OBJECTIVETo explore the clinical effect of Hook-screw combination treatment for the unstable Hangman's fracture.

METHODSFrom March 2005 to May 2008, 17 patients with unstable Hangman's fracture, of whom there were 15 males and 2 females aged from 28 to 75 years old with an average age of 46 years, were treated by Hook-screw combination. Of injury reasons, there were 8 patients caused by falling injury, 5 patients caused by traffic accident injury, 3 patients by tumble and 1 patient by crash injury of heavy object. Type of bone fracture: there were 3 patients with type II, 5 patients with type I a and 9 patients with type Ill. The level of nerve injury according to ASIA criteria, there were 3 patients with grade C, 5 patients with grade D and 9 patienst with grade E.

RESULTSAll patients were followed up for 3 to 22 months averaged 8 months. All patients were recover completely without upper cervical spine pain and C2, C3 loss of reduction. No patients' nerve function was injured in the patients with normal function before operation. The patients with injured nerve function before operation improved 1 to 2 grade.

CONCLUSIONThe method of transarticular Hook-screw combination treatment for the unstable Hangman's fracture can obtain effective anatomical reduction and biological stability.

Adult ; Aged ; Bone Screws ; Female ; Fractures, Bone ; diagnostic imaging ; physiopathology ; surgery ; therapy ; Humans ; Internal Fixators ; Male ; Middle Aged ; Tomography, X-Ray Computed ; Treatment Outcome

ObjectiveTo investigate the identification and treatment of variation of extrahepatic bile duct in laparoscopic cholecystectomy (LC), and to reduce the occurrence of bile duct injury. MethodsThis study included 60 patients who received LC in the People′s Hospital of Caidian District in Wuhan and had structural variation of extrahepatic bile duct found during the operation from January 2012 to January 2014. The clinical data were retrospectively analyzed, and the intraoperative and postoperative conditions were summarized. ResultsDuring operation, cystic duct variation was found in 32 cases, abnormal position of the point where the cystic duct joins the extrahepatic bile duct in 20 cases, the cystic duct and the common hepatic duct having the common wall before joining the common bile duct in 2 cases, aberrant bile duct in the gallbladder bed in 2 cases, and accessory hepatic duct in 4 cases. Fifty-one patients (85%) successfully underwent LC; 9 patients (15%) were converted to open surgery. All patients finished surgery successfully. There were 2 cases of postoperative complications; one patient developed residual stones in the bile duct, and bile leakage occurred in the other patient at one week after LC, who recovered after reoperation. All patients were cured and discharged, without severe complications such as intraperitoneal hemorrhage, infection, and intestinal injury. ConclusionIdentifying the structural variation of extrahepatic bile duct, dissecting the Calot′s triangle meticulously, and determining the type of variation of extrahepatic bile duct play important roles in LC and significantly reduce the incidence of bile duct injury.

AIM: To detect the thickness of tear film lipid layer(LLT)in children with abnormal blink, to explore the relationship between abnormal blink and LLT, and to find out the diagnostic value of LLT in children with abnormal blink.

METHODS: Prospective comparative study. Selecting 46 cases of children with "frequent blink" as the first reason in our ophthalmic outpatient clinic in 2016-11/2017-02 as abnormal blink group. In the same period, 46 children with non-anomalous blink were selected as control group. The history collection, slit lamp examination, refractive examination, Schirmer I test(SⅠt), tear film break-up time(BUT), and the number of times of LLT and incomplete blink(PB)were measured and compared surface light interferometer were compared.

RESULTS: The LLT of the abnormal blink group was 72.17(22.13, 91.00)nm, which was lower than that of the control group 81.97(30.25,95.27)nm,(U=674.5, P=0.028); The mean equivalent spherical degrees(-0.98±3.09D)and SⅠt(11.39±2.46mm/5min)in the abnormal blink group were not different from those in the control group(-0.24±3.06D, 11.74±2.10mm/5min)(P>0.05). Mean PB(0.58±0.28)and mean BUT in the eyes of blink group There was a difference(18.27±5.51s)from the control group(0.43±0.17, 21.01±6.14s)(P<0.05).

