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The anterior cruciate ligament (ACL) injury is a common sports injury that has a significant impact on knee function and patients′ mobility. With the popularity of national fitness campaign in China, the incidence of ACL injury is increasing year by year. Currently, there still lacks clinical standards or guidelines on how to choose appropriate treatment methods, surgical plans and rehabilitation protocols for ACL injury. In order to timely reflect the new treatment concept of ACL injury, standardize its diagnosis and treatment and improve the curative effect, the Sports Medicine Society of Chinese Research Hospital Association and the Editorial Board of Chinese Journal of Trauma organized domestic orthopedic and sports medicine experts to formulate the "clinical evidence-based guideline for the diagnosis and treatment of anterior cruciate ligament injury (2022 version)" based on the level of evidence-based medicine and in compliance with the principle of scientificity, practicability and advancement. The present guideline includes 12 recommendations for the diagnosis, treatment and rehabilitation of ACL injury in order to provide guidance and assistance for the clinical diagnosis and treatment of ACL injury in China.
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The clinical data of 2 children with refractory Mycoplasma pneumoniae pneumonia complicated with intracardiac thrombosis and pulmonary embolism, treated in Tianjin Children′s Hospital from July 2019 to January 2020, were analyzed retrospectively.One patient was an 8-year-old girl, who was admitted to the hospital mainly because of " fever for 5 days and cough for 2 days" . The other patient was a 7-year-old boy, who was admitted due to " intermittent fever with cough for 24 days and chest pain for 1 day" . Both children were complicated with elevated D-dimer levels and positive antiphospholipid antibody.During the treatment, right cardiac thrombosis and pulmonary embolism occurred in both cases, and the manifestations of thrombosis related symptoms were not typical.After the patients received anticoagulation treatment and thrombolytic therapy with urokinase, the cardiac thrombus dissipated and the pulmonary embolism improved.For refractory Mycoplasma pneumoniae pneumonia complicated with intracardiac thrombosis and pulmonary embolism, thrombolytic therapy can be applied to some children in addition to anticoagulant therapy.
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ObjectiveTo evaluate the efficacy and safety of An'erning granules in the treatment of community-acquired pneumonia in children. MethodA randomized， double-blind， single-simulation， placebo-controlled trial was designed in this study. The children were randomly assigned into an observation group （An'erning granules combined with ceftriaxone sodium） and a control group （An'erning granules placebo combined with ceftriaxone sodium） according to the ratio of 2∶1. The disease cure rate was taken as the main indicator of efficacy， and the safety of An'erning granules was observed. ResultA total of 206 children （137 in the observation group and 69 in the control group） were included in this study. Before treatment， the age， sex， body height， body weight， diagnosis time of pneumonia， and symptom and sign scores had no significant differences between the two groups. After 8 days of continuous medication， the observation group［70.80%（97/137）］ had higher cure rate than the control group［56.52%（39/69）］（χ2=4.17，P<0.05） and total effective rate of chest X-ray ［97.98%（97/99）］ than the control group［86.27%（44/51）］ （χ2=12.98，P<0.01）. The observation group was superior to the control group in the alleviation of TCM syndrome under the condition of 0-3 g dose stratification on day 3 of medication （P<0.01）. The recovery time， time to complete fever abatement， time to fever abatement and expectoration alleviation， rate of conversion to severe case， and reduction in the frequency of antibiotic use showed no significant differences between the two groups. In terms of safety， 13 and 7 adverse events occurred in the observation group and control group， respectively， which were relieved or disappeared after drug withdrawal or symptomatic treatment and showed no significant difference between the two groups. ConclusionIntravenous drip of ceftriaxone sodium combined with An'erning granules is effective in the treatment of community-acquired pneumonia in children. It can accelerate the absorption of pulmonary inflammation， alleviate the clinical symptoms in a short time for young children or the children with mild symptoms， and is safe in clinical application.
