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Objective:To investigate the clinical effect of arthroscopic reduction of tibial intercondylar ridge fractures in children using a 2.0 mm perforated Kirschner wire to establish bone tunnels and the Krackow-" 8" suture.Methods:From January 2018 to December 2020, 24 children (14 males and 10 females, aged 6-15 years) with tibial intercondylar ridge fractures admitted to Children′s Hospital of Nanjing Medical University were retrospectively recruited for analyses.All patients were treated with arthroscopic reduction, non-absorbable Krackow-" 8" suture for the base of the anterior cruciate ligament, and establishment of bone tunnels by 2.0 mm perforated Kirschner wire from the proximal tibial epiphysis for inserting a suture to fix the fractures.The affected limb was immobilized with a cast for 4 weeks, followed by active exercises postoperatively.Knee function was assessed using the Lysholm score and IKDC 2000 subjective score.Knee stability was evaluated using the Lachman test.X-rays were taken at 3 and 6 months postoperatively to evaluate fracture healing.Growth retardation of epiphyseal plate at 2 years of follow-up was assessed by bilateral knee X-rays.Results:All the 24 cases were successfully operated, with the operation time of (63.1±20.2) (40-115) min.All children were followed up for 24-36 months[(28.7±3.4) months]. All children achieved an anatomical reduction of the fracture postoperatively.No complications like fracture displacement, suture rupture, or infection were reported.All fractures healed completely at 3 months postoperatively.At the last follow-up, the Lysholm score and IKDC 2000 subjective score were (94.4±4.8) points and (93.8±5.6) points, respectively.The positive Lachman test was detected in 2 patients.No inhibition of proximal tibial epiphyseal growth was observed.Conclusions:Arthroscopic reduction with non-absorbable Krackow-" 8" suture and establishment of bone tunnels using a 2.0 mm perforated Kirschner wire for the treatment of tibial intercondylar ridge fractures in children has the advantages of simple surgical procedures, minimal invasiveness, which is an effective treatment method.
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Objective:To explore the surgical strategy of coronary artery bypass grafting(CABG) for moderate ischemic mitral regurgitation(IMR), and to clarify the impact of mitral valve surgical intervention(MVS) on the long-term prognosis of such patients.Methods:The clinical data of 234 consecutive patients with moderate IMR who received CABG from January 2013 to December 2018 were retrospectively included, with 184 males and 50 females. The age ranged from 29 to 78 years, with a mean of(61.5 ± 8.7) years old. According to whether MVS was performed at the same time, they were divided into CABG group(108 cases, CABG alone) and CABG+ MVS group(126 cases, CABG+ MVS at the same time). The long-term cardiac events, all-cause deaths, major cardiovascular and cerebrovascular adverse events(MACCE) and other end events were followed up. A matching queue was established by propensity matching score for statistical analysis.Results:After propensity matching score, a matching queue was established, including 78 pairs of patients. Survival analysis showed that the incidence of long-term cardiac events and postoperative new onset atrial fibrillation in CABG+ MVS group was significantly higher( P<0.05). However, there was no significant difference between the two groups in all-cause mortality, cardiogenic mortality, and the incidence of MACCE events( P>0.05). Cox regression analysis showed that simultaneous CABG+ MVS was a risk factor for long-term cardiac events and new postoperative atrial fibrillation. The results of subgroup studies showed that for patients without tricuspid regurgitation before operation, left ventricular end diastolic diameter>55 mm, and left ventricular ejection fraction(LVEF) ≤0.55, the probability of cardiac events after MVS at the same time of CABG was higher( P<0.05). However, patients with no tricuspid regurgitation before operation, left ventricular end diastolic diameter>55 mm, LVEF≤0.55, and left atrial diameter≥40 mm had a higher probability of atrial fibrillation after MVS at the same time of CABG( P<0.05). Conclusion:CABG can improve left ventricular remodeling in patients with moderate IMR, whether MVS intervention is performed at the same time or not, and the long-term survival rate of both is similar. CABG+ MVS in the same period can maintain a low residual reflux, but the incidence of long-term cardiac events and arrhythmias is high. The longer-term prognosis needs to be further studied. The surgical strategy of such patients should be selected individually according to the specific situation and the surgical quality in medical centers.
