Objective: To study the incidence, influencing factors and corresponding treatment of complications of endoscopic retrograde cholangiopancreatography (ERCP) in children with pancreaticobiliary diseases. Method: Clinical data of 172 children aged under 16 years with pancreaticobiliary diseases receiving ERCP between January 2008 and December 2017 in Hangzhou First People′s Hospital were studied retrospectively. Anesthesia type, diagnosis, therapeutic methods and postoperative complications were analyzed. Results: A total of 375 ERCP procedures were performed on 172 patients, among whom there were 210 cases (56.0%) of bile duct diseases and 245 (65.3%) pancreatic diseases. Dissection of pancreatic duct and biliary duct, calculus removal, insertion of endoprosthesis and drainage of pancreatic duct or biliary duct were performed. The success rate of ERCP was 99.5% (373/375). The incidence of complications was 6.7% (25/375) including 13 cases (3.5%) of post-ERCP pancreatitis, 8 cases (2.1%) of bleeding, and 6 cases (1.6%) of postoperative cholangitis. All the complications were cured. No severe pancreatitis, perforation or ERCP-related death occured. The first ERCP procedure and repeated cannulations were the risk factors of post-ERCP pancreatitis (P<0.05). Children had higher risk of post-ERCP bleeding after endoscopic sphincterotomy (P<0.05). Conclusion The incidence of post-ERCP complications in children is similar to that of adults and is related to therapeutic methods. More attention and timely treatment should be given to those children. ERCP can be effectively and safely for children operated by an experienced endoscopic physician with appropriate therapeutic methods.

AIM: To observe the clinical effect of vitrectomy(PPV)combined with internal limiting membrane(ILM)peeling in the treatment of refractory diabetic macular edema.

METHODS: The data of 56 eyes(56 patients)with refractory diabetic macular edema accepted PPV combined with ILM peeling were collected and retrospectively analyzed. The patients were divided into Group A(no posterior vitreous detachment): 35 cases(35 eyes)and Group B(with posterior vitreous detachment): 21 cases(21 eyes). The best corrected visual acuity(BCVA)and central macular thickness(CMT)before and 1, 3, 6mo after operation were compared and analyzed.

RESULTS: The mean CMT and LogMAR BCVA of Group A at 1, 3 and 6mo after operation were significantly different from those before operation(P<0.05); There was no significant difference in BCVA between those before and 1, 3, 6mo after operation in Group B(P>0.05). The mean CMT of 1mo after operation was significantly different from that before operation(P<0.05). There was no significant difference in mean CMT between 3 and 6mo after operation and before operation(P>0.05). CMT and BCVA were significantly different between the two groups at 1,3 and 6mo postoperatively(P<0.05).

CONCLUSION: PPV combined with ILM peeling can effectively treat refractory diabetic macular edema without posterior vitreous detachment, improve the patient's vision; However, PPV combined with ILM peeling was not effective in patients without posterior vitreous detachment.

Objective To analyze the control status and influencing factors of glycosylated hemoglobin (HbA1c) in children with type 1 diabetes mellitus (T1DM) in Tianjin from 2020 to 2021, and to provide a theoretical basis for controlling blood glucose in children with type 1 diabetes mellitus. Methods A total of 538 children with type 1 diabetes, including 275 males and 263 females, were selected from our hospital from January 2020 to June 2021. All the children were determined according to the level of HbA1c and divided into well-controlled group (HbA1c<7.0%, n=469) and poorly controlled group (HbA1c≥7.0%, n=69), 3ml fasting elbow venous blood was extracted from the two groups, and the levels of HbA1c, FPG, 2hPG, TC and LDL-C were compared between the two groups. Clinical data of the children were collected from the medical record system. The factors affecting the control of HbA1c in children with type 1 diabetes were analyzed by univariate analysis and logistic regression. Results The comparison of general data between the two groups showed no significant difference in age, sex and course of type 1 diabetes mellitus (P<0.05). The levels of HbA1c, FPG, 2hPG, TC and LDL-C in poorly controlled group were significantly higher than those in well controlled group (P<0.05). The blood glucose monitoring <60 times/month (OR=3.017), uncontrolled diet (OR=2.871), obesity (OR=2.623) were independent risk factors for poor control of HbA1c in children with type 1 diabetes (P<0.05). Conclusions Children with type 1 diabetes mellitus have a greater risk of poor control of HbA1c. It is necessary to strengthen publicity and education for parents of children with diabetes, regularly monitor blood glucose and control diet to effectively improve blood glucose control in children.

