Objective: To investigate the incidence and trend of short-term outcomes among preterm infants born <34 weeks' gestation. Methods: A secondary analysis of data from the standardized database established by a multicenter cluster-randomized controlled study "reduction of infection in neonatal intensive care units (NICU) using the evidence-based practice for improving quality (REIN-EPIQ) study". This study was conducted in 25 tertiary NICU. A total of 27 192 infants with gestational age <34 weeks at birth and admitted to NICU within the first 7 days of life from May 2015 to April 2018 were enrolled. Infants with severe congenital malformation were excluded. Descriptive analyses were used to describe the mortality and major morbidities of preterm infants by gestational age groups and different admission year groups. Cochran-Armitage test and Jonckheere-Terpstra test were used to analyze the trend of incidences of mortality and morbidities in 3 study-years. Multiple Logistic regression model was constructed to analyze the differences of outcomes in 3 study-years adjusting for confounders. Results: A total of 27 192 preterm infants were enrolled with gestational age of (31.3±2.0) weeks at birth and weight of (1 617±415) g at birth. Overall, 9.5% (2 594/27 192) of infants were discharged against medical advice, and the overall mortality rate was 10.7% (2 907/27 192). Mortality for infants who received complete care was 4.7% (1 147/24 598), and mortality or any major morbidity was 26.2% (6 452/24 598). The incidences of moderate to severe bronchopulmonary dysplasia, sepsis, severe intraventricular hemorrhage or periventricular leukomalacia, proven necrotizing enterocolitis, and severe retinopathy of prematurity were 16.0% (4 342/27 192), 11.9% (3 225/27 192), 6.8% (1 641/24 206), 3.6% (939/25 762) and 1.5% (214/13 868), respectively. There was a decreasing of the overall mortality (P<0.001) during the 3 years. Also, the incidences for sepsis and severe retinopathy of prematurity both decreased (both P<0.001). However, there were no significant differences in the major morbidity in preterm infants who received complete care during the 3-year study period (P=0.230). After adjusting for confounders, infants admitted during the third study year showed significantly lower risk of overall mortality (adjust OR=0.62, 95%CI 0.55-0.69, P<0.001), mortality or major morbidity, moderate to severe bronchopulmonary dysplasia, sepsis and severe retinopathy of prematurity, compared to those admitted in the first study year (all P<0.05). Conclusions: From 2015 to 2018, the mortality and major morbidities among preterm infants in Chinese NICU decreased, but there is still space for further efforts. Further targeted quality improvement is needed to improve the overall outcome of preterm infants.
Bronchopulmonary Dysplasia/epidemiology* ; Gestational Age ; Humans ; Infant ; Infant Mortality/trends* ; Infant, Newborn ; Infant, Premature ; Infant, Premature, Diseases/epidemiology* ; Patient Discharge ; Retinopathy of Prematurity/epidemiology* ; Sepsis/epidemiology*

