ObjectiveTo evaluate the effectiveness of Cross-Union surgery for the treatment of pseudarthrosis of the tibia (PT) with neurofibromatosis type 1 (NF1). MethodsThe clinical data of 8 children of PT with NF1 who met the selection criteria between January 2018 and December 2023 was retrospectively analyzed. There were 5 boys and 3 girls, and the operative age ranged from 1.8 to 13.3 years with a median age of 3.5 years. According to Paley classification, there were 2 cases of type 2a, 2 cases of type 3, 2 cases of type 4a, and 2 cases of type 4c. There were 5 cases of first operation and 3 cases of re-fracture after previous operation. Six cases had leg length discrepancy before operation, and 2 of them had shortening over 2.0 cm. Except for 1 case of ankle fusion, the other 7 cases had ankle valgus. Preoperative coronal/sagittal angulation was recorded. Postoperative pseudarthrosis healing and refracture were observed. Leg length discrepancy and tibiotalar angle were measured and recorded before operation and at last follow-up. Inan imaging evaluation criteria was used to evaluate the imaging effect. ResultsAll patients were followed up 12-37 months (mean, 23.5 months). One pseudarthrosis failed to heal at 12 months after operation and healed at 3 months after reoperation, while the other pseudarthrosis healed with a healing rate of 87.5% and a healing time of 4-8 months (mean, 5.3 months). No refracture occurred during the follow-up. At last follow-up, there were 2 new cases with leg length discrepancy, which were 0.7 cm and 1.3 cm, respectively. In 2 cases with the leg length discrepancy more than 2.0 cm before operation, the improvement was from 4.1 cm and 12.6 cm to 2.1 cm and 9.0 cm, respectively. There was no significant difference in leg length discrepancy between pre- and post-operation in 8 cases (P>0.05). At last follow-up, 6 patients still had ankle valgus, and there was no significant difference in the tibiotalar angle between pre- and post-operation (P>0.05); the tibial coronal/sagittal angulation significantly improved when compared with that before operation (P<0.05). According to Inan imaging evaluation criteria, 1 case was good, 6 cases were fair, and 1 case was poor. Conclusion Cross-Union surgery is an effective method for the treatment of PT with NF1 in children, can achieve good bone healing results with a low risk of re-fracture. The surgery may not have significant effects on leg length discrepancy and ankle valgus, and further treatment may be required.
ObjectiveTo explore the clinical efficacy of thoracoscopy-assisted modified Nuss procedure for pectus excavatum (PE) in children.MethodsThe clinical data of patients with PE who underwent thoracoscopy-assisted modified Nuss procedure from October 2013 to October 2020 in Daping Hospital were retrospectively analyzed.ResultsA total of 86 patients were collected, including 79 males and 7 females with a mean age of 14.03±3.36 years. The operations were performed successfully in all patients without intraoperative cardiac vascular injury or perioperative death. The mean operation time was 87.30±33.45 min, bleeding volume was 19.94±14.60 mL, and the postoperative hospitalization stay time was 6.89±2.59 d. Early postoperative complications included 2 patients of pneumothorax, 2 patients of wound fat liquefaction and infection, 2 patients of bar flipping and displacement. One patient had bar displacement 1 year after the surgery. The total complication rate was 8.14%. All patients were followed up for 3-42 months. The bars were taken out about 36 months after the surgery. According to the evaluation criteria of orthopedic effect, 68 (79.07%) patients were excellent, 10 (11.63%) patients were good, 5 (5.81%) patients were moderate and 3 (3.49%) patients were poor.ConclusionMinimally invasive and individualized shaping via the Nuss procedure for PE children is safe and convenient, with satisfied effect. It is worthy of popularization in the clinic.
