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Childhood is an important period for individual health. In order to provide community child health services, Zhoujiaqiao Community Health Service Center of Shanghai Changning District has opened a pediatric clinic since July 2017. Through equipping basic facilities, personnel training, extending service items and service time, allocating resources with cooperative hospitals, optimizing internal system management and other methods, the community pediatric service under the family physician team model has been initially constructed. The article summarizes experiences in the construction and operation of community pediatric services and child health care, to provide reference for the development of a replicable and promotable urban community pediatric service system under the contracted family physician team model.
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Objective:To evaluate the clinical value of intraoperative sliding CT in deep brain stimulation (DBS) for Parkinson's disease (PD).Methods:A total of 117 PD patients accepted DBS in Department of Neurosurgery, First Affiliated Hospital of Zhengzhou University from May 2019 to May 2023 were chosen; 46 patients had local anesthesia and 71 had general anesthesia. Bilateral subthalamic nucleus (STN) DBS was performed in 73 patients, bilateral medial globus pallidus (GPi) DBS was performed in 43 patients, and right GPi and left STN DBS was performed in 1 patient. Preoperative/intraoperative sliding CT images and preoperative MRI images were fused to calculate the spatial distance between the preoperative planned target and actual target (adjusting electrode position timely in case of spatial distance greater than 2 mm [electrode displacement]). Differences of spatial distance between preoperative planned target and actual target in patients accepted different types of anesthesia and surgical modalities were compared.Results:All 117 patients were successfully operated and 234 electrodes were implanted. No patients needed a second operation for misalignment of electrodes or poor efficacy. During CT scan, neither anesthesia extubation or mechanical collision nor intracranial hemorrhage complications occurred. Spatial distance between the preoperative planned target and actual target was (1.35±0.50) mm in 117 patients. Displacement was noted in 4 electrodes and immediately adjusted during the operation; and CT re-examination confirmed good electrode position. No statistical significance in spatial distance between the preoperative planned target and actual target was noted between the general anesthesia group and local anesthesia group, and between the STN group and GPi group ( P>0.05). Conclusion:Intraoperative sliding CT is simple, safe and effective, which helps to timely adjust the electrode position during operation, avoids second operation and complications, and improves the safety and efficacy of DBS.
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Mannose phosphate isomerase-congenital disorders of glycosylation (MPI-CDG) is a treatable congenital genetic metabolic disease caused by the pathogenic variation of the gene encoding MPI.It is mainly manifested as diarrhea, hepatomegaly, hypoglycemia, and coagulation dysfunction.This review described the pathogenesis, clinical manifestations, genotypes, diagnosis, treatment and management of MPI-CDG, aiming to enhance the understanding of MPI-CDG.
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Objective:To evaluate the clinical efficacy of metal braided stent deployed by fully protruding into the inferior vena cava for the treatment of iliac vein compression syndrome(IVCS).Methods:The clinical data of patients with IVCS treated with interwoven nitinol mesh stent protruding into the inferior vena cava and released from Jan 2018 to May 2021 in our center were retrospectively analyzed.Results:A total of 118 patients were included in this study. Among them, 7 cases were complicated with acute thrombosis, 3 cases were complicated with post thrombotic syndrome (PTS), and 108 cases were no more thrombotic iliac vein compression. The technical success rate was 100%, with an average of 2.03±0.77 stents implanted. Of the 23 ulcer patients, 18 ulcers healed after intervention, and the healing rate was 78.26%. The postoperative CEAP grade was significantly improved ( t=11.54, P<0.01), and the primary patency rate and second patency rate were 97.46% and 98.31% at 1 year after intervention. Conclusion:The fashion of fully protruding into inferior vena cava deployment in the treatment of iliac vein compressive disease has a high patency rate and satisfactory clinical efficacy.