Humans ; Orgasm ; Sexual Dysfunction, Physiological/etiology* ; Syndrome

Objective: At present, though the laparoscopic delta-shaped anastomosis and overlapping delta-shaped anastomosis have been gradually applied to complete laparoscopic radical resection of left hemicolon cancer, the comparative evaluation of their efficacy has not been mentioned in the published literatures. This study aims to explore the safety, feasibility and short-term efficacy of overlapping delta-shaped anastomosis (ODA) in totally laparoscopic left hemicolectomy. Methods: A retrospective cohort study was performed. The clinical and pathological data of patients who underwent totally laparoscopic left hemicolectomy at Department of Colorectal Surgery, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College from May 2017 to October 2020 were retrospectively analyzed. The case inclusion criteria were as follows: (1) age of 18-75 years; (2) body mass index (BMI) of 18.5-30 kg/m(2); (3) descending colonic and proximal sigmoid colonic adenocarcinoma was confirmed by preoperative colonoscopy and pathology. The exclusion criteria: (1) multiple primary colorectal cancers; (2) uncontrolled or poorly controlled diabetes mellitus, immune system diseases, or hematological diseases; (3) severe intestinal obstruction; (4) left transverse colonic or splenic flexure colonic adenocarcinoma; (5) distant metastasis of liver, lung and other viscera determined by enhanced computed tomography in the chest, abdomen and pelvis. According to the above criteria, a total of 115 patients with left hemicolon cancer were enrolled. All the patients underwent totally laparoscopic left hemicolectomy. Patients who underwent laparoscopic traditional delta-shaped anastomosis were selected as the control group. Patients who underwent laparoscopic ODA were selected as the ODA group. Effects of these two laparoscopic reconstruction methods on postoperative recovery and perioperative complications were analyzed and compared. Results: A total of 60 patients were enrolled in the ODA group, including 32 males and 28 females, with mean age of (57.3±10.4) years and body mass index (BMI) of (25.0±3.1) kg/m(2). While mean 55 patients were enrolled in the control group, including 31 males and 24 females, with mean age of (56.7±9.9) years and BMI of (24.4±2.9) kg/m(2). There was no statistically significant differences between the two groups in gender, age, BMI, American Society of Anesthesiologist (ASA) classification, TNM staging, preoperative abdominal surgery history, neoadjuvant chemotherapy and nutritional status (levels of hemoglobin, lymphocyte count, prealbumin, and albumin) (all P>0.05). All the patients in both groups received R0 resection without conversion to open laparotomy or conversion to extra-abdominal anastomosis. The digestive tract reconstruction time of the ODA group was significantly shorter than that of the control group [(15.1±1.7) minutes vs. (15.9±2.4) minutes, t=-2.053, P=0.042]. There were no statistically significant differences in the total operation time, intraoperative blood loss, length of skin incision, tumor size, proximal and distal margins, harvested lymph nodes, postoperative first ambulatory time, and postoperative hospital stay (all P>0.05). However, the time to the first flatus and the first defecation in the ODA group was significantly shorter as compared to control group [(1.5±0.5) days vs. (1.7±0.5) days, t=-2.028, P=0.045; (3.1±0.6) days vs. (3.4±0.7) days, t=-2.095, P=0.039], indicating faster intestinal function recovery in patients with ODA. The morbidity of postoperative complication was 6.7% (4/60) in the ODA group and 7.3% (4/55) in the control group and no significant difference was found (χ(2)=0.016, P=0.898). Two cases of incision infection, 1 case of lung infection, and 1 case of intra-abdominal infection occurred in the ODA group, while 3 cases of lung infection and 1 case of intra-abdominal infection occurred in the control group. All these complications were resolved after conservative treatment, and no secondary operation was performed due to complications. Conclusion: Compared with the traditional delta-shaped anastomosis, ODA is associated with a faster recovery of postoperative intestinal function without increasing the morbidity of postoperative complications, and has the satisfactory short-term efficacy.
Adolescent ; Adult ; Aged ; Anastomosis, Surgical ; Colectomy ; Female ; Humans ; Laparoscopy ; Male ; Middle Aged ; Retrospective Studies ; Treatment Outcome ; Young Adult

OBJECTIVE: To explore the effect of multi-disciplinary team (MDT) in general hospitals on severe trauma patients. METHODS: This study reviewed the treatment of patients with severe trauma in trauma center of Peking University People's Hospital from March 2017 to April 2019. The baseline information: the patients' gender, age, injury mechanism, etc.; the start indicators: the Glasgow coma scale (GCS), trauma index (TI), injury severity score (ISS); the start related indicators: time for activation, time for MDT to arrive, time for CT scan, time for damage control surgery; patient treatment and prognosis: ICU (intensive care unit) length of stay, number of cured and discharged patients, number of dead cases, number of patients transferred to rehabilitation hospital, were all analyzed. It discussed the composition of MDT, the initiation scheme, the indicators of initiation of MDT for severe trauma, and analyzed the correlation between the application of MDT and the prognosis of patients. RESULTS: From March 2017 to April 2019, 112 trauma patients were treated by MDT in Peking University People's Hospital. There were 69 males and 43 females. The minimum age was 15 years, the maximum age was 89 years, most of them were 36-55 years old. The main injury mechanism was traffic accident injury. The GCS, TI, ISS were 13.0±2.9, 13.0±2.8, and 21.5±11.9, respectively. It took 3.7±0.8 minutes to start the call, 6.1±0.9 minutes for MDT personnel to arrive at the emergency rescue area, 23.8±3.0 minutes for fast CT and 92.6±15.4 minutes for injury control operation. All the hospitalized patients were treated effectively. ICU (Intensive care unit) hospitalization time was 12.6±6.7 days. 55 discharged patients were cured, 5 died (1 died of hemorrhagic shock, 4 died of severe brain injury) and 52 transferred to rehabilitation hospital. CONCLUSION The treatment of severe trauma patients by MDT in trauma center of general hospitals can greatly improve the ability and level of treatment of severe trauma patients, make up for the lack of treatment of severe trauma especially multiple trauma patients in large general hospitals, and improve the treatment effect of severe trauma patients. It provides a reference model for large general hospitals to treat patients with severe trauma and multiple trauma and for the construction of trauma centers.
Adult ; Emergency Service, Hospital ; Female ; Humans ; Injury Severity Score ; Intensive Care Units ; Male ; Middle Aged ; Patient Care Team ; Retrospective Studies ; Trauma Centers