Objective To analyze the complaint characteristics of emergency department of women and children’s specialized hospital, and to provide a basis for improving medical service quality, enhancing hospital management, increasing satisfaction, and reducing complaint rates in specialized hospitals. Methods Using the Healthcare Complaint Analysis Tool classification framework, a retrospective analysis was conducted on complaints from the Emergency Department of West China Second University Hospital of Sichuan University. Results The total number of complaints from 2020 to 2022 was 525, and the number of complaints had been increasing year by year. There were 196 complaints against personnel and 329 complaints against regions. There were 320 complaints related to management issues (61.0%), 143 complaints related to doctor-patient relationship issues (27.2%), and 62 complaints related to clinical issues (11.8%). The complained areas were mainly fever clinics (193 cases), and the complained personnel were mainly nurses (82 cases). Conclusion The emergency department of women and children’s specialized hospitals is different from comprehensive hospitals, and active optimization should be carried out to address the main issues. While continuously improving the level of medical technology, it is also necessary to strengthen information technology construction, optimize medical procedures, improve environmental facilities, and provide psychological support for patients and their caregivers.
Objective To investigate the effects of children’s crawling-promotion-training-robot on gross motor function and cognitive function in children with global developmental delay (GDD). Methods A total of 40 children with GDD admitted to the Department of Rehabilitation Medicine, Children’s Hospital of Nanjing Medical University were selected as the research subjects. By envelope method, the children were randomly and equally divided into experimental group and control group, with 20 cases in each group. The experimental group received children’s crawling-promotion-training-robot combined with conventional rehabilitation therapy, while the control group received manual crawling training combined with conventional rehabilitation therapy. Before and after treatment, the scores of Gross Motor Function Measure Scale-88 (GMFM-88) and Gesell Developmental Scale (GDS) were respectively used to evaluate gross motor function and cognitive function. Results There was no significant difference in gender (χ2=0.100, P=0.752) and age (t=0.053, P=0.962) between the two groups. Before treatment, there was no significant difference in GMFM-88 and GDS scores between the two groups (P>0.05). After treatment, there were statistically significant differences in GMFM-88 and GDS scores between the two groups (P<0.05). The comparison within the group showed that there were statistically significant differences in GMFM-88 and GDS scores between the two groups before and after treatment. Conclusion Children’s crawling-promotion-training-robot is more effective than manual crawling training in improving gross motor function and cognitive function in children with GDD.
ObjectiveTo systematically review the diagnostic accuracy of MRI in preschool children with autism spectrum disorder. MethodsDatabases including Web of Science, PubMed, The Cochrane Library, EMbase, CBM, CNKI, WanFang Data, and VIP were electronically searched for studies on MRI in diagnosis of preschool children with autism spectrum disorder from inception to January 2022. Two reviewers independently screened the literature, extracted data, and assessed the risk of bias the included studies. Then, meta-analysis was performed using Meta-Disc, RevMan 5.4 and Stata 16.0 software. ResultsA total of 17 studies were finally included. The pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, diagnosis odds ratio and area under the curve of SROC were 0.78 (95%CI 0.76 to 0.81), 0.77 (95%CI 0.75 to 0.79), 3.92 (95%CI 2.83 to 5.41), 0.28 (95%CI 0.23 to 0.35), 14.8 (95%CI 9.31 to 23.52) and 0.86, respectively. Subgroup analysis revealed that the source of patients, age, prediction methods and analysis features were potential sources of heterogeneity. Heterogeneity in the subgroup of 1-3 years old was small, and the pooled sensitivity, specificity and area under the curve of SROC were 0.81 (95%CI 0.76 to 0.85), 0.82 (95%CI 0.78 to 0.86) and 0.87, respectively. The pooled sensitivity, specificity and area under the curve of SROC for non-site studies were 0.80 (95%CI 0.75 to 0.84), 0.80 (95%CI 0.76 to 0.85) and 0.86, respectively. ConclusionMRI has a high accuracy in the diagnosis of preschool children with autism spectrum disorder; however, the possibility of misdiagnosis and missed diagnosis should be considered. Due to the limited quantity and quality of the included studies, more high-quality studies are needed to verify the above conclusion.
