Nursery services are a vital component of childcare for infants and toddlers.The quality and management of nursery services significantly impact the holistic development of infants and toddlers in terms of their physical,psychological,and social skills and capabilities.The first 1000 days in the life of an infant or toddler are a critical period that shapes their health status for their whole life,which highlights the need to prioritize health in childcare for infants and toddlers and to approach daily childcare services from a medical perspective.Based on the approach of integrating medical care and education,we innovatively explored and constructed a multidisciplinary patrol supervision model for childcare services,focusing on the PDCA cycle(Plan-Do-Check-Act cycle).We aim at establishing a multidisciplinary team of medical and nursing experts who provide evaluation and guidance for the institutional management,health management for infants and toddlers,disease prevention,and risk identification and screening of childcare services for infants and toddlers.This approach addresses the issue of the simplistic nature of the traditional patrol supervision involving only childcare physicians,improves service quality with high efficiency,meets the expectations of both childcare service providers and the families of infants and toddlers-the users of childcare services,enhances the effective implementation of childcare for infants and toddlers based on the integration of medical care and education,and improves the quality of a health-centered approach to childcare for infants and toddlers.

Intracerebral hemorrhage is the most important complication after intravenous thrombolytic therapy for acute ischemic stroke.It often occurs inside the infarct focus,and a considerable proportion occurs outside the infarct focus (i.e.remote intracerebral hemorrhage).Remote intracerebral hemorrhage has different risk factors,pathophysiological mechanisms and prognosis from intralesional hemorrhage.In recent years,more and more research has begun to focus on remote intracerebral hemorrhage.This article reviews the diagnostic typing,clinical features,risk factors and potential pathophysiological mechanisms of remote intracerebral hemorrhage after intravenous thrombolysis in acute ischemic stroke.

Objective To establish the animal model of traumatic myositis ossificans through striking the quadriceps muscle of rabbits repeatedly.Methods Nine white adult New Zealand rabbits were selected,as their left lower limbs were used as the model group and the right lower ones served as controls.The left hind limbs were stricken by a 0.25 kg ball falling from a height of 100 cm every 3 days for and then immobilized with the knee in extension,while the right knees were immobilized in the same way without striking.The rabbits were sacrificed at the 4th,6th and 8th weeks respectively.The swelling,local physical signs and pathological changes of the heterotopic ossification had been assessed.Results The swelling of left quadriceps was obvious,with progressively stiffness of the left knees accompanied by distinctly palpable indurations,while in the right hind limbs,the joint was stiff but without indurations.The imaging examination showed the ossification began to appear in the impact sites of the model group at the 4th,6th and 8th weeks.The hematoxylin-eosin staining demonstrated that there was obvious cartilage or bone formation in the muscle tissues of the left quadriceps at the 8th weeks.Conclusion An animal model of post-traumatic myositis ossificans can be successfully established in rabbits through beating their quadriceps repeatedly.

Objective To explore the proliferative changes and clinical significance of osteoclasts (OC) in various stages of osteoarthritis (OA). Methods Twenty healthy adult male SD rats were made the model by modified Hulht procedure,the left knee served as the control group and the right knee as the OA model group. The total knee joint (n=5) was collected at postoperative 1, 2,4,8 weeks, fixed at 4 ℃ 4% poly formaldehyde (PFA) liquid, embedded by paraffin for conducting sections, and stained by TRAP,toluidine blue(TB) and safranine O (Saf O)fast staining. Then the cartilage morphology change was observed and OC positive cells number with TRAP staining were semi-quantitatively detected,the OA cartilage destruction progression was evaluated by Mankin's method and SPSS17.0 statistics software was used to conduct statistical analysis. Results OC in the two groups showed the transient change of rapidly increasing and then decreasing. The OC number at 1 week in the control group (left knee) was (65.20±4.12) cells/mm2 ,and was gradually reduced at 2,4 weeks,which were (47.20±4.31) cells/mm and (26.20±3. 87) cells/mm2 ,which at 8 weeks was almost invisible, the number of cells was (7.00 ± 2.28) cells/mm2 ;the OC number at 1 week in the OA model group (right knee) was (70.40 ± 5.46) cells/mm2 ,increased to (86.20± 5.42)cells /mm2 at 2 weeks, reduced to (38. 0 ± 3.16) cells/mm2 at 4 weeks , was almost invisible at 8 weeks, the number of cells was (6.21 ± 2.93 ) cells/mm2 . The OC number at 2,4 weeks in the model group was significantly higher than that in the control group, the difference had statistical significance (P<0.05). Conclusion Large numbers of osteoclasts are proliferated in the early and middle stages of rat knee osteoarthritis, which indicating that OC might be involved in the formation of osteoarthritis.

