OBJECTIVETo analyze the causes of delayed union or nonunion of the ulna after intramedullary nailing in pediatric forearm fractures.

METHODSFrom February 2005 to February 2010,5 patients with forearm fractures who were treated with titanium elastic nailing (TEN) were identified to fulfill the criteria of having developed a delayed union or nonunion of the ulna. The causes of delayed union or nonunion were investigated according to mechanism of injury, fracture location, treatments methods and postoperative management. All patients were male and the age was 3 to 14 years old with an average of 9.4 years. All fractures were located on the mid-third part of forearm. Two cases had a re-fracture. Among them, 3 cases caused by high-energy injury and 2 cases by falling down. Open reduction were performed in 4 cases while the other one was treated with closed reduction. Four patients were immobilized in an above-elbow cast, postoperatively.

RESULTSAll patients were followed up from 7 to 19 months with an average of 11.4 months. There were 4 delayed union and 1 nonunion. Three patients healed after the removal of the nail and avoidance of weight-bearing. Two patients healed by replacing another fixation. No patients had soft-tissue irritation or nail-entry-site infections.. The clinical effect was evaluated according to Daruwalla and Price scores with 3 excellent and 2 good of the results.

CONCLUSIONSUsing titanium elastic nailing for the treatment of pediatric both-bone forearm fractures is a good method. However,strict indication selection should be followed to avoid delayed union or nonunion.

Adolescent ; Child ; Child, Preschool ; Fracture Fixation, Intramedullary ; methods ; Fracture Healing ; Humans ; Male ; Radius Fractures ; physiopathology ; surgery ; Retrospective Studies ; Ulna Fractures ; physiopathology ; surgery

In this paper, Fourier transform infrared spectroscopy fingerprint analysis of Marsdenia tenacissima samples was used to develop a reliable method of tracing the geographical origins. Forty-eight samples from four provinces of China were analyzed by FTIR. We analyzed and characterized the fingerprints in both the full spectrum peaks and characteristic peaks, then the principal component analysis and the cluster analysis were carried out. The results of fingerprint analysis, correlation analysis, principal component analysis and cluster analysis can identify the geographic origins correctly, which verified and supplemented each other; the identification results and the actual location showed a high degree of consistency, namely the lower the space distance, the greater the similarity of different samples. These results revealed the obvious superiority and practical value in comparison to the more tedious and time-consuming wet chemistry method normally used. Using appropriate metrology methods can trace the geographical source correctly. The M. tenacissima materials from the region of Maguan should be considered as genuine medicinal materials taking into account the good quality.
China ; Cluster Analysis ; Drugs, Chinese Herbal ; analysis ; classification ; standards ; Geography ; Marsdenia ; chemistry ; classification ; Medicine, Chinese Traditional ; Principal Component Analysis ; Quality Control ; Reproducibility of Results ; Spectroscopy, Fourier Transform Infrared ; methods

Objective To investigate the incidence of electrocoagulation syndrome after endoscopic submucosal dissection (ESD) in the colorectal laterally spreading tumors (LST) and the risk factors. Methods Data of 51 patients with coloretral LST,treated with ESD from January 2010 to May 2014 at Shengjing hospital affiliated to China Medical University,were reviewed.The incidence of electrocoagulation syndrome was analyzed and logistic regression was used to evaluate risk.Results The incidence of electro-coagulation syndrome was 9.8%(5 /51).The incidence of tumors in the rectal area(7.1%,2 /28)was lower than that of the left half colon (12.5%,1 /8),and the right colon (13.3%,2 /15).Multivariable logistic regression analysis showed that the independent risk factors for the development of electrocoagulation syndrome were LST located in non-rectum area (OR =1.655,P <1.655),lesion size larger than 25 mm (OR =1.028, P <0.05),the operation time longer than 129 min (OR =1.016,P <0.05),age older than 62 year old (OR =0.987,P <0.05).Conclusion For the patients aged over 62 year old,lesion size larger than 25 mm,the operation time longer than 129 min and LST located outside the rectum,the mucous membrane should be separated from the muscularis propria in the ESD procedure to reduce electrocoagulation time as much as possible. In the postoperative period,patients need fasting,fluid replacement support,and prevention of post endoscopic submucosal dissection electrocoagulation syndrome (PEECS).

Objective To evaluate the clinical effects and safety of double-channel forward-view endoscopy for lower-position biliary obstruction after Billroth-Ⅱ gastrectomy.Methods A total of 18 patients with lower-position biliary obstruction after Billroth-Ⅱ gastrectomy were enrolled and treated with doublechannel forward-view endoscopy.The process and the outcomes were recorded.Effectiveness and safety were evaluated.Results Double-channel forward-view endoscopic treatment was successfully performed in 13 of the 18 patients (72％),with stone removal or stents implantion to resolve biliary obstruction.The procedure failed in 5 patients,who were transferred to surgery or underwent percutaneous transhepatic cholangial drainage.Delayed bleeding occurred in 1 patient,and pancreatitis in 2,who were cured after standard treatments.Conclusion Double-channel forward-view endoscopy is effective and safe for lower-position biliary obstruction in patients after Billroth-Ⅱ gastrectomy.

Objectives To investigate the rational treatment strategy of hepatoblastoma (HB) in children. Methods Clinical data and follow-up of 25 children with HB admitted from February 2009 to March 2013 were retrospectively analyzed. Results Twenty-five children with newly diagnosed HB (14 males and 11 females) were enrolled. The median age on diagnosis was 25 months (3-92 months);In 18 of 25 cases with complete resection of the primary tumor, 17 cases survived. Only 1 of 7 cases with incomplete resection survived. The survival rate in children with complete resection of primary tumor is significantly higher than those without complete resection (P<0.05). The survival rate in children of stage I or II is significantly higher than the children of stage III or IV (P<0.05). Conclusions Complete tumor resection is the cornerstone of therapy for long-term disease-free survival in HB patients. Treatment strategy remains to be further improved for children with recurrent and metastatic HB.

