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OBJECTIVE@#To investigate the feasibility and effectiveness of "tail compression fixation+suture bridge" technology under shoulder arthroscopy for treating primary tear in medial enthesis of rotator cuff.@*METHODS@#The clinical data of 11 patients with primary tear in medial enthesis of rotator cuff who met the selection criteria between October 2020 and October 2022 were retrospectively analyzed, including 3 males and 8 females, aged 39-79 years, with an average of 61.0 years. Rotator cuff injury was caused by traumatic fall in 8 cases, and the time from injury to admission was 1-4 months, with an average of 2.0 months; the remaining 3 cases had no obvious inducement. The active range of motion of the affected shoulder was limited, with an active forward flexion range of motion of (64.1±10.9)°, abduction of (78.1±6.4)°, internal rotation of (48.2±6.6)°, and external rotation of (41.8±10.5)°; 5 cases had shoulder stiffness. The preoperative visual analogue scale (VAS) score was 7.8±0.8 and the American Society of Shoulder and Elbow Surgeons (ASES) score was 23.9±6.4. The patients were treated with "tail compression fixation+suture bridge" technology under shoulder arthroscopy, and the pain and functional recovery were evaluated by VAS score, ASES score, and active range of motion of shoulder joint at last follow-up; MRI was performed after operation, and the integrity of rotator cuff was evaluated by Sugaya classification system.@*RESULTS@#All the 11 patients were followed up 2-22 months, with an average of 13.5 months. All incisions healed by first intention, and there was no complication such as infection, rotator cuff re-tear, and anchor falling off. At last follow-up, the VAS score was 0.8±0.7 and the ASES score was 93.5±4.2, which significantly improved when compared with those before operation ( P<0.05). All 11 patients had no significant swelling in the shoulders, and the active range of motion was (165.1±8.8)° in flexion, (75.3±8.4)° in abduction, (56.6±5.5)° in internal rotation, and (51.8±4.0)° in external rotation, which significantly improved when compared with those before operation ( P<0.05). Shoulder MRI showed adequate tendon thickness and good continuity in 9 cases, including 4 cases with partial high signal area; and 2 cases with inadequate tendon thickness but high continuity and partial high signal area. According to Sugaya classification system, there were 4 cases of type 1 (36.4%), 5 cases of type 2 (45.5%), and 2 cases of type 3 (18.1%).@*CONCLUSION@#For the patients with primary tear in medial enthesis of rotator cuff, the "tail compression fixation+suture bridge" technology under shoulder arthroscopy is simple and effective.
Subject(s)
Male , Female , Humans , Rotator Cuff/surgery , Shoulder , Arthroscopy , Retrospective Studies , Treatment Outcome , Rotator Cuff Injuries/surgery , Rupture , Shoulder Joint/surgery , Sutures , Range of Motion, ArticularABSTRACT
Objective To study the degradation behavior and mechanical properties of magnesium alloy plate on treatment of tibial fracture in New Zealand rabbits. Methods Thirty-six adult New Zealand rabbits were randomly divided into experimental group (magnesium alloy bone plate group, n=18) and control group (titanium alloy bone plate group, n=18). Tibial fractures in experimental group and control group were fixed with magnesium alloy bone plate and titanium alloy bone plate, respectively. After operation, X-ray, scanning electron microscopy, energy spectrum analysis, weight loss test and four-point bending test were performed in each group to analyze the degradation behavior and mechanical properties of magnesium alloy plate after tibial fracture treatment. Results Magnesium alloy bone plate could be degraded gradually in vivo. The degradation of magnesium alloy bone plate was deepened gradually with the implantation time, and the surface was corroded uniformly. The mechanical properties of magnesium alloy bone plate decreased gradually with the degradation in vivo. Conclusions Magnesium alloy bone plate can degrade gradually with fracture healing in vivo, and its mechanical properties gradually decline, but it can still meet the requirements of fracture internal fixation, and is a kind of good new degradable orthopedic implant material.
