Finite element analysis of PMMA bone cement reinforced screw plate fixation for osteoporotic proximal humeral fracture / 中国骨伤

OBJECTIVE@#With the help of finite element analysis, to explore the effect of proximal humeral bone cement enhanced screw plate fixation on the stability of internal fixation of osteoporotic proximal humeral fracture.@*METHODS@#The digital model of unstable proximal humeral fracture with metaphyseal bone defect was made, and the finite element models of proximal humeral fracture bone cement enhanced screw plate fixation and common screw plate fixation were established respectively. The stress of cancellous bone around the screw, the overall stiffness, the maximum stress of the plate and the maximum stress of the screw were analyzed.@*RESULTS@#The maximum stresses of cancellous bone around 6 screws at the head of proximal humeral with bone cement enhanced screw plate fixation were 1.07 MPa for No.1 nail, 0.43 MPa for No.2 nail, 1.16 MPa for No.3 nail, 0.34 MPa for No.4 nail, 1.99 MPa for No.5 nail and 1.57 MPa for No.6 nail. These with common screw plate fixation were:2.68 MPa for No.1 nail, 0.67 MPa for No.2 nail, 4.37 MPa for No.3 nail, 0.75 MPa for No.4 nail, 3.30 MPa for No.5 nail and 2.47 MPa for No.6 nail. Overall stiffness of the two models is 448 N/mm for bone cement structure and 434 N/mm for common structure. The maximum stress of plate appears in the joint hole:701MPa for bone cement structure and 42 0MPa for common structure. The maximum stress of screws appeared at the tail end of No.4 nail:284 MPa for bone cement structure and 240.8 MPa for common structure.@*CONCLUSION@#Through finite element analysis, it is proved that the proximal humerus bone cement enhanced screw plate fixation of osteoporotic proximal humeral fracture can effectively reduce the stress of cancellous bone around the screw and enhance the initial stability after fracture operation, thus preventing from penetrating out and humeral head collapsing.

Surgical treatment methods and classification of proximal clavicle fracture / 中国骨伤

OBJECTIVE@#To summarize the surgical treatment of different proximal clavicle fractures, and discuss the classification of proximal clavicle fractures.@*METHODS@#Total of 24 patients with displaced proximal clavicle fractures were treated from January 2017 to December 2020 including 16 males and 8 females, aged 28 to 66 years old. Among them, 20 cases were fresh fractures and 4 cases were old fractures. According to the Edinburgh classification, 14 cases were type 1B1 fractures and 10 cases were type 1B2 fractures. The different internal fixation methods were selected for internal fixation treatment according to different fracture types.The operation time, blood loss, preoperative and postoperative displacement difference, fracture healing time and Rockwood scoring system were recorded.@*RESULTS@#All patients were followed up for 12 to 24 months. There were no patients with infection or loss of reduction after the operation. Three patients had internal fixation failure after operation, and the internal fixation device was removed. Results The operation time was 30 to 65 min, and the blood loss was 15 to 40 ml. No important nerves, blood vessels, or organs were damaged. The imaging healing time was 3 to 6 months. According to the Rockwood functional score, the total score was (13.50±1.86), pain (2.57±0.50), range of motion (2.78±0.41), muscle strength (2.93±0.28), restricted daily activity (2.85±0.35), subjective results (2.63±0.61);the results were excellent in 20 cases, good in 3 cases, fair in 1 case.@*CONCLUSION@#Proximal clavicular fracture is a type of fracture with low incidence. According to different fracture types, different internal fixation methods and treatment methods can be selected, and satisfactory surgical results can be achieved.

Toxicity Management and Efficacy Evaluation of BCMA-CART in the Treatment of Relapsed and Refractory Multiple Myeloma / 中国实验血液学杂志

