Treatment of calcaneal fractures has always been the focus of many clinical researchers.The goals of traditional surgical treatment are not only to restore the integrity of calcaneal articular surface but also to reconstruct the anatomy of the calcaneus.More importantly,we need to reduce postoperative soft tissue swelling and incidence of postoperative complications.In recent years,scholars have reported satisfactory clinical efficacy and prognosis resulting from a sinus tarsal approach for treatment of calcaneal fractures.This paper reviews the latest research progress concerning the sinus tarsal approach for treatment of calcaneal fractures at home and abroad,intending to provide helpful information for the clinical surgeons.

BACKGROUND:Early-onset scoliosis is a kind of disease that seriously affects the growth of children’s spine and development of cardiorespiratory function. The treatment of the disease has always been the focus of many clinical researchers.OBJECTIVE:To analyze the therapy for early-onset scoliosis and explore the spinal fusion, spinal non-fusion, conventional growth rod technology and magnetic control ed growth rod technology of early-onset scoliosis. METHODS:We retrieved PubMed, CENTRAL, EMbase, the ISI Web of Knowledge Databases, VIP, CNKI, CBM and Wanfang Database for related studies published from inception of the database to March 2016. The key words were“scoliosis, growing rod, complications”. The included 54 studies were analyzed and discussed. RESULTS AND CONCLUSION:For these children of early-onset scoliosis, we should not only maintain the correction of spine deformities, but also protect the ability of spine growth, keeping the normal cardiopulmonary function. In addition to conventional (non-surgical) treatment, there are surgical treatment (such as spinal fusion and growing rod technique) and magnetical y control ed growing rod, a new technology for the treatment of early-onset scoliosis. A comprehensive understanding of the effect of surgical treatment on the spine growth and cardiopulmonary function of children with early-onset scoliosis wil help to prevent the occurrence of related complications, so as to obtain a better therapeutic effect.

Objective To study the effects of dynamic,support-inducing exercise on the support,balance and gait ability of patients with moderate-to-severe hemiplegia after stroke.Methods Fourteen stroke patients were randomly assigned to an experimental or a control group (7 cases to each).The patients in the experimental group received both dynamic,support-inducing exercise and routine exercises,while the patients in the control group received routine exercises only.Before training and after 40 and 60 days of training,their functional capacity was evaluated with the Chinese stroke scale (CSS) for neurological deficits,Berg's balance scale (BBS) and using functional ambulation categories (FACs).Results Before training there was no inter-group difference in average CSS or BBS scores or in FACs.For the experimental group there were significant intra-group differences compared with 0th day in all three items at both time points.At days 40 and 60 there were also significant intra-group differences in BBS scores and FACs in the control group,and CSS scores improved significantly only in the experimental group.At day 40 there were significant inter-group differences in average CSS,BBS and FAC results.However,by day 60 a significant difference persisted only in average CSS scores.Conclusions Dynamic,support-inducing exercise can improve support,balance and gait in patients with moderate-to-severe hemiplegia after stroke.

Objective To explore the efficacy of continuous renal replacement therapy (CRRT) in the treatment of neonatal acute kidney injury (AKI).Methods Totally 17 critically ill neonates treated with CRRT were selected who were hospitalized at Department of Neonatology,Shanghai Children's Hospital,Children's Hospital Affiliated to Shanghai Jiaotong University,from June 2012 to June 2017,and among them there were 15 cases with AKI,and the clinical data of these 15 patients were retrospectively analyzed,while 15 AKI neonates were treated with CRRT combined with conventional treatment.The model for CRRT was continuous veno-venous hemofiltration dialysis (CVVH-DF) in 13 cases,plasma exchange (PE) in 2 cases.The changes of blood pressure(BP),renal function,electrolyte,acid-base balance index and hemodynamic indicators were analyzed respectively before CRRT treatment,12 h,24 h,48 h after treatment and by the end of CRRT treatment.The efficacy of CRRT treatment was evaluated in these 15 AKI neonates.Results Gestational age of 15 AKI newborns was 33 +4-40 +1 weeks,admission day age was 2-28 days,birth weight was 2.25-4.00 kg.Primary diseases were severe asphyxia in 6 cases,neonatal septicemia in 5 cases,congenital hereditary metabolic disease in 2 cases,traumatic asphyxia in 1 case,and liver failure in 1 case.CRRT treatment persisted for 49-190 hours.BP value [(50.8 ± 6.57) mmHg(1 mmHg =0.133 kPa)] could reach normal level after 12 h CRRT treatment,and blood pH value (7.31 ± 0.25) increased significantly after 12 h CRRT treatment,while blood K+[(5.51 ±1.86) mmoL/L],urea nitrogen (BUN) [(9.5 ±3.7) mmol/L],creatinine(Cr) [(93± 14)μmol/L] significantly decreased after 12 h CRRT treatment,and reached the normal range [K + (4.78 ± 2.95)mmol/L,BUN (7.5 ±2.1) mmol/L,Cr (54 ± 13) μmol/L] after 24 h treatment,but urine volume[(0.8 ±0.2)mL/(kg· h)] significantly increased after 24 h treatment.Partial pressure of oxygen/fraction of inspired oxygen reached 200 mmHg after 12 h treatment and more than 300 mmHg after 24 h treatment.CRRT treatment of 15 AKI neonates turned out to be effective.Conclusions CRRT can effectively improve the internal environment of AKI neonates and reduce the death rate of neonatal AKI,which can provide an effective adjuvant treatment measures for the treatment of AKI neonates.

