Objective:To explore the perioperative airway management and treatment of newborns with micrognathia and laryngomalacia. Methods:From January to December 2022, a total of 6 newborns with micrognathia and laryngomalacia were included. Preoperative laryngoscopy revealed concomitant laryngomalacia. These micrognathia were diagnosed as Pierre Robin sequences. All patients had grade Ⅱ or higher symptoms of laryngeal obstruction and required oxygen therapy or non-invasive ventilatory support. All patients underwent simultaneous laryngomalacia surgery and mandibular distraction osteogenesis. The shortened aryepiglottic folds were ablated using a low-temperature plasma radiofrequency during the operation. Tracheal intubation was maintained for 3-5 days postoperatively. Polysomnography（PSG） and airway CT examination were performed before and 3 months after the surgery. Results:Among the 6 patients, 4 required oxygen therapy preoperatively and 2 required non-invasiveventilatory support. The mean age of patients was 40 days at surgery. The inferior alveolar nerve bundle was not damaged during the operation, and there were no signs of mandibular branch injury such as facial asymmetry after the surgery. Laryngomalacia presented as mixed type: type Ⅱ+ type Ⅲ. The maximum mandibular distraction distance was 20 mm, the minimum was 12 mm, and the mean was 16 mm. The posterior airway space increased from a preoperative average of 3.5 mm to a postoperative average of 9.5 mm. The AHI decreased from a mean of 5.65 to 0.85, and the lowest oxygen saturation increased from a mean of 78% to 95%. All patients were successfully extubated after the surgery, and symptoms of laryngeal obstruction such as hypoxia and feeding difficulties disappeared. Conclusion:Newborns with micrognathia and laryngomalacia have multi-planar airway obstruction. Simultaneous laryngomalacia surgery and mandibular distraction osteogenesis are safe and feasible, and can effectively alleviate symptoms of laryngeal obstruction such as hypoxia and feeding difficulties, while significantly improving the appearance of micrognathia.
Humans ; Infant, Newborn ; Infant ; Micrognathism/surgery* ; Laryngomalacia/surgery* ; Treatment Outcome ; Mandible/surgery* ; Airway Obstruction/surgery* ; Intubation, Intratracheal ; Laryngeal Diseases ; Osteogenesis, Distraction ; Oxygen ; Retrospective Studies

Objective:To analyze the clinical characteristics and differences of inpatients who have been diagnosed with both cardiovascular and cerebrovascular diseases.The findings from this study will help medical professionals make informed decisions regarding diagnosis and treatment strategies for patients with coexisting cardiovascular and cerebrovascular diseases.Methods:This study included a total of 275 patients who were hospitalized in both the Neurology and Cardiology Departments of our hospital between January 2012 and December 2019.The study compared the treatment, hospitalization, and prognosis of the two departments using retrospective stratified analysis.Results:The majority of patients hospitalized in the Cardiology Department were diagnosed with circulatory system diseases(I00-I99), accounting for 92.0%(253 cases). In the Neurology Department, the main diagnoses were circulatory system diseases(I00-I99), nervous system diseases(G00-G99), symptoms and signs involving circulatory and respiratory systems, cognition, perception, emotional state and behavior(R00-R09, R40-R46), accounting for 69.8%(192 cases), 16.7%(46 cases)and 13.1%(36 cases), respectively.There was a significant difference in the distribution of diagnoses between the Cardiology and Neurology Departments( χ2=67.8, P<0.001). The Cardiology Department had a higher proportion of patients with 5 or more other diagnoses[153(55.6%) vs.59(21.5%)], while Neurology Department had a higher proportion of patients with 2-4 other diagnoses(64.0% vs.36.4%). When comparing the distribution of other diagnoses during hospitalization in the Cardiology Department, the proportion of patients with only one other diagnosis was higher in the first visit group of Neurology Department compared to those with two or more diagnoses, which was statistically significant( χ2=9.3, P=0.03). There was no statistical difference in hospitalization days between the two departments( χ2=2.2, P=0.14). Although there was a significant difference in patient outcomes, with a lower proportion of patients not recovering or dying in the Neurology Department( χ2=4.6, P=0.03), there was no significant difference in the interval between hospitalizations for the two groups(180 d, χ2=0.1, P=0.72; 90 d, χ2=1.8, P=0.18). Conclusions:The need for early prevention, diagnosis, and treatment of patients with both cardiovascular and cerebrovascular diseases is still a pressing concern.Exploring a combined diagnosis and treatment model for multiple diseases may prove useful in overcoming the limitations of the current single disease diagnosis and treatment approach.

