Objective To investigate the clinical efficacy of lengthening osteotomy for leg bone defect. Methods The clinical data of 22 patients who received lengthening osteotomy for leg bone defect from February 2005 to March 2011 were retrospectively analyzed. Operative methods were designed according to the patients' general condition, condition of fracture nonunion and bone defect accompanied by osteomyelitis. They included Z-shaped, oblique, and cortical bone osteotomy. The modified Ilizarov external fixator was used after osteotomy. Bone lengthening was performed 1 week after the operation, and the lengthening rate was 0.5-1mm/d. Results The bone defects achieved bone union in the 22 patients by fixation and lengthening for 3-10 months (8 months on average), followed by external fixation for 6 months to achieve clinical union. The follow-up period for all the patients ranged from 12 to 15 months, and remediable complication was found in 2 patients (1 mild, 1 moderate), and no irredeemable complication was observed. Conclusions Lengthening osteotomy is safe, reliable, and easy to operate. Furthermore postoperative nursing care is simple and complications are less, thus it is an ideal surgical method for leg bone defect.

ObjectiveTo explore the clinical effect of modified Wuhutang in the treatment of children with acute asthma. MethodA total of 130 children with acute asthma were randomly divided into an observation group and a control group， with 65 cases in each group. The observation group was treated with modified Wuhutang and the control group was treated with procaterol hydrochloride for one week. The scores of primary symptoms （wheezing， cough， shortness of breath， and chest tightness） and secondary symptoms （mental status， runny nose， dry mouth， tongue texture， tongue coating， stool， etc.）， lung functions， immunoglobulin E （IgE） expression， eosinophil （EOS） count， and serum inflammatory factors， including interleukin （IL）-5， IL-6， IL-8， and IL-1β in two groups before and after treatment were compared. ResultThe data of 126 children were statistically analyzed. As revealed by the results， compared with the conditions before treatment， the scores of primary symptoms and secondary symptoms， serum levels of IL， IgE expression， and EOS count were both reduced in two groups （P<0.05）， lung functions were increased in the two groups（P<0.05）. Compared with the control group after treatment， the observation group showed decreased scores of cough and secondary symptoms （P<0.05）， and insignificant decrease in IL-1β （P<0.05）. The improvement in lung functions， IgE expression， and EOS count in observation group was equivalent to that in control group. ConclusionModified Wuhutang for treatment of acute asthma in children （phlegm-heat obstructing lung syndrome） can significantly relieve the clinical symptoms， improve lung functions， and reduce IgE， IL-5， IL-6， IL-8， IL-1β expression levels and EOS count， and its overall clinical efficacy is superior or equivalent to that of tprocaterol hydrochloride.

Objective: To investigate the value of thoracoscopy in diagnosis and treatment of pleural diseases in children. Method: Clinical manifestations and treatment outcomes of 19 patients who had refractory pleural diseases treated with thoracosocy during May 2011 to August 2016 in Hunan Provincial People′s Hospital were retrospectively analyzed. In 19 cases, 15 were male and 4 were female, with an average age of (4.8±2.0) years. Thirteen patients had left pleural lesion, while 5 patients had right lesion, and 1 had bilateral lesions. Result: All cases were successfully treated with thoracoscopy without emergent thoracotomy. Pre- and post operative diagnosis was compatible in 10 cases, including 8 cases of empyema (Streptococcus pneumoniae infection in 6 cases, and Staphylococcus Aureus infection in 2 cases), and 2 cases of tuberculous pleuritis. Nine patients who had not been clearly diagnosed before surgery were diagnosed to be empyema (4 case), tuberculous pleuritic (3 cases), mycoplasma infection (1 case), and foreign body with infection (1 case) by thoracoscopy. The average duration of post-op closed thoracic drainage was (4.7±2.3) days. The average time to get normal temperature was (2.4±2.6) days. And the average length of hospital stay was (6.7±1.8) days. No hemothorax, chylothorax, or need for analgesic occurred. Conclusion Thoracoscopy can be recommended for diagnosis and treatment of refractory pleural lesions diseases in children, with minimal trauma and complications.

