Objective:To investigate the efficacy of posterior cranial fossa in- situ floating bone flap osteotomy in the treatment of syndromic craniosynostosis(SCS). Methods:The clinical data of SCS children who underwent posterior cranial fossa in- situ floating bone flap osteotomy at the Shanghai Children’s Medical Center, Shanghai Jiao Tong University School of Medicine from April 2020 to August 2022 were retrospectively analyzed. The surgical procedures were as follows. The occipital bone was cut into several mosaic bone flaps of varying sizes, without peeling it off the dura, which were left as a small free floating bone flap. The anteroposterior cranial diameter, cranial height, intracranial volume, and degree of improvement in tonsillar herniation and hydrocephalus of the children (hydrocephalus quantification was performed using the ratio of the ventricular diameter to the biparietal diameter)were measured preoperatively, 7 days postoperatively, 3 months postoperatively, and at the last follow-up (at least 12 months after the operation) to evaluate the surgical outcomes. The measurement data of normal distribution were expressed as Mean±SD. The paired t-test was used for comparison within the repeated measurement data groups at the two time points. One-way repeated measures analysis of variance (ANOVA) was performed on the repeated measurement data at multiple time points, and pairwise comparisons in post hoc tests were corrected using the Bonferroni method. Results:A total of 17 pediatric patients with SCS were included, comprising 10 males and 7 females, with ages ranging from 4 to 18 months (mean age: 9.5 months). Among them, 12 patients were complicated with Chiari malformation and hydrocephalus (1 severe case, 8 moderate cases, and 3 mild cases). Postoperative follow-up lasted 12 to 35 months, with an average of 17 months. After surgery, the posterior cranial appearance of the children was enlarged, with increased convexity of the occiput and a full contour. At the last follow-up, the middle cranial height [(107.80±10.72) mm vs. (102.82±10.09) mm, P<0.05], the posterior cranial height [(124.91±10.40) mm vs. (107.58±13.46) mm, P<0.01] and anteroposterior diameter [(153.30±11.26) mm vs. (123.64±17.44) mm, P<0.01] as well as the intracranial volume [(1 317.92±225.77) cm 3 vs. (1 014.93±231.81) cm 3,P<0.01] were increased compared with the preoperative period, and the average improvement rate of intracranial volume was 37.0% (18.1%-79.2%). Among the 12 cases of tonsillar herniation, 7 cases had improvement. Moreover, all the 12 cases of hydrocephalus witnessed a mitigation in severity, from (46.33±9.34)% preoperatively to (35.24±9.88)% postoperatively, with a statistically significant difference ( P<0.01). Conclusion:Posterior cranial fossa in- situ floating bone flap osteotomy can effectively improve the appearance of patients with SCS, increase the intracranial volume, relieve the degree of hydrocephalus, and reduce the intracranial pressure.

Objective:To investigate the efficacy of posterior cranial fossa in- situ floating bone flap osteotomy in the treatment of syndromic craniosynostosis(SCS). Methods:The clinical data of SCS children who underwent posterior cranial fossa in- situ floating bone flap osteotomy at the Shanghai Children’s Medical Center, Shanghai Jiao Tong University School of Medicine from April 2020 to August 2022 were retrospectively analyzed. The surgical procedures were as follows. The occipital bone was cut into several mosaic bone flaps of varying sizes, without peeling it off the dura, which were left as a small free floating bone flap. The anteroposterior cranial diameter, cranial height, intracranial volume, and degree of improvement in tonsillar herniation and hydrocephalus of the children (hydrocephalus quantification was performed using the ratio of the ventricular diameter to the biparietal diameter)were measured preoperatively, 7 days postoperatively, 3 months postoperatively, and at the last follow-up (at least 12 months after the operation) to evaluate the surgical outcomes. The measurement data of normal distribution were expressed as Mean±SD. The paired t-test was used for comparison within the repeated measurement data groups at the two time points. One-way repeated measures analysis of variance (ANOVA) was performed on the repeated measurement data at multiple time points, and pairwise comparisons in post hoc tests were corrected using the Bonferroni method. Results:A total of 17 pediatric patients with SCS were included, comprising 10 males and 7 females, with ages ranging from 4 to 18 months (mean age: 9.5 months). Among them, 12 patients were complicated with Chiari malformation and hydrocephalus (1 severe case, 8 moderate cases, and 3 mild cases). Postoperative follow-up lasted 12 to 35 months, with an average of 17 months. After surgery, the posterior cranial appearance of the children was enlarged, with increased convexity of the occiput and a full contour. At the last follow-up, the middle cranial height [(107.80±10.72) mm vs. (102.82±10.09) mm, P<0.05], the posterior cranial height [(124.91±10.40) mm vs. (107.58±13.46) mm, P<0.01] and anteroposterior diameter [(153.30±11.26) mm vs. (123.64±17.44) mm, P<0.01] as well as the intracranial volume [(1 317.92±225.77) cm 3 vs. (1 014.93±231.81) cm 3,P<0.01] were increased compared with the preoperative period, and the average improvement rate of intracranial volume was 37.0% (18.1%-79.2%). Among the 12 cases of tonsillar herniation, 7 cases had improvement. Moreover, all the 12 cases of hydrocephalus witnessed a mitigation in severity, from (46.33±9.34)% preoperatively to (35.24±9.88)% postoperatively, with a statistically significant difference ( P<0.01). Conclusion:Posterior cranial fossa in- situ floating bone flap osteotomy can effectively improve the appearance of patients with SCS, increase the intracranial volume, relieve the degree of hydrocephalus, and reduce the intracranial pressure.

