[Objective] To summarize the clinical experience on treating thoracic spinal little joints disorder by manipulation of embracing cervical and extracting chest. [Method] To col ect and analyze the theory and methodology of Pro.Fan's clinical treatment on thoracic spinal little joints disorder. [Result]Professor Fan has rich clinical experience for many years in the study and treatment of spinal diseases. He puts forward theories of“close relationship between symptoms with etiology”and“correct spinal little joints disorder”, that is to say, considering symptoms to detect it's etiology, thinking etiology to find out it's dislocation, the method of treatment is removing pathogeny, etiology is removed, symptoms are removed. Based on the theory, Pro.Fan invents the manipulation of “embracing cervical and extracting chest”to treat thoracic spinal little joints disorder.And this manipulation has significant effect on clinic. [Conclusion] Pro.Fan has great innovation on treatment of thoracic spinal little joints disorder and the manipulation of“embracing cervical and extracting chest”has significant effect on clinic.

Objective To summarize the experience in the diagnosis and treatment of intraductal papillary mucinous neoplasms (IPMN) of the pancreas.Methods The clinical data of 16 cases of intraductal papillary mucinous neoplasms of the pancreas in the First Affiliated Hospital of China Medical University from January,2000 to October,2013 was retrospectively analyzed.Results There were 9 males and 7 females,age ranging from 37 to 61 years (average 49 years).The common complaint was epigastric pain.Ultrasonography and CT scan found solid lesions in all cases,main pancreatic duct dilatation was found in 10 cases.All the cases received surgical resection of the tumor.Pathology showed adenomas in 14 cases,borderline tumors in one,and adenocarcinoma in one.14 patients were followed-up ranging from 5 to 48 months,all were alive without recurrence and metastasis.Conclusions IPMT is a special type of pancreatic tumor.Surgical resection is the most effective treatment with excellent prognosis.

Objective To compare the effects of oxygen therapy and local pressurization in alleviating plateau hypoxia at high altitude.Methods Forty-five healthy male soldiers were investigated at an altitude of 3992 meters.The subjects were randomly divided into three groups, ie.an oxygen inhalation group, a single-soldier oxygen increasing respirator (SOIR) group and a BiPAP group.The oxygen inhalation group was treated with oxygen inhalation via nasal catheter at 2 L/min.SOIR was used to assist breath in the SOIR group.The BiPAP group were treated with bi-level positive airway pressure ventilation, with IPAP of 10 cm H20 and EPAP of 4 cm H2O.PaO2、PaCO2、SpO2 and heart rate were measured before and 30 minutes after the treatment.Results There were continuous increase of PaO2 from (53.30±4.88) mm Hg to (58.58±5.05) mm Hg and (54.43±3.01) mm Hg to (91.36±10.99) mm Hg after BiPAP ventilation and oxygen inhalation, respectively (both P < 0.01).However, the PaO2、of the SOIR group was decreased from (56.00±5.75) mm Hg to (50.82±5.40) mm Hg (P < 0.05).In the other hand, the PaCO2、 was increased from (30.41±1.51) mm Hg to (32.5±2.98) mm Hg in the oxygen inhalation group (P< 0.05), declined from (28.74±2.91) mm Hg to (25.82±4.35) mm Hg in the BiPAP group (P < 0.05), and didn't change significantly from (28.65±2.78)mm Hg to (29.75±3.89) nun Hg in the SOIR group (P > 0.05).Conclusions Both BiPAP ventilation and oxygen inhalation can alleviate plateau hypoxia by improving PaO2 at 3992 meter altitude while SOIR has no significant effect.

Objective: To investigate the corrective effect of modified Brisson technique to treat concealed penis in children. Methods: From July 2015 to July 2017, 32 patients(3-10 years old, mean 7.2 years old )with concealed penis were treated with the modified Brisson technique in the Children′s Hospital of Zhengzhou University. All the children with concealed penis were treated by the modified Brisson technique, complications, postoperative results and followed-ups were retrospectively analyzed. Results: 32 cases of concealed penile children had pain on the postoperative day, 2 cases required patient controlled analgesia device. No infection and dehiscence were noticed after discharge. All the children were followed up for 6 months to 1 year, and the results were satisfactory. Review showed that the penile body was similar to the appearance after circumcision, with obvious extension exposure, normal exposure of penile scrotal Angle and penile pubic Angle, and no obvious retraction. The internal plate of the prepuce in 5 cases was slightly edema, and edema dissolved within 2 months. Conclusions Modified Brisson is a better method to treat concealed penis in children, which can correct the pathological structure and retain the integrity of penile skin to the greatest extent.

