Objective:To investigate the risk factors associated with post-prematurity respiratory disease (PPRD) in very preterm infants.Methods:A prospective cohort study was conducted, enrolling 369 very preterm infants who were admitted to the neonatal intensive care unit of Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, within one week of birth from January 2019 to June 2023. Data on maternal and infant clinical characteristics, neonatal morbidities, and treatments during hospitalization were collected. The very preterm infants were divided into 2 groups based on whether they developed PPRD. Continuous variables were compared using Mann-Whitney U test, while categorical variables were compared using χ2 tests or continuity correction χ2 test. Multivariate Logistic regression analysis was used to identify the independent risk factors for PPRD in very preterm infants. Results:Among the 369 very preterm infants, 217 cases(58.8%) were male, with a gestational age of 30 (28, 31) weeks at birth and a birth weight of 1 320 (1 085, 1 590) g. Of these, 116 cases (31.4%) developed PPRD, while 253 cases (68.6%) did not. The very preterm infants in the PPRD group had a lower gestational age and lower birth weight (both, P<0.001). The PPRD group also had a higher proportion of males, lower Apgar scores at the 1 th minute after birth and the 5 th minutes after birth, a higher rate of born via cesarean delivery, and a higher incidence of bronchopulmonary dysplasia, more pulmonary surfactant treatment, longer durations of mechanical ventilation, longer total oxygen therapy, and lower Z-score for weight at discharge (all P<0.05). Multivariate Logistic regression analysis showed that gestational age ( OR=0.85, 95% CI 0.73-0.99, P=0.037), born via cesarean delivery ( OR=2.23, 95% CI 1.21-4.10, P=0.010), a duration of mechanical ventilation ≥7 days ( OR=2.51, 95% CI 1.43-4.39, P=0.001), and a Z-score for weight at discharge ( OR=0.82, 95% CI 0.67-0.99, P=0.040) were all independent risk factors for PPRD in very preterm infants. Conclusion:Very preterm infants with a small gestational age, born via cesarean section, mechanical ventilation ≥7 days, and a low Z-score for weight at discharge should be closely monitored for PPRD, and provided with standardized respiratory management after discharge.

Objective:To introduce a surgical technique of " short distances and multi-segment" buried-guiding suture method and its effects in the surgery of early descent of prosthesis after augmentation mammaplasty.Methods:From August 2019 to January 2022, 15 cases of early descent of prosthesis after augmentation mammaplasty due to axillary approach breast augmentation for micromastia were admitted to the Plastic Surgery Department of Sichuan Provincial People′s Hospital, aged 23-35 years (27.3±3.6) and duration of dislocation from 16 to 35 days (23.8±5.8). There were 12 patients showed unilateral prosthesis drops and 3 patients showed bilateral prosthesis drops. " Short distances and multi-segment" buried-guiding suture method was used to solve the problem, i. e., 2-0 non-absorbable sutures were used to eliminate the lower pole of prosthetic cavity with " short distances and multi-segment" sutures. The distance from the nipple to the midline of the sternum, the distance from the sternotomy to the nipple, the distance from the nipple to the inframammary fold and the distance from the midclavicular point to the inframammary fold were measured bilaterally before and after surgery, and statistical analysis was performed to evaluate the efficacy of the " short distances and multi-segment" buried-guiding suture method for early descent of prosthesis after breast augmentation.Results:All incisions healed by first intention without complications such as hematoma, infection, or scar hyperplasia. 15 patients were followed up for 6-12 months (8.0±1.9). 14 patients were satisfied with the results after surgery, and 1 patient received satisfactory results after secondary surgery. The distance from nipple to inframammary fold was shortened by 0.8-1.4 cm after surgery (1.2±0.2), and the distance from mid-clavicle to inframammary fold was shortened by 1.0-1.6 cm (1.3±0.4), and the differences were statistically significant as compared with the values before surgery ( t=31.17, P<0.05; t=33.78, P<0.05). After surgery, the change in the distance from nipple to sternal was 0.1-0.3 cm (0.16±0.10), and the change in the distance from sternal notch to nipple was 0-0.2 cm (0.12±0.10), and the differences were not statistically significant ( P>0.05). Conclusions:With the advantages of simple operation, little trauma and no additional incision, the " short distance and multi-stage" buried-guiding suture method in the surgery of early descent of prosthesis after augmentation mammaplasty is worthy of clinical application.

