BACKGROUND:The use of donor rat of cardiac death inevitably experiences warm ischemia injury, so the length of warm ischemia time plays a significant role on the number and function of pancreatic islet obtained. OBJECTIVE:To investigate the effect of Exendin-4 on pancreatic islet function of donor rats with cardiac death at different heat ischemia time. METHODS:Islet cells from Wistar rats were cultured in vitro and randomly divided into three groups according to the experimental conditions:0, 30, 45 min heat ischemia groups. Each group was further assigned into two subgroups, control group was cultured for 24 hours while experimental group wad cultured with 10 nmol/L Exendin-4 for 24 hours. The number of isolated pancreatic islets was calculated with diphenylthiocarbazone staining, and the purity of the extracted islets was adjusted. The viability of the islets was examined by AO/EB staining, and insulin secretion index assay was used to detect the function of the islets. RESULTS AND CONCLUSION:With the time of heat ischemia increasing, the number, purity, viability and function of islet cells obtained were decreased. After the cells in heat ischemia 0, 30, 45 min groups were cultured with 10 nmol/L Exendin-4 for 24 hours, the number, purity and viability of isolated and purified islets were increased compared to the group without added Exendin-4. There was significant difference between experimental group and control group in 30-minute and 45-minute ischemia groups (P<0.05). Exendin-4 can protect pancreatic islet cells in donor rats with cardiac death at different heat ischemia times, reduce the apoptosis, and improve islet survival and functions. The use of Exendin-4 can be an effective pretreatment method at early ischemia phase of islet transplantation.

Objective To observe the influence of warm ischemia time on acquisition of rat pancreatic islets and islet function.Method Male Wistar rats were used.After heart beats stopped,the pancreases in four groups of rats were harvested,and warm ischemia time was 0,15,30 and 45 min separately.The pancrease was preserved in UW at 4℃C for 8 h,and subjected to injection of collagenase solutions.After islets were acquired,the purity,survival rate and islet activity were tested,and statistical analysis was performed.Result The number of islets obtained in 0 min group,15 min group,30 min group and 45 min group was (433 ± 41),(396 ± 38),(350 ± 31) and (66 ± 17)IEQ/one,islet viability was 94％,88％,77％ and 25％,and purity was 88％,78％,60％ and 32％,and insulin release index was 2.38 ± 0.23,2.25 ± 0.18,2.19-± 0.18 and 1.25 ± 0.12,respectively.There was no significant difference in islet number,purity,survival rate and activity 15 min group and 30 min group between 15 min group or 30 min group and 0 min group (P＞0.05).There was significant difference between 45 min group and 0 min group in islet number,purity,survival rate and activity (P＜0.05).The survival rate and purity in 45 min group were lower than the clinical standards for islet transplantation (survival rate ＞ 75％,and purity ＞ 50％).Conclusion Warm ischemia time of 15 min in non-heart-beating brain death(NHBD) rats had no effect on islet isolation and purification.Warm ischemia time within 30 min showed no significant influence on islets of NHBD rats,which can be used in islet transplantation.Warm ischemia time at 45 min showed significant influence on islets of NHBD rats,which can't be used in islet transplantation.

Objective To summarize the bacterial types and drug resistance of children with bone and joint purulent infection in the Affiliated Hospital of Zunyi Medical College in recent 9 years,so as to provide reference for rational use of antibiotics in clinics.Methods A retrospective study was performed on the clinical data of 102 children with hematogenous bone and joint purulent infection in the Affiliated Hospital of Zunyi Medical College from January 2008 to October 2016,in which there were 57 boys and 45 girls with a mean age 5.5 years old(from 10 days to 14 years old),among which 38 cases were acute osteomyelitis,30 cases were pyogenic arthritis,27 cases were chronic osteomyelitis,and 7 cases were arthritis with hematogenous osteomyelitis.The results of blood culture,pus culture and antibiotic sensitivity test results were analyzed and summarized.Results The results of blood culture or pus culture in 102 cases were all infected by single bacteria,including 89 cases of staphylococcus aureus(SA),accounting for 87.30％,3 cases (2.94％) of micrococcus scarlatinae,2 cases (1.96％) of klebsiella pneumoniae,2 cases (1.96％) of staphylococcus haemolyticus,and 1 case (0.98％) of methicillin-resistant staphylococcus epidermidis,streptococcus pneumoniae,streptococcus mitis,enterococcus hirae,enterobacter cloacae and pseudomonas aeruginosa,respectively.The resistance rate of SA to penicillin was 92.1％,but to Lincomycin,Erythromycin,Cefoxitin and Tetracycline it was more than 50.0％,and to Sulfamethoxazole,Gentamicin and Rifampicin it was quite low,and the resistant strains to Linezolid,Quinupristin/Dafoe Putin,Mo Xisha star,Tigecycline,Vancomycin,Levofloxacin,Nitrofurazone were no found.There were not multi drug resistant strains to be found except in the 45 cases of methicillin-resistant staphylococcus aureus(MRSA) and 1 case of methicillin-resistant staphylococcus epidermidis.Conclusion SA is the main pathogenic bacteria of bone and joint purulent infection in children in the local area.The resistant rate of penicillin and the detection rate of MRSA are high in the hematogenous osteoarticular infections caused by SA,but no vancomycin resistant cases were found.