Objective:To explore the teaching effect of PBL combined with "B-E-D-S-I-D-E" bedside teaching mode in clinical teaching of Otolaryngology nursing interns.Methods:From August 2016 to July 2018, 85 nursing students internship in Otolaryngology were selected as the research object. The nursing students were divided into control group and observation group according to the random number table method. PBL combined with "BEDSIDE" bedside teaching mode. After the internship, the teaching effect of the internship nurses, such as the evaluation of the theory of course preparation, the performance of operation, the satisfaction degree of teaching effect and the comprehensive ability of clinical nursing, was evaluated. The evaluation of mini-cex was used to evaluate the comprehensive ability of clinical nursing of nursing students.Results:The theoretical scores of nursing students in the observation group was 82.42±5.43 and the operational score was 81.83±4.51. The theoretical score of nursing students in the control group was 78.90±5.96 and the operational score was 74.84±6.14. The scores of nursing students in the two groups were significantly different ( t value was 2.844, 5.973, P < 0.01). The satisfaction of nursing students in the two groups was significantly higher than that in the control group ( t value was 4.224, 10.593, P<0.01). The scores of nursing measures, nursing diagnosis, nursing physical examination, nursing consultation, humanistic care, organizational efficiency, health consultation and overall evaluation in the mini clinical exercise evaluation scale of nursing students in the two groups were significantly higher than those in the control group ( t value was 3.483-9.070, P<0.01). Conclusions:PBL combined with "B-E-D-S-I-D-E" bedside teaching method could significantly improve the comprehensive ability of nursing students in clinical nursing practice, and also improve clinical teaching quality and satisfaction, which is suitable for promotion.

OBJECTIVE To evaluate the effect of intravenous infusion of methylprednisolone on postoperative recovery and complications after coblation tonsillectomy.METHODS Eighty three patients who were scheduled for coblation tonsillectomy from December 2015 to December 2016 were included in this study.Firstly,they were divided into 2 groups,i.e.,the younger group (＜12 years) and the older group (≥12 years old).Secondly,these two groups were further divided into experimental group and control group by the prospective,double-blind and randomized method.The experimental group was treated with methylprednisolone and antibiotics for 3 days.Then,the postoperative reactions such as the pain,activity,pharyngeal edema,body condition,exfoliation time of the tunic albuginea,post-tonsillectomy hemorrhage were observed.RESULTS 1.From the third day to fifth day,using methylprednisolone can alleviate pain (Z=4.42,P=0.00),increase the activity(Z=2.64,P=0.00)and reduce pharyngeal edema(Z=2.84,3.10,all P=0.00) in younger group.2.After operation,in the younger group,the incidence rate of gastrointestinal discomfort in control group was higher than that in experimental group(x2=4.97,P=0.03).In the older group,the incidence rate of gastrointestinal discomfort(x2=5.24,P=0.02) and sleep disturbance(x2=5.03,P=0.03) in control group was higher than those in experimental group.3.In the older group,exfoliation average time of the tunic albuginea in experimental group was longer than that in control group(t=2.16,P=0.04).4.Secondary bleeding rate was not statistically significant in the two groups(x2=1.29,P=0.26).CONCLUSION Intravenous infusion of methylprednisolone after coblation tonsillectomy is beneficial,especially in the relief of pain,gastrointestinal discomfort and pharyngeal edema.

