Objective To investigate the prevalence and influencing factors of thyroid nodules in children aged 8-10 years in Suzhou , and to provide a scientific basis for the rational prevention and treatment of iodine deficiency disorders (IDD). Methods PPS sampling method was used in this study. Questionnaire survey, physical examination and thyroid B-ultrasound examination were conducted on students aged 8-10 years. Salt samples and urine samples were collected for laboratory detection of the salt iodine and urinary iodine. Univariate and multivariate logistic regression models were used to analyze the risk factors related to thyroid nodules. Results A total of 2 048 children aged 8-10 years were included in the present survey, and the prevalence of thyroid nodules was 23.34% (478/2 048). The prevalence of nodules in boys was 20.98% (218/1 039), and the prevalence of nodules in girls was 25.77% (260/1 009). Multivariate analysis showed that gender (OR=1.338, P=0.006), height (OR=1.993, P=0.001), frequency of iodine-rich food intake (OR=0.862, P=0.048) and nutritional supplements (OR=1.469, P=0.008) were correlated with the prevalence of thyroid nodules. Conclusion The prevalence rate of thyroid nodules in children aged 8-10 years old in Suzhou is 23.34%. Female gender, higher height, regular intake of iodine-rich foods and dietary supplements are statistically associated with the prevalence of thyroid nodules, which may be risk factors for the prevalence of thyroid nodules , but further research is needed to confirm.

This article reports a case of adrenal tumor in a reproductive-aged woman with hyperandrogenism misdiagnosed as polycystic ovary syndrome. The patient presented with menstrual disorder, elevated testosterone levels, and polycystic ovaries, initially diagnosed as polycystic ovary syndrome. Menstrual regularity was achieved after intermittent use of ethinylestradiol/cyproterone acetate and progesterone. Five years later, during a physical examination, a mass was discovered in the right adrenal gland, accompanied by elevated testosterone levels, polycystic ovaries, obesity, and insulin resistance. Laparoscopic resection of the right adrenal tumor was performed, and the pathological diagnosis was adrenal cortical oncocytoma. Postoperatively, menstrual regularity was restored, and testosterone levels normalized. This case highlights the importance of considering adrenal tumors secreting androgens in patients clinically diagnosed with polycystic ovary syndrome, and emphasizes the need for regular adrenal imaging follow-up.

Objective:To analyze the risk factors of bronchopulmonary dysplasia(BPD)in very preterm infants(VPI), and to provide scientific basis for the prevention and treatment of BPD in VPI.Methods:A prospective multicenter study was designed to collect the clinical data of VPI in department of neonatology of 28 hospitals in 7 regions from September 2019 to December 2020.According to the continuous oxygen dependence at 28 days after birth, VPI were divided into non BPD group and BPD group, and the risk factors of BPD in VPI were analyzed.Results:A total of 2 514 cases of VPI including 1 364 cases without BPD and 1 150 cases with BPD were enrolled.The incidence of BPD was 45.7%.The smaller the gestational age and weight, the higher the incidence of BPD( P<0.001). Compared with non BPD group, the average birth age, weight and cesarean section rate in BPD group were lower, and the incidence of male infants, small for gestational age and 5-minute apgar score≤7 were higher( P<0.01). In BPD group, the incidences of neonatal respiratory distress syndrome(NRDS), hemodynamically significant patent ductus arteriosus, retinopathy of prematurity, feeding intolerance, extrauterine growth restriction, grade Ⅲ~Ⅳ intracranial hemorrhage, anemia, early-onset and late-onset sepsis, nosocomial infection, parenteral nutrition-associated cholestasis were higher( P<0.05), the use of pulmonary surfactant(PS), postnatal hormone exposure, anemia and blood transfusion were also higher, and the time of invasive and non-invasive mechanical ventilation, oxygen use and total hospital stay were longer( P<0.001). The time of starting enteral nutrition, cumulative fasting days, days of reaching total enteral nutrition, days of continuous parenteral nutrition, days of reaching 110 kcal/(kg·d) total calorie, days of reaching 110 kcal/(kg·d) oral calorie were longer and the breastfeeding rate was lower in BPD group than those in non BPD group( P<0.001). The cumulative doses of amino acid and fat emulsion during the first week of hospitalization were higher in BPD group( P<0.001). Multivariate Logistic regression analysis showed that NRDS, invasive mechanical ventilation, age of reaching total enteral nutrition, anemia and blood transfusion were the independent risk factors for BPD in VPI, and older gestational age was the protective factor for BPD. Conclusion:Strengthening perinatal management, avoiding premature delivery and severe NRDS, shortening the time of invasive mechanical ventilation, paying attention to enteral nutrition management, reaching whole intestinal feeding as soon as possible, and strictly mastering the indications of blood transfusion are very important to reduce the incidence of BPD in VPI.