Objective To study efficacy and safety of continuous renal replacement therapy (CRRT) in the treatment of neonatal sepsis-related acute kidney injury (AKI).Method From June 2011 to June 2018,neonates with sepsis-related AKI hospitalized in the neonatal intensive care unit of our hospital and treated with CRRT were enrolled.Before CRRT,12 h,24 h,48 h after CRRT and by the end of CRRT,their clinical data including renal function,acid-base balance,electrolytes,blood pressure (BP)and the change of hemodynamic indexes were retrospectively analysed.The efficacy and safety of CRRT was evaluated.Kruskal-wallis H test was used for statistical analysis.Result A total of 9 cases of sepsis-related AKI neonates were enrolled in the study,all treated with continuous veno-venous hemofiltration dialysis.5 cases had oliguria,2 cases fluid overload and 2 cases shock.The duration of CRRT was 49 ～ 110 h (76.2 ±23.5) h.12 h after CRRT,BP were maintained at 40 ～60 mmHg and stable during the treatment,the blood pH value increased to 7.35 ～ 7.45 and the oxygenation index reached 200 mmHg.24 h after CRRT,the oxygenation index rose to more than 300 mmHg.Serum potassium,urea nitrogen and creatinine levels decreased significantly after 12 h of CRRT,and reached the normal range after 24 h of CRRT.After 24 h of CRRT,the urine volume significantly increased.Venous catheterization was performed successfully in 9 cases.2 cases had thrombocytopenia,1 case catheterization obstruction and 1 case hypotension during CRRT.No complications such as hypothermia,hemorrhage,thrombosis or infection occurred.All 9 patients were cured and discharged.Conclusion CRRT is safe and effective for the treatment of neonatal sepsis-related AKI.

Objective To analyze the effect of quality of life (QOL) on the prognosis of long-term survivors with nasopharyngeal carcinoma (NPC). Methods A total of 192 NPC patients treated between 1999 and 2000 and with tumor-free survival before July 2003 were enrolled in this study. All patients received QOL measurement between July and August in 2003. Measurement scales included Chinese SF-36 questionnaire and a checklist consisting of fourteen items about self-rating symptoms. The median follow-up time was 7.9S years (range 2.67-9.55 years). The effects of QOL, social demographic and clinical factors on prognosis were analyzed. Results Univariate analysis showed that QOL affected the tumor-free survival and overall survival. Multivariate analysis showed that hypomnesia was an independent prognostic factor of tumor-free survival, while trismus, headache and age were independent prognostic factors of overall survival. The younger and the better QOL had better prognosis. The other sociodemographic and clinical factors had no prognostic value. Conclusion QOL is an important factor affecting the prognosis of long-term survivors with NPC, and it should be routinely evaluated during the follow-up.

Objective To evaluate the reliability, validity and feasibility of the Chinese version of SF-36 health survey questionaire in long-term survivors of nasopharyngeal carcinoma (NPC). Methods A total of 85 long-term NPC survivors completed the Chinese version of SF-36 by either telephone or mail survey. Correlation analysis, reliability analysis and factor analysis were performed to evaluate the reliability and validity of the scale. Results The Chinese version of SF-36 was easy to complete. The split-half reliability was 0. 92 and the Cronbach's α coefficient among domains were all above 0. 70, which showed good reliability and discrimination capacity among domains. All the correlation coefficients between each item and its domain achieved or approached 0. 5, which were greater than those between the item and other domains. These results demonstrated that the Chinese version of SF-36 had good content validity and discriminatory validity. Six principal components were extracted from the scale, which could basically represent eight domains. The cumulative variance was 71.4%. Two common factors were extracted from the eight domains, which accounted for 73.3% of the variance. The Chinese version of SF-36 was able to detect differences in the quality of life between NPC patients and healthy populations. Conclusions The Chinese version of SF-36 has good feasibility, reliability and validity in evaluating the quality of life in long-term NPC survivors.

