Objective To explore the factors influencing the nosocomial pulmonary infection in patients with ischemic stroke.Methods The clinical data of 214 patients with ischemic stroke treated in the Third People's Hospital of Nantong from March 2020 to February 2022 were retrospectively analyzed.According to the Guidelines for Diagnosis and Treatment of Adult Hospital-acquired Pneumonia and Ventilator-related Pneumonia in China,the patients without lung infection were assigned to control group(n=104),and the patients with lung infection were enrolled in observation group(n=110).Clinical data such as gender,age,time from onset to admission,underlying diseases,nasogastric feeding,National Institute of Health Stroke Scale(NIHSS)score,Glasgow Coma Scale(GCS)score,endotracheal intubation,and ventilator-assisted ventilation were investigated.The risk factors for nosocomial pulmonary infection in patients with ischemic stroke were analyzed.Results There were 56 males and 54 females in the observation group,with a mean age of(73.59±8.21)years.There were 45 males and 59 females in the control group,with a mean age of(65.32±5.62)years.Univariate analysis showed significant differences in the age,nasogastric feeding,NIHSS score,GCS score,endotracheal intubation,and ventilator-assisted ventilation between the two groups(t=8.511,χ2=11.622,t=5.721,t=4.282,χ2=6.868,χ2=6.145,all P<0.05).Multivariate Logistic regression analysis result showed that nasogastric feeding(OR=5.447,95%CI:2.477-11.976),NIHSS score(OR=8.339,95%CI:2.598-26.768),GCS score(OR=7.660,95%CI:3.369-17.413),endotracheal intubation(OR=6.184,95%CI:2.447-15.628),and ventilator-assisted ventilation(OR=4.302,95%CI:1.830-10.110)were independent risk factors for pulmonary infection in patients with ischemic stroke.Conclusion The nasogastric feeding,severity of illness,impairment of consciousness,endotracheal intubation and ventilator-assisted ventilation are independent risk factors for pulmonary infection in patients with ischemic stroke.Therefore,the patients should be evaluated in time and taken targeted preventive measures on admission.

This commentary reviews the updates on laser and aesthetic medicine in recent two years and provide the evidence-based conclusion for recent laser treatments for our patients. Progress has been made in the following respects. Combined laser or drug treatment is better than single treatment for hypertrophic scar. The picosecond laser has recently been shown to be safe and effective for Asian atrophic acne scars. Picosecond laser with or without diffractive lens array (DLA) lens has been proved safe and effective for melasma. The effect of port-wine stains could only be increased by 5%-10% after 10 times of pulsed dye laser (PDL), so that more sessions has less benefit. Radiofrequency and focused ultrasound are still the mainstream devices for photoaging, but recently it has been proved that picosecond laser and CO 2 injection are also safe and effective. Nonablative laser is still the main device for improving facial pores and stretch marks.

