Objective To study the characteristics and differences of phonetic pronunciation between hearing-impaired and normal children in 4.5~5.5 years old groups. Methods Phonetic articulation of consonants and vowels were tested by three-grade assessors for 20 hearing- impaired children and 20 normal children in 4.5~5.5 years old group using Question Bank for Hearing-impaired Children's Rehabilitation Evaluation of Hearing and Speech. Results and Conclusion For hearing-impaired children, the consonants of /b. m. d. l. j/ were the most articulative, followed with /h. f. r. p. t. n. g. x/, and then /zh. z. k. c. sh. q. s. ch/; for normal children, the consonants of /b. p. f. g. m. d. h/ were the most articulative, followed with /k. j. x. t. r. l/, and then /q. zh. ch. sh. n. z. s. c/. For both groups, the single final was the most articulative, followed with the compound final, and then the nasal. The articulation of these 3 types of vowels were poorer in hearing-impaired children than in normal children (P<0.01)

Abstract: Objective To analyze and compare the differences in serum lipid metabolomics between patients with moderate to severe acne and healthy controls to understand the characteristics of serum lipid metabolism in acne patients. Methods Serum samples were collected from 30 patients with moderate to severe acne and 30 healthy controls matched for age, gender and body mass index in the Department of Dermatology, the Affiliated Hospital of Southwest Medical University from May 2019 to Apr. 2020. Serum lipid metabolomics was analyzed by liquid chromatography-tandem mass spectrometry. Partial least squares discriminant analysis (PLS-DA) was used for multivariate statistical analysis of differentially expressed lipid metabolites. The metabolic pathways with significant differences between the two groups were screened by Kyoto Encyclopedia of Genes and Genomes (KEGG) database. Using Mann-Whitney U test to calculate differential metabolites. Spearman correlation analysis was used to analyze the correlation between serum PC (18: 2e/20: 2) concentration and acne severity. Results The PLS-DA results showed that the composition of serum lipid metabolites in acne patients was significantly separated from that in healthy controls. Of the top 30 lipid metabolites with the most significant differences, four kinds of triglycerides (TG), two kinds of diglycerides (DG), six kinds of phosphatidylcholine (PC), one kind of MePC, two kinds of sphingomyelin (SM), two kinds of phosphatidylinositol (PI), two kinds of ceramide (monohexosyl ceramide, Hex1Cer;dihexosyl ceramide, Hex2Cer), two cardiolipin (CL) were found to be increased in the acne group (P<0.05). The levels of one kind of DG, two kinds of lysophosphatidyl ethanolamines (LPE), one kind of dimethylphosphatidyl ethanolamine (dMePE), one kind of bismethyl phosphatidic acid (BisMePA), three kinds of phosphatidyl ethanolamine (PE) and one kind of ceramide were found to be decreased in the acne group (P<0.05), and most of them belonged to phospholipid metabolites. Spearman correlation analysis showed that serum PC (18:2e/20:2) concentration was positively correlated with acne severity (r=0.456, P=0.004). KEGG enrichment function analysis revealed that the differential lipid metabolites were primarily enriched in metabolic pathways such as sphingolipid signaling pathway, cholesterol metabolism, insulin resistance, glycerophospholipid metabolism, among which the sphingolipid signaling pathway may play an important role. Conclusion There are significant differences in serum lipid metabolism between acne patients and healthy controls. Lipid metabolism disorders may be related to the pathogenesis of acne, but it’s molecular mechanism still needs further experimental exploration.

Objective To evaluate the method, clinical efficacy and safety of one phase treat-ment of renal calculi associated with pyonephrosis by percutaneous nephrolithotripsy(PCNL) by pneu-matic combined with ultrasonic lithotriptor. Methods Sixty-six cases of renal calculi accompanied with pyonephrosis were treated with PCNL. The renal calyx was punctured under ultrasound gui-dance, then the tract was dilated from F8 to F16 by peel-away vascular access sheathes. After the in-sertion of the flexible sheath, metallic dilator was inserted and the flexible sheath was pulled out. The tract was dilated by metallic sheath to F21 and the operation sheath and nephroseope were placed into working tract. EMS III LithoClast Master was used. Ultrasonic powered lithotriptor probe with suc-tion was used to clear the liquor puris and calculus fragments with low-pressure or no-pressure. The combined pneumatic and ultrasonic powered lithotriptor was used to break and clear the calculi. Re-salts Of the 66 cases, there was no bacteremia or pyaemia intraoperatively and postoperatively. And there was no other severe complication occurred intraoperatively. One phase PCNL was successfully completed in 60 cases. Other 4 cases had residual calculi less than 1.5 em in diameter and received ESWL to break the calculi, 2 cases had bigger residual calculi and accepted second PCNL 1 week after the first intervention. In the follow-up period, the 3 month post-operative serum Cr was 56-203 μmol/L with an average decrease of 40 μmol/L, GFR was 5.0-56.2 ml/min with an average increase of 23.6 ml/min compared with the pre-operative data. At 6 months postoperative serum Cr was 56-158 μmol/L with average decrease of 31 μmol/L, GFR was 5.0-79.2 ml/min with an average in-crease of 30.2 ml/min. Conclusion Application of PCNL in the treatment of patients with renal cal-culi accompanied with pyonephrosis is safe, cost-effective and clinically efficient by pneumatic com-bined with ultrasonic lithotriptor.

