Objective To explore the change of degrade of clonazepam in serum with single and repeated - dose administration in children with seizure, and find a reasonable method for using the clonazepam. Methods Children with seizures were divided into single - dose paradigam, repeated - dose paradigam, and decreased - dose paradigam. The concentration of CZP in serum was determined by high performance liquid chromatography( HPLC). Results The serum concentrations of clanazepain in single - dose paradigam were (101.9?12.1),(76.9 ? 5.8),(50.7?2.9),(30.9?5.4),(21.5?6.8)?g/L,the time point that the blood samples collected were 15,30,60,120 and 480 min. The serum concentrations in repeated - dose paradigam were (97. 2 ? 6. 1),(130.4? 13. 4), (99. 4 ? 9.8),(79.6?2.4)?g/L,in decreased-dose paradigam were( 101.1 ?13.1),(123.1 ?6. 6), (99.4 ?9. 8), (79. 3 ? 2. 2)?g/L,in these two groups,the time point were 15,45,60 and 120 min. Conclusion Repeated administration of CZP with decreased dose may increase its effectiveness in treatment without substantially increasing toxicity.

Acute Disease ; Adolescent ; Adult ; Aged ; Child ; Female ; HLA-G Antigens ; metabolism ; Humans ; Interleukin-10 ; metabolism ; Leukemia ; metabolism ; Male ; Middle Aged ; Young Adult

Objective To study the iodine deficiency disorders (IDD) situation in Wenzhou City during 1995-2014.Method According to National IDD Surveillance Project,IDD surveillance had been consecutively carried out during the past 20 years,which consisted of goiter rate in 8-10 years old children,iodized salt and urinary iodine levels.Results The goiter rate of 8-10 years old children was decreased from the highest of 31.09％ (2 190/7 043) in 1995 to the lowest of 2.28％ (77/3 378) in 2014;the highest level of median urinary iodine was 214.78 μg/L,and the lowest level was 74.48 μg/L,and which was increased from 74.48 μg/L in 1995 to 187.00 μg/L in 1996,and then had been maintained at the appropriate level recommended by World Health Organiation (WHO),except that in 1998,2003,2004 and 2006.The qualified rate of iodized salt was increased from 54.95％ (1 471/2 677) in 1996 to 95.52％ (2 548/2 754) in 1999,but decreased to 62.75％ (768/1 224) in 2003,however it was fluctuated from 78.61％ (2 503/3 184) to 92.48％ (2 989/3 232) from 2004 to 2013,and it was 90.43％ in 2014 (2 983/3 300).Conclusions The comprehensive measures for controlling IDD,with universal salt iodization,has been gradually achieved remarkable effect in Wenzhou City,but the non-iodization salt existing in the market is still a problem,and people have misunderstandings about iodization salt.Iodine supplementation had better be conducted according to local conditions and based on scientific policy.

Objective To study the factors influencing the recurrence of aggressive fibromatosis(AF) patients.Methods Analyze clinical features and find out factors affecting AF recurrence with univariate and multivariate analysis. Results One hundred and three AF patients were analyzed. Diameter of all the masses was (7.84?5.62)cm. 98.2% of all patients received surgery and radical resection rate is 79.4%. First recurrent time after surgery of male and female is (1563?377) and (2117?3704) days for male and female cases respectively,it's (2723?461),(657?262),(2090?499),(812?220) and (721?234) days for that of abdomen wall、head and neck(H & N),deep mass,joints and chest wall. Recurrent time is (2232?271) and (1347?267) days for those with or without surgery history patients. Univariate analysis showed that gender,tumor site and surgery history of tumor site are prognostic factors of tumor recurrence. Multivariate analysis suggest that only surgery history of tumor site is an independant prognostic factors of AF recurrence after surgery. Conclusion Gender,tumor location and surgery history of tumor site can be valuable to predict postsurgery recurrence of AF.