Objective To investigate the optimal time for double balloon enteroscopy (DBE) in patients with obscure gastrointestinal bleeding (OGIB).Methods Data of 78 patients with OGIB who underwent DBE from January 2009 to November 2013 were retrospectively analyzed.They were classified into two groups:emergency DBE and non-emergency DBE.The demographic and clinical features and outcomes of DBE,the time of examination and complications were compared.Results The overall diagnostic yield of DBE was 48 lesions (61.54 ％).The overall diagnostic yield of emergency DBE group was 77.14％,which was significantly higher than that in non-emergency DBE group (48.83％) (P =0.019).The time of examination in emergency group was shorter than that of non-emergency group with significant difference (P =0.031).Conclusion Emergency DBE takes less time and yields a higher rate of detection.Patients withOGIB should receive DBE as soon as possible.

ObjectiveTo assess the diagnostic value of EUS for pancreatic neuroendocrine tumors.MethodsClinical data of 26 patients with final diagnosis of pancreatic neuroendocrine tumors,who had underwent EUS and EUS-FNA,were retrospectively analyzed.Results On EUS,pancreatic neuroendocrine tumors presented as hypoechoic masses with clear margins and rich blood flow.Of the 26 pancreatic lesions,3 were in the head,2 in unicate process,2 in neck,11 in body and 8 in tail.The tumors presented with function in 16 ( mean size 9 mm),and on function in 10 ( mean size 29 mm).EUS-FNA yeilded positive results in 22 patients and negative in 4.The accuracy rate of EUS for preoperative localization was 100％ in 23 patients who underwent surgery.ConclusionEUS can provide accurate preoperative localization and pathologic evidence for pancreatic neuroendocrine tumors.

Objective To investigate the effects of donor-specific regulatory T cells (Treg) transfusion on islet allograft survival. Methods Allogeneic fresh islets from Balb/c mice were transplanted to streptozotocin-induced diabetic C57 mice. The survival of islet allografts was observed. The experiment was divided into 3 groups: control group, nothing had been done to the recipients; simple islet transplantation group, the recipients received the islet transplantation only; experimental group, the recipients were given 1 ×106 Treg, then received islet transplantation. Results Blood glucose (BG) was above 16. 7 mmol/L after islet transplantation in control group; In simple islet transplantation group,BG level returned to normal level 1 to 2 days after transplantation, and hyperglycemia appeared 7 to 11 days after transplantation and maintained as the same as that before transplantation; In experimental group, BG level returned to normal level 2 days after transplantation and maintained at a low level,and at the 21st day after transplantation BG level was over 16. 7mmol/L in some recipients. Islet allograft survival in experimental group was significantly prolonged as compared with simple islet transplantation group. Conclusion Donor-specific Treg transfusion could prolong the islet allograft survival,and maybe have positive effect on tolerance induction of islet transplantation.

Objective To evaluate the short-term safety and efficacy of endoscopic implantation of self-expandable metallic stent (SEMs) for malignant colorectal obstruction.Methods A total of 208 patients who had undergone endoscopic SEMs implantation for malignant colonic obstruction from January 2012 to May 2014 at the endoscopy center of Shengjing hospital were enrolled.The technical and clinical success rate and the complications were reviewed.Results The technical and clinical success rates were 99.04％ (206/208) and 96.15％ (200/208), respectively.Abdominal pain, perforation and bleeding were the most common post-procedure complications, the rates of which were 13.46％ (28/208), 2.88％ (6/208), 1.92％ (4/208), respectively.The abdominal pain in most patients was self-relieving except for 6 patients with perforation of colon.Patients with perforation were cured by emergency surgery.One patient with intraperitoneal hemorrhage was also cured by emergency surgery, the other patients developing bleeding recovered themselves.Conclusion The success rate of endoscopic SEMs implantation is satisfactory in the study.As a bridge to surgery or a palliative care method, endoscopic SEMs implantation is effective and safe for malignant colorectal obstruction.

AIM:To evaluate 23G vitrectomy for macular edema in eyes with retinal vein occlusion (RVO) combined with vitreoretinal traction (VMT) or epiretinal membrane (ERM).METHODS:Totally 22 patients (22 eyes) diagnosed with macular edema of RVO combined with VMT or ERM were retrospectively analyzed.Twelve cases performed with 23G vitrectomy together with peeling of inner limiting membrane (ILM) and/or ERM were considered as the observation group or intervention group.Ten cases without vitrectomy were recruited as control group.The best corrected visual acuity (BCVA) and central retinal thickness (CRT) at baseline, 1, 3 and 6mo were recorded and compared.RESULTS:At baseline, the difference of BCVA and CRT between observation group and control group was not statistically significant (P=0.645, 0.206).After vitrectomy, the BCVA and CRT of RVO patients in observation group were significantly improved compared with baseline at each follow-up (F=2.895, P=0.048;F=16.431, P<0.01).However, the BCVA and CRT in control group remained the same as baseline at every follow-up.Moreover, the BCVA and CRT in observation group were much better than that in control group at both 3 and 6mo after vitrectomy.However, the BCVA and CRT between two groups were not significantly different at 1mo postoperatively.CONCLUSION:The 23G vitrectomy could markedly improve BCVA and reduce CRT in RVO patients with macular edema combined with VMT and/or ERM.