Self-assembling, pH-responsive nanoflowers for inhibiting PAD4 and neutrophil extracellular trap formation and improving the tumor immune microenvironment

Self-assembling carrier-free nanodrugs are attractive agents because they accumulate at tumor by an enhanced permeability and retention (EPR) effect without introduction of inactive substances, and some nanodrugs can alter the immune environment. We synthesized a peptidyl arginine deiminase 4 (PAD4) molecular inhibitor, ZD-E-1M. It could self-assembled into nanodrug ZD-E-1. Using confocal laser scanning microscopy, we observed its cellular colocalization, PAD4 activity and neutrophil extracellular traps (NETs) formation. The populations of immune cells and expression of immune-related proteins were determined by single-cell mass cytometry. ZD-E-1 formed nanoflowers in an acidic environment, whereas it formed nanospheres at pH 7.4. Accumulation of ZD-E-1 at tumor was pH-responsive because of its pH-dependent differences in the size and shape. It could enter the nucleus and bind to PAD4 to prolong the intracellular retention time. In mice, ZD-E-1 inhibited tumor growth and metastasis by inhibiting PAD4 activity and NETs formation. Besides, ZD-E-1 could regulate the ratio of immune cells in LLC tumor-bearing mice. Immunosuppressive proteins like LAG3 were suppressed, while IFN-γ and TNF-α as stimulators of tumor immune response were upregulated. Overall, ZD-E-1 is a self-assembling carrier-free nanodrug that responds to pH, inhibits PAD4 activity, blocks neutrophil extracellular traps formation, and improves the tumor immune microenvironment.

Early outcomes of arthroscopic repair of obsolete traumatic subscapularis tears / 中华创伤杂志

Objective:To study the early effect of arthroscopy in the treatment of obsolete traumatic subscapularis tears.Methods:A retrospective case series study was used to analyze the clinical data of 28 patients with obsolete traumatic subscapularis tears admitted to Second People 's Hospital of Changzhou City from July 2017 to July 2020，including 16 males and 12 females，aged 47-72 years［（60.5±6.3）years］. According to Lafosse classification，the injury size was upper one third tear in 9 patients，upper half tear in 18 and complete tear in 1. According to Patte classification of the degree of retraction，4 patients were with no retraction，7 with retraction to the level of the lesser tuberosity，14 with retraction to the level of the humeral head，and 3 with retraction to the level of the glenoid. According to Goutallier classification，the level of fatty infiltration was at grade 0-1 in 17 patients，at grade 2 in 10 and at grade 3-4 in 1. All patients were repaired by arthroscopic surgery. The wound healing was observed at 2 weeks postoperatively. The visual analogue score（VAS），University of California at Los Angeles（UCLA）shoulder rating score，shoulder active forward elevation（AFE），active external rotation（AER），active internal rotation（AIR）were assessed before operation and at 3 months and 6 months postoperatively. Six months after operation，reexamination of the front and side view of the shoulder and MRI of the shoulder were performed to assess the recovery of the subscapular tendon. Results:All patients were followed up for 6-12 months［（8.7±1.3）months］. All wounds healed 2 weeks after operation，with no infection occurred. The VAS was（3.5±0.7）points and（2.6±0.5）points at 3 months and 6 months postoperatively，lower than（6.3±1.2）points before operation（ P<0.01）. The UCLA score was（20.4±2.5）points and（25.6±6.2）points at 3 months and 6 months postoperatively，higher than（9.5±1.7）points before operation（ P<0.01）. The preoperative range of motion of the affected shoulder in AFE，AER and AIR was（80.2±12.6）°，（52.5±7.6）°，（3.7±1.2）°，respectively. Three months after operation，the range of motion was（113.2±7.5）°，（60.1±6.3）°，（6.8±1.6）°，respectively. Six months after operation，the range of motion was（122.3±15.2）°，（65.6±10.5）°，（7.8±2.3）°，respectively. The range of motion of the affected shoulder at 3 months and 6 months postoperativley was better than that before operation（ P<0.01）. Six months after operation，MRI showed good recovery in 27 patients，while a small re-tear in 1 patient（Goutallier classification grade 3）. Conclusion:For patients with obsolete traumatic subscapularis tears，arthroscopic repair can significantly relieve the pain，and recover range of motion and function of the joint.

