Objective To investigate the application value of bedside ultrasound monitoring of quadriceps muscle changes in mechanically ventilated children in the early treatment of ICU-acquired muscle weakness (ICU-AW). Methods Eighty-two pediatric ICU patients with mechanical ventilation for>48 hours were selected. On the day of admission (D₀) and on day 7 (D₇), bedside ultrasound was performed to measure the thickness and cross-sectional area of the rectus femoris and vastus intermedius muscles. Patients were classified using Medical Research Council scores into control group (n = 63) and muscle weakness group (n = 19). Muscle parameters and atrophy rates were compared between groups. Diagnostic performance was assessed using receiver operating characteristic curves. Results The incidence of ICU-AW was 23.17%. At both D₀ and D₇, the average thickness of the rectus femoris, the average thickness of the vastus intermedius, the average area of the rectus femoris, and the average area of the vastus intermedius were significantly different between the two groups (P<0.05). The atrophy rates of the thickness of the rectus femoris and the area of the vastus intermedius were lower in the control group than in the muscle weakness group at both D₀ and D₇ (P<0.05). The area under the receiver operating characteristic curve for quadriceps parameters in diagnosing ICU-AW was 0.871, with a sensitivity of 89.47% and a specificity of 79.37%. Conclusion Bedside ultrasound dynamic monitoring of quadriceps changes enables early identification of ICU-AW and provides a basis for clinical intervention.

Objective:To report the sampling study design and radiography protocol of a large-sample investigation on skeletal maturation of 3 to 18-year-old children in China.Methods:Multi-stage stratified random sampling was employed in this study. Two provinces, municipalities, or autonomous regions were randomly selected from each of the seven regions of China, including Northeast China, Northwest China, North China, Central China, East China, Southwest China, and South China. Then one rural and one urban investigation site were randomly selected from each province, municipality, or autonomous region. In total 28 sites were included. Among those sites, four residential districts were randomly selected from each urban site, and four townships from each rural site. For each residential district or township, 1-4 kindergartens, primary schools, and middle schools were chosen. Random cluster sampling was used to extract 3-<6-year-old children in kindergartens, and 6-18-year-old children in primary schools and middle schools. The investigation on skeletal maturation was sampled proportionate to the sampling of the whole study. The estimated simple size was 780 for each site, and 21 840 for all 28 sites in total. There were six groups of 3-<6-year-old children classified at 0.5-year intervals, and 12 groups of 6-18-year-old children classified at 1-year intervals. Posteroanterior position radiography of the left hand and wrist was achieved for all subjects.Results:The study was performed from August 26, 2019 to October 16, 2021. In total, 20 444 children received posteroanterior position radiography of the left hand and wrist, including 10 196 males and 10 248 females, 9 711 urban and 10 733 rural, respectively. The 3-<6-year-old group included 1 611 (male 819, female 792) subjects, and the 6 to 18-year-old group included 18 833 (male 9 377, female 9 456) subjects.Conclusion:This nationwide investigation on skeletal maturation of 3 to 18-year-old children in seven regions of China was successfully preformed. The results of this study can provide an important reference for establishing the current evaluation criteria of bone age in Chinese children and adolescents.

Objective To analyze the clinical characteristics and risk factors of myocardial damage in children with mycoplasma pneumonia in Qinghai area, and to provide evidence for clinical diagnosis and treatment. Methods A total of 328 children diagnosed with mycoplasma pneumonia in Qinghai region from June 2016 to June 2020 were selected as the research subjects. According to whether they were complicated with myocardial damage, they were divided into the control group (no myocardial damage, n=185) and the experimental group (complicated with myocardial damage, n=143). The data of the children were collected by using a questionnaire made by our hospital. These included gender, age, fever duration, initiation time of macrocyclic esters and fever degree, etc., and the levels of CK-MB, CK, CTNNI, NT-proBNP, CRP, LDH and RDW were determined. RESULTS: There were no significant differences in age, gender and complications between the two groups (P>0.05). There were statistically significant differences in the use time, fever duration and fever degree between the two groups (P<0.05). In terms of laboratory indicators, there were statistically significant differences in the levels of CK-MB, CK, cTNnI, NT-probNP, CRP, LDH and RDW between the two groups (P<0.05).Logistic regression analysis showed that the duration of fever (OR=3.105), the start time of macrolides (OR=1.457), the degree of fever (OR=2.495), CRP(OR=1.853) and RDW(OR=1.358) were the risk factors for myocardial damage in children with mycoplasma pneumonia in Qinghai area (P<0.05). Conclusion The duration of fever, the initiation time of macrolide drugs, the degree of fever, CRP and RDW are independent risk factors for myocardial damage in children with mycoplasma pneumonia in Qinghai area. The early use of macrolide drugs can prevent myocardial damage, improve the treatment effect and improve the prognosis of children.

