Abstract In recent years, the prevalence of overweight and obesity among children and adolescents has risen rapidly, posing a serious threat to their physical and mental health. To provide scientific, systematic, and standardized weight management guidance for overweight and obese children and adolescents, the study focuses on the core concept of healthy lifestyle intervention, integrates multidisciplinary expert opinions and research findings,and proposes a comprehensive multidisciplinary intervention framework covering scientific exercise intervention, precise nutrition and diet, optimized sleep management, and standardized psychological support. It calls for the establishment of a multi agent collaborative management mechanism led by the government, implemented by families, fostered by schools, initiated by individuals, optimized by communities, reinforced by healthcare, and coordinated by multiple stakeholders. Emphasizing a child and adolescent centered approach, the consensus advocates for comprehensive, multi level, and personalized guidance strategies to promote the internalization and maintenance of a healthy lifestyle. It serves as a reference and provides recommendations for the effective prevention and control of overweight and obesity, and enhancing the health level of children and adolescents.

Objective:The transjugular or transfemoral approach is used as a common method for hepatic venous pressure gradient (HVPG) measurement in current practice. This study aims to confirm the safety and effectiveness of measuring HVPG via the forearm venous approach.Methods:Prospective recruitment was conducted for patients with cirrhosis who underwent HVPG measurement via the forearm venous approach at six hospitals in China and Japan from September 2020 to December 2020. Patients' clinical baseline information and HVPG measurement data were collected. The right median cubital vein or basilic vein approach for all enrolled patients was selected. The HVPG standard process was used to measure pressure. Research data were analyzed using SPSS 22.0 statistical software. Quantitative data were used to represent medians (interquartile ranges), while qualitative data were used to represent frequency and rates. The correlation between two sets of data was analyzed using Pearson correlation analysis.Results:A total of 43 cases were enrolled in this study. Of these, 41 (95.3%) successfully underwent HVPG measurement via the forearm venous approach. None of the patients had any serious complications. The median operation time for HVPG detection via forearm vein was 18.0 minutes (12.3~38.8 minutes). This study confirmed that HVPG was positively closely related to Child-Pugh score ( r = 0.47, P = 0.002), albumin-bilirubin score ( r = 0.37, P = 0.001), Lok index ( r = 0.36, P = 0.02), liver stiffness ( r = 0.58, P = 0.01), and spleen stiffness ( r = 0.77, P = 0.01), while negatively correlated with albumin ( r = -0.42, P = 0.006). Conclusion:The results of this multi-centre retrospective study suggest that HVPG measurement via the forearm venous approach is safe and feasible.

Objective To evaluate the Nociception Index(NOX)combined with Bispectral Index(BIS)monitoring of anesthesia management during laparoscopic radical resection of colorectal cancer.Methods A total of 80 patients,regardless of gender,aged 50 to 80 years old,and ASA grade Ⅰ or Ⅱ,chose to undergo elective laparoscopic colorectal surgery under total intravenous anesthesia.They were randomly divided into two groups:NOX combined with BIS group(Group N)and BIS alone group(Group C),with 40 cases in each group.Group N maintains an appropriate analgesia depth(NOX value is 30～50)and sedation depth(BIS value is 40～60),and group C maintains an appropriate sedation depth(BIS 40～60)and is covered with opaque cards Hide NOX and adjust the appropriate analgesia depth based on the experience of the anesthesiologist.The main observational indi-cator is the intraoperative remifentanil dosage,and the secondary observational indicators include the intraoperative propofol and cisatracurium dosage,vasoactive drug use,anesthesia recovery and extubation time,postoperative NRS pain score and sufen.The dosage of Titanyl,adverse reactions such as agitation in the postoperative recovery period,postoperative nausea and vomiting,dizziness,and intraoperative awareness.Results The amount of remi-fentanil used during the operation in group N was significantly less than that in group C(P＜0.05).The time of postoperative recovery and extubation in group N was significantly earlier than that in group C(P＜0.05).The number of cases of intraoperative use of vasoactive drugs,the incidence of postoperative agitation during recovery,postoperative nausea and vomiting,and dizziness in group N were significantly lower than those in group C(P＜0.05).There were no significant differences in the amount of propofol and cis-atracurium used during surgery and the incidence of awareness between the two groups(P＞0.05).The NRS scores of patients in group N were signifi-cantly lower than those in group C at 2,4,6,and 24 hours after surgery(P＜0.05),while there was no signifi-cant difference in the NRS scores between the two groups at 48 hours after surgery(P＞0.05).The consumption of sufentanil in group N was significantly lower than that in group C during the first 12 hours and 12 to 24 hours after surgery(P＜0.05).There was no significant difference in the consumption of sufentanil between the two groups during the second 24 to 48 hours after surgery(P＞0.05).Conclusion Compared with BIS monitoring alone,the use of NOX combined with BIS monitoring can maintain relatively stable intraoperative hemodynamics,reduce the amount of general anesthesia drugs,accelerate postoperative anesthesia recovery,improve the quality of anesthesia recovery,and reduce acute postoperative pain,which is beneficial to patients postoperative recovery.