We report a fetus with ectopic connection of venous catheter into the dilated coronary sinus, right-sided aortic arch, left-sided ductal arch, and aberrant left subclavian artery detected by routine prenatal ultrasound screening at 23 +2 gestational weeks. The baby was born vaginally at 38 +2 gestational weeks with an Apgar score of 10 at both 1 and 5 min. The reexamination of neonatal echocardiography on the second day after birth showed dilation of the internal diameter of the coronary sinus, right-sided aortic arch, and aberrant left subclavian artery. Follow-up at 90 days after birth found no abnormal growth and development.

We reported a case of trisomy 18 with Abernethy malformation diagnosed by prenatal ultrasound, which was confirmed by chromosome karyotyping after cordocentesis and fetal autopsy. At 24 gestational weeks, fetal sonography revealed a fetus with multiple malformations (cleft lip/cleft palate of left side, left radial dysplasia, hooked hands, bilateral pes valgus, ventricular septal defect, and congenital extrahepatic portocaval shunt), which was diagnosed as trisomy 18 syndrome with Abernethy malformation. The fetus's karyotype was 47, XX+18.

This article reported a case of fetal congenital pyriform sinus fistula (CPSF) diagnosed by prenatal ultrasound. An oval cystic mass in the left side of the fetal neck was detected during routine prenatal ultrasonography at 17 +2 weeks of gestation, which was also found in the systemic ultrasound screening at 23 weeks. Besides, a narrow fistula between the cyst and pharynx was observed in the coronal view of the neck, raising the suspicion of CPSF. On day 21 after birth, the cystic mass bulged out of the neck and the neonate started choking and coughing during feeding alongside wheezing respiration. Ultrasound examination showed a strong gas echo in the cystic mass, which was also confirmed by CT scan on day 25. On day 26, cystectomy, ligation of high fistula, and fistulectomy were performed, and the diagnosis of CPSF was confirmed. The baby recovered after the operation and was healthy during follow-up till three months.

Objective To investigate the morphological characteristics of elbow dislocation associated with elbow fracture in children,to propose its injury mechanism,and to present its treatment and outcomes.Methods From January 2010 to September 2016 in Department of Pediatric Orthopedics,the Affiliated Hospital of Zunyi Medical College,the clinical data of elbow dislocation associated with elbow fracture were retrospectively analyzed in 12 children,in which there were 9 boys and 3 girls with a mean age of 7.6 (3.6-12.O) years,and the injury time was 6 h-32 days,with an average of 3.5 days.According to the direction of dislocation,posterior dislocation in 6 cases,posterolateral dislocation in 4 cases,and anterior dislocation in 2 cases.Twelve cases were caused by high energy injury,accompanied with violent rotary injury of forearm,including traffic accident injury in 5 cases,high fall injury in 4 cases,motor belt injury in 2 cases,and washing machine injury in 1 case.All these cases were treated with surgery,the dislocated elbow joint were reset,the fracture fragments were fixed with Kirschner wire or wire tension band,and the lateral collateral ligament were repaired.Results All cases were followed up for 6-23 months,with an average 13.5 months.The stability of elbow joint and the fracture healing were very good,and no elbow redislocation at the last follow-up.The function of elbow joint recovered satisfactorily,the extension-flexion motion ranged from 90°-145°,with an average of 125°,and the pronation-supination motion ranged from 85°-155°,with an average of 130°.According to the Mayo functional index,the results were excellent in 7 cases and good in 4 cases,and the excellent and good ratio was 91.7％ (11/12 cases).Conclusions The elbow dislocation of children is caused by high energy injuries and the violent rotational injury of the forearm,easily combined with different types of elbow fractures and severe injury of collateral ligament.Surgical treatment should be actively performed to restore the normal anatomy,reconstruct the stability and restore the function of the elbow joint.