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Objective:To analyze the curative effect of locking compression pediatric hip plate (LCH-PHP) in the treatment tumor-like lesions of femoral neck in children.Methods:From January 2012 to June 2019, 45 children with Erol type Ⅱ-Ⅳ tumor-like lesions of femoral neck were retrospectively analyzed, involving 32 males and 13 females, aged 2-14 years.Among them, 27 cases were simple bone cyst, 15 cases were fibrous dysplasia, 3 cases were Langerhans histiocytosis, and 17 cases were accompanied with pathological fracture.Patients without pathological fracture were divided into 2 groups according to different surgical methods: lesion removal and bone grafting+ LCH-PHP preventive fixation group (group A) and lesion removal and bone grafting group (group B). Patients with pathological fracture were divided into 2 groups according to the different surgical methods: lesion removal and bone grafting+ LCH-PHP fixation and reduction group (group C) and lesion removal and bone grafting group (group D). The loss of femoral neck-stem angle, healing time and Musculoskeletal Tumor Society (MSTS) scores were compared between group A and group B. Changes of femoral neck-stem angle were compared between group C and group D at postoperative 1 day and the last follow-up.Results:Forty-five patients were followed up for an average of 2.6 (1-4) years.The loss of femoral neck-stem angle in group A and group B were (0.50 ± 0.45)°, and (2.26 ± 1.64)°, which was significantly different ( t=-3.193, P<0.05). There were no significant differences in the healing condition, healing time and MSTS scores at the last follow-up between group A and group B(all P>0.05). In group C, the ipsilateral femoral neck-stem angle at the postoperative 1 day and the last follow-up were (133.67±4.53)°and (133.00±4.32)°, respectively, which was comparable ( P>0.05). In group D, the ipsilateral femoral neck-stem angle at the postoperative 1 day and the last follow-up were (133.36±7.82)°and (130.63±8.24)°, respectively, which was significantly different ( t=7.11, P<0.05). Conclusions:LCH-PHP fixation can effectively maintain the femoral neck-stem angle and prevent the occurrence of pathological fracture children with Erol Ⅱ-Ⅳ tumor-like lesions of femoral neck.
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Objective:To explore the outcomes of T?nnis triple osteotomy for developmental dysplasia of the hip (DDH) in older children.Methods:Clinical data of 21 children (22 hips, 12 left and 10 right hips) treated by T?nnis triple osteotomy from October 2016 to June 2019 were retrospectively analyzed.There were 8 males and 13 females with a mean age of operation at 13.5 (8.6-16.8) years.Based on the T?nnis classification, all the cases were in Grade Ⅰ.Statistical analysis was performed using the SPSS 22.0 statistical software.Results:All recruited patients were followed up for 1.5-3.5 years.Compared with preoperative values and those at the last follow-up visit, the mean Sharp acetabular angle of the affected side recovered from 53.5°±5.2° to 40.8°±2.3°.The mean center-edge angle increased from 10.5°±2.9° to 35.4°±5.6°.The mean acetabular roof angle decreased from 38.6°±2.8° to 6.7°±1.3°.The mean acetabular head index enhanced from (54.3±5.2)% to (86.2±2.7)%.The differences between the preoperative and postoperative values were statistically significant ( t=24.3, 17.6, 50.1, 27.5; all P<0.05). According to the Harris classification, there were 17, 3 and 2 hips achieved excellent, good and fair outcomes at the last follow-up visit, respectively, with the percentage of excellent and good outcomes up to 90.9%(20/22 hips). Accor-ding to the Severin radiographic classification, 8, 12 and 2 hips were in grade Ⅰ, Ⅱ, and Ⅲ, respectively, with the percentage of excellent and good hips at 90.9%(20/22 hips). At the last follow-up visit, the bone healing of iliac and pubic bones was well, and the nonunion of ischial bones were reported in 3 cases (13.6%). Conclusion:The outcome of the T?nnis triple osteotomy is satisfactory for DDH in older children.
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Objective:To assess the clinical effect of retrograde elastic stable intramedullary nailing(ESIN) in distal humerus metaphysis-diaphyseal junction fractures in children.Methods:A total of 14 cases of children with distal humerus metaphysis-diaphyseal junction fractures treated by retrograde ESIN in Children′s Hospital of Nanjing Medical University from January 2016 to December 2018 were retrospectively analyzed.There were 9 males and 5 females, aged 3.0-13.2 years old(median: 6.4 years old). Nine cases had fractures on the left side and 5 cases on the right side.Two prebent ESINs were inserted into the proximal humerus metaphysis through the humerus marrow cavity from medial and lateral sides of the distal humerus respectively after the closed/open reduction of fractures.After surgery, the shoulder abductor stent or long arm plaster was used for fixation post-operatively.X - ray examination was performed at regular post-operative follow-up.The stability of internal fixation was analyzed by measuring the Baumann angle and checking whether humeral anterior lines passed through capitulum humeri in lateral radiographs immediately after the surgery and at the last follow-up.Meanwhile, efficacy was evaluated according to Flynn functional evaluation criteria.Results:All the 14 patients in this group were followed up for 10-27 months after the operation, with an average of 18.4 months.The Baumann angle was within the normal range at both the end of the operation and the last follow-up, and no significant difference was observed.Lateral radiographs showed humeral anterior lines passed through the capitulum humeri.According to Flynn functional scores, there were 13 excellent cases and 1 good case.No wound infection, intramedullary nailing displacement, Volkmann contracture, cubital varus deformity, or iatrogenic nerve injury occurred in any of the children.Conclusion:Retrograde ESIN technique is a safe and reliable treatment for children with distal humerus metaphysis-diaphyseal junction fractures.
