Monteggia type-I equivalent fracture in a fourteen-month-old child: A case report.

BACKGROUND: Monteggia and equivalent lesions are relatively rare but result in severe injuries in childhood, typically affecting children between 4 and 10 years old. The diagnosis and treatment of an equivalent Monteggia lesion is more complicated than those of a typical Monteggia fracture. This type of lesion may be challenging and may lead to serious complications if not treated properly. Pediatric Monteggia equivalent type I lesions have been reported in a few reports, all of which the patients were all over 4 years old. CASE SUMMARY: A 14-mo-old boy was referred to our clinic after falling from his bed 10 d prior. With regard to the clinical examination, an obvious swollen and angular deformity was noted on his right forearm. Plain radiographs and reconstructed computed tomography scans showed a Monteggia type I fracture and dislocation. Magnetic resonance imaging (MRI) confirmed a type I Monteggia equivalent lesion consisting of ulnar fracture and Salter-Harris type I injury in the proximal radius. The radial head was still in the joint, and only the radial metaphysis was displaced anteriorly. Open reduction and pinning of both displaced radial and ulnar fractures achieved an excellent result with full function. CONCLUSION: We recommend MRI examination or arthrography during reduction, especially if the secondary ossification center has not appeared.

[Efficacy of recombinant human thrombopoietin combined with high-dose dexamethasone in the treatment of refractory immune thrombocytopenia in children].

OBJECTIVE: To explore the efficacy and safety of recombinant human thrombopoietin (rhTPO) combined with high-dose dexamethasone (DXM) in the treatment of children with refractory immune thrombocytopenic purpura (ITP). METHODS: Fifty-eight ITP children who had failed first-line therapy were randomly divided into two groups: DXM treatment (n=27) and rhTPO + DXM treatment (n=31). The DXM treatment group received two continuous cycles of DXM treatment; in each cycle, patients received high-dose DXM (0.6 mg/kg daily) by intravenous drip for 4 days every 28 days. The rhTPO group received subcutaneous injection of rhTPO (300 U/kg daily) for 14 days additional to DXM treatment. The overall response rate (marked response rate + slight response rate) and adverse reactions were evaluated after 3, 7, and 14 days and 1, 2, and 3 months of treatment. RESULTS: After 7 and 14 days and 1 month of treatment, the rhTPO + DXM treatment group had a significantly higher marked response rate and a significantly higher overall response rate than the DXM treatment group (P<0.05). After 2 months of treatment, the rhTPO + DXM treatment group had a significantly higher overall response rate than the DXM group (P<0.05). One patient in the DXM treatment group had liver damage during the first week of treatment. There was no hypertension, fever, rash, allergy, or weakness in the two groups. CONCLUSIONS: rhTPO combined with high-dose DXM is an effective and safe approach for treating refractory ITP.

Construction of Oxadiazepines via Lewis Acid-Catalyzed Tandem 1,5-Hydride Shift/Cyclization.

Expeditious access to oxadiazepines via 1,5-hydride shift/cyclization of pyrrolidine- or tetrahydroisoquinoline-containing nitrones has been developed. With 1,3-dipole nitrones serving as the hydride acceptors, this transformation was promoted by a Lewis acid, providing access to structurally diverse oxadiazepines in good yields. A one-pot process for in situ nitrone formation, a 1,5-hydride shift, and ring cyclization was also realized.

[Detected of associated contagious parameters of blood recipients before transfusion and their clinical significance].

OBJECTIVE: To investigate the significance in prevention of nosocomial infection of the testing of the associated contagious parameters of blood recipients before transfusion. METHODS: A retrospective analysis was adopted, 44 968 pre-transfusion patients were tested the serum hepatitis B virus surface antigen (HBsAg), antibody against hepatitis C virus (anti-HCV), antibody against T. pallidum (anti-TP) and antibody against human immunodeficiency virus(anti-HIV). RESULTS: The total positive rate was 22.41%. Positive rate of HBsAg, anti-HCV and anti-TP were 20. 67% (9294/44 968) , 0.33% (148/ 44 968) and 1.65% (9741/44968), respectively; anti-HIV was positive in 39 patients, 23 cases coinfection of the other three indicators at least one positive in 39 cases of anti-HIV-positive blood recipients, of which was mostly observed T. pallidum; co-infection of HBV, HCV and/or TP were 117 cases, and were mostly observed between HBV and HCV, HCV and TP; for HBV infection the department of digestive medicine was prevalent(Chi2>or=83.0, P <0.01). CONCLUSION: Part of blood recipients before admission had been infected with a contagious disease. The testing of the associated contagious parameters of blood recipients before transfusion is not only useful for both of the hospital and the patients, but also more important to ensure safe blood transfusion, decrease medial dissatisfaction and to prevent nosocomial infection.