According to the comparison between Ashi points and trigger points, a modern medical explanation that trigger points could be considered as a special Ashi points was put forward, and a further investigation on the enlightenment of theory and practice of trigger points to the pathological specificity, positioning and the intervention methods of trigger points was as follows: Ashi points could be central trigger points, whose pathology is degeneration and contracture of sarcomere; it is not always in the area of pain, while the signs of pain may be helpful for its stereotaxic positioning; the intervention methods of Ashi and trigger points can be learned from each other. This is a new angle of view on Ashi points, which has contributed to the exploration and improvement of its theory and practice.
Acupuncture Points ; Acupuncture Therapy ; Humans ; Pain ; physiopathology ; Pain Management ; Trigger Points ; physiopathology

AIM: To evaluate the efficacy of formaldehyde release agents(FARs)on scleral cross-linking in living rabbits by measuring the changes in scleral biomechanical properties after the cross-linking.

METHODS: Totally 170 healthy New Zealand white rabbits were randomized into 17 groups, including 15 FARs groups(sodium hydroxymethylglycinate, diazolidinyl urea, imidazolidinyl urea, hydantoin and oxazolidine, each of them has three groups based on dosing concentration: 1/10 maximum allowable concentration group, 1/2 maximum allowable concentration group and maximum allowable concentration group), 1 glutaraldehyde(positive control)group and 1 blank control group. Subconjunctivally injected each FAR in the right eye. 60d after the injection, took the sclera at 1:00 and 7:00 sites of the right eye to make scleral strips. The scleral strip's thickness, elastic modulus, creep rate, ultimate stress and ultimate strain were measured to calculate the scleral biomechanical strength.

RESULTS: Sodium hydroxymethylglycinate, diazolidinyl urea, imidazolidinyl urea, hydantoin and oxazolidine increased the scleral biomechanical strength in a concentration-dependent manner. In these drugs, sodium hydroxymethylglycinate, diazolidinyl urea and oxazolidine had strong cross-linking effects, with obvious effects at the 1/10 maximum allowable concentration.

CONCLUSION: Sodium hydroxymethylglycinate, diazoimidazolidinyl urea, and oxazolidine have strong effects on sclera collagen cross-linking, can significantly improve the biomechanical strength of posterior sclera and have the potential to treat pathological myopia.