Under the background that the family doctor teams undertake the evaluation function of long-term care insurance for the elderlies living at home, it is imperative to further improve the efficiency of its integrated aging-medical care by strengthening the management. The Huacao community health service center and Hongqiao community health service center in Minhang District of Shanghai explored the construction of a family doctor′s home-based aging care management path, a practice launched since February 2021. This path was mainly designed with the entry criteria, management requirements for various services and evaluation indicators, with a service path form formulated on such basis. The form covered three stages: that before the on-site service, that on the day of the on-site service and that after the on-site service. Each stage was subdivided into three dimensions: the work content of the main aging-medical care, the key works of family doctors and the key works of assistant nurses. The implementation of this management path can enable such teams to provide further refined, standardized and procedural aging-medical care services, avoid service delays, improve service quality and management efficiency, and improve the utilization efficiency of health resources.

Objective:To investigate the effects of obesity before pregnancy and excessive weight gain during pregnancy on the characteristics of offspring metabolism and the underlying mechanism.Methods:Pregnant women who delivered from April 2016 to December 2018 in Jiaxing Xiuzhou District Maternal and Child Health Hospital after providing written informed consent and their singleton newborns were considered for recruitment for this study. Finally, 2000 pregnant women and their newborns were included in this study. These pregnant women were divided into study control ( n = 1 576, normal body weight) and ( n = 424, overweight) groups according to their body mass before and during pregnancy. The levels of leptin, blood lipid, fasting blood glucose, fasting insulin, long form of leptin receptor (OB-Rb), suppressor of cytokine signaling 3 (SOCS3) gene expression, insulin resistance index, and insulin sensitivity index were compared between the control and study groups. Results:The body mass index before pregnancy and body mass during pregnancy in the study group were (30.91 ± 1.86) kg/m 2 and (21.25 ± 2.61) kg, respectively, which were significantly higher than those in the control group [(26.87 ± 1.05) kg/m 2, (14.57 ± 1.36) kg, t = 7.972, P = 0.013; t = 9.786, P = 0.001]. The levels of leptin, triglyceride, total cholesterol and low-density lipoprotein cholesterol in the study group were (1.23 ± 0.29) ng/mL, (0.65 ± 0.16) mmol/L, (1.40 ± 0.24) mmol/L, (0.76 ± 0.13) mmol/L, respectively, which were significantly higher than those in the control group [(0.63 ± 0.11) ng/mL, (0.38 ± 0.16) mmol/L, (1.13 ± 0.32) mmol/L, (0.56 ± 0.09) mmol/L, t = 7.701, P = 0.010; t = 7.329, P = 0.019; t = 5.734, P = 0.030; t = 9.387, P = 0.001]. The level of high-density lipoprotein cholesterol in the study group was significantly lower than that in the control group [(1.26 ± 0.17) mmol/L vs. (1.75 ± 0.26) mmol/L, t = 8.072, P = 0.008]. The expression of SOCS3 mRNA and OB-Rb mRNA in newborns from the study group was (1.44 ± 0.29) and (1.33 ± 0.39), respectively, which was significantly greater than that in the control group [(0.33 ± 0.19), (0.50 ± 0.21), t = 9.987, P < 0.001; t = 11.037, P < 0.001]. Fasting blood glucose and fasting insulin levels as well as insulin resistance index in the study group were (22.06 ± 3.94) mmol/L, (20.02 ± 4.61) mU/L, (19.79 ± 6.29) respectively, which were significantly higher than those in the control group [(11.73 ± 2.92) mmol/L, (13.31 ± 3.43) mU/L, (6.96 ± 2.52), t = 8.133, P = 0.001; t = 4.498, P = 0.027; t = 7.352, P = 0.002]. Insulin sensitivity index in the study group was significantly lower than that in the control group [(-6.07 ± 0.32) vs. (-4.98 ± 0.37), t = 8.244, P < 0.001]. Conclusion:Obesity before pregnancy and excessive weight gain during pregnancy will increase the expression of SOCS3 mRNA and further affect the expression of STAT3-SOCS3-leptin/insulin signaling pathway in offspring.