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Objective:To compare the efficacy between drug-coated balloon (DCB) combined with bare metal stenting (BMS) and plain old balloon angioplasty (POBA) with BMS placement in the treatment of femoral-popliteal TASC D lesions.Methods:According to the Trans-Atlantic Inter-Society Consensus (TASC) D grade femoral-popliteal lesions as the standard, we enrolled 115 cases (120 limbs) receiving DCB combined with BMS (group DCB, 37 limbs in 36 cases) and POBA combined with BMS (group POBA, 83 limbs in 79 cases) from Jan 2017 to Mar 2020 to observe patency rate, freedom from clinical-drived target lesion reintervention rate (FCD-TLR) and complications.Results:The mean follow-up time was 18.1 months and the average occlusion length was (29.1±6.5)mm. In group DCB vs group POBA, the primary patency rates at 3-month, 9-month, 1-year and 2-year were 89.2% vs. 86.7%, 86.4% vs. 76.9%, 66.8% vs. 70.9% and 63.1% vs. 56.9%, respectively ( P=0.73); FCD-TLRs were 100.0% vs. 95.1%, 94.3% vs. 82.3% , 78.5% vs. 80.6% and 74.1% vs. 68.9% ( P=0.69), respectively. Conclusion:The benefit of DCB combined with BMS over POBA combined with BMS in improving the early primary patency rate and reducing FCD-TLR was not definite.
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Objective:To evaluate the application value of three-dimension digital subtraction angiography (3D-DSA) in the diagnosis and treatment of iliac vein compression syndrome (IVCS).Methods:A retrospective analysis was made on 171 patients with a tentative diagnosis of IVCS based on signs, symptoms, and finding of CTV or MRV, and iliac vein angiography. The diagnostic efficacy of MRV, 2D-DSA and 3D-DSA were analyzed. The imaging advantages of 3D-DSA in the diagnosis and treatment of IVCS were evaluated.Results:Ninty-three patients underwent MRV and 3D-DSA simultaneously, 101 patients had 2D-DSA and 3D-DSA simultaneously. 3D-DSA was taken as gold standard, the diagonotic sensitivity, specificity, Youden index of MRV was 75.61%, 72.73% and 0.48 respectively. The sensitivity, specificity, Youden index of 2D-DSA was 90.22%, 100% and 0.90 respectively. There are significant differences in the diagonotic sensitivity between MRV and 3D-DSA, 2D-DSA and 3D-DSA ( P<0.05). There is no significant difference in the diagonotic specificity between MRV and 3D-DSA, 2D-DSA and 3D-DSA ( P=1.000). In this study, we found that 3D-DSA has greater imaging evaluation advantages in preoperative evaluation, intraoperative guidance and immediate postoperative reexamination in the diagnosis and treatment of iliac vein disease. Conclusions:3D-DSA can improve the detection rate of IVCS, and has its advantage in imaging evaluation.
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The ketogenic diet(KD) treatment program planned for a 2 years old and 5 months boy suffered from severe cerebral complications after ependymoma operation in the Children′s Hospital of Nanjing Medical University at December 2018 was analyzed retrospectively.The patient developed various complications, including cerebral hemorrhage, hydrocephalus and hernia after the operation of ependymoma, with coma, fever and convulsion, and 1 month of anti-infection and antiepileptic treatment was ineffective.After 2 weeks of 4∶1 KD, fever and convulsion were effectively relieved without obvious side effects.One month later, the patient regained consciousness, demonstrating that KD can be applied to treat severe cerebral complications after ependymoma operation.
