OBJECTIVE: To evaluate the effectiveness of tibial nerve transection with epineurial suture and division of the common plantar digital nerve branches in the treatment of congenital macrodactyly in children. METHODS: A retrospective analysis was conducted on clinical data from 9 children with congenital macrodactyly who met the selection criteria and were admitted between January 2018 and December 2024. The cohort included 4 boys and 5 girls, aged 1-6 years (median, 3 years). Syndactyly of the second and third toes was present in 2 patients. Hypertrophy distribution was as follows: 1 case of single-ray involvement, 4 of double-ray, 1 of triple-ray, 1 of quadruple-ray, and 2 of quintuple-ray. Preoperatively, 7 cases exhibited limitations in both active and passive flexion and extension of the affected toes; in 2 cases, active movement was restricted while passive motion remained intact. All 9 children were unable to wear standard-sized footwear for the unaffected foot. Six presented with a limp, and 3 had difficulty walking. All 9 cases were moderate to severe progressive macrodactyly, and the growth rate of the affected foot was significantly faster than that of the healthy side. Six cases had undergone prior surgical interventions at other institutions, but disease progression continued postoperatively. All 9 patients underwent tibial nerve transection with epineurial suture and selective division of the common plantar digital nerve branches. At last follow-up, the foot growth rate was calculated (compared with that immediately after operation), and the changes of plantar pain sensation in the affected foot were detected before operation, immediately after operation, and at last follow-up, and the surgical efficacy was evaluated based on improvements in shoe fit and gait function. RESULTS: All 9 children were followed up 6-36 months, with an average of 18 months. All the incisions healed by first intention, and no infection or plantar ulceration occurred. At last follow-up, the growth rate of the affected foot was 0.10 (0.04, 0.14) cm/month, which was significantly slower than that of the healthy foot [0.14 (0.08, 0.18) cm/month] ( Z=3.951, P<0.001). Preoperatively, plantar pain sensation was absent in all cases; it was restored immediately after operation. At last follow-up, 6 patients had absent pain sensation, 2 had partial preservation (involving certain toes and central plantar regions), and 1 patient (with 3-year follow-up) exhibited regained sensation in multiple plantar areas. Gait improved in most cases, in which 8 children achieved normal ambulation, while 1 continued to limp due to leg-length discrepancy. Surgical efficacy were rated as excellent in 1 case, good in 7, and fair in 1. CONCLUSION Tibial nerve transection with epineurial suture combined with selective division of the common plantar digital nerve branches effectively reduces the growth rate of congenital macrodactyly in children, has minimal impact on plantar sensory function, and does not result in plantar ulcers or impaired ambulation.
Humans ; Male ; Female ; Child, Preschool ; Child ; Retrospective Studies ; Infant ; Tibial Nerve/surgery* ; Toes/surgery* ; Treatment Outcome ; Suture Techniques ; Fingers/surgery* ; Foot/innervation* ; Limb Deformities, Congenital

Objective:To evaluate the efficacy of modified self-made Qingxin Buqi Pinggan Decoction combined with atomoxetine hydrochloride in the treatment of attention deficit hyperactivity disorder (ADHD).Methods:Randomized controlled trial. A total of 200 children with ADHD admitted to our hospital from January 2020 to January 2022 were selected as observation subjects by prospective cohort study, and were divided into two groups according to the random number table method. The control group was given oral administration of atomoxetine hydrochloride capsules, and the observation group was given self-made Qingxin Buqi Pinggan Decoction on the basis of the control group. Both groups were treated continuously for 3 months. Before and after treatment, the Traditional Chinese Medicine symptoms were scored, and the core symptoms of the children were evaluated by Swanson Nolan and Pelham-versionⅣ (SNAP-Ⅳ), and the hyperactivity tendency was assessed by Parent Symptom Questionnaire (PSQ). The serum cortisol (COR) and adrenocorticotropic hormone (ACTH) levels were measured by chemiluminescence immunoassay. Adverse reactions during treatment were observed and clinical efficacy was evaluated.Results:The total effective rate was 97.0% (97/100) in observation group and 88.0% (88/100) in control group ( χ2=5.84, P=0.016). After treatment, the scores of restlessness, hyperactivity, unsteadiness, emaciation, lusterless complexion and restless sleep in the observation group were significantly lower than those in the control group ( t=17.90, 11.79, 10.01, 23.27, 11.79, 12.03, P<0.01). The scores of impulsivity factor, learning factor, hyperactivity factor, behavior factor, psychosomatic factor and anxiety factor were significantly lower than those in the control group ( t=4.65, 42.83, 10.01, 41.89, 39.42, 18.30, P<0.01). The scores of attention deficit, hyperactivity-impulsivity and behavior performance were significantly lower than those in the control group ( t=11.68, 9.69, 28.42, P<0.01). After treatment, the levels of serum COR [(337.26±17.22) nmol/L vs. (275.51±15.49) nmol/L, t=26.66] and ACTH [(24.47±1.12) ng/L vs. (19.23±1.43) ng/L, t=28.85] were significantly higher in observation group than those in the control group ( P<0.01). During treatment, the incidence rate of adverse reactions was 6.0% in observation group and 5.0% in control group ( χ2=0.10, P=0.756). Conclusion:Modified self-made Qingxin Buqi Pinggan Decoction combined with atomoxetine hydrochloride can improve the clinical symptoms of children with ADHD, reduce the degree of hyperactivity disorder, increase the levels of serum COR and ACTH, and enhance the clinical efficacy.