Investigation of proper treatment for giant omphalocele with liver protrusion in neonates / 中华实用儿科临床杂志

Objective:To investigate the proper choice and improve the survival rate in neonates suffering from giant omphalocele (GO)with liver protrusion by analyzing the clinical characteristics, different treatments and outcomes.Methods:Neonates with GO admitted in Department of Neonatal Surgery in Wuhan Children′s Hospital were retrospected from January 2009 to May 2019.The treatment methods include: (1) repaired with similar silo-bag by staged operation; (2) one-stage repair with patch or not; (3) delayed repair by conservative treatment for some time (from 2 to 8 weeks) firstly.Data included gestational age, gender, birth weight, average diameter of omphalocele, contents of omphalocele, associated malformation, treatment method, duration of ventilator use and clinical outcome.These neonates were divided into 2 groups according to the contents of protrusion: group with liver protrusion and group with liver and other organs protrusion.Clinical data were summarized and compared between different groups.Results:Sixteen cases were collected, including 9 males and 7 females.The average age was (1.25±0.45) d (1-2 days), the average birth weight was (2.48±0.37) kg, and pregnant week was (36.23±1.17) weeks.The average diameter of the omphalocele was (9.88±3.30) cm, ranging from 5 cm to 15 cm.Seven cases were belonged to the group with liver protrusion, cases undergone one-stage repair, delayed repair were 6 cases and 1 case, respectively.There were 9 cases in group with liver and other organs protrusion, and the protruded organs included liver, intestine, colon or spleen.Among them, cases needed one-stage repair, delayed repair and silo-bag repair were 3 cases, 3 cases, 3 cases, respectively.Cases needed respiratory machine were 3 cases (42.8%) and 8 cases (88.89%) in group with liver protrusion and group with liver and other organs protrusion, respectively.Neonates had a longer time of needing respiratory machine in group with liver protrusion, comparing with the neonates in group with liver and other organs protrusion[(30.67±19.0) h vs.(106.25±69.36) h, P=0.021], and the risk rate to use respiratory machine was 5.143(95% CI: 0.727-36.368). There were no dead cases in group with liver protrusion.Three cases were dead in group with liver and other organs protrusion.All the patients were followed from 3 months to 4 years, and hernia in abdominal wall was found in 5 cases, including 1 case in group with liver protrusion and 4 cases in group with liver and other organs protrusion.If the dead cases had been excluded, the rate of hernia was 66.7% (4/6 cases) in group with liver and other organs protrusion. Conclusions:Individual treatment should be emphasized in neonates suffering from GO with liver protrusion.Neonates with single liver protrusion have a better prognosis than those with liver and other organs protrusion.One-stage repair is recommended in the former, and the delayed repair is highly recommended in the latter.The accessory liver should be considered when GO neonates presenting liver protrusion.

Thoracoscopic repair of congenital diaphragmatic hernia with hernia-ring pin in neonates / 中华实用儿科临床杂志