Objective To study the effect of different breast milk enhancement strategies and the incidence of complications in premature infants.Method Premature infants whose gestational age less than 34 weeks and birth weight less than 2 000 g were prospectively enrolled from January 2017 to February 2018 at the Department of Neonatology of Huangshi Maternal and Child Health-Care Hospital.According to the odd even number at the end of the hospitalization admission number,participants were assigned into 50～＜70 ml/(kg· d) group and 70～＜90 ml/(kg· d) group,When the children reached the corresponding amount of breast-feeding to be given breast milk fortifier.The demographic information,incidence of complications,rate of weight gain,percentage of extrauterine growth retardation (EUGR) and decrease of Z score at discharge were compared between groups.Result A total of 140 cases were included,with gestational age (31.4±1.9) weeks and birth weight (1 402±213) grams.Among the participants,67 infants were assigned to 50～＜70 ml/(kg·d) group,and 73 infants were assigned to 70～＜90 ml/(kg·d) group.There was no statistical difference between two groups in gender,gestational age,birth weight,length,head circumference,rates of asphyxia,ratio of intrauterine growth retardation,Z score of weight at birth,age at which breast milk fortifiers were added,full enteral feeding time,duration of parenteral nutrition,average length of hospital stay and the time of restoration of birth weight (P＞0.05).The proportion of feeding intolerance in 50～ ＜70 ml/(kg· d) group was higher than that in 70～＜90 ml/(kg· d) group (11.9％ vs.4.1％),the difference was statistical significant (P=0.013).There was no statistical difference in other complications between the two groups (P＞ 0.05).The body weight increase rate of premature infants in 50～＜70 ml/ (kg· d) group was higher than that in 70～＜90 ml/(kg· d) group,and decrease of Z score at discharge in 50～＜70 ml/(kg· d) group was lower than that of 70～＜90 ml/(kg· d),the difference was significant (P＜0.05).Conclusion Adding breast milk fortifier earlier——when the breast feeding amount of 50～＜70 ml/(kg· d)——is more beneficial to the growth and development of premature infants,it also reduces the incidence of EUGR on discharge.However,during the feeding process,it was necessary to be aware of the complications.

Objective To evaluate the application value of bedside noninvasive hemodynamic monitoring in the diagnosis and treatment of neonatal septic shock.Methods The purchase time and use of Ultrasound Cardiac Output Monitor (USCOM) to monitor hemodynamic status were taken as the grouping condition,and the infants admitted to Department of Neonatology in Shanghai Children's Hospital from March 2014 to December 2016 were divided into 3 groups,16 of USCOM's pre-purchased septic shock infants were taken as non-USCOM monitoring group,20 patients with septic shock received USCOM monitoring as USCOM monitoring group,the other 20 non-septic shock neonates were assigned as a control group,whose primary diseases were premature,neonatal jaundice or neonatal pneumonia.Systolic volume (SV),cardiac output (CO),heart rate (HR),cardiac index (CI) and systemic vascular resistance index (SVRI) in USCOM monitoring group and control group were recorded.The doses of dopamine,dobutamine,epinephrine or norepinephrine and the time of vasoactive drug administration were compared between the USCOM monitoring group and non-USCOM monitoring group.The data of 3 groups were analyzed statistically.Results Compared with the control group,the hemodynamic parameters of the USCOM monitoring group before treatment such as CO [(0.68 ± 0.44)L/min vs.(0.44 ± 0.17) L/min,t =3.306,P =0.004],CI [(4.40 ± 1.88) L/(min · m2) vs.(3.00 ±0.40) L/(min · m2),t =3.328,P =0.004],SV [(3.90 ±2.39) cm3 vs.(3.08 ±0.31) cm3,t =2.227,P =0.038]and HR [(166.09 ± 26.20) times/min vs.(145.35 ± 16.16) times/min,t =2.750,P =0.013] were increased,while the SVRI showed an obvious decline [(795.88 ± 450.19) d · s/(cm5 · m2) vs.(1 160.61 ± 49.59)d · s/(cm5 · m2),t =-2.898,P =0.009],and the differences were statistically significant.While in the USCOM monitoring group after treatment,the CO [(0.56 ± 0.28) L/min vs.(0.68 ± 0.44) L/min,t =2.456,P =0.024] and CI [(3.65 ± 1.10) L/ (min · m2) vs.(4.40 ± 1.88) L/ (min · m2),t =2.614,P =0.017] were decreased significantly compared with those in USCOM monitoring group before treatment.Compared with non-USCOM monitoring group,the doses of dopamine [(45.72 ± 28.80) mg/kg vs.(85.83 ± 69.33) mg/kg,t =2.352,P =0.005],dobutamine [(12.81 ±26.18) mg/kg vs.(85.83 ±69.33) mg/kg,t =4.351,P =0.002],epinephrine [(0.11 ±0.33) mg/kg vs.(0.90± 1.75) mg/kg,t=1.986,P =0.014],and the time of vasoactive drug use [(68.10 ±34.37) h vs.(167.75 ± 117.14) h,t =3.626,P =0.001] were decreased significantly in USCOM monitoring group.The doses of norepinephrine [(1.91 ± 3.79) mg/kg vs.(0.47 ± 0.90) mg/kg,t =-1.481,P =0.046] were increased significantly in USCOM monitoring group.Conclusion The noninvasive hemodynamic monitoring plays an important role in the diagnosis and treatment of septic shock in neonates by clarifying the hemodynamic status of shock and guiding the rational use of vasoactive drugs so as to improve the successful rescue rate.