CONCLUSION: Children's abnormal blinks are associated with many factors, and the LLT decline may be an important factor in children's abnormal blink.

Objective: To explore the application effects of enhanced computed tomography (CT) and three-dimensional reconstruction technology in the reconstruction of pediatric post-burn scars with expanded flaps. Methods: From May 2016 to March 2019, 19 children with hypertrophic scars after thermal injuries were admitted to our unit, including 10 boys and 9 girls, aged from 4 years and 5 months to 15 years and 11 months. The area of scars ranged from 5 cm×4 cm to 23 cm×9 cm. One or more skin and soft tissue expanders with suitable volume and shape were implanted into the normal skin area around scar of children. Three to six months later, enhanced CT and three-dimensional reconstruction were performed before the second stage operation to obtain three-dimensional images of the vascular branches in the donor site for expanded flaps to be cut, so as to determine the course and distribution of the vascular branches and guide the design of expanded flaps. According to the design scheme, the resection of scar, removal of expanders, and excision and transfer of flaps were performed to repair the wounds after scar resection. The area of flaps ranged from 6 cm×4 cm to 25 cm×10 cm. The donor site was closed directly. The number of flaps was counted. The anatomical structure, vascular distribution, and adverse reactions during enhanced CT and three-dimensional reconstruction of site for expanded flaps to be cut, the survival of expanded flaps and the follow-up after the second-stage operation were observed. Results: A total of 48 expanded flaps were designed and excised in 19 children. The anatomical structure of the site for expanded flaps to be cut and the adjacent spatial position relationship were visually observed through the three-dimensional reconstruction after enhanced CT, and no adverse reactions were observed. Arterial branch blood supply or venous return was observed in 29 sites for expanded flaps to be cut. All the expanded flaps survived well without blood supply disorder after the second stage operation. The children were followed up for 6 months to 1 year and 6 months after the second stage operation. The appearance of the flaps was natural, and the color and thickness of the flaps were similar to those of the surrounding normal skin, except for one child with obvious linear scar. Conclusions Enhanced CT and three-dimensional reconstruction can assist the vascular assessment of the expended flaps, which is helpful for rational design of the flap excision and transfer protocol to improve the survival rate of flaps. Thus, it has certain clinical application value in the reconstruction of post-burn scar in children with expanded flaps.

Objective: To analyze the epidemiological characteristics, clinical manifestations and imaging charac-teristics of 76 cases with neonatal cerebral infarction, in order to provide evidence for the diagnosis, treatment and prognosis for neonal cerebral infarction. Method: Newborns with cerebral infarction admitted into the Neonatal Center, Beijing Children′s Hospital, Capital Medical University from January 2007 to December 2017 were enrolled.According to neurological sequelae, the participants were divided into good prognosis group and poor prognosis group for retrospective analysis, and their cranial magnetic resonance imaging(MRI) changes and mental development were followed up. Results: The incidence of convulsion was the highest in 76 cases (73.7%, 56/76 cases), among which unilateral limb twitching was characteristic in 39.2% (22/56 cases). Clinical physical examination showed no significant positive signs in 13.2%(10/76 cases) of the patients, but middle cerebral artery involvement accounted for 80.3% (61/76 cases), and there was no abnormal discharge of electroencephalogram in 29.2% (19/65 cases) of the patients.Among 41 children (29.3%) received follow-up, 12 cases had neurological sequelae, and 15 cases (36.6%) received anticoa-gulant therapy.The median area of original damage of T2 sequence cerebral infarction was 10.3%, the median area of diffusion weighted image damage was 2.0%, and the median area of damage of T2 sequence was 1.0%.The median ratio of craniocerebral lesion damage was 8.4%.The ratios of poor prognosis were 14.9%, 4.8%, 0.5% and 14.4%, respectively. Conclusions Neonatal convulsion is the most common manifestation of neonatal cerebral infarction.Unilateral limb clonus is characteristic.The larger the infarct involvement area and the larger the intracranial lesion change area through reexamination, the poorer prognosis of the children.Early anticoagulant therapy could not improve the prognosis of neonatal cerebral infarction.

