A sewing needle in the liver in children: A case report and literature review

Rationale:In clinical practice, foreign bodies (FBs) in the digestive tract are more common in children, but intrahepatic FBs are rare, especially those that can cause infection, bleeding, bile leakage, and other complications. However, there is no consensus on its diagnosis and treatment due to the lack of large-scale cohort studies.Patient concerns:Case 1 is a 4-years 8-months-old girl, who at the age of 10 months, showed an X-ray finding of a striped FB in her liver, with no symptoms. However, the patient’s parents refused surgery. After nearly 4 years of active surveillance, the patient visited our hospital for surgery. Case 2, a 2-year-old male, reported a sewing needle that completely pierced into the right upper abdomen due to an accidental fall that took place half-a-day before admission. He only had right upper abdominal pain. CT showed a striped FB in the liver.Diagnosis:FB in the liver (sewing needle).Interventions:Both the patients were injected with human tetanus immunoglobulin and underwent surgical removal.Outcomes:Both patients recovered smoothly and had no complications during follow-up.Lessons:Active surveillance might be considered for cases with no symptoms or complications and no displacement of the FB, but surgery should be the first choice. If the patient’s condition is complicated, it is recommended to use ultrasound or X-ray to help decision-making during the operation. Additionally, tetanus, child safety, and family education are important supportive measures.     

2018年至2019年浙江省绍兴市新确证人类免疫缺陷病毒1型感染者的分子传播网络特征分析

目的:分析浙江省绍兴市新确证人类免疫缺陷病毒1型(human immunodeficiency virus type 1,HIV-1)感染者传播关系的分子网络特征,为疫情流行趋势和防治提供依据。方法:纳入2018年8月至2019年12月绍兴市新确证未经抗病毒治疗的423份HIV-1感染/艾滋病病例血液样本,获得375份...     

杨运宽调神意守针法

调神意守针法是将针法守神法和道家意守法结合起来,促使针刺得气后循经感传甚至气至病所,激发患者潜在的调整功能。杨运宽教授常运用此针法治疗某些痛证、神经系统疾病及慢性难治性疾病,可获得较一般针法更好的疗效。本文详细介绍了这一针法的操作方法和临床应用。     

血清RBP4、visfatin、RIPK1水平在冠心病伴颈动脉粥样硬化患者中的表达及临床意义

目的 探究血清视黄醇结合蛋白4(RBP4)、内脏脂肪素(visfatin)、受体相互作用蛋白激酶1(RIPK1)水平在冠心病伴颈动脉粥样硬化(CAS)患者中的表达及临床意义。方法 选取2020年2月至2021年2月于该院就诊的163例冠心病患者作为研究对象,按是否伴CAS分为冠心病组79例和冠心病伴CAS组84例。同期选取72例于该院进行体检的体检健康者作为健康组,检测上述研究对象血清RBP4、visfatin、RIPK1水平并分析其与冠心病伴CAS组的相关性。结果 与健康组、冠心病组相比,冠心病伴CAS组血清RBP4、visfatin、RIPK1水平较高,差异有统计学意义(P<0.05)。与中度、轻度冠心病伴CAS患者相比,重度冠心病伴CAS患者血清RBP4、visfatin、RIPK1水平较高,差异有统计学意义(P<0.05);Pearson相关性分析显示,RBP4、Gensini评分呈正相关(r=0.429,P=0.001);RBP4、Gensini评分呈正相关(r=0.486,P=0.001);visfatin、Gensini评分呈正相关(r=0.630,P=0.0...     

Special manifestations and treatment of rare cases of snoring with special facial features and hearing loss in children

This current case report describes two rare cases of children with both hearing loss and snoring. Case 1, a 17-month-old male patient, and case 2, an 11-year-old male patient, both presented with nasal obstruction, snoring and hearing loss. Physical examinations showed obvious enlargement of the head circumference and special facial features. The two children underwent otolaryngology examinations, endoscopy, hearing tests, laboratory examinations for bone metabolism markers, cranial computed tomography, X-rays and genome-wide exon sequencing. The first case was diagnosed with craniometaphyseal dysplasia, which was relieved after giving a low-calcium diet. The second case was diagnosed with osteopathia striata with cranial sclerosis by gene sequencing. Snoring improved after medication and the speech and quality of life improved with a hearing aid. Paediatric otolaryngological physicians need to have a deeper understanding of congenital diseases involving the bones. Only by genetic testing to determine the pathogenesis can those children be given the correct treatment, which is of great importance for improving their prognosis.     

Checklists for Assessing Skills of Children With Type 1 Diabetes on Insulin Injection Technique

Background:School-aged children often participate in type 1 diabetes (T1D) self-care tasks. Despite widespread discussion about the importance of developing self-care skills in childhood, few explain how the health care team should assess the skills of children with T1D when performing insulin injections.Objective:We sought to assess content validity evidence in two checklists regarding injection technique performed by children.Methods:Two checklists were designed based on a systematic review of the insulin injection technique. Experts in pediatric diabetes, health literacy, and diabetes education assessed the checklists regarding their clarity, objectivity, and relevance. Content validity was assessed using the content validity ratio (CVR).Results:Eleven providers (72% nurses or physicians, professional experience 19.4 ± 10.1 years, 45% of specialists in endocrinology, and 18% in pediatrics) participated in the assessment. Experts considered items containing the word homogeneity inappropriate. Items related to the needle insertion angle and the skin fold did not reach the CVR critical value. The final version of the checklist for syringe injection comprised 22 items with CVR = 0.91, and the checklist for pen injection comprised 18 items with CVR = 0.87.Conclusions:The checklists presented clear, objective, and relevant content that assesses the skills of children with T1D for insulin injection. The checklists formally present the order of the technique and all the steps for insulin injection and allow a quantitative assessment of the operational skills of children. The developed instruments offer providers the possibility of continuous assessment of the progress of the pediatric clientele until they reach independence in diabetes self-care.     

