Objective To explore the prenatal ultrasound imaging features of Tessier number 7 cleft.Methods From Janu-ary 2018 to June2024,8 cases of Tessier number 7 cleft were diagnosed in Maternal and Child Health Hospital of Hubei Prov-ince.Theprenatal ultrasound images were analyzed and compared with pathology result after induced labor or surgery after birth.Results There were 8 cases of Tessier number 7 cleft,among which 7 cases were singletons and 1 was one of twins.Prenatal ultrasound findings:5 cases were diagnosed by prenatal ultrasound at 23 to 27+5 gestational weeks.One case of bilateral ear anomaly,1 case of unilateral ear anomaly,2 cases of bilateral accessory auricle,3 cases of unilateral accessory auri-cle,1 case of facial cheek mass,and 1 case of micrognathia were found through two-dimensional combined with three-dimension-al prenatal ultrasound.Other associated malformations:2 cases of single umbilical artery,1 case of congenital vascular ring.One case was not diagnosed by prenatal ultrasound in other hospital;2 cases were not diagnosed in our hospital,including the twin case whose facial features weredifficult to indentify due to oligohydramnios.Pathological or surgical results:therewere 4 female cases and 4 male cases.Transverse facial fissures occurred on the right side in 6 cases and on the left side in 2 cases.Transverse facial fissures were rated as GradeⅠin 3 cases and GradeⅡin 5 cases.There were combined bilateral ear anomalies in 4 cases,u-nilateral ear anomalies in 3 cases,bilateral ear canal atresia in 1 case,unilateral ear canal atresia in 3 cases;bilateral accessory au-ricle in 3 cases,unilateral accessory auricle in 5 cases,facial cheek mass in 3 cases,and facial muscle depression in 3 ca-ses.Prenatal ultrasound findings wereconfirmed by pathological results.One case of median palatalcleft,one of twin cases with upper limb joint movement restrictions,and anal atresia were additionally found in pathological examination.Conclusion The location and size of facial transverse clefts,ear anomalies,accessory auricle and micrognathia can be observed by two-dimensional ultrasound.Three-dimensional ultrasound surface rendering improves the accuracy of diagnosis,and combined application is an important method for diagnosis of Tessier number 7 cleft in the fetal period.

Objective To explore the prenatal ultrasound imaging features of Tessier number 7 cleft.Methods From Janu-ary 2018 to June2024,8 cases of Tessier number 7 cleft were diagnosed in Maternal and Child Health Hospital of Hubei Prov-ince.Theprenatal ultrasound images were analyzed and compared with pathology result after induced labor or surgery after birth.Results There were 8 cases of Tessier number 7 cleft,among which 7 cases were singletons and 1 was one of twins.Prenatal ultrasound findings:5 cases were diagnosed by prenatal ultrasound at 23 to 27+5 gestational weeks.One case of bilateral ear anomaly,1 case of unilateral ear anomaly,2 cases of bilateral accessory auricle,3 cases of unilateral accessory auri-cle,1 case of facial cheek mass,and 1 case of micrognathia were found through two-dimensional combined with three-dimension-al prenatal ultrasound.Other associated malformations:2 cases of single umbilical artery,1 case of congenital vascular ring.One case was not diagnosed by prenatal ultrasound in other hospital;2 cases were not diagnosed in our hospital,including the twin case whose facial features weredifficult to indentify due to oligohydramnios.Pathological or surgical results:therewere 4 female cases and 4 male cases.Transverse facial fissures occurred on the right side in 6 cases and on the left side in 2 cases.Transverse facial fissures were rated as GradeⅠin 3 cases and GradeⅡin 5 cases.There were combined bilateral ear anomalies in 4 cases,u-nilateral ear anomalies in 3 cases,bilateral ear canal atresia in 1 case,unilateral ear canal atresia in 3 cases;bilateral accessory au-ricle in 3 cases,unilateral accessory auricle in 5 cases,facial cheek mass in 3 cases,and facial muscle depression in 3 ca-ses.Prenatal ultrasound findings wereconfirmed by pathological results.One case of median palatalcleft,one of twin cases with upper limb joint movement restrictions,and anal atresia were additionally found in pathological examination.Conclusion The location and size of facial transverse clefts,ear anomalies,accessory auricle and micrognathia can be observed by two-dimensional ultrasound.Three-dimensional ultrasound surface rendering improves the accuracy of diagnosis,and combined application is an important method for diagnosis of Tessier number 7 cleft in the fetal period.