Objective To evaluate the efficacy and safety of transcatheter arterial chemoembolization(TACE)followed by hepatic arterial infusion chemotherapy(HAIC)combined with TKI drugs and PD-1 inhibitors as the first-line treatment for advanced hepatocellular carcinoma(HCC).Methods We retrospectively analyzed the data of 70 patients with advanced HCC treated in the Department of Oncology of Guangdong Provincial Hospital of Integrated Traditional Chinese and Western Medicine between July,2020 and June,2023.23 of the patients received TACE combined with HAIC and TKI(TACE+HAIC+TKI group)and 47 received TACE combined with HAIC,PD-1 inhibitors and TKI(TACE+HAIC+PD-1+TKI group).The clinical characteristics,laboratory test results,efficacy,outcomes and adverse events of the patients were compared between the two groups.Results The TACE+HAIC+TKI and TACE+HAIC+PD-1+TKI groups had significantly different objective remission rates(ORR;60.87%vs 36.17%,P=0.031),comparable disease control rates(95.65%vs 93.62%,P=0.068),and different median progression-free survival(PFS)time(10.2 vs 11.8 months,P=0.003)and median overall survival(OS)time(15.7 vs 19.5 months,P=0.035).After propensity score matching(PSM),the median PFS and OS time of the two groups was 10.1 vs 14.5 months(P=0.024)and 14.2 vs 21.2 months(P=0.221),respectively.The 1-year PFS rates of the 2 groups were 24.0%vs 52.2%,and the 1-,2-and 3-year OS rates were 72.3%vs 93.1%,23.9%vs 63.8%,and 23.9%vs 36.5%,respectively.The incidence of proteinuria was significantly higher in TACE+HAIC+PD-1+TKI group than in TACE+HAIC+TKI group(21.28%vs 0,P=0.025),but the incidences of grade 3-4 treatment-related adverse events were all similar between the two groups.Conclusion The first-line treatment with TACE+HAIC+PD-1+TKI is safe and effective for advanced HCC and can significantly prolong the survival of the patients.

Objective To evaluate the efficacy and safety of transcatheter arterial chemoembolization(TACE)followed by hepatic arterial infusion chemotherapy(HAIC)combined with TKI drugs and PD-1 inhibitors as the first-line treatment for advanced hepatocellular carcinoma(HCC).Methods We retrospectively analyzed the data of 70 patients with advanced HCC treated in the Department of Oncology of Guangdong Provincial Hospital of Integrated Traditional Chinese and Western Medicine between July,2020 and June,2023.23 of the patients received TACE combined with HAIC and TKI(TACE+HAIC+TKI group)and 47 received TACE combined with HAIC,PD-1 inhibitors and TKI(TACE+HAIC+PD-1+TKI group).The clinical characteristics,laboratory test results,efficacy,outcomes and adverse events of the patients were compared between the two groups.Results The TACE+HAIC+TKI and TACE+HAIC+PD-1+TKI groups had significantly different objective remission rates(ORR;60.87%vs 36.17%,P=0.031),comparable disease control rates(95.65%vs 93.62%,P=0.068),and different median progression-free survival(PFS)time(10.2 vs 11.8 months,P=0.003)and median overall survival(OS)time(15.7 vs 19.5 months,P=0.035).After propensity score matching(PSM),the median PFS and OS time of the two groups was 10.1 vs 14.5 months(P=0.024)and 14.2 vs 21.2 months(P=0.221),respectively.The 1-year PFS rates of the 2 groups were 24.0%vs 52.2%,and the 1-,2-and 3-year OS rates were 72.3%vs 93.1%,23.9%vs 63.8%,and 23.9%vs 36.5%,respectively.The incidence of proteinuria was significantly higher in TACE+HAIC+PD-1+TKI group than in TACE+HAIC+TKI group(21.28%vs 0,P=0.025),but the incidences of grade 3-4 treatment-related adverse events were all similar between the two groups.Conclusion The first-line treatment with TACE+HAIC+PD-1+TKI is safe and effective for advanced HCC and can significantly prolong the survival of the patients.

