低出生体重食管闭锁患儿预后因素的研究

Objective To investigate the prognostic factors of survival rate after repair of esophageal atresia (EA) and/or tracheoesophageal fistula (TEF). Methods The clinical data of the 101 patients underwent TEF/EA repair between January 1999 and December 2008 at this center were retrospectively reviewed. The patients were divided into low-birth-weight group (29 patients, birth-weight＜2 500 grams) and normal-birth-weight group (72 patients, birth-weight＞2. 5 kg). The possible prognostic factors were retrospectively analyzed including patients status, the incidence of preoperative and intraoperative critical events, postoperative complications, postoperative mechanical ventilation time,stress hyperglycemia and survival rate. Logistic regression analysis was employed to predict the prognostic factors of the survival rate after repair of EA and/or TEF. Results Of the 29 low-birth-weight EA patients, the survival rate was significantly lower than that of the normal birth weight patients (75.9% vs 92. 3% ,P = 0. 027) ,and the survival rate positively correlated with the birth weight (r=0. 946,P= 0. 015). The incidence of preoperative and intraoperative critical events and postoperative complications in low-birth-weight EA patients were significantly higher than those of the normal birth weight patients (67. 7% vs 32. 9% ,P = 0. 002; 70% vs 26%, P = 0. 001 ). The morbidity of anastomotic stricture and leak was higher, and postoperative mechanical ventilation time was longer compared with the normal birth weight patients (P = 0. 001 ). The survival rate of the patients had postoperative stress hyperglycemia was lower than that of patients without stress hyperglycemia (93. 6% vs 81.0%,P = 0. 024) ,and the survival rate negatively correlated with the severity of postoperative stress hyperglycemia (r = - 0. 931, P = 0. 022). Conclusions Low-birth-weight and postoperative stress hyperglycemia are the prognostic factors of survival rate after repair of EA and/or TEF.     

Surgical options for esophageal stenosis in children北大核心CSCD

Objective To explore the clinical efficacy of progressive individualized options for esophageal stenosis (ES) in children. Methods From January 2017 to December 2022, retrospective review was conducted for 106 ES children with regular follow-ups. There were 59 boys and 47 girls with an age range of (3.00 ± 0. 75) year and a body weight of (9.00 ± 1. 25) kg. The causes were anastomotic (n: 58), corrosive (n: 47) and congenital (n: 1). Sequential treatments of direct balloon dilation under gastroscope, submucosal injection of drugs into esophagus, esophageal stenting and surgical procedures were applied. After interventions, degree of ES was observed by esophagography and gastroscopy along with dysphagia grade for evaluating clinical efficacy. Differences were compared by I or yr test. Results All of them were discharged uneventfully. After balloon dilatation, the outcomes were excellent under direct gastroscopic view alone (n: 55). Among 35 children with balloon dilation plus esophageal submucosal drug injection, the outcomes were excellent (n: 25) and esophageal stenting (n: 10). Among 25 children with esophageal stenting, the outcomes were excellent (n:21) and additional surgery (n: 4). Surgical procedures were performed with excellent outcomes (n:5). Conclusions The clinical outcomes progressive individualized options of direct visualization balloon dilation under gastroscope, balloon dilation plus submucosal injection of drugs into esophagus, esophageal stenting and surgical procedure are precise, convenient and efficacious for ES in children. © 2023 Chinese Medical Journals Publishing House Co.Ltd. All Rights Reserved.     

Relationship between heparin dosing and coagulation tests after cardiopulmonary bypass in young infants with congenital heart disease and low birth weight北大核心CSCD

ObjectiveTo explore the effect of early heparin anticoagulation on D-dimer of blood coagulation parameters in young and low-birth-weight congenital heart disease (CHD) after cardiopulmonary bypass (CPB). MethodsFrom December 2019 to December 2021, the relevant clinical data were retrospectively reviewed for 102 children undergoing CPB-assisted open-heart surgery for CHD at Shanxi Children's Hospital.There were 57 boys and 45 girls.Based upon an injection of heparin or not, they were assigned into two groups of observation (5 U·kg -1·h -1 low-dose heparin dosing) and control (non-heparin dosing). Fifty-four children in observation group were (119.81±66.90) day in age and (5.4±1.1) kg in weight.And 48 children in control group were (138.00±67.67) day in age and (5.65±1.31) kg in weight.Coagulation functions of two groups were detected preoperatively, postoperatively (admission into CCU), before medication (before heparin on the next day post-operation) and after medication (24h after heparin dosing). The change trends of D-dimer of coagulation function and the difference were observed between two groups.Pearson χ 2 test was utilized for counting data and t-test or Wilcoxon two-sample rank sum test for measurement data. ResultsNo significant inter-group differences existed in gender, age or weight ( P>0.05). No significant inter-group differences in D-dimer distribution pre/postoperatively or before medication ( P>0.05); After medication, D-dimer was significantly lower in observation group than that in control group and the difference was statistically significant ( Z=-2.21, P=0.027). The inter-group change of D-dimer after and before medication was statistically significant ( Z=-2.17, P=0.030). In observation group, D-dimer level continued rising pre/postoperatively and before medication and the difference was statistically significant ( P<0.05); No significant difference existed between before and after medication ( Z=-0.33, P=0.740). The difference was statistically significant after medication and post-operation ( Z=-3.41, P=0.001). The difference of D-dimer was statistically significant after medication as compared with that preoperatively ( Z=-3.06, P=0.002). It was still higher than that pre-operation.In control group, D-dimer continued rising from preoperative to after medication and statistically significant differences existed in D-dimer during each period ( P<0.05). ConclusionsEarly use of low-dose heparin anticoagulant therapy after CPB can relieve the coagulation dysfunction caused by CPB, and is conducive to the prevention of postoperative thrombosis and DIC. © 2023 Chinese Medical Journals Publishing House Co.Ltd. All Rights Reserved.     