Objective To evaluate the Nociception Index(NOX)combined with Bispectral Index(BIS)monitoring of anesthesia management during laparoscopic radical resection of colorectal cancer.Methods A total of 80 patients,regardless of gender,aged 50 to 80 years old,and ASA grade Ⅰ or Ⅱ,chose to undergo elective laparoscopic colorectal surgery under total intravenous anesthesia.They were randomly divided into two groups:NOX combined with BIS group(Group N)and BIS alone group(Group C),with 40 cases in each group.Group N maintains an appropriate analgesia depth(NOX value is 30～50)and sedation depth(BIS value is 40～60),and group C maintains an appropriate sedation depth(BIS 40～60)and is covered with opaque cards Hide NOX and adjust the appropriate analgesia depth based on the experience of the anesthesiologist.The main observational indi-cator is the intraoperative remifentanil dosage,and the secondary observational indicators include the intraoperative propofol and cisatracurium dosage,vasoactive drug use,anesthesia recovery and extubation time,postoperative NRS pain score and sufen.The dosage of Titanyl,adverse reactions such as agitation in the postoperative recovery period,postoperative nausea and vomiting,dizziness,and intraoperative awareness.Results The amount of remi-fentanil used during the operation in group N was significantly less than that in group C(P＜0.05).The time of postoperative recovery and extubation in group N was significantly earlier than that in group C(P＜0.05).The number of cases of intraoperative use of vasoactive drugs,the incidence of postoperative agitation during recovery,postoperative nausea and vomiting,and dizziness in group N were significantly lower than those in group C(P＜0.05).There were no significant differences in the amount of propofol and cis-atracurium used during surgery and the incidence of awareness between the two groups(P＞0.05).The NRS scores of patients in group N were signifi-cantly lower than those in group C at 2,4,6,and 24 hours after surgery(P＜0.05),while there was no signifi-cant difference in the NRS scores between the two groups at 48 hours after surgery(P＞0.05).The consumption of sufentanil in group N was significantly lower than that in group C during the first 12 hours and 12 to 24 hours after surgery(P＜0.05).There was no significant difference in the consumption of sufentanil between the two groups during the second 24 to 48 hours after surgery(P＞0.05).Conclusion Compared with BIS monitoring alone,the use of NOX combined with BIS monitoring can maintain relatively stable intraoperative hemodynamics,reduce the amount of general anesthesia drugs,accelerate postoperative anesthesia recovery,improve the quality of anesthesia recovery,and reduce acute postoperative pain,which is beneficial to patients postoperative recovery.

Objective:To evaluate the value of color Doppler ultrasonography in diagnosing primary squamous cell carcinoma of the thyroid(PSCCT).Methods:Ultrasound images of 13 patients from August 2010 to June 2019 in the Second Hospital of Hebei Medical University with PSCCT confirmed by surgery and pathology were analyzed retrospectively.The ultrasonographic features were summarized.Results:All of the cases were single lesion. 92.3%(12/13) of the lesions were hypoechoic on ultrasound, 69.2%(9/13) of the lesions were ≥5 cm in maximal dimension and occupied one lobe of the thyroid gland, 76.9%(10/13) of the lesions were irregular, 69.2%(9/13) of the lesions had unclear boundary, 61.5%(8/13) of the lesions broke through the thyroid capsule and showed invasive growth. Calcification was rare, 23.1%(3/13) of the lesions were accompanied by striated calcification, 7.7%(1/13) of the lesions were accompanied by eggshell calcification, 15.4%(2/13) of the lesions showed few blood flow, 53.8%(7/13) of the lesions showed moderate blood flow, 30.8%(4/13) of the lesions showed rich blood flow, 69.2%(9/13) of the lesions were detected higher vascular resistance spectrum, 53.8%(7/13) of the lesions exhibited cervical metastatic lymph nodes. The ultrasonographic features of metastatic lymph nodes were hypoechoic, the lymphatic hilum structures were absent, with cystic changes in the interior.Conclusions:The color Doppler ultrasound images of PSCCT have certain specific features, and the identification of its sonographic characteristics is helpful to improve the diagnosing level of PSCCT.