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Objective To study perioperative monitoring characteristics of severe Pierre Robin syn-drome in children. Methods The clinical data of 48 infants with Pierre Robin syndrome admitted to the de-partment of surgical intensive care unit from March 2013 to January 2015 were retrospectively reviewed. Results All 48 cases were cured and discharged without death. The average duration of mechanical ventila-tion after the operation was(2. 76 ± 3. 58)days. There were significant differences in blood gas analysis before and after treatment in surgical intensive care unit(pH:7. 33 ± 0. 07 vs. 7. 44 ± 0. 08,PaCO2:(49. 12 ± 15.63)mmHg vs.(36.19 ±8.13) mmHg,PaO2:(74.28 ±17.09) vs. (114.00 ±53.55) mmHg)(P ＜0. 05,respectively). The levels of prealbumin and retinol binding protein increased significantly after treatment [prealbumin:(0. 10 ± 0. 04) g/L vs. (0. 14 ± 0. 05) g/L,retinol binding protein:(19. 85 ± 9. 76) mg/L vs. (25.15 ±8.72)m g/L](P＜0.05,respectively). Conclusion Reasonable mechanical ventilation combined with available nourishments support could help to improve the prognosis of severe Pierre Robin syndrome.
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Objective To investigate the current status of nutritional support in the children with severe traumatic brain injury (TBI),and the influence of nutritional support on the clinical outcomes.Methods A total of 60 children with severe TBI who were admitted to the surgical intensive care unit (SICU) of our hospital from April 2016 to July 2017 were enrolled in this study.The clinical data like gender,age,height,weight,diagnosis and Glasgow coma scale were collected.The children were divided into two groups by actual energy intake:target energy achieved group and unachieved group.Nutritional support indexes including the start time and the way of nutritional support,interruption of enteral nutritional support,predicted target energy value and actual energy intake,incidence of infectious complications,duration of mechanical ventilation,length of SICU stay,length of total hospital stay,total hospital expenses and prognosis were compared between the two groups.Results Among 60 children recruited,37 (61.6％) were caused by traffic accident,16 (26.7％) were caused by falling,7 (11.7％) by other causes.The average duration of SICU were (13.3± 8.0) days.22 (36.7％) children achieved the target energy,while 38 (63.3％) failed,and the percentage of actual energy supply was 126％ and 65％,respectively (P=0.000).The average age of the target achieved group was younger than that of the target unachieved group [(3.5±2.8) years vs.(6.2±3.9) years,P=0.006],while the duration of the mechanical ventilation was shorter [(2.7±3.9) days vs.(6.8± 11.8) days,P=0.014],and the length of hospital stay was shorter [(16.8±7.7) days vs.(19.5±11.6) days,P=0.038].The total hospital expenses of the target achieved group were lower than the unachieved group [(5.4±4.1) × 104 yuan vs.(7.6±5.9) ×104 yuan,P=0.024] Conclusions The actual energy intakes of most severe TBI children are less than their target energy.Sufficient energy supply can shorten the length of SICU and hospital stay,and reduce the total hospital expenses.
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Objective]The aim of this study was to investigate the level of serum C3,C4 and HDL-C in patients with coronary heart disease and the correlation between C3,C4 and HDL-C in patients with coronary heart disease.[Methods]We collected 251 cases of patient diagnosed with coronary artery disease by coronary angiography in Sun Yat-sen Memorial Hospital ,Sun Yat-Sen University from 2015-12 to 2016-07 and collected over our Boji Medical Center healthy people in 214 cases. These patients were divided into acute coronary syndrome group with 180 cases and stable coronary heart disease group with 71 cases. Each test results was adopted from clinical laboratory of Sun Yat-Sen Memorial Hospital ,Sun Yat-Sen University.[Results]Compared with the healthy control ,the difference of serum C3,C4 and HDL-C from acute coronary syndrome group and stable coronary heart disease group,was statistically significant(P 0.05)between C3,C4 and HDL-C. In healthy group,complement C3 negatively correlated with HDL-C,the difference was statistically significant(P<0.05).[Conclusions]In patients with coronary heart disease, the level of C3 and C4 increased,while the level of HDL-C decreased ,and inflammation may affect the relevance judgments between complement and HDL-C.