Objective:To summarize the clinical effect of laparoscopic medial umbilical ligament dissection in two-stage Fowler-Stephens orchiopexy (FSO).Methods:A case-series study was conducted.Clinical data of children who underwent two-stage FSO from March 2020 to July 2022 in the Department of Urology, Children′s Hospital Affiliated to Zhengzhou University were retrospectively analyzed.Indexes such as operation time, amount of blood loss, degree of postoperative pain in the operative area, testicular position, size, texture and parental satisfaction at the operative side 1 month, 6 months and 1 year after surgery were collected.Measurement data of normal distribution were expressed as Mean± SD and compared using the independent sample and paired sample t-tests. Results:A total of 18 children with complete clinical data were included in this study.Their age ranged from 7 months to 10 years, with an average of 2 years.There were 10 cases of FSO on the left side and 8 cases on the right side.Twelve cases (group A) had the testis directly descending to the scrotum without amputation of the umbilical medial ligament during the operation, including 7 cases on the left side and 5 cases on the right side; 6 cases (group B) with testis not descending to the scrotum received amputation of the umbilical medial ligament, and the testicle was pulled into the scrotum without tension, including 3 cases on the left side and 3 cases on the right side.The age of patients in group A [(0.88±0.26) years] was lower than that in group B [(4.32±2.96) years] ( t=-4.11, P<0.05).The operation time of patients in group B was (47.50±1.87) min, slightly longer than that in group A [(46.17±1.47) min] ( t=-1.66, P>0.05).The intraoperative bleeding volume in group B was (5.18±0.42) mL, slightly higher than that in group A [(4.96±0.20) mL] ( t=-1.56, P>0.05).Patients in both groups had mild pain in the operative area, which could be tolerated by the children.There were no significant differences in testicular position, size, texture and satisfaction between the two groups 1 month after surgery.Reexamination at 6 months after operation showed that 1 case in group A had mild testicular retraction, located above the scrotum; no significant testicular retraction was observed in group B; the size and texture of testis in both groups had no significant change compared with those before operation, and the blood supply was normal according to the color ultrasound findings; parental satisfaction was high.Reexamination at 1 year after operation showed that 1 case of testis in group A was located above the scrotum, 2 cases had no obvious development, and the rest cases had increased testis size [(0.51±0.03) mL] compared with before operation [(0.31±0.02) mL] ( t=-22.97, P<0.05); all cases of testis in group B returned to normal position, 1 case had no obvious development, and the rest cases had increased testis size [(0.45±0.02) mL] compared with before operation [(0.24±0.01) mL] ( t=-32.87, P<0.05).There was no significant difference in testicular size increase between group A [(0.20±0.03) mL] and group B [(0.20±0.01) mL] ( t=-1.19, P>0.05). Conclusions:In the case that the medial umbilical ligament obviously affects the testicular descent, it can be dissected, which significantly shortens the distance of testis descending to the scrotum.The testicular position after surgery is normal, and the two-stage FSO does not affect the testicular development.

Objective:To investigate the clinical effect of progressive transfer of penile flap combined with local scrotal flap in correction of severe concealed penis in children.Methods:The clinical data of children with severe concealed penis admitted to the Children’s Hospital Affiliated to Zhengzhou University from July 2021 to July 2023 were retrospectively analyzed. The concealed penis was corrected by progressive transfer of penile flap combined with local scrotal flap. During the operation, a small amount of excess inner prepuce was removed and the outer prepuce was cut in the middle of the dorsal side of the penis. Then the penile flap was transferred from dorsal to ventral, gradually covering the wound without tension. The local scrotal flap was lifted upwards and sutured to the frenulum for covering the ventral foreskin defect of the penis. The amount of blood loss during the operation was recorded. The pain tolerance, the duration of prepuce edema, the length of penis extension and the healing of skin flap were observed. The appearance of the penis was followed up to observe whether the penis was retracted, and the satisfaction of the children and their guardians was recorded.Results:A total of 32 male children were enrolled, ranging in age from 3 to 10 years, with an average age of 7.2 years. The penis of all the children had a conical appearance, and the penile shaft was buried under the subcutaneous anterior pubis, which was difficult to palpate in its natural state. The average intraoperative blood loss was about 5 ml. All patients had pain after the operation. Two patients needed a pump to relieve pain, and the rest could tolerate it after rectum administration of indomethacin suppositories. The edema of the prepuce was mild after the operation, and the edema basically disappeared when the patient was discharged 7-9 days later. The penis could be lengthened by 1.5-3.0 cm under static conditions, averaging about 2.0 cm. After surgery, only 1 patient had a small area (about 5 mm × 4 mm) of infection in the scrotal flap and poor incision healing, and scar healing after dressing change and intensive nursing. The other flaps healed well. After 6 to 12 months of follow-up, the penis length of 2 cases was slightly retracted from the time of discharge, and the remaining 30 cases had no significant change. The patients and their guardians were satisfied with the operation results.Conclusion:The progressive transfer of penile flap combined with local scrotal flap correction of severe concealed penis in children can fully lengthen the penile body, and the degree of postoperative retraction is low, the appearance of the penis is good, and the patient satisfaction is high.