Efficacy of gastroscopy assisted balloon dilation for anastomotic stricture after esophageal atresia surgery北大核心CSCD

Objective To explore the effect of gastroscopy assisted balloon dilation for anastomotic stricture after esophageal atresia (EA) surgery and to examine the relationship between esophageal stricture, dilation pressure and treatment efficacy. Methods From January 2021 to March 2023, retrospective analysis was conducted for 25 hospitalized children with anastomotic stricture after EA surgery.There were 11 boys and 14 girls with an age range of (54.10±25.93) days and a body weight of (4.35±0.86) kg.Diameter/length of anastomotic stricture segment during an initial balloon dilation, dilation pressure and total dilation frequency were recorded during a full dilation of 8 mm balloon.Based upon stricture diameter, they were assigned into two groups of ≤3 mm and >3 mm; According to the length of stricture, they were assigned into two groups of ≤5 mm and >5 mm.Treatment efficacy was evaluated by the Stooler method.Studert's t-test or Chisquare test was utilized for comparing the inter-group differences. Results There were a total of 104 balloon dilations.One case of perforation occurred during expansion and was conservatively cured.And all other anastomotic strictures were ultimately cured.The pressure during dilation was (332±33) and (252±21) kPa for groups ≤3 mm and >3 mm.And the expansion frequency was (6.30±2.21) and (2.47±1.06) respectively.φ8 mm balloon had a fully filled volume of 0.6 ml.Statistically significant differences existed in pressure and expansion frequency between groups.The pressure during dilation in stricture length ≤5 mm and >5 mm groups was (365±33) and (268±38) kPa.And the number of expansions was (6.90±2.22) and (3.06±1.66) respectively.Statistically significant differences existed in pressure and expansion frequency. Conclusions The efficacy of gastroscopy assisted balloon dilation is significant for anastomotic stricture after EA surgery.And degree of stricture greatly affects dilation pressure and frequency.The greater stricture, the higher dilation pressure and the greater frequency of dilation are needed. © 2023 Chinese Medical Journals Publishing House Co.Ltd.. All rights reserved.     

Effect of Ki-67 expression on prognosis of pediatric medulloblastomaCSCD

Objective To explore the clinical characteristics and survival profiles of pediatric medulloblastoma and examine the effect of Ki-67 on its prognosis. Methods From January 2006 to December 2015, a total of 67 postoperatively pathologically confirmed MB children were recruited. Their 5-year overall survival (OS) and progression-free survival (PFS) were calculated by Kaplan-Meier method. Univariate analysis was performed by Log-rank test and multivariate analysis by Cox regression. The relationship was examined between clinical characteristics of MB, treatments and the expression of Ki-67 on the prognosis. Results The average Ki-67 index was (34. 85 ± 16. 72%). There were 37 cases in low-expression of Ki-67 group (< 35%), 5-year PFS (70.27%, 26/37) and OS(51.35%, 19/37);30 cases in high-expression of Ki-67 group (^35%), 5-year PFS (40.00%, 12/30) and OS (36.67%, 11/30). Cox proportional risk regression model showed that a high expression of Ki-67 was an independent factor for MB survival in children(P =0. 04). However, no statistically significant difference existed in postoperative metastasis or recurrence. Conclusion Ki-67 is an independent prognostic biomarker for pediatric MB. © 2022, Science and Technology Association of Hunan Province. All rights reserved.     

电针可下调缺氧缺血性脑损伤幼鼠大脑皮层硫化氢含量

Objective To establish hypoxic-ischemic brain damaged (HIBD) rat model,investigate whether H2S and cystathionine-β-synthase (CBS), the key enzyme for its generation, may be a mediator of electro-acupuncture(EA) stimulation treatment for HIBD. Methods Thirty-two healthy Sprague-Dawley neonatal rats were divided into four groups randomly: sham control group ( n = 8 ); sham + EA group ( n =8); HIBD control group ( n = 8); and HIBD + EA group ( n = 8 ). HIBD rat models were established on their 7-day-old. From the next day ,rats of sham + EA group and HIBD + EA group were electric stimulated 30 min daily for 14 d,BAIHUI and DAZHUI as the acupoints. Control ones were just fixed at the same time,without acupuncture. The rats were sacrificed on the 22 nd day, one day after the treatment course. Cortical H2S concentration was measured by sensitive sulphur electrode assay. The CBS protein expression was measured by western blot analysis and immunohistochemistry for localization. Results The concentration of cortical H2S in HIBD control group was (26. 83 ± 4. 31 ) nmol/mg protein, which was significantly higher than that of sham control group[(22. 78 ± 1.54) nmol/mg protein]( P ＜ 0. 01 ). The H2 S levels in HIBD + EA group and sham + EA group were ( 18.08 ± 2.71 ) nmol/mg protein and ( 18.91 ± 2. 78 ) nmol/mg protein, respectively. Compared with corresponding control group, they were much lower( P ＜ 0. 01 ). The expression of CBS protein in rats with EA stimulation decreased in cortex compared to corresponding control group( P ＜0. 05 ).Conclusion EA can down-resulate H2S/CBS pathway. This may be one of the mechanisms of how EA contributes to the recovery of brain damage.     