  Objective  This study aimed to investigate Chinese anesthesiologists' comprehension of palliative care and their experiences with palliative sedation for patients in the end-stage of life.  Methods  From October to December 2021, a national cross-sectional survey was conducted among anesthesiologists in China distributed by the Chinese Society of Anesthesiology, Chinese Medical Association with convenient sampling. The survey questionnaire encompassed general information, professional experience, familiarity with palliative care, emotional responses to end-stage cases, experience with sedation for critically ill or end-stage patients, and preferences for sedation medication.  Results  A total of 2536 anesthesiologists from 29 provinces in China completed valid questionnaires. Among them, 572 anesthesiologists(22.6%, 572/2536) reported familiarity with palliative medicine. Male anesthesiologists, as well as those with prior experience in caring for critically ill or end-stage patients, involved in pain management and practicing in hospitals with established institutional palliative care teams, demonstrated greater familiarity with palliative care concepts(all P<0.05). Over 40% of respondents felt powerless, helpless, and indecisive when confronted with end-stage patients. Anesthesiologists knowledgeable about palliative care exhibited greater confidence in managing critically ill or end-stage patients(9.8% vs. 4.4%, P=0.001). Among the anesthesiologists surveyed, 734 had administered sedation to end-stage patients, with 151 of them(20.6%, 151/734) inappropriately relying solely on opioids for sedation.  Conclusions  The understanding of palliative care and palliative sedation medication choice among anesthesiologists in China is still very limited. The establishment of palliative care teams, provision of education and training in palliative care, and enhancement of familiarity with palliative principles may bolster anesthesiologists' confidence when encountering critically ill or end-stage patients and subsequently enhance the quality of care for patients in the terminal stages of life.

The awake prone position plays an important role in the treatment of hypoxemia and the improvement of respiratory distress symptoms in non-intubated patients. It is widely used in clinical practice because of its simple operation, safety, and economy. To enable clinical medical staff to scientifically and normatively implement prone position for awake patients without intubation, the committees of consensus formulation, guided by evidence-based methodology and Delphi method, conducted literature search, literature quality evaluation and evidence synthesis around seven topics, including indications and contraindications, evaluation, implementation, monitoring and safety management, termination time, complication prevention and health education of awake prone position. After two rounds of expert letter consultation, Expert consensus on implementation strategy of awake prone positioning for non-intubated patients in China (2023) was formulated, and provide guidance for clinical medical staff.
Humans ; Consensus ; Prone Position ; Wakefulness ; China ; Dyspnea

Objective:To explore the protective effect and underlying mechanism of hyperbaric oxygen (HBO) on delayed encephalopathy after carbon monoxide poisoning (DEACMP) in mice.Methods:Totally 225 adult male Kunming mice were selected to establish CO poisoning model via intraperitoneal injection carbon monoxide (CO), and were randomly divided into the air control group, CO poisoning group, and HBO group. Each group was further divided into five time points group, that was 1, 3, 7, 14 and 21 d. The mice in the air control group were injected intraperitoneally with the same amount of air, and the HBO group received HBO treatment at the same time every day. DEACMP mice model was screened by behaviors using the open field test, new object recognition test and nesting test, and the content of myelin basic protein (MBP) were assayed. The mouse brain tissue and mitochondrial were prepared and malonialdehyde (MDA) and adenosine triphosphate (ATP) content were measured with ultraviolet spectrophotometer. MBP content in brain tissue and cytochrome C (CytC) content in the mitochondrial were measured by ELISA. The mitochondria membrane potential (MMP) was measured by flow cytometry.Results:Compared with the air control group, the content of carboxyhemoglobin (COHB) in blood increased significantly and the content of MBP in brain tissue decreased significantly in CO poisoning mice. CO poisoning mice showed motor ability and cognitive dysfunction. Compared with the air control group, the contents of MMP, CytC and ATP were significantly decreased ( P<0.01) in the CO poisoning group; while the MDA content was significantly increased ( P<0.01). Compared with the CO poisoning group, mice behaviors were improved significantly ( P<0.05), the content of MBP, MMP, CytC and ATP were increased ( P<0.05), while the MDA content decreased significantly ( P<0.01) in the HBO group. Conclusions:The abnormal mitochondrial function might be closely related to the occurrence and development of DEACMP, and HBO therapy plays an effective role in preventing and treating the DEACMP mice model via the mitochondrial pathway.

