Sleep is an active and complex neurophysiological process.Premature babies sleep most of the day，and adequate sleep is conducive to the growth and development of premature infants.Sleep problems may be more common in preterm infants，but the studies about sleep and neurodevelopment in preterm infants are rare.This review systematically expounds the characteristics of shortened sleep time and fragmented sleep patterns in preterm infants，and the related mechanisms affecting their sleep quality，and summarizes measures to improve the sleep quality of preterm infants，in order to improve the sleep quality of preterm infants and thus promote neurodevelopment.

Objective:To evaluate the clinical efficacy and the mid- and long-term follow-up outcomes of transanal anaplasty for treating rectovestibular fistula.Methods:The clinical data of 68 female infants diagnosed with rectovestibular fistula undergoing transanal anoplasty at the Department of Pediatric Surgery, the First Affiliated Hospital of Zhengzhou University from Oct 2014 to Dec 2023 was collected. Postoperative complications, perineal and anal appearances, and defecation function of postoperative children aged 3 years or older were recorded.Results:After surgery 68 children followed-up for 6 months of recent with short-term complications in 6 cases, including 3 cases of incision infection, 2 cases of rectal mucosal prolapse, and 1 case of anal stenosis. Rintala score was (18.65±1.99). Twenty-five children underwent anorectal manometry, no significant differences were observed in the maximal systolic pressure of the anal canal( t=-0.596, P=0.563) and the maximum systolic time( t=-0.183, P=0.854). The resting pressure( t=-3.050, P=0.005), functional length( t=2.696, P=0.012), and positive rate of rectal anal inhibitory reflex( χ2=6.382, P=0.012) of the anal canal were significantly lower than those of the normal group( P<0.05). Conclusions:Transanal anaplasty for the treatment of rectovestibular fistula in girls has a low incidence of complications. It results in a normal perineal body appearance, good anal bowel control, and high quality of life.

Background and Aims:Body mass index(BMI),an important indicator of nutrition and health,is closely associated with postoperative complications.This study was performed to investigate the relationship between preoperative BMI and severe complications in patients undergoing liver resection for hepatolithiasis,aiming to provide preoperative guidance for clinicians,reduce the risk of postoperative complications,and ensure surgical safety and efficacy.Methods:The clinical data of 484 patients with hepatolithiasis who underwent liver resection between May 2006 and December 2022 at the First Affiliated Hospital of Army Medical University and Beijing Tsinghua Changgung Hospital were retrospectively collected.Patients were classified into low BMI group(≤18.4 kg/m2),normal BMI group(18.5-24.9 kg/m2),and high BMI group(≥25.0 kg/m2)based on preoperative BMI.Baseline characteristics,overall complications,severe complications,and other postoperative outcomes were compared between the normal BMI group and the low group as well as the high BMI group.Risk factors for severe complications after liver resection were analyzed.Results:Among the 484 patients,79(16.3％)were in the low BMI group,328(67.8％)in the normal BMI group,and 77(15.9％)in the high BMI group.The high BMI group had significantly higher ASA score,preoperative albumin level,and proportion of hypertension compared to the normal BMI group(all P＜0.05).Baseline characteristics in the low BMI group showed no significant differences compared to the normal BMI group(all P＞0.05).The incidence rates of overall complications were not significantly among the three groups(P＞0.05).However,the high BMI group had significantly higher incidence rates of severe complications(Clavien-Dindo grade Ⅲ-Ⅳ),postoperative infections,liver failure,and bile leakage compared to the normal BMI group;the low BMI group had significantly higher rates of perioperative blood transfusion,postoperative infections,liver failure,and reoperation compared to the normal BMI group(all P＜0.05).Univariate and multivariate Logistic regression analyses identified high BMI and preoperative total bilirubin ≥54 pmol/L as independent risk factors for severe complications after liver resection in patients with hepatolithiasis(both P＜0.05).Conclusion:Preoperative BMI is closely associated with the occurrence of complications after liver resection in patients with hepatolithiasis,with high BMI being an independent risk factor for severe complications.To mitigate the risk of severe complications,clinical practice should prioritize monitoring and management of individuals with high BMI and other risk factors

