AIM:To analyze the effectiveness and safety of upper eyelid combined fascia sheath(CFS)suspension and levator muscle(LM)shortening surgery in correcting severe ptosis.METHODS:Retrospective study. A total of 80 cases(84 eyes)of severe ptosis treated in our hospital from June 2018 to June 2022 were divided into two groups based on the surgical method, including 40 cases(41 eyes)underwent CFS suspension + LM shortening surgery in CFS group, and 40 patients(43 eyes)underwent frontal muscle flap suspension surgery in frontal muscle group; the clinical total effective rate, postoperative complications, and patient satisfaction rate of both groups of patients were compared.RESULTS:At 12 mo postoperatively, the clinical effective rates of the two groups of patients were 98% and 91%, respectively(P>0.05). The incidence of complications was 26%(11/43)in the frontal muscle group and 7%(3/41)in the CFS group(P=0.024). The satisfaction rate of the frontal muscle group was 80%(32/40), while the CFS group was 98%(39/40; P=0.029).CONCLUSION:The use of CFS+LM surgery can effectively correct severe ptosis, with fewer complications and a more natural appearance.

Objective: To examine the Longitudinal influence of perceived discrimination on pro social behavior of left alone junior middle school students and to explore the longitudinal mediating role of teacher-student relationship and classmate relationship, so as to provide a reference for improving pro social behavior of left behind junior middle school students. Methods: The Perceived Discrimination Questionnaire, Teacher-Student Relationship Questionnaire, Classmate Relationship Questionnaire and Prosocial Behavior Questionnaire were used to conduct two follow up surveys on 930 left behind junior middle school students in Guizhou Province at two time points, in mid November 2021(T1) and mid May 2022(T2). Deviation corrected Bootstrap method was used to examine the mediating effect of T2 teacher-student relationship and T2 classmate relationship on the impact of T1 discrimination perception on T2 pro social behavior. Results: The perceptions of discrimination, teacher-student relationship, classmate relationship, and pro social behavior scores of the left behind junior high school students were (1.98±0.94) (4.13± 0.77 ) (3.54±0.91) (3.52±0.75) for T1, and (3.98±0.83)(3.42±0.86)(3.48±0.72) for teacher-student relationship, classmate relationships and pro social behavior scrores of T2. After controlling for gender, age and self assessment of family economic status, T1 perceived discrimination negatively predicted T2 pro social behavior ( β =-0.07); and T1 perceived discrimination indirectly influenced T2 pro social behavior through T2 teacher-student relationship, and mediated effect value was -0.02(95% CI = -0.02 to -0.01); and T1 perceived discrimination indirectly influenced T2 pro social behavior through T2 classmate relationship, mediated effect was -0.03(95% CI =-0.05 to -0.02)( P <0.05). Conclusions Perceived discrimination not only directly reduces pro social behavior of left behind junior middle school students, but also indirectly and negatively affects pro social behavior of left alone junior middle school students by reducing teacher-student relationship and classmate relationship.

Objective To summarize current status of multidrug-resistant organism (MDRO) infection in lung transplant recipients and analyze the risk factors of MDRO infection. Methods Clinical data of 321 lung transplant recipients were retrospectively analyzed. According to the incidence of postoperative MDRO infection, they were divided into the MDRO group (n=122) and non-MDRO infection group (n=199). The incidence of MDRO infection in lung transplant recipients was summarized. The risk factors of MDRO infection in lung transplant recipients were analyzed by logistic regression model. The dose-response relationship between MDRO infection and time of ventilator use was determined by restricted cubic spline model. Results Among 321 lung transplant recipients, 122 cases developed MDRO infection, with an infection rate of 38.0%. Two hundred and twenty-nine strains of pathogenic bacteria were detected in the MDRO infection group, mainly Gram-negative bacteria (92.6%), and the top three strains were carbapenem-resistant acinetobacter baumannii (46.3%), carbapenem-resistant pseudomonas aeruginosa (22.3%) and carbapenem-resistant klebsiella pneumoniae (14.8%), respectively. MDRO infection mainly consisted of lower respiratory tract infection (61.5%), followed by ventilator-associated pneumonia (26.2%). Univariate analysis showed that the risk factors of MDRO infection in lung transplant recipients were single-lung transplantation, long-time postoperative use of extracorporeal membrane oxygenation (ECMO), long operation time, long-time urinary catheterization, long-time central venous catheterization and long-time ventilator use (all P < 0.05). Multivariate logistic regression analysis indicated that single-lung transplantation and long-time ventilator use were the independent risk factors for MDRO infection in lung transplant recipients (both P < 0.05). Results of restricted cubic spline model analysis showed that the risk of infection continued to increase with the prolongation of ventilator use time within 20 d. After 20 d, prolonging the time of ventilator use failed to increase the risk of infection, showing a plateau effect. Conclusions The MDRO infection rate tends to decline in lung transplant recipients year by year. Single-lung transplantation and long-time ventilator use are the independent risk factors for MDRO infection in lung transplant recipients.