Objective To investigate the correlation between Framingham stroke risk profile(FSRP) and vascular cognitive impairment in stroke-free patients with cerebrovascular risk factors.Methods One hundred and eighty-four stroke-free subjects,selected from Zhejiang hospital,were divided into low risk group (56 subjects),moderate risk group (70 subjects) and high risk group (58 subjects) according to their FSRP score,and their cognitive function including memory ability,attention,executive function and language ability were assessed by Montreal cognitive assessment (MoCA),auditory verbal learning test (AVLT),digit symbol test,trail making test(TMT),digit span and verbal fluency test.Results The total MoCA scores which were (7.2±4.6),(13.8±3.9),(29.6± 12.7) respectively,AVLT-delay recall scores which were(8.2± 1.6),(6.7± 1.4),(5.9± 1.5) respectively,and digit symbol test score which were(34.7±9.3),(32.6± 16.4),(29.7± 13.6) respectively in low,intermediate and high risk groups,decreased with the increasing risk of stroke(P＜0.05).The elapsed time in TMT-B which were (115.2 ±36.9) s,(147.6±44.8) s,(173.9±58.5) s respectively in low,intermediate and high risk groups,prolonged with the increasing risk of stroke (P＜0.05).FSRP was associated with cognitive function,but inversely related to MoCA,AVLT-delay recall,digit symbol test,TMT-B and digit span fall back (P＜0.05),but positively related to consuming time in TMT-B (P＜ 0.05).Multivariate regression analysis showed that advanced age,hypertension,diabetes and smoking were the risk factors for vascular cognitive impairment(P＜0.05).Conclusion Advanced age,smoking,hypertension and diabetes are the most important in vascular risk factors for cognitive impairment.Vascular risk factors can damage cognitive function with the increased risk of stroke,among which delayed recall and executive function are the main affected cognitive area.

Objective To investigate the mechanism of restenosis after carotid stent and balloon angioplasty for the Guangxi swines by intravascular ultrasound(IVUS). Methods Twelve Guangxi swines fed by a high cholesterol diet were randomly divided into two groups. Seven stents were implanted in the left carotid artery of six swines in the first group, and balloon angioplasty was performed in the left carotid artery of swines in the other group. Digital subtraction angiography(DSA) and IVUS were conducted respectively before and after the intervention and in the 13th week. Results IVUS found that the percentage of area stenosis in stent group was (18.31±7.79) % and in balloon group (37.28±7.89) % in the 13th week. The percentage of area restenosis in stent was obviously related to neointimal hyperplasia (r = 0.897, P<0.05), the percentage of area restenosis due to balloon angioplasty was markedly related to area decrease of external elastic lamina (r = 0.856, P<0.05). Conclusions The restenosis in stent was related to intimal hyperplasia of blood vessel,and restenosis after balloon angioplasty had some connection with area decrease of external elastic lamina.