Objective    To explore whether surgery combined with adjuvant chemotherapy can bring survival benefits to patients with cervical and upper thoracic esophageal squamous cell carcinoma (ESCC). Methods    The clinical data of patients with cervical and upper thoracic ESCC who underwent R0 resection and neck anastomosis in our department from 2006 to 2010 were retrospectively analyzed. Patients received neoadjuvant therapy or adjuvant radiotherapy were excluded. The adjuvant chemotherapy group was given a combination of taxanes and platinum based chemotherapy after surgery; the surgery alone group did not receive adjuvant chemotherapy. The Kaplan-Meier method was used to analyze the survival difference between the adjuvant chemotherapy group and the surgery alone group. Results    A total of 181 patients were enrolled, including 141 (77.9%) males and 40 (22.1%) females, with an average age of 61.0±8.2 years (80 patients aged≤61 years, 101 patients aged>61 years). There were 70 (38.7%) patients of cervical ESCC, and 111 (61.3%) patients of upper thoracic ESCC. Eighty-seven (48.1%) patients underwent postoperative adjuvant chemotherapy, and 94 (51.9%) patients underwent surgery alone, and the basic clinical characteristics were well balanced between the two groups (P>0.05). The median survival time of patients in the adjuvant chemotherapy group and the surgery alone group was 31.93 months and 26.07 months, and the 5-year survival rate was 35.0% and 32.0%, respectively (P=0.227). There was no statistical difference in median survival time between the cervical ESCC and upper thoracic ESCC group (31.83 months vs. 29.76 months, P=0.763). For cervical ESCC patients, the median survival time was 45.07 months in the adjuvant chemotherapy group and 14.70 months in the surgery alone group (P=0.074). Further analysis showed that the median survival time of lymph node negative group was 32.53 months, and the lymph node positive group was 24.57 months (P=0.356). The median survival time was 30.43 months in the lymph-node positive group with adjuvant chemotherapy and 17.77 months in the lymph-node positive group with surgery alone. The survival curve showed a trend of difference, but the difference was not statistically significant (P=0.557). Conclusion    There is no statistical difference in the long-term survival of cervical and upper thoracic ESCC patients after R0 resection. Postoperative adjuvant chemotherapy may have survival benefits for patients with cervical ESCC and upper ESCC with postoperative positive lymph nodes, but the differences are not statistically significant in this setting.