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Objective@#To summarize the clinical and electrophysiological characteristics of children with Wolff-Parkinson-White syndrome or ventricular pre-excitation.@*Methods@#One hundred and seventy-nine consecutive children with Wolff-Parkinson-White syndrome or ventricular pre-excitation who were hospitalized at Beijing Anzhen Hospital Affiliated to Capital Medical University and planned to accept radiofrequency ablations were selected.Electrocardiogram and echocardiography were completed and detailed clinical data were collected before ablations.Anterograde refractory period of accessory pathways (ERPAPA) and retrograde ventriculoatrial conduction were measured during electrophysiology studies.The clinical and electrophysiological characteristics of these children were analyzed.@*Results@#The ratio of left-sided to right-sided accessory pathways was 1.001.93(61 cases vs.118 cases). Six out of 61 patients with left-sided accessory pathways were verified by electrophysiology study.There was no statistical difference of P-R interval and QRS duration between patients with right-sided and left-sided accessory pathways(all P>0.05). Twelve patients were combined with congenital heart diseases.Fourteen patients with right-sided accessory pathways were of ventricular pre-excitation induced dilated cardiomyopathy.ERPAPA was measured successfully in 110 patients, ERPAPA less than 250 ms accounted for 32.7%(36/110 cases). Six children with two pathways were recognized.Antidromic atrioventricular reentrant tachycardia was induced in 3 children.One child had slow conduction pathway localized in right-sided septum.@*Conclusions@#Right-sided overt accessory pathways are more common in children with Wolff-Parkinson-White syndrome or ventricular pre-excitation.Organic heart diseases are not uncommon.Besides congenital heart disease, a small proportion of patients with right overt accessory pathways may develop ventricular pre-excitatory induced dilated cardiomyopathy resulting from ventricular wall dyskinesia.Most of the decremental retrograde ventriculoatrial conduction is the characteristic of ventricular muscles rather than the accessory pathways in nature.Two pathways are not uncommon in children with Wolff-Parkinson-White syndrome or ventricular pre-excitation.Before finishing radiofrequency ablation, the anterograde and retrograde function of the accessory pathway should be evaluated in detail again because it is easy to neglect the existence of another accessory pathway.
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Pulmonary arterial hypertension(PAH) is the most common complication of congenital heart disease(CHD). Because of the complexity and diversity of cardiac anatomy and pathophysiology, as well as a variety of adaptive mechanisms that are not fully understood, little attention is paid on pulmonary arterial hypertension associated with congenital heart disease(CHD-PAH). This article aims to summarize the clinical status, disease characteristics, outcomes, and prognosis of CHD-PAH in Pediatric Cardiology, Beijing Anzhen Hospital, proposing current unresolved issues and future challenges.
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Pulmonary arterial hypertension(PAH)is the most common complication of congenital heart disease (CHD). Because of the complexity and diversity of cardiac anatomy and pathophysiology,as well as a variety of adap-tive mechanisms that are not fully understood,little attention is paid on pulmonary arterial hypertension associated with congenital heart disease(CHD-PAH). This article aims to summarize the clinical status,disease characteristics,out-comes,and prognosis of CHD -PAH in Pediatric Cardiology,Beijing Anzhen Hospital,proposing current unresolved issues and future challenges.
