Pediatric preoperative risk factors to predict postoperative ICU admission and death from a multicenter retrospective study.

BACKGROUND: Although some studies have investigated the potential predictors of perioperative mortality, there are few specifically for pediatrics. OBJECTIVE: The aim of the retrospective study was to analyze potential preoperative risk factors and to develop a pediatric preoperative risk prediction score (PRPS), and to predict postoperative ICU admission and the incidence of perioperative death in pediatric patients. METHODS: Patients who postoperatively admitted to ICU or died (occurred within 30 days after the surgery) from 263 607 pediatric surgical patients with age from 1 day to 14 years old in eight centers in China from October 2010 to September 2013 were retrospectively analyzed. About 5500 non-ICU admission and death patients were randomly selected from those 263 607 patients as controls for analysis comparison. Independent risk factors and a risk model were derived from these analyses, and were further assessed with the likelihood ratio test and the area under the receiver operating characteristic (ROC) curve. RESULTS: There were 1812 ICU admission or death patients but 187 patients' records are incomplete. There were 487 patients with incomplete records among 5500 controls. Collectively, data from 6626 patients were enrolled in final analyses. With multiple logistic regression analysis, age, ASA physical status, SpO2 , prematurity, and unfasted status were found to be independent predictors for critical patients. The AUC value of 0.905 indicated excellent predictive performance between critical and noncritical predictors. CONCLUSIONS: Our study revealed that age, ASA physical status, SpO2 , prematurity, and unfasted status are risk factors to predict postoperative ICU admission and death in pediatric patients.

[Analysis on the relationship between adolescent myopia and serum sex hormone].

OBJECTIVE: To investigate the quantitative changes of the serum sex hormone levels in juvenile myopia patients. METHODS: In January 2013, investigation of Wenzhou middle school 822 adolescents, including 432 male patients and 390 female patients were involved in the study Visual acuity ≥ 5 was set as the normal value. The subjects were divided into two groups, the myopia group and the non-myopia group. Chemiluminescence immunoassay analyzer was used to detect the subjects' sex hormone concentration of estradiol (E2), testosterone (T), follicle stimulating hormone (FSH) and luteinizing hormone (LH). RESULTS: The follicle stimulating hormone and luteinizing hormone of the female patients were significantly higher than those of male counterparts (P < 0.01); among the two groups consisting female myopia and non-myopia patients, a significant difference in luteinizing hormone and follicle stimulating hormone was shown (P < 0.05); the distinct differences in the level of luteinizing hormone and testosterone level showed in the male myopia group and non-myopia group were of outstanding statistics significance (P < 0.01), showing the result that the level of sex hormone in myopia group was higher than that in the non-myopia group. CONCLUSION: A close relationship perhaps between the level of sex hormone with gender differences and juvenile myopia is confirmed.

[Myopia prevalence and influencing factor analysis of primary and middle school students in our country].

OBJECTIVES: To explore the situation and the affect factors of myopia and scientificalness and effectiveness of eye exercises about primary and middle school students. METHODS: Through the random cluster sampling method, 20 000 students of 90 schools including key and non-key primary or junior or senior school in country and city of shandong, qinghai, yunnan, Shanghai and wenzhou were random selected. Primary students is 11 246 junior students is 3673 senior students is 4220.We surveyed related situation of eye exercises, myopia. a total of 19 139 valid questionnaires were received. By random sampling stratification method, freshmen were selected and retrospective surveyed. 929 freshmen have normal vision when they graduated primary school. 338 freshmen have normal vision when they graduated primary school.2 groups are considered analysis object, and Myopic students of the former in junior school stages and the latter in senior school stages are considered case group, normal vision are considered control group, and then through the Logistic multiple stepwise regression analysis, a regression analysis model is established. RESULTS: This survey show that myopia prevalence was 13.7% of primary students, 42.9% of junior students, 69.7% of senior students. According to the significant P < 0.001, Rsquare = 0.14, the result shows that the model has the significant statistical significance. Among the influence factors, whether to long-term excessive use eye is the most significant, and following by outdoor activities and gender. A chi-square test χ(2) = 0.371 and P = 0.543 show that doing eye exercises was not statistically significant to prevalence of myopia. CONCLUSION: The influence factors are changed, and the preventive methods should be adjusted with the social environment.

[Impact factor of timeliness lag for seeing a doctor about cataract patient in Wenzhou region of Zhejiang province].