Objective@#To evaluate the indications and outcomes of thoracoscopic repair with hernia-ring pin (TRHP) applied in neonates with congenital diaphragmatic hernia (CDH).@*Methods@#Fifty-six cases diagnosed as CDH were collected from Department of Neonatal Surgery or Cardiothoracic Surgery in Wuhan Children′s Hospital, Tongji Medical College, Huazhong University of Science and Technology from May 2013 to September 2018.Patients were divided into thoracoscopic repair (TR) group and TRHP group, and the data, including birth weight, pregnant weeks, ages at operation, hospital stay postoperatively and the number of recurrence cases were compared, between the 2 groups.The size of defect was coded into A, B, C and D grades.Status of patients was grouped into Ⅰ, Ⅱ, Ⅲ, Ⅳ, and Ⅴstages according to the defect size and complicated congenital heart disease.@*Results@#There were 7 cases in TRHP group, including 3 boys and 4 girls.Four cases belonged to A-class defect and 3 cases were of B-class defect, respectively.The contents of the hernia included small intestine, colon, kidney and spleen.Six cases presented left CDH and 1 case presented right CDH.One of the left CDH cases and the 1 right CDH case had hernia sac.The right CDH neonate presented haematuria in the first day and the second day postoperatively, whose symptom disappeared after treatment.The follow-up time was (12.17±3.41) months, and no recurrent cases were found.All the cases in TRHP group belonged to Ⅰ or Ⅱ stage.There were 49 cases in the TR group.Among them, 29 cases belonged to class-A defect, 18 cases class-B defect, and 4 cases class-C defect, respectively.Cases classified into A and B defects were in stageⅠorⅡ, and cases classified into C defect were in stage Ⅲ.In those 45 cases belonged to A or B defect, 40 cases presented left CDH and 5 case presented right CDH.Among them, 5 neonates had hernia sac.The contents of the hernia included small intestine, colon, kidney and spleen.There were significant differences in the operative time [(83.47±10.28) min vs.(54.29±17.09) min, P<0.05] and length of stay postoperatively [(12.76±5.89) d vs.(7.86±2.03) d, P<0.05] in both groups.TRHP was carried out by the same surgeon, and he also operated on other 18 cases in TR group.Compared with the operative time of cases operated by the same surgeon in both groups, significant diffe-rence was found [(83.47±10.28) min vs.(54.29±17.09) min, P<0.05]. The cases were followed up for (46.17±6.92) months postoperatively and 4 recurrent cases were tracked.One A defect and 1 B defect patients had recurrence 1 month or 2 months postoperatively.Two C defect cases were found to have recurrence postoperatively in 2 months or 6 months, respectively.All 4 cases mentioned above recovered by reoperation.The risk of recurrence in C defect CDH cases existed as high as 21.5 times compared with the A or B defect cases.@*Conclusions@#It is safe to repair CDH by THRP in neonates with CDH A or B defect, for their operative time may be shorter.TRHP should be highly recommend for CDH cases with A or B defect.

Diagnosis and treatments in simple meconium ileus in neonates: ten-year experience in a single center / 中华实用儿科临床杂志

Objective@#To improve the accuracy of the diagnosis and decrease the unnecessary surgical exploration in neonates with simple meconium ileus (SMI) by analyzing clinical characteristics of SMI.@*Methods@#Forty-five neonates identified as SMI from January 2008 to May 2018 had been collected, and the data of pregnancy, birth weight, treatments, hospital stay and results of follow-up were included.The patients were divided into 2 groups: surgical group and non-surgical group.The surgical group underwent enterostomy at the end of ileum, meanwhile, the intestinal wall was biopsied for checking the existence of ganglion cells.All the neonates in the surgical group underwent stoma closure in 3 to 6 months postoperatively.The non-surgical group received fasting, intravenous nutritional support, enema with amiotol diluted into 11 or injected into the stomach by the gastric tube.They all received enema with warm salt (9 g/L) 1-2 times per day.Once the abdominal dilation was mitigated and autonomous defecation obtained, the neonates gradually began the oral feeding and weaned from the total parenteral nutrition(TPN). The 45 neonates were also divided into earlier group (from January 2008 to May 2013) and later group (from June 2013 to May 2018) according to the time of diagnosis.The relationships between the SMI treatment choice and the pregnancy, birth weight and time of diagnosis were analyzed.@*Results@#No cystic fibrosis lesions were found in 45 neonates, of which 21 and 24 neonates were in non-surgical group and surgical group, respectively.In the operation, the intestine presented similar anatomy to the total Hirschsprung′s disease.However, the ganglion was observed not only in the stricture, transitional and dilated zone of ileum, but also in the colon.There were no significant differences in the pregnancy and birth weight in both groups(P>0.05), but there was significant difference in the duration of hospitalization [(21.19±5.13) d vs.(12.29±3.85) d, P=0.000]. There were complications in those patients who had undergone enterostomy, including wound infection (2 cases), prolapse of stoma (2 cases), water and electrolyte disorders (2 cases), malnutrition (21 cases). After the stoma closure, no signs of ganglion cell dysplasia were found in follow-up.In non-surgical group, there were 20 pre-term reonates and 1 full-term neonate, respectively.In surgical group, there were 22 pre-term reonates and 2 full-term neonate, respectively.Neither pregnancy nor birth weight was related to the choice of treatment (P>0.05), but the time when to be admitted was highly related to the choice of treatment (P<0.05).@*Conclusions@#It is not rare for the occurrence of SMI in neonates in China, especially in preterm neonates.Amiotol may have effects not only on diagnosis but also on treatment of SMI, which can be applied repeatedly.Non-surgical treatment can help most of the neonates with SMI to avoid surgical exploration.Enhancing apprehension about the SMI may have great advantages to decrease the rate of unnecessary laparotomy.

