Objective To evaluate the effects of continuous intra-tracheal gas insufflation (TGI) during mechanical ventilation for protecting the juvenile piglets with acute lung injury (ALI) induced by endotoxin. Method Twelve healthy juvenile piglets were anesthetized and mechanically ventilated at 2 cmH2O PEEP with 10 cmH2O peak inspiration pressure. The piglets were challenged with lipopolysaccharide (LPS) and randomly (random number) assigned to two groups (n = 6 each): (1) piglets treated with mechanical ventilation alone (group MV) and (2) piglets treated with TGI by continuous airway flow of 2 L/min (group TGI). FiO2 was set at 0.4 to avoid oxygen toxicity, and the piglets were continuously monitored with an oxygen analyzer. Results Tidal volume, ventilation efficacy index and mean airway pressure were significantly improved in piglets of TGI group (P < 0.01 or P < 0.05). Four hours after ALI, pH decreased to below 7.20 in piglets of MV group, and was higher in piglets of TGI group (P < 0.01). Similarly, PaCO2 was stable and was significantly lower in piglets of TGI group than that in piglets of MV group (P < 0.01). PaO2 and PaO2/FiO2 increased in piglets of TGI group (P < 0.05). There were no significant differences in heart rate, respiraaatory rate, mean arterial pressure, central venous pressure, dynamic lung compliance and mean resistance of airway between two groups. Lung histopathological changes showed severe inflammation,and intra-alveolar hemorrhage and interstitial patchy hemorrhage were ameliorated and the lungs were more homogenously expanded in piglets of TGI group. Conclusions Continuous TGI during MV can significantly improve gas exchange and ventilation efficacy, and may provide a better treatment for acute lung injury.

BACKGROUND:Traditionally, forced expiratory volume in one second (FEV1) was used to evaluate exercise response of patients with asthma; however, patients obviously had panting after exercise, so FEV1 was affected commonly. Impulse oscillometry (IOS) is a new technique for measuring respiratory impedance that do not require maximal inspiration and forced expiration.OBJECTIVE: To study airway resistance with IOS before and after exercise in healthy and asthmatic patients and investigate the significance of exercise excitation and IOS assessment.DESIGN: Synchronically non-randomized case contrast study.SETTING: Department of Respiratory Medicine, East Hospital Affiliated to Tongji University.PARTICIPANTS: A total of 14 male patients with bronchial asthma who were regarded as the asthmatic group were selected from Department of Respiratory Medicine of Shanghai East Hospital from January to October 2006. They were in a clinical stationary phase. Another 14 male healthy subjects were selected as the control group and ages of all subjects ranged from 29 to 50 years. All subjects provided the confirmed consent.METHODS: IOS was used to measure basic value of respiratory resistance, and then subjects underwent exercise challenge. Nose of subjects was clipped breathing through mouth. Within 3-4 minutes, heart rate was increased to 90% and maintained for 6 minutes during challenge. Respiratory resistance was repeatedly measured at 1, 5, 10, 15 and 20 minutes after exercise, including airway hyperresponse (AHR), total respiratory resistance, central resistance, peripheral resistance and resonance frequency at 5, 20 and 35 Hz of pulse frequency, elasrtic resistance and inertia resistance (X5 and X35) at 5 and 10 Hz of pulse frequency. In addition, difference of AHR at 5 and 35 Hz was calculated, and change ratios of both Rcentral and Rperipheral were calculated as (highest value after exercise-baseline value)/baseline value × 100%.MAIN OUTCOME MEASURES: Basic value of respiratory resistance by using IOS and exercise challenge test.RESULTS: All 14 patients with bronchial asthma and 14 healthy subjects were involved in the final analysis. Peripheral resistance (Rperiphera) was significantly higher than central resistance (Rcentral) in asthmatic patients (P ＜ 0.01). The maximal increase of respiratory impedance occurred from 5 minutes to 10 minutes after exercise in asthmatics. Resonance frequency (Fres) of asthmatics before and after exercise was significantly increased than that of controls (P ＜ 0.01).Change ratios of Fres from asthmatics were higher than that from control group (P ＜ 0.01). After challenge, R5, R5-R20,Zrespir and X5 from asthmatics changed significantly than that from controls (P ＜ 0.01). The increment change value of After exercise Zrespir increased significantly, because obstruction of small bronchi during expiration and impedance increased abruptly. Air trapping was expressed in VT-Zrespir graph in 57.1% patients. There was no difference in the VT-Zrespir graph of controls before and after exercise.CONCLUSION: The main site of airflow obstruction was in small airways in asthmatics after exercise challenge. The general acceptance of IOS method was good among the asthmatic patients. The airway response of exercise challenge may be assessed more accurately with IOS that do not require a maximal inspiration and forced expiration.