Objective To analyze the outcomes of clinical management and rehabilitation interventions for earthquake victims with spinal cord injury. Methods Comprehensive rehabilitation intervention was conducted for 3 to 4 months with 51 earthquake victims with spinal cord injuries. The study involved their physical examination and on site interviews during hospitalization, and follow-up by telephone. Etiology, severity, complications and outcomes of rehabilitation and clinical management were analyzed. Results In 9.8% of the patients the spinal cord injury was at C7 or above, 5.9% at C8 to T6 , 68.6% at T7 to L2 , 13.7% at L3 to S2 and 2.0% at S2 or below. There were 22 complete injuries and 29 incomplete. After 4 months of training, 76.5% of the wounded reached wheelchair independence, 78.4% ambulated with an orthosis and 88.2% were partially independent in the activities of daily living.Conclusions The comprehensive rehabilitation intervention allowed most of the victims to resume an independent life. Their long-term care remains a challenge.

Objective To refine the technique and improve the efficacy of seminal vesiculoscopy in the diagnosis and treatment of seminal vesicle disease.Methods The refined techniques of seminal vesculoscopy,using a patent catheter into the slit-like ejaculatory duct orifice through the verumontanum and another patent catheter introduced into seminal vesicle lumen,were performed in 58 cases,including intractable hematospermia in 42 cases and azoospermia in 16 cases.Results Seminal vesiculoscopy was successfully entered into the seminal vesicular lumen in 46 patients (79％) within 2-3 min.There was no obvious ejaculatory duct orifice in 12 of 16 azoopermia cases,and transurethral resection of verumontanum was performed,then seminal vesiculoscope was directly entered into seminal vesicle lumen.Symptoms of hematospermia were disappeared in 25 cases (60％),improved in 11 cases (26％),and azoospermia were cured in 6 cases (37％),improved in 5 (31％),unchanged in 5 (31％) during the follow-up period of 6-36 months (average 18 months).There were no major or minor complications in this series,and no urine reflux into ejaculatory duct in 19 cases demonstrated by contrast medium.Conclusion Refined seminal vesiculoscopy was technically safe,efficient,simple,and potentially widely used in the cases of hematospermia and ejaculatory duct obstructions.

The process flow and the main devices of a new two-stage dry-fed coal gasification pilot plant with a throughout of 36 t/d are introduced in this paper. For comparison with the traditional one-stage gasifiers, the influences of the coal feed ratio between two stages on the performance of the gasifier are detailedly studied by a series of experiments. The results reveal that the two-stage gasification decreases the temperature of the syngas at the outlet of the gasifier, simplifies the gasification process, and reduces the size of the syngas cooler. Moreover, the cold gas efficiency of the gasifier can be improved by using the two-stage gasification. In our experiments, the efficiency is about 3%-6% higher than the existing one-stage gasifiers.

To assess the efficacy and safety of a new traditional Chinese medicine called Naomaixin granules in the treatment of arterial cerebral infarction in convalescent. Methods: A randomized, double-blind and parallel controlled clinical study was carried out, and three sets of parallel controlled clinical design with the test group, positive drug group and placebo group were per-formed. The clinical efficacy of Naomaixin granules on arterial cerebral infarction in convalescent was confirmed based on the main ef-fective indicators including NIHSS scale score and the life state assessment for the patients. Meanwhile, the curative effect of Naomaixin granules on stroke disease with Qi deficiency and blood stasis ( QDBS) was observed. The safety of Naomaixin granules was evaluated as well. Results:The clinical design enrolled a total of 177 cases of patients, including 60 ones in Naomaixin granules group, 59 ones in Mailuotong granules group and 58 ones in the placebo group. After the 4-week treatment,NIHSS scale score, life skills, TCM syn-dromes efficacy and the curative effect of Naomaixin granules group and Mailuotong granules group were better than those of the placebo group(P<0. 01 or P <0. 05). Furthermore, compared with Mailuotong granules group, the curative effect of Maomaixin granules group was much better (P<0. 05). The incidence of adverse events of the test group, positive drug group and placebo group respec-tively was 1. 67%,1. 69% and 1. 72% without statistical significance (P>0. 05). No serious adverse events appeared during the ob-servation. Conclusion:Naomaixin granules are safe and effective in the treatment of atherosclerotic cerebral infarction in convalescen.