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ObjectiveTo evaluate the efficacy and safety of An'erning granules in the treatment of community-acquired pneumonia in children. MethodA randomized， double-blind， single-simulation， placebo-controlled trial was designed in this study. The children were randomly assigned into an observation group （An'erning granules combined with ceftriaxone sodium） and a control group （An'erning granules placebo combined with ceftriaxone sodium） according to the ratio of 2∶1. The disease cure rate was taken as the main indicator of efficacy， and the safety of An'erning granules was observed. ResultA total of 206 children （137 in the observation group and 69 in the control group） were included in this study. Before treatment， the age， sex， body height， body weight， diagnosis time of pneumonia， and symptom and sign scores had no significant differences between the two groups. After 8 days of continuous medication， the observation group［70.80%（97/137）］ had higher cure rate than the control group［56.52%（39/69）］（χ2=4.17，P<0.05） and total effective rate of chest X-ray ［97.98%（97/99）］ than the control group［86.27%（44/51）］ （χ2=12.98，P<0.01）. The observation group was superior to the control group in the alleviation of TCM syndrome under the condition of 0-3 g dose stratification on day 3 of medication （P<0.01）. The recovery time， time to complete fever abatement， time to fever abatement and expectoration alleviation， rate of conversion to severe case， and reduction in the frequency of antibiotic use showed no significant differences between the two groups. In terms of safety， 13 and 7 adverse events occurred in the observation group and control group， respectively， which were relieved or disappeared after drug withdrawal or symptomatic treatment and showed no significant difference between the two groups. ConclusionIntravenous drip of ceftriaxone sodium combined with An'erning granules is effective in the treatment of community-acquired pneumonia in children. It can accelerate the absorption of pulmonary inflammation， alleviate the clinical symptoms in a short time for young children or the children with mild symptoms， and is safe in clinical application.
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Objective:To investigate the prevalence and clinical characteristics of Mycoplasma pneumoniae( Mp) genotypes and subtypes in children in Tianjin. Methods:Children with pneumonia admitted to Tianjin Children′s Hospital from December 2017 to December 2019 were selected as the research objects. Bronchoalveolar lavage fluid was collected by fiberoptic bronchoscopy. The positive samples were detected by real-time fluorescent quantitative PCR and Mp culture. PCR-restriction fragment length polymorphism(RFLP) and multiple variable number tandem repeats were used for genotyping. Detailed clinical and laboratory data were collected for all cases. Results:The results of RFLP showed that there were 138 cases (78.9%) of typeⅠand 37 cases (21.1%) of type Ⅱ; 37 cases of type M3-5-6-2, including six subtypes B, G, M, S, V and Y; 138 cases of M4-5-7-2 were detected, including seven subtypes of E, J, P, U, X, Z and a. In M3-5-6-2 type, there were 1 case of P1-Ⅰtype (2.7%), 36 cases of P1-Ⅱtype (97.3%), 137 cases of P1-Ⅰ type (99.2%) and 1 case of P1-Ⅱ type (0.7%) in M4-5-7-2 type. There was no significant difference in genotype distribution among different age groups. There were statistical differences in the distribution of four seasons among the 13 genotypes of B, G, M, S, V, Y and E, J, P, U, X, Z, a. All Mp infected children had symptoms of fever and cough. The hospitalization time, fever duration, high fever (>39℃), cough duration, skin changes, digestive system symptoms and liver function injury rate of P1-Ⅰ/M4-5-7-2 pneumonia children were higher than those of P1-Ⅱ/M3-5-6-2 pneumonia children, but the difference was not statistically significant. The WBC count of P1-Ⅱ/M3-5-6-2 types was higher than that of typeⅠand M4-5-7-2; the LDH of P1-Ⅰ/M4-5-7-2 was higher than that of Ⅱ and M3-5-6-2, with statistical difference. There was no significant difference in the incidence of inflammatory consolidation, atelectasis, pleural thickening and pleural effusion among different genotypes. Conclusions:Mp infection in children with pneumonia in Tianjin is mainly P1-Ⅰ/ M4-5-7-2, and P1-Ⅱ is on the rise. P1-Ⅰ and M4-5-7-2 were associated with fever and severe symptoms.