OBJECTIVE@#To investigate the toxicity management and efficacy evaluation of BCMA-chimeric antigen receptor T cells(CART) in the treatment of relapsed and refractory multiple myeloma (MM).@*METHODS@#The efficacy and adverse reactions of 21 patients with MM who received BCMA-CART treatment at the First Affiliated Hospital of Wenzhou Medical University from December 2017 to September 2020 were evaluated, and the efficacy assessment and survival analysis for high-risk patients and non-high-risk patients were evaluated.@*RESULTS@#After infusion of BCMA-CART cells in 21 MM patients, the number of effective cases was 17, of which the complete remission (sCR/CR) was 10, and the partial remission (VGPR/PR) was 7. The median OS time for all patients was 19.4 months, and the median PFS time was 7.9 months. The number of patients with extramedullary disease(EMD), high-risk genetics, and ISS stage Ⅲ were 5, 15 and 8, and the effective number was 3, 11 and 6, respectively. The treatment of 3 patients without high-risk factors was effective. The median OS and median PFS of patients with EMD were 14.2 and 2.5 months, respectively, which were shorter than those of patients without EMD (19.4 months and 8.9 months, respectively). The median OS and median PFS of patients with high-risk cytogenetic factors and ISS Ⅲ were not significantly different from those of non-high-risk patients. Cytokine release syndrane (CRS) occurred in 20 patients, of which 14 cases were Grade 1 CRS, while 6 were Grade 2, no CRS of Grade 3 or above occurred. IL-6 receptor inhibitors were used in 9 patients. All CRS were controlled effectively, and no patients had neurological toxicity.@*CONCLUSION@#BCMA-CART is a certain curative effect in the treatment of relapsed and refractory multiple myeloma, and the adverse reactions can be well controlled through close monitoring and timely treatment.

Diversity of the T cell receptor β chain complementarity-determining region 3 in peripheral blood of neonates with sepsis: an analysis based on immune repertoire sequencing / 中国当代儿科杂志

OBJECTIVES@#To investigate the diversity of peripheral blood T cell receptor (TCR) β chain complementarity-determining region 3 (CDR3) based on immune repertoire sequencing in neonates with sepsis and the possible pathogenesis of neonatal sepsis.@*METHODS@#A total of 12 neonates with sepsis were enrolled as the case group, and 9 healthy full-term infants, matched for gestational age, birth weight, and age, were enrolled as the control group. Omega nucleic acid purification kit (SQ blood DNA Kit II) was used to extract DNA from peripheral blood samples, TCR β chain CDR3 was amplified by multiplex PCR, and then high-throughput sequencing was performed for the products to analyze the diversity of TCR β chain CDR3 and the difference in expression.@*RESULTS@#The length and type of TCR β chain CDR3 were similar between the case and control groups, and Gaussian distribution was observed in both groups. With D50 and Shannon-Wiener index as the evaluation indices for diversity, the case group had a significantly lower diversity of TCR β chain CDR3 than the control group (@*CONCLUSIONS@#There is a significant change in the diversity of TCR β chain CDR3 in the peripheral blood of neonates with sepsis, suggesting that it might be associated with the immune pathogenesis of neonatal sepsis.

Application of Renaissance spinal surgical robot in middle and upper thoracic fractures / 中华骨科杂志

Objective:To explore the safety and effectiveness of the Renaissance spine surgery robot in the middle and upper thoracic spine fractures.Methods:62 patients with middle and upper thoracic vertebra fractures from March 2015 to March 2019 were prospectively analyzed. These patients were randomly divided into robot group (Renaissance robot-assisted nailing) and free hand group (unarmed nailing under perspective). There were 32 patients in robot group, including 25 males and 7 females with an average age of 43.1±8.91 years (range, 18-65 years). Body mass index (BMI) was 26.15±3.97 kg/m 2 (range, 16.3-41.7 kg/m 2). The preoperative Cobb angle was 20.9 °±2.83° (range, 10.7 °-33.9°). In the free hand group, there were 30 cases, including 24 males and 6 females; Age 44.2±9.10 years (range, 20-67 years), BMI 25.97±4.02 kg/m 2 (range, 17.1-43.2 kg/m 2); The preoperative Cobb angle was 21.3°±3.01° (range, 11.6°-35.1°). The 2 groups were compared in terms of accuracy of screw placement, one-time success rate of screw placement, completion time of screw placement, time of total operation and penetration rate of anterior vertebral margin. The robot group also compared the consistency of screw placement angle with preoperative planning. Results:All patients completed the operation successfully. The number of fractured vertebrae in the robot group was 37; the screw placement time was 16.11±5.82 min; the total number of screws was 230, of which 227 were successfully placed at one time, with a success rate of 98.70% (227/230); 1 screw was inserted through the anterior edge of the vertebral body, and the penetration rate was 0.43% (1/230). The number of fractured vertebrae in the free hand group was 35; the nail placement time was 21.09±7.31 min; the total number of screws was 216, of which 195 were successfully placed at one time, with a success rate of 90.28% (195/216); 12 screws was inserted through the anterior edge of the vertebral body, and the penetration rate was 5.56% (12/216). There were significant differences in the time, success rate and penetration rate between the two groups. There was no significant difference in the total operation time between the robot group and the unarmed nail group 137.23±12.68 min and 140.23±13.13 min, respectively. There was no significant difference in the angle of screw placement between pre-operative planning image and post-operative CT scan in the robot group.Conclusion:Renaissance spinal surgery robot in the treatment of middle and upper thoracic vertebra fractures has the advantages of high accuracy, low intraoperative risk, high safety and satisfactory effect of pedicle screw placement.

