Objective:To determine the predictive value of high-frequency ultrasonography for necrotizing enterocolitis (NEC) requiring surgical treatment in neonates.Methods:From January 2018 to December 2021, neonates diagnosed with NEC (Bell stage Ⅱ and above) in our hospital were retrospectively analyzed. The neonates were assigned into surgical group and non-surgical group according to the treatment. The following ultrasonography results were compared between the two groups: intestinal motility, gastrointestinal (GI) wall perfusion, pneumatosis intestinalis (PI), portal vein gas, peritoneal effusion translucency, depth of ascites fluid and GI wall thickness. Logistic regression was used to determine risk factors of surgical treatment for NEC. ROC curve was drawn to calculate the predictive value of combined and individual factors for NEC requiring surgical treatment.Results:A total of 40 neonates were enrolled, including 18 in the surgical group and 22 in the non-surgical group. No significant differences existed between the two groups in PI and depth of ascites fluid ( P>0.05). The surgical group had higher incidences of decreased intestinal motility, portal vein gas, reduced GI wall perfusion, poor peritoneal effusion translucency and thinner GI wall than the non-surgical group (all P<0.05). Logistic regression analysis showed that poor translucency of peritoneal effusion, thinning of GI wall, reduced GI wall perfusion and decreased intestinal motility were risk factors for surgical treatment of NEC. ROC curve showed that the cut-off value predicting surgical treatment based on GI wall thickness was 1.2 mm, with an area under the curve (AUC) of 0.746, sensitivity of 87.5% and specificity of 65.6%. The AUC of the combined factors predicting surgical treatment was 0.867, with sensitivity of 96.9% and specificity of 75.8%. Conclusions:Decreased intestinal motility and GI wall perfusion, thinning of GI wall and poor peritoneal effusion translucency on high-frequency ultrasonography have high predictive efficacy for the need of surgical treatment in the acute phase of NEC.