Most gastrointestinal endoscopic procedures are now performed with sedation. Moderate sedation using benzodiazepines and opioids continue to be widely used, but propofol sedation is becoming more popular because its unique pharmacokinetic properties make endoscopy almost painless, with a very predictable and rapid recovery process. There is controversy as to whether propofol should be administered only by anesthesia professionals (monitored anesthesia care) or whether properly trained non-anesthesia personnel can use propofol safely via the modalities of nurse-administered propofol sedation, computer-assisted propofol sedation or nurse-administered continuous propofol sedation. The deployment of non-anesthesia administered propofol sedation for low-risk procedures allows for optimal allocation of scarce anesthesia resources, which can be more appropriately used for more complex cases. This can address some of the current shortages in anesthesia provider supply, and can potentially reduce overall health care costs without sacrificing sedation quality. This review will discuss efficacy, safety, efficiency, cost and satisfaction issues with various modes of sedation for non-advanced, non-emergent endoscopic procedures, mainly esophagogastroduodenoscopy and colonoscopy.
Analgesics, Opioid ; Anesthesia ; Benzodiazepines ; Colonoscopy ; Conscious Sedation ; Deep Sedation ; Endoscopy ; Endoscopy, Digestive System ; Health Care Costs ; Propofol

AIM:To observe and analyze the effect of non-mydriatic fundus photography in screening diabetic retinopathy(DR), so as to provide the basis for clinical screening.

METHODS:In our hospital from December 2016 to November 2017, 120 patients(240 eyes)was diagnosed as diabetes(DM), which were treated as the subjects of observation. By the same operator with non-mydriatic fundus photography, fundus photography and 7 range fundus fluorescein angiography(FFA)after mydriasis were taken. Taking the international clinical classification of diabetic retinopathy(DR)as the standard, the above three examinations were review, grade and record by the same physician by blind method. The fundus fluorescein angiography as the gold standard, the other two results were compared to detect the sensitivity, specificity, Youden index, Kappa value of the two for DR with different grade.

RESULTS: There was 70.0% eyes diagnosed as diabetic retinopathy after screened by fundus angiography, 66.7% by post-mydriatic fundus photography, 65.0% by non-mydriatic fundus photography. The grading results of diabetic retinopathy screened by different methods were basically consistent, with no significant difference(P>0.05). When screening for diabetic retinopathy of different degrees, the sensitivity and specificity of the non-mydriatic group were 92.9% and 90.3%, respectively. There was no significant difference between the results of the non-mydriatic group and the non-mydriatic group. Compared with the gold standard group(FFA), the Youden index(83.14%)was close to 1, with high reliability; Kappa=0.81, and the validation was consistent. When screening for moderately nonproliferative diabetic retinopathy, the sensitivity and specificity of non-mydriatic fundus photography were 90.6% and 95.5%; there was no significant difference between the results of non-mydriatic and the results of fundus photography after mydriasis. Compared to the gold standard group, the Youden index was 86.09%, the reliability is high, Kappa=0.86, and the test was consistency.

CONCLUSION:Non-mydriatic fundus photography can be used as a simple and accurate method for screening diabetic retinopathy. It is simple and easy to carry out without risk. It is easy to train specialist technicians for multi-point operation. With the help of today's convenient network, the image is transmitted to an experienced ophthalmologist for reading and diagnosis, which is convenient and fast, so that the patient can be diagnosed and treated nearby, which has positive significance for the society.

AIM: To observe the effect of built-in type OASIS iris expander in phacoemulsification surgery for cataract with small pupil.

METHODS: Totally 44 cataract patients with small pupil were treated in our hospital from January 2016 to October 2017 were randomly divided into the control group(22 cases, 31 eyes)and the observation group(22 cases, 30 eyes). The patients in control group was treated by conventional phacoemulsification surgery, within surgery the small pupils were dilated by cleavage and lens position hook; the patients in observation group use OASIS iris expander within surgery. The best corrected visual acuity(BCVA), corneal endothelial cell counts, pupil size, intraocular pressure(IOP)of two groups before and after surgery were compared and analyzed, and the application effect of built-in type OASIS iris expander was evaluated.