Comparison between direct anterior approach and posterolateral approach in hip arthroplasty for elderly patients with femoral neck fractures / 中华创伤杂志

Objective To compare the efficacy of direct anterior approach ( DAA ) and posterolateral approach (PA) in hip arthroplasty for elderly patients with femoral neck fractures. Methods A retrospective case-control study was conducted to analyze the clinical data of 67 elderly patients with femoral neck fractures admitted to Second People's Hospital of Changzhou City, Affiliated Hospital of Nanjing Medical University from July 2015 to December 2017. There were 25 males and 42 females, aged 60-90 years [(76. 1 ± 7. 6)years]. There were 31 patients with right femoral neck fracture and 36 with left femoral neck fracture, all of whom underwent operations within 72 hours after injury. There were 18 patients with type III and 49 with type IV according to Garden typing. All patients were treated with total hip arthroplasty. Direct anterior approach ( DAA) was performed in 36 patients ( DAA group) and posterior approach ( PA) was performed in 31 patients ( PA group) . The operation time, intraoperative blood loss, postoperative drainage, recessive blood loss, total blood loss, the time when the patients got out of bed, and hospitalization time were compared between the two groups. Visual analogue scale ( VAS) and Harris score were used to evaluate hip joint function one month after operation. The complications of the two groups were recorded. Results All patients were followed up for 3-6 weeks, with an average of one month. The operation time of DAA group was longer than that of PA group [(75. 0 ± 10. 5)minutes vs. (54.0±11.4)minutes] (P<0.01). The DAA group had less intraoperative blood loss [(174.3 ± 60.1)ml vs. (254.8±79.9)ml] (P<0.05), total blood loss [(745.7 ±238.8)ml vs. (977.9 ± 301. 9)ml] (P<0. 05), recessive blood loss [(315. 4 ± 196. 7)ml vs. (457. 7 ± 286. 2)ml] (P<0. 05) than the PA group. There was no significant difference in the postoperative drainage between DAA groupandPAgroup[(246.1 ±110.1)ml vs. (265.3±164.2)ml] (P >0.05). DAA group had shorter durations in terms of the time when patients got out of bed [(23. 7 ± 18. 1)hours vs. (35. 1 ± 22. 5)hours] (P<0. 01) and hospitalization time [(9. 2 ± 1. 5)days vs. (12. 3 ± 2. 0)days] than the PA group (P <0. 05). The VAS scores of the DAA group and PA group at 1 month after surgery [(3. 0 ± 1. 9)points vs. (3. 3 ± 1. 9) points] and the Harris score [(87. 9 ± 6. 5) points vs. (87. 0 ± 6. 1)points ] were not significantly different (P>0. 05). Intraoperative and postoperative complications included femoral periprosthetic fracture in three patients, lateral femoral nerve injury in two patients and severe anemia requiring blood transfusion in two patients in DAA group. In the PA group, there was one patient with deep venous thrombosis of the lower extremity at one month after operation, two patients with posterior dislocation of the hip, four patients with periprosthetic fracture and four patients with severe anemia requiring blood transfusion (P>0. 05). Conclusion For femoral neck fracture in the elderly, compared with PA hip arthroplasty, DAA hip arthroplasty has less bleeding, earlier time to get out of bed and shorter hospital stay, with satisfactory short-term results.