OBJECTIVE:To study the protective effects of Mongolian medicine Lomatogonium rotatum water extract against acute liver injury in mice caused by D-GlaN and CCl4. METHODS:60 mice were randomly divided into normal group(normal sa-line),D-GlaN model group(normal saline),positive control group(Kuihua hugan tablet,0.56 g/kg)and L. rotatum water extract high-dose,medium-dose and low-dose groups [3,1.5,0.75 g(crude drug)/kg] 10 rats in each group. They were given relevant medicine intragastrically once a day for consecutive 23 days. 30 min after last administration,those group were given D-GlaN ip to induce acute liver injury model except normal group. The activity of AST,ALT,ALP,and acetylcholinesterase(CHE)content in serum were detected,and liver index was calculated. Liver histopathology was observed and scored. Other 60 mice were selected, and then grouped,given medicine and detected in lab index with same method with above group,except for modeling method(ig, 0.1% CCl4). RESULTS:Compared with normal group,necrosis or degeneration of liver cells were obvious in 2 model groups, pathological score,the activity of AST,ALT and ALP increased while CHE content decreased;liver index of D-GlaN model group increased while that of CCl4 model group decreased (P<0.05). Compared with D-GlaN model group,the activity of AST,ALT and ALP and liver index decreased in L. rotatum water extract groups,while CHE content increased(P<0.05);pathological mor-phology had been improved,and pathological score decreased. Compared with CCl4 model group,ALT activity decreased in L. rota-tum water extract low-dose group,while CHE content and liver index increased;CHE content of L. rotatum water extract medi-um-dose group decreased,while liver index increased;the activity of AST,ALT and ALP decreased in L. rotatum water extract high-dose group,while CHE content increased(P<0.05). Pathological morphology of L. rotatum water extract groups had been im-proved to certain extent,and pathological score decreased. CONCLUSIONS:L. rotatum water extract could protect acute liver inju-ry in mice induced by D-GlaN and CCl4.

Objective To investigate the value of susceptibility weighted imaging in grading brain tumors in children.Methods Twenty-eight children with surgically or pathologically proved primary brain tumor were recruited during 2010 to 201 1.All patients were scanned with conventional MRI and SWI sequences on a 1.5T or 3.0T scanner before surgery.The cases of tumors were divid-ed into low grade (9 males and 2 females)and high grade groups (10 males and 7 females),according to the WHO classification of the tumors of the central nervous system in 2007.The low-intense signals within the abnormalities on SWI images were analyzed and classified into the different shapes,including punctuate,tubular,cluster-like,linear signal,irregular patchy signal.As for the num-ber of low-intense signals,we applied the four-score system.The irregular patchy signals were considered to be artifacts of SWI, namely hemorrhage,after exclusion of the isolated veins and calcification.The differences of rate of hemorrhage and scores between the two groups in SWI were analyzed statistically.Results The low-signal scores were significantly different between two groups with higher scores in high grade tumors than in low grade tumors(P <0.001).The rate of intratumor hemorrhage was also signifi-cantly different between two groups.The rate is higher in high-grade group than low-grade group,given the fact that the hemor-rhage was showed in 2 low grade tumors (18.18%),while in 1 1 high grade tumors (76.37%)(P =0.01 5 9<0.001).Conclusion Different grades of pediatric brain tumors manifest significant difference on susceptibility weighted imaging(SWI).It may be helpful in the preoperative classification of brain tumors by analyzing the relevant signals on SWI.

Objective To validate the clinical effect of evidence-based nursing on early rehablilitation of patients with acute myocardial infarction undergoing PTCA and intracoronary stenting. Methods 47 patients with acute myocardial infarction undergoing PTCA and intracoronary stenting were divided into the nursing group(24 cases)and the control group(23 cases).The nursing group received nursing with evidence-based nursing pattern while the control adopted routine nursing method. The nursing effect in the two groups was compared in the following aspects such as the incidence rate of adverse effect,average hospitalization days, athletic ability and psychological status. Results The incidenece rate of adverse effect Was lower(P＜0.05)and the average hospitalization days were shorter(P＜0.01)than those of the control group with addition of cardiovascular complications(P＞0.05).The athletic ability and psychological status were also superior to those of the control group(P＜0.05).Conclusion Application of evidence-based nursing could hasten the rehabilitative process of patients undergoing PTCA and intracoronary stenting.