To investigate the relationship between glucocorticoid receptor (GRα, GRβ) expression and hormone sensitivity in kaposiform hemangioendothelioma (KHE) patients complicated by Kasabach-Merritt phenomenon (KMP).Methods: In this study, 25 cases of KHE with KMP (mean age 2.4±1.5 months), including 9 males and 16 females at Henan Provincial People′s Hospital between May 2013 and May 2016 were included. All patients underwent surgical resection after being treated with hormone for one week, and were divided into sensitive group (10 cases) and resistance group (15 cases) according to the efficacy evaluation criteria. Normal tissues collected from 15 patients received surgical excision of lipoma was performed as a control group.Immunohistrochemical SP method was adopted in detecting GRα and GRβ expression in all groups. The expression intensity and positive rate were analyzed. Statistical significance was determined using the Wilcoxon rank sum test for the group samples and the Kruskal-Wallis test for multiple samples. Values of P<0.05 were considered statistically significant. Results: ①There was no significant difference among the control group, the resistance group and the sensitive group in expression intensity of GRα (control group 4.20±1.01, resistance group 4.10±0.99, sensitive group 3.53±0.52, P=0.632). The number of GRα positive cells in the sensitive group(46.20±2.57)was higher than that in the resistance group (40.93±5.18, P=0.032). ②The expression intensity of GRβ in the resistance group(5.40±0.51)was significantly higher than that in the sensitive group(2.60±0.52)and the control group(2.87±0.64, P=0.000, 0.002); there was significant difference among the sensitive group(29.70±2.50), the control group(36.07±3.47)and the resistance group (47.27±5.59)in the number of GRβ positive cells (P=0.000). ③The ratio of GRα/Grβ expression intensity was significantly lower in the resistance group than in the sensitive group and the control group; The ratio of GRα/GRβ positive cells was gradually decreased in the sensitive group, control group and resistance group, and the difference was statistically significant (P=0.000). Conclusions In the tumor tissue of KHE children with KMP, the increase of GRβ expression negatively regulats GRα, leading to imbalance of the expression ratio of the two, which may be an important cause for GC resistance.

Objective To analyze the distribution characteristics of elderly people with chronic obstructive pulmonary disease (COPD) risk in Shanghai, and to investigate the mortality of patients. Methods From January 2015 to December 2019, the COPD surveillance data of Shanghai residents aged not younger than 60 years old was selected. The mortality data of the Shanghai population collected by the Shanghai Center for Disease Control and Prevention was used to analyze the mortality data of the elderly with COPD. Results A total of 3 894 questionnaires for elderly people with COPD risk were collected from 2015 to 2019 in Shanghai, and 879 COPD death data were collected during the same period. Patients in the urban area accounted for relatively a higher proportion. Presence of chronic respiratory symptoms such as chronic sputum, chronic cough, and dyspnea, past or existing exposure to occupational harmful factors, indoor use of polluted fuel, smoking, and severe childhood respiratory infections accounted for the highest proportion. The proportion of people with combined two risk factors of COPD was the highest. From 2015 to 2019, the mortality rate of COPD patients in Shanghai showed a significant year by year decline. Further analysis found that as the age of patients increased, their mortality rate also increased significantly. Conclusion Among the elderly at risk of COPD, the population in the urban area was at higher risk. The chronic respiratory symptoms, exposure history of risk factors, and the combination of two risk factors accounted for a relatively high proportion of the elderly at risk of COPD. From 2015 to 2019, the mortality rate of COPD patients in Shanghai significantly decreased year by year. The mortality rate also increased significantly with the age.

Objective Loop mediated isothermal amplification(LAMP)was used to detect the distribution of pathogens in sputum samples,namely combined nucleic acid detection of respiratory pathogens(13 pairs),so as to provide provide reference for clinical accurate diagnosis and treatment.Methods A total of 1642 patients with lower respiratory tract infection admitted to Tongren City People's Hospital from January to December in 2022 were selected.Each patient collected sputum specimens/bronchoalveolar for detection by using LAMP(13 pairs).The detection of pathogenic bacteria in respiratory tract and the relationship with sex,age and season were analyzed.Results The overall detection rate of 13 respiratory pathogens was significantly higher in males than in females(P<0.01);In different age groups,the detection rates of Haemophilus influenzae and Streptococcus pneumoniae in patients aged 3-6,Mycoplasma pneumoniae in patients aged 6-18,and methicillin-resistant Staphylococcus aureus,Streptococcus maltophilus,and Klebsiella pneumoniae in patients aged over 60 were significantly higher than those in other groups(P<0.05);In different seasonal groups,Streptococcus pneumoniae and Chlamydia pneumoniae were more prevalent in spring,while Mycoplasma pneumoniae had the highest infection rate in autumn,and the differences were statistically significant(P<0.05).Conclusion LAMP can be used to detect the pathogen rapidly and provide the basis for clinical diagnosis and treatment.