Objective To preliminarily analyze the acute myocardial damage and important risk factors caused by sepsis in children in Qinghai, and analyze and discuss preventive measures on the basis of the foregoing. Methods The study selected 385 children with sepsis in our hospital from January 2016 to December 2020 and included 158 children with acute myocardial damage caused by sepsis (case group), and the remaining 227 cases (control group) were not seen Myocardial damage. The study collects basic information such as sociodemographic information of all children, and collects serum troponin I (cTnI) and CK-MB levels (determined by chemiluminescence method); as well as serum CRP levels and PCT levels. To compare and analyze the levels of related indexes in children with myocardial damage, and the differences from those in the control group. Then analyze and see the risk factors that are potentially associated with acute myocardial damage. Use SPSS statistical software package to analyze the data. cTnI enzyme-labeled immunoassay assay, reagents are provided by Nanjing Jidan Biotechnology Co., Ltd.; medicine is (0.00~0.01) μg/mL, cTnI level normal group (≤0.01 μg/mL) and cTnI level elevated group ( > 0.01 μg/mL) ); CK-MB>5 ng/mL is the positive standard for myocardial muscle injury; CRP medical reference value < 8mg/L, PCT< 0.1 ng/mL; CRP is detected by the turbidimetric method, and the instruments and reagents are manufactured by German Deling BNⅡ specific protein analyzer and original matching reagents. Pediatric Critical Case Score (PCIS) and Pediatric Death Risk Factor Score (PRISM Ⅲ) (evaluate twice, take the lowest value). Results In this study, the majority of male children were male, and the proportion of children with active myocardial damage had a higher proportion of low-grade fever. At the same time, the disease was more severe than the control group. It can be seen that the PCIS score is lower and the PRISM Ⅲ is higher. The difference is statistically significant. (P<0.05). The serum troponin I (cTnI), CK-MB, CRP, and PCT levels in the case group were significantly higher than those in the control group, and the differences were statistically significant (P<0.05); the serum albumin levels were significantly lower than those in the control group, and the differences were statistically significant Scientific significance (P<0.05); the risk factor analysis was carried out with the presence of myocardial damage as the dependent variable, and the potential influencing factors as the independent variables (social demographic factors, basic conditions of hospitalization, levels of indicators related to myocardial damage, etc.). Including single factor analysis (adjustment for potential confounding factors) and multivariate analysis. The results showed that increased age, low fever, increased PCT, low albumin level ( ≤ 25g/L), and increased PRISMⅢ were risk factors for myocardial damage (P<0.05). Conclusions Acute myocardial damage caused by sepsis in children with sepsis can be seen in male children, and children with active myocardial damage have a higher proportion of low-grade fever. At the same time, the condition is more severe than that of the control group. It can be seen that the PCIS score is higher. Low, higher PRISMⅢ, and other significant characteristics; analysis of potential influencing factors suggests that increased age, low fever, increased PCT, low albumin levels, and increased PRISMⅢ are positively correlated with the increased risk of acute myocardial damage in children. Therefore, it is planned to be clinically 1. Pay attention to older children with low fever and more critically ill children; 2. Detect or monitor the levels of PCT and albumin in children to early warn the occurrence of myocardial damage; carry out necessary and timely warning and prevention.

Objective:To evaluate the effect of adductor canal block(ACB)and local infiltration anesthesia(LIA)around the knee joint on inflammatory responses in the patients undergoing total knee arthroplasty(TKA).Methods:Sixty American Society of Anesthesiologists physical status Ⅱor Ⅲ patients of both sexes, aged 54-76 yr, scheduled for elective TKA, were divided into 2 groups ( n=30 each) using a random number table method: ACB group (group A) and ACB combined with LIA around knee joint group (group AL). ACB was performed with 0.5% ropivacaine 15 ml after endotracheal intubation in group A and group AL, and in addition LIA was performed around the knee joint after the osteotomy was completed during surgery in group AL.The patient-controlled ACB analgesia was applied at the end of surgery in both groups.The analgesic solution contained ropivacaine 400 ml (in 0.9% normal saline 200 ml), and the analgesic pump was set up to deliver a 5 ml bolus dose with a 30-min lockout interval and background infusion at 5 ml/h.When visual analog scale score>4, and pain was still not relived at 30 min after pressing by patients, pethidine hydrochloride 100 mg was intramuscularly injected as rescue analgesic.Peripheral venous blood samples were collected immediately before surgery (T 0) and at 24, 48 and 72 h after surgery (T 1-3) for determination of serum interleukin-6 (IL-6) and IL-10 concentrations by enzyme-linked immunosorbent assay.The muscle strength on the affected side was assessed at T 1-3.The patients′ satisfaction score, requirement for rescue analgesia, and adverse effects were recorded. Results:Compare with group A, the serum IL-6 concentrations were significantly decreased and serum IL-10 concentrations were increased at each time point after surgery, postoperative patients′ satisfaction scores were increased, the requirement for rescue analgesia was decreased ( P<0.05), and no significant change was found in the quadriceps strength of the affected limb and incidence of adverse reactions after surgery in group AL ( P>0.05). Conclusion:ACB and LIA around the knee joint can mitigate postoperative inflammatory responses in the patients undergoing TKA.