Objective:To evaluate the relationship between preoperative sarcopenia and severe pulmonary complications after cardiac surgery in elderly patients.Methods:Elderly patients undergoing elective open heart surgery in our hospital were collected and divided into non-sarcopenia group and sarcopenia group, according to the diagnostic criteria updated and revised by the Asian Sarcopenia Working Group in 2019. The outcome measure was the development of severe postoperative pulmonary complications (PPCs). The general information of patients and various indexes of surgical conditions were recorded. Risk factors for severe PPCs were identified by multivariate logistic regression analysis. The accuracy of sarcopenia score, American Society of Anesthesiologists (ASA) Physical Status classification, and combination of ASA Physical Status classification and sarcopenia score in predicting severe PPCs was assessed using the receiver operating characteristic curve.Results:A total of 158 patients were finally enrolled, including 36 patients with sarcopenia (22.7%), and the incidence of severe PPCs was 22.2%. Multivariate logistic regression analysis showed that ASA classification, sarcopenia, and duration of surgery were independent risk factors for severe PPCs after cardiac surgery in elderly patients ( P<0.05), and the risk of severe PPCs was approximately 3.21 times higher in sarcopenic patients than in non-sarcopenic patients. The area under the receiver operating characteristic curve of sarcopenia score, ASA Physical Status classification, and ASA Physical Status classification combined with sarcopenia score in predicting severe PPCs were 0.686 (95% confidence interval [ CI] 0.607-0.757), 0.603 (95% CI 0.522-0.680), and 0.714 (95% CI 0.637-0.783), respectively. Conclusions:Preoperative sarcopenia is an independent risk factor for severe PPCs after cardiac surgery in elderly patients, and the preoperative sarcopenia in combination with ASA Physical Status classification in predicting severe PPCs has a certain accuracy.

Objective To investigate the predictive value of preoperative frailty for pulmonary com-plications(PPCs)after cardiac surgery in elderly patients.Methods A total of 162 elderly patients,109 males and 53 females,aged 65-83 years,BMI 18-36 kg/m2,ASA physical status Ⅱ-Ⅳ,underwent elec-tive open heart surgery from July 2022 to January 2023 were collected.The patients were divided into two groups according to the occurrence of PPCs:the PPCs group(n=57)and the non-PPCs group(n=105).General information,smoking history,alcohol consumption history,EuroSCORE Ⅱ,frailty,chronic comorbidities(hypertension,diabetes mellitus,myocardial infarction,pulmonary hypertension,chronic ob-structive pulmonary disease,sleep apnea syndrome,etc.),Hb,creatinine,albumin,pulmonary function indices,left ventricular ejection fraction,type of surgery,duration of surgery,aortic clamping time,and cardiopulmonary bypass time were collected.Factors with P＜0.2 and clinically significant in the univariate regression analysis were included in the multivariate logistic regression analysis,and the predictive efficacy of the Fried frailty scale and EuroSCORE Ⅱ for PPCs were compared by the area under the ROC curve(AUC).Results PPCs occurred in 57 patients(35.2％).Multifactorial Logistic regression analysis showed that frailty(OR=3.14,95％CI 1.05-9.37,P＜0.05)and EuroSCORE Ⅱ(OR=2.16,95％CI 1.01-4.60,P＜0.05)were risk factors for the development of PPCs.The predictive power of Fried frailty scale(AUC=0.76,95％CI 0.68-0.82)was significantly higher than that of EuroSCORE Ⅱ(AUC=0.65,95％CI 0.57-0.72)(P＜0.05).Conclusion Preoperative frailty is the independent risk factors for pulmonary complications after cardiac surgery in elderly patients,and the Fried frailty scale has a better predictive efficacy compared to EuroSCORE Ⅱ,a traditional risk predictor.

