Clinical characteristics of children with SARS-CoV-2 Omicron variant infection in Kunming / 中华儿科杂志

Objective: To investigate the clinical characteristics of hospitalized children infected with the Omicron variant in Kunming after the withdrawal of non-pharmaceutical interventions (NPI) and analyze the risk factors of severe cases. Methods: Clinical data was retrospectively collected from 1 145 children with SARS-CoV-2 Omicron infection who were hospitalized in six tertiary grade A hospitals in Kunming from December 10th, 2022 to January 9th, 2023. According to clinical severity, these patients were divided into the general and severe SARS-CoV-2 groups, and their clinical and laboratory data were compared. Between-group comparison was performed using t-test, chi-square test and Mann-Whitney U test. Spearman correlation test and multivariate Logistic regression analysis were used to determine the risk factors of severe illness. Results: A total of 1 145 hospitalized patients were included, of whom 677 were male and 468 female. The age of these patients at visit was 1.7 (0.5, 4.1) years. Specifically, there were 758 patients (66.2%) aged ≤3 years at visit and 387 patients (33.8%) aged >3 years. Of these children, 89 cases (7.8%) had underline diseases and the remaining 1 056 cases (92.2%) had no combined diseases. Additionally, of all the patients, 319 cases (27.9%) were vaccinated with one or two doses of SARS-CoV-2 vaccine, 748 cases (65.3%) had acute upper respiratory tract infection (AURTI), and six cases died (0.5%). A total of 1 051 cases (91.8%) were grouped into general SARS-CoV-2 group and 94 cases (8.2%) were grouped into severe SARS-CoV-2 group. Compared with the general cases, the severe cases showed a lower rate of SARS-CoV-2 vaccination and younger median age, lower lymphocyte count, as well as proportions of CD8+T lymphocyte (36 cases (38.3%) vs. 283 cases (26.9%), 0.5 (2.6, 8.0) vs. 1.6 (0.5, 3.9) years, 1.3 (1.0, 2.7) ×109 vs. 2.7 (1.3,4.4)×109/L, 0.17 (0.12, 0.24) vs. 0.21 (0.15, 0.16), respectively, χ2=4.88, Z=-2.21,-5.03,-2.53, all P<0.05). On the other hand, the length of hospital stay, proportion of underline diseases, ALT, AST, creatine kinase isoenzyme, and troponin T were higher in the severe group compared to those in the general group ((11.6±5.9) vs. (5.3±1.8) d, 41 cases (43.6%) vs. 48 cases (4.6%), 67 (26,120) vs. 20 (15, 32) U/L, 51 (33, 123) vs. 44 (34, 58) U/L、56.9 (23.0, 219.3) vs. 3.6 (1.9, 17.9) U/L, 12.0 (4.9, 56.5) vs. 3.0 (3.0, 7.0) ×10-3 pg/L,respectively, t=-20.43, χ2=183.52, Z=-9.14,-3.12,-6.38,-3.81, all P<0.05). Multivariate regression analysis indicated that increased leukocyte count (OR=1.88, 95%CI 1.18-2.97, P<0.01), CRP (OR=1.18, 95%CI 1.06-1.31, P<0.01), ferritin (OR=1.01, 95%CI 1.00-1.00, P<0.01), interleukin (IL)-6 (OR=1.05, 95%CI 1.01-1.08, P=0.012), D-dimer (OR=2.56, 95%CI 1.44-4.56, P<0.01) and decreased CD4+T lymphocyte (OR=0.84, 95%CI 0.73-0.98, P=0.030) were independently associated with the risk of severe SARS-CoV-2 in hospitalized children with Omicron infection. Conclusions: After the withdrawal of NPI, the pediatric inpatients with Omicron infection in Kunming were predominantly children younger than 3 years of age, and mainly manifested as AURTI with relatively low rate of severe SARS-CoV-2 infection and mortality. Elevated leukocyte counts, CRP, ferritin, IL-6, D-dimer, and decreased CD4+T lymphocytes are significant risk factors for developing severe SARS-CoV-2 infection.