ObjectiveTo evaluate the clinical and functional outcome of traumatic segmental defects of the tibia treated by internal bone transport using the the adjustable mono-lateral external fixation.Methods12 patients who underwent internal bone transport using the the adjustable mono-lateral external fixation for traumatic segmental defects in the tibia were reviewed, the length of bone defect was 6～10 cm.ResultsMean follow-up was 14 months. All the cases got primary bone union. The length of time in healing was 9～14 months.ConclusionTraumatic segmental defects of the tibia treated by internal bone transport using the adjustable mono-lateral external fixation is a simple, less traumatic, non-bone graft and effective way.

Three cases of Langerhans cell histiocytosis (LCH)with central diabetes insipidus as the first manifestation were reported, with the summary of their clinical manifestations, laboratory examinations, imaging examinations, pathological results, diagnosis process, and treatment response. All three patients presented with central diabetes insipidus in the early stage. The pituitary magnetic resonance imaging (MRI)showed thickened pituitary stalks, and all lost the normal high signal of the posterior pituitary. Two patients showed isolated hypothalamic-pituitary lesions, while one case showed pituitary and thyroid systems involvement. Pathological findings showed typical Langerhans cells, immunohistochemistry showed positive for S-100, CD1a, Langerin. The clinical manifestations of LCH manifested distinct heterogeneity, which is easy to be misdiagnosed and left out. The diagnosis should be confirmed by pathological examination. The biopsy of isolated hypothalamic-pituitary lesions is difficult. It is recommended to actively screen other organs to increase the probability of biopsy. LCH-induced neurohypophysis requires life-long hormone replacement therapy.

BACKGROUND: Three kinds of donor meniscus are commonly used at present, namely cryopreserved, fresh and deep-frozen meniscus, which,however, almost invariably give rise to degenerative changes of various degrees after transplantation.OBJECTIVE: To compare the outcome of transplantation of allograft deep-frozen meniscus and meniscal acellular matrix to determine the most preferable means of allograft meniscus preservation.DESIGN: Randomized controlled experiment with rabbits.SETTING: Department of Orthopedics, Second Hospital Affiliated to Harbin Medical University.MATERIALS: Sixty-four male Japanese white rabbits with body mass of 3.0 - 3.5 kg.METHODS: This experiment was carried out in the Animal Experimental Center, Second Hospital Affiliated to Harbin Medical University between September 2002 and September 2003. Totally 64 adult rabbits were assigned into 32 pairs according to the body weight to served as the donor and the recipient animals, respectively. The medial menisci was obtained from the bilateral knees of the donor animals with the right one cryopreserved at -80 ℃ and the left prepared into acellular matrix for deep-frozen preservation. The donor menisci were respectively transplanted into the corresponding knee joints of the recipient animal's hindlimbs, with the left side taken as the experimental side and right as control. Gross observation,X-ray examination, and histological examination of the tissues were carried out at postoperative 4, 8, 12 and 16 weeks, respectively.MAIN OUTCOME MEASURES: Findings in X-ray, gross observation and histological observation of the grafted meniscus with meniscal measurement and findings in abdominal aorta perfusion.RFSULTS: All the 64 rabbits were observed for result analysis. X-ray examination of the grafted meniscus revealed no obvious changes in either the experimental and control side at 4 and 8 weeks postoperatively, but mild changes occurred on the control side at 12 weeks, which became obvious at 16 weeks, presented by joint space narrowing, hyperostosis and osteosclerosis below the cartilage of varied severities (with scores of 1.3 and 0.6, respectively, P ＜ 0.05). By gross observation, meniscal atrophy on the experimental side was milder and slower than the control side, with al so lower atrophy rate [(15.14±4.62) % vs (20.97±4.72) % at week 4, P ＜ 0.001, and (19.23±11.27) % vs (32.74±10.43) % at week 16, P ＜ 0.05].Perfusion of the abdominal aorta revealed no revascularization in the surrounding tissues of the meniscus by gross observation in either groups, but histologically, the experimental side showed more favorable structure than the control side at postoperative weeks 4, 8, 12 and 16.CONCLUSION: Meniscal acellular matrix may produce better outcome than deep-frozen meniscus after transplantation and can be a more practical means for preservation of the meniscus.