Objective:To investigate the early outcome of endoscopy-assisted percutaneous non-fusion fixation of unilateral C 1 lateral mass screw and C 2 pedicle screw in treatment of type II odontoid fracture in elderly patients. Methods:A retrospective case series study was conducted to analyze clinical data of 12 elderly patients with type II odontoid fracture admitted to Second Affiliated Hospital of Chongqing Medical University from July 2016 to September 2018. There were 5 males and 7 females, aged 66-89 years [(75.2±6.7)years]. American Society of Anesthesiologists (ASA) scores for all patients were greater than 2 points. Ten patients were classified to Grade E and the other two were classified to Grade D by American Spinal Injury Association (ASIA) scale scores. All patients underwent endoscopy-assisted percutaneous non-fusion fixation of unilateral C 1 lateral mass screw and C 2 pedicle screw. The operation time, intraoperative blood loss, hospital stays, intraoperative and postoperative complications were collected. The Neck Disability Index (NDI) scores and ASIA scale scores were compared preoperatively and 6 weeks postoperatively. The visual analogue scales (VAS) were recorded preoperatively, 6 weeks, 3, 6, 9 and 12 months postoperatively. Fracture healing was followed up postoperatively. Results:Operation time was 98-169 minutes [(123.2±17.7)minutes]. Intraoperative blood loss was 20-40 ml [(30.0±7.1)ml]. Hospital stays were 6-9 days [(7.3±0.7)days]. No neurovascular injury was observed intraoperatively and postoperatively. The NDI were 8%-30%[(19.3±6.3)%] 6 weeks postoperatively, significantly lower than 19%-45%[(33.1±9.9)%] preoperatively( P<0.05). All patients' ASIA scale scores reached grade E postoperatively. The VAS constantly decreased from 6-9 points [(7.8±0.9)points] preoperatively to 1-3 points [(1.8±0.6)points] 12 months postoperatively ( P<0.05). All the patients achieved bone healing after 4-11 months [(7.3±2.1)months]. Conclusion:For type II odontoid fracture in elderly patients, endoscopy-assisted percutaneous unilateral atlantoaxial screw non-fusion fixation can relieve pain and achieve rapid recovery of neck function and bone healing.

Objective: To explore the clinical effect of negative pressure wound therapy (NPWT) in emergency limb-salvage operation of destructive injury of limb. Methods: From July 2014 to December 2017, 43 patients with destructive injury of limb in one side conformed to the inclusion criteria were admitted to our hospital. The patients were divided to NPWT group of 24 patients [ 21 males and 3 females, aged (38±10) years] and routine dressing change group of 19 patients [ 17 males and 2 females, aged (37±10) years] according to their treatment methods. After the emergency debridement, fracture external fixation, neurovascular exploration, and microsurgical repair were performed, NPWT were applied on wounds of patients in NPWT group and routine dressing change treatment on wounds of patients in routine dressing change group. On 7 to 10 days after the emergency operation, incidence of arterial embolism of patients in the two groups were calculated, and condition of wound infection of patients in the two groups were observed. Complete wound healing time and survival condition of limb were recorded. Data were processed with independent sample t test or chi-square test. Results: Incidence of arterial embolism of patients in NPWT group on 7 to 10 days after the emergency operation was 6.67% (3/45), which was close to 5.56% (2/36) of patients in routine dressing change group (χ²=0.043, P>0.05). There was 1 patient with wound infection in NPWT group on 7 to 10 days after the emergency operation, obviously less than 6 patients in routine dressing change group (χ²=5.847, P<0.05). Complete wound healing time of patients in NPWT group was (30±4) d, significantly shorter than (36±8) d of patients in routine dressing change group (t=2.813, P<0.01). Limbs of 24 patients in NPWT group survived, which was close to 18 patients in routine dressing change group (χ²=1.293, P>0.05). Conclusions NPWT can significantly reduce tthe wound infection rate and shorten the time of wound healing of limb with destructive injury after emergency operation, which is worthy of popularization in clinic.

Objective: To study the clinical effect of relaying peroneal artery perforator flap on anterior middle and lower tibia and donor-site defects repair. Methods: From July 2014 to June 2017, 12 patients were included. The anterior middle-lower tibia soft tissue defects and the primary donor-sites were repaired by relaying peroneal artery perforator flaps, and the second donor-sites were directly closed. The size of anterior middle-lower tibia defects ranged from 5 cm × 3 cm to 13 cm × 9 cm. The flaps repairing the wounds ranged from 6 cm × 4 cm to 14 cm × 10 cm in size. The flaps restoring the first donor-site ranged from 5 cm×4 cm to 10 cm×6 cm in size. The clinical effect was evaluated by observing the appearance of the recipient sites and the donor sites. Results: All the flaps survived uneventfully. All patients were followed up for 8-36 months (average 20 months). The flaps remained with good texture and color. The second donor-sites only left linear scar, which do not affect the overall appearance of limb. Conclusions The blood supply of relaying peroneal artery perforator is reliable without any disturbing of the main artery. The flap located on the lateral of the calf. The relaying peroneal artery perforator flap can repair the soft tissue defect at the anterior middle-lower tibia and improve the appearance of the first donor-site.