Two approaches for newborns with critical congenital heart disease: a comparative study

Background Prenatal diagnosis and planned peripartum care is an unexplored concept in China.This study aimed to evaluate the effects of the“prenatal diagnosis and postnatal treatment integrated model”for newborns with critical congenital heart disease.Methods The medical records of neonates(≤28 days)admitted to Fuwai Hospital were reviewed retrospectively from January 2019 to December 2020.The patients were divided into“prenatal diagnosis and postnatal treatment integrated group”(n=47)and“non-integrated group”(n=69).Results The age of admission to the hospital and the age at surgery were earlier in the integrated group than in the non-integrated group(5.2±7.2 days vs.11.8±8.0 days,P<0.001;11.9±7.0 days vs.16.5±7.7 days,P=0.001,respectively).The weight at surgery also was lower in the integrated group than in the non-integrated group(3.3±0.4 kg vs.3.6±0.6 kg,P=0.010).Longer postoperative recovery time was needed in the integrated group,with a median mechanical ventilation time of 97 h(interquartile range 51–259 h)vs.69 h(29–168 h)(P=0.030)and with intensive care unit time of 13.0 days(8.0–21.0 days)vs.9.0 days(4.5–16.0 days)(P=0.048).No significant difference was observed in the all-cause mortality(2.1 vs.8.7%,P=0.238),but it was significantly lower in the integrated group for transposition of the great arteries(0 vs.18.8%,log rank P=0.032).Conclusions The prenatal diagnosis and postnatal treatment integrated model could significantly shorten the diagnosis and hospitalization interval of newborns,and surgical intervention could be performed with a lower risk of death,especially for transposition of the great arteries.     

加速康复外科技术在肛门闭锁并直肠前庭瘘中的应用CSCD

Objective To explore the efficacy and safety of enhanced recovery after surgery (ERAS) in children with anal atresia and rectal vestibular fistula. Methods From January 2017 to October 2021, prospective review was conducted for 50 children with anal atresia and rectal vestibular fistula undergoing transanal analoplasty. They were randomized into two groups of ERAS and non-ERAS (n =25 each). ERAS group received enema once in the morning of operation day, oral 12.6% carbohydrate liquid 2 h pre-operation, intraoperative heat preservation, target-oriented rehydration ,no indwelling catheter post-operation, postoperative analgesia and other new measures; non-ERAS group had traditional perioperative treatment. Blood glucose at the beginning of anesthesia, blood glucose 24 h post-operation, white blood cell count ( WBC), C-reactive protein (CRP), time of initial exhaust and defecation post-operation, amount of intraoperative infusion, time of postoperative intravenous infusion ,time of postoperative hospitalization, expenditure of hospitalization incidence of complications and readmission rate at Day 30 post-discharge were compared between two groups. Results No significant inter-group differences existed in average age, weight, preoperative WBC, CRP, hemoglobin, albumin, prealbumin or blood glucose at admission. Blood glucose at the beginning of anesthesia in ERAS and non-ERAS groups was (4.92±0.50) and (4.53 ±0.42) mmol/L, blood glucose (5.03 ±0.66) and (5.96±41.18) mmol/L at 24 h post-operation. WBC at 24h post-operation (9.97 3.24) x 10°/L and (8.28 ±3.51) x 10°/L;CRP at 24 h post-operation (3.63±4.00) and (9.03±15.77) mg/L;initial postoperative exhaust and defecation time (12.1 ±6.4) and (14.0 ±9.3) h;intraoperative infusion volume (83.1 ±32.2) and (136. 1±68.4) mL;postoperative intravenous infusion time (4.68 ±1.25) and (6.6 ±1.68) days; postoperative hospital stay (7.12 ± 1.56) and (10.56 ±3.58) days; hospitalization expense (13 314. 34 ±2 856.86) and (16 088.69 ±3 282.34) CNY ;complications occurred (n =3,12%) and (n =6,24%) ;overall satisfaction was 88% and 60%. Both groups were cured and discharged and there was no re-admission within 30 days post-discharge. No inter-group differences existed in initial exhaust or defecation time, WBC and CRP at 24 h post-operation (P >0.05).In nonERASgroup, blood glucose declined at the beginning of anesthesia while postoperative blood glucose level rose with statistical difference (P <0. 05) ; overall satisfaction of ERAS group was higher than that of non-ERAS group with statistical difference (P lt; 0.05). Conclusion Conceptual application of ERAS is both safe and effective in children with anal atresia with rectovestibular fistula. It can effectively shorten the average time of hospital stay, curtain the length of postoperative hospitalization and lower hospitalization expenditure. A wider popularization is worthy. © 2022, Journal of Clinical Pediatric Surgery. All rights reserved.     

