ObjectiveTo investigate the clinical characteristics of motorcycle spoke heel injury and the effectiveness of sequential therapy of vacuum sealing drainage (VSD) and pedicled flap transplantation for treating motorcycle spoke heel injury in children.
MethodsBetween January 2010 and January 2014, 15 children (aged from 3 to 8 years, 5.7 years on average) with motorcycle spoke heel injury received sequential therapy of VSD and pedicled flap transplantation. The interval from injury to admission was 3-7 days, with an average of 4.9 days. The locations were the heel in 8 cases, the heel and lateral malleolus in 2 cases, and the medial malleolus and medial heel in 4 cases, and the medial and lateral malleolus and heel in 1 case. The patients had different degrees of defects of the skin, tendon, and bone. The skin defect size ranged from 3 cm×3 cm to 13 cm×6 cm. VSD was applied for twice in 13 cases and three times in 2 cases. Reversed flow sural flap was applied in 8 cases, lateral supramalleolar flap in 2 cases, medial supramalleolar perforator-based flaps in 4 cases, and posterior tibial artery flap in 1 case. Eight pedicled flaps with neuroanastomosis were selected according to the wound characteristics. The flap size ranged from 4 cm×4 cm to 14 cm×7 cm.
ResultsOf 15 cases, 13 flaps survived well except that two had partial skin necrosis at the distal site. Primary healing was obtained, and skin graft at donor site survived. The patients were followed up 9-21 months (mean, 13 months). Mild and moderate bulky flaps were observed in 9 cases and 6 cases respectively. Of 15 cases, 13 could walk with weight loading, and 2 had slight limping. Superficial sensation recovered to S3 in 8 patients undergoing neuroanastomosis, and recovered to S2 in 7 patients not undergoing neuroanastomosis at 6 months after operation. According to AOFAS evaluation system for Ankle-Hindfoot, the results were excellent in 13 cases and good in 2 cases, with an excellent and good rate of 100% at 8 months after operation.
ConclusionThe main characteristic of motorcycle spoke heel injury lies in a combination of high energy damage and thermal damage. Sequential therapy of VSD and pedicled flap transplantation can be regarded as a reliable option to obtain good outcome of wound healing and satisfactory functional recovery for the management of motorcycle spoke heel injury.
ObjectiveTo summarize the results of testing and analysis of antigen and antibody for diseases under the frame of children's immunization program, in order to know the effects of prevention and control of such diseases in this area.
MethodsA total of 150 children from each of the 5 communities or administrative villages in Yongning District of Nanning City were selected for our survey between January and December 2012. The 150 children were composed of 30 children (residents, 1-6 years old, 5 children from each different age group) randomly selected from each of the four directions (east, south, west and north) and the mid-area of each community or village. The serum samples were collected to analyze the existence of poliomyelitis antibody, measles antibody, hepatitis B surface antigen (HBsAg), hepatitis B surface antibody (HBsAb), and diphtheria antibody.
ResultsAmong the 150 school-age children, antibody immune qualified rate was high for hepatitis B (HBV) antigen, in which the HBsAg immune qualified rate was 99.3%, and HBsAb immune qualified rate was 88.0%, showing no significant difference between boys and girls (P>0.05). All poliomyelitis Ⅰ, Ⅱ, and Ⅲ antibody positive rates reached 100.0%. Measles antibody test results were also satisfying for each age group, among whom the 2 and 3 year-olds reached a positive rate of the highest, 100%, and the 1, 4, 5, and 6 year-old children had a measles antibody positive rate of 96.0%, 84.0%, 88.0%, and 96.0%, respectively. The positive rate for diphtheria antibody was 100%.
ConclusionThe antibody and antigen detection and analysis results for the children's immune program targeted diseases are generally satisfying in this area. Especially, the prevention of poliomyelitis and diphtheria is the best. However, prevention of HBV and measles is not as good. Therefore, tracking immunization coverage, promoting public awareness on immune planning, actively participating in the vaccination of children should be enhanced for further disease prevention.
