Objective:To explore the clinical outcome of internal fixation in the treatment of AO C-type distal radius fracture accompanied with dorsoulnar fragment involving 1/8 to 1/3 of the articular surface of the lunate facet.Methods:A total of 55 patients of AO C-type distal radius fracture accompanied with dorsoulnar fragment involving 1/8 to 1/3 of the articular surface of the lunate facet from July 2017 to July 2022 in Tongji Hospital Affiliated to Tongji University were retrospectively analyzed. In the volar plate group (volar locking plate treatment alone), there were 22 cases, 11 males and 11 females, aged 56.7±10.1 years, 10 C1 type, 7 C2 type and 5 C3 type. There were 15 patients in the volar plate+dorsal plate group (treated with volar locking plate combined with dorsal plate), including 6 males and 9 females, aged 55.7±8.1 years old, 4 C1 type, 5 C2 type and 6 C3 type. In the volar plate+dorsal screw group (treated with volar locking plate combined with dorsal screw), there were 18 cases, 8 males and 10 females, aged 53.5±11.6 years, 7 cases of C1 type, 5 cases of C2 type, and 6 cases of C3 type. The operation time, postoperative radiographic indicators, wrist range of motion (ROM), disability of arm, shoulder and hand (DASH) score, visual analogue scale (VAS) and postoperative complications were evaluated and compared between the three groups.Results:All operations were successfully completed. Patients were followed up for 14.9 ± 2.2 months (range, 12-18 months), and the fracture healing time was 12.4±2.3 weeks (range, 9-16 weeks). The operative time of patients in the volar plate group, volar plate+dorsal plate group and volar plate+dorsal screw group was 54.3±7.6 min, 70.7±5.9 min and 65.8± 7.1 min, respectively. Patients in the volar plate group had less operative time ( F=27.04, P<0.001). The residual displacement of the dorsoulnar fragment in sagittal, coronal, and axial CT scans in the three groups were (1.3±0.8 mm, 0.6±0.4 mm, 0.7±0.4 mm), (1.1±0.8 mm, 0.6±0.4 mm, 0.6±0.6 mm), (1.4±0.8 mm, 0.7±0.4 mm, 0.7±0.5 mm). The displacement of the dorsoulnar fragment of the two groups of combined volar and dorsal internal fixation was smaller than that of the volar plate group ( P<0.05). The ROM of wrist flexion of the three groups at 3 months after operation were 44.2°±4.6°, 47.7°±5.9°, 48.8°±5.1°, the ROM of wrist extension were 39.8°±6.2°, 44.3°± 4.6°, 44.7°±5.1°, the wrist DASH scores were 23.0±4.2, 20.1±4.1 and 19.4±3.0, and the VAS were 2.3±1.2, 1.6±1.3 and 1.3±1.0, respectively. The ROM of wrist flexion and extension and DASH score in volar plate+dorsal plate group were better than those in volar plate group ( P<0.05). The ROM of wrist flexion and extension, DASH score and VAS in the volar plate+dorsal screw group were better than those in the volar plate group ( P<0.05). There were no significant differences in terms of the wrist ROM, DASH score and VAS at 12 months after operation among the three groups ( P>0.05). There were 2 patients in the volar plate group with reduction loss, 3 patients with wrist chronic pain; 1 patient in the volar plate combined with dorsal plate group with dorsal tendon irritation, and no complications in the volar plate combined with dorsal screw group. Conclusion:For AO C-type distal radius fractures accompanied with a dorsoulnar fragment involving 1/8 to 1/3 of the articular surface of the lunate facet, the use of combined volar and dorsal internal fixation can improve the reduction accuracy and stability of the dorsoulnar fragment, and contribute to the early rehabilitation of postoperative wrist joint function. The effect of combined dorsal screw is comparable to that of dorsal plate internal fixation, but the complications of screw internal fixation are less.

Objective:To analyze the patterns of antibacterial agents in Chinese children surveyed by the China multi-center monitoring network for the application of antibacterial agents in children and neonates in 2019 by using World Health Organization (WHO) Access, Watch, Reserve and Not-recommended (AWaRe) and typical anatomical/therapeutic/chemical (ATC) in this study.Methods:The cross-sectional method was adopted.A multi-center cross-sectional survey was conducted on one day from September to December 2019.The information of all inpatients taking antibiotics was uploaded to the network-based data collection system (https: //garpec-31.mobilemd.cn/login.aspx? relogin=true). This study covered 13 hospitals from 10 provinces and cities in China.All hospitalized children in the Respiratory Department, Infectious Disease Department, General Surgery Department, Pediatric Intensive Care Units, Neonatal Intensive Care Units and Neonatology joined in this survey.The clinically used antibacterial agents were classified by AWaRe and ATC, and the AWaRe and ATC distributions of antibacterial agents prescribed for Chinese children and neonates were described.Results:Of the 2 644 antibiotic prescriptions included from 13 hospitals, 2 134 (80.71%) were for children and 510 (19.29%) were for neonates.Of all antibiotic prescriptions, there were 368 (13.92%) Access antibiotics prescriptions, 1 973 (74.62%) Watch prescriptions, 60 (2.27%) Reserve prescriptions and 243 (9.19%) Not-recommended prescriptions.The top-five antibiotics prescribed for children and neonates were third-generation cephalosporins (1 056, 39.94%), macrolides (492, 18.61%), carbapenems (275, 10.40%), beta lactam-beta lactamase inhibitors (246, 9.30%), and second-generation cephalosporins (136, 5.14%). The use ratios of Access, Watch, Reserve and Not-recommended antibiotics in each center ranged from 0 to 30.00%, 36.67% to 97.20%, 0 to 17.02% and 0 to 33.33%, respectively.In 1 360 antibiotic prescriptions for children and neonates with pneumonia, there were 152 (11.18%) Access antibiotics, 1 051 (77.28%) Watch antibiotics, 37 (2.72%) Reserve antibiotics, and 120 (8.82%) Not-recommended antibiotics.The top-five antibiotics prescribed for children with pneumonia were third-generation cephalosporins (522, 38.38%), macrolides (388, 28.53%), beta lactam-beta lactamase inhibitors (141, 10.37%), carbapenems (117, 8.6%) and penicillins (49, 3.60%).Conclusions:Watch antibiotics and broad spectrum antibiotics such as third-generation cephalosporins and macrolides prone to induce resistance are the main antibacterial agents used in Chinese children and neonates with pneumonia.Broad-spectrum antibiotics may be overused in Chinese children and neonates.

Acute respiratory tract infection is the most common infectious disease in children, which seriously threatens children′s health.Rapid and accurate etiological diagnosis is of great significance for the clinical treatment and control of these diseases.Pathogen nucleic acid test was applied and became the main method of respiratory tract infection diagnosis for its high sensitivity and specificity.To regulate the application of pathogen nucleic acid amplification test in respiratory tract infection in children, improve the diagnosis level, expert consensus on nucleic acid amplification test of respiratory pathogens in children was prepared to guide the application and promote pathogens diagnosis ability.