Diagnosis and treatments in simple meconium ileus in neonates:ten_year experience in a single center / 中华实用儿科临床杂志

Objective To improve the accuracy of the diagnosis and decrease the unnecessary surgical explo_ration in neonates with simple meconium ileus(SmI)by analyzing clinical characteristics of SmI. Methods Forty_five neonates identified as SmI from January 2008 to may 2018 had been collected,and the data of pregnancy,birth weight,treatments,hospital stay and results of follow_up were included. The patients were divided into 2 groups:surgi_cal group and non_surgical group. The surgical group underwent enterostomy at the end of ileum,meanwhile,the intes_tinal wall was biopsied for checking the existence of ganglion cells. All the neonates in the surgical group underwent sto_ma closure in 3 to 6 months postoperatively. The non_surgical group received fasting,intravenous nutritional support, enema with amiotol diluted into 1: 1 or injected into the stomach by the gastric tube. They all received enema with warm salt(9 g/L)1_2 times per day. Once the abdominal dilation was mitigated and autonomous defecation obtained, the neonates gradually began the oral feeding and weaned from the total parenteral nutrition( TPN). The 45 neonates were also divided into earlier group(from January 2008 to may 2013)and later group(from June 2013 to may 2018) according to the time of diagnosis. The relationships between the SmI treatment choice and the pregnancy,birth weight and time of diagnosis were analyzed. Results No cystic fibrosis lesions were found in 45 neonates,of which 21 and 24 neonates were in non_surgical group and surgical group,respectively. In the operation,the intestine presented similar anatomy to the total Hirschsprung＇s disease. However,the ganglion was observed not only in the stricture,transitional and dilated zone of ileum,but also in the colon. There were no significant differences in the pregnancy and birth weight in both groups(P>0. 05),but there was significant difference in the duration of hospitalization[(21. 19 ± 5. 13)d υs. (12. 29 ± 3. 85)d,P=0. 000]. There were complications in those patients who had undergone enterostomy,including wound infection(2 cases),prolapse of stoma(2 cases),water and electrolyte disorders(2 cases),malnutrition(21 cases). After the stoma closure,no signs of ganglion cell dysplasia were found in follow_up. In non_surgical group, there were 20 pre_term reonates and 1 full_term neonate,respectively. In surgical group,there were 22 pre_term reonates and 2 full_term neonate,respectively. Neither pregnancy nor birth weight was related to the choice of treat_ment(P>0. 05 ),but the time when to be admitted was highly related to the choice of treatment( P <0. 05 ). Conclusions It is not rare for the occurrence of SmI in neonates in China,especially in preterm neonates. Amiotol may have effects not only on diagnosis but also on treatment of SmI,which can be applied repeatedly. Non_surgical treat_ment can help most of the neonates with SmI to avoid surgical exploration. Enhancing apprehension about the SmI may have great advantages to decrease the rate of unnecessary laparotomy.

Thoracoscopic repair of congenital diaphragmatic hernia with hernia-ring pin in neonates / 中华实用儿科临床杂志

Objective To evaluate the indications and outcomes of thoracoscopic repair with hernia-ring pin (TRHP) applied in neonates with congenital diaphragmatic hernia (CDH).Methods Fifty-six cases diagnosed as CDH were collected from Department of Neonatal Surgery or Cardiothoracic Surgery in Wuhan Children's Hospital,Tongji Medical College,Huazhong University of Science and Technology from May 2013 to September 2018.Patients were divided into thoracoscopic repair (TR) group and TRHP group,and the data,including birth weight,pregnant weeks,ages at operation,hospital stay postoperatively and the number of recurrence cases were compared,between the 2 groups.The size of defect was coded into A,B,C and D grades.Status of patients was grouped into Ⅰ,Ⅱ,Ⅲ,Ⅳ,and Ⅴ stages according to the defect size and complicated congenital heart disease.Results There were 7 cases in TRHP group,including 3 boys and 4 girls.Four cases belonged to A-class defect and 3 cases were of B-class defect,respectively.The contents of the hernia included small intestine,colon,kidney and spleen.Six cases presented left CDH and 1 case presented right CDH.One of the left CDH cases and the 1 right CDH case had hernia sac.The right CDH neonate presented haematuria in the first day and the second day postoperatively,whose symptom disappeared after treatment.The follow-up time was (12.17 ± 3.41) months,and no recurrent cases were found.All the cases in TRHP group belonged to Ⅰ or Ⅱ stage.There were 49 cases in the TR group.Among them,29 cases belonged to class-A defect,18 cases class-B defect,and 4 cases class-C defect,respectively.Cases classified into A and B defects were in stage Ⅰ or Ⅱ,and cases classified into C defect were in stage Ⅲ.In those 45 cases belonged to A or B defect,40 cases presented left CDH and 5 case presented right CDH.Among them,5 neonates had hernia sac.The contents of the hernia included small intestine,colon,kidney and spleen.There were significant differences in the operative time [(83.47 ± 10.28) min vs.(54.29 ± 17.09) min,P ＜0.05] and length of stay postoperatively [(12.76 ±5.89) d vs.(7.86 ± 2.03) d,P ＜ 0.05] in both groups.TRHP was carried out by the same surgeon,and he also operated on other 18 cases in TR group.Compared with the operative time of cases operated by the same surgeon in both groups,significant difference was found [(83.47 ± 10.28) min vs.(54.29 ± 17.09) min,P ＜ 0.05].The cases were followed up for (46.17 ± 6.92) months postoperatively and 4 recurrent cases were tracked.One A defect and 1 B defect patients had recurrence 1 month or 2 months postoperatively.Two C defect cases were found to have recurrence postoperatively in 2 months or 6 months,respectively.All 4 cases mentioned above recovered by reoperation.The risk of recurrence in C defect CDH cases existed as high as 21.5 times compared with the A or B defect cases.Conclusions It is safe to repair CDH by THRP in neonates with CDH A or B defect,for their operative time may be shorter.TRHP should be highly recommend for CDH cases with A or B defect.

