Crohn's disease (CD) is an autoimmune disease with an unclear pathogenesis, primarily affecting the digestive tract. Perianal involvement represents a complex form of CD. Refractory proctoanal CD is a major cause of rectal resection and permanent anal sphincter dysfunction in patients. The colon pull-through with delayed anastomosis of the anal canal involves the resection of the diseased rectum and the management of the dentate line and anal canal. After the pulled-through colon has adhered to the anal canal, a revision and anastomosis are performed, aiming to preserve anal function and enhance the patients' quality of life. The specific criteria and timing for selecting this surgical approach for refractory proctoanal CD merit further discussion and investigation.

Crohn's disease (CD) is an autoimmune disease with an unclear pathogenesis, primarily affecting the digestive tract. Perianal involvement represents a complex form of CD. Refractory proctoanal CD is a major cause of rectal resection and permanent anal sphincter dysfunction in patients. The colon pull-through with delayed anastomosis of the anal canal involves the resection of the diseased rectum and the management of the dentate line and anal canal. After the pulled-through colon has adhered to the anal canal, a revision and anastomosis are performed, aiming to preserve anal function and enhance the patients' quality of life. The specific criteria and timing for selecting this surgical approach for refractory proctoanal CD merit further discussion and investigation.

Crohn′s disease (CD) is an autoimmune disease that mainly affects the digestive tract. Rectal and perianal involvement is a complex manifestation of CD. Refractory proctoanal type CD is the main cause of rectal resection and permanent anal dysfunction. Recently, our center performed modified Bacon surgery in two CD patients with complex rectoperineal and rectovaginal fistulas who were about to undergo rectotomy and enterostomy. The data of these two cases are summarized and reported.

Crohn′s disease (CD) is an autoimmune disease that mainly affects the digestive tract. Rectal and perianal involvement is a complex manifestation of CD. Refractory proctoanal type CD is the main cause of rectal resection and permanent anal dysfunction. Recently, our center performed modified Bacon surgery in two CD patients with complex rectoperineal and rectovaginal fistulas who were about to undergo rectotomy and enterostomy. The data of these two cases are summarized and reported.

Objective:To investigate the effects of breast milk to total milk intake ratio during hospitalization on the duration of antibiotic therapy in preterm infants less than 34 weeks of gestation.Methods:Clinical data of preterm infants ( n=1 792) less than 34 gestational weeks were retrospectively collected in 16 hospitals of Jiangsu Province Neonatal-Perinatal Cooperation Network from January 1, 2019, to December 31, 2021. The days of therapy (DOT) were used to evaluate the duration of antibiotic administration. The median DOT was 15.0 d (7.0-27.0 d). The patients were divided into four groups based on the quartiles of DOT: Q 1 (DOT≤7.0 d), Q 2 (7.0 d27.0 d) groups. According to the breast milk intake ratio (breast milk intake to total milk intake during hospitalization×100%), they were also divided into four groups: very-low-ratio breastfeeding group (breast milk intake ratio≤25%), low-ratio breastfeeding group (25%75%). Univariate analysis ( Chi-square test and Kruskal-Wallis rank-sum test) was used to analyze the factors influencing DOT. Spearman correlation analysis and trend Chi-square test were used to explore the relationship between breast milk intake ratio and DOT. After using multiple imputations to address missing data, two models were constructed after adjusting for different factors, and multinomial logistic regression model was applied to evaluate the effects of the breast milk intake ratio on DOT. Finally, sensitivity analysis was conducted to assess the stability of the models. Results:(1) Of the 1 792 preterm infants, there were 507 (28.3%) in the Q 1 group, 422 (23.5%) in the Q 2 group, 438 (24.4%) in the Q 3 group and 425 (23.7%) in the Q 4 group. (2) The median values of DOT in the very-low-ratio, low-ratio, medium-ratio and high-ratio breastfeeding groups were 20.0 d (11.0-31.0 d), 20.0 d (11.0-32.0 d), 13.0 d (6.0-25.8 d) and 10.0 d (4.0-21.0 d), respectively. Compared with the very-low-ratio and low-ratio breastfeeding groups, the medium-ratio and high-ratio breastfeeding groups had shorter DOT (all P<0.05). (3) After adjusting for factors with P<0.1 (prenatal glucocorticoid exposure, antimicrobial use within 24 h before delivery, gestational age at delivery, birth weight, Apgar score≤7 at 1 min, neonatal respiratory distress syndrome, infectious pneumonia and early-onset neonatal sepsis) between the DOT quartile groups, it showed that medium-ratio and high-ratio breastfeeding were protective factors in contrast to very-low-ratio breastfeeding in the Q 2, Q 3 and Q 4 groups as compared with the Q 1 group [Q 2 group: OR=0.50 (95% CI: 0.30-0.85) and OR=0.36 (95% CI: 0.26-0.51); Q 3 group: OR=0.31 (95% CI: 0.18-0.55) and OR=0.20 (95% CI: 0.14-0.29); Q 4 group: OR=0.22 (95% CI: 0.12-0.42) and OR=0.17 (95% CI: 0.12-0.26)]. Conclusion:Breast milk intake accounting for over 50% of total milk intake has a positive impact on reducing DOT in premature infants requiring antibiotics, which suggests that breastfeeding should be actively encouraged.