Objective: To investigate the impacts of ash2 (absent, small, or homeotic)-like (Ash2L) and Jumonji domain-containing protein 3 (Jmjd3) on histone methylation of interferon-gamma(IFN-γ) gene and association with vascular damage of Kawasaki disease (KD) in acute phase. Methods: This study was performed among 36 children with KD in acute phase (KD group) and 28 age-matched health children (control group), who were treated or underwent physical examination in our hospital between February 2015 and June 2016. Patients were further divided into KD groups with or without coronary artery lesions (KD-CAL⁺ , 16 cases; KD-CAL^-, 20 cases). All KD patients were treated with intravenous immunoglobulin. The proportion of type 1 helper T(Th1) cells and protein levels of IFN-γ, T-box expressed in T cells(T-bet), phosphorylated signal transducer and activator of transcription 1(pSTAT1) and phosphorylated signal transducer and activator of transcription 4(pSTAT4) were analyzed by flow cytometry.Chromatin immunoprecipitation was performed to determine histone methylation (histone H3 tri-methyl K4(H3K4me3), histone H3 tri-methyl K27(H3K27me3)) and binding levels of Ash2L, Jmjd3 and Ezh2 associated with IFN-γ in CD4⁺ T cells. Quantitative real-time PCR was used to determine mRNA levels of IFN-γ, interferon γ receptor 1(IFN-γR1), interferon γ receptor 2(IFN-γR2), interleukin 12 receptor subunit beta 1(IL-12Rβ1), interleukin 12 receptor subunit beta 2(IL-12Rβ2), interleukin 18 receptor subunit beta α(IL-18Rα), interleukin 18 receptor subunit beta β(IL-18Rβ), tumor necrosis factor receptor 1(TNFR1), toll-like receptor 4(TLR4), receptor interacting serine/threonine kinase 1(RIP-1) and myeloid differentiation primary response gene 88(MyD88) in CD4⁺ T cells. Plasma concentrations of IFN-γ, interleukin 12(IL-12), interleukin 18(IL-18) and tumor necrosis factor α(TNF-α) were measured by enzyme-linked Immunosorbent assay. Results: (1)The proportion of Th1 and its protein level of IFN-γ were significantly higher in KD group than those in control group and higher in KD-CAL⁺ group than in KD-CAL^- group (all P<0.05), and lower after treatment than before treatment (all P<0.05). (2)Compared with control group, mRNA level of IFN-γ and IFN-γ-associating H3K4me3 was increased, while level of IFN-γ associating H3K27me3 in CD4⁺ T cells was reduced in KD group (all P<0.05), which resulted in a higher rate of H3K4me3/H3K27me3 (P<0.05) in KD group, which was positively correlated with IFN-γ mRNA in KD group(r=0.55, P<0.05). Similar results were found between KD-CAL⁺ group and KD-CAL^- group (all P<0.05). Level of IFN-γ associating H3K27me3 was increased, and mRNA level of IFN-γ and IFN-γ associating H3K4me3 was decreased after treatment than before treatment (all P<0.05). (3)Expression of T-bet protein and binding levels of Ash2L and Jmjd3 with IFN-γ gene were significantly higher in KD group than those in control group(all P<0.05), higher in KD-CAL⁺ group than those in KD-CAL^- group (all P<0.05). These parameters were significantly lower after treatment than before treatment (all P<0.05). Binding level of Ezh2 with IFN-γ gene was similar among various groups (all P>0.05). (4)In comparison with control or after treatment, surface receptors(IFN-γR1/2, IL-12Rβ1/2, IL-18Rα/β, TNFR1 and TLR4) and its downstream molecules(pSTAT1, pSTAT4, RIP₁ and MyD88) in CD4⁺ T cells, and plasma concentrations of inflammatory cytokines(IFN-γ, IL-12, IL-18 and TNF-α) were found to be higher in KD group(all P<0.05). These parameters were also higher in KD-CAL⁺ group than in KD-CAL^- group (all P<0.05). Conclusion Aberrant histone methylation of IFN-γ associating H3K4me3 and H3K27me3 caused by over-binding of Ash2L and Jmjd3 might be involved in immune dysfunction and vascular damage in KD in the acute phase.

Implantable cardioverter defibrillator (ICD) plays an irreplaceable role in preventing sudden cardiac death.There has been a continuous increase in the implantation rate of ICD in children along with technologic improvement.However, the choice of indication, device and implantation approaches of ICD still faces great challenges due to the particularity of children.Related issues on the clinical application of ICD in children, including common diseases, indications and the clinical application of ICD, are reviewed in this paper.

The interventional treatment of congenital heart diseases has been developed for more than 50 years since Rashkind et al.performed balloon atrial septostomy in 1966.From the initial catheter examination and palliative operation to the current radical occlusion, stent implantation, valve replacement, etc, interventional catheterization has become one of main means of treating congenital heart disease.The interventional therapy of congenital heart disease in China has made great progress, but there is still a certain gap with developed countries.This article summarizes the progress of interventional treatments in septal defect diseases, aortic artery to pulmonary artery shunt diseases, valvular diseases, and hybrid therapy, in order to provide reference for the interventional treatment of congenital heart disease in China.