Preliminary development of guided template of middle and upper thoracic percutaneous vertebroplasty in thoracic pedicle approach due to three dimentional soft tissue print technique / 中国骨伤

OBJECTIVE@#To investigate the feasibility of a drill template for the placement of guided template of middle and upper thoracic percutaneous vertebroplasty in thoracic pedicle approach on digital design and 3D printing technology.@*METHODS@#The preoperative CT images of 20 patients with thoracic fracture were collected retrospectively. With the 3D soft tissue printing technology, the data was reconstructed by 3D imaging reconstruction software to produce 1∶1 three dimensional soft tissue model. The pedicle screw channel and the digital template were designed by the 3-matic module of Mimics15.0 software. After guide template was printed by 3D printer and three dimensional template was fixed on the model, 2.0 mm Kirschner was placed and the accuracy of a drill template was observed by CT scans, bone cement was injected through the puncture tube and verified with images. The time of nail guide design, guide template production and cost were recorded.@*RESULTS@#The effectiveness of three dimensional thoracic model and digital guided template of middle and upper thoracic percutaneous vertebroplasty of thoracic fractures in thoracic pedicle approach was confirmed. Kirschner was placed and the accuracy of screw placement was confirmed with CT scanning. Template and the corresponding anatomical landmark fitted well, bone cement had showed good filling. The average printing time of upper thoracic spine model with soft tissue, the mean time of nail guide design, guide template production and cost were (719.00±3.03) min, (12.30±1.01) min, (55.50±10.30) min and RMB 3 150 yuan on average respectively.@*CONCLUSION@#By means of individual design and 3D soft tissue printingtechnology, accurate placement of guided template of middle and upper thoracic percutaneous vertebroplasty could be realized.

Surgical treatment of capitellum and trochlea fractures in adult through Kaplan approach associated with anteromedial approach / 中国骨伤

OBJECTIVE@#To investigate the surgical treatment and outcome of capitellum and trochlea fractures in adult through Kaplan approach associated with anteromedial approach.@*METHODS@#From September 2012 to September 2016, 15 patients with capitellum and trochlea fractures were treated by Kaplan approach associated with anteromedial approach. Of the 15 cases, there were 6 males and 9 females, aged from 21 to 69 years old, with a mean of (42.0±10.5) years old. Eight patients had fractures on the left and 7 patients on the right. All the fractures were classified into type IIA(5 cases), type IIIA(4 cases) and type IIIB (6 cases) according to Dubberley classification. The results were evaluated by Mayo elbow function score for analysis.@*RESULTS@#All the patients were followed up, the mean follow-up duration was(13.0±4.7) months(ranged 8 to 26 months). The mean Mayo elbow function score was 85.6±5.3(ranged 76 to 94). Postoperative follow-up had 4 cases excellent, 7 cases good, and 4 cases fair. Average arc of motion in elbow was(129.2±12.1)° in flexion and(6.6±1.9)° in extension.@*CONCLUSIONS@#The surgical treatment of capitellum and trochlea fractures in adult through Kaplan approach associated with anteromedial approach can better expose the fractures to achieve the satisfactory exposure and finish the surgical procedure, and the short-term outcome is satisfactory.

A study of polyvinyl alcohol hydrogel simulating human vitreous body / 眼科新进展

Objective To screen a kind of polyvinyl alcohol (PVA) hydrogel with similar physical properties to human vitreous body as to provide basis for exploring new vitreous substitutes.Methods Different concentrations (1％,3％,7％) PVA solution were crosslinked by γ-irradiation (Co60),and 1％,3％ and 7％ PVA hydrogels were harvested.Then PVA hydrogels with similar properties to natural vitreous were screened by detecting the physical and optical properties (density,water content,light transmittance,refractive index,pH value,swelling property) and rheological properties and cytotoxicity of PVA hydrogels.Results As for the physical and optical properties of the hydrogels,the water content,refractive index,light transmittance,pH value and density of 1％,3％ and 7％ PVA hydrogel was 98.90％ vs.98.10％ vs.93.50％,1.335 5 vs.1.336 1 vs.1.342 5,94.80％ vs.93.20％ vs.88.20％,7.22 vs.7.25 vs.7.41 and 1003.9 g · L-1d vs.1014.4 g · L-1 vs.1114.7 g · L-1,respectively.Finally,1％ and 3％PVA hydrogels had the similar physical and optical properties to the human vitreous.As for rheological properties,the storage modulus (G') of the three PVA hydrogels was larger than the loss modulus (G"),indicating that these three hydrogels were viscoelastic gel,and the elastic properties was greater than the viscosity.1％ PVA:G'was (3.2 ±1.1)Pa,G" was (0.8 ±0.5)Pa;3％ PVA:G'was (6.1 ± 1.3)Pa,G" was (1.3 ±0.9)Pa;7％ PVA:G'was (106.5 ± 18.6) Pa and G" was (18.3 ± 12.8) Pa.According to resilience,the hydrogels can be ranked as follows:7％ PVA ＞ 3％ PVA ＞ 1％ PVA;in terms of creep,3％ PVA ＞ 7％ PVA ＞ 1％ PVA.Additionally,MTT colorimetric assay showed that there was no significant difference in A values among the three groups by cells culture in 1％,3％ and 7％ PVA for 72 hours (all P ＞0.05),suggesting that all the three hydrogels showed no obvious cytotoxicity and had good biocompatibility.Conelusion 3％ PVA hydrogel has similar optical,physical and rheological properties to the human vitreous,and shows good biocompatibility,which can be one of vitreous substitutes.