BACKGROUND: Foreign and domestic scholars have made some studies on local anatomy and imageology of osseous pterygopalatine fossa, but studies on anatomy of section of osseous pterygopalatine fossa are few.OBJECTIVE: To measure hole-hole distance and aperture of pterygopalatine fossa from adult cranial bone at coronary and horizontal planes, and to observe the morphology of pterygopalatine fossa at corresponding sections.DESIGN: Repeated measurement design.SETTING: Scientific Research Office, Chengdu Medical College.MATERIALS: This experiment was carried out in the Laboratory for Local Anatomy, Department of Human Anatomy,Chengdu Medical College from March to November 2006. Sixty sides of complete dry cranial bone samples from 30 Chinese adult cases, who were of either gender and regardless of age, were involved in this study.METHODS: Bilateral pterygopalatine fossa of 30 dry cranial bone samples (60 sides) were sliced, 15 for slicing at coronary plane, and 15 for slicing at horizontal plane. Morphology of pterygopalatine fossa at the corresponding layers was observed, and related hole-hole distance and aperture were measured. Outcome was performed statistical analysis.MAIN OUTCOME MEASURES: Measurement at coronary plane: [1]orbit-rotundum distance (distance from the lowest point of inferior orbotal fissure to the center of rotundum); ② rotundum- pterygoid canal distance Ⅰ (vertical distance from the center of rotundum to the center of pterygoid canal); ③ rotundum- pterygoid canal distance Ⅱ (Distance from the area where rotundum appeared to the area where pterygoid canal appeared). Measurement at horizontal plane: [1]anterior-posterior dimension ( the largest distance between anterior and posterior walls which paralleled to perpendicular plate of palatine bone in each layer); ② lateral dimension (distance from midpoint of perpendicular plate of palatine bone to midpoint of line, which was between outermost sphenoidal process in the anterior wall of pterygopalatine fossa and foremost evagination in the posterior wall of pterygopalatine fossa). Morphology of pterygopalatine fossa in each layer was observed at coronary and horizontal planes, separately.RESULTS: ①At the coronary plane, the 1st to 6th layers of bilateral pterygopalatine fossa presented with inclined inverted trapezoid (70%, 21 sides), and inclined quadrilateral (30%, 9 sides), and the 7th to 10th layers of bilateral pterygopalatine fossa presented with canal-shape (100%). Themean value of right orbit-rotundum distance was (5.0±2.7) mm, andthat of left orbit-rotundum distance was (5.3±2.1) mm; The mean value of right rotundum- pterygoid canal distance Ⅰ was (6.4±3.9) mm, and that of left rotundum- pterygoid canal distance Ⅰ was (6.1±4.3) mm; The mean value of right rotundum- pterygoid canal distance Ⅱ was (7.3±2.6) mm, and that of left rotundum- pterygoid canal distance Ⅱ was (7.5±2.1) mm. ② At horizontal plane: The anterior and posterior walls of the 1st and 2nd layers of bilateral pterygopalatine fossa mainly presented with double curves with palinal convex surfaces (80%, 24 sides); the 3rd and 4th layers mainly presented with opposing convex surfaces (66.7%, 20 sides); The 5th to 6th layers mainly presented with canal shape (60%, 18 sides);And the 7th to 10th layers presented with canal shape (100%). At horizontal plane, for the pterygopalatine fossa in the 1st to 6th layers, its lateral dimension was larger than its anteroposterior dimension, and for the pterygopalatine fossa in the 7th to 10th layers, its lateral dimension was equal to its anteroposterior dimension. There were no significant differences of aperture in each layer of pterygopalatine fossa between bilateral samples (P＞ 0.05).CONCLUSION: Anatomical studies on the section of osseous pterygopalatine fossa retrieve the limitation in local anatomy,and provide reliable anatomical evidence for imageology of pterygopalatine fossa and related surgical operation.

BACKGROUND: Researches are recently focus on topography and image dissection of nasolacrimal duct, but it is lack of systemically contrast researches between sectional anatomy and image anatomy on bone nasolacrimal duct by using dry cranium samples.OBJ ECTIVE: To investigate the characteristics of sectional anatomy and image anatomy on bone nasolacrimal duct and provide evidences for related operations of nasolacrimal duct.DESrGN: Self controlled study.SETTING: Office of Teaching Supplies, Chengdu Medical College.MATERIALS: The experiment was carried out in the Topography Laboratory, Department of Human Anatomy, Chengdu Medical College from September 2005 to September 2006. Non-injured dry cranium was randomly selected from 34 adults (68 sides), including 34 sides on males and 34 sides on females.METHODS: ① Based on OM line, a routine scanning base line, which was regarded as the axial scanning baseline,samples were scanned at flat level with SHIMADZU CT device. Bone nasolacrimal duct was factitiously divided into three parts, including 1/3 superior segment, 1/3 middle segment and 1/3 inferior segment. The means at each related layer were determined as the final results. ② Cranium samples were signed based on image scanning baseline, and then they were cut into sections at cross section fault along scanning baseline at flat level with section razor. In addition, related indexes of bone nasolacrimal duct were measured and compared with image results.MAIN OUTCOME MEASURES: ① Anterior, posterior, left and right diameters of superior aperture, 1/3 superior segment,1/3 middle segment, 1/3 inferior segment and inferior aperture of bone nasolacrimal duct; ② depth of internal bone wall and posterior bone wall in superior aperture, 1/3 superior segment, 1/3 middle segment, 1/3 inferior segment and inferior aperture if bone nasolacrimal duct; ③ position and form of inferior aperture of bone nasolacrimal duct; ④ comparisons of bone nasolacrimal duct between image anatomy and sectional anatomy.RESULTS: ① Anterior, posterior, left and right diameters of cross section of bone nasolacrimal duct: Superior aperture of bone nasolacrimal duct was narrow, but inferior aperture was changed obviously. Diameter was increased from top to bottom. In addition, anterior and posterior diameters were more than left and right ones. There was significant difference in internal diameter of superior aperture and 1/3 inferior segment of bone nasolacrimal duct between male and females (t =2.458, 2.227, P ＜ 0.05). However, there was no significant difference in internal diameter of 1/3 superior segment, 1/3 middle segment and inferior aperture of bone nasolacrimal duct between male and female (P ＞ 0.05). ② Depth of internal bone wall and posterior bone wall of bone nasolacrimal duct at cross section: Depths of internal bone wall and posterior bone wall of bone nasolacrimal duct were (0.87±0.23) mm and (0.21±0.19) mm, respectively. In addition, there was significant difference between them (t =2.547, P ＜ 0.05). However, there was no significant difference in depth of internal bone wall and related posterior bone wall of superior aperture, 1/3 superior segment, 1/3 middle segment, 1/3 inferior segment and inferior aperture of bone nasolacrimal duct between male and female (P ＞ 0.05). ③ Position and form of inferior aperture of bone nasolacrimal duct changed remarkably. Results of image anatomy of bone nasolacrimal duct were as the same as those of sectional anatomy.CONCLUSION: Perfection of normal sectional anatomy and image anatomy of bone nasolacrimal duct is beneficial for successfully performing related operations of nasolacrimal duct and reducing complications.

