Analysis of risk factors of mortality in infants and toddlers with moderate to severe pediatric acute respiratory distress syndrome / 中华儿科杂志

Objective: To identify the risk factors in mortality of pediatric acute respiratory distress syndrome (PARDS) in pediatric intensive care unit (PICU). Methods: Second analysis of the data collected in the "efficacy of pulmonary surfactant (PS) in the treatment of children with moderate to severe PARDS" program. Retrospective case summary of the risk factors of mortality of children with moderate to severe PARDS who admitted in 14 participating tertiary PICU between December 2016 to December 2021. Differences in general condition, underlying diseases, oxygenation index, and mechanical ventilation were compared after the group was divided by survival at PICU discharge. When comparing between groups, the Mann-Whitney U test was used for measurement data, and the chi-square test was used for counting data. Receiver Operating Characteristic (ROC) curves were used to assess the accuracy of oxygen index (OI) in predicting mortality. Multivariate Logistic regression analysis was used to identify the risk factors for mortality. Results: Among 101 children with moderate to severe PARDS, 63 (62.4%) were males, 38 (37.6%) were females, aged (12±8) months. There were 23 cases in the non-survival group and 78 cases in the survival group. The combined rates of underlying diseases (52.2% (12/23) vs. 29.5% (23/78), χ2=4.04, P=0.045) and immune deficiency (30.4% (7/23) vs. 11.5% (9/78), χ2=4.76, P=0.029) in non-survival patients were significantly higher than those in survival patients, while the use of pulmonary surfactant (PS) was significantly lower (8.7% (2/23) vs. 41.0% (32/78), χ2=8.31, P=0.004). No significant differences existed in age, sex, pediatric critical illness score, etiology of PARDS, mechanical ventilation mode and fluid balance within 72 h (all P>0.05). OI on the first day (11.9(8.3, 17.1) vs.15.5(11.7, 23.0)), the second day (10.1(7.6, 16.6) vs.14.8(9.3, 26.2)) and the third day (9.2(6.6, 16.6) vs. 16.7(11.2, 31.4)) after PARDS identified were all higher in non-survival group compared to survival group (Z=-2.70, -2.52, -3.79 respectively, all P<0.05), and the improvement of OI in non-survival group was worse (0.03(-0.32, 0.31) vs. 0.32(-0.02, 0.56), Z=-2.49, P=0.013). ROC curve analysis showed that the OI on the thind day was more appropriate in predicting in-hospital mortality (area under the curve= 0.76, standard error 0.05,95%CI 0.65-0.87,P<0.001). When OI was set at 11.1, the sensitivity was 78.3% (95%CI 58.1%-90.3%), and the specificity was 60.3% (95%CI 49.2%-70.4%). Multivariate Logistic regression analysis showed that after adjusting for age, sex, pediatric critical illness score and fluid load within 72 h, no use of PS (OR=11.26, 95%CI 2.19-57.95, P=0.004), OI value on the third day (OR=7.93, 95%CI 1.51-41.69, P=0.014), and companied with immunodeficiency (OR=4.72, 95%CI 1.17-19.02, P=0.029) were independent risk factors for mortality in children with PARDS. Conclusions: The mortality of patients with moderate to severe PARDS is high, and immunodeficiency, no use of PS and OI on the third day after PARDS identified are the independent risk factors related to mortality. The OI on the third day after PARDS identified could be used to predict mortality.

Observation of the clinical efficacy of the bone filling bag vertebroplasty for the treatment of osteoporotic vertebral compression fractures / 中国骨伤

OBJECTIVE@#To explore the clinical effects of bone filling bag vertebroplasty in treating osteoporotic vertebral compression fractures.@*METHODS@#The clinical data of 127 patients (145 vertebrae) with osteoporotic vertebral compression fractures who corresponded the criteria of inclusion and exclusion from December 2015 to June 2017 were retrospectively analyzed. Responsible vertebral bodies were identified by clinical situation, X-rays, CT scan, MRI. Among them, 95 cases (110 vertebrae) were treated by percutaneons kyphoplasty (PKP group), there were 34 males (42 vertebrae) and 61 females (68 vertebrae), with an average age of (73.92±7.14) years, 47 thoracic vertebra (T₈-T₁₂) and 63 lumbar vertebra (L₁-L₅). Other 32 patients (35 vertebrae) were treated by bone filling bag vertebroplasty(bone filling bag vertebroplasty group). There were 11 males (12 vertebrae) and 21 females (23 vertebrae), with an average age of (71.56±7.89) years, 16 thoracic vertebra (T₉-T₁₂) and 19 lumbar vertebra(L₁-L₅). Postoperative pain after 3 days, vertebral body height, improvement of lumbar function were recorded and bone cement diffusion and leakage were observed by X-rays.@*RESULTS@#All operations were successful and no complications were found. In bone filling bag vertebroplasty group, operation time was (31.75±4.99) min, postoperative VAS score at 3 days was(2.38±0.94) points, anterior and middle height of the vertebral body were(19.54±2.36) mm and (18.16±2.65) mm, respectively; ODI score was(25.19±5.49) points, all above items after operation were better than preoperation(0.05). Bone cement was patchy, clumpy or slightly dispersed by X-rays at 3 days after operation, the leakage rate of bone cement in bone filling bag vertebroplasty group was 2.86%(1/35), while was 6.36%(18/110) in PKP group, all of them were "trailing sign", there was significant difference between two groups (<0.05).@*CONCLUSIONS@#The clinical effect of bone filling bag vertebroplasty in the treatment of osteoporotic vertebral compression fractures is similar to percutaneous kyphoplasty, it can effectively relieve the pain, restore part vertebral body height and obviously reduce the leakage rate, with safer, it is a simple, rapid and effective therapeutic method.

