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Objective:To investigate the application value and treatment opportunity of single balloon enteroscopy in children with Peutz-Jeghers syndrome(PJS).Methods:A retrospective analysis was conducted on 33 children diagnosed with PJS in Hunan Children′s Hospital from January 2011 to September 2021.The patient′s age, gender, family history, clinical symptoms, enteroscopy examination and treatment, number of polyps, intraoperative and pos-toperative complications, surgical treatment, recurrence of surgery, and follow-up data were analyzed, and the chi- square test was used for statistical analysis. Results:A total of 33 PJS children aged (9.00±3.13) years, including 21 males and 12 females, were included.All of them received at least once single balloon enteroscopy test.The main manifestations of the children were black spots (33 cases) and multiple polyps in the digestive tract (31 cases). In all the 33 cases, black spots were distributed on lips.Some black spots were also found at the end of fingers (3 cases), at the end of foot toes(2 cases), and at the end of finger toes (6 cases). During the operation, 391 polyps were removed, most of which were jejunum polyps (37.08%, 145/391 polyps). Eleven children with PJS has intussusception, of which intestinal intussusception accounted for 90.91% (10/11 cases). Ten cases (30.30%, 10/33 cases) received surgical treatment, and 72.73% (8/11 cases) underwent surgery for acute refractory intussusception.One case had intestinal perforation and 2 cases were bleeding during the operation, and the 3 cases recovered completely after hemostatic clip sealing and surgical treatment.The incidence of hollow ileum polyps and giant polyps in children aged >8 years was higher than that in children aged ≤8 years[92.55% (149/161 polyps) vs.7.45%(12/161 polyps), 96.20%(76/79 polyps) vs.3.80% (3/79 polyps)]. The differences were statistically significant ( χ2=9.854, 8.711, all P<0.05). There was no significant difference in the incidence of intussusception among different age groups ( P>0.05). Among the 33 children with PJS, 57.58% (19/33 cases) had recurrence 1-3 years after operation, and no cases of cancer have been followed up so far. Conclusions:Intestinal polyps are common in children with PJS, and the application of single-balloon enteroscopy in children with PJS is reliable and safe.Children over 8 years old are more vulnerable to empty ileum polyps and giant polyps.Therefore, it is advised that children aged above 8 years with PJS should undergo at least once enteroscopy.
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OBJECTIVE@#To observe the efficacy of early treatment of suspension moxibustion for Bell's palsy and its influence on the prognosis, and to explore whether the early treatment of suspension moxibustion has non-inferiority effect to hormone treatment and whether suspension moxibustion combined with hormone treatment has the synergistic effect.@*METHODS@#A total of 132 patients with acute-stage Bell's palsy were divided into a hormone group (94 cases) and a moxibustion group (38 cases) by non-random method, and the hormone group was further randomly divided into a hormone with moxibustion group (48 cases) and a hormone without moxibustion group (46 cases). The acupuncture and oral administration of mecobalamin capsule were used as basic treatment. Acupuncture was applied at Yangbai (GB 14), Sibai (ST 2), Quanliao (SI 18), Dicang (ST 4), Jiache (ST 6), Yifeng (TE 17), etc., with the needles retained for 30 min, once a day, 5 consecutive days per week; there was an interval of 2 days between two weeks, and a total of 4-week treatment was given. The oral administration of mecobalamin capsule was given 0.5 mg each time, 3 times a day for 4 weeks. The patients in the moxibustion group, on the basis of basic treatment, were treated with the suspension moxibustion at Yangbai (GB 14), Sibai (ST 2), Dicang (ST 4), Jiache (ST 6), Wangu (GB 12), Yifeng (TE 17) of affected side, 5 min per acupoint, once a day, 5 consecutive days per week; there was an interval of 2 days between two weeks, and a total of 4-week treatment was given. The patients in the hormone without moxibustion group, on the basis of basic treatment, were treated with prednisone acetate tablets. The patients in the hormone with moxibustion group, on the basis of basic treatment, were treated with suspension moxibustion and prednisone acetate tablets. All the treatment was given for 4 weeks. The House-Brcackmann facial nerve grading (H-B) global score and facial disability index (FDI) scale were used to evaluate the curative effect in the three groups before treatment, 2 weeks and 4 weeks into treatment and 4 weeks after treatment; the efficacy was compared among the three groups.@*RESULTS@#Compared before treatment, the H-B grading and FDI scores were significantly improved 2 weeks and 4 weeks into treatment and 4 weeks after treatment (0.05); the H-B grading and FDI scores in the hormone with moxibustion group were superior to those in the moxibustion group and the hormone without moxibustion group 4 weeks into treatment and 4 weeks after treatment (0.05). At the end of follow-up, the cured rate in the hormone with moxibustion group was 81.3% (39/48), which was superior to 68.4% (26/38) in the moxibustion group and 60.9% (28/46) in the hormone without moxibustion group (0.05).@*CONCLUSION@#The three treatment methods are all safe and effective for acute-stage Bell's palsy. The suspension moxibustion combined with hormone therapy are superior to suspension moxibustion or hormone therapy alone. Early treatment of suspension moxibustion is safe and effective for Bell's palsy, and has obvious synergistic effect with hormone. For the patients who cannot use hormone, suspension moxibustion could replace hormone, which is non-inferior to hormone.
