Circulatory state and metabolic homeostasis could be more easily disturbed during perioperative periods for children compared with those of adults especially when receiving massive transfusions.Patient's age would be an important factor for clinical evaluation if certain amount of blood was lost.Component transfusions have now gained wide recognitions.Specific blood components should be considered according to different diseases,which would make transfusion more accurate and blood resources used more efficiently.This article focused on the indications,doses and several specific issues for perioperative component transfusions among pediatric patients.

Objective To master the status of iodine content in drinking water and iodine nutritional status of population before and after the salt iodine concentration reduction in 2012 in Meizhou City, and to provide a scientific basis for safety assessment of salt iodine content after adjustment of the policy.Methods Using stratified random sampling method, drinking water samples were collected, and iodide content was measured by cerous sulfate catalytic spectrophotometry.Urine samples of children aged 8-10 were collected, in which the iodide content was quantitatively tested by arsenic cerium catalytic spectrophotometry.Samples of household edible salt were collected to determine iodine content by direct titration in 2012 before (September 2011), and after the salt iodine concentration reduction (September 2012 and September 2013).Results A total of 422 water samples were measured, the median iodine content of water was 2.4 μg/L.The water iodine median was 2.1 μg/L in centralized water supply (n =163),and 2.9 μg/L in decentralized water supply (n =259), the difference was statistically significant (U =-2.526, P ＜ 0.05).Totally 800 and 803 urine samples of children aged 8-10 were collected in 2011 and 2012, median urinary iodine was 216.5 and 207.5 μg/L, respectively, which were higher than that in 2013 (n =807, 190.0 μg/L, x2 =17.040,24.868, all P ＜ 0.05).Urinary iodine ≥300 μg/L ratio was significantly decreased (2013 than 2011 and 2012,19.3％ (156/807) vs.26.5％ (212/800) and 24.5％ (197/803), x2 =6.363, 11.695, all P ＜ 0.05), and urinary iodine ＜ 100 μg/L rose in the proportion (2013 than 2011, 18.0％ vs.13.5％, x2 =6.045, P ＜ 0.05).A total of 2 410 household salt samples were tested, and the coverage rate of iodized salt, iodized salt qualified rate, the consumption rate of qualified iodized salt were all higher than 98.8％.Totally 800, 803 and 807 salt samples were collected in 2011, 2012 and 2013, the salt iodine medians were 31.0, 27.7 and 25.4 mg/kg, respectively, the difference between the salt iodine medians was statistically significant (H =91.422, P ＜ 0.05).Conclusions Iodine excess risk is significantly decreased, and the level of iodine nutritional status of the city's population is appropriate after the salt iodine concentration reduction in 2012.The salt iodine concentration adjusted is suitable and safe.

Objective To observe the effect and safety of the human glucagon-like peptide-1 analogue,liraglutide,versus insulin glargine in patients with type 2 diabetes mellitus inadequately controlled with metformin alone.Method Ninty patients with type 2 diabetes mellitus(aged 18-79 years,HbA1C 7.5％-10.0％,body mass index＜40 kg/m2) who had inadequate glycaemic control on metformin were allocated for the research with an open,randomized,parallel controlled clinical research method.The patients kept the original dose of metformin unchanged and were randomly assigned to the liraglutide group or the insulin glargine group according to a proportion of 1 ∶ 1.Liraglutide group started with a dose of 0.6 mg subcutaneous injection qd,changed to 1.2 mg subcutaneous injection qd after one week and kept unchanged until the end of the research.Insulin glargine group started with a dose of 0.1-0.2 U/kg according to the fingertips peripheral blood glucose level before breakfast on the continuous 3 d before every follow-up.At the baseline,after 4 weeks,12 weeks,20 weeks,and 26 weeks of treatment,HbA1C,blood glucose,lipids weight,blood pressure were arranged to measured.86 patients finally completed the study.Results Mean HbA1C and the success rate of HbA1C ＜7％ were similar between liraglutide group and insulin glargine group [(7.06 ± 0.87) ％ vs (7.25 ± 1.20) ％,47.73 ％ vs 45.23 ％,P＞0.05],while the percentage of subjects reaching the composite endpoint of HbA1C＜7％ with no hypoglycemia and no weight gain was significantly higher in liraglutide group than insulin group(P＜0.05) ; Fasting plasma glucose decreased more markedly in insulin glargine group,2 h postprandial plasma glucose was decreased more markedly in liraglutide group(P＜0.05 or P＜0.01).Liraglutide significantly reduced mean body weight by (3.21 ± 1.18) kg,waist circumference by (3.82 ± 1.21) cm,and body mass index by (1.95 ± 0.61) kg/m2 (P＜0.01 or P＜0.05),while in the insulin glargine group there sere rise of respective figure of(2.86 ± 0.43) kg,(1.52 ± 0.56) cm,and (0.61 ± 0.25) kg/m2 (P＜0.05),systolic blood pressure and serum triglyceride declined.There was no serious adverse affect in both groups,the incidence of mild hypoglycemia was significantly less in liraglutide group and has a statistically significant difference (4.55％ vs 21.43％,P＜0.05).Conclusions Liraglutide showed a good effect on reducing weight,systolic blood pressure,blood lipid and in addition to blood glucose control which is comparable to insulin glargine.What is more,liraglutide had good safety and tolerability,which can be regarded as a good choice for patients with type 2 diabetes mellitus inadequately controlled with metformin alone.