Objective:To evaluate the value of shear wave elastography (SWE) and salivary gland ultrasound scoring(SGUS) system in the diagnosis of salivary glands lesions in patients with Sj?gren′s syndrome(SS) and to compare the diagnostic efficiency of the two methods.Methods:From June 2019 to November 2020, Fifty-eight patients with suspected SS were selected from the Affiliated Changzhou No.2 People′s Hospital of Nanjing Medical University. According to the 2002 American-European Consensus Group classification standard, the enrolled patients were divided into two groups: SS group (47 cases) and non-SS group(11 cases). According to symptom duration, SS group was divided into the ≤5 years group (29 cases) and the >5 years group (18 cases). Meanwhile, 40 healthy volunteers were enrolled in this study as normal control group. The diagnostic value of salivary gland ultrasound scoring system and Young′s modulus in SS were analyzed.Results:The differences in Young′s modulus of parotid gland and submandibular gland between SS group and non-SS group (or control group) were statistically significant (all P<0.05). The ultrasound score of SS group was significantly higher than that of non-SS group and control group (all P<0.05). SGUS and Young′s modulus were not significantly different between different course groups (all P>0.05). The areas under ROC curve of the mean Young′s value in parotid and submandibular gland and the SGUS were 0.801, 0.829 and 0.676, respectively. The comparison of the area under the curve between the Young′s modulus of the parotid and submandibular glands and the ultrasound score was statistically significant (all P<0.05). Conclusions:SWE and Ultrasonography scoring system have certain value in the diagnosis of salivary gland lesions in SS, and can provide important reference information for clinical diagnosis from different perspectives. The diagnostic efficiency of SWE for salivary glands lesions in patients with SS is better than that of SGUS scoring system.

Total hip arthroplasty (THA) is a well developed technique to which the spatial orientation of acetabular component is crucial. Since the idea of "safe zone" being proposed, such idea has long been obeyed by hip surgeons but has also been challenged in recent years. This is because post-operative instability could happen even if acetabular components are placed within "safe zone" . The latest researches have demonstrated that sagittal spinal balance and spino-pelvic mobility can affect the spatial orientation of acetabular components. Factors including spinal degenerative changes, long lumbosacral changes and spinal ankyloses can lead to sagittal spinal imbalance and/or influence spino-pelvic mobility, which subsequently affect pelvic retroversion. Proper pelvic retroversion is a way to compensate for sagittal spinal imbalance and is beneficial to post-operative stability. It is necessary for hip surgeons to rethink "safe zone" before performing THA and understand spinal balance as well as spinopelvic mobility. The goal is to reduce the rate of dislocation. This review started by introducing the related spinopelvic parameters frequently seen in papers published recently and the definitions of acetabular cup orientations. After the spinal sagittal balance and its compensatory mechanisms session, discussed its clinical relevance, as well as the significance of spinal mobility, in spinopelvic motion under three different postures.

This article analyzed relevant guidelines and literature on Parkinson's disease-mild cognitive impairment (PD-MCI) , reviewed the current status of PD-MCI assessment, two commonly used assessment methods and timing of assessment, aiming to provide a reference for the clinical assessment of PD-MCI in China and reduce the occurrence of Parkinson's disease dementia.