High glucose suppresses the corneal limbal stem cell migration and changes the cell phenotype / 眼科新进展

Objeetive To explore the influence of extracellular high glucose on the proliferation,migration and biomarkers of corneal limbal stem cells.Methods Establishment of a model of high glucose in cultured human limbal stem cells to observe and investigate the effects of extracellular high glucose on the proliferation and migration of corneal limbal stem cells by immunoflurescence,CCK-8 and Transwell assay,respectively.Totally 16 SPF rats were collected and induced diabetic model by streptozotocin as the high-glucose group,and the normal rats of the same age served as the control group.Corneal epidermises of rats in both groups were scraped to observe the repair of corneal epithelium.And the corneas were treated with HE staining and immunohistochemical staining to detect the expression of biomarkers of corneal limbal stem cells and the modality changes of cells.Results The proliferation rate of human limbal epithelial cells was significantly decreased when exposed to high glucose,and the rate at 24 h,48 h and 72 h was 0.728,0.345 and 0.395,respectively,which was markedly lower than that in the control group,with a significant difference (P ＜ 0.05);meanwhile the cell migration rate of the high-glucose group was 17.6％ at 48 h,which was significantly slower than that of the control group (100％).And the inhibition was accompanied by the decreased expression of β-catenin and vimentin.Furthermore,the expression levels of β-catenin and vimentin mRNA and protein were down-regulated,with abnormal location,in the high-glucose group.And diabetic rats had poor corneal epithelial healing.The epithelial layer became thinner and the structures were disorganized in diabetic rats through HE staining.The immunohistochemical assay revealed the expression of β-catenin and vimentin of cornea limbal stem cells was down-regulated in high-glocose group when compared with the control group.Conclusion High glucose can significantly inhibit the proliferation and migration of cornea limbal stem cells,and its main damage mechanism is correlated with the abnormalities of β-catenin and vimentin.

linical application of personalized 3D printing-guided template of intramedullary lag screw insertion on lateral superior ramous of pubic / 中国骨伤

<p><b>OBJECTIVE</b>To evaluate the efficacy and advantages of personalized 3D printing-guided template of lateral superior ramous of pubic intramedullary lag screw.</p><p><b>METHODS</b>From July 2015 to December 2016, 20 patients with the superior and inferior ramous of pubis fracture were treated with lag screws placement. All the patients were divided into test group(with guided template) and control group(with general operation). There were 7 males and 3 females with an average age of (46.20±3.03) years old in test group and 6 males and 4 males with (48.50±2.25) years old in control group. There were 6 cases and 5 cases of superior and inferior branches fractures of pubic on the left side and 4 cases and 5 cases on the right side in two groups respectively. The operation time, perspective times and bleeding loss were compared between two groups.</p><p><b>RESULTS</b>The test group and the control group had no statistically significant relative to gender, age, fracture classification. The average time of surgery, average intraoperative fluoroscopy times, mean blood loss in test group were (31.0±5.3) min, (3.5±2.1) times, (75.6±10.5) ml respectively, and in control group were(55.0±6.8) min, (27.6±3.2) times, (85.5±12.5) ml respectively. There were significant Statistical differences between two groups(<0.05) in average operation time and average fluoroscopy times, however, mean blood loss had no significant differences between two groups(>0.05).</p><p><b>CONCLUSIONS</b>The personalized guide template based on 3D printing technology could realize precise placement of the lateral intramedullary lag screw fixation in the superior branch of pubic, also could save the operation time and reduce the times of radiation exposure of patients and surgeons.</p>

