Objective: To evaluate the efficacy of ultrasound-guided caudal epidural block for postoperative analgesia in the infants undergoing lobectomy under general anesthesia. Methods: Sixty American Society of Anesthesiology physical status Ⅱ or Ⅲ pediatric patients of both sexes, aged 1-3 yr, weighing 10-16 kg, scheduled for elective lobectomy under general anesthesia, were divided into 2 groups (n=30 each) using a random number table method: control group (group C) and epidural block group (group E). Caudal epidural block was performed under ultrasound guidance after induction of general anesthesia and at 15 min before surgery in group E. An epidural catheter was inserted at T_{6, 7} interspace, 0.1% ropivacaine 1 mg/kg was injected at 5 min after injecting 1% lidocaine 3 ml, the diffusion of epidural fluid was controlled at T_3-10, and the epidural catheter was then removed.An analgesia pump was connected at the end of the surgery in two groups.Pain was evaluated using Face Legs Activity Cry Consolability scale.When Face Legs Activity Cry Consolability scale score>3, the pump was pressed.When pain was still unrelieved 5 min later, sufentanil 0.1-0.2 μg/kg was intravenously injected.The patients were followed up for 48 h after operation, and the requirement for additional remifentanil and sufentanil, and the occurrence of postoperative nausea and vomiting, respiratory depression, hypoxemia and over-sedation was recorded.The number of pressing times, extubation time and duration of intensive care unit stay were also recorded.Pain at 1 and 2 days after operation was evaluated using the Postoperative Pain Measure for Parents. Results: Compared with group C, the consumption of remifentanil, the number of pressing times and requirement for additional sufentanil were significantly decreased, the incidence of each index of the Postoperative Pain Masure for Patients was decreased at 1 day after surgery, the extubation time and duration of intensive care unit stay were shortened, and the incidence of nausea and vomiting and over-sedation was decreased in group E (P<0.05). Conclusion Ultrasound-guided caudal epidural block provides better efficacy and fewer side effects for postoperative analgesia in the infants undergoing lobectomy under general anesthesia.

Objective: To evaluate the clinical effectiveness of combining electrical stimulation with manual massage in treating women′s myofascial pelvic pain (MPPS). Methods: A total of 93 MPPS patients were recruited and randomly divided into an infrared irradiation group (n=30), an electrical stimulation group (n=31) and a combination group (n=32). Those in the infrared group and the electrical stimulation group were given 30 minutes of infrared irradiation or electrical stimulation daily for 10 days, while the combined group was given a manual massage with electrical stimulation. The response to treatment was evaluated using a visual analogue scale (VAS) to rate discomfort, plus a physical examination, and surface electromyography results using Glazer′s protocol. The treatments′ efficacy and the recurrence of pain were evaluated 1 month after the treatment. Results: The average VAS ratings, resting potentials and their variability of the three groups all improved significantly after the treatment. The average VAS scores of the combined and electrical stimulation groups after the treatment were significantly lower than that of the infrared group. Moreover, the total effective rates of the combined group (96.87%) and the electrical stimulation group (80.65%) were significantly higher than that of the infrared group (56.67%), and the resting potential and variability of the former two groups were also significantly better. All of the above measurements among the combined group after the treatment were significantly better, on average, than in the electrical stimulation group. A month later the recurrence rate in the combined group (6.25%) was significantly lower than in the electrical stimulation group (25.81%) and the infrared group (56.67%). Conclusion Electrical stimulation combined with manual massage is effective in relieving myofascial pelvic pain.

Male infertility microsurgery represents the fastest growing sub-specialty in urology and clinical andrology over the past two decades. The importance of microsurgery for male infertility has risen as a part of the urologist's armamentarium in the medical and surgical management of male infertility. Despite the advances in male infertility microsurgery in China, the lack of standardized and well-organized training programs for male infertility microsurgery remains a serious problem affecting its development. In this article, Zhao and Peng have shared their experience with the learning curve of male infertility microsurgery at the Center for Male Reproductive Medicine and Microsurgery, Weill Medical College of Cornell University, which centers on how to pay attention to the details and basic principles of microsurgery. Male infertility microsurgery is physically, technically and mentally challenging, and must be first learned in the laboratory. Clinical success depends heavily upon appropriate training in a microsurgical laboratory. Good training can significantly reduce operation time and surgical errors as well as improve the quality of outcomes.
Andrology ; education ; Humans ; Infertility, Male ; surgery ; Male ; Microsurgery ; education