Open reduction and internal and external fixation combined with anchor repair of intercarpal ligament for the treatment of peripheral injury of lunate bone / 中国骨伤

<p><b>OBJECTIVE</b>To evaluate the feasibility of internal and external fixation after open reduction combined with suture anchors to repair the intercarpal ligaments for the treatment of perilunate injury, and to explore its operative techniques and therapeutic efficacy.</p><p><b>METHODS</b>From September 2012 to September 2016, 11 patients with perilunate injury were surgically treated with Kirschner wires in intercarpal articulations, 3.0 mm cannulated screws for scaphoid fracture, absorbable anchor for intercarpal ligament repair, together with fixators at intercarpal joints, among whom 6 suffered from perilunate dislocations and 5 from trans-scaphoid fracture dislocations. There were 7 males and 4 females with an average age of 43.6 years old ranging from 29 to 68 years old. Scapho-lunate angle, radio-lunate angle, index of carpal height and ROM of the wrist were observed.</p><p><b>RESULTS</b>All wounds were healed at stage I. All patients were followed up from 12 to 24 months. The height of the carpal was maintained well with a mean scapho-lunate angle of 51°(35° to 65°), mean radio-lunate angle of 7°(-10° to 15°), and mean index of carpal height being 0.51(0.50 to 0.53), 5 patients of scaphoid fracture obtained bone union. Necrosis of lunate and scaphoid was not observed. The ROM of the wrist averages about 91.5°. The grip strength was recovered and amounted to 78.5% of that of the contralateral side. Among them, 6 cases reported no feeling of pain, 3 mild feeling of pain, and 2 medium level of pain. According to Cooney wrist score, 8 cases were considered excellent, 2 good and 1 fair.</p><p><b>CONCLUSIONS</b>The wrist functions can be obtained satisfactorily by intervening in the early stage through internal and external fixation after open reduction combined with suture anchors to repair intercarpal ligaments for the treatment of perilunate injury. It has advantages of shorter operation time, smaller invasive trauma, less blood loss and etc. Therefore, this technique is safe and practicable, yielding satisfying clinic effects.</p>

Minimally invasive internal fixation of pelvic ring for type C pelvic fracture / 中国骨伤

<p><b>OBJECTIVE</b>To evaluate the feasibility of minimally invasive internal fixation of pelvic anterior and posterior ring for the treatment of type C pelvic fracture, and to explore its operative techniques and therapeutic efficacy.</p><p><b>METHODS</b>From December 2010 to December 2015, 18 patients with type C pelvic fracture were treated by reconstructive plates fixation through minimally invasive ilioinguinal approach for pelvic anterior ring injuries, and by invasive percutaneous sacroiliac joint screw fixation for pelvic posterior ring injuries. There were 11 males and 7 females ranging from 29 to 68 years old with an average age of 43.6 years old. According to Tile classification, there were 14 cases of type C1, 3 cases of type C2, 1 case of Type C3. To be specific, 12 cases with hemi-fracture of rami ossa pubis accompanied with fracture of the sacrum, 2 cases with hemi-fracture of rami ossa pubis accompanied with sacro-iliac joint dislocation, 3 cases with bilateral-fracture of rami ossa pubis combined with pubic symphysis separation accompanied with single-fracture of the sacrum, 1 case with bilateral-fracture of rami ossa pubis combined with bilateral-fracture of sacro-iliac joint were included. Operation time, intra-operative blood loss, injuries of lumbosacral nerves and iliac blood vessels, and fracture reduction were observed.</p><p><b>RESULTS</b>All wounds were primary healing. No complications such as infection, deep venous thrombosis, injuries of lumbosacral nerves and iliaca vessels or heterotopic ossification occurred. According to Matta criterion of fracture reduction, 14 cases got excellent results, 3 good and 1 fair. Sixteen patients were followed up in a period varying from 6 to 33 months with 16.7 months on average. And according to functional score of Majeed, 13 cases obtained excellent results, 2 good and 1 fair, with an average score of 92.13±5.44.</p><p><b>CONCLUSIONS</b>Internal fixation with reconstructive plates through the ilioinguinal approach and with percutaneous iliosacral screw for type C pelvic facture on pelvic anterior ring and pelvic posterior ring respectively have advantages of shorter operation time, smaller invasive trauma, less blood loss and etc. Thus, this technique is safe and practicable, yielding satisfying results.</p>

Application of internal fixation for injuries of pelvic anterior ring through minimally invasive ilioinguinal approach / 中国骨伤