Clinical characteristics of children with pertussis syndrome and attention to the effect of gastroesophageal reflux caused by gastric volvulus on small infants with pertussis syndrome: an analysis of 807 cases / 中国中西医结合急救杂志

Objective To observe the clinical characteristics of infants with pertussis syndrome and the influence of gastroesophageal reflux (GER) on pertussis syndrome in small infants, and provide experience for improving curative effect. Methods ① The clinical data of 807 infants with pertussis syndrome treated at Wuhan Children's Hospital from January 2015 to June 2017 were retrospectively analyzed, in which their clinical characteristics including symptoms, signs and related physical and chemical examinations were summarized. ② Prospective randomized controlled trials were performed at the Children's Hospital of Wuhan from June 2017 to June 2018, there were 120 infants with ages < 6 months diagnosed as pertussis syndrome and simultaneously accompanied by gastric volvulus (GV) and GER, and they were randomly divided into a study group and a control group according to the date sequence of definite diagnosis, 60 cases in each group. The control group was given conventional medical treatment, while in the study group, additionally the infants received massage to restore gastric proper position and anti-reflux therapy. The clinical efficacies of two groups were observed. Results ① Retrospective analysis showed that clinically, pertussis syndrome commonly occurred in infants of ages < 6 months, accounting for 88.30% (713 cases); all cases had spastic cough, and 60.00% (484 cases) infants' coughing was severer at night. In laboratory examinations, 83.27% (672 cases) of the infants had elevated platelets (PLT), 25.03% (202 cases) had abnormal myocardial zymograms, and 70.38% (568 cases) had elevated white blood cells (WBC). In the pathogen examination, only were pathogens found in 34.8% infants, mainly single pathogen infection, accounting for 86.12%. Chest radiographs suggested 71.50% of infants with pneumonia, and 73.00% of infants with GER, among which 77.92% of infants were accompanied by GV. ② The prospective study showed that in the treatment of infants with pertussis syndrome accompanied by GV and GER, manual massage should be used timely to correct GV and simultaneously anti-reflux therapy should be given, in the aspects of time required to improve cough symptoms (days: 5.36±1.40 vs. 6.59±1.56, P < 0.01) and shortening of the hospital stay (days: 6.50±1.41 vs. 8.09±1.63, P < 0.01) in the study group were superior to those in the control group; the case of respiratory failure in the study group was lower than that in the control group [2 cases vs. 8 cases, P < 0.05]. Conclusions In pertussis syndrome, lymphocytes occupy the main proportion of WBC elevation that is an important differential criterion between pertussis syndrome and infantile pneumonia with gastric volvulus and gastroesophageal reflux. PLT elevation in pertussis syndrome suggests that attention should be paid to the elevation as that might be related to the disease prognosis. It is necessary to further investigate whether the positive pathogen discovered in the course of pertussis syndrome is a pathogenic one, and attention should also be paid to the medical examination of GV and GER in the small infants with pertussis syndrome, since early proper intervention to correct GV and GER can significantly improve their clinical efficacies.