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Objective To explore the changes of serum cortisol and its influence on prognosis in children with traumatic brain injury( TBI) . Methods A total of 52 children suffering from TBI hospitalized in SICU of Nanjing Children′s Hospital from June 2014 to December 2015 were analyzed. According to the glasgow coma scale(GCS),they were divided into three groups:mild injury group(19 cases,GCS≥13), moderate injury group(16 cases,8
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Objective To study the clinical characteristics,treatment and prognosis of neonatal intestinal muscle defect with perforation.Methods The clinical data of 8 cases of newborns who had intestinal muscle defect with perforation in Department of Surgical Intensive Care Unit,Nanjing Children's Hospital Affiliated to Nanjing Medical University,were analyzed retrospectively.Results These 8 cases included 1 premature infant,1 term low birth weight infant,6 cases of term infants with normal birth weight,and all had no history of perinatal asphyxia.The ages of onset of all cases were ＜ 7 d.Clinical manifestations were crying and sudden onset of obvious abdominal distention.Bile or fecal vomiting occurred in 5 cases.These patients included 5 cases with congenital anorectal malformations,of which 3 cases had low deformity,1 case with middle deformity and 1 case with high deformity,with no other complications of gastrointestinal malformation.Surgical treatment was used in 8 cases,in which 7 cases of rectal perforation and 1 case of ileal perforation were confirmed.All cases were isolated perforation with a diameter of about 0.8-2.0 cm.The perforated periphery of the intestine was membranous.Intestinal repair was performed after total removal of the diseased tissue,and the patients with rectal perforation were performed at the same time for the proximal colostomy.The histopathologic examinations showed that the periphery of perforation had intact mucosa,muscularis propria was absent,myenteric plexus was absent in the region of muscle loss.Two cases were discharged within 1 d after colostomy.Except for 1 case with high anorectal malformation in the control of poor defecation functions,there were no other postoperative gastrointestinal complications in these 6 cases.Conclusions Rectal perforation is the most common in neonatal intestinal muscle defects,and it is an isolated and large diameter perforation.Most cases are term infants with normal birth weight.These patients are often associated with congenital anorectal malformations.High,middle and low deformity can be accompanied by intestinal muscle defect.Surgical excision of diseased tissue should be complete,in principle,and intestinal stoma should be performed proximal to the perforation.In case of congenital anorectal malformations complicated with gastrointestinal perforation,the rectum should be explored as an important region.Neonatal intestinal muscle defect maybe a primary lesion according to clinical characteristics of early sudden onset after birth and pathological examinations.Except for complications caused by associated malformations,the prognosis is satisfactory.
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Objective To compare the therapeutic effect of inhaled aerosolized and intravenous milrinone (a phosphodiesteraee-3 inhibitor) on postoperative pulmonary artery hypertension (PAH) in children with congenital heart disease (CHD).Methods Forty CHD complicated with PAH children aged 5-14 yr weighing 15-38 kg with pulmonary artery pressure (PAP) 30-90 mm Hg were randomly divided into 2 groups (n = 20 each): Ⅰ milrinone inhalation group and Ⅱ intravenous milrinone group. At the end of CPB, aerosolized milrinone 1 ml/kg was inhaled for 12 h at 30 min intervals, and each time milrinone was inhaled for 10 min in group Ⅰ . In group Ⅱ , a bolus of 10 g/kg milrinone was given iv followed by 12 h milrinone infusion at 0.5 μg·kg-1 ·min-1 . Blood samples were taken from aorta and pulmonary artery for blood gas analysis at the end of administration and venous oxygen saturation (S(-v)O2) was recorded. MAP, PAP, pulmonary vascular resistance index (PVRI) and systemic vascular resistance index (SVRI) were recorded every 2 h during milrinone administration. The duration of endotracheal tube, PAH, lung infection and postoperative hyoxemia were recorded during milrinone administration. Results PAP, PVRI and the incidence of lung infection and PAH were significantly lower, while MAP, SVRI and S(-v)O2higher in group Ⅰ than in group Ⅱ (P ＜ 0.05), but there was no significant difference in the duration of endotracheal tube and incidence of hyoxemia between the two groups(P ＞ 0.05). Conclusion Inhaled aerosolized milrinone has better therapeutic effect than intravenous milrinone on PAH in children with CHD.