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Objective:To investigate the therapeutic effect of human umbilical cord mesenchymal stem cells (MSCs) on psoriasis-like mouse models induced by imiquimod and the underlying mechanisms.Methods:Eighteen C57BL/6 mice were randomly and equally divided into vaseline group, model group and treatment group according to a random number table. The mice in the model group and treatment group received topical treatment with 5% imiquimod cream at a dose of 62.5 mg once a day for 6 consecutive days on the shaved back, and those in the vaseline group received the treatment with the same amount of vaseline ointment; the mice in the treatment group were injected with 1.5×10 6 human umbilical cord MSCs via the caudal vein on days 1 and 4. The severity of skin lesions on the back of the mice was assessed everyday according to the psoriasis area and severity index (PASI) . Twenty-four hours after the last treatment, that is, on day 7, blood samples were taken, and the mice were sacrificed. The dorsal skin tissues were resected and subjected to hematoxylin and eosin (HE) staining. A single cell suspension of the resected spleen was prepared, and flow cytometry was performed to detect the Th1 and Th17 cell subsets in the spleen cells. Enzyme-linked immunosorbent assay was conducted to detect serum levels of cytokines interleukin (IL) -17A and tumor necrosis factor (TNF) -α. One-way analysis of variance was used for comparisons among groups, Tukey test for multiple comparisons, and repeated measures analysis of variance for the analysis of changes in the PASI score over time. Results:On day 7, there was obvious scaly erythema on the back of the mice in the model group, and the skin thickness and number of infiltrating inflammatory cells were significantly higher in the model group (78.73 ± 23.11 μm, 36.16 ± 2.95 cells/mm 2) than in the vaseline group (13.28 ± 4.57 μm, 13.33 ± 1.15 cells/mm 2, q=19.25, 7.21, respectively, both P < 0.001) . The treatment group showed significantly decreased PASI score, epidermal thickness and number of infiltrating inflammatory cells compared with the model group (all P < 0.001) . The percentage of Th17 cell subsets in the spleen cells and serum level of TNF-α were significantly lower in the treatment group than in the model group (both P < 0.05) . There were no significant differences in the spleen weight, spleen index, spleen cell count, Th1 cell percentage or serum IL-17A level between the treatment group and the model group (all P>0.05) . Conclusion:Human umbilical cord MSCs can effectively alleviate skin inflammation induced by imiquimod in the psoriasis-like mouse models, likely by inhibiting Th17 cell formation and TNF-α expression.
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Objective:To explore the relationship between the type of mutation and clinical features, prognosis, and clinical characteristics of chronic granulomatous disease (CGD) caused by compound heterozygous mutations in the NCF2 gene in children. Methods:The clinical data of 1 case of neonatal CGD caused by compound heterozygous mutations of NCF2 gene at Tianjin Children′s Hospital in August 2019 was analyzed, and domestic and international literatures were searched to summarize the clinical characteristics, gene mutation type and prognosis of CGD caused by NCF2 mutation. Results:The diagnosis of CGD was confirmed by the presence of compound heterozygous mutations c. 196_197insA (p.Arg66Glnfs23X) and c. 1180T>G (p.Tyr394Asp) in the NCF2 gene, accompanied with the clinical manifestations of fever, cough, multiple clumps and nodules in the chest CT at 25 days after birth, and the neutrophil respiratory burst test stimulation index(SI) 23.This new mutation was not reported in the Human Genetic Mutation Database.The child had a residual portion of nicotinamide adenine dinucleotide phosphate (NADPH) oxidase activity and was followed up until the age of 9 months with an antifungal drug without recurrent infection.A total of 101 cases of CGD patients with NCF2 gene mutation were reported in domestic and international databases.Totally, 33 cases had SI results, with 22 cases below 3, 11 cases above 3, and 8 cases of missense mutations. Conclusions:c. 196_197insA and c. 1180T>G are new mutations in NCF2 gene that can lead to CGD.CGD patients containing missense mutations in the NCF2 gene may have more residual NADPH oxidase activity.
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Respiratory virus remains to be an important pathogen of respiratory disease in children.The disease can occur in all age groups, especially in young children.Most viral infections have a good prognosis, but special viruses still cause great harm to the health of children.Respiratory viral therapy includes symptomatic therapy, broad-spectrum antiviral drugs, drugs that directly target the viral replication cycle, drugs that attenuate the inflammatory response, and anti-viral nanodrugs.New antiviral drugs are urgently needed to develop.The repurposing of the existing therapeutic agents previously designed for other virus infections is also an effective way.The treatment of respiratory virus infection has become an important topic in clinical research.
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Mycoplasma pneumoniae is one of the most common pathogens in children with community-acquired pneumonia.Some cases of mycoplasma pneumoniae pneumonia may develop into refractory mycoplasma pneumoniae pneumonia(RMPP). Glucocorticoid therapy can delay the disease and shorten the hospital stay, which is an effective method for the treatment of children with RMPP.This paper reviews the progress of glucocorticoids in the treatment of RMPP in children.
