[The experience of surgical treatment for Ebstein anomaly in 141 children].

Objective: To explore the surgical strategy for Ebstein anomaly in children. Methods: From January 2003 to December 2015, a total of 141 cases of Ebstein anomaly were treated at Department of Pediatric Cardiothoracic Surgery, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiaotong University. There were 65 male and 76 female patients, with age of (6.9±1.6) years (ranging from 10 months to 15 years), weight of (19.6±4.7) kg (ranging from 6.5 to 59.0 kg). All patients were diagnosed by 2 dimensional Doppler echocardiography and the septal leaflet and posterior leaflet displaced downward from 1.0 to 5.0 cm. The tricuspid valve regurgitation (TR) were mild in 26 cases, moderate in 46 cases and severe in 69 cases. Tricuspid valvuloplasty were performed in 131 cases (94 cone reconstruction, 37 valve hoist), tricuspid valve replacement in 2 cases and tricuspid valve closed in 8 cases. Surgical strategy were divided into biventricular heart function in 77 cases, one and a half ventricular heart function in 56 cases, and single ventricular heart function in 8 cases. Results: Three patients were changed to one and a half ventricular repair from biventricular repair due to unstable hemodynamics in the early postoperative period. One case died in biventricular group. The complete atrioventricular block were occurred in 3 patients and pacemaker were applied. One hundred and forty cases discharged from hospital. There were mild TR in 118 cases, moderate in 14 cases and closed in 8 cases. One hundred and thirty-seven cases were followed up regularly in 18 to 172 months. Ninety-one cases were treated by cone reconstruction (mild TR in 75 cases, moderate in 15 cases and severe in 1 case). Thirty-six cases were operated by tricuspid valve hoist (mild TR in 21 cases, moderate in 12 cases and severe in 3 cases). In the patients with severe TR (4 cases), 3 cases were reoperated by cone reconstruction. One case's valve was closed because of the dysplasia of the anterior valve and then from one and a half ventricular heart function to single ventricular function, the oxygen saturation was increased. Two patients underwent tricuspid valve replacement, 1 died and the other's mechanical valve was removed, and changed to single ventricular function repair. Conclusions: Although tricuspid cone reconstruction can achieve good results, the stable hemodynamic of early postoperative can be effectively maintained by using the surgical strategy of one and a half ventricular repair. To the patients with severe tricuspid regurgitation and hypoxemia due to severe tricuspid valve dysplasia, transforming to a functional single ventricle may be the only choice when there comes to the unstable hemodynamic.

[Clinical efficacy observation of atomization inhalation combined with oral administration of oseltamivir in 4 cases with H7N9 avian influenza].

Objective: To investigate the clinical efficacy of atomization inhalation combined with oral administration of oseltamivir in treatment of human infection with H7N9 avian influenza. Methods: To analyze the clinical data of 4 patients hospitalized from Mar 6th 2017 to Apr 12th 2017 with avian influenza(H7N9) infection treated by conventional therapy(oseltamivir, 150 mg, po, Bid) plus with oseltamivir inhalation(75 mg dissolved in 20 ml N. S, Bid) and administered with antibacterial treatment, blood purification and immunomodulators. Results: Undergoing these comprehensive therapies, Bronchial lavage fluid and pharynx of 1 case was negative for H7N9 RNA after 24 h, 2 cases negative for H7N9 after 3 d and 1 case negative for H7N9 RNA after 4 d. All patients were cured and discharged without any complications. Conclusions: Aseltamivir inhalation combined with oral treatment can significantly shorten the time of virus nucleic acid turning negative, improve the efficacy of anti avian influenza virus H7N9, and increase the cure rate of avian influenza H7N9 infection patients.

[Prevention and treatment of root surface caries].

With the acceleration of population aging in China, the incidence of root surface caries is increasing year by year. Different from coronal caries, lesions of root surface caries mostly occur on the exposed root surfaces after gingival recession in elderly patients, mainly involving cementum and dentin. Root surface caries shows specificity in the pathogenic characteristics, clinical manifestations, diagnosis, treatment, and prevention. This review mainly summarizes the etiology and prevalence, pathology and clinical manifestations, classification, as well as three-level-prevention of root caries, in order to provide relevant guidance for the clinical prevention and treatment of root caries.

Sequential therapy with "vacuum sealing drainage-artificial dermis implantation-thin partial thickness skin grafting" for deep and infected wound surfaces in children.