<p><b>OBJECTIVE</b>To evaluate the reliability of limited open reduction and minimally invasive plate osteosynthesis (MIPO) for injuries of pelvic anterior ring and to explore its operative techniques and therapeutic efficacy.</p><p><b>METHODS</b>From March 2009 to March 2012,20 patients with injuries of pelvic anterior ring were surgically fixed with reconstructive plates through minimally invasive ilioinguinal approach. There were 13 males and 7 females with an average age of 41.6 years ranging from 25 to 61 years. According to classification of Tile, there were 5 cases of type A2, 2 cases of type B1, 9 cases of type B2, 1 case of type B3, 3 cases of type C1. Including 15 cases with anterior ring fracture, 2 cases with anterior ring fracture combined with pubic symphysis separation, and 3 cases with anterior and posterior fractures. Operation time, intra-operative blood losing, injuries of femoral nerve and iliac blood vessels, condition of fracture reduction were observed.</p><p><b>RESULTS</b>All wounds healed at one stage. No complications such as infection or deep venous thrombosis occurred. According to Matta criterion of fracture reduction, 12 cases got excellent results, 7 good, 1 fair. Eighteen patients were followed up from 6 to 32 months with a mean of 16.3 months. According to functional score of Majeed, 15 cases obtained excellent results and 3 good,with an average score of 94.3 +/- 6.0.</p><p><b>CONCLUSION</b>The modified ilioinguinal approach has advantage of short operation time, less blood losing,minimally invasive in treating injuries of pelvic anterior ring and can obtain satisfactory outcomes.</p>

Expression and clinical significance of vascular endothelial growth factor-C and nm23-H1 in stage II and III colorectal carcinomas / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To discuss the expression and clinical significance of VEGF-C and nm23-H1 in stage II and III colorectal carcinomas.</p><p><b>METHODS</b>SP immunohistochemical staining was employed to determine the expression of vascular endothelial growth factor-C (VEGF-C) and nm23-H1 in the tumor tissues of 110 cases of stage II and III colorectal carcinomas and in the adjacent mucosal tissues of 53 cases as control, and analyze their correlation with cliniopathological features and prognosis.</p><p><b>RESULTS</b>The positive expression of VEGF-C in the carcinoma tissues was 71.8%, significantly higher than that in the adjacent mucosal tissues (22.6%, P < 0.001). The positive expression of nm23-H1 in the carcinoma tissues was 57.3%, significantly lower than that in the adjacent mucosal tissues (90.6%, P < 0.001). The expression of VEGF-C was significantly correlated with lymph node metastasis (P < 0.05), and the nm23-H1 expression was significantly correlated with lymph node metastasis and pathological type (P < 0.05). The expression of VEGF-C and nm23-H1 did not show a significant correlation with age, gender, primary tumor site, tumor size and depth of invasion (P > 0.05). The VEGF-C expression was negatively related with nm23-H1 expression in colorectal carcinoma (r = -0.361, P < 0.001). The median overall survival (MOS) and median disease free survival (MDFS) of 110 patients with colorectal carcinoma were 55 and 48 months, respectively. The colorectal patients with different VEGF-C and nm23-H1 expression showed significant differences in the 5-year OS rate and 5-year DFS rate (P < 0.001). The patients with negative VEGF-C expression and positive nm23-H1 expression had a better prognosis.</p><p><b>CONCLUSIONS</b>The joint detection of VEGF-C and nm23-H1 expression is very promising in prediction of the prognosis of patients with stage II and III colorectal carcinoma. However, whether it can be used as a marker in prognosis judgment needs further investigation.</p>

Changes of C-Reactive Protein and Von Willebrand Factor in Children with Systemic Inflammatory Response Syndrome Caused by Non-Infective Diseases / 实用儿科临床杂志

Objective To explore the changes of C-reactive protein(CRP) and von willebrand(VW) factor levels on pathogenesis of systemic inflammatory response syndrome(SIRS)caused by non-infective diseases in children.Methods Thirty-two children who attained to SIRS criterias caused by non-infective diseases were selected as study group,who were further divided into multiple organ(fai)-lure(MOF)group and non-MOF group according to whether the patients had MOF.Blood samples were taken to measure VW factor and CRP by ELISA and immune turbidimetry respectively.Twenty health children were as control group.Results Concentrations of blood VW factor(37 mg/L) and CRP[(185.50?27.71)%] were significantly higher in children with SIRS than those in control group(all(P