Objective To construct a cloud-based platform for healthcare-associated infection(HAI)management based on multi-source data fusion and data visualization,and evaluate its application effectiveness.Methods A ter-tiary first-class cancer hospital was selected as the research object.Aligned with graded hospital accreditation stan-dards and based on grid-based management and responsibility zone mode,a platform was constructed in 2023 with low-code technology,multi-source data fusion,and visualization function.The self-comparison method was adopted to compare occurrence of HAI before and after the operation of the platform.A questionnaire survey was adopted to assess the experience and workload reduction feelings of full-time and part-time infection surveillance and control profe-ssionals using the platform.Results 81.56％of the surveyed respondents believed that the platform could re-duce the workload of infection surveillance and control.Compared with before the trial operation,the hospital achieved an annual reduction of 11 200 yuan in paper costs,with associated labor savings of approximately 4 482.5 hours.The incidence of HAI cases in the whole hospital decreased from 0.67％to 0.45％.The pathogen detection rate before therapeutic use of antimicrobial agents increased from 51.26％to 71.54％.Differences were both statis-tically significant(both P＜0.05).The detection number and proportion of carbapenem-resistant Pseudomonas aeruginosa(CRPA)and extended-spectrum β-lactamase-producing Klebsiella pneumoniae(ESBL-KP)in HAI cases decreased(54.55％vs 36.47％and 51.14％vs 32.50％,respectively,both P＜0.05).Conclusion The construc-tion and application of smart HAI management cloud-based platform can reduce cost,improve management quality,and provide a theoretical basis and technical paradigm for the construction of smart HAI management system.

Objective To construct a cloud-based platform for healthcare-associated infection(HAI)management based on multi-source data fusion and data visualization,and evaluate its application effectiveness.Methods A ter-tiary first-class cancer hospital was selected as the research object.Aligned with graded hospital accreditation stan-dards and based on grid-based management and responsibility zone mode,a platform was constructed in 2023 with low-code technology,multi-source data fusion,and visualization function.The self-comparison method was adopted to compare occurrence of HAI before and after the operation of the platform.A questionnaire survey was adopted to assess the experience and workload reduction feelings of full-time and part-time infection surveillance and control profe-ssionals using the platform.Results 81.56％of the surveyed respondents believed that the platform could re-duce the workload of infection surveillance and control.Compared with before the trial operation,the hospital achieved an annual reduction of 11 200 yuan in paper costs,with associated labor savings of approximately 4 482.5 hours.The incidence of HAI cases in the whole hospital decreased from 0.67％to 0.45％.The pathogen detection rate before therapeutic use of antimicrobial agents increased from 51.26％to 71.54％.Differences were both statis-tically significant(both P＜0.05).The detection number and proportion of carbapenem-resistant Pseudomonas aeruginosa(CRPA)and extended-spectrum β-lactamase-producing Klebsiella pneumoniae(ESBL-KP)in HAI cases decreased(54.55％vs 36.47％and 51.14％vs 32.50％,respectively,both P＜0.05).Conclusion The construc-tion and application of smart HAI management cloud-based platform can reduce cost,improve management quality,and provide a theoretical basis and technical paradigm for the construction of smart HAI management system.

OBJECTIVE To investigate the causes of abnormal rising trends of isolation rate and infection of Staph-ylococcus aureus in the breast surgery department of a specialized cancer hospital.METHODS By means of pro-spective survey in combination with retrospective survey,an epidemiological survey was conducted for 5 patients with hospital-associated S.aureus infection who were treated in breast surgery department of Sun Yat-sen Univer-sity Cancer Center from Jan.2023 to Aug.2023,and the homology was observed.RESULTS The incidence rate of hospital-associated S.aureus infection(ward E 0.08％,ward F 0.38％)of the breast surgery department patients was higher during the period from Jan.2023 to Aug.2023,higher than 0.004％of the whole patients during the same period.The environmental sampling result showed that the colonized rate of S.aureus was 17.39％(4/23)and in nasal cavity 7.41％(2/27)in hands of the healthcare workers,and 28.57％in nasal cavity of logistical per-sonnel.Bundle interventions could reduce the incidence of hospital-associated methicillin-resistant S.aureus(MRSA)infection and the colonized rate in hands of the healthcare workers but had less impact on the colonized rate in the nasal cavity.The result of pulse field gel electrophoresis(PFGE)indicated that there was risk of cross transmission of colonized S.aureus between the hands of healthcare workers and the nasal cavities.The hand hy-giene,measures for contact transmission and environmental disinfection were supposed to be taken as the major links for control of the hospital-associated S.aureus infection.CONCLUSIONS The sporadic community-ac-quired infections and hospital-associated infections are the leading causes of the abnormal rise of the isolation rate and the infection rate of S.aureus in the breast surgery department.The bundle prevention and control measures can block the transmission of infections.