Objective: To retrospectively analyze the laboratory findings and ultrasonographic features in acute phase of children suffering from Kawasaki disease (KD) with stable hemodynamics and Kawasaki disease shock syndrome (KDSS), so as to provide the evidence for early diagnosis, timely treatment and improvement of prognosis of KDSS. Methods: Four hundred and eighteen patients with KD diagnosed at Shenzhen Children′s Hospital from November 2016 to May 2018 were selected, including 23 KDSS patients(KDSS group) and 395 cases with stable hemodynamic(KD without shock group). The clinical characteristics, laboratory index and ultrasonic examination data of the 2 groups were collected and compared for statistical conclusion. Results: (1)The level of C-reaction protein(CRP)[166.20 mg/L (74.40 mg/L)], γ-glutamyl transpeptidase(γ-GT)[88.00 IU/L (126.00 IU/L)], creatine kinase isoenzyme(CKI)[1.78 μg/L (5.17 μg/L)], troponin(TP)[0.01 μg/L (0.39 μg/L)] in the KDSS group in acute phase were all higher than those in the KD without shock group[70.50 mg/L (54.30 mg/L), 40.00 IU/L (89.00 IU/L), 1.20 μg/L (0.85 μg/L), 0.01 μg/L (0.01 μg/L)], hemoglobin(Hb)[90.00 g/L (15.00 g/L)], ablumin [24.20 g/L (4.30 g/L)], serum sodium[130.90 mmol/L (5.60 mmol/L)] levels in the KDSS group were lower than those in the KD without shock group[107.00 g/L (14.00 g/L), 33.40 g/L (4.08 g/L), 136.10 mmol/L (3.25 mmol/L)], and the differences were statistically significant (all P<0.05). (2)The incidence rates of impaired left ventricular ejection fraction(LVEF)[<55%: 3 cases (13.03%) vs.8 cases (2.00%)], coronary artery abnormalities[left anterior descending branch(LAD) Z-score>2.5: 6 cases (26.09%) vs.35 cases (8.86%)]and valvular regurgitation[tricuspid regurgitation(TR)≥moderate: 3 cases (13.03%) vs.5 cases (1.26%)]in the KDSS group were higher than those in the KD without shock group, and the differences were statistically significant (all P<0.05). (3)Among acute phase in KDSS group, 9 cases (39.13%) had liver enlargement, 9 cases (39.13%) had peritoneal effusion, 3 cases (13.04%) had diffuse renal lesions, 3 cases (13.04%) had joint effusion (2 cases of knee joint effusion, 1 case of hip joint effusion), and 2 cases (8.70%) had enteritis.In the KD without shock group, only 3 cases (0.76%) had hepatomegaly and 2 cases (0.51%) had a small amount of knee effusion. Conclusions Laboratory findings of KDSS group showed higher level of CRP, CKI, TP as well as γ-GT than those in KD without shock group, who are more prone to suffer from hypohemoglobin, hyponatremia and hypoalbuminemia.Ultrasound examination showed that KDSS children were more prone to have heart or multiple-organ damage.Clinicians should raise their awareness to provide comprehensive assessment as well as timely and effective treatment.

Objective To explore the application of painless diagnosis and treatment technology in children's peripherally inserted central catheter(PICC)guided by ultrasound.Methods Totally 82 children who planned to undergo PICC in the hospital from January 2021 to January 2023 were selected and randomly divided into a control group and an observation group using a random number table method,with 41 cases in each group;The control group underwent conventional ultrasound guided PICC catheterization,while the observation group underwent painless diagnostic and therapeutic techniques using ultrasound guided PICC catheterization;Compare the success rate of catheterization,completion time of catheterization,degree of pain in the child pain[children's pain behavior scale(FLACC)],tolerance[Houpt behavior scale(HBS)],compliance[Frankl scale(FCS)],and family satisfaction between the two groups.Results The success rate of catheterization in the observation group was higher than that in the control group,and the catheterization time was shorter than that in the control group,with a statistically significant difference(P<0.05).The FLACC score of the observation group was lower than that of the control group,while the HBS score and FCS score were higher than those of the control group,with a statistically significant difference(P<0.05);The total satisfaction of family members in the observation group was higher than that in the control group,and the difference was statistically significant(P<0.05).Conclusion The use of painless diagnosis and treatment technology in ultrasound-guided PICC catheterization in children can improve the success rate of catheterization,shorten the catheterization time,reduce the degree of pain in children,enhance tolerance and compliance,and improve family satisfaction.