OBJECTIVE: To evaluate the efficacy of a "vacuum sealing drainage (VSD) - artificial dermis implantation (ADI) - thin partial thickness skin grafting (TSG)" sequential therapy for deep and infected wounds in children. MATERIALS AND METHODS: Fifty-three pediatric patients with deep and infected wounds were treated with sequential VSD-ADI-TSG therapy. The efficacy of this treatment was compared with that of the surgical debridement-change dressings-thin partial thickness skin grafting previously performed on 20 patients. Survival of tissue grafts, color and flexibility, subcutaneous fullness and scar formation of the graft site were examined and compared. RESULTS: The sequential therapy combined the advantages of the VSD treatment, in reducing tissue necrosis and infection on the wound surfaces and promoting the growth of granulation tissue, with the enhancement of grafting by artificial dermis. Compared with the 20 controls, skin grafted on the artificial dermis was more smooth and glossy, while the textures of the region were more elastic, and the scars were significantly lighter in Vancouver scale. CONCLUSION: The sequential VSD-ADI-TSG therapy is a simple and effective treatment for children with deep and infected wounds. LEVEL OF EVIDENCE: IV.

A smoking cessation intervention among tuberculosis patients in rural China.

OBJECTIVE: To assess the integration of a smoking cessation intervention into routine tuberculosis (TB) services. METHOD: Consecutive TB patients registered from 1 March to 31 August 2010 were enrolled in an intervention for self-reported smoking to promote tobacco cessation during treatment for TB. Information on the harmful health effects of tobacco smoke and smoking and TB were provided to TB patients who self-reported as current smokers. Smoking status was reassessed at every follow-up visit during anti-tuberculosis treatment with reinforced health messages and advice to quit. RESULTS: Of 800 TB patients enrolled, 572 (71.5%) were male and 244 (30.5%) were current smokers. Females were more likely to be non-smokers (100% vs. 35.8%, P < 0.001). Of the 244 current smokers, 144 (59.0%) started smoking at <20 years, 197 (80.7%) consumed ⩾20 cigarettes per day, 211 (86.5%) had perceived smoking dependence and 199 (81.6%) had made no attempt to quit before the diagnosis of TB. Of the 244 current smokers, 234 (95.9%) were willing to quit, and 156 (66.7%) reported abstinence at month 6. Challenges to implementing smoking cessation intervention were identified. CONCLUSION: The majority of current smokers among TB patients were willing to quit and remained abstinent at the end of anti-tuberculosis treatment. This intervention should be scaled up nationwide.

Objectif : Evaluer la possibilité d'intégrer une intervention d'arrêt du tabac dans les services de routine de la tuberculose (TB).Méthode : Les patients tuberculeux consécutifs inscrits entre le 1e mars et le 31 août 2010 ont été enrôlés dans une intervention visant à promouvoir l'arrêt du tabac chez ceux qui disaient fumer pendant le traitement de leur TB. Des informations sur les effets sanitaires dangereux de la fumée de tabac et sur le fait de fumer en étant tuberculeux ont été fournies aux patients qui se sont dit fumeurs actuels. Le statut en matière de tabac a été réévalué à chaque visite de suivi pendant le traitement antituberculeux avec des messages sanitaires renforcés et des conseils visant à l'arrêt.Résultats : Sur 800 patients TB enrôlés, 572 (71,5%) étaient des hommes et 244 (30,5%) étaient des fumeurs actuels. Les femmes étaient plus souvent non fumeuses (100% contre 35,8% ; P < 0,001). Des 244 fumeurs actuels, 144 (59,0%) avaient commencé à fumer avant 20 ans, 197 (80,7%) consommaient ⩾20 cigarettes par jour, 211 (86,5%) étaient conscients de leur dépendance au tabac et 199 (81,6%) n'avaient jamais essayé d'arrêter avant le diagnostic de TB. Des 244 fumeurs actuels, 234 (95,9%) voulaient arrêter et 156 (66,7%) ont déclaré être toujours abstinents à 6 mois. Les défis à la mise en œuvre d'une intervention d'arrêt du tabac ont été identifiés.Conclusion : La majorité des fumeurs actuels parmi les patients TB voulaient arrêter et sont restés abstinents à la fin du traitement antituberculeux. Cette intervention devrait être étendue au pays tout entier.