Objective:To analyze the factors related to the duration of chest compression pause time during the manual-mechanical conversion process in cardiopulmonary resuscitation (CRP).Methods:A retrospective study was devised in a cohort comprising patients with out-of-hospital cardiac arrest, who were assigned to receive mechanical CRP in the Department of Emergency of Huzhou First People's Hospital from January 2019 to December 2020. Patient’s general characteristics, CRP data and data on CRP-free intervals were collected multiple linear regression to analyze associations with the duration of chest compression pause time during the manual-mechanical conversion process in CRP. At the same time, the effect of CPR treatment qualification of nurses on CPR compression quality was evaluated.Results:The study selected 32 eligible patients. Patient's height, actual body weight, and body mass index showed a positive liner correlation with the duration of chest compression pause time ( r=0.61, 0.92, 0.49; P<0.01). Multiple stepwise regression analysis showed that actual body weight was an independent risk factor for prolonged duration of chest compression pause time ( P<0.01). Moreover, responsible nurses with advanced cardiac life support (ACLS) certification had significantly higher compression scores than those without ACLS certification (χ 2=0.002, P<0.01). Conclusions:The actual body weight of patients and the ACLS qualification of nurses on duty have a certain relationship with the duration of chest compression pause time during the manual-mechanical conversion process in CRP, which is worthy of further research.

Objective:To investigate the expression and cellular provenance of interleukin 17A (IL-17A) in non-eosinophilic chronic rhinosinusitis with nasal polyps (nECRSwNP), and to analyze the possible reasons for its different expression.Methods:Samples were collected from 14 patients with eosinophilic chronic rhinosinusitis with nasal polyps (ECRSwNP) and 28 patients with nECRSwNP, who underwent functional endoscopic sinus surgery in the Third Affiliated Hospital of Sun Yat-sen University from January 2017 to May 2018, including 33 males and 9 females, with the age ranging from 18 to 65 years old. Enzyme linked immune sorbent assay (ELISA) and flow cytometry were used to investigate the expression and cellular origins of IL-17A in the nasal tissue of ECRSwNP and nECRSwNP groups. Then the difference of quantity and differentiation ability of the major cells producing IL-17A between ECRSwNP and nECRSwNP groups were analyzed by flow cytometry. Finally, the expressions of IL-6, transforming growth factor-β(TGF-β), and IL-23, which were considered as the important factors in promoting Th17/Tc17 differentiation in CRSwNP and their correlation with IL-17A, were analyzed by ELISA. Statistical analysis was performed using IBM SPSS 20.Results:The IL-17A protein levels and IL-17A +lymphocyte percentages were higher in nECRSwNP group compared with that of the ECRSwNP group (158.56 (167.76) pg/ml ( M( QR)) vs. 9.42 (11.33) pg/ml, 10.21%±1.54% ( ± s) vs. 3.93%±0.80%, Z=2.95, t=3.62, all P<0.01). Tc17 cells (CD8 +T cells producing IL-17A) and Th17 cells (CD4 +T cells producing IL-17A) were major IL-17A producers in both ECRSwNP and nECRSwNP group. Further analysis revealed that there was no significant difference in quantity of CD8 +and CD4 +T cells between ECRSwNP and nECRSwNP group, but the differentiation ability about CD8 +and CD4 +T cells differentiating into Tc17 and Th17 in nECRSwNP group was stronger than that in ECRSwNP. The high expressions of IL-6 and TGF-β, which were considered as the important factors in promoting Th17/Tc17 differentiation were also found in nECRSwNP group compared with ECRSwNP (56.07 (234.25) pg/ml vs. 8.27 (12.51) pg/ml, (5.44±0.34) pg/ml vs. (4.17±0.22) pg/ml, Z=2.426, t=2.29, all P<0.05). But the difference in expression of IL-23 was not significant difference between the two groups. Moreover, the expression of IL-17A showed significantly positive correlation with IL-6 ( r=0.615, P=0.009). No positive correlation between IL-17A and TGF-β or IL-23 was observed. Conclusions:The expression of IL-17A in nasal mucosa of nECRSwNP patients is significantly higher than that of ECRSwNP, which is due to the increase of expression and differentiation of Tc17/Th17 cells. IL-17A shows positive correlation with IL-6 in CRSwNP, which is the important factor in promoting Th17/Tc17 differentiation.