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Objective:To explore the feasibility of accurate localization for the acetabular direction in Salter pelvic osteotomy for the developmental dislocation of the hip joint in children by using computer aided design and 3D printing technique.Methods:The clinical data of 12 patients of unilateral hip dislocation treated with Salter pelvic osteotomy by using 3D printed navigation template in Department of Orthopedics, Children′s Hospital of Nanjing Medical University From October 2016 to April 2017 were retrospectively analyzed.Among the 12 cases, there were 4 males and 8 females, 5 hips on the left and 7 hips on the right, aged 1.5 to 5.0 years old (mean 2.3 years old). According to the CT data, the models of the healthy hip joint were mirrored to the contralateral side by Mimics software.Computer-aided simulations of Salter pelvic osteotomy on models of the affected hip joints were performed.Then, the models of the affec-ted hip joint were rotated to the mirror models of the contralateral hip joint.The navigation templates were designed according to the exposed pelvic surface morphology during the operation.The navigation templates were printed by rapid prototyping technology to guide the operation.Preoperative and postoperative acetabular index (AI) and center edge angle (CEA) of affected side were compared to postoperative AI and CEA of contralateral side respectively.Results:A method of making personalized navigation templates for Salter pelvic osteotomy was established in 12 children with developmental dislocation of the hip joint.The operation time ranged from 40.2 to 64.5 min, averaging (50.6±8.5) min.The intraoperative bleeding volume ranged from 35 to 60 mL, averaging 52 mL.No vascular and nerve injury was found in the postoperative examination, and no child had complications such as infection, residual foreign body of the guide plate and so on.There was significant difference in preoperative measurements regarding AI between the affected side [(38.4±2.8)°] and the contralateral side [(21.6±0.8)°]( t=-18.77, P<0.05), and there was significant difference in preoperative measurements regarding CEA between the affected side[(-5.8±12.6)°] and the contralateral side[(21.1±2.4)°]( t=-7.348, P<0.05). But there was no significant difference in postoperative mea-surements regarding AI between the affected side [(21.7±0.8)°] and the contralateral side ( t=-2.037, P>0.05), there was no significant difference in postoperative measurements regarding CEA between the affected side[(21.2±2.6)°] and the contralateral side( t=-0.435, P>0.05). Conclusions:The navigation template prepared by computer aided design and 3D printing technology has good accuracy, and is a new approach to accurate acetabular rotation in children with the developmental dislocation of the hip joint for Salter pelvic osteotomy.
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Objective To compare the effectiveness of snail control between immersion of molluscicides through tide diversion and mollusciciding by spraying in marshland areas. Methods Immersion of 26% suspension concentrate of metaldehyde and niclosamide through tide diversion and spraying 26% suspension concentrate of metaldehyde and niclosamide alone were employed for snail control in two neighboring snail-breeding marshlands, and snails were surveyed before and after mollusciciding. The mortality of snails and the density of living snails were estimated. Results The density of living snails reduced by 72.19% and 100.00% 1 and 2 years after immersion of 26% suspension concentrate of metaldehyde and niclosamide through tide diversion, and 5.93% and 18.15% 1 and 2 years after spraying 26% suspension concentrate of metaldehyde and niclosamide alone. Conclusion Immersion of 26% suspension concentrate of metaldehyde and niclosamide through tide diversion is significantly superior to spraying 26% suspension concentrate of metaldehyde and niclosamide along for snail control, and implementation of immersion of 26% suspension concentrate of metaldehyde and niclosamide through tide diversion for more than 2 successive years may achieve a higher snail control efficiency.