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Anticholinergic drugs play an important role as bronchodilators in the treatment of obstructive airway diseases, including chronic obstructive pulmonary disease and asthma.Anticholinergic drugs are divided into short-acting muscarinic antagonists(SAMA)and long-acting muscarinic antagonists(LAMA). Ipratropium bromide is a commonly used SAMA in pediatrics and is administered by inhalation.The combination of ipratropium bromide and β 2 receptor agonist can control the acute attack of asthma patients of different ages and degrees.Tiotropium bromide is not only LAMA, but also a long-acting bronchodilator, which selectively and competitively binds to M1, M2, and M3 receptors.Tiotropium bromide can reduce Th2 cytokines and airway inflammation, reduce airway hyperresponsiveness, and inhibit airway remodeling.This article reviews the recent progress of anticholinergic drugs in the treatment of childhood asthma.
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Liver fibrosis is the result of the progressive development of various chronic liver diseases and can develop into liver cirrhosis and liver cancer with high mortality rates. Early diagnosis of liver fibrosis is of great significance for disease reversal. At present, liver biopsy is considered the gold standard for the diagnosis of liver fibrosis, but it cannot be used as a routine screening method due to its shortcomings. In recent years, progress has been made in various noninvasive imaging methods, and this article reviews the current status of the research on computed tomography, magnetic resonance imaging, nuclear medicine, and ultrasound in the diagnosis of liver fibrosis.
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Interstitial lung diseases (ILD) are a heterogeneous group of disorders, which are functionally cha-racterized by a restrictive ventilatory defect and exercise induced hypoxemia.Most lung function abnormalities in ILD share common features but are not specific.Pulmonary function is important for the diagnosis of patients with suspected ILD.For the diagnosis of ILD cases, pulmonary function test can assess the severity of the diseases and monitor progre-ssion of diseases.
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Objective To evaluate the biomechanical effects of lateral meniscus posterior root (LMPR) tears fixed at different suture positions, so as to investigate the optimal suture method for repairing LMPR tears. Methods Eight fresh cadaveric knees were used. Each knee was tested under 6 conditions: intact knee, ruptur of LMPR, suture of LMPR to the center point of root insertion, suture of LMPR posterior, interior and later 5 mm to the center point of root insertion, respectively. The peak contact pressure, the average contact pressure and contact area were evaluated using a Tek-scan sensor positioned between the meniscus and tibial plateau, under 1 kN compressive loading, at 0 degree knee extension. Results In the lateral compartment, the average contact pressure and peak pressure significantly increased under rupture of LMPR compared with the intact state (P0.05). Conclusions The average contact pressure, the peak contact pressure and the contact area between the lateral meniscus and the tibial plateau changed obviously due to the LMPR tears. When the suture position was 5 mm lateral to the center point of root insertion, similar biomechanical function with the intact knee could be obtained.
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Bacillus Calmette- Guérin(BCG) is still an effective way to prevent tuberculosis, but BCG vaccination reaction has various forms, mainly including lymphadenitis associated with BCG vaccination and disseminated BCG disease, the latter is relatively rare, lymphadenitis associated with BCG vaccination is relatively common, it is unclear that diagnosis and treatment, especially the timing of treatment and the choice of treatment methods, and lack of authoritative guidelines.Through further understanding of the pathogenesis, risk factors, clinical classification and diagnosis of this disease, clinicians can choose the optimized treatment plan for this disease.At the same time, the development and use of new vaccines are expected to reduce the occurrence of this disease.
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Some patients with tuberculosis will undergo abnormal deterioration after appropriate anti-tuberculosis treatment, manifested by deterioration of the original lesions or new lesions, known as contradictory reactions, in patients co-infected with human immunodeficiency virus(HIV), this phenomenon is called immune reconstruction inflammatory response syndrome.It is generally believed that the contradictory reaction is an excessive inflammatory reaction, which is related to the host immune response and the direct action of Mycobacterium products.Before diagnosing contradictory reactions, factors such as treatment failure, drug resistance, re-infection, surgical impact and adverse drug events should be excluded.Regulating host immune response is the main way to deal with contradictory reactions.Some patients may need more active treatment.
