[Development and validation of risk behavior scale for in-home unintentional injury in urban children aged 0-6 years in China].

Objective: To develop and evaluate the reliability and validity of risk behavior scale for in-home unintentional injury in urban children aged 0-6 years in China. Methods: Through literature review, expert consultation and pre-survey, the final scale was determined with 10 dimensions and 54 items. A total of 1 104 children aged 0-6 years were randomly selected by using multi-stage stratified cluster sampling in the urban area of Changsha and their guardians were invited to participate in this questionnaire survey. The information about the basic characteristics, incidence of unintentional injury and risk behaviors of the children were collected. Cronbach's α coefficient and split-half reliability were used to evaluate the reliability of the scale. Pearson correlation coefficient, Spearman correlation coefficient and factor analysis were used to evaluate the content validity and structural validity of the scale respectively. The children were divided into two groups according to the incidence of unintentional injury, and t-test was used to analyze the discriminant validity of the scale. Results: The children risk behavior scale had 54 items in 10 dimensions. A total of 1 094 valid questionnaires were returned and the effective response rate was 99.09%. The incidence of unintentional injury in the children was 18.65% (204/1 104). The Cronbach's α coefficient of the scale was 0.94, and the split-half reliability was 0.87. The Pearson correlation coefficients between each dimension and the total scale were 0.50-0.84 (all P<0.001). A total of 11 common factors were extracted from the total scale, and the cumulative variance contribution rate was 56.52%. The average factor load of 54 items was more than 0.30. The fitting indexes of the scale were 0.06 for root mean square error of approximation, 0.78 for comparative fit index, 0.79 for goodness-of-fit index, and 0.77 for adjusted goodness-of-fit index. The children with injuries had higher scores than those without injuries, the difference was significant (P<0.001). Conclusion: The scale developed has good reliability and validity on assessing the risk behaviors of unintentional injury in urban children in China.

[A combined method of proximalization of the patella tendon and double boundle reconstruction of medial patellofemoral ligament with adductor magnus tendon autograft for the treatment of habitual dislocation of patella in adolescent].

Objective: To present the technique and clinic effect of the combined method of proximalization of the patella and double boundle reconstruction of medial patellofemoral ligament (MPFL) with adductor magnus tendon autograft for the treatment of habitual dislocation of patella (HDP) in adolescent. Methods: From August 2016 to August 2018, a total of 33 consecutive skeletally immature adolescent patients (37 knees) with HDP were surgically treated in Beijing Jishuitan Hospital and were retrospectively reviewed. Among them, 10 patients (12 knees) with severe quadriceps contracture underwent the index comprehensive procedure. There were 4 males and 6 females with a mean age of (12.1±1.4) years (10 to 14 years old) at the operation. Before surgery and at the final follow-up, subjective symptoms were scored by Lysholm knee score, physical examination and radiological assessment were performed. Results: of patellar tracking were assessed by congruence angle and lateral patellofemoral angle. Results Patients were followed up for an average period of 23 months (12-36 months). No infection, patella redislocation were observed in all cases. Lysholm scores improved from 77±9 before surgery to 96±6 at the final follow-up (t= -23.155, P<0.05). There was a statistically significant improvement in the congruence angle, from 72.4°±17.2° preoperatively to -7.5°±4.8° at the final follow-up (t=21.392, P<0.01) and in the lateral patellofemoral angle, from -64.6°±9.4° preoperatively to 6.5°±3.7° at the final follow-up (t=-22.874,P<0.01). Conclusion: In this short term study, the novel comprehensive procedure, including proximalization of the patella and double boundle reconstruction of MPFL with adductor magnus tendon autograft, treats HDP effectively in skeletally immature adolescent patients with severe quadriceps contracture.

[Single portal arthroscopic-assisted reduction technique in the treatment of irreducible developmental dislocation of the hip in infants and toddlers].

Objective: To investigate the efficacy of single-portal arthroscopic-assisted reduction technique in the developmental dislocation of the hip in infants. Methods: From January 2014 to December 2016, 12 dislocated hips in 12 children with a median age of 14 months (10 to 20 months) were treated with single-portal arthroscopic-assisted reduction technique. The indication for intervention was failure of closed reduction after bilateral adductor and unilateral iliopsoas release under anesthesia. Adductor and iliopsoas tendon were released routinely through a medial approach. Through the same medial approach a single-portal arthroscopic-assisted reduction technique was selected, with a medial sub-adductor portal for both 4.0 mm cannulated system with a 30° arthroscope and the instruments. After assessing of the intraarticular structures, the hypertrophic ligamentum teres and acetabular pulvinar were resected, and transverse acetabular ligament (TAL) was incised and a limited release of the capsule was performed prior to reduction of the hip. Arthrography was performed after reduction in all children. Safe zone angle and the medialization ratio on the arthrogram were compared pre and post arthroscopic reduction. Acetabular index were compared at two time points: before operation and at the latest follow-up with paired t test. Results: All hips were reduced with single-portal arthroscopic procedures. The reduction was confirmed on arthrography. With a median follow-up of 26 months (18 to 36 months), all 12 hips remained stable. Safe zone angle increased from 18.5°±3.8° to 61.9°±6.5° immediately after arthroscopic reduction(t=-28.944, P<0.01); and the medialization ratio on the arthrogram increased from 62%±20% to 104%±16% immediately after arthroscopic reduction (t=-3.519, P<0.05). The mean acetabular index decreased from 40.6°±5.0° to 29.4°±5.0° at the latest follow-up (t=5.463, P<0.01). However, Kalamchi-MacEwen type Ⅰ avascular necrosis was developed only in 1 case, and residual dysplasia was observed in 2 hips. Conclusions: Single-portal arthroscopic-assisted reduction technique is a safe and effective treatment for developmental dislocation of the hip in infants and toddlers.

[Prognostic factors and treatment of severe acute pancreatitis].

Seventy two cases of severe acute pancreatitis (SAP) all documented by laparotomy. Fifteen were found to be of edematous and 58 of hemorrhagic and necrotic type, 29 cases died (39.7%). The following 6 items are of prognostic importance in both the survival and the dead groups: (1) Shock, (2) Serum albumin less than 30 g/L. (3) BUN greater than 7 mmol/L, (4) Blood glucose greater than 11.1 mmol/L, (5) Abnormal urine analysis, (6) PaO2 less than 8.6 kPa. Thirty two cases showed positivity of 3 or more of the 6 items, among them 21 died (65.6%). Fourty one cases had 2 or less positive items and 8 (19.5%) died. The mortality rate was not significantly different between the group who had either the edematous or the hemorrhagic necrotizing varieties. It was found that 88.2% of the patients in the dead group had hemorrhagic and necrotizing variety in the peripancreatic and similar pathology appeared in the survival group only in 50% (P less than 0.05). The risk was markedly increased in these patients with systemic complication in the lungs, kidney and brain. We found no effect of vasodilatation drugs (salvia miltiorrhiza and anisodamine) in the treatment of SAP.