OBJECTIVETo explore the effective method of preventing cubitus varus deformity in nonoperative treatment of humeral supracondylar fracture in children.

METHODSFrom May 1992 to December 2013,319 patients with hemeral supracondylar fracture in children were treated with manual reduction and external plaster fixation in extension position. There were 253 males and 66 females, aged from 15 months to 13 years old with an average of 6.7 years. Among the patients with humeral supracondylar fracture, extension type was in 284 cases and inflexion type was in 35 cases; 167 cases on the left and 152 cases on the right. Injury to treatment time was 1 hour to 7 days with a mean of 1.8 days. No included nerve injury and operative case in the patients.

RESULTSAll patients were followed up from 3 months to 14 years with an average of 37.3 months. All fractures obtained bone healing and healed time was 6 to 8 weeks with an average of 6.9 weeks. No complications of serious cubitus varus deformity,vascular nerve injury or volkmann contracture were found. In 183 cases, the carrying angle was consistent with itself contralateral,ranged from 5° to 15°; in 105 cases, the carrying angle of uninjuryed side was decreased. During the reset, the carrying angle of 26 patients with ulnar deviation angle was for -5° to 0°; and 5 patients with radial deviation angle was for 15° to 18°, basically does not affect the appearance. The activities of all elbow joint were normal.

CONCLUSIONExternal plaster fixation in extension position has some value to preventing cubitus varus deformity in nonoperative treatment of humeral supracondylar fracture in children and hope that more scholars to do further study.

Adolescent ; Casts, Surgical ; Child ; Child, Preschool ; Female ; Fracture Fixation ; methods ; Humans ; Humeral Fractures ; surgery ; Infant ; Male

Objective:To assess the guidance of 3D reconstruction in the surgical and orthodontic management of maxillary palatal impacted canines with cone-beam computed tomography (CBCT).Methods:22 adolescent patients with 26 impacted maxillary conines were examined by CBCT.CBCT 3D reconstruction was used to observe the impaction of the canines.Measurements were taken to evaluate spatial relationship between the canine and adjacent structures and resorption of neighboring incisor roots.Results:CBCT was effective to localize the impacted canines.All of the maxillary palatal impacted canines inclinated mesially,angles of impacted ca-nines to occlusal plane were 61.1°±18.1°,there were 8,5,3 and 10 impacted canines found in classⅠ,Ⅱ,Ⅲ and Ⅳ mesial mal-position respectively.3 adjacent lateral incisors and 2 central incisors were extracted because of severely root resorption.Normal occlu-sion was achieved for 26 impacted canines by the traction of the canines into dental arch and reaching the occlusal plane.Conclusion:CBCT can spatially show the palatal impaction of maxillary canines and the relationship to adjacent tooth,can guide the treatment plan and traction direction,therefore increase therapeutic effect.

Objective:To report the diagnosis, treatment, and follow-up of a 21-hydroxylase deficiency boy with central precocious puberty caused by complex heterozygous mutation of CYP21A2 gene.Methods:The child was symptomatic of rapid growth and secondary sexual characteristics at the age of 6. The diagnosis of central precocious puberty was confirmed by serum testosterone, gonadotropin levels, and gonadotropin-releasing hormone (GnRH) stimulation test. 21-hydroxylase deficiency was diagnosed clinically based on the serum adrenocorticotropic hormone (ACTH), 17-hydroxyprogesterone levels, and images on the computed comography (CT) of the adrenal glands.Results:The CYP21A2 gene was detected to have a compound heterozygous mutation by Sanger sequencing and multiplex ligation-dependent probe amplification. During the 3 years follow-up, the effects of glucocorticoids, GnRH analogs, and recombinant human growth hormone were regularly monitored and evaluated.Conclusions:Glucocorticoid replacement followed the principle of the lowest effective dose. GnRH analogs showed an effective inhibition of the hypothalamus-pituitary-gonadal axis, while recombinant human growth hormone had no such growth-promoting effect.