Objective: To retrospectively review 4 cases diagnosed with pediatric acute respiratory distress syndrome (ARDS) who were transported with veno-venous (V-V) extracorporeal membrane oxygenation (ECMO) from April 2016 to March 2017. Methods: Four patients were transported to Bayi Children's Hospital Afflicted to the PLA Army General Hospital, with V-V ECMO. Their vital signs, blood-gas analysis and chest X-ray before and after transportation were compared. The length of ECMO, pediatric intensive care unit (PICU) stay and hospitalization, and the prognosis were analyzed. Results: All the four cases were transported to our hospital successfully from distances between 1 000 km to 1 210 km. The 4 cases were 4 to 6 years old with the body weight of 19 to 35 kg, of whom 3 were boys and 1 was girl. The catheters were inserted in the right jugular vein and femoral vein. The vital signs and blood-gas analysis after transportation did not change significantly compared to baseline. The length of ECMO for the four patients were 48, 754, 157 and 438 hours. They stayed in the PICU for 10, 32, 14 and 19 days, respectively. At last, 2 of them were successfully discharged from hospital without any complications; however, the other 2 died of multiple organ failure. Conclusion Transporting ARDS patients with a satisfactory cardiac function under VV-ECMO by an experienced ECMO team is safe.

Objective The aim of our study was to explore the relationship between prostate cancer and four serum markers,including Prostate specific antigen (PSA),Beta 2 Microglobulin (β2M),Neutrophil-to-lympochyte ratio (NLR) and Lactic dehydrogenase (LDH),and their variation rules in development of prostate cancer.Then to find one or more markers that can increase the sensitivity and specificity of diagnosis to provide reference for clinic.Methods A total of 149 prostate cancer patients,40 patients with benign prostatic hyperplasia,80 healthy subjects in our hospital were analyzed,and subsequent the T-PSA,F-PSA,β2M,LDH and NLR were measured.The correlation between these markers and prostate cancer as well as its different types and Gleason score was assessed statistically.We determined the cut-off point of the NLR and T-PSA according to the specificity and sensitivity levels derived from area under receiver operator characteristic (ROC) curve.Results The level of T-PSA was significantly higher in patients of prostate cancer and benign prostatic hyperplasia,and the level of NLR was higher only in patients of prostate cancer.Based on the area under ROC,the cut-off value of T-PSA was determined to be 4.625 ng/ml,and NLR was 2.11,and combined NLR and T-PSA can increase the specificity of diagnose.There is a statistical difference in Gleason scores in patients with different NLR of prostate cancer (P =0.030).Conclusions It could increased the specificity when combined NLR and T-PSA to diagnose prostate cancer.And NLR has positive correlation with the prognosis of patients of prostate cancer as well.

Objective To observe the effect of transcranial direct current stimulation (tDCS) with mirror neuronal rehabilitation training system (MNST-V1.0) in post-traumatic unconscious patients after severe craniocerebral injury. Methods A prospective, self controlled and open-label method was used. Thirty-six post-traumatic unconscious patients with severe craniocerebral injury from January 2016 to July 2017 were selected. Four cases of the patients did not complete the treatment and the last 32 cases completed the study. All patients were given routine wake-up therapy, and tDCS combined with MNST-V1.0 (20 min/time, 1 time/d, 6 times/week, a total of 8 weeks) was given at the same time. The Glasgow coma scale (GCS), JFK coma recovery scale and Four coma rating scale before treatment and 2, 4, 8 weeks after treatment were recorded. Results The scores of open reaction, language and motor response score of GCS 2, 4, 8 weeks after treatment were significantly higher than those before treatment:(1.56 ± 0.82), (2.06 ± 1.01) and (3.11 ± 1.45) scores vs. (1.00 ± 0.45) scores, (2.23 ± 1.06), (2.56 ± 1.08) and (3.02 ± 1.04) scores vs. (1.00 ± 0.61) scores, (2.79 ± 1.12), (3.22 ± 1.33) and (4.44 ± 1.07) scores vs. (1.00 ± 0.54) scores, and there were statistical differences (P ＜ 0.01 or ＜0.05). The scores of hearing, vision, movement, speech response, communication and arousal of JFK coma recovery scale 2, 4, 8 weeks after treatment were significantly higher than those before treatment, and there were statistical differences (P＜0.01). The scores of open reaction, sport reaction, brainstem response of Four coma rating scale 2, 4, 8 weeks after treatment were significantly higher than those before treatment, and there were statistical differences (P＜0.05); there was no statistical difference in respiratory score of Four coma rating scale before and after treatment (P＞0.05). Conclusions The tDCS combined with MNST-V1.0 can improve the consciousness level in post-traumatic unconscious patients with severe craniocerebral injury, and have the effect of promoting awakening.