Objective:To investigate the value of electronic nasolaryngoscope combined with nasopharyngeal three dimensional computed tomography(3D-CT)in postoperative assessment for the surgery of pediatric tonsil adenoid.Methods:A total of 106 pediatric patients with tonsil adenoid admitted to the Affiliated Hospital of Weifang Medical College from January 2021 to January 2024 were selected,and all of them underwent electronic nasal laryngoscopy combined with nasopharyngeal 3D-CT before and after surgery.According to different assessment methods,pediatric patients who underwent the assessment of electronic nasolaryngoscope combined with nasopharyngeal 3D-CT were included in the combined assessment group(42 patients),and pediatric patients who underwent the assessment of electronic nasolaryngoscope were included in the electronic nasolaryngoscope assessment group(30 patients),and pediatric patients who underwent the assessment of nasopharyngeal 3D-CT were included in the nasopharyngeal 3D-CT assessment group(34 patients).Descriptive statistics was conducted on the basic characteristics of the three groups.The accuracies of nasopharyngeal 3D-CT combined with electronic nasolaryngoscope,the single electronic nasolaryngoscope,and the single nasopharyngeal 3D-CT in the postoperative assessment were calculated and compared.Results:In assessment effect of 42 pediatric patients of the combined assessment group,20 cases were effective,and 22 cases were ineffective,and the effective rate of assessment was 47.62%(20/42).In assessment effect of 30 pediatric patients of the electronic nasolaryngoscope assessment group,5 cases were effective,and 25 cases were ineffective,and effective rate of assessment was 16.67%(5/30).In assessment effect of 34 pediatric patients of the nasopharyngeal 3D-CT assessment group,13 cases were effective and 21 cases were ineffective,and the effective rate of assessment was 38.24%(13/34).The effective rate of the assessment of the combined assessment group was significantly higher than that of each single assessment group,and the difference was statistically significant(x2=7.414,P<0.05).The sensitivity,specificity,accuracy,positively predictive value and negatively predictive value of the combined assessment were respectively 47.60%,83.30%,55.60%,80.00%and 53.60%.These indicators of single electronic nasolaryngoscope assessment were respectively 16.70%,47.60%,35.70%,18.20%and 44.40%.These indicators of single nasopharyngeal 3D-CT assessment were respectively 38.20%,83.30%,50.00%,72.20%and 54.30%.Conclusion:The combined application of nasopharyngeal 3D-CT and electronic nasolaryngoscope can improve the accuracy of postoperative assessment for the surgery of pediatric tonsil adenoid,and it is helpful to timely find and deal with postoperative problems,and improve the treatment effect.

Objective: To describe bullying victimization of middle school students in Dalian and associated factors, so as to provide scientific basis for campus bullying prevention. Methods: The stratified cluster sampling method was used to select 2 540 middle school students from urban and rural areas in Dalian, who were investigated with campus bullying victimization and related factors. Results: The reported rate of campus bullying victimization among middle school students in Dalian was 25.11%. The rates of physical violence (5.99%, 3.66%) and verbal violence(24.93%, 15.87%) of male students were higher than that of female students( χ 2=6.56, 27.94, P <0.05). The rates of verbal violence (22.84%, 16.25%) and emotional neglect(16.84%, 13.18%) of junior high school students were higher than those of high school students( χ 2=14.21, 5.44, P < 0.05 ). The rates of physical violence(6.07%, 3.55%), verbal violence(24.58%, 16.05%) and emotional neglect(18.88%, 12.06 %) of rural students were higher than those of urban students( χ 2=7.72, 24.81, 19.64, P <0.05). Male students, junior high school students and rural students suffered more severe campus bullying than female students, high school students and urban students( Z =3.46, 3.75, 5.89, P <0.01). The structural equation model showed that academic performance (path coefficient -0.003) and father s education (path coefficient -0.004 ) have a direct negative effect on campus bullying behavior, while mother s education (indirect action coefficient -0.000 8), height(indirect action coefficient -0.000 3), father s education (indirect action coefficient -0.000 3) and weight (indirect action coefficient 0.000 2) indirect effects on campus bullying through academic performance. Conclusion The prevalence of campus bullying victimization among middle school students in Dalian is relatively high, which worths further attention to. Rural students, junior high school students and boys are more likely to suffer campus bullying. Improving academic performance might be beneficial for campus bullying prevention.

Objective:To evaluate the implementation of the China Healthcare Improvement Initiative(CHII)from 2018 to 2020 in 143 tertiary public hospitals in China.Methods:In March 2019 and from January to March in 2021, 143 tertiary public hospitals in 31 provinces of China were investigated using the unified " medical institution questionnaire Ⅰ" and " medical institution Questionnaire Ⅱ" . The data were collected by means of hospital self-report and expert on-site scoring. Descriptive and inferential statistical analysis were used to analyze the data, and the data of two cross-sectional surveys were compared and analyzed.Results:The average score rate of implementing CHII in 143 sample hospitals in 2020 was 88.9%, which was higher than that in 2018(84.4%). The appointment diagnosis and treatment system, clinical pathway management system, day service, smart hospital and humanistic service were significantly improved. In 2020, the average score rate of logistics service, high quality nursing service and clinical pathway management system was higher than 95%, while the average score rate of day service, telemedicine system and medical social work system was lower than 85%. The total score rate of general hospitals was significantly higher than that of specialized hospitals( P<0.001). In 2020, the proportion of hospitals with full marks in 29 secondary indicators(74.4%)was more than 80%, reaching the standard level. Conclusions:The implementation level of CHII in tertiary public hospitals in China has been improved continuously and made significant progress, but some dimensions and indicators need to be further improved.