ObjectiveTo systematically review the relationship between cadmium (Cd) and childhood autism.MethodsPubMed, EMbase, Web of Science, The Cochrane Library, CNKI, VIP, WanFang Data and CBM were electronically searched to collect case-control studies on the relationship between Cd and childhood autism from inception to July 2019. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Then, meta-analysis was performed by using RevMan 5.3 software.ResultsA total of 8 case-control studies were included. The results of meta-analysis showed that whether the specimen was from whole blood, urine or hair, there were no correlations between Cd and childhood autism (MDblood=0.17, 95% CI ?0.06 to 0.39, P=0.15; MDurine=?0.43, 95%CI ?1.44 to 0.58, P=0.4; MDhair=?0.08, 95%CI ?0.52 to 0.36, P=0.72).ConclusionsCurrent evidence shows that Cd concentration is not correlated with autism in children. Due to limited quality and quantity of the included studies, more high quality studies are required to verify above conclusions.
ObjectiveTo systematically review the efficacy and safety of pediatric tuina in the treatment of children with acute diarrhea.MethodsCNKI, VIP, WanFang Data, CBM, PubMed and The Cochrane Library databases were electronically searched to collect randomized controlled trials (RCTs) on the treatment of children acute diarrhea with tuina from inception to November 20th, 2020. Two researchers independently screened literature, extracted data, and assessed the risk of bias of included studies. Meta-analysis was then performed using RevMan 5.3 software.ResultsA total of 15 RCTs involving 1 464 children were included. The results of meta-analysis showed that compared with Western medicine, tuina for children with acute diarrhea could increase the cure rate (RR=1.43, 95%CI 1.26 to 1.63, P<0.001), shorten the time for the frequency of diarrhea to return to normal (MD=?0.86, 95%CI ?1.05 to ?0.66, P<0.001) and the time for stool traits to return to normal (MD=?1.07, 95%CI ?1.15 to ?0.99, P<0.001). There was no statistically significant difference in the incidence of adverse reactions between tuina and Western medicine (RR=0.25, 95%CI 0.03 to 2.23, P=0.22).ConclusionsCurrent evidence shows that tuina has a superior effect on treating children with acute diarrhea, the incidence of adverse reactions is not increased. Due to limited quality and quantity of the included studies, more high-quality studies are needed to verify above conclusions.
Objective? To investigate the dysfunction information of children suffering from Wenchuan earthquake and analyze their rehabilitation requirements. Methods A survey of rehabil itation requirements of 87 children with earthquake injuries was performed using self-made questionnaires. Results Among the 87 children investigated, 64.4% suffered from restricted joint range of motion, 95.4% had abnormal sensory (pain occupying 89.7%). Conclusion The earl ier the patients received the rehabilitation therapy, the better for them to recover functions, improve activity ability in daily life and promote participation ability.
ObjectiveTo investigate the effectiveness and technical key points of limb salvage surgery by allotransplantation of cryopreservated vascularized bone in children and adolescents with osteosarcoma.
MethodsA retrospective analysis was made on the clinical data of 21 children and adolescents with osteosarcoma receiving limb salvage surgery by allotransplantation of cryopreservated vascularized bone from their relatives between February 2004 and April 2012. There were 13 males and 8 females, aged from 7 to 16 years (mean, 12.6 years). According to Enneking stage system, 15 cases were rated as stage ⅡA and 6 cases as stage ⅡB. The tumors located at the distal femur in 10 cases, at the proximal femur in 1 case, at the proximal tibia in 8 cases, at the proximal humerus in 1 case, and at the distal radius in 1 case. Imaging examination showed that epiphyseal extension of malignant bone tumors in 7 cases. The iliac bone allograft with deep iliac vessels was obtained from their lineal consanguinity. After preservation by a twostep freezing schedule, the iliac bone allograft with deep iliac vessels was implanted into the bone defect area after tumor resection. The size of iliac bone flap was 8.0 cm×3.0 cm×2.0 cm-14.0 cm×5.0 cm×2.5 cm. Reserved joint surgery was performed on 16 cases and joint fusion surgery on 5 cases, and external fixation was used in all cases. The chemotherapy was given according to sequential high-dose methotraxate, adriamycin, and cisplatine before and after operation.