Effects of different treatments on patients with osteoporotic fracture after percutaneous kyphoplasty / 中国骨伤

<p><b>OBJECTIVE</b>To evaluate effects of different treatments on patients with osteoporotic vertebral fracture after percutaneous kyphoplasty in pain and function.</p><p><b>METHODS</b>From March 2010 to March 2012,138 patients (165 vertebrae) with thoracic and lumbar vertebral osteoporotic fracture were randomly divided into three groups (control group, treatment group and comprehensive group), 46 cases in each group, and all patients were treated by PKP. Control group were treated with calcium and calcitriol after operation, treatment group added salmon calcitonin see calcimar based on control group, comprehensive group added incrementality waist musculi dorsi function exercise based on treatment group. VAS, ODI scores and BMD before operation, 3 d, 2 weeks, 1 month, 6 months and 12 months after operation were detected and compared.</p><p><b>RESULTS</b>All operation were performed successfully,38 cases (45 vertebrae) in control group, 36 cases (44 vertebrae) in treatment group and 40 cases (49 vertebrae) were obtained complete following up, there was no significant meaning in following time among three groups (P>0.05). Postoperative VAS and ODI scores at 3 d, 2 weeks and 1 month among three groups were lower than that of before operation (P<0.01). Compared with control group, postoperative VAS score at 3 d, 2 weeks and 1 month were decreasedin treatment group and comprehensive group, but there was no significant meaning in ODI scores (P>0.05). At 6 and 12 months after operation,there was no significant differences in VAS and ODI between control group and treatment group (P>0.05), while VAS score in comprehensive group decreased much than other two groups,decreased continuously (P<0.01). At 12 months after operation, BMD among three groups were increased more than preoperative,and BMD in comprehensive group was more obviously than that of in control and treatment group.</p><p><b>CONCLUSION</b>PKP, an effective method for the treatment of thoracic and lumbar vertebral osteoporotic fracture, could improve short-term clinical effects by adding calcitonin with calcium supplements and activated vitamin D. Waist musculi dorsi function exercise could improve long-term clinical effects of PKP and improve quality of life.</p>

Comparative study of intertrochanteric fractures treated with proximal femur locking compress plate in aged / 中国骨伤

<p><b>OBJECTIVE</b>To compare the clinic outcomes of dynamic hip screw (DHS), intramedullary fixation (IF) and proximal femur locking plate (PF-LCP) in the treatment of intertrochanteric fractures in the elderly patients.</p><p><b>METHODS</b>From July 2000 to August 2009, 165 old patients with intertrochanteric fractures were treated respectively by DHS, IF, PF-LCP. Fifty-eight patients were in DHS group including 30 males and 28 females with an average age of 71 years old; there were 30 cases of type II fracture of Jensen, 28 cases of type III fracture. Sixty-five patients were in IF group including 35 males and 30 females with an average age of 73 years old; there were 37 cases of type II fracture of Jensen, 28 cases of type III fracture. Forty-two patients were in PF-LCP group including 23 males and 19 females with an average age of 74 years old; there were 22 cases of type II fracture of Jensen,20 cases of type III fracture. The operative procedures,complications and therapeutic effects were compared among 3 groups.</p><p><b>RESULTS</b>All patients were followed up from 15 to 21 months (averaged 18.3 months). The incision length and the operation time of IF group were shorter than that of DHS and PF-LCP, but there were no significant difference between DHS group and PF-LCP group. The intraoperattive blood loss, rehabilitation and healing time of IF and PF-LCP were less or shorter than that of DHS group, but there were no significant difference between IF group and PF-LCP group. The functional recovery of IF group and PF-LCP were better than that of DHS group, there were significant difference among 3 groups. The complications of PF-LCP group was fewer than that of IF group and DHS group.</p><p><b>CONCLUSION</b>PF-LCP is the credible method for intertrochanteric fractures in the elderly patients, especially for severe comminuted fracture and osteoporosis, for it can reduce operation complications and benefit for fracture healing and hip functional recovery.</p>