Objective:To investigate and compare the effectiveness and safety of infrared bipolar radiofrequency (IR-RF) and nonablative fractional laser (NAFL) including 1 540 nm Er: glass and 1 927 nm thulium-doped laser, so as to choose a better pathway for clinical treatments on periorbital wrinkles.Methods:A prospective randomized self-controlled study was conducted in the Department of Laser and Aesthetic Medicine, Shanghai Ninth People’s Hospital. A total of 27 patients divided into 3 groups by random number table underwent split-face treatments between December 2019 and January 2021. Two of the three treatments were selected randomly for patients in each group: Group A, left side IR-RF vs. right side 1 540 nm NAFL; Group B, left side IR-RF vs. right side 1 927 nm NAFL; Group C, left side 1 540 nm NAFL vs. right side 1 927 nm NAFL. In total 3 sessions were given at 2 months interval. Therapeutic outcomes were evaluated by subjective (GAIS and Fitzpatrick wrinkle score) and objective (VISIA-CR) assessments. Side effects and pain visual evaluation (VAS) were also recorded. Wilcoxon signed-rank tests were used to evaluate the differences among the three therapeutic method , and relationships with VAS and patients’ age.Results:In total 30 patients (10 in each group) were recruited and finally 27 cases completed all treatments and follow-ups: Group A, 9 patients (male 3, female 6); Group B, 8 patients (male 3, female 5); Group C, 10 patients (male 4, female 6). The age distributions: Group A, 33-65 years, mean 36.9 years; Group B, 28-67 years, mean 38.6 years; Group C, 25-58 years, mean 37.8 years. GAIS comparisons: no statistical differences were found in each group between baseline and post-treatment ( P>0.05). Fitzpatrick wrinkle score: the overall analysis showed significant improvements were not found in IR-RF treated-side but were observed in 1 540 nm and 1 927 nm NAFL treated sides ( P<0.05). Furthermore, the 1 927 nm NAFL treated side showed more decreased scores than 1 540 nm NAFL treated side ( P<0.05). The VISIA analysis of feature counts of skin texture showed similar result. Besides, the patients over 50 years old showed significantly improvements compared with the ones under this age threshold in IR-RF treated sides ( P<0.05). The pain VAS in IR-RF treated side was significant lower than NAFL-treated side (2.2 vs. 5.8, P<0.05). Only one patient reported post-inflammatory hyperpigmentation (PIH) in 1540 nm NAFL treated side, which disappeared progressively in 4 months after last treatment. Conclusion:Nonablative fractional laser is effective and safe in improving periorbital wrinkles. Infrared bipolar radiofrequency might be more suitable for elderly patients especially with low pain level.

This commentary reviews the updates on laser and aesthetic medicine in recent two years and provide the evidence-based conclusion for recent laser treatments for our patients. Progress has been made in the following respects. Combined laser or drug treatment is better than single treatment for hypertrophic scar. The picosecond laser has recently been shown to be safe and effective for Asian atrophic acne scars. Picosecond laser with or without diffractive lens array (DLA) lens has been proved safe and effective for melasma. The effect of port-wine stains could only be increased by 5%-10% after 10 times of pulsed dye laser (PDL), so that more sessions has less benefit. Radiofrequency and focused ultrasound are still the mainstream devices for photoaging, but recently it has been proved that picosecond laser and CO 2 injection are also safe and effective. Nonablative laser is still the main device for improving facial pores and stretch marks.

Objective:To investigate and compare the effectiveness and safety of infrared bipolar radiofrequency (IR-RF) and nonablative fractional laser (NAFL) including 1 540 nm Er: glass and 1 927 nm thulium-doped laser, so as to choose a better pathway for clinical treatments on periorbital wrinkles.Methods:A prospective randomized self-controlled study was conducted in the Department of Laser and Aesthetic Medicine, Shanghai Ninth People’s Hospital. A total of 27 patients divided into 3 groups by random number table underwent split-face treatments between December 2019 and January 2021. Two of the three treatments were selected randomly for patients in each group: Group A, left side IR-RF vs. right side 1 540 nm NAFL; Group B, left side IR-RF vs. right side 1 927 nm NAFL; Group C, left side 1 540 nm NAFL vs. right side 1 927 nm NAFL. In total 3 sessions were given at 2 months interval. Therapeutic outcomes were evaluated by subjective (GAIS and Fitzpatrick wrinkle score) and objective (VISIA-CR) assessments. Side effects and pain visual evaluation (VAS) were also recorded. Wilcoxon signed-rank tests were used to evaluate the differences among the three therapeutic method , and relationships with VAS and patients’ age.Results:In total 30 patients (10 in each group) were recruited and finally 27 cases completed all treatments and follow-ups: Group A, 9 patients (male 3, female 6); Group B, 8 patients (male 3, female 5); Group C, 10 patients (male 4, female 6). The age distributions: Group A, 33-65 years, mean 36.9 years; Group B, 28-67 years, mean 38.6 years; Group C, 25-58 years, mean 37.8 years. GAIS comparisons: no statistical differences were found in each group between baseline and post-treatment ( P>0.05). Fitzpatrick wrinkle score: the overall analysis showed significant improvements were not found in IR-RF treated-side but were observed in 1 540 nm and 1 927 nm NAFL treated sides ( P<0.05). Furthermore, the 1 927 nm NAFL treated side showed more decreased scores than 1 540 nm NAFL treated side ( P<0.05). The VISIA analysis of feature counts of skin texture showed similar result. Besides, the patients over 50 years old showed significantly improvements compared with the ones under this age threshold in IR-RF treated sides ( P<0.05). The pain VAS in IR-RF treated side was significant lower than NAFL-treated side (2.2 vs. 5.8, P<0.05). Only one patient reported post-inflammatory hyperpigmentation (PIH) in 1540 nm NAFL treated side, which disappeared progressively in 4 months after last treatment. Conclusion:Nonablative fractional laser is effective and safe in improving periorbital wrinkles. Infrared bipolar radiofrequency might be more suitable for elderly patients especially with low pain level.