Objective:To explore the disease-related impairment of functional and structural connectivity network and their relationship with psychometric hepatic encephalopathy score (PHES) in patients with chronic hepatitis B virus-related cirrhosis (HBV-RC) by combining resting-state functional MRI (rs-fMRI) and diffusion tensor imaging (DTI).Methods:Data of 30 HBV-RC patients [including 13 HBV-RC patients with minimal hepatic encephalopathy (MHE) and 17 HBV-RC patients without MHE (NMHE)] from April 2011 to October 2011 in Guangdong No.2 People′s Hospital were analyzed prospectively, and 38 healthy individuals matched for age, sex, and education with HBV-RC patients (HC group) were included during the same period. Rs-fMR and DTI data as well as PHES data of all participants were collected. Gretna and PANDA software package were used to preprocess the imaging data and construct the functional and structural network respectively. The network-based statistic (NBS) approach was used to compare the differences of the functional and structural connections among three groups. Spearman′s correlation analysis was used to identify the relationship between functional or structural connectivity and PHES. The structural equation modeling (SEM) was used to explore the relationships among functional connectivity, structural connectivity, and PHES.Results:Compared to HC group, both functional and structural connectivity in the whole brain progressively destroyed from NMHE to MHE, mainly involving cognitive control network, default mode network, and limbic network (NBS corrected, all P<0.01). There were significantly negative relationships between functional or structural connectivity and PHES in HBV-RC patients (false discovery rate corrected, all P<0.05). The SEM results showed the influence of structural connectivity on neurocognitive impairment was mediated by functional connectivity ( P<0.05). Conclusion:Both functional and structural networks progressively destroy in HBV-RC patients as the disease advanced and these alterations significantly correlate with PHES. Besides, the influence of structural connectivity on neurocognitive impairment is mediated by functional connectivity.

Objective:To investigate the role of follicular helper T(Tfh) cells and galactose deficiency IgA 1(Gd-IgA 1) in the children that were suffering from Henoch-Sch?nlein purpura(HSP) and Henoch-Sch?nlein purpura nephritis(HSPN)and the correlation between them. Methods:According to the presence or absence of renal injury, 62 children with HSP were divided into HSP group with 32 children and HSPN group with 30 children.Twenty children who underwent physical examination at outpatients were known as the healthy control group.Flow cytometry was used to measure the proportion of Tfh(CD4 + CXCR5 + PD-1 + ) in peripheral blood.Immunoturbidimetry and ELISA were used to measure the serum levels of IgA 1 and Gd-IgA 1 respectively. Results:(1) The proportion of Tfh cells in peripheral blood and the serum levels of Gd-IgA 1 in both HSP group and HSPN group had significantly increased than those in healthy control group( P<0.01). Compared result of the HSPN group with HSP group, the proportion of Tfh cells in peripheral blood and the serum levels of Gd-IgA 1 in HSPN group were higher than that in HSP group( P<0.05). (2) In the HSPN group, the proportion of peripheral blood Tfh cells and the serum levels of Gd-IgA 1 in group of renal pathology ≥ grade Ⅲ and heavy proteinuria were significantly elevated compared with group of renal pathology < grade Ⅲ and non-heavy proteinuria(<0.01). (3) In the healthy control group, the serum levels of Gd-IgA 1 was positively correlated with the proportion of Tfh cells in peripheral blood and the serum levels of Gd-IgA 1( P<0.05). Conversely, a non-positive correlation was shown in HSP and HSPN groups( P>0.05). Conclusion:The excessive activation of Tfh cells and the serum levels of Gd-IgA 1 may be one of the pathogenesis of HSP/HSPN, the degree of increment of the two factors may be related to the activity and severity of the disease.The mechanism of Tfh cells potentially leading to an increase of Gd-IgA 1 production requires further study.