Objective:To investigate the clinical effect of progressive transfer of penile flap combined with local scrotal flap in correction of severe concealed penis in children.Methods:The clinical data of children with severe concealed penis admitted to the Children’s Hospital Affiliated to Zhengzhou University from July 2021 to July 2023 were retrospectively analyzed. The concealed penis was corrected by progressive transfer of penile flap combined with local scrotal flap. During the operation, a small amount of excess inner prepuce was removed and the outer prepuce was cut in the middle of the dorsal side of the penis. Then the penile flap was transferred from dorsal to ventral, gradually covering the wound without tension. The local scrotal flap was lifted upwards and sutured to the frenulum for covering the ventral foreskin defect of the penis. The amount of blood loss during the operation was recorded. The pain tolerance, the duration of prepuce edema, the length of penis extension and the healing of skin flap were observed. The appearance of the penis was followed up to observe whether the penis was retracted, and the satisfaction of the children and their guardians was recorded.Results:A total of 32 male children were enrolled, ranging in age from 3 to 10 years, with an average age of 7.2 years. The penis of all the children had a conical appearance, and the penile shaft was buried under the subcutaneous anterior pubis, which was difficult to palpate in its natural state. The average intraoperative blood loss was about 5 ml. All patients had pain after the operation. Two patients needed a pump to relieve pain, and the rest could tolerate it after rectum administration of indomethacin suppositories. The edema of the prepuce was mild after the operation, and the edema basically disappeared when the patient was discharged 7-9 days later. The penis could be lengthened by 1.5-3.0 cm under static conditions, averaging about 2.0 cm. After surgery, only 1 patient had a small area (about 5 mm × 4 mm) of infection in the scrotal flap and poor incision healing, and scar healing after dressing change and intensive nursing. The other flaps healed well. After 6 to 12 months of follow-up, the penis length of 2 cases was slightly retracted from the time of discharge, and the remaining 30 cases had no significant change. The patients and their guardians were satisfied with the operation results.Conclusion:The progressive transfer of penile flap combined with local scrotal flap correction of severe concealed penis in children can fully lengthen the penile body, and the degree of postoperative retraction is low, the appearance of the penis is good, and the patient satisfaction is high.

[Objective] To summarize various treatment methods and experiences of bladder and urethral foreign bodies in children. [Methods] A total of 15 children with bladder and urethral foreign bodies admitted to our hospital during Aug.2015 and Feb.2024 were selected.The characteristics, clinical manifestations, surgical methods, surgical skills and postoperative recovery were analyzed. [Results] The patients aged 7-13 (11.0±1.6) years, including 14 males and 1 female.Preoperative diagnosis was confirmed with color Doppler ultrasound and abdominal standing plain film.Emergency surgery was performed in 14 cases, and open surgery in 1 case with concurrent pyuria, whose foreign bodies were removed after 2 days of anti-infection treatment.Among the 15 children, 9 had foreign bodies removed through cystoscopy, 2 through cystoscopy combined with percutaneous renal puncture kit, 2 through cystoscopy combined with a small incision on the pubic bone, 1 through cystoscopy combined with a scrotal incision, and 1 through cystoscopy combined with a perineal incision.The average surgical time was (63.3±50.5) min, blood loss (1.9±1.9) mL, and postoperative hospitalization (5.8±3.8) days.No complications such as urinary extravasation, urinary fistula, bladder diverticulum, or urinary disorders occurred.Postoperative follow-up of 1 and 3 months showed no complications such as abnormal urination or urinary tract infections. [Conclusion] The onset of bladder and urethra foreign bodies in children is concealed.Once the diagnosis is confirmed, surgery should be performed as soon as possible.The surgical method should be selected based on the comprehensive evaluation of the location, size, shape, and number of foreign bodies and presence of calculi.Minimally invasive surgery can be performed in most cases.

Patients with severe trauma require an extremely timely treatment and transfusion plays an irreplaceable role in the emergency treatment of such patients. An increasing number of evidence-based medicinal evidences and clinical practices suggest that patients with severe traumatic bleeding benefit from early transfusion of low-titer group O whole blood or hemostatic resuscitation with red blood cells, plasma and platelet of a balanced ratio. However, the current domestic mode of blood supply cannot fully meet the requirements of timely and effective blood transfusion for emergency treatment of patients with severe trauma in clinical practice. In order to solve the key problems in blood supply and blood transfusion strategies for emergency treatment of severe trauma, Branch of Clinical Transfusion Medicine of Chinese Medical Association, Group for Trauma Emergency Care and Multiple Injuries of Trauma Branch of Chinese Medical Association, Young Scholar Group of Disaster Medicine Branch of Chinese Medical Association organized domestic experts of blood transfusion medicine and trauma treatment to jointly formulate Chinese expert consensus on blood support mode and blood transfusion strategies for emergency treatment of severe trauma patients ( version 2024). Based on the evidence-based medical evidence and Delphi method of expert consultation and voting, 10 recommendations were put forward from two aspects of blood support mode and transfusion strategies, aiming to provide a reference for transfusion resuscitation in the emergency treatment of severe trauma and further improve the success rate of treatment of patients with severe trauma.