Follow-up and prognosis analysis of rheumatic disease complicated with pulmonary arterial hypertension in children北大核心CSCD

Objective To explore the clinical features, follow-up characteristics and prognosis of rheumatic disease complicated with pulmonary arterial hypertension (PAH) in children, and to provide support for its clinical diagnosis and treatment. Methods A retrospective analysis was conducted on the data of rheumatic 24 patients complicated with PAH hospitalized in the Department of Rheumatology and Immunology, Children′s Hospital Affiliated to the Capital Institute of Pediatrics, Department of Rheumatology and Immunology, Jiangxi Children′s Hospital, Department of Pediatrics Ⅰ, the First Affiliated Hospital of Zhengzhou University and Department of Pediatrics, the Affiliated Hospital of Inner Mongolia Medical University from January 2013 to June 2022.The rheumatic patients complicated with PAH were followed up by telephone on June 30, 2022, and their clinical symptoms, treatment, follow-up, and prognosis data were collected.According to different treatment methods, the patients were divided into different clinical subgroups. The change of PAH was analyzed. The t-test was used for comparison between groups.P<0.05 was statistically significant. Results A total of 24 cases were enrolled, with 7 males and 17 females.The average onset age of PAH was (10.97±3.79) years old.The median duration of PAH was 6.00 (32.20) months.The average pulmonary artery pressure was (51.71±17.66) mmHg(1 mmHg=0.133 kPa). There were 9 cases of systemic lupus erythematosus, 5 cases of Takayasu′s arteritis, 3 cases of juvenile dermatomyositis, 3 cases of undifferentiated connective tissue disease, 2 cases of systemic juvenile idiopathic arthritis, 1 case of Behcet′s disease, and 1 case of Kawasaki disease.Among 24 cases, the common symptoms were fever (14 cases), fatigue (10 cases) and dyspnea (7 cases). Of the 24 cases, 10 cases were complicated with hydropericardium, 9 cases with valve regurgitation, and 5 cases with decreased systolic and/or diastolic function.Lung changes were observed in 17 cases.Eleven cases were tested for B-type natriuretic peptide (BNP), and the BNP levels were all elevated in them (11 cases), with a median BNP of 3 073 (10 645) ng/L.After the first occurrence of PAH, 12 cases were treated with Methylprednisolone therapy, 10 cases received Cyclophosphamide therapy, and 2 cases who were both systemic lupus erythematosus, underwent blood purification.In the treatment of PAH, 11 cases were treated with pulmonary artery pressure reduction, and 7 of the 11 cases took PAH-targeted drugs.The mean decrease of the average pulmonary artery pressure in children receiving the targeted therapy[(44.80±24.08) mmHg] was significant higher than that in children not receiving the targeted therapy [(16.15±17.25) mmHg] (t=2.661, P=0.016). Twenty children were reexamined and/or followed up, and the average course of PAH at the telephone follow-up was (36.29±26.67) months.The pulmonary arterial hypertension in 6 cases completely recovered, with median recovery time of 8.00 (13.47) months, but 2 of them died after the complete recovery.The pulmonary arterial hypertension improved in 11 children, 1 of whom died and the remaining children were in stable condition.The pulmonary arterial hypertension worsened in 2 children, 1 of them improved previously but aggravated recently, and the other child did not monitor pulmonary artery pressure and died during telephone follow-up. Conclusions Rheumatic diseases complicated with PAH are rare and most often diagnosed in severe rheumatic children.It can lead to death, and is commonly accompanied by notably elevated BNP levels.The patients who have early PAH detection, intensive treatment of the primary disease, symptomatic and targeted pulmonary artery pressure reduction show a better prognosis. © 2023 Journal of Chinese Agricultural Mechanization. All rights reserved.     

先天性巨结肠根治术后医源性直肠阴道瘘的再手术治疗CSCD

Objective To explore the causes of iatrogenic rectovaginal fistula after pull-through in Hirschsprung’s disease (HD) and summarize the experiences and efficacies of reoperation. Methods From December 2007 to December 2020 , retrospective review was conducted for clinical data of 6 HD children with iatrogenic rectovaginal fistula after pull-through. The surgical procedures for repairing rectovaginal fistula included transabdominal and transanal Soave , transperineal or transanal surgery. Results A total of six girls were included. Clinical manifestation was vaginal excretion. Injuries occurred in initial surgery (n =4) and during redo pull-through (n =2). The reasons for re-operation were postoperative abdominal hemorrhage and aganglionic segment residue. Rectovaginal fistula with anastomotic retraction and stenosis were successfully repaired by transabdominal and transanal Soave procedure in single time(n =4). The remaining two cases underwent simple local repair of rectovaginal fistula , including fistula closure after anal repair twice (n =1) and failed closure after five local (perineal/anal) repairs (n =1). Conclusion Rectovaginal fistula after pull-through in HD is a serious iatrogenic injury. It should be separated close to rectal submucosa/rectal wall to avoid vaginal injury. Transabdominal and transanal Soave procedure has a high success rate for repairing rectovaginal fistula and managing anastomotic retraction and stenosis. © 2022, Journal of Clinical Pediatric Surgery. All rights reserved.     