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Objective To evaluate the effect and cost-effectiveness of three commonly used molluscicides, 4% "Luo-wei" (tea-seed distilled saponins, TDS), 50% niclosamide ethanolamine salt wettable powder (NESWP), and 26% metaldehyde and niclosamide suspension concentrate (MNSC) in large-scale field application, so as to provide the references for formulating the strategy of snail control. Methods The field test and parallel comparison were implemented. A marshland with Oncomelania hupensis snails of the Yangtze River was divided into 4 parts (10 hm2) for the research, and three of them were experimental areas while the last one was a blank control area. The experimental areas were sprayed with 4% "Luo-wei", 50% NESWP and 26% MNSC respectively for 3 times and the interval was 1 week. Seven days after each spraying the effect of snail control was investigated, and the costs of molluscicides, labor, transportation, fuel consumption and mechanical loss were recorded. The cost of each molluscicide, snail mortality, snail density, and the cost of increasing 1% of snail mortality per 100 m2 were analyzed and compared. Results After the first, second and third spraying, the corrected snail mortality rates were 67.34%, 76.55% and 84.60% respectively in the 4% "Luo-wei" group; the corrected snail mortality rates were 64.71%, 75.17% and 83.89% respectively in the 50% NESWP group; the corrected snail mortality rates were 66.55%, 76.27% and 86.67% respectively in the 26% MNSC group. There was no significant difference among the 3 groups in the snail mortality at the same spraying time (χ2 = 1.590, 0.571, 3.238, all P > 0.05) . In addition, along with the increase of the spraying times, the snail mortality of each group was increased significantly compared to that of the control group (χ2 = 79.333, 94.718, 117.020, all P < 0.01) . After the first, second and third spraying, the reduction rates of snail density were 69.82%–86.60% in the 4% "Luo-wei" group, 68.66%–86.55% in the 50% NESWP group, and 71.89%–88.87% in the 26% MNSC group respectively. The decreasing amplitude of the snail density was more than 85% in all the experimental areas after 3 rounds of spraying molluscicide. The snail control costs per 100 hm2 were 19.57, 11.97 Yuan and 10.47 Yuan in the 4% "Luo-wei" group, 50% NESWP group, and 26% MNSC group respectively. After the first, second and third spraying, the costs of increasing 1% of snail mortality per 100 m2 were 0.30, 2.08 Yuan and 2.38 Yuan in the 4% "Luo-wei" group, 0.20, 1.10 Yuan and 1.32 Yuan in the 50% NESWP group, and 0.17, 1.04 Yuan and 0.97 Yuan in the 26% MNSC group respectively, and the cost-effectiveness was the highest at the first spraying in all the three groups. Conclusions The effects of the three molluscicides for snail control are similar, but the efficacy of snail control is reduced as the spraying time increases.
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Objective To compare the effectiveness of snail control between immersion of molluscicides through tide diversion and mollusciciding by spraying in marshland areas. Methods Immersion of 26% suspension concentrate of metaldehyde and niclosamide through tide diversion and spraying 26% suspension concentrate of metaldehyde and niclosamide alone were employed for snail control in two neighboring snail-breeding marshlands, and snails were surveyed before and after mollusciciding. The mortality of snails and the density of living snails were estimated. Results The density of living snails reduced by 72.19% and 100.00% 1 and 2 years after immersion of 26% suspension concentrate of metaldehyde and niclosamide through tide diversion, and 5.93% and 18.15% 1 and 2 years after spraying 26% suspension concentrate of metaldehyde and niclosamide alone. Conclusion Immersion of 26% suspension concentrate of metaldehyde and niclosamide through tide diversion is significantly superior to spraying 26% suspension concentrate of metaldehyde and niclosamide along for snail control, and implementation of immersion of 26% suspension concentrate of metaldehyde and niclosamide through tide diversion for more than 2 successive years may achieve a higher snail control efficiency.
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Objective@#To investigate the early clinical outcomes of hip anterior short incision and open reduction and internal fixation for the treatment of children with Delbet Ⅱ femoral neck fracture.@*Methods@#A retrospective analysis of 12 children with DelbetⅡ femoral neck fractures was performed with the anterior short incision approach at Department of Pediatric Orthopaedic, Children′s Hospital, Nanjing Medical University from January 2014 to August 2016. There were 7 males and 5 females including 8 cases at left side and 4 cases at right side,aged (11.5±0.8) years (range: 8-14 years).Patients underwent surgery in (12.0±0.9) hours (range: 6-20 hours) after the injury. Displaced fractures were treated by open reduction if closed reduction failed.The surgical incision was performed with the anterior inferior iliac spine centered on, extending along the groin crease, and the length was 3 to 4 cm. The interval between the sartorius and the tensor fascia latae was applied, and the direct and indirect head of rectus femoris were resected to visualize the hip joint capsule. T-shaped incision was made in the capsule. After the reduction was obtained, two or three compression canulated screws were used to fix the fracture site. The healing time, complications and corresponding record outcome by X-ray and clinical examination were recorded. At the latest follow-up,the results were analyzed using the Ratliff criteria and clinical outcomes were assessed by pain, restrictive hip movement, normal activity or the avoidance of games, and the femoral neck in the radiograph.@*Results@#Twelve patients had been followed-up for (30.0±4.1)months(range: 24-36 months). X-ray showed the fractures′ healing time was (8.0±0.4) weeks(range: 7-9 weeks). Ten of the 12 fractures healed after one operation and were associated with no evidence of osteonecrosis of the femoral head. One case occurred premature physeal closure. There were no cases with fracture relocation, coaxvara, delayed union and nonunion or any significant postoperative complications. There was no infection, flexible internal fixation or ruptures. According to Ratliff grade, 9 cases of 12 patients were fine and 3 cases was acceptable.@*Conclusions@#Satisfactory short-term effects can be achieved by a mini-incision on the anterior hip for Delbet Ⅱ pediatric femur neck fractures. The anterior incision has the advantage of less trauma, smaller incision scar, better fracture reduction and fixation, and less wound complications.