Objective To investigate the drug resistance and its changes of Staphylococcus aureus (SA) in children with bone and joint infection caused by hematogenous dissemination in Zunyi area.Methods A retrospective study was performed on the clinical data of 95 cases with bone and joint infections caused by SA from January 2008 to December 2016 in the Affiliated Hospital of Zunyi Medical College,in which there were 53 boys and 42 girls with a mean age of 5.6 years (ranging from 10 days to 14 years),including 39 cases of acute osteomyelitis,31 cases of acute suppurative arthritis,19 cases of chronic osteomyelitis,and 6 cases of acute osteomyelitis and arthritis.According to the results of drug sensitivity,the drug resistance of SA was analyzed,and the detection rates of Methicillin resistant Staphylococcus aureus (MRSA) were compared in different genders and timeframes,and the drug resistance of SA to other antibiotics were also analyzed.Results The detection rate of MRSA was 50.53％ (48 cases) in 95 cases,the resistance rate to Penicillin was 92.63％ (88 cases),and to Lincomycin,Erythromycin,Tetracycline and Cefoxitin were 64.21％ (61 cases),57.90％ (55 cases),55.79％ (53 cases) and 53.68％ (51 cases) respectively,but to Sulfamethoxazole Co.,Gentamicin and Rifampicin it was relatively low[25.26％ (24 cases),11.58％ (11 cases),6.32％ (6 cases) respectively],while the resistance to Moxifloxacin,Linezolid,Tigecycline,Vancomycin and Nitrofurantoin was not found.The detection rate of MRSA in boys (52.83 ％,28/53 cases) was slightly higher than that of girls (47.62％,20/42 cases),but the difference was not statistically significant (x2 =0.255,P ＞0.05).The detection rates of MRSA in 2008-2010,2011-2013 and 2014-2016 were 27.78％ (5/18 cases),51.61％ (16/31 cases) and 58.70％ (27/46 cases) respectively,and it was obviously higher in 2014-2016 than in 2008-2010,and the difference was statistically significant (x2 =4.95,P ＜ 0.05).The drug resistance rate of SA to Lincomycin,Erythromycin and Cefoxitinis was obviously higher in 2014-2016 than in 2008-2010,and the differences were all statistically significant (all P ＜ 0.05).Conclusions The drug resistance of SA is high with the bone and joint infection caused by hematogenous dissemination in children,and the detection rate of MRSA and the drug resistance of SA to a variety of antimicrobial agents are gradually increasing.

Objective To compare and study the effect of two practice models on clinical practice teaching in pediatric orthopedic surgery.Methods A total of 60 5-year undergraduate interns were selected and assigned randomly separately into control group (n=30) and experimental group (disease-based internship group,n=30).The control group took bed-based internship model,that is,interns managed patients with fixed beds.The experimental group took disease-based internship model,that is,interns managed the same disease patients and rotated regularly.Both groups used the same teaching method,namely the PBL+ LBL teaching.At the end of the internship,SPSS 18.0 was used to analyze the data,the independent sample t test and Chi-square test were used to compare the results of the two groups.Results In the dimensions of theoretical knowledge,medical records written and consolidated results,the score of the experimental group were higher than the control group,and the differences were statistically significant (P＜0.05).The score of practical skill in two groups had no statistically significant difference (P＞0.05).The satisfaction survey showed that the experimental group had higher satisfaction than the control group,and the difference was statistically significant (P＜0.05).Conclusion The disease-based internship model is better than the bedbased internship model in clinical practice teaching in pediatric orthopedic surgery,and can improve the quality of clinical teaching practice.

We reported a case of fetus with right atrial isomerism diagnosed by ultrasound prenatally. Right atrial isomerism was suspected based on several kinds of abnormalities detected at 24 gestational weeks by ultrasound imaging, such as levocardia complicated by complex cardiovascular malformations (double outlet of right ventricle, atrioventricular septal defect, pulmonary artery dysplasia, bilateral superior vena cava and infracardiac total anomalous pulmonary venous drainage), abnormal right-sided stomach bubble, midline liver, suspicious absence of the spleen, juxtaposition of the abdominal aorta and the inferior vena cava to the left side, and mirror-image right bronchia. Autopsy confirmed all of the prenatal diagnosis with an additional finding of splenic dysplasia. Right atrial isomerism should be considered when ultrasound findings indicate complex cardiovascular malformations. Given the high mortality rate of right atrium isomerism, prenatal diagnosis is of great importance.