Treatment Selection of Elderly Acute Myeloid Leukemia Patients Guided by HCT-CI Score / 中国实验血液学杂志

<p><b>OBJECTIVE</b>To explore the feasibility of guiding the individalized treatment strategy for elderly AML patients by using hematopoietic cell transplantation-comorbidity index(HCT-CI) score.</p><p><b>METHODS</b>The clinical and biological data of 165 elderly (260 years) AML patients in department of hematology of the first affiliated hospital of Wenzhou medical universtity from January 2000 to December 2014 were analyzed retrospectively. The AML patients were divided into 3 groups: score 0-1, 2-3 and ≥4 according to HCT-CI, then the patients in each group again were divided into standard chemotherapy group, low dose chemotherapy group and support therapy group accoriding to therapeutic regimens, and the efficacy of above mentioned 3 kinds of treatment and their effects on survival of ealderly AML patients were compared, the prognostic risk factors for patients were analyzed further.</p><p><b>RESULTS</b>A total of 165 patients (100%) were followed-up, and the mean follow-up time was 309 days, median survival time was 210 days. The survival analysis showed that the patients in HCT-CI score 0-1 group and 2-3 group banefited from chemotherapy, while the survival analysis of the HCT-CI score ≥4 group showed that there were no significant differance in survival rate between support therapy and chemotherapy groups. The complete remission rate and early mortality of patients received low dose or standard dose chemotherapy in HCT-CI score 0-1, 2-3 and ≥4 groups were not significantly different. Univariate analysis and multivariante analysis of COX ratio risk model showed that the EOCG-PS≥2, WBC≥100×10/L at initial diagnosis and HCT-CI score ≥4 were the independent risk factor affecting the prognosis of elderly AML patients. The median survival time of patients received chemotherapy and support therapy was 840 and 150 d(P<0.01) in HCT-CI score 0-1 group respectively, 210 and 60 days (P<0.01) in HCT-CI score 2-3 group respectively, 130 and 90 days (P>0.05) in HCT-CI score ≥4 group, respectively.</p><p><b>CONCLUSION</b>The HCT-CI score can be used as simple and feasible evaluation criteria to judge the selection of individualized treatment strategy for elderly AML patients.</p>

Single rectangle cage interbody fusion combined with pedicle screw fixation in treatment of isthmic spondylolisthesis / 中华骨科杂志

Objective To explore the effects of single rectangle cage interbody fusion combined with pedicle screw fixa?tion for isthmic spondylolisthesis. Methods Data of the 34 cases with isthmic spondylolisthesis hospitalized at our department from March 2012 to February 2015 were retrospectively analyzed. All cases were operated by posterior pedicle screw fixation com?bined with single rectangle cage interbody fusion. There were 21 males and 13 females, aging from 18 to 63 years old (with an aver?age age of 41.6±8.2 years). Lesion segments were L4 in 15 cases and L5 in 19 cases;there were 12 cases in Meyerding I degree, 16 in II degree and 6 in III degree;28 patients had lower back pain associated with lower limb pain;19 patients had lower back pain associated with numbness of lower limb;18 patients had lower back pain associated with lower limb muscle weakness and 2 pa?tients had urination and defecation function disturbance. The surgical operation time, bleeding, postoperative drainage flow, graft fusion rate, complications were measured, and the intervertebral disc height, Japanese Orthopaedic Association (JOA), Oswestry disability indes (ODI), visual analogue scale (VAS) score were compared before and after treatment. Results The operation of 34 patients was successfully completed with the average operation time of 1.8 ± 0.8 h, and the bleeding in operation was 362.4 ± 93.7 ml, while postoperative drainage flow was 116.3±54.2 ml. All patients were effectively followed up for 12 months to 46 months (av?erage, one year and 10 months). Two weeks after operation, the intervertebral disc height were obviously increased (9.85±1.11 mm, 9.63 ± 1.04 mm), and there were significant difference compared with preoperative results (6.53 ± 0.98 mm, 6.24 ± 1.07 mm), but there were no significant difference compared with the latest follow?up results (9.23±1.33 mm, 9.30±1.16 mm). At the latest follow?up, JOA score was 13.19±1.08, ODI score 12.34±7.52, VAS score 2.23±1.51, and there were significantly different in each score compared with preoperative results. The symptoms of low back pain, lower limb nerve dysfunction and quality of life were signifi?cantly improved compared with preoperative situation. At the 16 month follow?up, all postoperative patients with vertebral body bone graft were judged to be fused. There was no pedicle screw loosening, fracture and so on. Conclusion Single rectangle cage interbody fusion combined with pedicle screw fixation for the treatment of isthmic spondylolisthesis is a kind of mini?invasive, less bleeding, safe and effective surgical method.