OBJECTIVE: Investigation the impact factor of timeliness lag about cataract patient of operation. METHODS: Through Opportunistic Screening , from January 2007 to January 2012, we extracted people aged 50 or above and carried out the cataract screening in 10 towns of Wenzhou region of Zhejiang province. People extracted was checked by slit lamp microscope and ophthalmoscope directly, and the people who are suit for operation were brought to a first-rate of level three eye hospital and operated by MSICS . At the same time we have made questionnaire about five aspect including basic situation, economic status, basic life status, health and medical status and health needs for the operator and this questionnaire involves twenty-three relevant indexes about the timeliness, these factors of timeliness for patients seeing a doctor are judged. RESULTS: 36 681 people are checked for five years and 10 326 people(10 326 eyes) are suitable for surgery. Through analyzing sixteen relevant indexes about the timeliness , there are ten indexes which have Statistical Significance including in transportation, the distance for nearest medical aid post , care knowledge, population of family, income of family, respondents degree , the highest degree of family members type of work, structure of building, government subsidies. The first reason that the people can't be operated in time are economic difficulties, next are older and making children trouble for seven factors of no operation in time. The people for this three reason is more than 75% for not seeing a doctor in time. CONCLUSION: The key work of blindness prevention and treatment is the cataract surgery for our country.Eye doctors pay attention to new surgical technique , at the same time we should promote MSICS which is technique of low cost and have good effect of the operation.

[Analysis of correlative factors and prevalence on China's youth myopia].

OBJECTIVE: To understand and address our vision changes in primary and secondary students, in order to explore the prevention of juvenile myopia to provide a response and suggestions. METHODS: A random cluster sampling method, random sample of 90 rural and urban schools in Shandong, Qinghai, Yunnan, Shanghai and Wenzhou from May 2008 to September 2009, including 20 000 students (per province, 4000 x 5) from elementary school and junior high school of focus and non-focus, primary 11 246, junior high school students 3673, high school 4220, of which 11 177 were from the urban students, rural students in 7962, aged 6 to 19 years old, male to female ratio is basically the same. For myopia and related survey, a total of 19, 139 valid questionnaires were recovered. Using SPSS 13.0 software statistical analysis, different regions and different grades was used to compare the prevalence of myopia chi(2) test, using Logistic regression analysis on the major risk factors for myopia. RESULTS: The survey are as follows, the prevalence of myopia in primary was 13.7%; the prevalence of myopia in junior high was 42.9%, the prevalence of myopia in high school was 69.7%. The highest rate of myopia prevalence of primary school students in Shandong was 19.7%, the lowest was 11.9% in Qinghai, Shanghai, Wenzhou and Yunnan are similar; prevalence myopia of junior high in Wenzhou up to 50.6%, followed by Shanghai, and 47.2%, the lowest was 33.6% in Qinghai; the highest prevalence of myopia and high school students in Shandong, reaching 87.3%, followed by 72.0% in Wenzhou, and the lowest was 60.2% in Shanghai. CONCLUSION: This survey shows that the prevalence of myopia of China's primary and secondary schools in coastal was higher than areas of mainland, in developed regions was higher than in less developed regions, and the plateau region and the strong ultraviolet light similar to the plain areas. Provincial prevalence of myopia increased from primary to high school continued the same trend.

The Impact of the COVID-19 Pandemic on Pediatric Clinical Practice in Wenzhou, China: A Retrospective Study.

Introduction: The COVID-19 pandemic has affected all aspects of life worldwide. The aim of the present study was to review and describe and acknowledge the impact of COVID-19 on the pediatric health care system at a pediatric tertiary hospital in Wenzhou. Methods: A retrospective study was conducted at Yuying Children's Hospital of Wenzhou Medical University, a public pediatric tertiary hospital in Southern Zhejiang Province that specializes in pediatrics. The data regarding the primary diagnosis of patients were extracted from the electronic medical records system of the hospital. Data for outpatients and inpatients treated at the pediatric department were analyzed in the time frame of 22 weeks since the beginning of the pandemic (from December 30, 2019 to June 2, 2020) and compared with data from the same period in 2019. Results: The total number of outpatient cases in the previous 22 weeks of the year declined from 560,620 in 2019 to 247,030 in 2020, and inpatient cases decreased from 14,177 to 7,555. This negative trend settled by week 6 and 7 and subsequently approached the 2019 numbers. The most noticeable decrease in the number of cases was observed in children of preschool age. Moreover, the number of weekly visits decreased at the beginning of the epidemic, reached the lowest value during the lockdown period, and recovered after the lockdown. Conclusion: Based on the results of this study, clinical practice in a pediatric department in Wenzhou was substantially affected by the epidemic and measures such as physical distancing and increased personal hygiene, particularly in preschool-age children. An understanding of the trends and impacts of the pandemic on pediatric patients and health systems will facilitate better preparation of pediatricians in the future.