摘要:目的:探索區域文化、亞文化、經濟水平、教育環境、家庭環境等因素對學齡兒童行為的影響。方法: 比較分析岳陽市與濟寧市學齡兒童行為問題調查結果。結果:岳陽市與濟寧市學齡兒童行為問題總體現患率分別為9.19%和10.7%(χ2=8.804, Plt;0.05),但與全國22個城市協作調查組報告結果(12.97±2.19)%基本相符;行為問題現患率和構成比存在性別與地區差異(Plt;0.05),男性兒童行為問題現患率高于女性兒童、男性兒童以“A行為”為主、女性兒童以“N行為”為主;行為問題現患率在8、9、12歲三個年齡段有地區差異(Plt;0.05)。結論:學齡兒童行為問題與區域文化、亞文化、經濟水平、教育環境、家庭環境等因素有關聯,與男女生物學特征的差異和不同環境的反應傾向及年齡等生物社會心理因素有關。Abstract: Objective: To explore the factors affect schoolaged children behavior by regional culture, subculture, economic level, educational environment, family environment and so on. Methods: Compared and analyzed the investigation results of schooleaged children behavior from Yueyang City and Jining City. Results: The prevalence rate of schoolaged children with behavior problems reflects respectively 9.19% and 10.7% (χ2 = 8.804, Plt;0.05), which is in collaboration with the National Investigation Unit report on the results (12.97 ± 2.19)%; the prevalence rate and composition exist gender and regional differences (Plt;0.05). The behavior problems prevalence rate of male child is higher than female children, male children in “A behavior” mainly, female children in “N behavior” mainly; The behavior problems prevalence rate at the age of 8,9,12 exist regional differences (Plt;0.05). Conclusion: Schoolaged children behavior problems are associated with regional culture, subculture, economic level, educational environment, family environment and other factors, and have something with biopsychosocial factor as the differences in male and female biological characteristics, different environments and age.
Objective To assess the global situation of off-label drug use in outpatient children.Methods A search was conducted in PubMed, EMbase, CBM, CNKI and VIP for collecting studies on off-label drug use in outpatient children aged 0 to 18 years, and the publication language was limited to English and Chinese. The quality assessment was based on Crombie Criteria for cross-sectional studies, and the descriptive analysis was performed to analyze the incidence of off-label drug use at all levels of medical institutes and different age groups, the common types of off-label used drugs, and the constitution ratio of off-label use drugs. Results A total of 20 cross-sectional studies were included, involving 1 933 760 children and 5 262 573 prescriptions. The results of descriptive analysis showed: a) The incidence of off-label drug use in outpatient children in primary care and tertiary care institutes were 19.5% (IQR 13.5%, 24.5%) and 26.0% (IQR 24.0%, 35.0%), respectively; b) The primary studies reported that neonate, infant and adolescent had the highest incidence of off-label drug use, while the other children had the lowest incidence; c) Drugs for respiratory system, anti-infection, sensory organs, and dermatosis were listed as the top 5 frequently used off-label drugs by more than half of the studies; d) The studies with issue of “lack of instruction for children” showed it was exactly the type with highest incidence of off-label use, while other studies without that issue showed the highest incidence was over aged off-label use. Conclusion a) Off-label drug use is common in outpatient children. The incidence of off-label drug use may be higher in tertiary care institutes than primary care institutes, and it is higher in neonate, infant and adolescent rather than other age groups of children; b) Incidence of off-label use may be higher in inpatient children than outpatient ones; c) Drugs for respiratory system, anti-infection, sensory organs, and dermatosis were most common types of off-label use; and d) Off-label use due to both “lack of instruction for children” and “over aged use” is more common. So it suggests that further studies trials should focus on fields in which clinical trials of drugs are totally absent.
ObjectiveTo investigate the diagnosis and treatment of thumb polydactyly with symphalangism in children.MethodsSeven cases of thumb polydactyly with symphalangism were treated between January 2013 and May 2017. There were 5 males and 2 females, aged from 10 months to 11 years, with an average age of 3.1 years. The thumb-polydactyly was diagnosed with MRI and it was seen that the base of radial multi-finger and the proximal phalangeal joint were connected by cartilage. All patients were treated with resection, lateral collateral ligament reconstruction, bone osteotomy and internal fixation.ResultsThe operation was successfully completed, and there was no early complications such as infection and flap necrosis. All patients were followed up 6-23 months (mean, 14.1 months). At last follow-up, there was no deformity finger, scar contracture, and other complications. The extension of the interphalangeal joint was no limited, and the flexion range of the interphalangeal joint was 20-75° (mean, 56.7°). The appearance and function of the thumb was rated as excellent in 3 cases and good in 4 cases by Japanese Society for Surgery of the Hand (JSSH) scoring, with the excellent and good rate of 100%.ConclusionThe thumb polydactyly with symphalangism in children can be combined with clinical manifestations, X-ray film, and MRI examination to diagnose, and can obtain satisfactory results through the reconstruction of lateral collateral ligament, bone osteotomy, and internal fixation.