手足口病病原体流行特征分析及临床意义

Objective To investigate the epidemic characteristics of etiological agents in children with hand, foot and mouth disease (HFMD) and analyze the differences between the severe and mild cases with HFMD seen from 2008 to 2009 in the Children's Hospital Methods A total of 154 patients with HFMD were enrolled from May 2008 to September 2008 and from May 2009 to September 2009, including 28 severe HFMD patients. Data from 80 cases with suspected herpangina were collected as control. Enterovirus universal type, enterovirus type 71 (EV71) and coxsackie virus group A 16 (CA16) were detected by realtime RT-PCR respoctively. Results The positive rate of enterovirus universal type in the 154 patients with HFMD was 81.82% (126/154). EV71 positive rate in these 126 patients with enterovirus universal type infection was 57.14% (72/126). The positive rate of enterovirus universal type in the 80 cases with suspected herpangina was 68.75% (55/80). There was no EV71 infection in these 80 cases with suspected herpangina. EV71 infection was mainly popular in 2008. Both EV71 and CA16 were prevalent in 2009. The epidemic characteristics of enterovirus infection with HFMD between 2008 and 2009 had significant differences (X2 = 23.50, P = 0.000) ( P ＜ O.01 ). The epidemic characteristics of enterovirus infection between severe and mild HFMD patients also had significant differences (X2 = 29.85, P ＜ O. 01). There were 28 cases with severe HFMD, in whom the EV71 positive rate was 92.86% (26/28). EV71 positive rate in the mild HFMD was 36.51% (46/126) (X2 =29.22, P ＜0.01). There was no significant difference in the gender ( X2 = 0.135, P = 0.714) and virus load (t = 0.141, P = 0.889) between the mild and severe HFMD cases. But the age of mild and severe HFMD showed a significant difference ( t = 2.926, P =O.009). Patients who were less than 2 years of age had a proportion of 88.89% (8/9) with severe HFMD.The mean age of mild HFMD patients was 3.19 years. Conclusion HFMD showed different epidemic characteristics at different times of enterovirus infection. There was no significant difference in the gender and virus load between the mild and severe cases with HFMD. Children under 3 years of age with EV71 infection were at high risk for severe HFMD.     

手足口病病原体流行特征分析及临床意义

Objective To investigate the epidemic characteristics of etiological agents in children with hand, foot and mouth disease (HFMD) and analyze the differences between the severe and mild cases with HFMD seen from 2008 to 2009 in the Children's Hospital Methods A total of 154 patients with HFMD were enrolled from May 2008 to September 2008 and from May 2009 to September 2009, including 28 severe HFMD patients. Data from 80 cases with suspected herpangina were collected as control. Enterovirus universal type, enterovirus type 71 (EV71) and coxsackie virus group A 16 (CA16) were detected by realtime RT-PCR respoctively. Results The positive rate of enterovirus universal type in the 154 patients with HFMD was 81.82% (126/154). EV71 positive rate in these 126 patients with enterovirus universal type infection was 57.14% (72/126). The positive rate of enterovirus universal type in the 80 cases with suspected herpangina was 68.75% (55/80). There was no EV71 infection in these 80 cases with suspected herpangina. EV71 infection was mainly popular in 2008. Both EV71 and CA16 were prevalent in 2009. The epidemic characteristics of enterovirus infection with HFMD between 2008 and 2009 had significant differences (X2 = 23.50, P = 0.000) ( P ＜ O.01 ). The epidemic characteristics of enterovirus infection between severe and mild HFMD patients also had significant differences (X2 = 29.85, P ＜ O. 01). There were 28 cases with severe HFMD, in whom the EV71 positive rate was 92.86% (26/28). EV71 positive rate in the mild HFMD was 36.51% (46/126) (X2 =29.22, P ＜0.01). There was no significant difference in the gender ( X2 = 0.135, P = 0.714) and virus load (t = 0.141, P = 0.889) between the mild and severe HFMD cases. But the age of mild and severe HFMD showed a significant difference ( t = 2.926, P =O.009). Patients who were less than 2 years of age had a proportion of 88.89% (8/9) with severe HFMD.The mean age of mild HFMD patients was 3.19 years. Conclusion HFMD showed different epidemic characteristics at different times of enterovirus infection. There was no significant difference in the gender and virus load between the mild and severe cases with HFMD. Children under 3 years of age with EV71 infection were at high risk for severe HFMD.     