Objective: To observe the efficacy and safety of intensive cladribine-based conditioning regimen for allogeneic hematopoietic stem cell transplantation (allo-HSCT) in children with major thalassemia. Methods: Retrospective analysis was performed for the clinical data of 12 children with major thalassemia undergoing allo-HSCT from March 2017 to July 2018. All of them were diagnosed definitely and the median age at transplantation was 5 years (range: 2-13 years), including HSCT from HLA-matched unrelated donor (n=8), HLA8/10-matched unrelated donor (n=1), HLA-matched sibing donor (n=2) and haploidentical donor (n=1). They received a new intensive conditioning regimen of cyclophosphamide (CTX), cladribine, busulfan (Bu) and antithymocytic globulin. The median doses of mononuclear cell (MNC) and CD34 positive cell were 10.97×10⁸/kg (range: 5.72-12.49×10⁸/kg) and 12.2×10⁶/kg (range: 6.7-22×10⁶/kg). Graft-versus-host disease (GVHD) was prevented by cyclosporine A (CSA), methotrexate (MTX) and mycophenolate mofetil (MMF). Results: Engraftment succeeded (n=11) and failed (n=1). The median time of neutrophil and platelet engraftment was 11 days (range: 8-17 days) and 13 days (range: 8-37 days) respectively. There were grade II acute GVHD (n=6) and grade IV intestinal acute GVHD (n=1) at 35 days post-transplantation. The latter one finally died of severe infection at 70 days post-transplantation. Two recipients of DLI developed limited chronic GVHD. Three cases (25%) developed cytomegaloviremia. None suffered from severe transplantation-related complications, such as cytomegalovirus diseases, hepatic veno-occlusive disease (HVOD), hemorrhagic cystitis or septicemia, etc. The median follow-up time was 15(8-18) months. Among 11 survivors, ten became transfusion-independent. Conclusions Cladribine-based conditioning regimen is both safe and effective for allo-HSCT in children with major thalassemia. However, vigorous immunosuppression may increase the risks of infection and viral activation after transplantation.

Objective To prepare a novel loaded NdFeB and Fe3O4 liquid-solid phase inversion poly (polylactic-co-glycolic acid,PLGA) in situ implant (PLGA 60％ NdFeB-20％ Fe3O4) for ultrasound-guided intratumoral injection,and to investigate its intensity of magnetism and therapeutic efficiency of nude mice bearing MDA-MB-231 breast cancer.Methods PLGA-60 ％ NdFeB-20 ％ Fe3O4 in situ implant was prepared.The microstructure of PLGA-60 ％ NdFeB-20 ％ Fe3O4 was tested with scanning electron microscope (SEM).Magnetometer was used to qualify the intensity of magnetism.For the in vitro assay,60 μl solid PLGA-60％ NdFeB-20％ Fe3O4 implant was put in the center of the electromagnetic induction heating coil.Infrared thermal video of the tubes was simultaneously recorded.The size of 2 cm × 2 cm× 2 cm fresh ex vivo bovine liver was prepared,and then 60 μl PLGA-60％ NdFeB-20％ Fe3O4 was injected into it.Similarly,ex vivo bovine liver was heated by the above intermittent time for 1,2,3,4 minutes,respectively,and the ablation volume was calculated.Finally,nude mice were equally divided into treatment group and control group.Mice in treatment group were discontinuously heated for 3 min after being injected with the above mentioned implant,while CEUS was performed before and after heating to observe the blood perfusion in the tumor.One nude mouse was executed on the next day in each group,then pathological sections and HE staining of tumor tissue were taken,whereas the growth of the remaining nude mice were observed daily.Results SEM showed the implant with rough and porous surface.The magnetism increased with the volume of material.The tube and bovine liver experiments showed that the PLGA-60 ％ NdFeB-20％ Fe3O4 generated heat efficiently.The bovine liver ablation experiment showed that the range of ablation of 60 μl PLGA-60 ％ NdFeB-20％ Fe3O4 implant reached (2.34±0.25)cm3 after 3 min heating.In vivo experiments showed that the tumor tissue began to form a scab on the 2nd day,and the scab began to desquamate on the 20th day.CEUS showed the original predominant enhancement disappeared significantly after the treatment.HE staining proved that cancer cells had coagulative necrosis,whereas tumors in control group became bigger.Conclusion PLGA-60％ NdFeB-20％ Fe3O4 in situ implant can produce obvious thermal effect under high frequency alternating magnetic field,therefore can be effectively ablated with nude mice MDA-MB-231 breast cancer during time interval heating.