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Objective@#To investigate the risk factors, clinical features, treatments, and prevention of pulmonary hypertensive crisis (PHC) in children with idiopathic pulmonary arterial hypertension (IPAH) undergoing cardiac catheterization.@*Methods@#This retrospective study included 67 children who were diagnosed with IPAH and underwent cardiac catheterization between April 2009 and June 2017 in Beijing Anzhen Hospital. The medical histories, clinical manifestations, treatments, and outcomes were characterized. Statistical analyses were performed using t test, χ2 test and a multiple Logistic regression analysis.@*Results@#During cardiac catheterization, five children developed PHC who presented with markedly elevated pulmonary artery pressure and central venous pressure, decline in systemic arterial pressure and oxygen saturation. Heart rate decreased in 4 cases and increased in the remaining one. After the treatments including cardiopulmonary resuscitation, pulmonary vasodilator therapy, improving cardiac output and blood pressure, and correction of acidosis, 4 of the 5 cases recovered, while 1 died of severe right heart failure with irreversible PHC 3 days after operation. Potential PHC was considered in 7 other patients, whose pulmonary artery pressure increased and exceeded systemic arterial pressure, oxygen saturation decreased, and central venous pressure and vital signs were relatively stable. Univariate analysis showed that the risk factors of PHC in children with IPAH undergoing cardiac catheterization were younger age (t=3.160, P=0.004), low weight (t=4.004, P<0.001), general anesthesia (χ2=4.970, P=0.026), history of syncope (χ2=4.948, P=0.026), and WHO cardiac functional class Ⅲ or Ⅳ (χ2=19.013, P<0.001). Multivariate Logistic regression analysis revealed that worse WHO cardiac functional class (Wald=13.128, P<0.001, OR=15.076, 95% CI: 3.475-65.418) was the independent risk factor of PHC.@*Conclusions@#PHC is a severe and extremely dangerous complication in children with IPAH during cardiac catheterization. WHO cardiac functional class may be associated with PHC. Integrated treatment is required for these patients. Reducing risk factors, early identification, and active treatment may help to prevent the occurrence and progression of PHC.
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Objective@#To analyze the prognosis and associated risk factors of pediatric idiopathic pulmonary arterial hypertension.@*Methods@#A total of 119 patients under 18 years of age diagnosed as idiopathic pulmonary arterial hypertension in the Pulmonary Arterial Hypertension Center in Beijing Anzhen Hospital between June 2007 and May 2017 were enrolled in this retrospective study. The clinical informations and follow-up data were collected. The endpoints of follow-up were defined as death or undergoing lung transplantation. Kaplan-Meier survival curve was used to assess the survival,and the COX risk regression model was used to analyze the prognostic risk factors.@*Results@#The mean age at diagnosis was (5.9±4.2) years. For 92 (77.5%) patients, the main reason for visit was decreased activity with shortness of breath after exercise. Seventy patients (58.8%) were in baseline NYHA functional class Ⅲ-Ⅳ and 49 patients (41.2%) were in NYHA functional class Ⅰ-Ⅱ. The mean systolic pulmonary arterial pressure estimated by echocardiography was (90±23) mmHg (1 mmHg=0.133 kPa) . Right heart catheterization was performed in 50 patients. Hemodynamic parameters revealed that the mean pulmonary artery pressure was (66±19) mmHg. Mean right atrium pressure was (8.5±3.4) mmHg. Mean pulmonary vascular resistance index was (17±9) wood·m2 and the mean cardiac index was (3.4±1.3)L/m2; 100 patients (84.0%) received targeted therapy in which 55 patients (46.2%) were on monotherapy,40 patients (33.6%) were on dual therapy and 5 patients (4.2%) were on triple therapy. The mean time of follow-up was 22.0 months (0-108 months). During follow-up, 43 patients (36.1%) died and 1 patient received double-lung transplantation. Main causes of death including right heart failure, pulmonary hypertension crisis, asphyxia and massive hemoptysis. The mean survival time from diagnosis was 37.0 months,1-,2-,3-and 5-year survival rates were 86.3%, 72.2%, 51.4%and 37.8% respectively. Survival analysis showed that patients in baseline NYHA functional class Ⅰ-Ⅱ had better prognosis. COX regression analysis showed that NYHA function class, edema, increased total bilirubin and troponin concentration and the pulmonary artery and aorta diameter ratio measured by echocardiogram are risk factors of pediatric IPAH (HR=2.310, 2.723, 1.066, 1.696, 3.719, P=0.028, 0.005, 0.001, 0.024, 0.030) . While the existence of aterial septal defect or patent foramen ovale, using bosentan and phosphodiesterase inhibitors, dual or triple therapy were protective factors (HR=0.563, 0.559, 0.603, 0.682, 0.044, P=0.169, 0.076, 0.115, 0.258, 0.220) . In multivariate analysis only edema associated with decreased survival (HR=2.398, P=0.025) .@*Conclusion@#Childhood idiopathic pulmonary arterial hypertension patients are seriously ill at visit. Worse cardiac function classification at visit associate with high mortality. Target therapy including using bosentan, dual or triple therapy can improve survival.