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Objective To observe the anti-inflammatory effect and opportunity of continuous blood purification (CBP) for treatment of patients with severe acute pancreatitis (SAP). Methods A retrospective study was conducted. One hundred and sixty patients with SAP admitted into the Department of Critical Care Medicine of the First Hospital of Wuhan from May 2013 to February 2017 were enrolled, and they were treated after admission by continuous vein-venous hemofiltration (CVVH) with blood flow volume 150-200 mL/min, displacement fluid velocity 2000-3500 mL/h and maintenance of ultrafiltration rate 35 mL·kg-1·h-1. According to the acute physiology and chronic health evaluationⅡ (APACHE Ⅱ) scores in 24 hours after admission, the patients were divided into four groups: 15-19 scores (group A), 20-24 scores (group B), 25-29 scores (group C), ≥ 30 scores (group D), 40 cases in each group. Before and after treatment for 72 hours, the difference of serum adiponectin, endotoxin, tumor necrosis factor-α (TNF-α), interleukin (IL-6, IL-8) were compared, the changes of APACHE Ⅱ score, multiple organ dysfunction syndrome (MODS) score, systemic inflammatory response syndrome (SIRS) score, and also complications and mortality in 14 days after treatment were observed for the patients. Results Compared with those before CVVH treatment, the levels of endotoxin, TNF-α, IL-6, IL-8 were significantly decreased, adiponectin was significantly increased among the various APACHEⅡ score groups after CVVH treatment, and the changes of various index amplitude variations in groups B and C were more obvious [endotoxin (EU/L): 2.9±1.0 vs. 3.6±1.5, 3.1±1.2 vs. 3.8±1.4; TNF-α (μg/L): 100.5±15.3 vs. 177.5±24.6, 113.7±17.2 vs. 190.4±25.8; IL-6 (μg/L): 107.3±13.5 vs. 230.5±32.4, 118.2±16.1 vs. 244.6±30.2;IL-8 (μg/L): 201.5±25.7 vs. 355.6±47.2, 215.4±29.4 vs. 376.4±47.3; adiponectin (mg/L): 21.9±3.6 vs. 17.6±3.4, 20.8±3.7 vs. 15.8±2.9, all P < 0.05]. Compared with those before treatment, the scores of APACHEⅡ, MODS and SIRS in groups A, B and C were significantly decreased after treatment, among which the changes of the index amplitude variation of group B and group C were more significant (APACHEⅡ: 16.2±1.4 vs. 22.9±1.7, 18.2±1.4 vs. 28.3±2.1; MODS score: 4.4±1.5 vs. 7.7±1.5, all P < 0.05), the scores of APACHE Ⅱ and SIRS in group D were not significantly decreased, but on the contrary the MODS score had an increasing tendency. After treatment, the 14-day mortality was 0%, 0%, 12.5%, 47.5% in group A, B, C, D respectively (χ2 = 8.350, P = 0.039 ), and the incidence of complications was 32.5%, 52.5%, 60.0%, 80.0% after CVVH in group A, B, C, D respectively(χ2 = 27.04, P = 0.028). Conclusion Early CBP treatment can decrease the inflammatory reaction of SAP patients, and the CBP therapeutic effect is relatively good if it is carried out for SAP patients with 20 ≤ APACHE Ⅱ score < 30.