Objective To investigate the correlation between serum vascular endothelial growth factor(VEGF),Cystatin C(CysC),and retinol-binding protein(RBP)levels and the pathology and prognosis of chronic glomerulonephritis(CGN).Methods A total of 102 patients with CGN diagnosed and treated between June 2020 and August 2022 were selected as study participants and assigned to the observation group,which was divided according to pathological types into the mesangial proliferative nephritis(MSPGN,n=35),mesangial capillary glomerulonephritis(MPGN,n=23),membranous nephropathy(MN,n=23),and focal segmental glomerulosclerosis(FSGS,n=17)groups.Healthy subjects(n=51)were selected as the control group.Changes in serum VEGF,CysC,and RBP levels were compared,and the correlation between VEGF,CysC,and RBP levels and pathological scores was analyzed using the Pearson method.All patients were followed up for 12 months and divided according to prognoses into a progression group(n=28)and no progression/remission group(n=74).The effects of VEGF,CysC,and RBP levels on the prognosis of patients with CGN were analyzed using Cox multifactor risk regression.The area under the curve(AUC),sensitivity,and specificity of VEGF,CysC,RBP,and the combined prognoses of patients with CGN were analyzed using a receiver operating characteristic(ROC)curve.Results The VEGF,CysC,and RBP levels were higher in the observation group than in the control group(P<0.05).The VEGF,and CysC,levels in the FSGS group were higher than those in the MSPGN,MPGN,and MN groups(P<0.05).The level of RBP in FSGS group was higher than that in MSPGN group(P<0.05).Pearson correlation analysis showed that VEGF,CysC,and RBP levels were positively correlated with the pathological scores(P<0.05).The VEGF,CysC,and RBP levels were higher in the progression group than in the no progression/remission group(P<0.05).Multivariate Cox regression analysis showed that increased VEGF,CysC,and RBP levels were risk factors for the prognosis of patients with CGN(P<0.05).The ROC curve analysis showed that the AUC values predicted by VEGF,CysC,RBP,and the combination of the three were 0.828,0.844,0.760,and 0.940,respectively(P<0.05);sensitivity was 75.00%,71.40%,57.10%,and 89.30%,respectively,and specificity was 93.20%,93.20%,95.90%,and 89.20%,respectively.Conclusion Serum VEGF,CysC,and RBP are highly expressed in patients with CGN,and high pathological scores are associated with increased levels,thus also affecting patient prognosis.

Objective:To investigate the predictive value of neutrophil/lymphocyte ratio (NLR) on the discharge outcome in elderly patients with acute ischemic stroke (AIS) receiving intravenous thrombolysis (IVT).Methods:Elderly patients with AIS received IVT in the Department of Neurology, the Second Affiliated Hospital of Soochow University from August 2018 to August 2020 were retrospectively included. The modified Rankin Scale was used to evaluate discharge outcome, and the score >2 was defined as poor outcome. Symptomatic intracranial hemorrhage (sICH) was defined as any intracranial hemorrhage found on imaging examination accompanied by neurological deterioration, where the National Institutes of Health Stroke Scale (NIHSS) score increased by ≥4 from baseline or bleeding led to death. Multivariate logistic regression analysis was used to determine independent risk factors for sICH and poor discharge outcome. Receiver operating characteristic (ROC) curves were used to analyze the predictive value of NLR for sICH and poor discharge outcome. Results:A total of 228 elderly patients with AIS receiving IVT were enrolled, including 118 males (51.8%), aged 73.64±8.16 years, with a baseline NIHSS score of 6.23±6.54. Ninety patients (39.5%) had poor outcome at discharge, and 16 (7.0%) developed sICH. Univariate analysis showed that the NLR in the poor outcome group was significantly higher than that in the good outcome group ( P<0.01). Multivariate logistic regression analysis showed that a higher NLR was an independent risk factor for poor discharge outcome (odds ratio [ OR] 1.245, 95% confidence interval [ CI] 1.044-1.484; P< 0.05) and sICH ( OR 1.124, 95% CI 1.010-1.251; P<0.05). ROC curve analysis showed that the area under the curve of NLR for predicting poor discharge outcome was 0.693 (95% CI 0.620-0.765; P<0.01). The optimal cutoff value was 4.345. Its corresponding sensitivity and specificity were 47.8% and 87.7%, respectively. The area under the curve of NLR for predicting sICH was 0.651 (95% CI 0.498-0.804; P<0.05). The optimal cutoff value was 3.515. Its corresponding sensitivity and specificity were 68.8% and 61.8%, respectively. Conclusions:A higher NLR is independently associated with sICH and poor discharge outcome in elderly patients with AIS receiving IVT, and have certain predictive value for sICH and poor discharge outcome.