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Objective To explore the long-term prognosis of the patientswithpulmonary arterial hypertension ( PAH) after cardiac repair operations through follow up .Methods We filtered the CHD patients with PAH after cardiac repair operation , admitted to the department of pediatric cardiology in Beijing Anzhen Hospital from June 2004 to December 2014, and collected their preoperative and postoperative data to analysis the long-term prognosis.Results 92 patients were included, median age was 20.78 years(2.44-60.26 years),median operation age was 13.54 years(1.33-53.99 years), World Health Organiza-tion functional classⅠ-Ⅱ was 80(86.96%), Ⅲ -Ⅳ was 12(13.04%), mean 6 min walk test distance was(481.74 ± 80.74) meters, mean Borg score was 1.53 ±1.14, and mean percutaneous oxygen saturation was 0.95 ±0.05.Among them, 64 patients completed preoperative right heart catheterization.Their average pulmonary artery pressure was(72.23 ±12.83) mmHg, aortic pressure on average was(85.57 ±11.91) mmHg, and average pulmonary vascular resistancewas(10.79 ±5. 04) Wood· U.The range of follow-up was between 6 months and 28.32 years(median 13.67years).During the follow-up, there were arrhythmia in 2 cases(2.17%), syncope in 7 cases(7.61%), hemoptysis in 4 cases(4.35%),heart failure in 8 cases(8.70%) and death in 1 case(1.09%).Compared with preoperative data, WHO cardiac function was found decreased in 22 patients(23.91%), stabled in 61 patients(66.30%) and significantly improved in 9 patients (9.78%).63 patients (68.48%) received targeted drug therapy, only 5 patients were treated with combined therapy,29 cases were not.Conclusion Compared with idiopathic pulmonary hypertension , PAH after defect correction has a lower incidence of arrhythmia , hemop-tysis and heart failure, and a higher long-term survival rate, and heart function is stable.To patients with PAH after defect cor-rection, targeted therapy is not only in perioperative period, but also more important in the long-term after surgery.In the targe-ted drug therapy, the combination treatment rate is low.
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Background Epidemiologieal survey suggests that visual impairment in teenagers is a worldwide public health problem,and its leading cause is uncorrected refractive error.To conduct an extensive screening of visual impairment in teenagers and analyze the relevant affecting factors are significant works for the prevention and management of refractive errors.But high-quality epidemiological data on visual impairment and refractive error from large groups of children are lacking in Shanghai.Objective This study was to investigate the prevalence of ametropia and visual impairment in schoolchildren aged 6 to 12 years old.Methods In this cross-sectional study,4 686 students from 6 elementary schools in Baoshan District of Shanghai,a rural-urban fringe zone,China were selected by clustering sampling from May 2010 to April 2011.The eye examinations included visual acuity,ocular surface,ocular anterior segment,ocular media,fundus and intraocular pressure measurement,and the data autorefraction under cycloplegia and eye position were recorded.The cause of visual impairment was evaluated.Results A total of 4 594 students received examination with the response rate 98.0％,and autorefraction under cycloplegia was completed in 84.8％ schoolchildren (3 975/4 594).The prevalence rate of uncorrected visual acuity 0.5 or worse in both eyes was 14.4％ (662/4 594),with the wearing glasses rate 51.8％ (343/662).The percentage of students with the uncorrected visual acuity 0.5 or worse in at least one eye was 22.4％ (1 031/4 594).The prevalence rate of refractive error in the visual impaired students was 96.9％ (999/1 031),followed by amblyopia (37/1 031,3.6％).The prevalence rate of myopia,hyperopia,and astigmatic in the pupils after cycloplegia was 31.1％,4.3 ％ and 33.0％,respectively.In addition,the prevalence rate of myopia in public elementary schools was higher than that in migrant elementary schools (33.9％ versus 30.3％) (x2 =5.46,P =0.02).Logistic regression analysis showed that myopia was associated with age (OR =1.60,95 ％ CI:1.53-1.68,P ＜ 0.01) and female (OR =1.33,95％ CI:1.16-1.54,P＜0.01).Conclusions The leading cause of vision impairment is myopia in the elementary school students in Shanghai,China.The screening-ratio of refractive error and the coverage of refractive correction in the elementary school students in Shanghai are matters of urgent concern.