Research and Reflection on Reprocessed Medical Devices Supervision / 中国医疗器械杂志

Under the precondition of ensuring safety and effectiveness, whether to reuse reprocessed medical devices to reduce the medical expenses has become the focus of the relevant regulatory authorities in our country. In this paper, we studied the regulatory policy for reprocessed medical devices in major international economies, such as United States, Japan, European Union and so on. From the regulatory and technical level, we thought about the risks of supervising reprocessed medical devices, and analyzed the ideas and risk concerns of supervising reprocessed medical devices to provide reference for regulation of such devices in our country.

Clinical features of Amyand's hernia in neonates: cases report and literature review / 中华实用儿科临床杂志

Objective To investigate the characteristics of Amyand's hernia (AH) in neonates in order to decrease the complications and to improve the prognosis.Methods Data about neonates with AH in Department of Neonatal Surgery,Wuhan Children's Hospital,Tongji Medical College,Huazhong University of Science and Technology,were collected from January 2010 to February 2017,and the AH cases published from 1997 to 2017 in PubMed and Wanfang Data were also reviewed.Results Twenty-two cases were collected,including 8 cases treated in Wuhan Children's Hospital,Tongji Medical College,Huazhong University of Science and Technology,and 14 cases from literature reports.In this group,4 cases underwent traditional operation and 4 cases underwent laparoscopy,respectively.All the patients underwent appendix resection and the ligation of the hernia sac.Among the 4 cases who underwent laparoscopic operation,contra-lateral hernia was found in 2 cases and pyocelia in 1 case.However,the appendix had a solid adhesion with the inguinal canal in those 4 cases and it was difficult to return the appendix to the cavity.Thus,the laparoscopy had to be terminated and the traditional procedure was carried out to separate the adhesion.In those 4 cases to whom the traditional operation was applied,1 case presented inflammation in abdomen and the contra-lateral hernia after operation.According to the pathological results of appendix,in this group,there were 3 cases,4 cases,and 1 case that presented Ⅱ,Ⅲ,Ⅳ type,respectively.In literature cases,there were 13 cases and 1 case that underwent traditional operation and laparoscopy,respectively.There were 4 cases,9 cases,and 1 case that presented Ⅱ,Ⅲ,Ⅳ type,respectively.The complications included located peritonitis (1 case),testicular torsion (1 case) and orchitis (1 case).All cases recovered smoothly.Conclusion Most of the AH cases in neonates present appendix suppuration,gangrene or perforation.The neonatal cases with AH also present obvious local infection and they are prone to develop into pyocelia in inguinal canal and abdominal cavity.In AH cases,laparoscopy has its own advantages,which not only help to make it clear if there is the contralateral hernia,but also helps to treat the complicated pyocelia in abdominal cavity,which help to avoid the residual infection efficiently.

Hemostatic effect of carboxymethyl chitosan and its biosecurity properties / 中国组织工程研究

BACKGROUND:Carboxymethyl chitosan (CMCS),a chitin derivative,has a good application performance that makes it become a safe and effective hemostatic material.OBJECTIVE:To determine the hemostatic effect of CMCS and its biosecurity properties.METHODS:(1) CMCS powder was scattered on the caudal vein and liver wounds of Sprague-Dawley rats,and the hemostatic time was recorded as experimental group,while the time for natural haemostasis of the wound was recorded as control group.(2) CMCS powder was scattered on the tail,femoral artery and liver wounds of ICR mice,and the hemostatic time was recorded as experimental group,while the time for natural haemostasis of the wound was recorded as control group.(3) CMCS,Sodium dodecyl sulfate solution and distilled water were respectively applied on the skin of albino rabbits in a skin irritation test.(4) A delayed-type hypersensitivity test of CMCS was carried out by intradermal injection of CMCS in guinea pigs.(5) An intradermal irritation test was carried out by subcutaneous injection of normal saline containing CMCS and normal saline,respectively.Another intradermal irritation test was carried out by subcutaneous injection of the supernatant of CMCS olive oil extract and olive oil,respectively.RESULTS AND CONCLUSION:(1) Compared with the control group,the hemostatic time for caudal vein and liver wounds were significantly shortened in the Sprague-Dawley rats in the experimental group (P ＜ 0.01).(2) Compared with the control group,the time of hemostasis on the tail,femoral artery and liver wounds was significantly shortened in the ICR mice in the experimental group (P ＜ 0.05 or P ＜ 0.01).(3) The CMCS had no irritation to the skin of albino rabbits and no allergic reaction to the skin of guinea pigs.To conclude,the CMCS has good hemostatic effect on the wound in Sprague-Dawley rats and ICR mice,and has no skin irritation,allergic reactions and intradermal irritation reactions in albino rabbits and guinea pigs,which is a relatively safe hemostatic material.