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Objective To observe the anti-inflammatory effect and opportunity of continuous blood purification (CBP) for treatment of patients with severe acute pancreatitis (SAP). Methods A retrospective study was conducted. One hundred and sixty patients with SAP admitted into the Department of Critical Care Medicine of the First Hospital of Wuhan from May 2013 to February 2017 were enrolled, and they were treated after admission by continuous vein-venous hemofiltration (CVVH) with blood flow volume 150-200 mL/min, displacement fluid velocity 2000-3500 mL/h and maintenance of ultrafiltration rate 35 mL·kg-1·h-1. According to the acute physiology and chronic health evaluationⅡ (APACHE Ⅱ) scores in 24 hours after admission, the patients were divided into four groups: 15-19 scores (group A), 20-24 scores (group B), 25-29 scores (group C), ≥ 30 scores (group D), 40 cases in each group. Before and after treatment for 72 hours, the difference of serum adiponectin, endotoxin, tumor necrosis factor-α (TNF-α), interleukin (IL-6, IL-8) were compared, the changes of APACHE Ⅱ score, multiple organ dysfunction syndrome (MODS) score, systemic inflammatory response syndrome (SIRS) score, and also complications and mortality in 14 days after treatment were observed for the patients. Results Compared with those before CVVH treatment, the levels of endotoxin, TNF-α, IL-6, IL-8 were significantly decreased, adiponectin was significantly increased among the various APACHEⅡ score groups after CVVH treatment, and the changes of various index amplitude variations in groups B and C were more obvious [endotoxin (EU/L): 2.9±1.0 vs. 3.6±1.5, 3.1±1.2 vs. 3.8±1.4; TNF-α (μg/L): 100.5±15.3 vs. 177.5±24.6, 113.7±17.2 vs. 190.4±25.8; IL-6 (μg/L): 107.3±13.5 vs. 230.5±32.4, 118.2±16.1 vs. 244.6±30.2;IL-8 (μg/L): 201.5±25.7 vs. 355.6±47.2, 215.4±29.4 vs. 376.4±47.3; adiponectin (mg/L): 21.9±3.6 vs. 17.6±3.4, 20.8±3.7 vs. 15.8±2.9, all P < 0.05]. Compared with those before treatment, the scores of APACHEⅡ, MODS and SIRS in groups A, B and C were significantly decreased after treatment, among which the changes of the index amplitude variation of group B and group C were more significant (APACHEⅡ: 16.2±1.4 vs. 22.9±1.7, 18.2±1.4 vs. 28.3±2.1; MODS score: 4.4±1.5 vs. 7.7±1.5, all P < 0.05), the scores of APACHE Ⅱ and SIRS in group D were not significantly decreased, but on the contrary the MODS score had an increasing tendency. After treatment, the 14-day mortality was 0%, 0%, 12.5%, 47.5% in group A, B, C, D respectively (χ2 = 8.350, P = 0.039 ), and the incidence of complications was 32.5%, 52.5%, 60.0%, 80.0% after CVVH in group A, B, C, D respectively(χ2 = 27.04, P = 0.028). Conclusion Early CBP treatment can decrease the inflammatory reaction of SAP patients, and the CBP therapeutic effect is relatively good if it is carried out for SAP patients with 20 ≤ APACHE Ⅱ score < 30.
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Objective:To estimate the effect of treatment opportunity for severe caries in primary molars on child dental fear and dent-al behavior.Methods:288 children aged 3 -6 years with primary molars caries were included on the first visit.The children in the ex-perimental group(n =144),with obvious clinical symptom,were initiative to see a dentist.Those in control group(n =144)without evident symptom were found with caries in conventional dental examination.The change of the children fear before and after the first treatment was assessed by MCDASf within the first week,the change of children's clinical behavior in their first and return visit was esti-mated by Venham Clinical Anxiety and Cooperation Behavior Measurement Scale.Data was statistically analyzed.Results:After the first treatment and during the return visit,the MCDASf average score of the experimental group was decreased(P 0.05).On their return visit,the behavior of the 2 groups was similar (P >0.05),and which was ameliora-ted in the experimental group during their own first and return visit,compared with the control group(P <0.05).Conclusion:Treat-ment of severe caries before acute symptom arising in young children may alleviatie the child dental fear.