Short bowel syndrome (SBS) is a disabling malabsorptive disease in which patients are incapable of maintaining proper nutrition and hydration through normal oral intake alone because of extensive resection of the small intestine.The incidence, which has been increasing in recent years, is relatively low, but patients with SBS are seriously affected in their everyday life. The severity and prognosis of SBS are largely decided by the etiology and the length of remaining small intestine. The key strategy to prevent and reduce SBS is to fully understand the etiology.This paper summarizes the common etiologies of SBS, in order to provide references for clinical work.

Short bowel syndrome (SBS) is a disabling malabsorptive disease in which patients are incapable of maintaining proper nutrition and hydration through normal oral intake alone because of extensive resection of the small intestine.The incidence, which has been increasing in recent years, is relatively low, but patients with SBS are seriously affected in their everyday life. The severity and prognosis of SBS are largely decided by the etiology and the length of remaining small intestine. The key strategy to prevent and reduce SBS is to fully understand the etiology.This paper summarizes the common etiologies of SBS, in order to provide references for clinical work.

Objective To review the classification,the related risk factors and surgical intervention of unruptured intracranial aneurysms (UIA) upon the cases at home and aboard and to guide the treatment and physical examination assessment principle for China's civil aviation pilots.Literature resource and selection The related articles published at home and abroad.Literature quotation Nineteen published references were cited.Literature synthesis Intracranial aneurysm was a common cause of idiopathic subarachnoid hemorrhage.But the definite pathogenesis and impact factors were not clear.Modern epidemiological studies have shown that UIA and ruptured aneurysm had completely different course of the disease,treatment and prognosis.In recent years,either the incidence or prevalence of UIA has shown increased trend.The widely used imaging technology has improved the diagnosis for UIA.UIA could be classified into 3 types:①accidental asymptomatic aneurysm;② UIA manifested as occupying,uncomfortable or infarcted symptoms;③unruptured aneurysms of intracranial multiple aneurysms,which was found due to the subarachnoid hemorrhage.Related risk factors of UIA rupture included..diameter of aneurysm,location of occurrence,hypertension,age of onset,race and gender difference,formation time,etc..Conclusions The impact factors and the surgical choice are not the same in different population.The principles of UIA surgical intervention for civil pilots are as follows:①aneurysm with the diameter ＞5 mm.②if aneurysm diameter ≤5 mm,the treatment should be decided in accordance with the symptoms,occurrence location,body/neck ratio,etc..

Objective To review the classification,the related risk factors and surgical intervention of unruptured intracranial aneurysms (UIA) upon the cases at home and aboard and to guide the treatment and physical examination assessment principle for China's civil aviation pilots.Literature resource and selection The related articles published at home and abroad.Literature quotation Nineteen published references were cited.Literature synthesis Intracranial aneurysm was a common cause of idiopathic subarachnoid hemorrhage.But the definite pathogenesis and impact factors were not clear.Modern epidemiological studies have shown that UIA and ruptured aneurysm had completely different course of the disease,treatment and prognosis.In recent years,either the incidence or prevalence of UIA has shown increased trend.The widely used imaging technology has improved the diagnosis for UIA.UIA could be classified into 3 types:①accidental asymptomatic aneurysm;② UIA manifested as occupying,uncomfortable or infarcted symptoms;③unruptured aneurysms of intracranial multiple aneurysms,which was found due to the subarachnoid hemorrhage.Related risk factors of UIA rupture included..diameter of aneurysm,location of occurrence,hypertension,age of onset,race and gender difference,formation time,etc..Conclusions The impact factors and the surgical choice are not the same in different population.The principles of UIA surgical intervention for civil pilots are as follows:①aneurysm with the diameter ＞5 mm.②if aneurysm diameter ≤5 mm,the treatment should be decided in accordance with the symptoms,occurrence location,body/neck ratio,etc..

OBJECTIVEIn search of a simpler and safer technique for auricular reconstruction with good appearance.

METHODSMedpor implant was used as auricular framework, and covered by temporal fascia flap and skin graft.

RESULTSEar reconstruction was successfully achieved in 19 cases, the newly formed ears all had good appearance after edema disappeared 1 or 2 months postoperatively.

CONCLUSIONMedpor is a kind of good implant material because it is steady in nature, easy to be sculptured. Temporal fascia flap is rich in blood supply, tough and tensile in biomechanics. So the combination of Medpor implant framework with temporal fascia flap is preferable in auricular reconstruction.

Adolescent ; Adult ; Child ; Child, Preschool ; Ear, External ; abnormalities ; surgery ; Fascia Lata ; surgery ; Female ; Humans ; Male ; Polyethylenes ; Prostheses and Implants ; Reconstructive Surgical Procedures ; methods ; Surgical Flaps ; blood supply ; Time Factors