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<p><b>OBJECTIVE</b>As an important method of hemodynamic assessment in idiopathic pulmonary arterial hypertension (IPAH), cardiac catheterization combined with pulmonary vasoreactivity testing remains with limited experience in children, and the acute pulmonary vasodilator agents as well as response criteria for vasoreactivity testing remain controversial. The aim of this study was to investigate the clinical importance, agent selection, and responder definition of cardiac catheterization combined with pulmonary vasoreactivity testing in pediatric IPAH.</p><p><b>METHOD</b>The patients admitted to Department of Pediatric Cardiology of Beijing Anzhen Hospital between April 2009 and September 2013 with suspected IPAH, under 18 years of age, with WHO functional class II or III, were enrolled. All the patients were arranged to receive left and right heart catheterization and pulmonary vasoreactivity testing with inhalation of pure oxygen and iloprost (PGI2) respectively. Hemodynamic changes were analyzed, and two criteria, the European Society of Cardiology recommendation criteria (Sitbon criteria) and traditional application criteria (Barst criteria), were used to evaluate the test results.</p><p><b>RESULT</b>Thirty-nine cases of children with suspected IPAH underwent cardiac catheterization. In 4 patients IPAH was excluded; 4 patients developed pulmonary hypertension crisis. The other 31 patients received standard cardiac catheterization and pulmonary vasoreactivity testing. Baseline mean pulmonary artery pressure (mPAP) was (66 ± 16) mmHg (1 mmHg = 0.133 kPa), and pulmonary vascular resistance index (PVRI) (17 ± 8) Wood U · m². After inhalation of pure oxygen, mPAP fell to (59 ± 16) mmHg, and PVRI to (14 ± 8) Wood U · m² (t = 4.88 and 4.56, both P < 0.001) . After inhalation of PGI2, mPAP fell to (49 ± 21) mmHg, and PVRI to (12 ± 9) Wood U · m² (t = 7.04 and 6.33, both P < 0.001). According to the Sitbon criteria, the proportion of pure oxygen responders was 6.5% (3/31) , while PGI2 responders was 35.5%, and the difference was significant (P = 0.004). According to the Barst criteria, the proportion of pure oxygen responders was 16.1% (5/31), while PGI2 responders was 51.6% (16/31), and the difference was significant (χ² = 0.09, P = 0.001).</p><p><b>CONCLUSION</b>For children with IPAH, cardiac catheterization combined with pulmonary vasoreactivity testing has important value in differential diagnosis, severity estimation, and treatment (including the emergency treatment) choices. Pulmonary hypertension crisis is an important complication of cardiac catheterization in pediatric IPAH. Younger age, general anesthesia, crisis history, and poor heart function are important risk factors for pulmonary hypertension crisis. PGI2 is a relatively ideal agent for vasoreactivity testing in children with IPAH, which has more responders than traditionally used pure oxygen.</p><p><b>RESULTS</b>of responders are not completely consistent using different criteria, and comprehensive evaluation should be done according to the goals of treatment in clinical practice.</p>