OBJECTIVE: To study the clinical features of children with recurrent Kawasaki disease (KD). METHODS: PubMed, Web of Science, Embase, CNKI, Wanfang Med Online, and Weipu Data were searched for case-control studies on the clinical features of initial and recurrent KD. The articles were screened according to the inclusion and exclusion criteria. RevMan 5.3 software was used to perform the Meta analysis. Effect models were selected based on the results of heterogeneity test, and then pooled RESULTS: A total of 9 case-control studies were included, with 12 059 children with KD in total, among whom 206 children had recurrent KD (127 boys/61.7%; 79 girls/38.3%). The results of the Meta analysis showed that compared with the initial KD onset, the children with recurrent KD had a shorter duration of fever ( CONCLUSIONS Current evidence shows that children with recurrent KD tend to have a shorter duration of fever and a lower incidence of swelling of the hands and feet. KD recurrence is more common in boys. Current evidence does not show an increased risk of developing coronary artery lesions in children with recurrent KD.
Child ; Chronic Disease ; Coronary Vessels/pathology* ; Edema/etiology* ; Female ; Fever/etiology* ; Humans ; Male ; Mucocutaneous Lymph Node Syndrome/physiopathology* ; Recurrence

Objective To improve the load resistance ability of students in teenager aviation schools and carry out specialized training for the body situation and shape of students.Methods We selected students from 14 teenager aviation schools and measured their height,weight,and the circumferences of necks,chests,upper-arms,waists,hips,and thighs.We compared the data of these students from different areas and the parameters were analyzed statistically by correlation analysis.Results Totally 411 students from 6 southern schools and 403 students from northern schools were investigated.Their average body height,weight and body mass index (BMI) were (172.3 ± 4.39) cm,(62.7 ± 7.3) kg,and (21.1 ± 2.23)kg/m2 respectirely.Students from northern schools were taller and heavier than those from southern schools (P ＜ 0.05).There was no difference between students from northern and southern schools in BMI.Compared with the domestic average levels of height,weight and chest circumference of teenagers aged 14 to 17,students of teenager aviation schools were higher,but there was no difference in weight or chest circumference.The average circumferences of the chest,neck,left upper-arm,right upper-arm,waist,hip,left thigh and right thigh were (83.1 ± 5.06),(34.7 ±3.07),(25.2±2.33),(25.5 ±2.30),(73.4 ±6.73),(89.7 ±5.89),(50.1 ±5.22),and (50.2 ±5.27)cm,respectively.According to the data,students from northern schools had a bigger chest circumference and thigh circumference but a smaller neck circumference and upper-arms circumference than those from southern schools (P ＜ 0.05).The correlation coefficient between BMI and the circumferences of the chest,neck,left upper-arm,right upperarm,waist,hip,left thigh and right thigh was 0.2201,0.1066,0.2466,0.2499,0.2291,0.2149,0.2299,0.2264,respectively.All of them were statistically significant (P ＜ 0.0001).Conclusion Load resistance related parameters of students in teenager aviation schools are not different from the domestic levels,which points to the urgent need for load resistance ability training for these students.Some parameters vary between areas.BMI is positively related to those load resistance parameters.Based on regional variations and regularities found in this study,specialized load resistance ability training could be made more efficient.

OBJECTIVES: To observe the expression changes of hypoxia inducible factor-1α（HIF-1α） and vascular endothelial growth factor-A （VEGF-A） in rats with arrhythmias, and to explore the differences of the expression pattern in the two indicators of acute myocardial ischemia caused by arrhythmias and coronary insufficiency. METHODS: The arrhythmia was induced by CaCl₂, and the expression changes of HIF-1α and VEGF-A were detected by immunohistochemistry, Western blotting and real-time PCR within 6 h after the arrhythmia in rats. RESULTS: The expression of HIF-1α and VEGF-A showed diffuse in the myocardial tissue of rats died from arrhythmias. Both of them increased in the early arrhythmia, then decreased. Extensive myocardial ischemia happened at the beginning of arrhythmia occurrence and its range didn't expand with time. CONCLUSIONS The expressions of HIF-1α and VEGF-A in myocardium of the rats with arrhythmia can provide evidence for the differential diagnosis of acute myocardial ischemia caused by fatal arrhythmia and coronary insufficiency.
Animals ; Arrhythmias, Cardiac/metabolism* ; Hypoxia-Inducible Factor 1, alpha Subunit/metabolism* ; Myocardial Ischemia/metabolism* ; Myocardium/metabolism* ; Rats ; Vascular Endothelial Growth Factor A/metabolism*