OBJECTIVE To investigate the causes of abnormal rising trends of isolation rate and infection of Staph-ylococcus aureus in the breast surgery department of a specialized cancer hospital.METHODS By means of pro-spective survey in combination with retrospective survey,an epidemiological survey was conducted for 5 patients with hospital-associated S.aureus infection who were treated in breast surgery department of Sun Yat-sen Univer-sity Cancer Center from Jan.2023 to Aug.2023,and the homology was observed.RESULTS The incidence rate of hospital-associated S.aureus infection(ward E 0.08％,ward F 0.38％)of the breast surgery department patients was higher during the period from Jan.2023 to Aug.2023,higher than 0.004％of the whole patients during the same period.The environmental sampling result showed that the colonized rate of S.aureus was 17.39％(4/23)and in nasal cavity 7.41％(2/27)in hands of the healthcare workers,and 28.57％in nasal cavity of logistical per-sonnel.Bundle interventions could reduce the incidence of hospital-associated methicillin-resistant S.aureus(MRSA)infection and the colonized rate in hands of the healthcare workers but had less impact on the colonized rate in the nasal cavity.The result of pulse field gel electrophoresis(PFGE)indicated that there was risk of cross transmission of colonized S.aureus between the hands of healthcare workers and the nasal cavities.The hand hy-giene,measures for contact transmission and environmental disinfection were supposed to be taken as the major links for control of the hospital-associated S.aureus infection.CONCLUSIONS The sporadic community-ac-quired infections and hospital-associated infections are the leading causes of the abnormal rise of the isolation rate and the infection rate of S.aureus in the breast surgery department.The bundle prevention and control measures can block the transmission of infections.

Background and Aims:Body mass index(BMI),an important indicator of nutrition and health,is closely associated with postoperative complications.This study was performed to investigate the relationship between preoperative BMI and severe complications in patients undergoing liver resection for hepatolithiasis,aiming to provide preoperative guidance for clinicians,reduce the risk of postoperative complications,and ensure surgical safety and efficacy.Methods:The clinical data of 484 patients with hepatolithiasis who underwent liver resection between May 2006 and December 2022 at the First Affiliated Hospital of Army Medical University and Beijing Tsinghua Changgung Hospital were retrospectively collected.Patients were classified into low BMI group(≤18.4 kg/m2),normal BMI group(18.5-24.9 kg/m2),and high BMI group(≥25.0 kg/m2)based on preoperative BMI.Baseline characteristics,overall complications,severe complications,and other postoperative outcomes were compared between the normal BMI group and the low group as well as the high BMI group.Risk factors for severe complications after liver resection were analyzed.Results:Among the 484 patients,79(16.3％)were in the low BMI group,328(67.8％)in the normal BMI group,and 77(15.9％)in the high BMI group.The high BMI group had significantly higher ASA score,preoperative albumin level,and proportion of hypertension compared to the normal BMI group(all P＜0.05).Baseline characteristics in the low BMI group showed no significant differences compared to the normal BMI group(all P＞0.05).The incidence rates of overall complications were not significantly among the three groups(P＞0.05).However,the high BMI group had significantly higher incidence rates of severe complications(Clavien-Dindo grade Ⅲ-Ⅳ),postoperative infections,liver failure,and bile leakage compared to the normal BMI group;the low BMI group had significantly higher rates of perioperative blood transfusion,postoperative infections,liver failure,and reoperation compared to the normal BMI group(all P＜0.05).Univariate and multivariate Logistic regression analyses identified high BMI and preoperative total bilirubin ≥54 pmol/L as independent risk factors for severe complications after liver resection in patients with hepatolithiasis(both P＜0.05).Conclusion:Preoperative BMI is closely associated with the occurrence of complications after liver resection in patients with hepatolithiasis,with high BMI being an independent risk factor for severe complications.To mitigate the risk of severe complications,clinical practice should prioritize monitoring and management of individuals with high BMI and other risk factors