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Bacillus Calmette-Guérin(BCG) is still an effective way to prevent tuberculosis,but BCG vaccination reaction has various forms,mainly including lymphadenitis associated with BCG vaccination and disseminated BCG disease,the latter is relatively rare,lymphadenitis associated with BCG vaccination is relatively common,it is unclear that diagnosis and treatment,especially the timing of treatment and the choice of treatment methods,and lack of authoritative guidelines.Through further understanding of the pathogenesis,risk factors,clinical classification and diagnosis of this disease,clinicians can choose the optimized treatment plan for this disease.At the same time,the development and use of new vaccines are expected to reduce the occurrence of this disease.
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Some patients with tuberculosis will undergo abnormal deterioration after appropriate anti-tubercu losis treatment,manifested by deterioration of the original lesions or new lesions,known as contradictory reactions,in patients co-infected with human immunodeficiency virus (HIV),this phenomenon is called immune reconstruction inflammatory response syndrome.It is generally believed that the contradictory reaction is an excessive inflammatory reaction,which is related to the host immune response and the direct action of Mycobacterium products.Before diagnosing contradictory reactions,factors such as treatment failure,drug resistance,re-infection,surgical impact and adverse drug events should be excluded.Regulating host immune response is the main way to deal with contradictory reactions.Some patients may need more active treatment.
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Objective To assess the ability of simultaneous amplification and testing ( SAT ) in bacteria detection , bronchoalveolar lavage fluid from children was collected and detected by SAT , combined with in vitro culture experiment , providing theoretical support for the application of SAT in the diagnosis and treatment of mycoplasma pneumonia ( MP ) .Methods A total of 572 bronchoalveolar lavage fluid from children with community acquired pneumonia during October 2015 and December 2017 in Tianjin Children′s Hospital were collected and detected by Mycoplasma pneumonia ( MP ) nucleic acid quantitative assay and SAT technology.Among them, 161 bronchoalveolar lavage fluid were also detected using in vitro culture and the positive ones for MP were analyzed by nucleic acid quantification and SAT after exposing to high concentration of antibiotic .Results The positive rates of MP by nucleic acid quantitative assay and SAT technology in 572 samples were 74.7％ (427/572) and 71.9％ (411/572), respectively.These two detection methods have high consistency (χ2 =1.142,P=0.285).According to the test results of SAT , the positive rates of male and female were 72.7％(224/308) and 70.8％(187/264), respectively.There was no significant difference of positive rate between different sex (χ2 =0.252, P=0.616).The positive rate of MP in 4-14 years old children (78.1％, 317/416) was higher than that in infants (≤3 years) (56.6％, 94/166) (χ2 =26.811, P=0.000).After adding azithromycin (5 MIC) to MP positive medium for 5 days, the result of nucleic acid quantification was positive but SAT was negative .Conclusions SAT technology is a rapid, sensitive and specific method for detection of MP .In addition, SAT technology could identify the "dead" and"live" bacteria and could evaluate the effect of clinical treatment effectively .
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Pertussis infection can mimick the clinical manifestations of lower airway infection, while the symptoms and signs in some cases are like Bronchiolitis. The paper carried out retrospective analysis of infant pertussis bordetella infected cases admitted by the Respiratory Dept. of Tianjin Children's Hospital for "capillary bronchitis" from Sept. 2015 to Feb. 2016. It analyzed its clinical features, radiological features, laboratory characteristics and outcome through comparing the capillary bronchitis cases induced by the non-bordetella pertussis. 26 cases of patients infected with bordetella pertussis were included in the group, 15 male patients and 11 female patients, aging from 40 days to 11 months. Comparing with non-pertussis infected cases, the capillary bronchitis induced by pertussis presents spasmodic cough, vomiting after cough, apnea suspension and lymphocythemia and obvious prolong of LOS. However the clinical symptom score is decreased and the duration of breathing is shorter. The follow-up visit detects that the recurrent number of respiratory symptoms of pertussis infected children is higher than that of non-pertussis infected children. The clinical symptoms of patients with capillary bronchitis infected by bordetella pertussis are not typical and are susceptible to be ignored. The duration of respiratory symptoms is longer and susceptible for recurrence
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Humans , Male , Female , Infant , Bronchitis , Infant , Whooping Cough , Retrospective StudiesABSTRACT
Surfactant protein C(SP-C)is found to be expressed only in the alveolar type Ⅱ cells(AECⅡ),surfactant protein C gene mutations are found to be associated with Children interstitial lung disease.This review discusses the mechanism,diagnosis and therapy of the interstitial lung disease induced by the surfactant protein C gene mutations.