Objective: To analyze the issuance of Chinese adolescents mental health promotion policies and policy objects, and to explore the use of different object policy tools and the effectiveness of the policy, so as to provide reference for the improvement of the subsequent policy. Methods: Adolescents mental health promotion policies published and policy documents that included adolescents in mental health promotion policies and regulations in China from 2014 to the present were obtained, with the search period of July to August 2024. Policy content and effectiveness were analyzed by using content cross tabulation analysis and Policy Modeling Consistency Index Model (PMC index model). It coded with Nvivo 20 software to understand the types of tools that policy depends on. Results: A total of 41 documents were included. The number of adolescent mental health promotion policy texts rose by year, most of which were issued independently, accounting for 70% of the total number of texts issued; 30% were jointly issued, with the Ministry of Education and the National Health Commission as the core subjects. Supply type policy tools accounted for 47.45 % of the total, while environment type and demand type policy tools accounted for 29.68% and 22.87% respectively; the use of policy tools by different policy targets varies, with families and social organizations using more supply type and demand type policy tools, while the education system and healthcare institutions were more inclined to supply type policy tools, and the government departments were more inclined to supply type policy tools and environment type policy tools. In terms of policy effectiveness, there was a common problem of a lack of incentives and constraints, and the PMC values of two long term planning mental health policies were high (7.76, 7.56), and both reached the excellent level. Conclusions China has paid more attention to adolescents mental health, and the basic guarantees have been established and overall policy effectiveness is good, but the use of policy tools is uneven. There is a need to improve the operational content of medium and long term policies and to strengthen synergies between implementing departments.

Objective:To investigate the clinical effect of medial plantar flap combined with free groin flap in the reconstruction of heel defect.Methods:The patients with heel skin and soft tissue defects admitted to the Department of Burns & Plastic and Hand & Foot Surgery of Yulin No.2 Hospital from October 2015 to December 2020 were retrospectively analyzed. After emergency debridement, a plantar medial island flap was used to repair the foot heel defect, a free groin flap was used to repair the medial plantar donor site, and the groin donor site was closed primarily. Postoperatively routine anti-infection, spasmolysis, anticoagulation, expanding treatment were performed after the procedure. The blood supply, survival of the flap, and the healing of the donor area of the flap were observed. The shape and function of the heel were observed in follow-up.Results:Eight patients were enrolled, including 7 males and 1 female, aged from 20 to 71 years, with an average of 32.2 years. There were 5 cases of heel trauma, 1 case of heel squamous cell carcinoma, 1 case of heel frostbite, and 1 case of heel ulcer. The wound area of the heel was 4 cm×3 cm-7 cm×6 cm. The surgical procedure was smooth, and the incision range of the heel island flap and groin flap was 0.5-1.0 cm larger than that of the heel wound. All 8 patients had primary healing after the operation. Follow-up for 3-12 months showed that all patients were satisfied with heel shape, sensory function and walking function. There was no depression, scar hyperplasia, and contracture in the medial plantar donor area, and no local skin ulcer. There is only a linear scar in the groin donor area.Conclusions:Medial plantar island flap combined with a free groin flap can repair the defect of the heel, and the affected foot has good healing, certain sensory function, and satisfactory curative effect.

Objective:To investigate the clinical effect of medial plantar flap combined with free groin flap in the reconstruction of heel defect.Methods:The patients with heel skin and soft tissue defects admitted to the Department of Burns & Plastic and Hand & Foot Surgery of Yulin No.2 Hospital from October 2015 to December 2020 were retrospectively analyzed. After emergency debridement, a plantar medial island flap was used to repair the foot heel defect, a free groin flap was used to repair the medial plantar donor site, and the groin donor site was closed primarily. Postoperatively routine anti-infection, spasmolysis, anticoagulation, expanding treatment were performed after the procedure. The blood supply, survival of the flap, and the healing of the donor area of the flap were observed. The shape and function of the heel were observed in follow-up.Results:Eight patients were enrolled, including 7 males and 1 female, aged from 20 to 71 years, with an average of 32.2 years. There were 5 cases of heel trauma, 1 case of heel squamous cell carcinoma, 1 case of heel frostbite, and 1 case of heel ulcer. The wound area of the heel was 4 cm×3 cm-7 cm×6 cm. The surgical procedure was smooth, and the incision range of the heel island flap and groin flap was 0.5-1.0 cm larger than that of the heel wound. All 8 patients had primary healing after the operation. Follow-up for 3-12 months showed that all patients were satisfied with heel shape, sensory function and walking function. There was no depression, scar hyperplasia, and contracture in the medial plantar donor area, and no local skin ulcer. There is only a linear scar in the groin donor area.Conclusions:Medial plantar island flap combined with a free groin flap can repair the defect of the heel, and the affected foot has good healing, certain sensory function, and satisfactory curative effect.