ResultsAll 21 cases were followed up from 5 months to 11 years (mean, 6.4 years). At 2 weeks after operation, the erythrocyte rosette forming cells accounted for 56.7%±3.9%, showing no significant difference when compared with that of normal control (58.3%±4.3%) (t=1.56, P=0.13), which suggested no acute rejection. At 4 weeks after operation, single photon emission computerized tomography bone scan indicated that the blood supply of bone graft was rich, and the metabolism was active. At 12 weeks after operation, the digital subtraction angiography showed the artery of iliac bone flap kept patency. X-ray films showed that malunion and non-union occurred at 5 and 6 months after operation in 1 case, respectively. The bone graft healed in the other patients, and the healing time was 3.2-6.0 months (mean, 4.4 months). At last follow-up, American Musculoskeletal Tumor Society (MSTS) score was significantly improved to 26.80±2.14 from preoperative value (17.15±1.86) (t=-4.15, P=0.00). The survival rate was 85.7% (18/21) and the recurrence rate was 9.5% (2/21).
ConclusionAllotransplantation of cryopreservated vascularized bone from the relatives provides a new method for the treatment of osteosarcoma in children and adolescents. A combination of allotransplantation and chemotherapy can achieve the ideal treatment effect. The correct cutting, preservation, and transplantation of the donor bone, and indication are the key to improve the effectiveness.
Objective To study the medication usage in children with crush syndrome in Wenchuan Earthquake. Methods The information of the medications of 7 children with crush syndrome in West China Second University Hospital, Sichuan University was collected by medical history. The cases and times of medication, the total number of drugs, the drug cost per capita and the drug cost per day were calculated by Excel. Results A total of 113 drugs in 19 categories were appl ied to 7 children with crush syndrome. Most children used Vitamins and antibacterial agents. The cost of gamma globul in injection was the highest. Conclusions The rational ity valuation for children medication lacks international vulgate index and needs more basic research.
Objective To investigate the anatomical features of congenital chordee without hypospadias in children and to discuss the diagnosis and treatment.Methods From August 1984 to December 2004, 94 children with chordee withouthypospadias treated in the West China Hospital of Sichuan University were classified and analyzed for anatomical alterations. Their ages ranged from 18 months to 13 years (mean 6.9 years). Ninety-four patients were divided into four groups. With intraoperation artificial erection, the patients with penis straightened after degloving were classified as type Ⅰ patients (skin-tethering), those with peins straightened after fibrotic tissue in Buck’s fascia released as type Ⅱ patients (dysgenetic fascia), those with normal urethra and orthoplasty failed after degloving and removing fibrotic tissue as type Ⅲ patients (corporal disproportion), and those with dysgenetic urethra tethering the corpora cavernosa as type Ⅳ patients (short urethra).Results In type Ⅰ (n=31, 32.9%) patients, the ventral skin and dartos fascia were contracted while Buck’s fascia and the urethra was normal, in some (7 cases) scrotal skin extended to the ventral portion of penis (webbed penis). In type Ⅱ (n=45, 47.9%), contracture of Buck’s fascia was evident and the thickening fibrotic tissue constituted the chief obstacle to orthoplasty, though in some skin was shortened. In type Ⅲ (n=6), the dorsal and ventral sides of the corpora cavernosa were disproportionated, and the morphologically normal urethra tightly adhered to the ventral aspect of corpora cavernosa. In some cases ventral skin and fascia were contracted, but orthoplasty could notbe achieved through releasing these layers. In type Ⅳ (n=12, 12.8%), the distal urethra was paper-thin and lacking corpus spongiosum, or dense fibrotic bandswere found to be deep to the urethra. The urethra tethered the corpora cavernosaand formed a bow-to-string relation. The overlying skin and fascia were contracted in varying degrees while none had significance in straightening the penis. After operation, the length of penis increased to 6.9 cm from 5.2 cm on average and the chordee was corrected to 1.6° from 42.6° before operation on average. The patients were followed up 1 months to 15 years. The results were satisfactory.Chordee remained in 2 cases, fistula and urethral stricture occurred in 2 casesrespectively, fistula in association with urethral stricture and diverticulum in 1 case; the operation was given again and the results was satisfactory. Conclusion Patients with chordee without hypospadias may be divided into four types depending on which layer of the ventral penis constitutes thechief contribution to chordee. A systematic approach with repeated artificial erection tests is needed in determining the classification and surgical correction.