BACKGROUND: There have been some foreign studies on the general anatomy of meniscus, while domestic materials about adult normal meniscus are few.OBJECTIVE: To measure the various data of adult meniscus, so as to provide anatomical basis for clinical meniscal sport injury.DESIGN: Repetitive measurement design.SETTING: Department of Scientific Research, Chengdu Medical College.MATERIALS: This experiment was carried out in the Laboratory of Local Anatomy, Department of Human Anatomy, Chengdu Medical College during September 2003 to September 2005. Totally 94 adult knee joint samples, without any diseases were harvested from 94 patients, including 48 male and 46 female.METHODS: Skin of knee joint, subcutaneous tissue and muscle were removed. Tendon of musculus quadriceps fexoris was cut above the whirbone. Articular capsule was open, and incisions were made and prolonged to the posterior wall of articular capsule. Anterior and posterior cruciate ligaments were exposed and cut near the starting point of anterior cruciate ligaments. Fat pad of articular capsule was carefully cleaned. Various data of adult medial and lateral meniscus before and after ex vivo were measured up and down.MAIN OUTCOME MEASURES: Measurement before ex vivo: ① The largest sagittal diameter, the length of outer arc, the width of anterior angle, caudomedial part and posterior angel of medial meniscus. ②The largest sagittal diameter, the length of outer arc, the largest transverse diameter, aperture length ( distance between anterior and posterior angel border of lateral meniscus), the width of anterior angle, caudomedial part and posterior angle of the lateral meniscus. Measurement after exvivo: ①The largest sagittal diameter, the length of outer arc, the width of anterior angle, caudomedial part and posterior angel as well as the thickness of lateral border, center and free edge of anterior angle, caudomedial part and posterior angel of medial meniscus. ② The largest sagittal diameter, the length of outer arc, the largest transverse diameter,aperture length, the width of anterior angle, caudomedial part and posterior angel as well as the thickness of lateral border, center and free edge of anterior angle, caudomedial part and posterior angel of lateral meniscus. RESULTS: ①The measuring data of medial and lateral meniscus of female samples were a little smaller than those of male samples. The measuring results of medial and lateral meniscus of male samples were basically consistent with the observed results. ②The anterior angle, caudomedial part and posterior angle of medial and lateral meniscus were gradually thinned from lateral border to interior free edge, and they were filled in the plateau between medial or lateral condyles and tibia in wedge shape. ③ Medial meniscus presented "C" or crescent shape. An terior angle adhered to the anterior intercondylar fossa of tibia which located in the front of the attachment point of anterior cruciate ligament, and posterior angle adhered to posterior intercondylar fossa of tibia which located in the rear of posterior angle of lateral meniscus and in the anteriomedialis of the attachment point of posterior cruciate ligament; There was no obvious changes in the length of outer arc of medial meniscus be- fore ex vivo (t=1.98,P ＞ 0.05). ④The lateral meniscus presented "0" shape a little , and anterior angle adhered to the front part of nodus among condyles of tibia and the rear of anterior cruciate ligament, and the posterior angle adhered to the rear of lateral intercondylar tubercle which located in the front of attachment point of posterior angle of medial menisus; There were no obvious changes in the length of outer arc of lateral meniscus before and after ex vivo (t=0.61,P ＞ 0.05), but ob vious changes existed in the width of anterior angle, caudomedial part and posterior angel of medial meniscus (t=2.49,P ＜ 0.05). CONCLUSION: The obtained measuring data of meniscus provide referencing basis for clinical meniscal sport injury.