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Objective To understand infection status of human immunodeficiency virus (HIV) and analyze the influencing factors among men who have sex with men (MSM) in Guangzhou. Methods Men who have sex with men (MSM) were recruited from 2014 to 2017. Face-to-face questionnaire survey was conducted to collect information of characterisitc and behaviors. Blood samples were used to detect HIV antibodie. Data were analyzed using SPSS 19.0. Results Among 2 419 MSM, 200(8.27%) participants were confirmed positive for HIV. Multivariate Logistic regression analysis showed that with Guangzhou and monthly economic income >0.5 million as reference, non-Guangzhou (OR=1.712, 95% CI: 1.176-2.492，P=0.005) and monthly economic income ≤0.5 million (OR=1.998, 95% CI: 1.409-2.833，P<0.001) were associated with HIV infection among MSM. Diagnosed syphilis (OR=2.461, 95% CI: 1.375-4.405,P=0.002) , undetected syphilis (OR=2.333, 95% CI: 1.635-3.331,P<0.001), anal sex role passive (OR=2.015, 95% CI: 1.244-3.267,P=0.004), both active and passive (OR=2.115, 95% CI: 1.374-3.251,P=0.001), non-using condoms every time during anal sex (OR=1.955, 95% CI: 1.374-2.781,P<0.001), non-fixed anal sex objects (OR=2.150, 95% CI: 1.463-3.160,P<0.001) were major risk factors for HIV infection among MSM. Conclusions The prevalance of HIV infection and high-risk sexual behavior were high among MSM in Guangzhou. It is urgent to expand the scope of HIV testing and advocate safe sexual behaviors among MSM.
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Objective To evaluate the effect and cost-effectiveness of three commonly used molluscicides, 4% "Luo-wei" (tea-seed distilled saponins, TDS), 50% niclosamide ethanolamine salt wettable powder (NESWP), and 26% metaldehyde and niclosamide suspension concentrate (MNSC) in large-scale field application, so as to provide the references for formulating the strategy of snail control. Methods The field test and parallel comparison were implemented. A marshland with Oncomelania hupensis snails of the Yangtze River was divided into 4 parts (10 hm2) for the research, and three of them were experimental areas while the last one was a blank control area. The experimental areas were sprayed with 4% "Luo-wei", 50% NESWP and 26% MNSC respectively for 3 times and the interval was 1 week. Seven days after each spraying the effect of snail control was investigated, and the costs of molluscicides, labor, transportation, fuel consumption and mechanical loss were recorded. The cost of each molluscicide, snail mortality, snail density, and the cost of increasing 1% of snail mortality per 100 m2 were analyzed and compared. Results After the first, second and third spraying, the corrected snail mortality rates were 67.34%, 76.55% and 84.60% respectively in the 4% "Luo-wei" group; the corrected snail mortality rates were 64.71%, 75.17% and 83.89% respectively in the 50% NESWP group; the corrected snail mortality rates were 66.55%, 76.27% and 86.67% respectively in the 26% MNSC group. There was no significant difference among the 3 groups in the snail mortality at the same spraying time (χ2 = 1.590, 0.571, 3.238, all P > 0.05) . In addition, along with the increase of the spraying times, the snail mortality of each group was increased significantly compared to that of the control group (χ2 = 79.333, 94.718, 117.020, all P < 0.01) . After the first, second and third spraying, the reduction rates of snail density were 69.82%–86.60% in the 4% "Luo-wei" group, 68.66%–86.55% in the 50% NESWP group, and 71.89%–88.87% in the 26% MNSC group respectively. The decreasing amplitude of the snail density was more than 85% in all the experimental areas after 3 rounds of spraying molluscicide. The snail control costs per 100 hm2 were 19.57, 11.97 Yuan and 10.47 Yuan in the 4% "Luo-wei" group, 50% NESWP group, and 26% MNSC group respectively. After the first, second and third spraying, the costs of increasing 1% of snail mortality per 100 m2 were 0.30, 2.08 Yuan and 2.38 Yuan in the 4% "Luo-wei" group, 0.20, 1.10 Yuan and 1.32 Yuan in the 50% NESWP group, and 0.17, 1.04 Yuan and 0.97 Yuan in the 26% MNSC group respectively, and the cost-effectiveness was the highest at the first spraying in all the three groups. Conclusions The effects of the three molluscicides for snail control are similar, but the efficacy of snail control is reduced as the spraying time increases.