[Effects of electroacupuncture at acupoints "changbingfang" on serum IL-4 content and colonic NF-kappaB p65 expression in rats with ulcerative colitis].

OBJECTIVE: To observe the effect of electroacupuncture (EA) of "Zhongwan"(CV 12), "Tianshu"(ST 20) and "Shangjuxu"(ST 37) (an acupoint prescription "Changbingfang" for treatment of intestinal disorders) on the expression of colonic nuclear factor kappaB p65 (NF-kappaB p65) protein expression and serum interleukin-4 (IL-4) content in rats, so as to explore its mechanism underlying improvement of ulcerative colitis (UC). METHODS: Thirty SD rats were randomly and equally divided into normal control, model and EA groups (10 rats/group). The UC model was made by enema with 8% acetic acid. EA stimulation (6 Hz/30 Hz) was delivered to "Zhongwan" (CV 12), "Tianshu" (ST 20) and "Shangjuxu" (ST 37) for 15 min separately, 0 h, 24 h and 48 h post-enema. The blood and colon tissues were taken for detection of serum IL-4 content with ELISA, and for assaying colonic NF-kappaB p65 protein expression with immunohistochemistry and Western blot, respectively. RESULTS: Compared with the normal control group, colonic NF-kappaB p65 protein expression level shown by immunohistochemistry and Western blot and serum IL-4 content were significantly higher in the model group (P < 0.01, P < 0.05). After EA stimulation, colonic NF-kappaB p65 protein expression levels shown by both immunohistochemistry and Western blot were down-regulated significantly (P < 0.01, P < 0.05) and serum IL-4 content was up-regulated further in comparison with the model group (P < 0.01). CONCLUSION: EA of acupoint recipe "Changbingfang" can down-regulate the proinflammatory NF-kappaB p65 protein expression and up-regulate serum anti-inflammatory cytokine IL-4 level in rats, which may contribute to its effect in improving ulcerative colitis.

[Distribution of Salmonella paratyphi A outer membrane protein X gene and immune-protective effect related to its recombinant expressed products].

OBJECTIVE: To determine the distribution and sequence conservation of outer membrane protein X(ompX)gene in Salmonella paratyphi A isolates as well as the immunogenicity and immuno-protection of ompX gene products. METHODS: OmpX gene in Salmonella paratyphi A isolates was detected by PCR and the amplification products were sequenced after the T-A cloning process. OmpX gene product was expressed with E. coli expression system and the expressed rOmpX was extracted by Ni-NTA affinity chromatography. SDS-PAGE and Bio-Rad Gel Image Analyzer were applied to examine the expression and yield of rOmpX. Both antigenicity and immune-reactivity of rOmpX were detected by immune-diffusion test, ELISA and Western blot assay. The immunoprotective effect of rOmpX against infection of Salmonella paratyphi in mice was determined and the agglutinative titers of sera from rOmpX-immunized mice was measured by micro-Widal's test. RESULTS: All the tested Salmonella paratyphi A isolates had ompX gene with high nucleotide or amino acid sequence identity (99.2%-100.0% or 98.4%-100.0%). When rOmpX was induced to rabbits to produce high level antibody and combined with antiserum against whole cell of Salmonella paratyphi A, the results displayed a positive Western hybridization signal. Results from ELISA demonstrated that 95.6% (65/68) of the serum samples from paratyphoid-A patients were positive on rOmpX antibody. Mice that were immunized with 100 µg or 200 µg rOmpX displayed an immune-protective rate of 93.3% (14/15) or 100.0% (15/15). Sera from those rOmpX-immunized mice provided 1 : 10-1 : 40 agglutination titers in both H antigens of Salmonella paratyphi A and Salmonella typhi. CONCLUSION: The recombinant expression product of ompX gene could be used as a candidate antigen for developing genetic engineering vaccines against Salmonella paratyphi A infection.

Identification and analysis of mutations in WTX and WT1 genes in peripheral blood and tumor tissue of children with Wilms' tumor.

BACKGROUND: Wilms' tumor (nephroblastoma) is the most common pediatric kidney cancer. Only one Wilms' tumor gene is known, WT1 at 11p13, which is mutated in 5% - 10% of Wilms' tumors. Recently, mutations were reported in WTX at Xq11.1 in Wilms' tumors. This study investigated the mutation proportion, type, and distribution in WTX and WT1 in children with Wilms' tumor. The role of WTX/WT1 in the development of Wilms' tumor, and the relationship between clinical phenotype and genotype, were also studied. METHODS: Wilms' tumor specimens (blood samples from 70 patients and tumor tissue samples from 52 patients) were used. A long fragment of WTX and 10 exons and intron sequences of WT1 were amplified by polymerase chain reaction (PCR) from extracted genomic DNA and sequenced. A chi-square test compared the difference between the WTX mutation group and the no mutation group. The relationship between the mutations and clinical phenotype was analyzed. RESULTS: WTX mutations were found in 5/52 tumor tissues and in 2/70 peripheral blood samples (five cases in total, all point mutations). Two patients had a WTX mutation in both samples. WT1 mutations were found in 2/52 tumor tissues and in 4/70 peripheral blood samples (five cases in total, all point mutations). One patient had a WT1 mutation in both samples. Ten cases had WTX or WT1 mutation (19.2% of Wilms' tumors). No overlapping WTX and WT1 mutations were found. No significant differences in clinical parameters were found between patients with and without a WTX mutation. CONCLUSIONS: WTX mutations occur early in Wilms' tumor development, but at a low proportion. There was no evidence that WTX is the main cause of Wilms' tumor. Clinical parameters of patients with WTX mutations are not related to the mutation, indicating a limited impact of WTX on tumor progression. WTX and WT1 mutations occur independently, suggesting a relationship between their gene products.