Investigation on epidemiology of nosocomial sepsis of premature infants with gestational age less than 34 weeks in Shaanxi province北大核心CSCD

Objective To investigate the epidemiological data of nosocomial sepsis of premature infants with gestational age less than 34 weeks and the distribution characteristics of pathogenic bacteria in Shaanxi province. Methods A retrospective analysis of clinical data of premature infants born with gestational age < 34 weeks born between January 1 and December 30,2018 in Neonatal Intensive Care Units(NICU) in 4 Grade A Class Three hospitals in Shaanxi province was performed. The high risk factors and pathogenic bacteria were analyzed by using chi - square test and t test for statistical analysis. Results Totally 823 infants were included in this study,among whom,73 patients developed nosocomial sepsis,and the incidence was 8. 9%. The mean gestational age of the 73 patients with nosocomial sepsis was (30. 6 ±2.2) weeks and mean birth weight was (1 320. 3 ± 450. 5) g. The rate of invasive ventilator was 23.4% (52/222 cases).The rate of peripherally inserted central catheter (PICC) was 20. 1% (61/303 cases). The rate of early antibiotic use was 8. 1 % (39/481 cases) and breast feeding rate was 9. 3% (63/675 cases). The rate of PICC and ventilator use were statistically different between the non-infection group and the infection group (all P < 0.05). There were 31 strains of pathogenic bacteria, among which gram-negative bacilli was the most common (22 strains,70. 9%), which mainly were klebsiella pneumoniae strains (15 strains,48. 4%), and 6 strains(19. 4%) of Fungus was detected. Conclusions The incidence of nosocomial sepsis in NICU in Shaanxi province is higher,gram -negative bacilli was the most common pathogenic bacteria, among which, klebsiella pneumoniae was main, it is necessary to strengthen the regular monitoring and analysis of nosocomial infection in NICU in order to reduce the incidence of nosocomial infection and sepsis. © 2019 Authors. All rights reserved.     

小剂量肝素微量泵持续定时静脉注射治疗小儿原发性肾病综合征的临床研究

Objective To explore the efficacy and safety of low-dose heparin in the treament of children with primary nephrotic syndrome (PNS). Methods It was an open and comparative trial. Eightyeight children with PNS in the hypercoagulable state,on the basis of administrating with glucocorticosteroid,were administrated with low-dose heparin that infused by micro pump oriented to time ( group A). Eighty patients only treated with glucocorticosteroid were chosen as control (group B). Results Serum-albumin and activated partial thromboplastin time (APTT) increased,but fibrinogen (Fib) decreased after therapy in the group A,and they all showed significant differences (P ＜ 0. 01 ). Serum-albumin increased after therapy in the group B and there was significant difference (P＜0. 01 ). However,APTT and Fib in the group B showed no significant difference( P ＞ 0. 05 ) between post-treatment and pretherapy. Post-treatment serum-albumin and APTT in the group A were significantly higher than those in group B, and Fib was significantly lower than that in group B ( P ＜ 0. 01 ). The rate of urine protein remission in group A (82/88) was significantly higher than that in group B (63/80). Urine protein remission time and edema disappearance time were significantly shorter in group A than group B ( P ＜ 0. 01 ). APTT of group A at the peak concentration of heparin after therapy was significantly higher than that of pretherapy ( P ＜ 0. 01 ), and the ratio was 2. 38. However, there was no significant difference in APTT at the valley concentration of heparin between post-treatment and pretherapy ( P ＞ 0.05 ). Conclusion Low dose-heparin infused by micro pump oriented to time in the treatment of children with PNS has an obvious anticoagulative effect. It can improve the rate of urine protein remission and shorten edema disappearance time. Meanwhile it is safety ,requires no laboratory monitor and has few drug side effects,thus it deserves further clinical application.     

Clinical application of a Kirschner wire assisted double - hook water - injection hernia needle in complicated pediatric oblique inguinal hernia北大核心CSCD

Objective To explore the clinical value of single -hole laparoscopic percutaneous extraperitoneal closure operation using a Kirschner wire assisted double - hook water - injection hernia needle in treating complicated pediatric oblique inguinal hernia. Methods The clinical data of 366 children with oblique inguinal hernia treated in the Department of Urology Surgery, Children's Hospital of Nanjing Medical University from December 2020 to October 2021 were retrospectively analyzed. According to the surgical methods, the children were divided into the ordinary crochet needle group and the Kirschner wire assisted group. Children treated by a single - port laparoscopic double hook water -injection hernia crochet needle (309 cases) were classified into the ordinary crochet needle group. Children treated by a single - port laparoscopic Kirschner wire assisted double hook water - injection hernia crochet needle (57 cases) were included in the Kirschner wire assisted group. The independent sample t - test and rank sum test was used to compare the relevant clinical indicators between the two groups. Results Compared with the ordinary crochet needle group, children in the Kirschner wire assisted group were younger at surgery [(2. 87 ± 1. 88) years vs. (4. 91 ±2. 39) years] and had larger hernia sacs [17 303.89(8 622.49, 37 295.42) mm3 vs. 9 650.97(3 849.24, 17 539.51) mm3]. The differences in the age at surgery and hernia sac volume were statistically significant (t - 5. 407, Z - 4. 218;all P <0. 001). There was no significant difference in body mass index between the 2 groups (P > 0. 05). Taking hernias with sac volume > 10 000 mm as huge hernias, there were 70. 18% (40/57 cases) and 47. 25% (146/309 cases) of huge hernias in the Kirschner wire assisted group and the ordinary crochet needle group, respectively. The overall operation time of the Kirschner wire assisted group was significantly longer than that of the ordinary crochet needle group [(20(15, 20) min vs. 15 (15, 20) min] (Z - 2. 842, P < 0. 05). However, the operation time for huge oblique hernias with sac volume > 10 000 mm was not statistically significant between the 2 groups (P >0. 05). No recurrence in both groups was found during 6-1 6 months of follow - up. Conclusions For complicated oblique inguinal hernia in children with a huge hernia or obvious retroperitoneal folds at the internal ring and heavy scar adhesion between the hernia sac and abdominal wall, the insertion of a Kirschner wire can help the hernia crochet needle to traverse the vas deferens and spermatic cord vessels smoothly. As a single port laparoscopic operation, the Kirschner wire assisted hernia crochet needle requires no addition of trocar holes and leaves only a small surgical scar. With good feasibility and safety, it is applicable for clinical popularization. © 2022 Chinese Journal of Applied Clinical Pediatrics. All rights reserved.     