Objective:To explore the current situation and influencing factors of most prominent character strength among disabled elders.Methods:The study selected 228 disabled elders of Department of Geriatrics and Cardiovascular Department at a ClassⅡ Grade A general hospital in Shanghai as subjects by convenience sampling. The cross-sectional survey was carried out with the self-designed General Information Scale, Chinese Virtues Questionnaire-96 (CVQ-96) and Barthel Index (BI) and influencing factors were analyzed.Results:Among 228 disabled elders, there were 90 cases with character strength in affinity, 137 cases with character strength in vitality and one case with character strength in willpower. The most prominent character strength of disabled elders was vitality. Single factor analysis showed that there were statistical differences in the scores of vitality among disabled elders with different ages, education levels, use smart products or not, religious belief, relationships with spouse, social communications, overall life satisfaction, monthly income and with or without speech disorders ( t=5.562, 5.025, 10.551, -2.098, 4.047, 96.006, 11.094, 20.952, -2.196; P<0.05) . The independent influencing factors of vitality strength of character among disabled elders included the age> 85, education levels with high school or above, being able to use smart products, high frequencies of social communication as well as high level of overall life satisfaction with statistical differences ( P<0.05) . Conclusions:Those protective factors under the direction of character strength theory can provide a theoretical basis for related departments to perfect health policies of disable elders and build health assessment system of the aged.

Objective: To investigate the clinical characteristics, diagnosis, treatment and prognosis of therapy-related myeloid neoplasms (t-MNs) after successful treatment for acute promyelocytic leukemia (APL) . Methods: Clinical data of 4 patients, diagnosed as t-MNs secondary to APL at Hematology Hospital of Chinese Academy of Medical Sciences from October 2012 to January 2019, were collected retrospectively. T-MNs related literature was reviewed. Results: The 4 cases were all females, with the median age 42 (range 40-53) years old at the diagnosis of APL. Regarding the induction and consolidation regimens, 3 patients received all-trans retinoid acid (ATRA) and arsenic trioxide (ATO) combined with anthracycline/anthraquinone and/or cytosine. One patient only received ATRA and other auxiliary drugs. Alkylating agents were not administrated. The 4 patients developed t-MNs 40 to 43 months after complete remission (CR) of APL, including 1 case of therapy-related myelodysplastic syndrome (t-MDS) and 3 cases of acute myeloid leukemia (t-AML) . The PML-RARα fusion genes were all negative when t-MNs developed. The three patients with t-AML were treated with 3 to 4 re-induction regimens, one of whom underwent allogeneic hematopoietic stem cell transplantation (allo-HSCT) after complete remission (CR) . One patient with t-MDS received hypomethylating agents. After a median follow-up of 54.5 (48-62) months, 2 patients with t-AML died, the median overall survival after t-MN was 12 (5-18) months. From 1989 to 2018, a total of 63 t-MN cases were reported in the literature. Therefore, 67 cases were analyzed when four patients in our center were added, including 27 males and 40 females with median age 52.5 (15-76) years. The median latency was 39 (12-126) months and the median overall survival after diagnosis of t-MN was 10 (1-39) months. Conclusions Although rare, t-MNs may occur after successful control of APL. There are no existing guidelines for prevention and treatment of t-MNs, which have very poor prognosis. If cytopenia or other abnormalities of peripheral blood cells develop after 3 years of APL, t-MNs should be considered as a differential diagnosis.

Objective: To observe the clinical effect of traditional Chinese medicine enema combined with rhubarb acupoint in the treatment of severe acute pancreatitis(SAP) complicated with paralytic ileus. Methods: A total of 60 SAP patients complicated with paralytic ileus treated in the First People's Hospital of Huzhou from June 2015 to June 2017 were selected and randomly divided into two groups by random lottery method, with 30 cases in each group.The two groups were treated with routine anti-infection and rehydration.The control group was treated with traditional Chinese medicine enema combined with placebo, and the observation group was treated with traditional Chinese medicine enema combined with rhubarb on Shenque acupoint, and the two groups were treated for 7d.The recovery time of blood amylase, bowel sounds recovery time, first self defecation time, local complications and mortality were observed in the two groups. Results: The recovery time of blood amylase, the recovery time of intestinal sound and the time of the first defecation were (8.87±2.30)d, (2.88±1.09)d and (3.51±1.32)d, respectively, which were significantly shorter than those of the control group [(10.29±2.01)d, (3.67±1.30)d and (4.57±1.41)d], the differences were statistically significant(t=-3.601, -3.607, -4.251, all P<0.001). The incidence rate of local complications in the observation group was 6.7%(2/30), which was significantly lower than 36.7%(11/30) in the control group(χ²=16.875, P<0.001), and there was no statistically significant difference in the mortality rate between the two groups(χ²=3.333, P=0.068). Conclusion The application of Chinese medicine enema combined with the acupoint of rhubarb in the treatment of SAP patients complicated with paralytic ileus can effectively promote the recovery of intestinal peristalsis, shorten the duration of paralytic intestinal obstruction, reduce the complications and improve the clinical effect.