RESULTS: At 1mo after operation, the BCVA of the two groups were significantly improved, and the BCVA of the observation group(0.09±0.04)was significantly better than that of the control group(0.20±0.03), the difference was statistically significant(P<0.05). At 1mo after operation, the corneal endothelial cell counts of the two groups were significantly decreased, but the corneal endothelial cell counts of the observation group(2455.77±52.98/mm²)were significantly higher than those of the control group(2298.94±49.12/mm²), the difference was statistically significant(P<0.05). At 1mo after operation, the pupil diameter of the two groups was enlarged(P<0.05), and the pupil diameter of the observation group(3.52±1.14mm)was larger than that of the control group(3.15±1.02mm, P>0.05). At 6mo after operation, the pupil diameter of the two groups was significantly enlarged(P<0.05), but there was no significant difference in the pupil diameter between the two groups(P>0.05). At 1mo after operation, intraocular pressure in both groups was lower than that before operation(P<0.05), and the intraocular pressure in observation group(13.40±1.73mmHg)was lower than that in control group(13.93±1.98mmHg, P>0.05). At 6mo after operation, intraocular pressure in both groups was lower than that before operation and 1mo after operation(P<0.05), but there was no significant difference in intraocular pressure between the two groups at 6mo after operation(P>0.05).

CONCLUSION: The OASIS built-in iris dilator can improve the best corrected visual acuity, reduce intraocular pressure and expand pupil diameter in small pupil phacoemulsification.

ObjectiveTo investigate the effects of Monsel′s solution on bleeding in endoscopic sclerotherapy for esophageal varices. MethodsOne hundred and sixteen patients with cirrhosis and esophageal variceal bleeding who were admitted to our hospital from February 2013 to February 2015 were enrolled as subjects. All patients received endoscopic sclerotherapy. Forty-six patients had hemorrhage after removal of needles, and they were treated with topical spraying of 15% Monsel′s solution. The instant and long-term hemostatic effects were evaluated. ResultsAfter spraying of 15% Monsel′s solution, the immediate formation of coagulum and no bleeding were found in the bleeding spots of 46 patients undergoing bleeding in endoscopic sclerotherapy. At one week after surgery, the blood pressure, pulse, fecal occult blood, and routine blood indices were evaluated, and no signs of active bleeding were found. ConclusionThe response rate of topical spraying of Monsel′s solution is 100%. Moreover, with a convenient preparation, few adverse reactions, and low economic burden on patients, the simple method is the best choice in the treatment of bleeding in sclerotherapy.

ObjectiveTo explore the clinical value of low- and high-frequency ultrasound in the diagnosis of benign lesions of the gallbladder. MethodsA retrospective analysis was performed in 110 outpatients with pathologically confirmed benign lesions of the gallbladder in our hospital from January 2015 to January 2016. All patients were examined with low-frequency ultrasound, and the results were recorded. Then, they were examined with a combination of low- and high-frequency ultrasound, and the results were recorded. The rate of agreement with pathological diagnosis was compared between the two examination methods. The chi-square test was used for comparison of categorical data between groups. ResultsIn the 110 patients, 83 had the low-frequency ultrasound results in accordance with pathological diagnosis; 102 had the low- and high-frequency ultrasound results in accordance with pathological diagnosis, consisting of 70 cases of polypoid lesions of the gallbladder (68.63%) and 32 cases of adenomyomatosis of the gallbladder (31.37%). Eight (7.3%) of the 110 patients were misdiagnosed by the combined examination. The rate of agreement with pathological diagnosis of the combined examination (9273%) was significantly higher than that of low-frequency ultrasound (75.45%) (χ2=12.666, P=0.001). ConclusionsA combination of low- and high-frequency ultrasound helps increase the diagnostic rate for benign lesions of the gallbladder.

AIM: To investigate the effects of conjunctival approach, lateral approach, skin approach and lateral medial conjunctival approach on visual acuity, tumor residual rate and complications in patients with deep cavernous hemangioma of the orbit.

METHODS: Totally 114 patients with deep cavernous hemangioma of the orbit were divided into group A(30 cases, conjunctival approach), group B(34 cases, translateral approach)and group C(27 cases, transcutaneous)according to the surgical approach. The approach and the D group(23 cases, combined with the medial conjunctival approach via the lateral side), compared the visual acuity improvement effect, tumor residual rate and postoperative complications in the four groups.

RESULTS: There was no difference in visual acuity improvement between the four groups(P=0.918). The residual tumor rates of patients in group A, group B, group C and group D were 0, 2.9%, 3.7%, and 0, respectively. There was no difference in the incidence of postoperative complications between the four groups(P=0.244).

CONCLUSION: According to the indications of deep cavernous hemangioma of the orbit, the reasonable choice of minimally invasive surgery can effectively maintain the normal visual acuity level and the safety is consistent.