Objective:To investigate the early clinical characteristics of elderly patients with severe burns and the risk factors on prognosis.Methods:This study was a retrospective case series study. Clinical data of 124 elderly patients with severe burns who met the inclusion criteria and were admitted to the 12 hospitals from January 2015 to December 2020 were collected, including 4 patients from the Fourth People's Hospital of Dalian, 5 patients from Fujian Medical University Union Hospital, 22 patients from Guangzhou Red Cross Hospital of Jinan University, 5 patients from Heilongjiang Provincial Hospital, 27 patients from the First Affiliated Hospital of Naval Medical University, 9 patients from the First Affiliated Hospital of Nanchang University, 10 patients from Affiliated Hospital of Nantong University, 9 patients from Tongren Hospital of Wuhan University & Wuhan Third Hospital, 12 patients from the 924 th Hospital of PLA, 6 patients from Zhangjiagang First People's Hospital, 4 patients from Taizhou Hospital of Zhejiang Province, and 11 patients from Zhengzhou First People's Hospital. The patients' overall clinical characteristics, such as gender, age, body mass index, total burn area, full-thickness burn area, inhalation injury, causative factors, whether combined with underlying medical diseases, and admission time after injury were recorded. According to the survival outcome within 28 days after injury, the patients were divided into survival group (89 cases) and death group (35 cases). The following data of patients were compared between the two groups, including the basic data and injuries (the same as the overall clinical characteristics ahead); the coagulation indexes within the first 24 hours of injury such as prothrombin time (PT), activated partial thromboplastin time (APTT), thrombin time, D-dimer, fibrinogen degradation product (FDP), international normalized ratio (INR), and fibrinogen; the blood routine indexes within the first 24 hours of injury such as white blood cell count, platelet count, neutrophil-to-lymphocyte ratio, monocyte count, red blood cell count, hemoglobin, and hematocrit; the organ function indexes within the first 24 hours of injury such as direct bilirubin, total bilirubin, urea, serum creatinine, aspartate aminotransferase, alanine aminotransferase, total protein, albumin, globulin, blood glucose, triglyceride, total cholesterol, alkaline phosphatase, creatine kinase, electrolyte indexes (potassium, sodium, chlorine, calcium, magnesium, and phosphorus in blood), uric acid, myoglobin, and brain natriuretic peptide; the infection and blood gas indexes within the first 24 hours of injury such as procalcitonin, C-reactive protein, pH value, oxygenation index, base excess, and lactate; treatment such as whether conducted with mechanical ventilation, whether conducted with continuous renal replacement therapy, whether conducted with anticoagulation therapy, whether applied with vasoactive drugs, and fluid resuscitation. The analysis was conducted to screen the independent risk factors for the mortality within 28 days after injury in elderly patients with severe burns. Results:Among 124 patients, there were 82 males and 42 females, aged 60-97 years, with body mass index of 23.44 (21.09, 25.95) kg/m 2, total burn area of 54.00% (42.00%, 75.00%) total body surface area (TBSA), and full-thickness burn area of 25.00% (10.00%, 40.00%) TBSA. The patients were mainly combined with moderate to severe inhalation injury and caused by flame burns. There were 43 cases with underlying medical diseases. The majority of patients were admitted to the hospital within 8 hours after injury. There were statistically significant differences between patients in the 2 groups in terms of age, total burn area, full-thickness burn area, and inhalation injury, and PT, APTT, D-dimer, FDP, INR, white blood cell count, platelet count, urea, serum creatinine, blood glucose, blood sodium, uric acid, myoglobin, and urine volume within the first 24 hours of injury (with Z values of 2.37, 5.49, 5.26, 5.97, 2.18, 1.95, 2.68, 2.68, 2.51, 2.82, 2.14, 3.40, 5.31, 3.41, 2.35, 3.81, 2.16, and -3.82, respectively, P<0.05); there were statistically significant differences between two groups of patients in whether conducted with mechanical ventilation and whether applied with vasoactive drugs (with χ2 values of 9.44 and 28.50, respectively, P<0.05). Age, total burn area, full-thickness burn area, serum creatinine within the first 24 hours of injury, and APTT within the first 24 hours of injury were the independent risk factors for the mortality within 28 days after injury in elderly patients with severe burns (with odds ratios of 1.17, 1.10, 1.10, 1.09, and 1.27, 95% confidence intervals of 1.03-1.40, 1.04-1.21, 1.05-1.19, 1.05-1.17, and 1.07-1.69, respectively, P<0.05). Conclusions:The elderly patients with severe burns had the injuries mainly from flame burns, often accompanied by moderate to severe inhalation injury and enhanced inflammatory response, elevated blood glucose levels, activated fibrinolysis, and impaired organ function in the early stage, which are associated with their prognosis. Age, total burn area, full-thickness burn area, and serum creatinine and APTT within the first 24 hours of injury are the independent risk factors for death within 28 days after injury in this population.

Humans ; Sarcoma, Synovial/diagnostic imaging* ; Infratemporal Fossa ; Tomography, X-Ray Computed

Humans ; Solitary Fibrous Tumors/pathology* ; Neck/pathology* ; Head/pathology*

Objective:To compare and analyze the ultrasonic images between intestinal involvement in Kawasaki disease (IIKD) and abdominal type allergic purpura (ATAP), so as to improve the understanding of IIKD.Methods:From July 2014 to January 2020, the ultrasonographic images of 21 children with IIKD and 24 children with ATAP in Tianjin Children′s Hospital were collected and analyzed.Results:Univariate analysis showed that there were significant differences between IIKD group and ATAP group in non stratified thickening of intestinal wall, decreased echo of serosa and adjacent mesentery (irregular shape), thickening of peripheral fat tissue and abnormal shape of adjacent lymph nodes (all P<0.05); Multivariate analysis showed that decreased echo of serosa and adjacent mesentery (irregular shape) were independent influencing factors of IIKD. The area under ROC curve was 0.914(95% CI=0.819-1.000, P<0.001). The sensitivity and specificity of IIKD were 95.2% and 87.5%, respectively. Conclusions:The ultrasonographic images of intestinal involvement in IIKD and ATAP have certain specificity. Decreased echo of serosa and adjacent mesentery (irregular shape) can effectively distinguish IIKD and ATAP.

