow eyes in the BRVO group and the control group ( F=4.925, P<0.001), but there was no difference in the venous SO 2 (SO 2-V) ( F=0.607, P=0.178). Compared with the control group, the SO 2-A in the MROI of the affected side and the non-involved side of the untreated group was increased, and the difference was statistically significant ( F=4.925, P=0.012); there was no significant difference in SO 2-V ( F=0.607, P=0.550). There was no significant difference in SO 2-A and SO 2-V in the MROI between the affected side, the non-involved side in the treatment group and the control group ( F=0.159, 1.701; P=0.854, 0.197). There was no significant difference in SO 2-A and SO 2-V in MROI between the affected side of the treatment group, the untreated group and the control group ( F=2.553, 0.265; P=0.088, 0.546). The ophthalmic artery diameter, arterial curvature, arterial fractal dimension, vein fractal dimension, arterial density, and vein density were compared in the untreated group, the treatment group, and the control group, and the differences were statistically significant ( F=3.527, 3.322, 7.251, 26.128, 4.782, 5.612; P=0.047, 0.044, 0.002, <0.001, 0.013, 0.006); there was no significant difference in vein diameter and vein curvature ( F=2.132, 1.199; P=0.143, 0.321). Conclusion:Arterial SO 2 in BRVO patients is higher than that in healthy eyes, it decreases after anti-anti-vascular endothelial growth factor drugs treatment, SO 2-V is unchanged.