肺保护性通气策略在儿童急性呼吸窘迫综合征中的应用价值

Objective To assess the effect of lung protective ventilation on outcome of children with acute respiratory distress syndrome(ARDS).Methods Between January 1999 and December 2007,43 children with ARDS were enrolled from PICU of Shanghai Children's Medical Center and assigned to the protective-ventilation group(group A) or the conventional-ventilation group(group B).The patients in group A (from January 2004 to December 2007)received lower tidal volume(6～7 ml/kg) and high levels of positive end-expiratory pressure(PEEP),and optimal oxygenation was achieved by adjusting FiO2 and PEEP.The patients in group B(from January 1999 to December 2003) received relatively higher tidal volume(8～12 mL/kg) with lower PEEP(2～6 cm H2O),and optimal oxygenation was achieved by adjusting FiO2.Tidal volume,PEEP,arterial blood gas,mortality and the number of ventilator-free days were compared between the two groups.Results Since protective ventilation was adopted after 2004,tidal volume was significantly lower in group A[(7.09±1.66)ml/kg]as compared with that in group B[(9.82±2.31) ml/kg](P=0.001).PEEP was significantly higher in group A[(7.15±2.08) cm H2O]as compared with that of group B[(5.40 + 1.84) cm H2O](P=0.021).The mortality was 30.3% in group A and 60.0% in group B.The number of ventilator-free days were(10.88±8.84) d in group A and(8.40±10.86) d in group B.Although mortality was lower and number of ventilator-free days was greater in group A,no significant differences were found between the two groups(P＞0.05).Conclusion Lung protective ventilation may improve the outcome for pediatric patients with ARDS,however,larger trials are required before a definite conclusion can be reached.     

肺保护性通气策略在儿童急性呼吸窘迫综合征中的应用价值

Objective To assess the effect of lung protective ventilation on outcome of children with acute respiratory distress syndrome(ARDS).Methods Between January 1999 and December 2007,43 children with ARDS were enrolled from PICU of Shanghai Children's Medical Center and assigned to the protective-ventilation group(group A) or the conventional-ventilation group(group B).The patients in group A (from January 2004 to December 2007)received lower tidal volume(6～7 ml/kg) and high levels of positive end-expiratory pressure(PEEP),and optimal oxygenation was achieved by adjusting FiO2 and PEEP.The patients in group B(from January 1999 to December 2003) received relatively higher tidal volume(8～12 mL/kg) with lower PEEP(2～6 cm H2O),and optimal oxygenation was achieved by adjusting FiO2.Tidal volume,PEEP,arterial blood gas,mortality and the number of ventilator-free days were compared between the two groups.Results Since protective ventilation was adopted after 2004,tidal volume was significantly lower in group A[(7.09±1.66)ml/kg]as compared with that in group B[(9.82±2.31) ml/kg](P=0.001).PEEP was significantly higher in group A[(7.15±2.08) cm H2O]as compared with that of group B[(5.40 + 1.84) cm H2O](P=0.021).The mortality was 30.3% in group A and 60.0% in group B.The number of ventilator-free days were(10.88±8.84) d in group A and(8.40±10.86) d in group B.Although mortality was lower and number of ventilator-free days was greater in group A,no significant differences were found between the two groups(P＞0.05).Conclusion Lung protective ventilation may improve the outcome for pediatric patients with ARDS,however,larger trials are required before a definite conclusion can be reached.     