Application of pattern plastic plate and red color stimulation in continuous video-electroencephalography monitoring / 中华实用儿科临床杂志

Objective To evaluate the clinical efficiency of intermittent photic stimulation (IPS) with pattern and red color plastic plates in video-electroencephalography(EEG).Methods Three hundred and fifty-eight patients hospitalized in Wuhan Children's Hospital from March 2013 to March 2014 were selected,and they were examined by using stroboscope with a red plastic plate,a dots printed plastic plate,and ordinary white flicker for photic driving response (PDR),photoparoxysmal responses (PPR),photoconvulsive response (PCR).The results of patients with PDR,PPR,PCR were analyzed.Results The PDR synchronously evoked by the three flickering patterns were in 29 cases,and the amplitude of photic drivings evoked by ordinary white flicker and red flicker were higher than that of flickering dot pattern [(30.294 ± 7.767) μV,(31.103 ± 8.920) μV vs (24.436 ± 8.075) μV],and there were significant differences(t =2.983,2.815,P =0.003,0.008).However,there was no significant difference between ordinary white flicker and red flicker (t =0.368,P =0.710).The PPR evoked were in 17 cases,and 16 cases (94.12％) of them were evoked by red color,while 10 cases (58.82％) wcre evoked by white light,and 1 case only evoked by flickering dot pattern.However,stronger intensity and longer duration time of PPR were evoked by red color than by white light.In 3 patients with positive PCR,the epileptic seizure was more likely to be evoked by red color or pattern plastic plate.Conclusions IPS with red and pattem plastic plate is more potent in eliciting photosensitive epilepsy in video-EEG than the ordinary white light.Moreover,it could reduce the discomfort of eyes without influencing PDR in comparison to the ordinary white light.

Discussion on the electromagnetic compatibility testing and evaluation of radio frequency ablation catheter / 中国医疗器械杂志

With the enforcement of YY 0505-2012, the testing items and evaluation points of radio frequency ablation catheter in electromagnetic compatibility field should be studied and discussed. Based on the requirements of relevant standards, this paper discusses on the testing items that should be applied and the evaluation points that should be focused on by analyzing the intended use and the structure of radio frequency ablation catheter, when it intends to apply registration individually with the basic knowledge of electromagnetic compatibility field.

Dependability of trochlear line as femoral rotation osteotomy axis in total knee arthroplasty / 中华创伤杂志

ObjectiveTo probe into the dependability of trochlear line (TL) as the reference axis for femoral component rotation in total knee arthroplasty.MethodsEighty-nine healthy adults had computed tomography (CT) scan for knees to position the surgical transepicondylar axis (STEA),posterior condylar line (PCL) and TL on the transverse sections.In the meantime,the angles including angle between TL and STEA (TSA),angle between TL and PCL (TPA) and angle between PCL and STEA (PCA) were measured and compare the dependability of TSA and PCA.ResultsThe TSA,TPA and PCA were (6.77 ± 3.12) °,(4.22 ± 2.64) ° and (2.95 ± 1.77) °,respectively.Three types of angles showed no statistical differences between males and females or between right knees and left knees (P ＞0.05).Rank sum test displayed significant differences in the overall distributions of three kinds of angles ( HC =66.837,P ＜0.01 ).The coefficient of variation of TSA was insignificant,but the standard variation was significant (3.12°).ConclusionTL can be considered only as the subsidiary femoral rotation osteotomy axis in total knee arthroplasty.