Transplantation with three-dimensional spheroid-cultured mesenchymal stem cells down-regulates expression of TNF-α and apoptosis-related proteins in rats with cerebral ischemia/reperfusion injury / 第二军医大学学报

Objective To investigate the effect of the placenta-derived three-dimensional (3-D) spheroid-cultured mesenchymal stem cells (MSCs) on the expression of tumor necrosis factor-α (TNF-α) and apoptosis-related proteins in rats with cerebral ischemia-reperfusion injury, so as to explore the neuroprotective effects and mechanism of 3-D spheroid-cultured MSCs. Methods The experimental animals were randomly divided into Sham group, Vehicle group and 3-D spheroid-cultured MSCs treated group (n=36). In the Sham group, the middle cerebral artery (MCA) was simply isolated but not ligated. In the MSC treated group, focal ischemia/reperfusion in rats was induced by intraluminal middle cerebral artery occlusion (MCAO) with a nylon monofilament suture and then MSCs transplantation was done. In the Vehicle group, the MCAO model was set up and an equal volume of vehicle was given. Neurological scores of animals were evaluated at different time points: the first day, the third day and the seventh day after surgery. Enzyme-linked immunosorbent assay (ELISA) and RT-PCR method were used to detect TNF-α expression in rat brain tissues. The SABC immunohistochemical staining method was used to detect the expression of Caspase-3 and Caspase-8 in rat brain tissues. Results The neuromotor function of rats in MSCs treated group was significantly decreased compared with those in the other two groups (P <0.05). Compared with the Sham group, the expressions of TNF-α, Caspase-3 and Caspase-8 in the brain tissue were significantly increased in the Vehicle group (P <0.01). Moreover, compared with the Vehicle group, expression of TNF-α, Caspase-3 and Caspase-8 in the brain tissue was significantly decreased in MSCs treated group (P <0.05, P <0.01). Conclusion 3-D spheroid-cultured MSCs transplantation may improve the neuromotor function in rats with cerebral ischemia/reperfusion injury via down-regulating inflammatory cytokine TNF-α and expression of Caspase-3 and Caspase-8 in the brain tissue.

Significance of Mycobacterium tuberculosis antigen expression in cerebrospinal fluid monocytes in diagnosing tuberculous meningitis.

Background: The aim of this study was to investigate the signifi cance of positive expression of Mycobacterium tuberculosis, (MTB) antigen in the cerebrospinal fl uid (CSF) monocytes in diagnosing tuberculous meningitis (TBM). Materials and Methods: A total of 50 inpatients of TBM, 30 viral meningitis and 20 healthy controls were studied at the 1st, 2nd, and 4th week during their treatment course. Immunohistochemical assay were used to detect early secreted antigenic target 6 (ESAT-6) positive cells, and positive cases were also observed. Results: The percentage of positive cases and positive cells of ESAT-6 in CSF monocytes were all higher in the 1st and 2nd week than in the 4th week in TBM patients (P < 0.01); and percentage of positive cases and positive cells of MTB antigen in CSF monocytes were higher in TBM patients than in viral meningitis and health control in the 1st and 2nd week (P < 0.01). The sensitivity was 90% and the specifi city was 92% in the early stage (within 2 weeks) of TBM. Conclusion: The positive expression of ESAT-6 in CSF monocytes is helpful for the early diagnosis of TBM.

Relative factors analysis on curative effect of children’ s tethered cord syndrome treatment / 局解手术学杂志

Objective To explore the risk factors of surgical treatment for children’ s tethered cord syndrome. Methods Retrospective-ly analyzed the clinical data of 43 tethered cord syndrome children who had undergone surgical treatment from January 2007 to December 2009,and to evaluate the efficacy of the surgical treatment. Meanwhile,The Cox proportional hazards regression model was adopted to evaluate the surgical efficacy. Results 28 children received effctive curative effect after the surgical treatment in 43children with tethered cord syn-drome,the total effective rate was 65. 12%. Cox medol showed that tight filum terminale(P<0. 05), operation methods (P<0. 05)and the duration of the disease(P<0. 05)were independent risk factors of surgical treatment for children’s tethered cord syndrome. Conclusion The operativeefficacy of children’ s tethered cord syndrome were influence by the tight filum terminale,operation methods and the duration of the disease.