Analgesic efficacy of ultrasound-guided subcostal transversus abdominis plane block.

BACKGROUND: To evaluate the analgesic efficacy on defined areas of the abdomen and back after ultrasound-guided subcostal transversus abdominis plane (TAP) block using 0.25% levobupivacaine 0.5 mL/kg. METHODS: Twenty patients undergoing elective laparoscopic cholecystectomy, between 20 and 60 years of age with operative time <1 hour, received subcostal TAP block using 0.25% levobupivacaine 0.5 mL/kg on the left side. Surgery started after 1 hour of observation. Sensory assessment was undertaken using pinprick and 75% ethyl alcohol at 10, 20, 30 minutes, 1, 3, and 12 hours after TAP block at 19 testing zones that were divided by anatomic landmark lines on the abdomen and the back. Efficacy of zone was defined as loss of cold temperature sensation or loss of pinprick pain sensation in more than 50% patients in that testing zone. Duration was determined by analgesia and loss of temperature sensation beginning within 30 minutes of TAP block placement lasting until time points of 1, 3, and 12 hours. All of the testing zones were divided as Group I effective at 20 minutes in less than 50% patients (0%-50%), Group II 50% to 70% patients, Group III 70% to 90% patients, and Group IV 90% to 100% patients. RESULTS: Twenty patients meeting the study requirements were included. At each time point, the efficacies among 4 groups were significantly different. Subcostal TAP had good efficacy and stable duration in zones 1, 2, 3, 5, and 6. CONCLUSION: Subcostal TAP block with 0.25% levobupivacaine 0.5 mL/kg dose provided effective analgesia in the anterior abdominal wall between medioventral line to anterior axillary line except the lateral upper abdominal region.

Relevant factors of estrogen changes of myopia in adolescent females.

BACKGROUND: Gender is one of the risk factors accounting for the high prevalence of adolescent myopia. Considerable research results have shown that myopia incidence of female is higher than that of male. This study aimed to analyze the correlation between ocular parameters and serum estrogen level and to investigate the vision changes along with estrogen change in menstrual cycle of adolescent females. METHODS: A total of 120 young females aged between 15 and 16 years, diagnosed with myopia were recruited. Spherical lens, cylindrical lens, axis, interpupillary distance (IPD), and vision in each tested eye of the same subject were measured by automatic optometry and comprehensive optometry, with repetition of all measurements in the menstrual cycle of the 2 nd or 3 rd days, 14 th days, and 28 th days, respectively. Serum estradiol (E 2 ) levels were assayed by chemiluminescence immunoassay at the same three times points of the menstrual cycle mentioned above. RESULTS: In young females with myopia, the spherical lens showed a statistically significant difference among all different time in menstrual cycle (all P < 0.0001). The cylindrical lens, axis, and IPD were changed significantly during the menstrual cycle (P < 0.05). The vision of the three different time points in menstrual cycle had a significant difference (χ2 = 6.35, P = 0.042). The vision during the 14 th and 28 th day was higher compared to that on the 2 nd or 3 rd days (P = 0.021). Serum E 2 levels were significantly different at different time points in menstrual cycle (P < 0.05). E 2 levels reached its maximum value on the 14 th day and the minimum value on the 2 nd or 3 rd day. CONCLUSIONS: In adolescent females, the spherical lens and other related ocular parameters vary sensitively with different levels of E 2 in menstrual cycle. Vision in late menstrual stage is significantly higher than that in premenstrual stage.

Double contrast-enhanced ultrasonography for the preoperative evaluation of gastric cancer: a comparison to endoscopic ultrasonography with respect to histopathology.

BACKGROUND: This study was designed to compare the accuracy of endoscopic ultrasound (EUS) with double contrast-enhanced ultrasound (DCUS) in the staging of gastric malignancies. DCUS is a transabdominal ultrasound technique using both intravenous and intraluminal contrast to enhance sonographic visualization. METHODS: This retrospective study included 162 patients with biopsy-proven gastric cancer who underwent DCUS and EUS preoperatively with the ultrasound results compared with the pathologic findings of the resected specimens. RESULTS: The overall accuracy of DCUS and EUS for tumor (T) staging was 77.2% and 74.7%, respectively. Comparison of ultrasound techniques for T staging revealed that DCUS was superior to EUS only for a tumor depth of T3 (chi-square, P = .025). Lymph nodes were staged correctly with DCUS and EUS in 78.4% and 57.4% of cases, respectively (chi-square, P = .001). CONCLUSIONS: DCUS offers a noninvasive approach for the staging of gastric cancer. DCUS was comparable to EUS in tumor depth evaluation but offered an advantage in lymph node detection.