Background: Granular cell tumor (GCT) is an uncommon tumor, and gastrointestinal tract GCT is even more rare. Aims: To investigate the clinicopathological characteristics, treatment and prognosis of gastrointestinal tract GCT. Methods: Nine cases of gastrointestinal tract GCT from January 2017 to June 2021 at the 903rd Hospital of Joint Logistics Support Force, PLA and Jinhua Municipal Central Hospital Medical Group were retrieved. The clinical data, histopathological characteristics, treatment, and prognosis were retrospectively analyzed. Results: In the 9 patients with gastrointestinal tract GCT, ratio of male to female was 2:1, age at diagnosis was 19-60 years, with a median age of 52 years. Six GCT were found in esophagus, 2 in colorectum and 1 in anus. Endoscopic results showed submucosal protrusion or sessile polyps ranging in size from 2-12 mm with a median of 5 mm. Histology results showed that tumors were located in mucosa and/or submucosa, arranged in solid sheets or nests, with an infiltrative margin and inflammatory infiltrates. Tumor cells were mainly plump and polygonal with abundant cytoplasm and eosinophilic granules. Nuclei were small, the nuclear-cytoplasmic ratio was very low. Mitotic figure was rare. Immunohistochemistry results showed that S100 and CD68 proteins were positive in all patients, SOX10, CD56, Calretinin and Syn were positive in some patients, and CKp, Desmin, SMA, CD117, CD34, Dog1, and α-inhibin were negative in all patients. Esophageal and colorectal GCT patients received endoscopic mucosal resection (EMR) or endoscopic submucosal dissection (ESD). The anal GCT patient underwent local resection. Recurrence or metastasis were not observed during 9-53 months of follow-up. Conclusions: Gastrointestinal tract GCT is rare with non-specific clinical symptoms and submucosal protrusion or sessile polyps under endoscopy. Gastrointestinal tract GCT has special pathomorphology and immunophenotype. EMR or ESD is recommended for small and superficial lesions. Long-term follow-up should be performed.

Objective:To investigate the predictive factors of poor prognosis in children with acute kidney injury (AKI) treated with renal replacement therapy (RRT).Methods:In this retrospective case-control study, the clinical data were collected from 134 pediatric patients (82 male, 52 female) with AKI treated with RRT in six tertiary hospitals from May 2015 to June 2018. According to the serum creatinine level at discharge, the patients were divided into the favorable outcome group and unfavorable outcome group. The data of sex, age, primary diseases, AKI stage, time from diagnosis of AKI to start of RRT (h) and whether to start RRT within 24 hours, urine volume and complications between the two groups were compared. Continuous variables were compared by t test and Mann-Whitney U test, and percentage or proportions were compared by Chi square test. The predictive factors of adverse prognosis were analyzed by using univariate and unconditional binary logistic regression analysis. Results:The average age of the 134 AKI patients was (6±4) years. There were 114 patients (85.0%) in the favorable outcome group and 20 patients (15.0%) in the unfavorable outcome group. No statistically significant differences were found between the two groups in terms of sex (χ 2=2.596, P=0.107), age ( t=0.718, P=0.474), primary disease (χ 2=2.076, P=0.722), AKI stage (χ 2=0.004, P=0.998), time from diagnosis of AKI to start RRT (h) ( P=0.745), whether to start RRT within 24 hours (χ 2=0.016, P=0.899), urine volume (χ 2=3.118, P=0.374), fluid overload (χ 2=0.014, P=0.905), multiple organ dysfunction syndrome (MODS) (χ 2=2.972, P=0.085), acidosis (χ 2=3.204, P=0.073), hyperkalemia (χ 2=2.829, P=0.093), the level of blood urea nitrogen ( t=1.351, P=0.179) and serum creatinine ( P=0.901) at the beginning of RRT. In the unfavorable outcome group, the proportion of patients with mechanical ventilation (45.0% (9/20) vs. 12.3% (14/114), χ 2=12.811, P<0.01) and the incidence of extra organ injury (≥3) (30.0% (6/20) vs. 10.5% (12/114), χ 2=6.365, P=0.041) were higher than those in the favorable outcome group. Logistic regression analysis showed that mechanical ventilation ( OR=12.540, 95 %CI: 3.376-46.577, P<0.01) and hyperkalemia ( OR=4.611, 95 %CI: 1.265-16.805, P=0.021) were the predictive factors of poor prognosis in patients with AKI treated with RRT. Conclusion:Mechanical ventilation and hyperkalemia may predict a poor prognosis in AKI patients treated with RRT.