Surgical mini-incision treatment of patent ductus arteriosus of premature infants with titanium clip in 110 cases / 中国综合临床

Objective To investigate the clinical effects of surgical small incision treatment of patent ductus arteriosus (PDA) in premature infants with titanium clip.Methods One hundred children received and cured by our hospital from January 2010 to January 2013 were divided into two groups.Group A:body weight ＞ 1.5 kg of patent ductus arteriosus (PDA),71 cases of premature children; group B:body weight ＜ 1.5 kg of low body weight preterm the children PDA,29 cases.The operations were performed in the newborn intensive care unit (NICU).The patient was placed in a lateral position with the left arm abduction under general anesthesia.A 1.5-2.5 cm long posterolateral mini-thoracotomy was made and the pleural cavity was entered via the 2-3rd intercostal space.The PDA was closed with two titanium clips.Results Ninety-nine cases were cured,1 died.2 residual shunt postoperatively.One patient on postoperative 5 day was found wound infected,wound healing after the use of antibiotics by intravenous.There was no significant difference in incidence of postoperative complications and mortality rate between group A and group B (P ＞ 0.05).Majority of children successfully weaned from the ventilator due to the rapid improvement of hemodynamics and lung conditions.In group B,mechanical ventilation time (12.6 ± 7.5) d and postoperative hospital stay (21.0 ± 15.4) d was significantly longer than group A ((9.6 ± 4.2) d and (12.0 ± 10.8) d),the difference between the two groups was significant (t =7.35,9.12,P ＜ 0.05).Conclusion (1) It is a viable treatment that bedside minimally invasive titanium clip closed ductus arteriosus in preterm children PDA.(2) As the treatment of low body weight premature children is poor,the tolerance of the surgical trauma of the surgery as a minimally invasive,simple method is particularly suitable for low body weight premature children PDA.

Hybrid treatment of pulmonary atresia with intact ventricular septum and critical pulmonary stenosis in neonates / 中华实用儿科临床杂志

Objective To investigate the outcomes of hybrid treatment of pulmonary valve's balloon valvuloplasty via right ventricle without cardiopulmonary bypass for pulmonary atresia with intact ventricular septum(PA/IVS) and critical pulmonary stenosis(PS) in neonates.Methods The clinical features and data of 3 children(1 case of PA/ IVS and 2 cases of critical PS),who underwent hybrid treatment of balloon valvuloplasty,were recorded and retrospectively analyzed.All patients' right ventricle grow well,tricuspid valve Z score ＞-2,and underwent pulmonary valve balloon valvuloplasty via fight ventricle without cardiopulmonary bypass.Results All the 3 children underwent pulmonary valve balloon valvuloplasty via fight ventricle without cardiopulmonary bypass,and there was no death.The mean arterial blood oxygen saturation after operation went up,and there was no complication related to balloon valvuloplasty.The children were followed up for 3 to 6 months,and all the patients had mild pulmonary stenosis,but they did not need any treatment.Conclusions Pulmonary valvuloplasty with hybrid technique is effective in treatment of selective PA/IVS children(fused leaflets of pulmonary valve) and critical PS in neonates.Hybrid therapy may provide adequate pulmonary blood flow and promote further growth of tricuspid valve and right ventricular cavity with less trauma and more safety.

Effect of glycemic control on progress of left ventricular structure and diastolic dysfunction in adolescent with type 1 diabetes mellitus / 中华实用儿科临床杂志

Objective To investigate the effect of glycemic control on progress of left ventricular structure and diastolic dysfunction in adolescents with type 1 diabetes mellitus (T1 DM).Methods A total of 36 T1DM adolescent patients(observation group) and 36 age-matched healthy controls (healthy control group),who consulted doctors in Chengdu Women and Children's Central Hospital between Dec.2009 and Dec.2010,were recruited into the study.Patients in the observation group were performed standard treatment for glycemic control.All patients were followed-up for 2 years.At the end of the study,the patients in observation group were divided into 3 subgroups according to the average HbA1 c level:excellent glycemic control group [glycosylated hemoglobin (HbA1 c) ＜ 7.6％],good glycemic control group(7.6％ ≤HbA1c≤9.0％) and bad glycemic control group(HbA1c ＞9.0％).All of the subjects were evaluated by means of echocardiography for assessment of left ventricular structural and functional parameters.Results Left ventricular posterior wall depth (LVPW),left ventricular mass index (LVMI) and isovolumic relaxation time (IVRT) were elevated,while E/A was decreased in the observation group compared with the healthy control group at baseline (all P ＜ 0.05).There was no significant difference between 2 groups in interventricular septum thickness (IVS),left ventricular end-diastolic dimension(LVEDd) and cardiac systolic function(all P ＞ 0.05).Echocardiographic parameters of left ventricular structure and function were unchanged in well-controlled patients.At the end of follow-up,mild-control group and non-control group demonstrated increased IVS,LVPW and LVMI,and exacerbated left ventricular diastolic function in the present of IVRT prolonging and E/A decreasing.Conclusions There is an inclination in T1 DM adolescent patients developing to left ventricular diastolic dysfunction,and improved glycemic control can delay the progress of left ventricnlar hypertrophy,but it can't ameliorate the decreased diastolic dysfunction.Whereas,non-improved glycemic control can accelerate left ventricular remodeling and exacerbate diastolic dysfunction in T1DM adolescent patients.