Objective To investigate the relationship between total cerebral small vessel disease (CSVD) burden and intracranial hemorrhage transformation (HT) after intravenous thrombolysis in patients with acute ischemic stroke (AIS).Methods One hundred and fifty-four patients who suffered from ischemic stroke within 4.5 hours of onset and received recombinant tissue plasminogen activator thrombolytic therapy in the emergency green channel of the First Affiliated Hospital of Soochow University from August 2016 to January 2018 were enrolled.HT examined by computed tomography scan within 24 hours after thrombolysis was included.The magnetic resonance imaging examination was performed within 48 hours.The patients were divided into two groups:HT group and control group according to the presence or absence of HT.Periventricular white-matter hyperintensities (WMH) with Fazekas score of 3 or deep WMH with Fasekas score of 2 or 3 was recorded as 1 point,MRI of cerebral microbleeds (CMBs) or lacunar infarction (LI) was recorded as 1 point respectively,and peripheral vascular space (PVS) in basal ganglia graded 2-4 (≥11)was counted 1 point.Single-factor analysis was used to compare total CSVD burden score,baseline data and clinical data between the two groups.Multivariate Logistic regression analysis was performed to explore the relationship between total CSVD burden score and HT.Results The age of the 154 patients was 66.00(59.00,74.25) years,males accounted for 66.9％ (103/154),onset to treatment time (OTT) was 174.50 (131.50,200.00) minutes and the NIHSS score before thrombolytic therapy was 6.00 (3.00,10.25).There were 43 cases (27.9％) with moderate to severe WMH,35 cases (22.7％) with CMBs,52 cases (33.8％) with PVS graded 2-4,and 96 cases (62.3％) with LI.There were 21 enrolled patients (13.6％) who suffered from HT.Symptomatic intracranial hemorrhage occurred in nine cases (5.8％).In the multivariate Logistic regression model,the results demonstrated that baseline diastolic pressure (OR=1.072,95％CI 1.027-1.118,P=0.001)and atrial fibrillation (OR=28.564,95％CI 6.217-131.241,P=0.000) were independently associated with HT.After using the mild CSVD burden score as a reference,moderate CSVD burden (OR=0.810,95％ CI 0.154-4.257,P=0.804) was not associated with HT after thrombolysis,and severe CSVD burden (OR=8.429,95％ CI 1.643-43.227,P=0.011) was independently associated with HT.Conclusions The severity of total CSVD burden in patients with AIS was closely related to HT after thrombolysis.Severe CSVD was an independent risk factor for HT after thrombolysis.

Objective: Symptomatic intracranial hemorrhage (sICH) is one of the severe complications of ischemic stroke thrombolysis. Several prognostic scales have been developed to predict the risk of sICH. The performance of seven scales was compared in a single center cohort. Methods: Data of patients with consecutive ischemic stroke who received 0.9 mg/kg intravenous recombinant tissue plasminogen activator (rt-PA) thrombolysis within 4.5 h time window from stroke onset were collected. Seven scales that can provide an estimate of risk of sICH were identified and evaluated: Hemorrhage After Thrombolysis (HAT), blood Sugar, Early infarct signs, (hyper) Dense cerebral artery sign, Age, National Institutes of Health (NIH) Stroke Scale (SEDAN), Stroke Prognostication using Age and NIH Stroke Scale (SPAN)-100, Safe Implementation of Thrombolysis in Stroke (SITS), Total Health Risks In Vascular Events (THRIVE), Glucose at presentation, Race (Asia), Age, Sex (male), systolic blood Pressure at presentation, and Severity of stroke at presentation (NIH Stroke Scale; GRASPS) and Multicenter Stroke Survey (MSS). The area under the receiver operating characteristic curve (AUROC) was calculated and Logistic regression and the Hosmer-Lemeshow test were also performed. Results: The current study included 293 patients, of whom 7.85% (23/293) had sICH by National Institute of Neurological Disorders and Stroke (SICH_NINDS), 5.46% (16/293) by Europe Cooperative Acute Stroke Study Ⅱ (SICH_ECASSⅡ) and 4.44% (13/293) by Safe Implementation of Thrombolysis in Stroke (SICH_SITS) criteria. SEDAN had the highest AUROC for predicting sICH: sICH_NINDS: AUROC=0.843, OR=3.167, 95%CI 2.106-4.762, P<0.01; sICH_ECASSⅡ: AUROC=0.797, OR=2.509, 95%CI 1.652-3.812, P<0.01; sICH_SITS: AUROC=0.784, OR=2.172, 95%CI 1.405-3.357, P<0.01. And SPAN-100 had the lowest AUROC among all the seven scales and was only associated with risk of SICH_NINDS in regression analysis. Furthermore, when sub-grouped the cohort into anterior circulation infarction and posterior circulation infarction, regression analysis suggested that all the seven scales were however not associated with sICH risk in patients with posterior circulation infarction. Conclusions SEDAN constantly had the highest predictive power, SPAN-100 had the worst. The seven scales studied could not predict sICH in posterior circulation infarction.