Policy background and stakeholder theory were elaborated.It could be concluded that the key stakeholders of the policy were residents,training hospitals,healthcare administrators,primary healthcare institutions and patients of such institutions.Through analysis of these stakeholders,effects on the interests of all parties were investigated and strategies to improve feasibility of the policy were put forward.Two key points were suggested for such policy goals.First,top-level policies should be designed and be effectively implemented.Second,conversion of the residents from permanent hospital employees to “contractors”or“ freelancers”.

Objective To analyze the feasibility of the policy that “Residents service or employment at primary care institutions after standardized training”.Methods Analyzing the feasibility of this policy by using questionnaire survey and in-depth interview.Results Constituent ratios of overall feasibility were 58.3％ (532/912)and 66.1％(603/912)for specialist and general practitioner respectively; percentage of feasibility of in-depth interview was 46.7％ (7/15).Conclusion The policy has feasibility,if government formulates and implements perfect complement policies effectively,and makes this policy to be impassable stage to resident.

Objective To investigate the effect of homeopathic reduction technique in treatment of irreducible variant femoral neck fractures.Methods A retrospective case control study was performed for 91 cases of irreducible variant femoral neck fractures surgically treated from January 2011 to January 2014.Forty-seven cases [31 males,16 females;23-61 years,mean 40.6 years] were assigned to homeopathic reduction treatment (study group) and 44 [30 males,14 females;28-63 years,mean 43.1 years] were assigned to closed reduction and open reduction (control group).All fractures were Garden type Ⅳ.All cases were stabilized with three cannulated screws (6.5 mm in diameter).Operation time,intraoperative blood loss,Garden index for reduction quality,bone healing,complications like femoral head necrosis and Harris hip score were evaluated.Results Operation time and blood loss in study group [(41.2 ± 7.5) min,(37.3 ± 9.5) ml] were significantly lower than those in control group [(105.0 ± 15.7) min,(269.6 ± 50.6) ml] (P ＜ 0.05).Garden index was Grade Ⅰ 44 cases and Grade Ⅱ three in study group compared to Grade Ⅰ 20 and Grade Ⅱ three in control group (P ＜ 0.05).Incidence of femoral head necrosis had no significant differences between study group (four cases) and control group (10 cases) (P ＞ 0.05).Nonunion was not observed in study group,while there were eight cases of nonunion in control group (P ＜ 0.05).According to the Harris score,the excellent rate in study group was 91％ (39 excellent,four good,four fair) versus 66％ (21 excellent,eight good,15 fair) in control group (P ＜ 0.05).Conclusion Compared to closed reduction and open reduction,homeopathic reduction technique in treatment of femoral neck fractures is associated with shortened operation time,reduced blood loss,improved reduction quality and lowered incidence of necrosis and nonunion.