儿童难复性肱骨髁上骨折的外科治疗

目的探讨肘关节内外侧联合小切口微创治疗儿童难复性肱骨髁上骨折的临床疗效。方法从2001-2007年,本科对51例难复性儿童肱骨髁上骨折采用内外侧联合手术入路,透视下复位,交叉克氏针固定,观察术后伤肢肿胀情况、早期功能锻炼时间、骨折愈合时间及肘关节功能恢复情况。结果伤肢肿胀程度轻,术后2-4d完全消退,术后2-3周即可取石膏进行早期功能锻炼。随访3个月至5年,全部骨折均愈合,按Flynn标准对术后肘关节功能恢复情况进行评价,其中优43例,良6例,差2例,发生肘内翻3例。结论肘关节内外侧联合小切口治疗儿童难复性肱骨髁上骨折具有微创、肘关节功能恢复良好及肘内翻发生率低等特点。     

儿童肱骨髁上骨折经皮克氏针治疗的临床疗效

目的 分析微创手术治疗儿童肱骨髁上骨折的临床疗效.方法 回顾分析我科自2000年8月至2007年10月采用微创手术治疗儿童肱骨髁上骨折获得随访46例,其中伸直尺偏型25例,伸直桡偏型21例.按Garland分型:Ⅰ型7例,Ⅱ型11例,Ⅲ型28例.患儿平均年龄为6岁2个月(1.6～8岁).手术方式为全身静脉麻醉下先在"C"型臂X线机引导下闭合复位,然后经皮穿入2～3枚克氏针固定骨折,并应用上肢石膏固定肘、腕关节于功能位.结果 本组46例获得随访,平均随访时间为10个月(3～36个月).所有患者均获得骨性愈合,患侧肘关节活动度:平均伸直角度为0°.平均屈曲角度为135°,无1例出现Volkmann挛缩及医源性神经损伤,1例患者出现肘内翻畸形.结论 微创手术治疗儿童肱骨髁上骨折具有创伤小、骨折固定稳定、防止Volkmann挛缩以及肘关节功能恢复良好等优点;但骨折复位不良,尤其是尺偏未恢复可能导致肘内翻畸形.     

SARS-CoV-2 Specific Immune Response and Inflammatory Profile in Advanced HIV-Infected Persons during a COVID-19 Outbreak

The main aim of this study was to describe the clinical and immunological outcomes, as well as the inflammatory profile, of patients with advanced HIV in an assisted-living facility in which an outbreak of SARS-CoV-2 occurred. SARS-CoV-2 humoral and specific T-cell response were analyzed in patients with HIV infection and COVID-19; as a secondary objective of the analysis, levels of the inflammatory markers (IL-1β, IL-6, IL-8, and TNFα) were tested in the HIV/COVID-19 group, in HIV-positive patients without COVID-19, and in HIV-negative patients with mild/moderate COVID-19. Antibody kinetics and ability to neutralize SARS-CoV-2 were evaluated by ELISA assay, as well as the inflammatory cytokines; SARS-CoV-2 specific T-cell response was quantified by ELISpot assay. Mann–Whitney or Kruskal–Wallis tests were used for comparisons. Thirty patients were included with the following demographics: age, 57 years old (IQR, 53–62); 76% male; median HIV duration of infection, 18 years (15–29); nadir of CD4, 57/mmc (23–100) current CD4 count, 348/mmc (186–565). Furthermore, 83% had at least one comorbidity. The severity of COVID-19 was mild/moderate, and the overall mortality rate was 10% (3/30). Additionally, 90% of patients showed positive antibody titers and neutralizing activity, with a 100% positive SARS-CoV-2 specific T-cell response over time, suggesting the ability to induce an effective specific immunity. Significantly higher levels of IL-6, IL-8, and TNF-α in COVID-19 without HIV vs. HIV/COVID-19 patients (p < 0.05) were observed. HIV infection did not seem to negatively impact COVID-19-related inflammatory state and immunity. Further data are mandatory to evaluate the persistence of these immunity and its ability to expand after exposure and/or vaccination.     

复方大承气汤中药灌注联合穴位按摩对老年不完全性肠梗阻肠功能的影响

目的:探讨复方大承气汤中药灌注联合穴位按摩对老年不完全性肠梗阻肠功能恢复的影响。方法:选取2018年6月—2019年6月医院收治的60～80岁肠梗阻病人126例为研究对象,随机分为研究组和对照组各63例。对照组给予常规护理干预,研究组给予复方大承气汤中药灌注联合穴位按摩干预,观察并比较两组病人干预后的肠功能恢复情况、临床疗效。结果:干预后,研究组病人首次肠鸣音时间、首次肛门排气时间、首次肛门排便时间、首次进食时间明显短于对照组(P<0.05),研究组病人临床疗效总有效率明显高于对照组(P<0.05)。结论:复方大承气汤中药灌注联合穴位按摩能够明显加快老年不完全性肠梗阻病人肠功能的恢复速度,提高临床疗效。