Objective To study the difference effects on clearing-heat and drying-damp of root and stem leaves of Scutellaria baicalensis from different areas in Gansu province.Methods One hundred SD rats were randomly divided into ten groups,including blank group,model group,Scutellaria baicalensis from Longxi Ⅰ and Ⅱ groups,Weiyuan Ⅰ and Ⅱ groups,Zhangxian Ⅰ and Ⅱ groups,Minxian Ⅰ and Ⅱ groups,Ⅰ group means root and Ⅱ group means stem leaves,each group had ten rats.The blank group rats were given ordinary feed and saline(10 mL · kg-1) in the natural environment.Rats in other groups were given fat feed and white wine [Red Star Zhenpin Erguotou (56 °),5 mL · kg-1] once daily,and placed into manual climatic box for 21 days.On the 22th day,the coli (1 × 109/mL) were given once (10 μL · g-1),and enhancement of infection after 4 hours (5 μL · g-1).The animal models were given the roots and steams leaves of Scutellaria baicalensis decoction (10 g · kg-1) by once daily with 7 days.The rats were placed into natural environment and given ordinary feed.The syndrome performance of rats in each group were observed.The contents of serum and stomach-intestine interleukin-4 (IL-4),interferon-γ (IFN-γ),motilin(MTL),gastrin(GAS)in rats were detected by ELISA.Results With the treatment of the roots and steams leaves of Scutellaria baicalensis decoction,the serum contents of IL-4 and IFN-γ were (25.36--2.56),(703.53-± 29.36);(31.54.± 3.81),(810.90 ± 24.07);(26.88 ± 2.91),(679.02±30.72);(30.81 ±3.19),(802.44 ±20.69);(26.61 ±3.94),(702.90 ±14.86);(32.45 ±5.12),(815.36 ± 34.78);(27.06 ± 4.01),(685.66 ± 42.05);(31.76 ± 3.98),(808.95 ± 38.22) ng· L-1 respectively in each drugs group,which were obviously lower than that of model group with (38.09 ± 1.41),(1203.90 ± 32.24) ng· L-1 on contents of IL-4 and IFN-γ.The contents of GAS and MTL in serum were (34.14 ± 1.47),(475.82 ±7.80);(35.12 ±3.40),(436.25±18.24);(34.77 ±2.65),(475.04 ±28.79);(33.28 ±3.58),(447.81±8.26);(35.26 ±4.89),(473.09 ±28.64);(36.02 ±5.12),(440.52 ±23.55);(35.20 ±4.55),(478.58 ± 31.24);(34.88 ± 5.07),(438.08 ± 25.43)ng · L-1 respectively in each drugs group,which were obviously higher than that of model group with (28.61 ± 0.12),(404.16 ± 18.48)ng · L-1 on contents of GAS and MTL,all about with statistical difference (all P ＜0.05).Conclusion There was a significant effect on clearing-heat and drying-damp of root and stem leaves of Scutellaria baicalensis from different areas in Gansu province.

OBJECTIVETo explore whether fractional anisotropy (FA) value could be taken as a quantitative indicator for tracing and reexamining amyotrophic lateral sclerosis (ALS), and to analyze the correlation between FA value and integrative medical treatment.

METHODSTotally 18 ALS patients were recruited in this study. All patients received diffusion tensor imaging (DTI) using 3. OT (Propeller HD) MRI twice. Six regions of interest (ROI) were selected to measure FA values. Survival analyses were performed in 11 cases of end point events.

RESULTS(1) Three ROI (cerebral peduncle, posterior limb of internal capsule, and corona radiata) all indicated that FA value was the highest in patients with mild health status scale of amyotrophic lateral sclerosis (ALS/HSS). (2) There was statistical difference in the means of FA values in cerebral peduncle, posterior limb of internal capsule, and corona radiata of 18 cases between initial examination and reexamination (P < 0.01). (3) Kaplan-Meier survival curve showed the survival rate of ALS patients decreased as time went by, with the median survival time of 48 months.

CONCLUSIONSFA value was inversely proportional to the severity of ALS, the more severe, the lower FA values. FA value was an objective indicator for assessing the severity of ALS. ALS is an incurable disease till now. Integrative medical treatment might become one direction for ALS patients.