Percutaneous kyphoplasty and conservative therapy for osteoporotic vertebral compression fractures: a clinical comparative study / 中国骨伤

<p><b>OBJECTIVE</b>To evaluate the clinical effects of percutaneous kyphoplasty (PKP) and conservative therapy in patients with osteoporotic vertebral compression fractures (OVCF).</p><p><b>METHODS</b>The data of 63 patients with OVCF from Sep. 2007 to Apr. 2009 were retrospectively analyzed. There were 14 males and 49 females,ranging in age from 63 to 92 years, with an average of 73.4 years. Among them, 30 cases(38 vertebrae), 33 cases (35 vertebrae) were respectively treated with PKP, conservative therapy. The VAS score, the height of vertebral body and the neighboring vertebral fracture were observed during follow-up.</p><p><b>RESULTS</b>All the patients were followed up from 10 to 15 months with an average of 13.3 months. Pain relieved in 27 cases with PKP, and VAS scores decreased from 8.32 before treatment to 2.63 at the 1st week after treatment; VAS scores still remained under 2 at the later follow-up. VAS scores had not changed at the 1st week after conservative therapy. VAS scores with conservative therapy were higher than with PKP after 1, 3 months (P < 0.05), but after 6 months, there was no significant difference between conservative therapy and PKP (P > 0.05). The average height of vertebral body on the X-rays increased in 4.1 mm at the 1st week after treatment with PKP (P < 0.01) and unchanged posteriorly. The height of vertebral body had some improvement at 3, 6 months after conservative therapy, but the height of vertebral body with PKP was significantly higher than with conservative therapy (P < 0.01). New fractures occurred in 4 cases (5 vertebrae) with PKP, in 2 cases (2 vertebrae) with conservative therapy.</p><p><b>CONCLUSION</b>PKP is an effective method in treating osteoporotic vertebral compression fractures, which can relieve pain quickly, increase stability immediately, recover height of vertebral body, but maybe can increase the risk of new fracture. Conservative therapy is not without any merit, as long as systemic treatment can still make good prognosis.</p>

Clinical features and surgery in children with plastic bronchitis / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To review the clinical features and therapeutic experience in children with plastic bronchitis.</p><p><b>METHODS</b>Fourteen children with plastic bronchitis were reviewed retrospectively, 12 of which were under two years old. The clinical features are characterized by sudden onset, episodes of profound hypoxia and respiratory tract obstruction. SaO2 was between 0.70 and 0.80 even with mask oxygen inhalation. Eight cases were pyretic, 4 cases expectorated jel-like bronchial casts. The chest X-ray picture showed patchy consolidation or atelectasis unilaterally (10 cases) or bilaterally (2 cases). Pulmonary marking thickening and patchy shadow were observed in 2 cases. Twelve cases underwent rigid bronchoscopy and the bronchial casts were removed. Two cases underwent endotracheal intubation.</p><p><b>RESULTS</b>Eight cases of 12 children received therapeutic bronchoscopy were cured. Other 4 cases had second therapeutic bronchoscopy and bronchial casts were removed again in 3 cases, one died from pulmonary hemorrhage. Two cases who underwent endotracheal intubation died from the multiple organ failure (MOF). Pathologic results showed:the bronchial casts were composed mainly of mucus and fibrin, inflammatory cell infiltrate were observed in 6 cases (Type 1, inflammatory), no cellular infiltrate occurred in 8 cases (Type 2, acellular).</p><p><b>CONCLUSIONS</b>Plastic bronchitis is a severe and dangerous disease. The branching plastic casts may obstruct part or the entire tracheobronchial, causing respiratory failure. Bronchoscopy and pathologic examination are essential for it's diagnosis and treatment.</p>

Significance of Monitoring Serum Level of Gentamycin in Children with Serious Illness / 实用儿科临床杂志

Objective To explore the serum level of gentamycin for orally in children with serious illness.Methods The serum level of gentamycin in 41 children who were in serious illness [multiple organ dysfunction(MODS)group with 21 cases and non-MODS group with 20 cases ] were monitored and the patients were treated with select decontamination of the digestive tract(SDD) from October 2004 to April 2005.Dosage:10 mg/(kg?d),orally taken three times(every 8 hours) one day.The blood after taking the drug one hour later in the fourth day was selected and the serum level of getamycin was monitored.Results Thirty-six children of 41 cases serum level of gentamycin were negative and 5 children(4 in MODS group and 1 in non-MODS group) who had alimentary tract hemorrhage were masccline in serum after taking gentamycin one hour later in the forth day.The absorption of gentamycin from enteric after orally was not(rela)-ted to MODS.There were statistics value between the gestrintestinal tract ulcer and serum level of gentamycin.Conclusions The safety for treating the children in serious illness with gentamycin for SDD is obvious.But we suggest to monitor the serum level of gentamycin for who has severe alimentary tract hemorrhage together with insufficiency of liver and kindey.