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 compare the effectiveness of ultrasound-guided closed reduction with Kirschner wire fixation and open reduction with Kirschner wire fixation in the treatment of humeral lateral condyle fracture (HLCF) in children. Methods A clinical data of 53 children with HLCF admitted between May 2020 and April 2023 and met selective criteria was retrospectively analyzed. Of these, 25 cases were managed with closed reduction and Kirschner wire fixation under ultrasound guidance (closed group), while 28 cases underwent open reduction and Kirschner wire fixation (open group). There was no significant difference between the two groups in terms of gender, age, cause of injury, fracture side, fracture classification, and time from injury to operation (P>0.05). The following variables were recorded and compared between the two groups: operation time, intraoperative fluoroscopy frequency, fracture healing time, incidence of complications, and the Flynn elbow function score at last follow-up. Results In the closed group, the fractures were successfully reduced under ultrasound guidance, with no nerve damage reported in either group. The operation time and intraoperative fluoroscopy frequency were significantly less in the closed group than in the open group (P<0.05). One case of infection (Kirschner wire irritation) was observed in the closed group, while 3 cases in the open group (2 of Kirschner wire irritation and 1 of incision infection). However, the difference in the incidence of infection between the two groups was not significant (P>0.05). All patients in both groups were followed up 6-18 months (mean, 10.2 months). X-ray examinations confirmed that fractures had healed in both groups, with no significant difference in healing time (P>0.05). During follow-up, 5 cases of lateral humeral process formation were observed in the closed group, compared to 12 cases in the open group, although this difference was not significant (P>0.05). At last follow-up, the excellent and good rate of elbow joint function was evaluated as 96.0% (24/25) in the closed group and 92.9% (26/28) in the open group according to the Flynn scoring criteria, with no significant difference between the two groups (P>0.05). Both groups showed no occurrence of ossifying myositis or elbow internal/external rotation. Conclusion The effectiveness of ultrasound-guided closed reduction and Kirschner wire fixation in the treatment of HLCF in children is comparable to open reduction and Kirschner wire fixation, but the former can reduce operation time and intraoperative fluoroscopy frequency, and obtain lower the incidence of complications.
ObjectiveTo investigate the effectiveness of soft tissue balance technique by flexor pollicis longus (FPL) tendon transfer for Wassel Ⅳ-D thumb duplication in children. Methods A clinical data of 14 children with Wassel Ⅳ-D thumb duplication met the selection criteria between January 2017 and January 2021 was retrospectively analyzed. There were 5 boys and 9 girls with an average age of 21.6 months (range, 18-35 months). Ten cases were left hand deformity and 4 cases were right hand deformity. During operation, the radial thumb was excised, and the FPL tendon of the radial thumb was used to reconstruct the soft tissue balance of the ulnar thumb. Postoperative evaluation included the range of motion (ROM) of passive flexion and extension of the interphalangeal joint (IP) and metacarpophalangeal joint (MCP), the alignments of the IP and MCP, the percentage of the width of the nail plate and the circumference of the thumb at the level of the IP to contralateral thumb. Results All operations were completed successfully, and all incisions healed by first intention. The children were followed up 12-36 months (mean, 21.7 months). At last follow-up, the ROM of passive flexion and the deviation of the IP, and the deviation of the MCP significantly improved when compared with those before operation (P<0.05); the ROM of passive extension of the IP and the ROM of passive flexion of the MCP did not significantly improve when compared with those before operation (P>0.05). The ROMs of passive extension of the MCP were 0° before and after operation. The width of the nail plate was 76.6%±4.1% of the unaffected side, and the circumference of the thumb at the level of the IP was 92.0%±9.1% of the unaffected side. ConclusionThe soft tissue balance technique by FPL tendon trasfer can effectively correct the alignment of the Wassel Ⅳ-D thumb duplication in children, and maintain the correction effect effectively, but further follow-up and comprehensive evaluation are needed to investigate the long-term effectiveness.
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.
ObjectiveTo explore the effectiveness of annular ligament reposition and repair via Henry’s approach for Monteggia fracture in children.MethodsA clinical data of 21 children with Monteggia fractures was retrospectively analysed, who underwent open reduction of the radial head and annular ligament reposition and repair via Henry’s approach between May 2015 and July 2019. There were 11 boys and 10 girls with an average age of 8 years and 1 month (range, 4 years and 5 months to 14 years and 4 months). The fracture was caused by falling in 17 cases and by falling from height in 4 cases. There were 16 fresh fractures and 5 old fractures. The Monteggia fractures were rated as Bado typeⅠin 14 cases and Bado type Ⅲ in 7 cases. Preoperative MRI examination and intraoperative observation confirmed that the annular ligament was intact. After operation, the fracture healing, elbow range of motion (ROM), and complications were recorded, and the effectiveness was evaluated according to the Mackay’s function scoring system.ResultsThe incisions healed by first intention after operation, and there was no complication such as radial nerve injury. All children were followed up 12-25 months, with an average of 15 months. No dislocation or subluxation of the radial head occurred after operation. At last follow-up, the ROM of elbow flexion and extension of the children with old fractures increased from (92.6±11.2)° before operation to (123.6±11.6)°, and the ROM of forearm rotation from (96.8±11.8)° to (129.8±5.9)°; the differences between pre- and post-operation were significant (t=7.672, P=0.002; t=9.487, P=0.001); the ROM of elbow flexion and extension of the children with fresh fractures was 139°-156° (mean, 145°); the ROM of forearm rotation was 158°-168° (mean, 162°). According to Mackay’s criteria, 17 cases were excellent and 4 cases were good, with an excellent and good rate of 100%. X-ray film examination showed no nonunion, heterotopic ossification, or loosening of internal fixation after operation. The ulnar fracture and the ulnar osteotomy healed in all cases.ConclusionThe annular ligament in Monteggia fractures in children is intact. Compared with the reconstruction of the annular ligament, the reposition and repair of the annular ligament via Henry’s approach is closer to the original anatomical state of the annular ligament and has the advantages of less trauma and fewer complications.