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Objective@#To summarize the clinical data of elastic stable intramedullary nailing(ESIN) in the treatment of long bone fracture of children in a single medical center, and to analyze the problems occurred after the ESIN surgery and corresponding solutions.@*Methods@#A retrospective analysis was conducted regarding the clinical data of 2 133 pediatric long bone fractures conforming to inclusion and exclusion criteria from June, 2005 to December, 2017 in Department of Orthopedics, Children′s Hospital of Nanjing Medical University.There were 1 191 boys and 942 girls, aged from 23 months to 14 years with mean age of (5.7 ± 3.1)years.There were 1 866 cases treated with closed reduction with ESIN, while 267 cases were treated with small incision assisted reduction with ESIN.Postoperative problems have been statistically analyzed.@*Results@#There were altogether 2 133 children, including 603 cases of femur, 311 cases of tibia, 8 cases of fibula, 219 cases of humerus, and 992 cases of ulna/radius.The postoperative complications mainly consist of 62 cases of needle tail irritation reaction, 21 cases of misalignments of fracture alignment, 11 cases of intramedullary nail deformity or angular deformity, 7 cases of limb shortening, 14 cases of limited joint activity, 4 cases of nerve injury, 2 cases of tendon injury, 14 cases of difficult nail removal, 4 cases of cortical cleavage, 8 cases of delayed union, 1 case of nonunion, 6 cases of varus/valgus deformity, 5 cases of epiphyseal injury, 6 cases of ESIN exposure, and 2 cases of metal debris of ESIN′ end.@*Conclusions@#The complications of treatment for children with long bone fractures by ESIN cannot be ignored.To master the important biomechanical properties, to get familiar with the local anatomy and to avoid obvious technical errors can reduce the occurrence of postoperative complications.
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Objective To investigate the feasibility and clinical effectiveness of fixation with Kirschner wires plus pediatric hip plate (PHP) for femoral neck fracture combined with avulsion fracture of the greater trochanter in children.Methods Between February 2014 and February 2016,6 children were treated by fixation with Kirschner wires plus PHP for femoral neck fracture combined with avulsion fracture of the greater trochanter at Department of Pediatric Orthopaedics,Children's Hospital,Nanjing Medical University.They were 4 boys and 2 girls,aged from 3.5 to 11.1 years (mean,7.2 years).By the Delbet's classification,all the fractures were of type Ⅲ.Clinical efficacy was evaluated according to the Ratliff scoring system at the last follow-ups.Results The intraoperative bleeding ranged from 20 to 50 mL (average,30 mL);the operation time ranged from 45 to 60 min (average,55 min).All the patients were followed up for 12 to 36 months (average,26 months).Bony union was obtained in all cases after an average time of 7 weeks (from 5 to 8 weeks).The Ratliff scores at the last follow-ups showed 5 good and one acceptable cases.No neurovascular lesion or incision infection was observed in the children.Anatomical reduction of the greater trochanter fracture was not achieved in one child but led to no adverse effect.Conclusion Fixation with Kirschner wires plus PHP can successfully treat femoral neck fracture combined with avulsion fracture of the greater trochanter in children.
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Sanqi in Chinese herbal medicine is the root and rhi-zoma of Panax notoginseng (Burk.)F.H.Chen. As the effects of strengthening with tonics, promoting blood circulation to re-move blood stasis,relieving swelling and pain and hemostasia,it is widely used as a tonic medicine in the traditional Chinese medicine. The main active constituents of Sanqi are panax noto-ginseng saponins,including ginsenoside Rg1,Rb1 and notogin-senoside R1. Notoginsenoside R1 is one of the unique monomer compositions of panax notoginseng,which is often used as an in-gredient indicator in new drug research and development.In cur-rent years, the scientists have been conducted tremendous fun-damental studies to research the pharmacological activities of no-toginsenoside R1, to reveal its protective effects on the cardio-vascular system,central nervous system as well as to many other aspects. It is hoped that the relevant study about the pharmaco-logical action of notoginsenoside R1 would help its further clini-cal application. This paper mainly reviews the research on the pharmacological mechanism of notoginsenoside R1 in recent years.