Objective To explore pathogenic bacteria distribution and drug susceptibility testing results in children with purulent meningitis in Jinan area. Methods A total of 54 children with purulent meningitis were selected from January 2010 to December 2014, the cerebrospinal fluid smear and culture, according to the national standard of clinical inspection technology for bacteria isolation and identification by disc diffusion method for drug sensitive test were retrospectively analyzed. Results A total of 54 strains of pathogenic bacteria including 36 strains of gram-positive coccus, and 17 strains of gram-negative bacillus and one strain of suspected Neisseria meningitides were found. A total of 31 strains gram positive coccus is Streptococcus pneumoniae, and most gram-negative bacilli is E. coli. In the Gram-positive coccus, 61.3% was sensitive to penicillin, and more than 90% was sensitive to ceftriaxone and cefepime, 83.3% was sensitive to meropenem, 94.7% resistant to azithromycin, and 58.1% resistant to oxazocilline. In Gram-negative bacilli, 60% was sensitive to ampicillin sulbactam 71.4% was sensitive to cephalosporin , 57.1% was sensitive to ceftriaxone , 66.6% was sensitive to cefepime. Conclusions From cerebrospinal fluid cultured of purulent meningitis, Streptococcus pneumoniae and E. coli were major pathogenic bacteria in children with purulent meningitis in Jinan area.

Objective To investigate the distribution and antimicrobial susceptibility of the bacteria isolated from bloodstream infections during 2013-2014 in Changhai Hospital for rational use of antibacterial agents.Methods The bacterial strains from blood samples were collected during the period from January 2013 through December 2014,and subjected to antimicrobial susceptibility testing by using automated system or Kirby-Bauer method.The results were interpreted according to CLSI M100-S24 breakpoints or FDA breakpoints.The data were analyzed by WHONET 5.6 software.Results A total of 1 048 nonduplicate isolates were collected,of which Escherichia coli,coagulase-negative Staphylococcus (CNS) and Klebsiella pneumoniae accounted for 29.5％,15.8％ and 13.8％,respectively.Gastroenterology,Hematology,General surgery,Urology and Department of Infectious Diseases are the top 5 departments according to their total number of bacterial isolates.The results of antimicrobial susceptibility testing showed that ESBLs-producing E.coli and K.pneumoniae accounted for 63.8％ and 38.6％,respectively.The prevalence of methicillinresistant CNS (MRCNS) was 77.6％.The E.coli strains isolated from Urology showed higher resistance rates to cephalosporins than the total E.coli strains,while the E.coli strains isolated from Gastroenterology showed higher resistance rates to betalactarn/beta-lactamase inhibitor combinations and carbapenems than the total E.coli strains.Higher prevalence of MRCNS was found in departments of Hematology,Urology and Neurosurgery.All the CNS strains isolated from Neurosurgery were resistant to methicillin.The K.pneumoniae strains isolated from Bum ICU had higher resistance rates to all the antibacterial agents tested than the total K.pneumoniae strains,while the K.pneumoniae strains isolated from Gastroenterology showed higher resistance rates to carbapenems and tigecycline than the total K.pneumoniae strains.Conclusions The pathogenic bacteria isolated from bloodstream infections vary with departments in terms of species distribution and antimicrobial susceptibility profile.It is necessary to strengthen the surveillance of antimicrobial resistance in hospital for rational use of antibiotics.

Objective To understand the carriage of NDM-1 and other carbapenemases in carbapenem-resistant Acinetobacterbaumannii(CRAB)in Jiangxi area,and provide laboratory basis for the prevention and control of healthcare-associated infection (HAI). Methods Sixty-four strains of CRAB isolated from clinical specimens from 3 tertiary first-class hospitals in Jiangxi area from January 2015 to June 2016 were collected,susceptibility to com-monly used antimicrobial agents were detected with Kirby-Bauer method. Carbapenemases and metalloenzyme in CRAB were screened with modified Hodge test and EDTA-disk synergy test respectively,carbapenems gene was de-tected by polymerase chain reaction (PCR),NDM-1-producing Acinetobacterbaumannii (A. baumannii)were per-formed conjugation test.Results The resistance rates of CRAB to ampicillin/sulbactam,ciprofloxacin,gentamicin, and levofloxacin were up to 95.31% ,98.44% ,90.63% ,and 54.69% respectively. The positive rates of modified Hodge test and EDTA-disk synergy test were 76.56% and 96.88% respectively. PCR amplification result showed that 87.50% (n= 56)of CRAB carried OXA-23 and VIM-1 genes,18.75% (n= 12)carried SIM,3.13% (n= 2)car-ried OXA-24,and 26.56% (n= 17)carried NDM-1 . CRAB carrying NDM-1 gene were all from The First Affilia-ted Hospital of Nanchang University,64.70% (11/17)of which were pandrug-resistant strains. Conjugation test re-sult showed that NDM-1-producing strains could transfer NDM-1 gene to recipient strain Escherichiacoli J53,then acquired resistance to imipenem. Conclusion Antimicrobial resistance rates of clinically isolated CRAB in this area are high,OXA-23 and VIM-1 genes are the main carbapenemase genes,NDM-1 gene positive CRAB is detected, and there may be a clonal spread of NDM-1 gene in hospital,effective measures should be taken as soon as possible to prevent and control the spread of NDM-1 positive CRAB.