Objective: To investigate the inhibitory effect of programmed cell death factor 4 (PDCD4) on arsenic trioxide (As₂O₃)-induced cell growth and nuclear factor kappa B (NF-κB) signaling pathway in neuroblastoma. Methods: The PDCD4 overexpression vector was transfected into neuroblastoma cells and detected by fluorescence quantitative PCR and Western blot. As₂O₃ was used to treat PDCD4 overexpressing neuroblastoma cells. MTT assay was used to measure the proliferation. Colony formation assay was used to determine the cell clone forming ability. Apoptosis was measured by flow cytometry. Western blot was used to detect the expression of NF-κB p65 and cleaved caspase-3 protein in cells. Results: The transfection of PDCD4 overexpression vector significantly increased the expression level of PDCD4 in neuroblastoma cells. The cell survival rates of the control group, PDCD4 group, As₂O₃ group and As₂O₃+ PDCD4 group were 100%, (72.14±5.20)%, (62.58±3.14)% and (40.87±2.47)%, respectively. The colony formation rates in these four groups were (91.25±8.36)%, (65.32±7.14)%, (57.23±5.28)% and (37.14±3.64)%, respectively. In addition, the cell apoptotic rates of these four groups were (3.57±0.24)%, (28.64±3.20)%, (36.41±4.58)% and (49.65±5.27)%, respectively. Therefore, overexpression of PDCD4 in the absence or presence of As₂O₃ inhibited cell proliferation and clone formation ability, while promoted apoptosis. Furthermore, the expression levels of cleaved caspase-3 in the control group, PDCD4 group, As₂O₃ group and As₂O₃+ PDCD4 group were 0.21±0.03, 0.30±0.02, 0.43±0.05 and 0.57±0.06, respectively. And the expression levels of NF-κB p65 protein were 0.68±0.04, 0.52±0.03, 0.43±0.04, and 0.32±0.02, respectively. Compared with the control group, the expression levels of NF-κB p65 protein in PDCD4 group, As₂O₃ group and As₂O₃+ PDCD4 group were significantly decreased (P<0.05), whereas the expression level of cleaved Caspase-3 protein was significantly increased (P<0.05). The changes in As₂O₃+ PDCD4 group were more significant than those in PDCD4 group and As₂O₃ groups (both P<0.05). Conclusion PDCD4 enhances the inhibitory effect of As₂O₃ on the growth and NF-κB signaling pathway in neuroblastoma cells.

Objective: To explore the clinical and genetic characteristics of primary coenzyme Q10 deficiency caused by coenzyme Q4 (COQ4) variants. Methods: Clinical data were collected, while COQ4 gene was sequenced. Results: Here were reported a boy of 3 months old who came to our hospital presented with feeding difficulties, repeated respiratory infections, convulsions for 3 months. He was subsequently diagnosed as cerebral atrophy, and growth retardation. All exons were sequenced.c.211G>A(p.A71T, maternal), c. 436T>A(p.F146I, paternal) were detected. After treatment with coenzyme Q10, the convulsive symptoms improved significantly. Literature review revealed that totally 14 cases with primary coenzyme Q10 deficiency caused by COQ4 gene mutation were reported. The onset age varies from neonatal to 18 years old, and the clinical manifestations are heterogeneous, including cardiomyopathy, epilepsy, ataxia, cerebellar atrophy, respiratory insufficiency, and growth retardation. Conclusion For cases with atypical clinical manifestations of primary coenzyme Q10 deficiency, gene detection is helpful for an early diagnosis and treatment.