Clinical application of dense fine spot anti-nuclear antibody in children with autoimmune diseases北大核心CSCD

Objective To analyze the differences of the clinical characteristics and laboratory indexes in children with positive dense fine spot (DFS) type anti-nuclear antibody, and thereby to explore the value of positive DFS in the diagnosis of immunological diseases. Methods Among 9 613 cases who were routinely tested for antinuclear antibody (ANA) from August 2017 to February 2020, there were 197 cases with DFS positive, who were subjected to a retrospective analysis.These patients were divided into the autoimmune diseases (AID) group (39 cases) and the non-AID group (158 cases) according to clinical diagnosis.Healthy children in the same physical examination were used as healthy control group (40 cases). T test was applied to analyze the differences of humoral immunity markers between AID and non-AID groups.What′s more, DFS positive patients in different clinical departments, initial symptom and the part of body were further compared. Results Among 9 613 children tested for autoantibodies, 2 654 (27.61%) were ANA positive, with the highest detection rate of the spotted type and 197 DFS positive cases, accoun-ting for 7.42% of ANA positive children; 97 DFS positive male patients accounted for 8.20% (97/1 183 case) of ANA positive male patients, 100 DFS positive female patients accounted for 6.80% (100/1 471 cases) of ANA positive female patients, and there was no significant difference in the positive rate.The departments with high positive ANA detection included the nephrology department (27.88%) and the rheumatology department (24.83%). The departments with a higher ANA positive rate in DFS positive children included the gastroenterology department (13.25%) and the infectious department (11.76%). Among the children with DFS antibody positive, 39 cases had AID, among which 38 cases had organ-specific AID, and juvenile idiopathic arthritis (JIA) had the highest detection rate in 13 cases.The diseases with a high DFS positive rate in 158 non-AID cases included allergic purpura (46 cases). Serum immunoglobulin (IgG) level in the AID group was significantly lower than this in the non-AID group, serum IgM and C4 levels in AID children were significantly lower than those in the non-AID group and healthy control group, and the serum IgA level of DFS positive group was significantly higher than that of children in the healthy control group.All children with DFS antibody positive had no specific autoantibodies. Conclusions DFS antibody positive is important for the diagnosis of systemic AID in children.The combined detection with the DFS, other autoimmunity antibody index, humoral immune function index contributes to the early differential diagnosis of autoimmune diseases in children. © 2021 Chinese Journal of Applied Clinical Pediatrics. All rights reserved.     

肺保护性通气策略在儿童急性呼吸窘迫综合征中的应用价值

Objective To assess the effect of lung protective ventilation on outcome of children with acute respiratory distress syndrome(ARDS).Methods Between January 1999 and December 2007,43 children with ARDS were enrolled from PICU of Shanghai Children's Medical Center and assigned to the protective-ventilation group(group A) or the conventional-ventilation group(group B).The patients in group A (from January 2004 to December 2007)received lower tidal volume(6～7 ml/kg) and high levels of positive end-expiratory pressure(PEEP),and optimal oxygenation was achieved by adjusting FiO2 and PEEP.The patients in group B(from January 1999 to December 2003) received relatively higher tidal volume(8～12 mL/kg) with lower PEEP(2～6 cm H2O),and optimal oxygenation was achieved by adjusting FiO2.Tidal volume,PEEP,arterial blood gas,mortality and the number of ventilator-free days were compared between the two groups.Results Since protective ventilation was adopted after 2004,tidal volume was significantly lower in group A[(7.09±1.66)ml/kg]as compared with that in group B[(9.82±2.31) ml/kg](P=0.001).PEEP was significantly higher in group A[(7.15±2.08) cm H2O]as compared with that of group B[(5.40 + 1.84) cm H2O](P=0.021).The mortality was 30.3% in group A and 60.0% in group B.The number of ventilator-free days were(10.88±8.84) d in group A and(8.40±10.86) d in group B.Although mortality was lower and number of ventilator-free days was greater in group A,no significant differences were found between the two groups(P＞0.05).Conclusion Lung protective ventilation may improve the outcome for pediatric patients with ARDS,however,larger trials are required before a definite conclusion can be reached.     

肺保护性通气策略在儿童急性呼吸窘迫综合征中的应用价值

Objective To assess the effect of lung protective ventilation on outcome of children with acute respiratory distress syndrome(ARDS).Methods Between January 1999 and December 2007,43 children with ARDS were enrolled from PICU of Shanghai Children's Medical Center and assigned to the protective-ventilation group(group A) or the conventional-ventilation group(group B).The patients in group A (from January 2004 to December 2007)received lower tidal volume(6～7 ml/kg) and high levels of positive end-expiratory pressure(PEEP),and optimal oxygenation was achieved by adjusting FiO2 and PEEP.The patients in group B(from January 1999 to December 2003) received relatively higher tidal volume(8～12 mL/kg) with lower PEEP(2～6 cm H2O),and optimal oxygenation was achieved by adjusting FiO2.Tidal volume,PEEP,arterial blood gas,mortality and the number of ventilator-free days were compared between the two groups.Results Since protective ventilation was adopted after 2004,tidal volume was significantly lower in group A[(7.09±1.66)ml/kg]as compared with that in group B[(9.82±2.31) ml/kg](P=0.001).PEEP was significantly higher in group A[(7.15±2.08) cm H2O]as compared with that of group B[(5.40 + 1.84) cm H2O](P=0.021).The mortality was 30.3% in group A and 60.0% in group B.The number of ventilator-free days were(10.88±8.84) d in group A and(8.40±10.86) d in group B.Although mortality was lower and number of ventilator-free days was greater in group A,no significant differences were found between the two groups(P＞0.05).Conclusion Lung protective ventilation may improve the outcome for pediatric patients with ARDS,however,larger trials are required before a definite conclusion can be reached.