Objective:To investigate and compare the value of cross-sectional area measurement and width measurement by high frequency ultrasound in the diagnosis of congenital adrenal hyperplasia (CAH) in infants.Methods:The abdominal ultrasound images of 20 infants who were diagnosed as CAH in Tianjin Children′s Hospital and clinical diagnosised from November 2013 to August 2018 were analyzed retrospectively. The maximum cross-sectional area of adrenal gland and the maximum width of single limb were measured respectively to assess the size of adrenal gland. Fifty normal full-term infants were selected as control group at the same period. The differences of maximum cross-sectional area of adrenal gland, the maximum width of single limb between CAH group and control group were compared. ROC curve was plotted to compare the diagnostic values of cross-sectional area measurement and width measurement.Results:①There was significant difference in maximum cross-sectional area of adrenal gland between infants with CAH and normal infants[(129.47±37.39)mm 2 vs (54.42±20.85)mm 2; t=10.004, P<0.001]. There was significant difference in maximum width of adrenal gland between infants with CAH and normal infants [(4.56±1.20)mm vs (3.25±0.66)mm; t=5.445, P<0.001]. ②The area under ROC curve(AUC) of cross-sectional area measurement was 0.966, the best cutoff value was 87.5 mm 2, the sensitivity was 95.0%, and the specificity was 92.5%. AUC of width measurement was 0.817, the best cutoff value was 5.25 mm, the sensitivity was 90.0%, and the specificity was 62.5%. The difference of AUC between cross-sectional area measurement and width measurement was 0.149, which was statistically significant ( Z=2.309, P=0.021). Conclusions:Both cross-sectional area measurement and width measurement by high frequency ultrasound have diagnostic values for CAH in infants, with the former more valuable than the latter.

To disscuss the role of cross‐sectional area measurement under high frequency ultrasound in the diagnosis of congenital adrenal hyperplasia ( CA H ) in infants . Methods T he abdominal ultrasound images of 20 infants with CA H w hich were admitted to our hospital and clinical diagnosised from November 2013 to August 2018 were analyzed retrospectively . T he size of adrenal glands were evaluated by measuring the maximum cross‐sectional area .Fifty normal full‐term infants were selected as control group synchronism . T he size of adrenal glands between infants with CA H and normal infants were compared . T he area under the curve ( AUC ) and best cutoff value were obtained by drawing ROC curve .Sensitivity and specificity were also obtained . Results T here was significant difference in maximum cross‐sectional area of adrenal gland between CA H group and control group[ ( 129 .70 ± 37 .34) mm2 vs ( 54 .41 ± 20 .84) mm2 , t ＝10 .004 , P ＝0 .001] . T he AUC of cross‐sectional area measurement was 0 .966 ,and best cutoff value was 87 .5 mm2 . T he sensitivity and specificity were 95 .0% and 92 .5% . Conclusions High‐frequency ultrasound is convenient and accurate in measuring the maximum cross‐sectional area of adrenal gland in infants . Cross‐sectional area measurement has high sensitivity and specificity to the diagnosis of CA H . T he presence of CA H is highly suspected w hen the area of adrenal gland reached 87 .5 mm2 .