Objective To explore the self-management behaviors of the patients with lumbar disc herniation. Methods Chronic disease self-management behavior measuring scale was used to investigate the self-management behaviors of 96 lumbar disc herniation patients. Results The score on self-management behaviors of the LDH patients was 20.42±7.52. 65.63%~84.38%of the patients took the wrong position at sitting, moving articles, and fetching articles from a low and high spot. 59.38%of them did not wear the waist supporter. 73.96%~95.83%of them did not follow the doctors' advice to sleep on hard bed, carry weights and keep the back warm. Conclusions The self-management behavior among LDH patients is dissatisfying. The nurses should provide patients with education on self-management behaviors, instructing them to take effective functional exercises, focusing on importance of cognitive symptom management in relieving pain and reducing negative emotion. Meanwhile, the nurses should advice patients to take right self-management behavior in daily life in order to promote the recovery of the function by patients' healthy behavior and life style.

Objective To investigated the effects of patient controlled intravenous analgesia and ultrasound guided patient?controlled paravertebral block on pulmonary function in patients with multiple fractured ribs? Methods From May 2015 to March 2016,60 patients with multiple rib fractures in Ningbo NO?6 Hospital with American Society of Anesthesiologists Ⅱ-Ⅲ underwent internal fixation, including 30 males and 30 females aged from 16 to 70 years ( mean age ( 54?6 ± 15?2 ) years ) . All patients were randomly divided into 2 groups (n=30 each):patient controlled intravenous analgesia(PCIA) group and patient controlled thoracic paravertebral block(PCPB) group.PCIA solution contained sufentanil 2 μg/kg in 100 ml of normal saline. The PCIA pump was set up to deliver a 2 ml bolus dose with 15 minutes lockout interval and background infusion at 2 ml/hour.In PCPB group,the patients received paravertebral injection of 0?2% ropivocaine 15 ml on the corresponding area of fractured side under ultrasound guidance at the end of operation,and then received PCPB.PCPB solution contained 0?75% ropivacaine 67 ml in 250 ml of normal saline,and the pump was set up to deliver a 5 ml bolus dose, with 15 minutes lock out interval and background infusion at 5 ml/hour? Both analgesia lasted to 72 hours after operation.Before the operation,at 30 minutes,60 minutes,1 day,2 days,3 days after analgesia,arterial blood samples were collected to test the levels of pH,PaO2 ,PaCO2 ,PaO2/FiO2 and PA?aDO2 . The pulmonary function was also examined before and 3 days after the operation through FEV1 and FEV1%? Results Compared with PCIA group at 30 minutes, 60 minutes, 1 day, 2 days, 3 days after analgesia, the level of PaO2 ( ( 85?1 ± 9?7 ) mmHg vs? ( 72?4 ± 12?3)mmHg,(90?3±12?4)mmHg vs? (73?5±7?8)mmHg,(94?2±8?2)mmHg vs? (86?1±5?6)mmHg, (98?5±7?0)mmHg vs? (88?8±7?5)mmHg,(99?6±9?8)mmHg vs? (91?3±8?6)mmHg,P<0?05)) and PaO2/FiO2 were significantly increased ( ( 405?1 ± 46?0 ) mmHg vs? ( 340?1 ± 58?9 ) mmHg, ( 430?5 ± 59?1) mmHg vs? ( 344?0 ± 65?4 ) mmHg, ( 448?3 ± 39?1 ) mmHg vs? ( 410?1 ± 26?7 ) mmHg, ( 460?1 ± 33?5)mmHg vs? (423?2±36?5)mmHg,(465?1±28?2)mmHg vs? (435?1±40?8)mmHg,P<0?05)), the level of PA?aDO2 was decreased ((22?9±4?6)mmHg vs? (36?6±5?1)mmHg,(17?7±4?7)mmHg vs?(34?5±2?9)mmHg,(13?8±4?1)mmHg vs? (21?9±3?2)mmHg,(13?5±4?6)mmHg vs? (19?2± 3?8)mmHg,(12?4±2?0)mmHg vs? (17?7±2?4)mmHg,P<0?05)), and FEV1,FEV1% were significantly increased at 3 days after operation in PCPB group ((2?9±0?4)mmHg vs? (2?2±0?5)mmHg, (78?1± 4?7) mmHg vs? ( 64?8 ± 4?3 ) mmHg; P<0?01 ) ) . Conclusion Ultrasound guided patient?controlled paravertebral block improves the arterial oxygenation function and accelerates the recovery of pulmonary function in patients with multiple?fractured ribs after internal fixation operation.