Objective Evaluation of Chinese-thyroid imaging reporting and data system(C-TIRADS)combined with contrast-enhanced ultrasound(CEUS)for the assessment of category 4 nodules in the setting of Hashimoto's thyroiditis.Methods Retrospective analysis of 120 C-TIRADS category 4 thyroid nodules from 79 patients with confirmed Hashimoto's thyroiditis who attended the Yiyang Central Hospital from June to December 2022.Thyroid nodules exhibiting one or more benign or malignant features that were suspicious on CEUS were treated as downgraded or upgraded one level.Using the final surgical pathology results as the gold standard,working characteristic(ROC)curves of subjects based on C-TIRADS grading before and after CEUS adjustment were plotted to compare diagnostic efficacy.Results The sensitivity,specificity,and accuracy of the CEUS-adjusted C-TIRADS were 93.0％,87.8％and 90.8％,respectively(P<0.05).The area under the ROC curve was 0.811 and 0.904,respectively(P<0.05).Conclusion C-TIRADS combined with CEUS has better diagnostic efficacy in evaluating category 4 nodules in Hashimoto's thyroiditis.

One of critical technologies in a non-invasive positive airway pressure respirator is to output the airflow for meeting the requirement of respiratory patient in breath. In order to develop a safe and reliable blower driving system, a circuit based on the special chips MC33035 and MC33039 was designed. The linear relationship between the input control voltage and the output air flow was achieved. This designed circuit will be embedded in the non-invasive ventilator system as a module. And based on this circuit, the secure and controllable ventilation flow can be performed.
Humans ; Lung ; Respiration ; Ventilators, Mechanical

Objective To explore the impact and change regularity of Oncomelania hupensis snails and vegetation in the marshlands of Poyang Lake caused by the impoundment of the Three Gorges Project. Methods By using the methods of stratified systematic sampling and pinpoint navigation,the succession of vegetation was observed and the distribution of O. hupensis snails was investigated in a period of 8 years on 4 typical marshlands in Poyang Lake. The regularity of changes in vegetation and O. hu-pensis snails was analyzed on the marshlands at high,medium and low elevations,respectively. Results After the impoundment of Three Gorges Project,the average flooding days of these 4 marshlands in 2004 and in 2008 were reduced of 74.8 and 65.8 days compared with those in 2002,the year just before the impoundment of the project,respectively. The change of spatial distribution pattern and the succession of dominant species of vegetation on the marshlands of Poyang Lake have taken place since 2005,and several vegetations showed a trend of moving toward the center of the lake. The hygrophilous vegetation has degenerated and gradu-ally been replaced by mesophily meadow in the marshland area above 14 m elevation. Carex,Phalaris arundinacea and Polygo-num appeared in large area and expanded slowly towards the center of the lake on the marshland below 14 m elevation. O. hupensis snails were mostly found under the Carex association. The tendency of decreasing in density of snails and of migration of snail habi-tats towards low terrain was observed. Conclusions The impoundment of Three Gorges Project has had a significant impact on hy-drological regimes,and a new succession of vegetation has taken place in the marshlands of Poyang Lake. O. hupensis snails and the mesophily vegetation show a trend of migrating slowly to the areas of low elevation in the marshlands.

Objective To investigate the relationship between recent chlamydia pneumoniae (Cp)infection and active ankylosing spondylitis (AS). Methods Seventy nine AS outpatients and 73 normal controls (NC) were enrolled into this study. Serum anti-Cp antibodies (CpIg) were tested using the enzymelinked immunosorbent assay (ELISA). Clinical and experimental data were collected. Patients with positive CpIgM or CpIgA were considered as having a recent Cp infection. Wilcoxon test, Student's t test, χ2 test and multivariate logistic regression were used for statistical analysis. Results Both AS patients and normal controls had a high prevalence for sero-positive CpIgG, which was 89％(70/79) vs 92％(67/73) respectively,while AS patients had a higher frequency of CpIgA and CpIgM when compared with NC [52％(41/79) vs 32％(23/73), χ2=6.61, P=0.010 for CpIgA; 80％(63/79) vs 21％(15/73), χ2=44.031, P＜0.01 for CpIgM]. The presence of CpIgM or CpIgA favored AS, the OR was 17.1 (95％CI 7.4～39.5), or 3.1 (95％CI 1.3～7.2),respectively. In addition, CpIgM was associated with disease activity parameters including ESR (χ2=2.56, P=0.021), CRP (χ2=7.28, P=0.007) and BASDAI (χ2=6.79, P=0.009). Furthermore, consecutive positive CpIgM favored the persistent active or relapsed disease, while negative CpIgM favored a reduced disease activity.There was no correlation between CpIgM/CpIgA and peripheral joint disease and enthesitis. Conclusion Recent Cp infection is highly associated with AS and CpIgM antibody relates with active AS, which indicates that Cp infections may be a critical triggering factor for active AS.