Objective: To study the epidemiology and antimicrobial resistance of Gram-negative bacterial bloodstream infections in children, and to guide the choice of antimicrobials and the control of nosocomial infection. Method: Clinical data, bacteriology and antimicrobial susceptibility test results were collected retrospectively in hospitalized children who were diagnosed with gram-negative bacterial bloodstream infections in Yuying Children′s Hospital of Wenzhou Medical University from January, 2010 to December, 2015. Result: A total of 399 cases (253 male and 146 female) were identified. The age ranged from 16 hours to 16 years (median age 10.1 months). The majority of cases were collected from division of neonatology (n=261, 65.4%), followed by 31 cases (7.8%) from pediatric intensive care unit and 29 cases (7.3%) from Gastroenterology Department; 275 cases (68.9%) had underlying diseases, mainly including preterm birth(n=172), neonatal respiratory distress syndrome(n=67) and newborn asphyxia(n=53). Eighty cases had received invasive procedures and 20 had surgical operation; 149 cases (37.3%) were community-acquired and 250 cases (62.7%) were hospital acquired. Fifty cases had complications, among those, 40 cases had septic shock, 32 cases had multiple organ dysfunction syndrome and 7 cases had disseminated intravascular coagulation; 288 cases were cured, 48 improved, 17 gave up treatment and discharged, and 46 died; totally 408 strains were isolated from 399 children, including Enterobacteriaceae (346, 84.8%), non-fermentative Gram-negative bacteria (49, 12.0%) and other gram-negative bacteria (13, 3.2%). The resistance rates of Escherichia coli (n=175) and Klebsiella pneumoniae (n=106) to carbapenems, β-lactams enzyme and its inhibitors, amikacin and cefoxitin were all lower than 10%. Totally 245 multi-drug resistant strains (60.1%) were isolated, including 225 strains of Enterobacteriaceae and 18 strains of non-fermentative Gram-negative bacteria (P<0.01) . Nine strains of Carbapenem-resistant Enterobacteriaceae were isolated, which were all sensitive to amikacin and the sensitive rates to fluoroquinolone reached 88.9%. Five strains which were detected sensitive to tigecycline were all sensitive. The proportion of Klebsiella sp in Gram-negative bacteria between 2013-2015 and 2010-2012 were 32.9% and 21.2%, respectively. The resistance rates of Escherichia coli and Klebsiella pneumoniae to β-lactams and its enzyme inhibitors and carbapenems had no significant change. Conclusion Gram-negative bacterial bloodstream infections occur more frequently in newborns. Most children had combined underlying diseases. Escherichia coli and Klebsiella pneumoniae are the most common pathogens. β-Lactams and its enzyme inhibitors and carbapenems are the empirical choice of antimicrobial therapy for severe Enterobacteriaceae bloodstream bacterial infections.