OBJECTIVE: To analyze the roles of multidisciplinary team (MDT) in the diagnosis and treatment of suspected cases of coronavirus disease 2019 (COVID-19). METHODS: The clinical data of 48 patients with suspected COVID-19 admitted in Jinhua Municipal Central Hospital from January 21, 2020 to March 20, 2020 were retrospectively analyzed. RESULTS: In the 48 suspected cases, 18 were diagnosed with COVID-19, and 30 were excluded. Each of the confirmed cases were discussed among MDT for 2 to 12 times with an average of (4.7±3.2) times; while for non-COVID-19 patients were discussed for 2 to 4 times with an average of (2.3±0.6) times. With the guidance of MDT, one COVID-19 patient was transferred to designated provincial hospital after effective treatment; one patient complicated with acute cholecystitis underwent gallbladder puncture and drainage; and COVID-19 was excluded in a highly suspected patient after alveolar lavage fluid examination. Except one transferred patient, all 17 confirmed COVID-19 patients were cured and discharged. There was no cross-infection occurred in suspected patients during the hospitalization. There were no deaths and no medical staff infections. CONCLUSIONS The efficiency of diagnosis and treatment for suspected COVID-19 patients can be improved with MDT, particularly for complicated cases.
Betacoronavirus ; isolation & purification ; China ; Coronavirus Infections ; diagnosis ; therapy ; Humans ; Interdisciplinary Communication ; Pandemics ; Patient Care Team ; standards ; Pneumonia, Viral ; diagnosis ; therapy ; Retrospective Studies ; Treatment Outcome

OBJECTIVE: To analyze the roles of multidisciplinary team (MDT) in the diagnosis and treatment of suspected cases of corona virus disease 2019 (COVID-19). METHODS: The clinical data of 48 patients with suspected COVID-19 admitted in Jinhua Central Hospital from January 21, 2020 to March 20, 2020 were retrospectively analyzed. RESULTS: Of the 48 suspected cases, 18 were diagnosed with COVID-19, and 30 were excluded. Each of the confirmed cases were discussed among MDT for 2 to 12 times with an average of (4.7±3.2) times; while for non-COVID-19 patients were discussed for 2 to 4 times with an average of (2.3±0.6) times per case. With the guidance of MDT, one COVID-19 patient was transferred to designated provincial hospital after effective treatment; one patient complicated with acute cholecystitis underwent gallbladder puncture and drainage; and COVID-19 was excluded in a highly suspected patient after alveolar lavage fluid examination. Except one transferred patient, all 17 confirmed COVID-19 patients were cured and discharged; there was no cross-infection occurred in suspected patients during the hospitalization; there were no deaths and no medical staff infections. CONCLUSIONS The efficiency of diagnosis and treatment for suspected COVID-19 patients can be improved under MDT mode, particularly for complicated and refractory cases.
Betacoronavirus ; Coronavirus Infections ; complications ; diagnosis ; therapy ; Disease Management ; Humans ; Interdisciplinary Communication ; Pandemics ; Patient Care Team ; standards ; Pneumonia, Viral ; complications ; diagnosis ; therapy ; Retrospective Studies ; Treatment Outcome

Objective:To investigate and analyze the current situation, screening, clinical characteristics, prevention and treatment of bleeding esophageal varices in cirrhotic patients with portal hypertension in Tibet region.Methods:Clinical data of cirrhotic patients with portal hypertension through March 2017 to February 2020 from Tibet region were collected and analyzed retrospectively.Results:511 cases with liver cirrhosis were included in the study, of which 185 cases (36.20%) had compensated cirrhosis and 326 cases (63.80%) had decompensated cirrhosis. Further analysis of the etiological data of liver cirrhosis showed that 306 cases (59.88%) were of chronic hepatitis B, 113 cases (22.11%) of alcoholic liver disease, and 68 cases (13.31%) of chronic hepatitis B combined with alcoholic liver disease. Among patients with compensated liver cirrhosis, 48 cases (25.95%) underwent endoscopic examination of which 33 diagnosed as high-risk variceal bleeding. However, none of these 33 cases had received non-selective β-blocker therapy, and only four patients had received endoscopic variceal banding therapy. Among patients with decompensated liver cirrhosis, 83 cases (25.46%) had a history of upper gastrointestinal bleeding, 297 cases (91.10%) had ascites, 23 cases (7.05%) had hepatic encephalopathy, and 3 cases (0.92%) had hepatorenal syndrome. Among the patients with a history of upper gastrointestinal bleeding, 42 cases (50.60%) had received secondary preventive treatment for bleeding esophageal varices, including 39 cases of endoscopic treatment, 1 case of endoscopic combined drug treatment, 3 cases of interventional treatment, and 2 cases of surgical treatment.Conclusion:Chronic hepatitis B and alcoholic liver diseases are the main causes of liver cirrhosis in Tibet region. Moreover, this region lacks screening, prevention and treatment for bleeding esophageal varices in cirrhotic patients with portal hypertension. Therefore, it is necessary to increase the screening of high-risk groups to prevent and improve the first-time bleeding, and promote multidisciplinary team to prevent and treat re-bleeding.