Objetivo: Evaluar la utilidad de la integración de las intervenciones de promoción del abandono del tabaquismo en los servicios ordinarios de atención de la tuberculosis (TB).Métodos: Se inscribieron de manera consecutiva los pacientes con diagnóstico de TB y tabaquismo actual del 1° de marzo al 31 de agosto del 2010 en una intervención cuyo objeto era a promover el abandono del hábito tabáquico durante el tratamiento antituberculoso. Se suministró información acerca de los efectos deletéreos del humo del tabaco sobre la salud y de la asociación del tabaquismo y la TB a los pacientes que autorrefirieron un tabaquismo actual. En cada consulta de seguimiento durante el tratamiento se evaluó de nuevo la situación frente al tabaco, se reforzaron los mensajes sobre la salud y se reiteró el consejo de abandonar el hábito.Resultados: De los 800 pacientes con TB inscritos, 572 fueron de sexo masculino (71,5%) y 244 eran fumadores actuales (30,5%). Las mujeres fueron con mayor frecuencia no fumadoras (100% contra 35,8%; P < 0,001). De los 244 fumadores actuales, 144 habían comenzado a fumar antes de los 20 años de edad (59,0%), 197 consumían ⩾20 cigarrillos por día (80,7%), 211 habían percibido la dependencia al tabaquismo (86,5%) y 199 nunca habían intentado abandonar el hábito antes del diagnóstico de TB (81,6%). De los 244 fumadores actuales, 234 estaban dispuestos a abandonar el tabaco (95,9%) y 156 notificaron abstinencia al sexto mes (66,7%). Se pusieron de manifiesto obstáculos a la aplicación de la intervención en favor del abandono del tabaquismo.Conclusión: En su mayoría, los fumadores actuales entre los pacientes con diagnóstico reciente de TB estaban dispuestos a abandonar el tabaquismo y cumplieron con la abstinencia hasta el final del tratamiento antituberculoso. Se debería ampliar la aplicación de esta intervención a escala nacional.

Design of a core-shelled polymer cylinder for potential programmable drug delivery.

A cylindrical dosage form comprising a laminated composite polymer core and a hydrophobic polycarbonate coating was proposed for programmable drug delivery. In the core, poly[(ethyl glycinate) (benzyl amino acethydroxamate) phosphazene] was synthesized as drug-loaded layers for its strong pH-sensitive degradation (eroded after 1.5 days at pH 7.4 and more than 20 days at pH 5.0 and 6.0). Poly(sebacic anhydride)-b-polyethylene glycol or poly(sebacic anhydride-co-trimellitylimidoglycine)-b-poly(ethylene glycol) was selected as isolating layers for their good processing properties at room temperature and suitable erosion duration. The in vitro drug release studies of these devices were conducted under physiological conditions (pH 7.4). The results revealed that the model drugs (brilliant blue, FITC-dextran, myoglobin) could be released in typical pulsatile manner. Moreover, the duration time of drug release (24-40 h) and the lag time (18-118 h) could be separately regulated by the mass of polyphosphazene and the type or mass of polyanhydride. In this experiment, the cooperative effect of polyanhydrides and pH-sensitive degradable polyphosphazene was specially demonstrated, which offers a new idea to develop a programmable drug delivery system for single dose vaccine and other related applications.

Long-term follow-up of autogenous canine transplants with application of guided bone regeneration.

The aim of this study was to evaluate the aesthetics and outcome of autotransplantation of impacted canines unsuitable for orthodontic realignment using a combination of surgery with guided bone regeneration and orthodontic treatment. Ten severely impacted canines in nine consecutive patients (mean age 14.8 years) were included. The recipient mesiodistal space was created orthodontically and the recipient socket prepared using dental implant drills. Following transplantation, bone defects were grafted using guided bone regeneration, teeth were aligned and occlusions adjusted orthodontically. Patients were followed-up every 6 months for an average of 7.1 years (range 2-11 years). The mean pink aesthetic score was 13.33 ± 0.87. Pocket depths were less than 3 mm. Radiographic examination showed an uninterrupted periodontal space and lamina dura in seven cases, unclear periodontal space in two, and replacement resorption in one case. The analysis showed that canine transplantation combined with guided bone regeneration and orthodontic treatment gives acceptable and predictable aesthetic results.

Case of acute akathisia from intravenous metoclopramide.

Intravenous (IV) metoclopramide is a frequently prescribed medication in the emergency department (ED). Extrapyramidal side effects like tardive dyskinesia are known to develop with chronic use of metoclopramide, while acute akathisia is a lesser known side effect following IV administration. Akathisia is characterised by a sensation of restlessness and distress, as well as constant, non-purposeful limb movement. It can present as a diagnostic challenge, cause distress and hinder the management of the primary condition of the patient in the ED. However, akathisia can be readily reversible, with a successful patient outcome if promptly diagnosed. We report a case of acute akathisia in a young female patient after IV bolus metoclopramide was administered to treat her gastroenteritis in our ED. We highlight the diagnostic process, the difficulties in the management of the primary condition resulting from her akathisia and its successful management using IV diphenhydramine and midazolam.