OBJECTIVE To improve the clinical result of repair on flexor tendon injury, and recover the defected finger function in children as far as possible. METHODS From January 1990 to October 1997, 12 cases with flexor tendon injury were repaired by microsurgical technique, sutured by modified Kessler method with 3/0 or 5/0 nontraumatic thread and followed by invering suture of the gap edge with 7/0 or 8/0 nontraumatic thread after debridement. Appropriate functional practice was performed postoperatively. RESULTS All the defected fingers were healed by first intention. Followed up 6 months to 1 year, there was excellent in 7 cases, better in 4 cases, moderate in 1 case and 91.67% in excellent rate according to the TAM standard of International Hand Committee. CONCLUSION The important measures to improve the clinical result in children’s flexor tendon injury are prompt and accurate diagnosis and repair of the injured tendon by microsurgical technique, and effective postoperative functional practice.
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.
ObjectiveTo systematically review the quality of evidence-based guidelines (EBGs) on medication therapy for children with vitamin D deficiency, and to compare differences and similarities of the drugs recommended, in order to provide guidance for clinical practice. MethodsDatabases such as the TRIP, PubMed, EMbase, CNKI, VIP, WanFang Data, CBM, National Guideline Clearinghouse and Guidelines International Network were searched to collect EBGs on medication therapy for children with vitamin D deficiency. The methodological quality of the guideline was evaluated according to the AGREE Ⅱ instrument, and the differences between recommendations were compared. ResultsA total of 9 EBGs were included. Among them, 3 guidelines were developed by America, 1 by Europe, 1 by France, 1 by China, 1 by Poland, 1 by Canadian and 1 guideline was by Australia and New Zealand. Seven guidelines were developed specially for children, while others were for people of different ages. According to the AGREE Ⅱ instrument, only "Scope and purpose" and "clarity and presentation" were scored more than 60%. The recommendations of different guidelines were of large different. ConclusionThe quality of included guidelines concerning children with vitamin D deficiency is vary. Although only the America 2011 guideline is of high quality, the strength of recommendation is not high. Thus, the development of national guidelines is urgently needed.
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.
ObjectiveTo systematically evaluate the efficacy and safety of local anesthesia for venipuncture in children, and to provide evidence for related nursing practice.MethodsWeb of Science, PubMed, Cochrane Library, Embase, China National Knowledge Infrastructure, Wanfang Data, Chinese Biomedical Database and VIP databases were searched for randomized controlled trials (RCTs) about the application of local anesthesia in venipuncture in children till June 25th, 2021. Two reviewers independently reviewed the literature, extracted data, and assessed the risk of bias of included RCTs. RevMan 5.3 software was used for meta-analysis.ResultsA total of 19 RCTs were included, comprising 2 566 patients. All of them were high-quality English articles included in SCI or Medline. The results of meta-analysis showed that: the painless rate [odds ratio (OR)=3.80, 95% confidence interval (CI) (1.88, 7.66), P=0.000 2] and satisfaction rate of venipuncture [OR=2.12, 95%CI (1.27, 3.54), P=0.004] in the local anesthesia group were higher than those in the non-anesthesia group, and the pain score [mean difference=?0.62, 95%CI (?0.77, ?0.48), P<0.000 01] in the local anesthesia group was lower than that in the non-anesthesia group. There was no statistically significant difference between the two groups in the success rate of the first puncture [OR=1.14, 95%CI (0.77, 1.68), P=0.52], the incidence of transient skin reactions [OR=1.15, 95%CI (0.67, 1.95), P=0.62], the incidence of paleness [OR=1.11, 95%CI (0.57, 2.15), P=0.76], or the incidence of edema at the puncture site [OR=0.64, 95%CI (0.21, 1.96), P=0.44].ConclusionsLocal anesthesia can effectively reduce pain and improve the satisfaction of children with venipuncture, and has good clinical safety. It can be used by nursing staff in clinical practice.
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.