Objective: To compare the clinical efficacy of the preserving insertion point of the rectus abdominis-Pfannenstiel approach with traditional Pfannenstiel approach in the treatment of pelvic anterior ring injuries. Methods: A retrospective analysis was performed on 43 cases with pelvic anterior ring injuries treated from September 2008 to February 2016. Among them, 20 cases were treated with the preserving insertion point of the rectus abdominis-Pfannenstiel approach (modified approach group) including 14 males and 6 females, aged 18-58 years, with an average age of 36.9 years. According to Tile classification of pelvic fractures, there were 8 cases of B1 type, 4 cases of B2 type, 2 cases of B3 type, 4 cases of C1 type and 2 cases of C2 type. And 23 cases were treated with traditional Pfannenstiel approach (traditional approach group, 16 cases of males and 7 cases of females, aged 19-59 years, with an average age of 36.8 years). Tile classification of pelvic fractures: 9 cases of B1, 4 cases of B2, 3 cases of B3, 4 cases of C1 and 3 cases of C2). The operative time, intraoperative blood loss, postoperative hospital stay, postoperative reduction, postoperative functional and complications were compared between the two groups. Results: 43 patients were followed up for 12-40 months, with an average of 20.5 months. All fractures healed in 8-20 weeks, with an average time of 10 weeks. Duration of anterior approach: 119.0±18.3 min in the modified approach group and 93.7±17.8 min in the traditional approach group (t=4.597, P< 0.05). Intraoperative blood loss: 206.0±38.2 ml in the modified approach group and 252.4±46.1 ml in the traditional approach group (t=-3.560, P< 0.05). Postoperative hospital stay: 14.5±3.0 d in the modified approach group, and 20.0±4.4 d in the traditional approach group (t=-4.775, P< 0.05). Postoperative reduction was evaluated according to the Matta reduction criteria, among which 15 cases were excellent and 5 cases were good in the modified approach group; 17 cases were excellent and 6 cases were good in the traditional approach group. According to the Majeed score, the postoperative function of pelvic fracture was excellent in 10 cases, good in 7 cases, and acceptable in 3 cases, with an excellent and good rate of 85.0% (17/20). There were 11 excellent cases, 8 good cases and 4 fair cases in the traditional approach group, with an excellent and good rate of 82.6% (19/23). There was no statistically significant difference between the two groups (χ²=0.04, P >0.05). Complications: 2 cases of internal fixation loosening and 2 cases of coital pain occurred in the modified approach group after surgery, with a complication rate of 20.0% (4/20). Postoperatively, 1 case of superficial infection, 1 case of pulmonary infection, 1 case of internal fixation loosening, 1 case of screw broken and 4 cases of coital pain occurred in the traditional approach group, with a complication rate of 34.8% (8/23). Conclusion Both approaches can achieve satisfactory results in the treatment of anterior pelvic ring injury. The preserving insertion point of the rectus abdominis-Pfannenstiel approach for the treatment of anterior pelvic ring injuries has the advantages of less bleeding, faster recovery and shorter hospitalization time.

"5+3" integrated training program is a new training model to cultivate doctors under the background of preclinical teaching and clinical training integration. Based on practice in Shantou University Medical College, the program design current progress and solution to the problem were elaborated. It adheres to principles of overall optimization and orienting to clinic, and to ensure the smooth implementation of the training model. Which will provide important reference for the reform of long-term medical training program in higher medical colleges and universities.

Objective To evaluate clinical outcomes of the Kocher-Langenbeck (K-L) approach combined with partial proximal Watson-Jones incision for the treatment of acetabular fractures involving the weight-bearing area.Methods From January 2012 to January 2017,20 patients were treated by the K-L approach combined with partial proximal Watson-Jones incision for acetabular fracture involving the weight-bearing acetabular dome.They were 13 males and 7 females,with an average age of 40.7 years (range,from 22 to 67 years).According to the Letournel-Judet classification,there were 8 posterior wall fractures,one transverse fracture,one T-shaped fracture,one transverse and posterior wall fracture,3 posterior column and posterior wall fractures,and 6 double-column fractures.All patients received open reduction and internal fixation with plates and screws.The outcomes of reduction were evaluated at follow-ups according to the Matta criteria.The hip function was evaluated according to the modified Merle d'Aubigne-Postel criteria and the abductor strength by the American Medical Research Council criteria at final follow-ups.Results All the 20 patients were followed up for an average of 8.2 months (range,from 7 to 21 months).They all obtained bony union after 10 to 18 weeks (average,11.4 weeks).No fracture displacement,internal fixation loosening or deep infection occurred.According to the Matta criteria,anatomic reduction was achieved in 13 cases,satisfactory reduction in 6 cases,and unsatisfactory in one (a satisfactory rate of 95％).The modified Merle d'Aubigne-Postel scoring for the hip function at the final follow-ups yielded 9 excellent cases,7 good cases,3 fair cases and one poor case (an excellent to good rate of 80％).Ectopic ossification of Brooker grade Ⅰ occurred in one case.The abductor strength was rated as grade Ⅳ in 3 cases and as grade Ⅴ in 17.Conclusions In the treatment of acetabular fractures involving the acetabular dome,the K-L approach combined with partial proximal Watson-Jones incision can increase the operation view of the weight-bearing area,enhance the anatomic matching of femoral head and acetabular roof,and reduce the difficulties in reduction and fixation.