ObjectivesTo understand the current situation of the nosocomial infection management system in maternal and child health care institutions at all levels in Sichuan province, and provide a feasible policy basis for strengthening the nosocomial infection management.MethodsThe expert group members of Sichuan Maternal and Child Health Association Academy Association designed a unified questionnaire, and distributed the questionnaire through “Questionnaire Star” to carry out on-site online survey.ResultsA total of 159 maternal and child health care institutions participated in the survey. Most secondary and below maternal and child health care institutions had not set up professional hospital infection monitoring system. A few secondary and below maternal and child health care institutions did not independently set up a hospital infection management committee, hospital infection management department, full-time hospital infection department head, the inspection team of infection control, monitoring system, and nosocomial infection management system and special supervision had not been established in special departments. There were statistical differences in some jobs in the construction of nosocomial infection management system in different levels of maternal and child health care institutions (P<0.05).ConclusionsThe organizational system construction of hospital infection managemen are at a low level in the second level and below maternal and child health care institutions in Sichuan province. The tertiary maternal and child health care institutions should give full play to the leading role in promoting the standard construction of nosocomial infection management system of maternal and child health care institutions in Sichuan province, and carry out nosocomial infection management of maternal and child health care institutions orderly.
In November 2022, the International Liaison Committee on Resuscitation updated the International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science with Treatment Recommendations for the sixth time. The 2022 review includes 21 topics addressed with systematic reviews by the Recovery Task Force of International Liaison Committee on Resuscitation. Among them, there are nine topics related to life support for newborns and children, including public-access defibrillation devices for children, pediatric early warning systems, maintaining normal temperature immediately after birth, suctioning of amniotic fluid at birth, tactile stimulation for resuscitation immediately after birth, use of continuous positive airway pressure for respiratory distress at term birth, respiratory monitoring in the delivery room, heart rate monitoring in the delivery room, and supraglottic airway use in neonates. The Task Force made treatment recommendations for each of the above topics after weighing evidence and discussion. In some cases, good practice statements have been provided for topics thought to be of particular interest to the resuscitation community when the evidence is insufficient to support a recommendation. Good practice statements are not recommendations but represent expert opinion. In order to facilitate the readers to understand the treatment recommendation well, in the recommendation basis part, the basic principle is briefly described. In addition, the existing problems and future research directions of each topic after the systematic reviews are also clearly stated.
摘要:目的: 探討兒童慢性淋巴細胞性甲狀腺炎的臨床特點、診斷方法、治療及預后。 方法 : 對77例CLT患兒的臨床資料進行回顧性分析。 結果 : 77例CLT患兒男女比例1:67,平均年齡1021±233歲(5~15歲)。86%患兒有甲狀腺腫大;初診時表現甲亢患兒51例,甲低20例,甲功正常6例; TGAb陽性率的94%,TPOAb陽性率96%;1例甲狀腺細針吸取細胞學檢查診斷合并甲狀腺乳頭狀癌。治療隨訪1~39月,77例患兒中出現甲低37例。 結論 : 兒童CLT多見于青春期女性,兒童和青春期患者病初表現甲亢較成人多見,TGAb 和TPOAb是CLT診斷的重要指標,隨著病程延長,表現甲低患兒比例逐漸增高。Abstract: Objective: To study the clinical feature, diagnosis, treatment and prognosis of Chronic lymphocytic thyroiditis in children. Methods : Analyze the clinical data of 77 children with Chronic lymphocytic thyroiditis. Results : The proportion of men to women was 1:67 in all 77 children, and the mean age at diagnosis was 1021±233(age range 5~15 years). The percentage of positive TGAb and TPOAb were 94% and 96%, respectively in all the 77 children. One children was diagnosed Chronic lymphocytic thyroiditis coexistent with thyroid papillary carcinoma by FNAB. There were 37 children had hypothyrodism in all the 77 after 1~39 months. Conclusion : CLT is more frequent in females, and at the time of diagnosis more children and adolescents had hypethyrodism than adults. TGAb and TPOAb are important markers for the diagnosis of CLT. The percentage of children had hypothyrodism is increasing along with the course of disease.