BackgroundThe mental health level of the prison police is relatively low， so finding innovative ways to improve the mental health of them is of great significance for the safety of prison supervision and the implementation of peaceful China initiative. ObjectiveTo explore the relationship between perceived social support， perceived stress and psychological resilience with mental health of prison police， and to provide references for improving their mental health. MethodsIn March 2022， 424 policemen working in a male prison in a western province were selected by cluster sampling method， and investigated with the Perceived Social Support Scale （PSSS）， Chinese Perceived Stress Scale （CPSS）， Connor-Davidson Resilience Scale （CD-RISC） and General Health Questionnaire 20 （GHQ-20）， then Process 4.2 was used employed to verify the mediating role of perceived stress as well as the moderating role of psychological resilience in the relationship between perceived social support and mental health. Results①Male subjects scored higher on GHQ-20 than female subjects （t=2.095， P<0.05）. ②CPSS score was negatively correlated with PSSS and GHQ-20 scores （r=-0.670， -0.703， P<0.01）， and GHQ-20 score showed a positive correlation with PSSS and CD-RISC scores （r=0.580， 0.693， P<0.01）. ③Perceived social support positively predict mental health （β=0.154， 95% CI： 0.133~0.175， P<0.01）. ④Perceived stress played a mediating role in the relationship between perceived social support and mental health， and the mediation effect size was 0.087， accounting for 88.78% of the total effect （95% CI： 0.064~0.112， P<0.01）. ⑤Psychological resilience played a moderating role in the second half （perceived stress→mental health） of the mediating path of "perceived social support→perceived stress→mental health"（β=0.074， 95% CI： 0.046~0.102， P<0.01）. ⑥Psychological resilience also regulated the mediation effect of perceived stress on the relationship between perceived social support and mental health ［three regression coefficients tested in turn are significant： a=-0.537 （95% CI： -0.594~-0.480， P<0.01）， b1=-0.162 （95% CI： -0.197~-0.127， P<0.01）， b3=0.074 （95% CI： 0.046~0.102， P<0.01）］. ConclusionPerceived social support of prison police has an impact on their mental health both directly and indirectly through perceived stress. In addition， perceived social support of prison police has a moderated mediation effect on mental health， and it is partially moderated by psychological resilience.［ Funded by General Project of Sichuan Prison Administrative Bureau in 2022］

Objective:To evaluate the value of the indocyanine green lymphography in diagnosing cystic lymphatic malformations (cLM) in children.Methods:Between October 2019 and August 2020, patients with cLM were treated in the Department of Burns and Plastic Surgery of Children’s Hospital of Nanjing Medical University. After preoperative intracutaneous and subcutaneous injection of indocyanine green, a near-infrared fluorescence imaging system was performed to observe the lymph flow. The number, morphology, contraction frequency of afferent lymph vessels, as well as dermal backflow, were recorded.Results:Thirty-two cases of cLM were enrolled in this study. The male-to-female ratio was 18∶14, with age ranging from 3 months to 8 years. All cLMs were histologically categorized as macro-cystic (16 cases), micro-cystic (six cases), and mixed-cystic (ten cases). Only one afferent lymph vessel was detected in most of the macro-cystic cases (14/16) and mixed-cystic cases (8/10), while all micro-cystic cases (6/6) had more than two inflows. The afferent lymph vessel in macro-cystic cases and mixed-cystic cases demonstrated the normal structure. In contrast, the inflow vessels in micro-cystic LM were tortuous and small, and a dermal backflow was recorded in one case. The contraction frequency of the afferent lymphatic vessels ranged from 0.40 to 1.50 times per min, with an average of 0.80 times per min. Another two cases were confirmed not lymphangiogenic by indocyanine green lymphography and postoperative pathology.Conclusions:Indocyanine green lymphography renders a reliable, safe, and useful approach for diagnosing cLM. The application of this technique is considered effective for exploring the cLM pathogenesis, evaluation of differential diagnosis, and appropriate selection of surgical intervention.

Objective:To evaluate the value of the indocyanine green lymphography in diagnosing cystic lymphatic malformations (cLM) in children.Methods:Between October 2019 and August 2020, patients with cLM were treated in the Department of Burns and Plastic Surgery of Children’s Hospital of Nanjing Medical University. After preoperative intracutaneous and subcutaneous injection of indocyanine green, a near-infrared fluorescence imaging system was performed to observe the lymph flow. The number, morphology, contraction frequency of afferent lymph vessels, as well as dermal backflow, were recorded.Results:Thirty-two cases of cLM were enrolled in this study. The male-to-female ratio was 18∶14, with age ranging from 3 months to 8 years. All cLMs were histologically categorized as macro-cystic (16 cases), micro-cystic (six cases), and mixed-cystic (ten cases). Only one afferent lymph vessel was detected in most of the macro-cystic cases (14/16) and mixed-cystic cases (8/10), while all micro-cystic cases (6/6) had more than two inflows. The afferent lymph vessel in macro-cystic cases and mixed-cystic cases demonstrated the normal structure. In contrast, the inflow vessels in micro-cystic LM were tortuous and small, and a dermal backflow was recorded in one case. The contraction frequency of the afferent lymphatic vessels ranged from 0.40 to 1.50 times per min, with an average of 0.80 times per min. Another two cases were confirmed not lymphangiogenic by indocyanine green lymphography and postoperative pathology.Conclusions:Indocyanine green lymphography renders a reliable, safe, and useful approach for diagnosing cLM. The application of this technique is considered effective for exploring the cLM pathogenesis, evaluation of differential diagnosis, and appropriate selection of surgical intervention.