[Selection of basic acupoints combined with "enteral-disorder-formuia" for electroacupuncture treatment of intestinal mucosal lesion in rats].

OBJECTIVE: To observe the effect of electroacupuncture (EA) stimulation of differently combined acupoints of "Zhongwan" (CV 12), "Tianshu" (ST 25) and "Shangjuxu" (ST 37, for treatment of enteral disorders) on acetic acid-induced intestinal mucosal lesion in rats so as to select the best combinations of acupoints. METHODS: A total of 126 SD rats were divided into nine groups: normal control (normal), model, CV 12, ST 25, ST 37, CV 12 + ST 37, ST 25 + ST 37, CV 12 + ST 25 and CV 12 + ST 25 + ST 37. Intestinal mucosal lesion model was established by using enema (8% acetic acid 1 mL). EA was applied to the above-mentioned acupoints for 15 min, once daily for 3 days. General conditions, colonic mucosal damage index (CMDI) and pathological damage integral (PDI) were detected respectively. The colonic mucosal membrane tissue was stained with H. E. stain for observing its morphological changes under light microscope, and the ultrastructural changes were observed using electron transmission microscope. RESULTS: Compared with the control group, CMDI was decreased significantly (P < 0.05) and PDI of the colonic mucosal membrane increased significantly in the model group (P < 0.05). Compared with the model group, CMDI was decreased markedly and PDI increased significantly (P < 0.05) in the CV 12, ST 25, ST 37, CV 12 + ST 37, ST 25 + ST 37, CV 12 + ST 25 and CV 12 + ST 25 + ST 37 groups (P < 0.05). Comparison among the 7 EA treatment groups showed that both CMDI and PDI of the CV 12 + ST 25 + ST 37 group were significantly superior to those of CV 12, ST 25, ST 37, CV 12 + ST 37, ST 25 + ST 37 and CV 12 + ST 25 groups (P < 0.05). Under light microscope, the colonic mucosal injury was remarkable, while those of the 7 EA treatment groups were relatively milder. Ultramicrostructural findings showed that the colonic mucosal lesion including shortening or sparseness of the intestinal epithelial villi, swelling of mitochondria with arrangement disorder, breaking or fusion of the cristae, and enlargement of the rough endocytoplasmic reticulum was found in the model group, while the situations were lighter in the 7 EA groups particularly in the CV 12 + ST 25 + ST 37 group. CONCLUSION: EA of CV 12, ST 25 and ST 37 acupoint alone or combination can relieve acetic acid-induced intestinal mucosal lesion in rats, and the effect of joint application of these 3 acupoints is obviously better, suggesting their clinical applicability in clinical treatment of intestinal disorders as a basic formula.

Preservation of the kidney with delayed diagnosis of traumatic pelvi-ureteric junction disruption secondary to blunt abdominal trauma in children.

BACKGROUND: The delayed diagnosis of pelvi-ureteric junction (PUJ) disruption in children following blunt abdominal trauma can result in loss of function of the involved kidney. We examined the potential for kidney preservation and the limits of diagnostic delays. METHODS: A retrospective review of 17 cases of PUJ disruption at Beijing Children's Hospital from 1993 to 2009 was done with respect to diagnosis, treatment and follow-up. RESULTS: The interval from trauma to diagnosis of PUJ disruption was (52 ± 52) days. If one case with nephrectomy was excluded, the interval from trauma to diagnosis was (40 ± 20) days. The average time between injury and first treatment was (49 ± 25) days. Pelvi-ureteric reanastomosis and caliceal ureterostomy were performed separately in 11 and 4 patients, respectively. Ileal replacement for ureter injuries was finally performed in one patient. Hydronephrosis of the injured kidney was reduced and the function improved in 15 out of 17 patients (88%). Only one patient received nephrectomy and the nephrectomy rate was 5.9%. CONCLUSION: Differential renal function at the PUJ disruption side can be saved and the rate of nephrectomy reduced by appropriate surgery if the time to diagnosis and first treatment is limited to within two months.