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Objective To investigate the regulatory roles of rno-miR-30b-5p in the expression of Atg5,Atg12 and Becn1 autophagy genes and their expressions in rats with experimental autoimmune uveitis (EAU).Methods Application of dual luciferase report system was conducted to detect the regulatory roles of rno-miR-30b-5p in Atg5,Atg12 and Becn1 gene expression.Lewis rats were randomly divided into control group and EAU group,with 6 rats in each group.Next,rats in EAU group were immunized to establish EAU model.After treatments,Genesis-D fundus camera was used to observe the fundus inflammation every day.After immunization for 12 days,the pathological features of rat ciliary body and retina were detected,and meanwhile,the spleen and lymph nodes in both groups were isolated to detect the expressions of rno-miR-30b-5p,Atg5,Atg12 and Becn1 genes by quantitative PCR (Q-PCR);the levels of autophagy related proteins were determined by ELISA.Results Dual luciferase report gene expression assay confirmed that Atg5,Atg12 and Becn1 were target genes of rno-miR-30b-5p.Twelve days after immunization,compared with the control group,rats in the EAU group had severe iris adhesions and severe blood vessel swelling,and pathological examination revealed massive infiltration of inflammatory cells in the ciliary body and retina.Furthermore,rno-miR-30b-5p mRNA was 0.46 ±0.01,0.29 ±0.17in the spleen and lymph nodes in EAU group,respectively,which was down-regulated when compared with the control group (P ＜0.01);whereas the expressions of Atg5,Atg12 and Becn1 were significantly upregulated,and the differences were statistically significant (all P ＜ 0.05).ELISA results showed that Atg5,Atg 12 and Becn 1 protein expression levels in the spleen and lymph nodes in EAU rats were significantly higher than those in the control group (all P ＜ 0.05).Conclusion rno-miR-30b-5p can regulate the expressions of Atg5,Atg12 and Becn1 autophagy-related genes.The down-regulation of rno-miR-30b-5p expression in the spleen and lymph nodes in EAU rats can significantly up-regulate the expressions of Atg5,Atg12 and Becn1 genes,thereby regulating the pathogenesis of uveitis.
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Objective To investigate the effects of Longdan Xiegan Decoction on the expression of Notch signaling-related genes in rats with experimental autoimmune uveitis (EAU).Methods Totally 24 Lewis rats were randomly divided into normal control group,EAU model group and Longdan Xiegan Decoction treatment group.A rat model of EAU was established in the EAU model group and Longdan Xiegan Decoction treatment group,followed by intragastrical administration of Longdan Xiegan Decoction in the latter group after successful modeling.On day 12 after different treatments,the spleen and lymph nodes were isolated from rats of all the three groups for the collection of CD4 + T ceils,and the levels of both Th17 and Treg cells were analyzed by flow cytometry to calculate the ratio of Th17 to Treg cells.Meanwhile the levels of Notch1,Notch2,Notch3,Notch4 mRNAs expression were monitored by qRT-PCR.Moreover,the expressions of Notch signaling-related proteins were further detected using ELISA technique.Results Flow cytometry showed increased Th17 cell level but decreased Treg cell level in the EAU model group when compared with the normal control group.However,after treatment with Longdan Xiegan Decoction,the Th17 level was decreased,whereas the Treg level was increased,and the ratio of Th17 to Treg gradually restored to equilibrium when compared to EAU model group.qRT-PCR results showed that the expression levels of Notch1,Notch2 and Notch4 mRNAs in Longdan Xiegan Decoction treatment group were significantly higher than those in the normal control group (all P ＜ 0.01),but lower than those in EAU model group on day 12 after treatment (all P ＜ 0.01),without Notch 3 expression in the spleen and lymph nodes.In addition,Notch 1,Notch 2 and Notch 4 protein levels of the spleen and lymph nodes in Longdan Xiegan Decoction treatment group showed the similar tendency as compared to those of Notch 1,Notch 2 and Notch 4 mRNAs (all P ＜ 0.01),and the expression of Notch 3 protein was still not observed.Conclusion Longdan Xiegan Decoction can effectively relieve the imbalance of Th17/Treg cells in EAU rats,and its mechanism may involve the differentiation of naive CD4+ T cells into Th17 and Treg cells,which is regulated by Notch signaling.