摘要:目的: 觀察急性鏈球菌感染后腎炎(APSGN)患兒血壓變化規律。 方法 :觀察15例重型APSGN(重型組)和20例普通型APSGN(普通組)患兒病程中各時期血壓及尿量變化,并進行免疫和生化指標對比。 結果 :APSGN患兒高血壓總共26例(7429%),其中重癥組高血壓14例(933%),普通組高血壓12例(60%),高血壓發生率重癥組高于普通組〖WTBX〗P lt;005。重癥APSGN患兒入院時舒張壓、少尿期收縮壓舒張壓、多尿期舒張壓與普通組比較均有顯著性差異,〖WTBX〗P lt;005;而且重癥APSGN與普通組在少尿期持續時間、尿量、多尿期持續時間、尿量的指標比較也均有顯著性差異,〖WTBX〗P lt;005。重癥APSGN患兒血IgG、BUN、Cr明顯高于普通APSGN,Plt;005。 結論 :高血壓是APSGN主要臨床表現之一,血壓增高多發生于少尿期,但重癥APSGN患兒于多尿期出現血壓增高的第二次高峰,臨床上應注意監測,及時治療。Abstract: Objective: To observe the law of the changes of children’s blood pressure after the infection of steptococcus with acute nephritis(APSGN).〖WTHZ〗Methods :Watching 15 cases of serious APSGN and 20 cases of ordinary APSGN for their changes in blood pressure and their urine amounts in various periods; contrasting their indexes in immunity and biochemistry.〖WTHZ〗Results :Among 26cases(7429%)of patients’high blood pressure with APSGN,of which 14cases (933%)are serious ones and 12cases (60%)are ordinary ones,the occurrence rate of the serious group is higher than that of the ordinary group, Plt;005At the initial stage, either the diastolic presssure or the diastolic pressure and the systolic pressure of the serious group with a small amount of unine, the diastolic pressure with a large amount of urine are evidently different from those of the ordinary group, Plt;005Furthermore,there are evident differences in the durations and amounts of urine with either a small or a large amount of urine, Plt;005The IgG,BUN and Cr of the serious group are evidently higher than those of the ordinary group,Plt;005 Conclusion :High blood pressure is one of the main clinical manifestations of APSGN.The increase of blood pressure mostly occurs during the period of a small amount of urine, but a second summit of high blood pressure with APSGN mostly appears in the period of a large amount of urine.It must be closely observed and therefore given the timely treatment.
ObjectivesTo investigate the occurrence and parents’ cognition of accidental injury among pre-school children in Nanchong city, and provide advice and countermeasures to reduce accidental child injuries.MethodsUsing the multi-stage cluster sampling method, a total of 945 students and parents from 3 classes in each of 4 kindergartens in three districts of Nanchong city were surveyed with questionnaire.ResultsA total of 945 questionnaires were issued and 858 valid questionnaires were returned and the effective response rate was 90.79%. The incidence of incidental injury of pre-school children in Nanchong city was 25.99%, with no difference between boys and girls, and no difference between age groups. The top three injuries were falling (35.64%), smashing/touching/squeezing (22.11%), cutting/stabbing (10.56%). The child smashing/touching/squeezing rate was higher in boys than in girls, the difference was statistically significant (χ2=5.549, P=0.018). The top three places of the occurred injury were outdoor (53.67%), home (43.58%), and playground and kindergarten (13.76%). Between parents who possess injury-related knowledge and those who didn’t, there was no difference in the incidence of accidental injuries among their children. Parents often learned from cell phone (23.88%), TV (21.76%) and computer (18.11%). Ways in which they most hoped to learn from were the school advertised education (22.67%), TV (18.80%) and cell phones (17.75%). Of all types of emergency management skills, the top three figures acquired by the largest population were post-burn emergency treatment (72.03%), emergency treatment for traumatic bleeding (52.56%) and emergency treatment of animal bites (37.53%).ConclusionsThe incidence of accident injuries is high in urban areas of Nanchong city. The safety management of home and kindergarten should be strengthened, including schools' safety education and skills training for children and parents.