Objective:To evaluate the clinical efficacy and the mid- and long-term follow-up outcomes of transanal anaplasty for treating rectovestibular fistula.Methods:The clinical data of 68 female infants diagnosed with rectovestibular fistula undergoing transanal anoplasty at the Department of Pediatric Surgery, the First Affiliated Hospital of Zhengzhou University from Oct 2014 to Dec 2023 was collected. Postoperative complications, perineal and anal appearances, and defecation function of postoperative children aged 3 years or older were recorded.Results:After surgery 68 children followed-up for 6 months of recent with short-term complications in 6 cases, including 3 cases of incision infection, 2 cases of rectal mucosal prolapse, and 1 case of anal stenosis. Rintala score was (18.65±1.99). Twenty-five children underwent anorectal manometry, no significant differences were observed in the maximal systolic pressure of the anal canal( t=-0.596, P=0.563) and the maximum systolic time( t=-0.183, P=0.854). The resting pressure( t=-3.050, P=0.005), functional length( t=2.696, P=0.012), and positive rate of rectal anal inhibitory reflex( χ2=6.382, P=0.012) of the anal canal were significantly lower than those of the normal group( P<0.05). Conclusions:Transanal anaplasty for the treatment of rectovestibular fistula in girls has a low incidence of complications. It results in a normal perineal body appearance, good anal bowel control, and high quality of life.

Objective To investigate the effect of medical ozone injection therapy on temporomandibular joint(TMJ)osteoarthritis and its pain in SD rats.Methods Fifity-four rats were randomly assigned according to a random number table into three groups:con-trol group,model group,and medical ozone group,with 18 rats in each group.In the control group,only physiological saline was in-jected during modeling;in the model group,only sodium iodoacetate was injected for modeling;in the medical ozone group,after in-jecting sodium iodoacetate into the joint cavity for modeling for one week,medical ozone was then injected into the joint cavity for inter-vention at a frequency of once a week,totaling 5 times.One week(week 2 after modeling),3 weeks(week 4 after modeling),and 5 weeks(week 6 after modeling)after medical ozone injections,6 rats from each group were euthanized.Mechanical withdrawal thresh-old of rats in each group was assessed before euthanasia,and the expression levels of interleukin-1β(IL-1β)in joint fluid of rats in each group were measured after euthanasia.Gross observation and modified Mankin's scoring were performed on TMJ cartilage of rats in each group after stained with Pelletier score and Safranin O-Fast Green.Results During the same time period,compared to the control group,the model group showed a significant decrease in the mechanical pain threshold of the TMJ in rats at 1 week,3 weeks,and 5 weeks(P＜0.01).The expression levels of IL-1β in the TMJ fluid increased(P＜0.01),and the Pelletier score and modified Mankin's score of TMJ cartilage increased(P＜0.01).In comparison to the model group,the medical ozone group exhibited a significant increase in the mechanical pain threshold of the TMJ in rats after 3 weeks and 5 weeks of medical ozone injections(P＜0.01).The expression levels of IL-1β in the TMJ fluid decreased(P＜0.01),and the Pelletier score and modified Mankin's score of TMJ cartilage decreased(P＜0.01).However,there were no statistically significant difference in the measured parameters in the TMJ cavity after 1 week of medical ozone injection(P＞0.05).Within the medical ozone group,compared to the 1-week treatment,the mechanical pain threshold of the TMJ increased(P＜0.01)and the expression levels of IL-1β in the TMJ fluid decreased at 3 weeks and 5 weeks(P＜0.01).However,there was no statistically significant difference in the Pelletier score and modified Mankin's score of TMJ cartilage(P＞0.05)between different treatment duration.Additionally,there were no statistically signif-icant differences in the mechanical pain threshold of the TMJ,expression levels of IL-1β in the TMJ fluid,Pelletier score,and modi-fied Mankin's score of TMJ cartilage between the medical ozone group at 3 weeks and 5 weeks(P＞0.05).Conclusion Medical ozone treatment for more than 3 weeks can improve temporomandibular joint osteoarthritis and its associated pain in rats.