OBJECTIVE:To observe the effects of dexmedetomidine combined with ulinastatin on stress reaction indexes,ex-travascular lung water value(EVLW)and pulmonary vascular permeability indexes(PVPI)and other parameters in one-lung venti-lation(OLV)lobectomy patients. METHODS:A total of 80 patients underwent OLV lobectomy selected from the Affiliated Hospi-tal of Southwest Medical University during Nov. 2015-Nov. 2016 were divided into control group (group N),ulinastatin pretreat-ment group(group U),dexmedetomidine continuous pump group(group D),ulinastatin pretreatment+dexmedetomidine continu-ous pump group(group U+D),with 20 cases in each group. Thirty min before anesthesia induction,all patients were given atro-pine sulfate 0.5 mg intramuscularly and received catheterization of right internal jugular vein and ipsilateral femoral artery under lo-cal anesthesia. Based on that,group N was given 0.9％ Sodium chloride injection 100 mL intravenously;group U was given sodi-um chloride mixed solution 100 mL containing Ulinastatin for injection 200000 U intravenously;group D was given continuous in-travenous pump of Dexmedetomidine hydrochloride injection 2 μg/mL mixed with sodium chloride mixed solution at 1 μg/(kg·h), and after induction intravenous pump at 0.5 μg/(kg·h)until the end of surgery;group U+D was given Sodium chloride mixed so-lution containing 200000 U ulinastatin 50 mL and 4 μg/mL dexmedetomidine sodium chloride mixed solution 50 mL intravenously (same dose as above during induction period and maintenance period). The levels of blood glucose,partial pressure of oxy-gen [p(O2)],adrenocorticotropic hormone (ACTH),norepi-nephrine (NE),heart rate (HR),cardiac output (CO),sys-temic vascular resistance(SVR),EVLW and PVPI were com-pared among 4 groups 30 min before anesthesia induction(T1),2 h after the beginning of surgery(T2),immediately after extuba-tion(T3)and 12 h after surgery(T4). Liquid intake and output volume were recorded during T2-T4. The occurrence of ADR among 4 groups was observed. RESULTS:There was no statistical significance in each index among 4 groups at T1 (P>0.05). During T2-T4,the levels of blood glucose,ACTH,NE,SVR,EVLW and PVPI in group N were significantly higher than other 3 groups, and group U and D were significantly higher than group U+D,with statistical significance(P<0.05);there was no statistical sig-nificance between U and D(P>0.05). The levels of p(O2)and CO in groups U+D were significantly higher than other 3 groups, with statistical significance (P<0.05);there was no statistical significance among other 3 groups (P>0.05). HR of group N and U were significantly higher than other 2 groups,with statistical significance (P<0.05). There was no statistical significance be-tween group N and U,between group D and U+D(P>0.05). There was no statistical significance in liquid intake or output vol-ume among 4 groups (P>0.05). No obvious ADR was found in 4 groups. CONCLUSIONS:Dexmedetomidine combined with ulinastatin can significantly relieve stress reaction,and reduce the levels of part blood flow and respiratory dynamics indexes as EV-LW,PVPI in patients with OLV lobectomy so as to play lung protective effect.

Objective To verify the feasibility and effectiveness of modified gastric bypass surgery in the treatment of non-obese type 2 diabetic mellitus(T2DM ) GK rats .Methods Forty male GK rats were randomly divided into four groups (n=10) ,the group A served as the modified gastric bypass ,group B as the Roux-en-Y gastric bypass ,group C as the sham operation and group D as the blank control group .Fasting blood glucose(FBG) ,glycosylated hemoglobin(HbA1c) and fasting serum insulin(FINS) in each group were detected at preoperative 1 week ,postoperative 1 ,2 ,4 ,8 ,12 weeks .Results The rat body mass at postoperative 1 week in the group A and B was significantly decreased compared with the group D ,and began to recover at postoperative 4 weeks , the rat body mass at the same time point had no statistical difference between the group A and B (P>0 .05) .FPG ,FINS and HbA1c at preoperative 1 week had no statistical difference among various groups (P>0 .05) .FPG and FINS at postoperative 1 week had no statistical difference among various groups (P>0 .05) .FPG and FINS at postoperative 2 ,4 ,8 ,12 weeks had no statistical difference between the group A and B(P>0 .05) ,which had no statistical difference between the group A with the group C and D (P>0 .05) . HbA1c at postoperative 4 weeks had no statistical difference among various groups (P>0 .05);which at postoperative 12 weeks had no statistical difference between the group A and B (P>0 .05) ,while which had no statistical difference between the group A with the group C and D(P>0 .05) .Conclusion The modified gastric bypass surgery has the improvement effect on glycometabolism of rat non-obese T2DM ,which is similar to that of Roux-en-Y gastric bypass surgery .