Objective To explore the efficacy of temporary titanium plate screwing for positional maintenance in reduction and internal fixation for displaced acetabular fractures.Methods A retrospective study was conducted of the 28 patients (28 hips) with displaced acetabular fracture who had been treated by open reduction and internal fixation from October 2013 to March 2016.They were 20 males and 8 females,aged from 24 to 68 years (average,42.3 years).The time from injury to surgery ranged from 7 to 21 days(average,14.5 days).According to the Letournel-Judet classification,there were 2 posterior column fractures,4 transverse fractures,5 posterior column plus posterior wall fractures,6 transverse plus posterior wall fractures,2 T-shaped fractures,3 anterior and posterior transverse fractures and 6 double column fractures.The posterior acetabular approach or combined anterior and posterior approach was used.In all the patients temporary titanium plate screwing was conducted to fix one side of the fracture so as to facilitate accomplishment of open reduction and internal fixation without losing the indirect anatomic reduction of the intraarticular fracture.After the open reduction and internal fixation was accomplished,the temporary screw fixation was removed in 26 patients but retained in 2 patients as needed.The reduction quality,complications and outcomes at the final follow-ups were recorded.Results All the 28 patients were followed up for 10 to 36 months (mean,15.6 months).By the Matta criteria,anatomical reduction was achieved in 26 cases,unsatisfactory reduction in one and poor reduction in one,yielding an anatomic reduction rate of 92.9％.By the improved Mere d'Aubigne & Postel criteria,the clinical outcomes at the final follow-up were excellent in 27 cases and good in one,yielding a good to excellent rate of 100％.Postoperatively,heterotopic ossification of different severities occurred in 11 cases but did not affect their joint function;transient paralysis of the sciatic nerve was reported in 6 cases but recovered 3 months after surgery.No complications like avascular necrosis of the femoral head or walking pain were observed during follow-ups.Conclusion Temporary fixation with titanium plate screws during open reduction and internal fixation for displaced acetabular fractures can effectively improve the reduction and fixation of the articular surface,leading to satisfactory short-term clinical outcomes.

Objective To investigate the feasibility and clinical effect of Kocher-Langebeck (K-L) approach without cutting the short external rotator muscles of hip for treatment of cetabular posterior column fractures.Methods A retrospective case series study was performed on 28 patients with acetabular fractures admitted from June 2015 to February 2017.There were 23 males and 5 females,averagely aged 43.6 years (range,26-71 years).According to the Letournel classification,there were 9 patients with simple fractures,14 back wall and back pillar fractures and 5 cross fractures.All patients were combined with posterior dislocation.The patients were given tibial tubercle traction after hip joint reduction in the hospital.During the surgery,K-L approach was adopted without cutting the short external rotator muscles of hip.Operation duration and intraoperative bleeding were recorded.Visual analogue score (VAS) was recorded before and after operation.The X-ray at 1 day,6 weeks,3 months and 1 year after operation were reviewed to evaluate fracture healing time.Matta criteria were used to assess the surface flatness of joint.The modified Merle d'Aubigné-Postel scoring system was applied to evaluate the function of hip joint.Intraoperative and postoperative complications were recorded.Results The operation duration was 76-120 min (mean,94 min),and the intraoperative blood loss was 120-320 ml (mean,265 ml).All patients were followed up for average 16 months (range,10-24 months).Preoperative VAS was 5-10 points [(7.5 ± 1.3) points],and 0-3 points [(0.9 ± 0.8) points] 6 months after operation (P ＜ 0.01).All fractures healed and the average healing duration was 10.1 weeks (range,6-12 weeks).According to the Matta criteria,24 patients were graded excellent and 4 good,with excellence rate of 100％.According to the modified Merle d'Aubigné-Postel grading system,clinical results were graded excellent in 23 patients,good in 5,with excellence rate of 100％.Transient sciatic nerve injury occurred in 3 patients after surgery,and the nerve function of these patients fully recovered within 3 months after operation.There were no infection,heterotopic ossification and other complications.The wound healing was good,without liquefaction or cracking.Sciatic nerve injury was found in five patients,three of whom were performed with a transient lesion and recovered within 3 months.Conclusion In the posterior pathway surgery for acetabular posterior column fractures,the K-L approach without cutting the short external rotator muscles of hip can be used to complete the internal fixation with a high rate of fracture healing,sound reduction outcome,satisfactory functional recovery and few complications.