Objective To study the pharmacokinetic characteristics of clobazam tablet in Chinese healthy subjects and evaluate the bioequivalence of test preparation(T)and reference preparation(R)under fasting or fed conditions.Methods A randomized,open-label,single-dose,two-period,two-way crossover bioequivalence trial was performed.34 healthy subjects were enrolled in fasting study and 30 in fed study.Each subjects received a single dose of T 20 mg or R 20 mg with a washout period of 28 days.Plasma concentrations of clobazam and its active metabolite,N-desmethylclobazam were determined by liquid chromatography-tandem mass spectrometry(LC-MS/MS).The pharmacokinetic parameters of clobazam and N-desmethylclobazam were calculated by non-compartment model.Geometric mean values for the T/R ratios of clobazam's main pharmacokinetic parameters and their corresponding 90 percent confidence intervals(CI)were evaluated to assess bioequivalence of the two preparations.Results In fasting study,the 90 percent CI of the geometric mean values for the T/R ratios were 94.46 to 103.82 percent for Cmax,99.64 to 103.62 percent for AUC0-tand 99.39 to 103.51 percent for AUC0-∞,respectively.In fed study,the 90 percent CI of the geometric mean values for the T/R ratios of were 93.86 to 106.02 percent for Cmax,100.37 to 104.51 percent for AUC0-tand 100.71 to 104.63 percent for AUC0-∞,respectively.Conclusion In this study,the 90 percent CI of the geometric mean values of Cmax,AUC0-tand AUC0-∞ for T/R ratios were all within the acceptable bioequivalence limits of 80 to 125 percent for clobazam.Therefore two formulations were considered bioequivalent.

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 an optimal surgical approach for different types of labia minora hypertrophy and to design a better personalized surgical treatment plan for patients.Methods:From October 2017 to October 2020, 71 patients with labia minora hypertrophy were treated in the plastic surgery department of Sichuan Provincial People＇s Hospital, aged 18-38 years, with an average of 26 years. According to the type and degree of hypertrophy, the appropriate surgical method was selected. The wound healing and complications were observed after operation, and the shape of labia minora was followed up.Results:Among the 71 patients, 1 patient had postoperative hematoma and no flap necrosis after active treatment. 1 patient had poor healing of distal labia minora incision and improved after dressing change. The other patients had good blood supply of labia minora, no necrosis, no postoperative infection, hematoma and other complications. The patients were followed up for 1-6 months. The appearance of labia minora was natural, bilateral symmetry, and the incision scar was hidden. The improvement was significant compared with that before operation. The patients were satisfied with the shape and function.Conclusions:According to the degree of hypertrophy of the labia minora, the specific shape and the psychological expectation of patients, we can choose the appropriate operation method, which can achieve the aesthetic standard of symmetry and beautiful shape of the labia minora, and meet the normal physiological function and aesthetic requirements of patients.

Objective:To discuss the application of free double-layered auriclar composite tissue flap (auriclar cartilage and the skin) in repairing the full-thickness nasal alar defects.Methods:The clinical data of the patients with unilateral full-thickness nasal alar defects who were admitted to the Department of Plastic Surgery of Sichuan Provincial People’s Hospital from June 2016 to December 2019 were analyzed. The free double-layered auricular composite grafts were harvested from the unilateral nasal cavity as the nasal lining and covered with pedicled skin flap. The survival of free double-layered auricular composite grafts and pedicled skin flap as well as the appearance of the reconstructed nasal alar were observed.Results:A total of 12 patients with unilateral full-thickness alar defect were included, including 4 females and 8 males, aged from 6 to 53 years old, with an average of 35.3 years old. The areas of the defects were 0.7 cm × 1.0 cm-2.0 cm × 2.6 cm, and the areas of double-layered auricular composite grafts(skin) were 0.8 cm × 1.0 cm-2.1 cm × 2.7 cm. All the 12 patients healed primarily. No necrosis or infection occurred in the double auricle composite tissue flap and pedicled skin flap. After the completion of the whole treatment, the reconstructed nasal alar with similar shape and function to the normal nasal alar was obtained. After the last operation, the patients were followed up for 3 months to 32 months, with an average of 15 months.Conclusions:The free double-layered auricular composite grafts breaks the area limitation of free transplantation of full-layer auricle composite tissue flap. The combined grafting with pedicled flap shortens the treatment duration with skin flap alone, and it is easier to obtain vivid nasal alar.