Objective: To explore the clinical characteristics of multiple magnetic digestive tract foreign bodies ingested by mistake, to review the previous literature and provide reference for clinical treatment. Methods: The clinical data, treatment process and outcome of 8 cases of children with multiple magnetic foreign bodies admitted to Shanxi Children′s Hospital were retrospectively analyzed, and relevant literatures were reviewed. Results: Eight children with multiple magnets were aged 1 to 9 years old, and their medical history ranged from 5 hours to 2 months.Number of magnets ingested was 2-25.During the operation, 6 patients were found with multiple intestinal perforations, 1 with internal fistula and 2 with internal abdominal hernia, with at least 2 perforations and at most 6 perforations.The perforation sites located in the distal esophagus, stomach, duodenum, jejunum, ileum and colon.Seven cases were treated by emergency surgery, and 1 case was removed by colonoscopy and discharged after conservative treatment.One case underwent simple repair, 1 case underwent gastrojejunostomy, intestinal perforation repair; partial intestinal resection was performed in 2 places in 2 cases; partial intestinal resection was performed in 1 place and simple repair in the other places in 2 case; 1 case of fistula in child with intestinal anastomosis laparoscopic exploration, incision bowel resection.Seven cases recovered after surgical treatment.The child with intestinal obstruction after colonoscopy was discharged uneventfully 9 days later by conservative treatment, no complications occurred by followed-up.Combined with experience and literature, we developed a management algorithm for digestive tract magnet foreign body. Conclusion Accidental ingestion of multiple magnets can cause multiple digestive tract perforations, internal hernia, intestinal obstruction and other serious diseases, which should be treated as soon as possible.Therefore, it is necessary to strengthen the understanding of multiple magnet foreign bodies in children, early detection and early treatment.

Hand, foot and mouth disease is a common acute fever and rash disease in pediatrics, which seriously affects children′s health.It is still an important public health problem for children in China.Now, a comprehensive review of early identification and standardized diagnosis and treatment of severe cases, especially critical hand, foot and mouth disease is performed, in order to improve the success rate of severe hand, foot and mouth disease.

Renovascular hypertension accounts for 5%-10% of hypertension in children, which is usually di-fficult to control by medicine and leads to severe clinical complications.However, it is potentially amenable to curative treatment.Clinical early recognition and proper treatment might not only effectively control hypertension, but also preserve renal blood supply and renal function, which is of great significance for the long-term prognosis in children.In this review, the author provide current knowledge of renovascular hypertension in children, including its cause, pathogenesis, diagnostic method, and medical, interventional, and surgical treatment.