Objective:To explore the clinical strategies for preservation of the exposed implant in chronic wounds and wound repair.Methods:From January 2016 to January 2019, totally 8 patients (4 males and 4 females, aged 10 to 73 years) sustaining postoperative chronic wounds with exposed implants were admitted to the Fourth Medical Center of PLA General Hospital. There were 2 cases of abdominal patch exposure after abdominal trauma surgery, 2 cases of titanium plate exposure post craniocerebral surgery, 3 cases of internal fixator exposure post orthopedic surgery, and 1 case of cerebrospinal fluid drainage tube exposure after craniocerebral surgery. The wound exudate was collected for bacterial culture on admission. On the basis of glycemic control and correction of anemia and hypoproteinemia, thorough wound debridement was performed as soon as possible and the wound area after debridement ranged from 2.0 cm×0.5 cm to 6.0 cm×5.0 cm. The wounds of 4 patients were immediately closed after debridement, including 1 case by primary closure, 1 case by primary closure after local filling of platelet rich plasma gel, and 2 cases by local flap transplantation, with flap size of 10.0 cm×8.0 cm and 12.0 cm×8.0 cm, respectively. The donor sites of flaps were sutured directly and all the incisions were treated with continuous vacuum sealing drainage (VSD) after surgery. The other 4 patients were treated with continuous VSD after debridement to improve the wound bed. The wound of 1 case healed gradually, 1 case received direct wound suturing, and the wounds of 2 cases were repaired with thin split-thickness skin grafts from the thigh or the head. The results of bacterial culture of wound exudate on admission, wound healing post surgery, and follow-up were observed and recorded.Results:The bacterial culture of wound exudate on admission was positive in 6 patients, and 10 strains of bacteria were isolated with Staphylococcus epidermidis as the main pathogen. All the skin grafts or flaps of patients survived post surgery, with the incisions and wounds healed and all the implants preserved. After 1 to 3 years of follow-up, no recurrence of wound was found in any patient. Conclusions:The postoperative chronic wounds with exposed implants can be closed in primary stage by direct suturing or flap transplantation if it is clean enough on the basis of thorough debridement. The wounds with large defects or serious infection can be treated with continuous VSD firstly and then closed with direct suturing or skin grafting for delayed wound closure, thereby to reach the treatment goal of preserving the implants and repairing the wounds simultaneously.

Objective To evalute the combination of dexmedetomidine and fentanyl in sedation during awake nasotracheal fiberoptic intubation. Methods One hundred and twenty ASAⅠ or Ⅱ patients scheduled to receive general anesthesia were randomly divided into 3 groups (n = 40 in each group). Patients in group L received an infusion of 1 μg/kg dexmedetomidine,patients in group H received an infusion of 2 μg/kg dexmedeto-midine ,and patients in group DF received an infusion of 1 μ g/kg dexmedetomidine added to 1 μ g/kg fentanyl. Nasotracheal intubation was performed after complete topical anesthesia. HR and MAP were recorded before anes-thesia(baseline,T0),before intubation(T1)and immediately after intubation(T2),respectively. The intubation score(vocal cord movement,coughing and limb movement),fiberoptic intubation score,nasotracheal intubation score and airway obstraction score were assessed in all aptients. On the first post-operative day,recall,adverse events and satisfaction score were also assessed. Results HR and MAP at T1 in three groups were significantly lower than those at T0(P < 0.05,respectively ). HR and MAP at T2 in group L were significantly higher than those in group H and DF(P<0.05,respectively). More incidence of vocal cord closed,severe cough,severe limb movement,heavy grimacing,defensive movement of head and hands after nasotracheal intubation were observed in group L than those in the other two groups. The incidence of airway obstraction and bradycardia in group H were higher than those in group L and DF. Patients in group L had lower postoperative satisfaction scores. Conclusion Adding 1 μg/kg fentanyl to 1 μg/kg dexmedetomidine is a good method for awake nasotracheal fiberoptic intuba-tion,which can prevent the risk of airway obstruction associated with the increase of dexmedetomidine dose,with the achievement of the same favorable sedation.