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Objective To investigate the feasibility and clinical effectiveness of modified humeral supracondy-lar step－cut osteotomy(M－HSSCO)for cubitus varus in children.Methods Between June 2016 and June 2017,the study included 25 children (20 boys and 5 girls)presenting cubitus varus at the age of (8.5 ± 0.3)years old (6－11 years old)in the Children's Hospital of Nanjing Medical University.M－HSSCO was used in the osteotomy operation. The initial osteotomy was performed as a right triangle osteotomy.The inferior margin of this right triangle was outlined parallel to the joint line 0.5－1.0 cm above the olecranon fossa.Then,they were incised from the medial end of this parallel line,which made an angle between the first and second lines equal to the desired corrective humerus elbow－wrist angle.Next,from the lateral end of the second line,the third line perpendicular to the first line was cut.Finally, desired right triangle was outlined and removed.The second right triangle osteotomy from proximal line of osteotomy was similar as the above.The medial cortex and periosteum was used as a hinge and rotated to make two osteotomy parts combined steadily.The Bellemore evaluation system was used to evaluate the difference in carrying angle degree be-tween the affected side and normal side after osteotomy,and the different degree of flexion and extension in the elbow joint between preoperation and post－operation.Residual varus deformity and other complications were also evaluated. Results All patients were followed up for 6－18 months (mean 12 months).The preoperative ipsilateral carrying an-gle was－(15°－30°)[－(22.20 ± 1.40)°],the postoperative was 5°－10°[(7. 60 ± 0.47)°]and the final follow－up was 5°－9°[(7.30 ± 0.40)°].There were statistically significant differences in the flexion angles before surgery and after surgery (t＝23.34,P＝0.000).There were statistically significant differences in the flexion angles before surgery and at final follow－up (t＝23.14,P＝0.000).The mean range of joint motion of the elbow was －5°－130° [(132.5 ± 0.5)°]before surgery,0°－125°[(123.6 ± 1.4)°]after surgery and 0°－130°[(126.8 ± 1.3)°]at fi-nal follow－up.The carrying angle reduced did not happen by the final follow－up.There was no statistically significant difference between the flexion angles before surgery and after surgery or by final follow－up(P＞0. 05).Twenty－three (92.0%)patients got an excellent result,2 cases(18.0%)got a good result and no patient (0)got worse according to the criteria described by Bellemore.The first－class incision healing were achieved in all patients.There was no case with postoperative infection,instabilities,vascular and neural injury or any significant postoperative complications. Conclusions M－HSSCO is an effective osteotomy procedure which shows good feasibility and apparent therapeutic effect in treating cubitus varus in children.
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Objective To compare the clinical effects of oral proton pump inhibitor and intravenous proton pump inhibitor in preventing re-bleeding for patients with peptic ulcer.Methods From January 2014 to December 2015,149 patients with peptic ulcer bleeding who came to our hospital for treatment and were successfully stanched by endoscopic therapy were chosen as study subjects.They were randomly divided into oral group and intravenous group according to random number table.The clinical effects,including re-bleeding rate,mortality and volume of blood transfusion were compared between the two groups.Results The re-bleeding rates within 20 days of the oral group and intravenous group were 5.6％ and 5.1％,respectively,and there was no statistically significant difference between the two groups (x2 =0.02,P ＞ 0.05).The hospital stay of the oral group and intravenous group were (4.0 ± 0.4) d and (2.1 ± 0.6) d,respectively,and there was statistically significant difference between the two groups (t =22.90,P ＜0.05).The volume of blood transfusion of the oral group and intravenous group were (1 001 ±284.2)mL and (601.0 ± 197.9) mL,respectively,and there was no significant difference between the two groups (t =0.90,P ＞ 0.05).Both two groups had no death within 30d and during surgery.Conclusion For the patients who were successfully cured by endoscopic therapy,the clinical effect of oral proton pump inhibitor is similar to the effect of intravenous proton pump inhibitor,and oral proton pump inhibitor is more easy operating and lower economic burden than intravenous proton pump inhibitor.
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Objective To understand the schistosomiasis control knowledge,attitude,and practice(KAP),and influenc-ing factors of behaviors among residents in Jiangsu Province,so as to provide the evidence for making effective health education and health promotion models. Methods The probability proportionate to size sampling(PPS)and multi-stage sampling meth-ods were adopted to sample the research objects. A questionnaire survey of schistosomiasis control KAP was conducted in the res-idents of 16 to 69 years old in schistosomiasis endemic areas of Jiangsu Province,and the results were statistically analyzed. Re-sults The total awareness rate of the participants was 95.98%for schistosomiasis control knowledge. The correct rates of atti-tude and practice were 89.06%and 77.43%,respectively. The awareness/correct rates of knowledge,attitude and practice re-duced in turns significantly(χ2=1282.96,P<0.01). The knowledge awareness rate of fishermen and boatmen was 90.98%, but their attitude correct rate was only 53.81%(χ2=120.52,P<0.01). The unconditional logistic regression analysis showed that with the education level increasing,their practice correct rate rose,and the participants with the college degree or above had a higher correct rate compared to illeterate ones(OR=6.411,95%CI:4.896-8.395). The practice correct rate of the fisher-men and boatmen was only 5.1%of the rate of the farmers(OR=0.051,95%CI:0.029-0.091). Conclusions The total aware-ness rate of basic knowledge of schistosomiasis prevention and control in the residents of Jiangsu Province has reached the re-quirements in the"National Schistosomiasis Control Long-term Planning Outline(2004-2015)",but the correct rate of behav-iors is low. The education level,occupation and residential areas affect the health behaviors of schistosomiasis prevention and control. Therefore,it is necessary to carry out targeted health promotion activities to promote the formation of healthy lifestyle and behaviors.