Objective: To assess the cognitive level of first aid knowledge regarding the small area burn among the child caregivers in Shanghai and improve the level of first aid for small area burn in children. Methods: From November 2017 to March 2018, 7 municipal districts in Shanghai were selected according to the random number table, from which 2 750 students of 4 nurseries, 5 kindergartens, 6 primary schools, and 2 junior middle schools were selected by adopting the convenience sampling method. Each student was limited to one caregiver as the research object. A cross-sectional survey was conducted on the cognitive level of first aid knowledge regarding small area burn among the caregivers with self-designed questionnaire through WeChat and Tencent QQ. The age, burn experience, and scarring after burns in children, the prevalence rate of burn in children of different age groups, the educational background of caregivers and their social relationship with their children, and the measures taken by caregivers firstly after small area burn occurred among their children were recorded. The choices of applying the folk prescription drugs to the wounds of their children made by caregivers and those with different educational backgrounds were recorded. The choices of applying daily necessities to the wound of their children made by caregivers were recorded. The caregivers′ knowledge of standard first aid measures for small area burn, and the knowledge of caregivers with different educational backgrounds of all standard first aid measures for small area burn were recorded. The caregivers′ choices of hospitals for treatment the first time, and the choices of going to the Grade Ⅲ Level A hospital with burn specialty for treatment made by caregivers with different knowledge levels about first aid measures for small area burn and those by caregivers whose children did or didn′t have burn experience were recorded. The caregivers′ choices of different types of medical institutions with burn specialty or specialized in burn treatment, and choices of going to burn department of comprehensive Grade Ⅲ Level A hospital for treatment made by caregivers with different knowledge levels about first aid measures for small area burn were recorded. Data were processed with Pearson chi-square test and partitions of chi-square test. Results: The effective recovery rate of questionnaire was 99.0% (2 723/2 750). The ages of children were mainly 6-11 years [64.7% (1 762/2 723)]The prevalence of burn in children was 19.4% (527/2 723). There was no statistically significant difference in the overall comparison of burn prevalence of children among the age groups (χ²=1.424, P>0.05). The percentage of scar formation after burn in children was 27.3% (144/527). The education backgrounds of caregivers were mainly undergraduate [40.2% (1 094/2 723)], and their social relationships with children were mainly children′s mothers [74.6% (2 030/2 723)]. Assuming that their children suffered from minor burns, the measures firstly taken by 74.0% (2 016/2 723) of the caregivers was to immediately access cool running water and remove clothing on the wound of children. Totally 19.2% (523/2 723) of the caregivers chose to apply folk prescription drugs for their burn children by themselves, and the percentage of caregivers with education background of junior middle school choosing to apply folk prescription drugs for their burn children by themselves was significantly higher than that of caregivers with education background of junior college, undergraduate, or graduate (χ²=18.502, 20.642, 13.319, P<0.05). Totally 49.2% (1 340/2 723) of caregivers chose to daub many kinds of daily necessities for their burn children by themselves. Totally 39.2% (1 068/2 723) of caregivers knew all standard first aid measures for small area burn, the percentage of caregivers with education background of undergraduate knowing all standard first aid measures for small area burn was significantly higher than that of caregivers with education background of senior high school and secondary specialized school (χ²=11.234, P<0.05). Assuming that their children suffered from minor burns, 39.0% (1 063/2 723) of the caregivers chose to go to the nearest hospital for treatment the first time, the percentage of caregivers who knew all standard first aid measures for small area burn choosing to go to Grade Ⅲ Level A hospital with burn specialty for treatment the first time was similar with that of caregivers who did not know/did not fully know (χ²=3.528, P>0.05), and the percentage of caregivers whose children had burn experience choosing to go to Grade Ⅲ Level A hospital with burn specialty for treatment in the first time was similar with that of caregivers whose children didn′t have burn experience (χ²=3.521, P>0.05). Among all medical institutions with burn specialty or specialized in burn treatment, 28.0% (762/2 723) of the caregivers chose to go to comprehensive Grade Ⅲ Level A hospital for treatment, and the percentage of caregivers who knew all standard first aid measures for small area burn choosing to go to comprehensive Grade Ⅲ Level A hospital for treatment was significantly higher than that of caregivers who did not know/did not fully know (χ²=4.890, P<0.05). Conclusions The caregivers of children are mainly children′s mothers with education background of undergraduate in Shanghai, and caregivers′ cognitive levels of first aid knowledge regarding the small area burn are low. Only a few caregivers know all standard first aid measures for small area burn, and there are still some caregivers who have the wrong idea of applying folk prescription drugs or daily necessities for children by themselves. The publicity and education of basic first aid knowledge of burn should be strengthened through various channels such as burn simulation exercise and network, and caregivers should be guided to take their children to hospitals with burn specialty for treatment after occurrence of burn in children, so as to obtain more professional medical treatment.

Objective To report the clinical effects of a 3D-printed metal drilling template used in surgery for complex upper cervical disorders.Methods Between August 2015 and June 2017,5 patients with upper cervical disorder complicated with complex cranial cervical junction deformity underwent instrumentation and fusion.They were 4 males and one female,aged from 3 to 36 years.All the patients underwent thin slice CT scan before operation.The CT image data were imported into a computer workstation for three dimensional reconstruction of individualized models of the upper cervical spine on which individualized drilling templates were designed.Guided by each of the individualized metal drilling templates manufactured by 3D printing,surgery via the posterior approach was performed in 2 cases and surgery via the combined anterior and posterior approach in 3 cases.After surgery,the screw trajectory was evaluated by CT scan.Results Surgery succeeded in all the 5 patients.A total of 5 pedicle screws and 5 laminar screws were drilled.Postoperative CT scan showed accurate placement of all the 10 screws.The patients recovered with no neurovascular complications.Conclusion Since an individualized 3D-printed metal drilling template can improve the accuracy and safety of screw placement,it can reduce surgical risks and enhance surgical success in the surgery for complex upper cervical disorders.