Objective:To establish the uncertainty evaluation method for total aerobic microbial count of Jingfang granule. Meth-ods:According to Chinese Pharmacopoeia (2015 edition, volume IV), the total aerobic microbial count of 20 samples of the same batch of Jingfang granule was detected. National specification of measuring instruments JJF1059.1-2012 was used to perform the uncer-tainty evaluation on the total count of aerobic microbial type A and type B,and the combined uncertainty and the extended uncertainty were calculated. SPSS statistics 19.0 software was used to analyze the normal distribution of data. Results:The combined standard was 0.043 9, the expanded measurement uncertainty was 0.088(k=2),the colony distribution range of the samples was 690-1 000 cfu· g-1,and the data was normal distribution. Conclusion:The established method for uncertainty assessment is simple and convenient, and the results of new test samples can be added. New range of uncertainty can be obtained by recalculating the standard deviation of the combined samples.

Objective To analyze the related risk factors of functional intestinal obstruction in general surgical patients and to discuss the feasible nursing and prevention measures. Methods The clinical data of totally 658 patients after abdominal surgery who received open abdominal surgery in the Department of General Surgery of the First People's Hospital of Huzhou in Zhejiang Province from January 2015 to January 2017 were retrospectively analyzed. These patients were divided into the intestinal obstruction group and the non-intestinal obstruction group based on the occurrence of postoperative functional intestinal obstruction. The single factor analysis was then conducted over the age, gender, operation time, anesthesia, postoperative analgesic use (opioids and non-opioids), abdominal operation history, smoking history, alcohol drinking history, diabetes mellitus history and history of hypertension; and Logistic regression analysis was also performed on the influencing factors to determine the impact of functional intestinal obstruction in patients who received open abdominal surgery. Results Totally 47 out of the 658 patients receiving open abdominal surgery developed functional intestinal obstruction, with an incidence of 7.14%. The univariate analysis showed that there were statistically significant differences between the two groups in gender, age, operation time, postoperative analgesic use, history of abdominal surgery and history of diabetes mellitus (P<0.05). According to the multivariate Logistic regression analysis, gender, age, operation time, history of abdominal surgery and history of diabetes were the risk factors of postoperative functional intestinal obstruction (P<0.01). Conclusions The relevant risk factors for postoperative functional intestinal obstruction in general surgical patients after abdominal surgery include gender, age, operation time, history of abdominal surgery and diabetes mellitus. Corresponding nursing and prevention measures should be taken according to the relevant risk factors of patients.

Objective To study and analysis the effect of different doses of sodium phosphate solution in bowel preparation for colorectal treatment in children. Methods 100 patients who underwent colonoscopic polypectomy treated in our hospital from February 2015 to September 2016 were randomly divided into group A and group B, each group of 50 patients each. A group was treated with 2 bottles of cleansing liquid heating boiling water, B group were treated with 1 bottles of cleansing liquid heating boiling water. The therapeutic effects of the experimental group and the control group were compared and analyzed. Results The tolerance of group B was 78.0%, significantly better than that of group A(50.0%), and the difference was statistically significant (P<0.05). The incidence of adverse reactions in group B was 24.0%, significantly lower than that in group A (60.0%), and the difference was statistically significant (P<0.05). In group B, cleanliness was common in 1 patients and poor in cleanliness in 3 patients. In the A group, 1 patients had poor cleanliness and 2 patients had general cleanliness. There was no significant difference between the two groups. Conclusion 1 bottles of sodium phosphate in intestinal cleaning colorectal bowel preparation effect is good, low incidence rate of adverse reaction, greatly improve the intestinal cleanliness, with further clinical promotion and application significance.