Objective To explore the application of micro screws in holistic management of comminuted fracture of posterior acetabular wall combined with posterior hip dislocation.Methods From October 2013 to March 2016,38 patients (38 hips) were managed for comminuted fracture of posterior acetabular wall combined with posterior hip dislocation.They were 29 males and 9 females,aged from 15 to 71 years (average,38.6 years).According to the Letournel-Judet classification,there were 35 simple fractures of posterior acetabular wall and 3 complex fractures (2 fractures of posterior column plus posterior wall and one transverse plus posterior wall fracture).All fractures were comminuted and involved the posterior wall.The posterior Kocher-Langenbeck approach was selected for all the patients.Intraoperative exploration revealed the comminuted posterior walls were complicated with broken acetabular rims and ruptured glenoid rims to various degrees.Micro screws or micro screw-plate system were used to repair the comminuted fractures and broken acetabular rims,bridge support fixation with a locking plate followed pelvic reconstruction,and at the same time the ruptured glenoid rims were sutured so that the whole posterior articular structure around the posterior wall was repaired and reconstructed in a holistic manner.Results All the 38 patients were followed up for 12 to 36 months (average,17.6 months).By the Matta assessment,the reduction was excellent in 36 cases and fine in 2,giving an excellent to good rate of 100％.All fractures got united after 9 to 14 weeks (average,10.2 weeks).By the improved Merle d'Aubigne & Postel criteria,the clinical outcome was excellent in 35 cases and good in 3,giving an excellent to good rate of 100％.After surgery,heterotopic ossification occurred in one case,and transient paralysis of the sciatic nerve in 3 cases.No infection,necrosis of the femoral head,joint pain,joint malfunction or unstable walking was observed.Conclusion In the management of comminuted fracture of posterior acetabular wall combined with posterior hip dislocation,the lesions of the whole posterior wall can be repaired primarily in a holistic manner by repairing the shattered posterior wall of the acetabulum wth micro plate and screw system and simultaneous suture and fixation of the broken actabular rim and ruptured glenoid rim.

Objective To investigate effectiveness of the modified Kocher-Langenbeck (K-L) approach for acetabular fractures.Methods A consecutive series of 58 patients with acetabular fracture were treated operatively from January 2013 to December 2016.They were divided into 2 groups according to the approaches used.In the experimental group of 30 patients (25 males and 5 females with an average age of 42.6 ± 13.8 years),the modified K-L approach was used not to dissect the external rotation short muscles and the anterior approach was also used when necessary.In the control group of 28 patients (24 males and 4 females with an average age of 45.2 ± 10.2 years),the traditional K-L approach was used and in combination with the anterior approach when necessary.The 2 groups were comnpared in terms of operation time,intraoperative blood loss,reduction,fracture union time and functional recovery of the affected hip at the last follow-up.Results The experimental group reported significantly shorter operation time (94.2 ± 32.8 min) and significantly less intraoperative bleeding (220.8 ± 96.7 mL) than the control group (135.8 ± 88.0 min and 405.5 ±95.7 mL) (P ＜ 0.05).According to the Matta's criteria for reduction,the experimental group had 24 excellent,4 good and 2 fair cases (an excellent to good rate of 93.3％) while the control group had 20 excellent,3 good and 5 fair cases (an excellent to good rate of 82.1％),showing no significant differences between the 2 groups (P ＞ 0.05).All the 58 patients obtained follow-up for 6 to 24 months (average,16 months).The fracture union time was 10.1 ± 1.9 weeks for the experimental group and 9.9 ±2.1 weeks for the control group,showing no significant differences between the 2 groups (P ＞ 0.05).According to the modified Merle d'Aubigne & Postel scoring for the functional recovery of the affected hip at the last follow-up,the experimental group had 23 excellent,5 good and 2 fair cases (an excellent to good rate of 93.3％) while the control group had 12 excellent,6 good,6 fair and 4 poor cases (an excellent to good rate of 64.2％),showing a significant difference between the 2 groups (P ＜ 0.05).Conclusion Compared with the traditional K-L approach,the modified K-L approach has advantages of small trauma,less hemorrhage and good postoperative recovery so that it can be a good choice among the posterior approaches for acetabular fractures.