Objective: To compare the safety and efficacy of pulsed dye laser (PDL) with different sessios for the East Asian infants with port-wine stains(PWS). Methods: From September 2016 to September 2017, 24 East Asian infants with untreated PWS, who met the standards of enrollment, received seven treatments by PDL at 2-week intervals and three treatments at 6-week intervals at adjacent locations in each patient 2 months after final treatment. The efficacy outcome was compared with Wilcoxon signed-rank test, while the safety was compared using Fisher′s exact test. Results: Of the 24 patients, 20 completed study. Seven patients had multiple sites, given a total of 62 treated PWS sites. Among the patients, 18 had lesions on the face and 2 on the extremities. The average blanching rate was (43.71 ± 27.16) % and (43.29 ± 31.58) % for PDL treatments with 7- and 3- sessions, respectively (P>0.05). The result was consistent with independent observer assessment judging that the result of 7 laser treatments was equally with that of 3 treatments (r=0.416, P=0.0008). The average grade was 3.58 ± 1.21 and 3.53 ± 1.16 for 7- and 3-sessions. The patients treated with 7-sessions developed a little more side effects than 3-sessions, including residue purpura, pigmentation changes, eczema and dermatitis. Conclusions After three treatments of PDL, the efficacy may not necessarily increased by more frequent treatments for East Asian infantile PWS.

Objective To investigate the clinicopathological features,diagnosis and treatment experience,in order to improve the recognition of male breast cancer and prepare for the study of standardized treatment of breast cancer.Methods Data of epidemiological characteristics,clinical and pathological parameters,treatment and outcome from 43 male breast cancer patients were collected and analyzed in Peking University Cancer Hospital and Beijing Hospital from January 2009 to December 2014.Results Of these patients,42 (97.6％) cases presented with located tumors,11 (25.5％) cases were on pathological stage Ⅲ or stage Ⅳ,and 40 (93.0％) cases were with hormone receptor positive breast cancer and 3 (6.9％) cases were with human epidermal growth factor receptors (HER)-2 positive breast cancer.Patients were stratified according to more or less than 70 years of age,and there were no significant differences in clinicopathological features between the two year groups.But 3 cases with HER-2 over-expressed were all less than 70 years old.38 (88.4％) patients underwent surgical treatment,among which 32 HR-positive patients (74.4％) received tamoxifen as adjuvant endocrine therapy.The median follow-up periods was 31 months (6.1-55.4 months),7 (16.3％) patients developed local recurrence or distant metastasis.Conclusions Male breast cancer is often diagnosed at a later stage and has inferior outcome.Majority of male breast cancer are found to be HR positive,hence hormonal therapy should be strongly considered.

Objective To investigate the clinical applications of the chain locking-type tension bands. Methods89 cases with patellar bone fractures,27 olecranal fractures patients,18 patients with fractures of surgical neck of humerus,16 patients with dislocation of the acromioclavicular joints and 12 patients with clavicular lateral fractures were treated with chain locking-type tension bands. ResultsTheResultsshowed that all patients wound were postoperative first intention.The healing time of the fractures were 6 ～ 18 months(average 10 months).The Kirschner's pins lapping,steel wire breaks and tension bands out of control were not found. ConclusionCompared with the traditional tension bands,the chain locking-type tension bands had stronger stability,stress distribution more even and less complications.