Objective: To learn the associated factors for fatal pertussis in children, so as to provide evidence for the prevention and treatment of fatal pertussis. Methods: We searched Pubmed, Embase, Ovid, Web of Science, Wanfang Data, CNKI and CBM up to May of 2020 for the analytical studies about the associated factors for fatal pertussis in children, and used weighted mean difference (WMD) and odds ratio (OR) for a meta analysis. Results : Finally 16 studies our of 5 418 preliminary ones were included. The meta analysis indicated that females (OR=1.36, 95%CI: 1.13-1.64) , low birth weight (WMD=-0.21, 95%CI: -0.40 - -0.03) , young age (WMD=-15.54, 95%CI: -28.97 - -2.10) , small gestational age (WMD=-0.96, 95%CI: -1.77 - -0.16), pertussis immunizations (OR=0.20, 95%CI: 0.11-0.36) , seizures (OR=9.88, 95%CI: 6.94-14.08), spasmodic cough (OR=0.61, 95%CI: 0.47-0.78), increased respiratory rate (WMD=10.68, 95%CI: 3.41-17.95) , increased heart rate (WMD=18.01, 95%CI: 7.33-28.69) , decreased percent oxygen saturation (WMD=-5.38, 95%CI: -10.36 - -0.39) , increased white blood cell counts (WMD=47.70, 95%CI: 40.95-54.46),increased absolute lymphocyte counts (WMD=17.03, 95%CI: 11.00-23.07) , increased absolute neutrophil counts (WMD=11.22, 95%CI: 6.04-16.40), pulmonary hypertension (OR=37.99, 95%CI: 16.76-86.13) , pneumonia (OR=37.65, 95%CI: 27.85-50.90) , encephalopathy (OR=23.38, 95%CI: 8.21-66.54) , any comorbidity (OR=3.00, 95%CI: 1.73-5.23), mechanical ventilation (OR=38.79, 95%CI: 11.81-127.42) , intubation (OR=297.36, 95%CI: 46.20-1 913.98), high-frequency ventilation (OR=18.34, 95%CI: 8.46-39.75) , extracorporeal membrane oxygenation (OR=47.49, 95%CI: 15.53-145.21), inhaled nitric oxide (OR=25.86, 95%CI: 8.52-78.43), use of vasoactive drugs (OR=54.42, 95%CI: 15.71-188.45) and blood exchange transfusion (OR=16.77, 95%CI: 6.53-43.09) were associated with fatal pertussis in children. The results of sensitivity analysis were stable. The results of Egger＇s assay showed publication bias in studies about spasmodic cough, encephalopathy and use of vasoactive drugs, while Begg＇s assay showed no publication bias at all. Conclusions Fatal pertussis in children is associated with gender, age, birth weight, gestational age as well as a variety of clinical features. Early identification and intervention are needed, and vaccination should be strengthened.

Idiopathic hypereosinophilic syndrome (IHES) is a very rare disorder in children, characterized by increased eosinophils in bone marrow, peripheral blood and tissue, resulting in multiple organ damage. We report a case of an 8-yearold girl with IHES, whose initial complaints were diarrhea and abdominal distension. Image examinations indicated that the digestive tract, lung and urinary bladder were all affected. Routine blood test showed that the eosinophilia was 20.64×109/L. Bone marrow smear showed that the mature eosinophilic granulocytes increased to 32%. The FIL1P1/PDGFRA, FGFR1 and IGH gene detection, parasites and antibody tests were all negative. The diagnosis of IHES was considered. The eosinophil decreased significantly and symptoms relieved after steroid treatment, though with recurrences, steroids were still sensitive. Then we reviewed the relevant literature and cases of children with IHES in China.

The application of 3D printing technology in medicine may greatly affect the surgical methods of spinal surgery. Currently, 3D printing technology has been applied to preoperative and intraoperative. Before surgery, 3D printing can be used to create precise anatomical models of spinal deformities. In addition, these anatomical models can be used to plan and simulate complex spinal lesions. 3D printed anatomical models can provide better understanding of anatomy than CT or MRI. During surgery, 3D printing has been used to create surgical guidance systems, create templates and customize specific shapes of implants. Although 3D printing technology still faces the challenge of expensive equipment and materials, this technology has many advantages such as improving patient prognosis and reducing the radiation dose of patients. This article mainly introduces the clinical application and future development of 3D printing technology in spine surgery.

AIM: To investigate the repeatability and agreement of Pentacam Front Section Analyzer and Keratron Scout Corneal Topographer in measuring Kappa angle.

METHODS: Totally 69 patients were randomly selected from Ophthalmology Department of Leshan People's Hospital. Three readings were taken by the same examiner. Results were recorded in(X, Y)coordinates format and assessed by intraclass correlation coefficient(ICC), Cronbach's Alpha Coefficient, t-test, Pearson correlation analysis and bland-altman analysis.

RESULTS: Both instruments showed excellent repeatability in Kappa angle assessment. The results significantly correlated(X value: r=0.90, P<0.01; Y value: r=0.91, P<0.01), however, no significant difference were found between the two instruments. The widest 95% LoA was -0.11-0.14mm for X coordinate and -0.10-0.11mm for Y.

CONCLUSION: Pentacam and Keratron Scout showed excellent repeatability and agreement in Kappa angle assessment. The two instruments could aid and verify each other.