Objective To investigate the effects of hypoxic conditions on expressions of hypoxia-inducible factor 1α (HIF-1α) and P-glycoprotein (P-gp),and the relationship between HIF-1α and P-gp.Methods Tumor tissues from 54 cases of patients with colonic neoplasm in Xingtai People's Hospital were selected after operation from June 2013 to June 2015.The expressions of HIF-1α and P-gp in colonic tumor tissues were detected by using immunohistochemistry,and their correlations to clinical and pathologic features were analysed.The expressions of HIF-1α and P-gp in colonic tumor cell lines under normoxia and hypoxia conditions were detected by using cell smear method,and correlation between HIF-1α expression and P-gp expression was analysed.Results Among tumor tissues from 58 cases of patients with colonic neoplasm,the positive rate of HIF-1α expression was 58.62％,and that of P-gp expression was 46.55％.The positive rates of HIF-1α and P-gp expressions of patients on the Dukes stage C+D were significantly higher than those of patients on A+B phase (P＜0.05).Additionally,the positive rates of HIF-1α and P-gp expressions of patients with lymphatic metastasis were significantly higher than those of patients without lymphatic metastasis (P＜0.05).The HIF-1α expression was positively correlated with the P-gp expression (r=0.574,P＜0.01).For the same cell lines,the expression levels of HIF-1α and P-gp under hypoxia condition were significantly higher than those under normoxia condition,there were statistically significant differences (P＜0.01).While,under the same oxygen conditions,no statistically significant difference was found in expression levels of HIF-1 and P-gp among different colonic tumor cell lines (P＞0.05).Conclusion Overexpression and coexpression of HIF-1α and P-gp exist in colon cancer.The expression levels of HIF-1α and P-gp in patients with different Dukes stages and patients with or without lymph node metastasis are significantly different,and positive correlation is observed between the expression of HIF-1α and P-gp.Hypoxia condition can induce an increase in expressions of HIF-1α and P-gp in colonic tumor cells.

Objective To investigate the relationship between the single nucleotide polymorphisms(SNPs) of disrupted in schizophrenia 1 (DISC1) gene and autism in Chinese Han children.Methods Genome-wide SNP genotyping was performed by using Illumina HumanHap CNV370-Duo Chip in 278 autistic trios,157 autistic individuals and 435 healthy controls.Genotype data of SNPs within DISC1 gene were selected.The association between these SNPs loci and autism was analyzed through case-control association analysis and family-based transmission disequilibrium test.Results Fifty-two SNPs were involved for further analysis.1.Case-control association analysis showed that 6 SNPs (rs4658939,rs2793093,rs10495309,rs2492367,rs1 1122362,rs1073179) and 7 haplotypes (AGAAAG constructed with rs823163-rs823161-rs4658933-rs1417585-rs10864693-rs6541281,GGG and AAA constructed with rs4658939-rs2793093-rs10495309,GG and AG constructed with rs2492367-rs12046794,GAA constructed with rs9432040-rs2356606-rs1 1122362 and GG constructed with rs9431714-rs1073179) had significant differences between autistic patients and controls(x2 =4.704,4.915,5.568,8.087,4.043,5.183,5.369,5.295,4.440,5.304,7.615,4.018,4.811,P =0.030,0.027,0.018,0.005,0.044,0.023,0.021,0.021,0.035,0.021,0.006,0.045,0.028).2.In the transmission disequilibrium test analysis,2 SNPs (rs4658945,rs11122362) and 2 haplotypes (AG constructed with rs10495310-rs4658945,GAA constructed with rs9432040-rs2356606-rs11122362) showed significant transmission disequilibrium(x2=4.445,5.400,3.973,5.126,P =0.035,0.020,0.046,0.024).Conclusions The polymorphism of rs11122362 and GAA haplotype constructed with rs9432040-rs2356606-rs11122362 are associated with autism,and DISC1 gene is a susceptibility gene for autism in Chinese Han children.

Objective:To study the effects of nitrous oxide(N2 O)sedation in the management of dental fear(DF)for dental treat-ments of children.Methods:66 cases of pediatric patients(aged 6 to 14 years)were given N2 O sedation for dental treatments.The heart rate(HR)and oxygen saturation(SpO2 )were measured before and after N2 O inhalation.N2 O effective concentration was eval-uated by Ramsay sedation score and Houpt behavior score.Results:The effective concentration of N2 O sedation was 25% -70%(49.6% ±12.1%),the maximum endurance concentration 35%-70% (56.4% ±10.1%).The Ramsy scores of N2 O sedation was (2.3 ±0.6).After N2 O inhalation,all patients could receive verbal demand during the treatments.The HR decreased(P <0. 05)and the Houpt behavior score increased(P <0.01).Before and after N2 O inhalation SpO2 had no significant difference(P >0.05).Conclusion:N2 O inhalation at 25% -70% is safe and effective in the management of DF for dental treatments of children.