Objective:To investigate the effect of continuous Z-flaps combined with scar debulking in correcting hyperplastic scar contracture deformity of children′s hand.Methods:From January 2016 to December 2018, 27 cases of children with scar contracture deformity after hand burn or scald were admitted to the Department of Burn and Plastic Surgery of Children′s Hospital of Nanjing Medical University, involving a total of 36 joint parts. 12 male patients and 15 female patients aged 10 months to 12.5 years were divided into mild, moderate and severe types according to the contracture angle of metacarpophalangeal joints and interphalangeal joints, so as to make the treatment plan. The transposition of flaps for wound closure was designed for both mild and moderate cases after continuous Z-flaps to release contracture deformity with scar debulking. For severe deformity, the transposition of flaps should be conducted to cover the wound after the complete release by continuous Z-flaps and scar debulking, and the residual wound was covered by free skin grafts. The hand function and appearance were followed up after operation.Results:In this study, 12 of the 36 joints were mildly deformed, 15 were moderately deformed, and 9 were severely deformed. No skin grafting was performed for mild and moderate deformities, and the amount of skin grafting was selectively reduced for severe deformities. All contracture joint deformities were completely corrected, with the follow-up period of 0.8-2.0 years, and no contracture deformities were found again. The hand joint function, skin flap color, texture of mild and moderate types were close to the surrounding normal skin. Severe type had only a small degree of pigmentation at the skin graft site. One 12.5-year-old child received second procedure 2 years later because of the poor elasticity of the skin graft and the tensions. The tension resolved after operation, with satisfactory results.Conclusions:Continuous Z-flaps combined with scar debulking could maximize the retention of skin of the scar surface and reduce the amount of skin grafts, providing an excellent method for the treatment of hand contracture deformities in children, with stable long-term postoperative effects.

Objective:To investigate the effect of continuous Z-flaps combined with scar debulking in correcting hyperplastic scar contracture deformity of children′s hand.Methods:From January 2016 to December 2018, 27 cases of children with scar contracture deformity after hand burn or scald were admitted to the Department of Burn and Plastic Surgery of Children′s Hospital of Nanjing Medical University, involving a total of 36 joint parts. 12 male patients and 15 female patients aged 10 months to 12.5 years were divided into mild, moderate and severe types according to the contracture angle of metacarpophalangeal joints and interphalangeal joints, so as to make the treatment plan. The transposition of flaps for wound closure was designed for both mild and moderate cases after continuous Z-flaps to release contracture deformity with scar debulking. For severe deformity, the transposition of flaps should be conducted to cover the wound after the complete release by continuous Z-flaps and scar debulking, and the residual wound was covered by free skin grafts. The hand function and appearance were followed up after operation.Results:In this study, 12 of the 36 joints were mildly deformed, 15 were moderately deformed, and 9 were severely deformed. No skin grafting was performed for mild and moderate deformities, and the amount of skin grafting was selectively reduced for severe deformities. All contracture joint deformities were completely corrected, with the follow-up period of 0.8-2.0 years, and no contracture deformities were found again. The hand joint function, skin flap color, texture of mild and moderate types were close to the surrounding normal skin. Severe type had only a small degree of pigmentation at the skin graft site. One 12.5-year-old child received second procedure 2 years later because of the poor elasticity of the skin graft and the tensions. The tension resolved after operation, with satisfactory results.Conclusions:Continuous Z-flaps combined with scar debulking could maximize the retention of skin of the scar surface and reduce the amount of skin grafts, providing an excellent method for the treatment of hand contracture deformities in children, with stable long-term postoperative effects.

Objective: To investigate the clinical outcome of distraction osteogenesis in the treatment of pediatric maxillofacial fractures. Methods: From November 2017 to November 2018, 6 cases of maxillofacial fractures were treated, including 3 cases of maxillary fracture and 3 cases of mandibular fracture. All of them were associated with facial asymmetry of different severity, disordered occlusion and displacement of fracture segments. The distraction osteogenesis device was used to fix the fracture during the operation. The distraction was initiated after 1 day latency period, and proceeded at approximately 0.5 mm each time, twice a day, until the normal occlusal relationship was achieved. Distractor was maintained for 1 month after distraction, and then removed. The degree of fracture healing, the mouth opening and the occlusal status at the fracture site were evaluated during follow-up, and the corresponding curative effect was observed and evaluated. Results: All fractures were healed well, without infection, dislocation, or pseudo-joint formation after 1 month. The distraction duration is 15-20 days and the distraction distance is 15-20 mm. At the end, the occlusal relationship was normal, and the mouth opening was not limited. The follow-up period was from 1 month to 1 year. The maxillofacial appearance of the children was normal, and the maxillofacial development was not significantly affected. Conclusions Distraction osteogenesis is an effective and controllable method for child maxillofacial fracture. It can be used as a supplement to the conventional treatment of maxillary and mandibular fracture in children.