Clinical experience of the treatment in congenital heart disease single ventricle with extracardiac conduit fenestration-95 cases / 中国综合临床

Objective To sum the clinical experiences of the treatment in congenital heart disease single ventricle with extracardiac conduit (EC) fenestration.Methods Ninety-five patients diagnosed with univentricular heart disease underwent EC using Gore-Tax conduits at the Department of Children's Heart Center,Justus-Liebig-University Giessen Germany from June 1996 to July 2010.According to EC with or without fenestration,the patients were divided into two groups.Seventy-one routine fenestration of the extracardiac conduit (the fenestration group),58 patients (58/71) of children with high-risk preoperative intraoperative fenestration,13 cases (13/71) were due to low cardiac Rankinginterventional fenestration; extracardiac conduit fenestration (non-windowed group) did not undergo surgery in 24 patients (24/95).Results The fenestration had no death; Three died in non-windowed group.Postoperative effusions and postoperative mean pulmonary artery pressure in group without fenestration ((14.2 ± 2.3) d and (15.1 ± 3.4) mm Hg respectively) were significantly higher than group with fenestration ((10 ± 3.2) d and (13.2 ± 2.8) mm Hg respectively).It had significant differences(P =0.016).In the group with fenestration and without fenestration,postoperative oxygen saturation((90.3 ±4.0)％,(91.7 ±5.2)％),postoperative thrombosis (11.3％ (8/71),12.5％ (3/24)),and postoperative neurological problems (18.3％ (13/71),20.8％ (5/24)) did not differ between cohorts.Conclusion It is effective and safe to treat congenital heart disease single ventricle with EC.EC with fenestration can improve acute postoperative mortality by rising cardiac output,thereby can reduce early postoperative mortality.

Factors influencing pleural effusion after Fontan operation: an analysis with 95 patients / 中国医学科学杂志(英文版)

<p><b>OBJECTIVE</b>To investigate the association between preoperative, operative, and postoperative factors and persistent pleural effusion after the extracardiac Fontan procedure.</p><p><b>METHODS</b>Ninety-five consecutive patients diagnosed with univentricular heart underwent extracardiac connection using Gore-Tax conduits at the Department of Children's Heart Centre, Justus-Liebig-University Giessen in Germany from June 1996 to July 2007. The outcome measures were duration and volume of chest tube drainage after surgical intervention. The investigated factors included age and weight at the time of operation, anatomical diagnosis, preoperative oxygen saturation, mean pulmonary artery pressure, ventricular end-diastolic pressure, fenestration, cardiopulmonary bypass time, conduit size, postoperative pulmonary artery pressure, administration of angiotensin-converting enzyme inhibitors, and postoperative infection. Associations between these factors and persistent pleural effusion after the extracardiac Fontan procedure were analyzed.</p><p><b>RESULTS</b>Every patient suffered postoperative effusion. The median duration of postoperative chest tube drainage was 9 days (range, 3-69 days), and the median volume was 12 mL kg(-1) x d(-1) (range, 2.0-37.5 mL x kg(-1) d x (-1)). Thirty-seven (38.9%) patients had pleural drainage for more than 15 days, and the volume in 35 (36.8%) patients exceeded 25 mL x kg(-1) x d(-1). Nineteen (20%) patients required placement of additional chest tubes for re-accumulation of pleural effusion after removal of previous chest tubes. Fifteen (17.8%) patients were hospitalized again due to pleural effusion after discharge. The median length of hospital stay after the operation was 14 days (range, 4-78 days). Multivariate analysis results showed that non-fenestration, low preoperative oxygen saturation, and postoperative infections were independent risk factors for prolonged duration of pleural drainage (P < 0.05). Long cardiopulmonary bypass time, non-fenestration, small conduit size, and low preoperative oxygen saturation were independent risk factors for excessive volume of pleural drainage (P < 0.05).</p><p><b>CONCLUSIONS</b>For reduing postoperative duration and volume of pleural drainage following Fontan procedure, it seems to be important to improve the preoperative oxygen saturation, use large size of conduit, shorten cardiopulmonary bypass time, and make fenestration during the operation, as well as avoid postoperative infections.</p>