ObjectiveTo investigate the timing and efficacy of continuous renal replacement therapy (CRRT) in neonatal acute kidney injury (AKI).MethodsNineteen AKI neonates treated with CRRT were enrolled during hospitalization in the Department of Neonatology of the Children's Hospital of Shanghai from June 2011 to June 2018. Their clinical data were retrospectively analyzed. According to their baseline renal function, these neonates were divided into two groups using an improved RIFLE (Risk, Injury, Failure, Loss and End-stage renal disease) standard: AKI stage 1-2 group and AKI stage 3 group. CRRT included continuous veno-venous hemodiafiltration (CVVHDF) and plasma exchange (PE). Several parameters included blood pressure (BP), renal function, electrolyte, blood gas and hemodynamic indicators were analyzed before, 12 h, 24 h, and 48 h after the initiation of CRRT and at the end of CRRT. Changes in neonatal renal function before, 24 h after the initiation of CRRT and at the end of CRRT were compared between the two groups. Efficacy of CRRT was evaluated, and clinical outcomes were analyzed. Kruskal-WallisH-test ort-test was applied for statistic analysis.Results(1) Among the 19 neonates with AKI, there were 12 in stage 1-2 and seven in stage 3. Seventeen cases were treated with CVVHDF, and the other two underwent plasma exchange. The duration of CRRT was 49-190 h with an average of (89.2±33.9) h. (2) After 12 h of CRRT, the blood pressure of all 19 AKI neonates returned to normal (40-60 mmHg, 1 mmHg=0.133 kPa) and was maintained at that level during the treatment. The blood pH value also increased to a normal range (7.35-7.45) at the same time. The oxygenation index reached 200 mmHg after 12 h of CRRT and rose to over 300 mmHg after 24 h. The levels of serum potassium, urea nitrogen, and creatinine decreased significantly after 12 h of CRRT and reached the normal range after 24 h of CRRT. After 24 h of CRRT, the urine volume significantly increased. (3) Serum levels of urea nitrogen and creatinine in neonates with AKI stage 1-2 decreased significantly after 24 h of CRRT. At any time points before and after CRRT (24 h before, 24 h after and at the end of CRRT), serum levels of urea nitrogen and creatinine in AKI stage 3 neonates were higher than those in AKI stage 1-2 neonates [urea nitrogen: (15.8± 4.1) mmol/L vs (10.2±5.1) mmol/L, (11.5±2.4) mmol/L vs (6.3±2.3) mmol/L, (9.8±2.1) mmol/L vs (5.1± 2.2) mmol/L,t=2.468, 2.226 and 2.171, respectively; creatinine: (184±32) μmol/L vs (152±26) μmol/L, (110±35) μmol/L vs (87±25) μmol/L, (63±12) μmol/L vs (44±9) μmol/L,t= 2.404, 2.423 and 3.972, respectively; allP<0.05]. (4) Venous catheterization was successful in the 19 AKI neonates. Three cases were complicated with thrombocytopenia, two with obstruction and two with hypotension during CRRT. Complications such as hypothermia, hemorrhage, thrombosis, and infection were not reported. (5) Among the 19 AKI neonates, 12 (including five of severe asphyxia, five of septic sepsis and two of inherited metabolic disorders and in metabolic crisis) were cured and discharged. The other seven cases (two in stage 1-2 and five in stage 3) lived through the oliguria stage but died after their family members gave up the treatment.ConclusionsCRRT is a safe and effective management for neonatal AKI. The optimal opportunity for CRRT treatment in AKI neonates should be at stage 1-2.