Objective: To investigate the treatment of nasal deformity in patients with unicoronal craniosynostosis. Methods: In patients over 6 months old, the nasal bones were wedge-removed without fixation. The management of all patients with unicoronal craniosynostosis was distraction osteogenesis of pedicled unilateral frontal bone flap. Results: Postoperative extended distance of the frontal bone was 28—41 mm (mean, 35.4 mm). After extension, three-dimensional reconstruction of cranial CT was carried out, which showed that CVAI was 0.8—1.2 (mean, 0.98), tending to normal. After discharge, dynamic cranial braces were put on for 1 year. Postoperatively, the children were followed up for 8—36 months (mean, 28 months). The shape and nasal deformity of all children were improved compared with those before surgery. Conclusions Nasal wedge resection should be used to correct nasal deformity in children over 6 months with unicoronal craniosynostosis.

We treated a neonate who was diagnosed as rapidly involuting congenital hemangioma (RICH). With a review on the clinical manifestation, differential diagnosis, and treatment of RICH that associated with thrombocytopenia(TP)and coagulopathy(CP)and received platelet transfusions and embolization therapy including absolute ethanol and polidocanol in our hospital in March of 2015. The platelets and coagulation function soon returned to normal, the tumor involuted significantly. Surgical excision was proceeded subsequently. The platelets returned to normal level after a one-time platelet transfusion, meanwhile, multiple reexaminations of blood coagulation function were normal. Postoperatively, incision wound healed well. There was no recurrence, and the functional recovery of upper limb was satisfactory. RICH is a rare type of vascular tumor which may present with TP and CP similar to KHE-KMP in the neonatal period. More attention should be addressed to identify these two diseases, because the treatment and prognosis of which have significant differences. Consumption of coagulation factors with milder platelet decrease may also be a complication of slow flow venous or venolymphatic malformations.

Objective: To explore the feasibility of mandibular distraction for the treatment of airway obstruction in neonates with Braddock-Carey syndrome. Methods: From August 2007 to November 2017, 6 neonates with Braddock-Carey syndrome were treated in our center. All patients experienced the combined thrombopoietic treatment before operation. Bilateral oblique mandibular osteotomy was performed by extraoral approaches and the distraction was initiated on postoperative day 3 at a rate of 1.2 mm/d. It usually took around 2 weeks to get required length of distraction. Distractor was removed after 3-months fixation at second stage. Results: The distraction distance of 6 cases was from 12 to 20 mm. The CT scan showed a widening gap of the airway by 6-10 mm, and the average width was around 7 mm. 5 patients had no bleeding and infection after the operation, while one patient experienced bleeding for 4 times treated by regional compression. All neonates felt painful during distraction, and got relieved after reduction of the frequency and pace. With mandibular advancement, all patients′ face type improved, while paroxysmal bruising, inspiratory dyspnea and difficulty in breastfeeding disappeared. After 6 months of follow-up, all patients′ weight and face type were basically the same as normal children. Conclusions With the treatment of thrombocytopenia before operation, complete hematischesis during the operation, and postoperative treatment of thrombocytopenia, mandibular distraction osteogenesis was a feasible and safe management of upper airway obstruction in neonates with Braddock-Carey syndrome.

Objective: To investigate a new method to treat unilateral coronal synostosis. Methods: 2 cm-wide osteotomy was performed over the fused unilateral coronal suture.Oblique osteotomy was performed along the supraorbital rim to do a frontal suture of the glabella (patients less than one year old) or on the opposite side of the supraorbital rim (patients over one year old) after performing a suturectomy of the effected coronal suture. Two internal distraction devices were subsequently placed across the osteotomized, fused coronal suture. At the top of the unfused metopic suture, bring two holes and fixing with 4-0 absorbable suture.Finally, the cranium pieces were divided into 2 pieces and placed in the middle of the frontal bone using biological glue or titanium screws. Five days after the operation, a 0.6 mm distraction was performed twice per day. The distraction was removed 6 months after distraction reaching 30—60 mm. Results: Internal distraction osteogenesis with supraorbital oblique osteotomy was performed in eleven patients suffering from unilateral coronal synostosis from 2014.1 to 2017.1. All the patients had no abnormalities in nerve system, such as cephalomeningitis/ fistaul of cerebrospinal fluid/ epidural hematoma and so on.The distractor was not exposed. The width of extension ranged from 25—39 mm. One patient had infection in the rods around the distraction during the period of fixed, but was cured with antibiotic treatment and got an ideal extension eventually. The rest of 10 patients obtained the expected result . During a mean follow-up period of 12 months (5 to 26 months), all patients were presented with satisfactory cosmetic and functional result . CVAI were close to normal. Conclusions Treating unilateral coronal synostosis by internal distraction osteogenesis with supraorbital oblique osteotomy reduces the necessity offrontal and supraorbital osteotomy, and the exposure of the base of anterior cranial fossa, renders a safe and effective approach.