ObjectiveTo evaluate the developing methodologies of Essential Medicines Lists for Children (EMLcs) in global, in order to provide reference in developing EMLc of China.
MethodsWe searched ProQuest, ScienceDirect, SpringerLink and MEDLINE databases, World Health Organization (WHO) official website, and 67 websites of National Ministry of Health and Drug Administration Section, to collect literature about selection methodology of children and/or adult essential medicines list (EML). A descriptive analysis was conducted.
ResultsA total of fourteen literatures were included. Of which, 6 were about the essential medicines selection methodology in children, and the other 8 were about the essential medicines selection methodology in adult. The WHO had established independent EMLc selection committee. Paediatricians were involved in the selection of EMLc in the WHO and India. There was no selection criteria and process for EMLc globally. The WHO, India, and South Africa selected their EMLcs referring to the WHO EML selection criteria. The WHO and South Africa had their own updating time, period and process for EMLc. The WHO EMLc was updated per 2 years, which in high frequency and conducts in rigorous process. However, the EMLc of India had not been updated yet.
ConclusionIt is suggested that China could build a national EMLc selection committee involving paediatricians and evidence-based medicine experts etc. in referring to the framework of the WHO Child Health Working Group. The EMLc selection criteria and process of China could be established referring to the one of the WHO, based on the disease burden, drug accessibility and medical insurance of children of China. The EMLc of China should be simultaneously updated with the adult EML of China.
Objective To review the surgical management for Chinese children urethral injury (CUI). Methods According to the evidence-based medicine principal and the approach of systematic review, we searched Chinese Biomedicine Database and PubMed, all literature retrievals were updated until September 8th, 2008. At least two reviewers independently screened the studies for eligibility, evaluated the quality with the Joanna Briggs Institute critical appraisal checklist for descriptive/cases series studies and extracted the data with excel 2003 from the eligible literatures, with confirmation of cross-check. Different views were consulted by the third party. The characteristics of literature, research quality, study content, cases characteristics, diagnosis and treatment, outcome appraisal and follow-up were analyzed. Results A total of 22 studies involving 1019 patients were included, most patients were male children. All 22 studies were descriptive researches and the study quality was low. The etiologies were mainly pelvic fracture and straddle injury as results of misadventure. The diagnosis was based on the relatively objective diagnostic tests such as urethrography, operations research and the exploration of urethral bougie etc in 16 studies. The most categories of CUI were obsolete urethral injuries such as stricture and atresia, the injury sites mainly lied in posterior urethra. The management of CUI were divided into the primary treatment included the first-stage operation and delayed-stage repair, and the second-stage management. Moreover, the individual operation was according to the injury sites and patterns. A total of 14 studies reported the outcomes of operation at various success rates (52%-100%). Except 4 studies, the others reported incomplete follow-up time, from 3 months to 16 years, but few adopted objective methods such as urethrography and urodynamic test. The main complications were urethral stricture, urinary fistula and sexual dysfunction etc. Conclusion The quality of CUI studies was low for lack of prospective randomized controlled trials. The major patients were male children with posterior urethra injuries. Because of the heterogeneitiy of the individual case, different surgeon’s managements and the variety of treatment options, we cannot make identical conclusion. We need more researches with high methodological quality. Moreover, we recommend that, following the clinical practice guideline of CUI made by Chinese Urological Association for the Chinese urologist, and then performing individual surgical management.
