OBJECTIVE: To investigate the surgical technique and preliminary effectiveness of closed reduction and internal fixation (CRIF) using antegrade elastic intramedullary nailing (ESIN) via a novel approach through the proximal radius for treating distal radius metaphyseal-diaphyseal junction (DRMDJ) fractures in children. METHODS: A retrospective analysis was conducted on 34 children with DRMDJ fractures who met the selection criteria and were treated between January 2020 and June 2023. There were 21 boys and 13 girls, aged 6-14 years (mean, 8.2 years). Injury causes included falls in 11 cases and sports-related trauma in 23 cases. Twenty-six cases were associated with ipsilateral distal ulnar fractures. All patients had failed initial closed reduction in the outpatient clinic. The time from injury to operation ranged from 1 to 15 days (mean, 4 days). All patients underwent CRIF using antegrade ESIN inserted via a novel approach at the proximal one-third of the radius. The operation time, intraoperative fluoroscopy frequency, fracture healing time, and complications were recorded. Fracture reduction was assessed immediately after operation on anteroposterior and lateral X-ray films for residual translation and angulation. Wrist function was evaluated using the modified Mayo wrist score. RESULTS: Surgery was successfully completed in all 34 children. CRIF with ESIN failed in 2 cases with associated ipsilateral distal ulnar fractures, requiring conversion to open reduction of the ulna. Operation time ranged from 15 to 56 minutes (mean, 21 minutes). Intraoperative fluoroscopy frequency ranged from 5 to 21 times (mean, 7 times). Immediate postoperative X-ray films showed residual translation of 0-15% on anteroposterior view and 0-10% on lateral view, and residual angulation of 0°-5° on both anteroposterior and lateral views. All children were followed up 6-18 months (mean, 12 months). There was no complication such as neurovascular injury, incision infection, or limitation of forearm rotation. Follow-up X-ray films showed no fracture displacement, implant loosening, delayed union, or nonunion. Fracture healing time ranged from 4 to 8 weeks (mean, 6 weeks). Implants were removed at 4-6 months postoperatively (mean, 5 months). At last follow-up, all fractures had achieved anatomic or near-anatomic healing. The modified Mayo wrist score ranged from 80 to 100 (mean, 94), with 27 excellent and 7 good results, yielding an excellent and good rate of 100%. CONCLUSION CRIF using antegrade ESIN via a novel approach through proximal radius is a safe and effective treatment for pediatric DRMDJ fractures, associated with few postoperative complications and excellent restoration of wrist function.
Humans ; Child ; Female ; Male ; Fracture Fixation, Intramedullary/instrumentation* ; Adolescent ; Radius Fractures/diagnostic imaging* ; Retrospective Studies ; Bone Nails ; Treatment Outcome ; Fracture Healing ; Diaphyses/surgery* ; Radius/surgery* ; Operative Time ; Closed Fracture Reduction/methods* ; Ulna Fractures/surgery*

Objective To examine the possible factors affecting the attainment of target serum trough concentration of vancomycin in premature newborns for optimization of clinical dosing regimens.Methods The vancomycin trough concentration data were collected retrospectively from preterm newborns who received intravenous infusion of vancomycin from December 2016 to March 2021.According to the Evidence-based Guideline for Therapeutic Drug Monitoring of Vancomycin:2020 Update by the Division of Therapeutic Drug Monitoring,Chinese Pharmacological Society,the patients were assigned to failure(＜5 mg/L)or success(5-15 mg/L)in target attainment,or beyond target group(＞15 mg/L)base on vancomycin trough concentration.Statistical software SPSS was used to analyze differences in clinical characteristics between different groups,and profile various factors that may affect attainment of target serum trough concentration of vancomycin.Results The median(interquartile range)trough concentration of vancomycin was 12.50(7.95-18.05)mg/L in 82 preterm newborns.The target trough concentration of vancomycin was attained in 47 preterm newborns(57.32％),and the corresponding trough concentration of vancomycin was 10.90(7.80-13.30)mg/L.The trough concentration of vancomycin was beyond target in 27 preterm newborns(32.93％).The corresponding median trough concentration of vancomycin was 21.80(18.00-23.80)mg/L.Serum trough concentration of vancomycin failed to achieve the target in only 8 preterm newborns(9.75％).The corresponding median trough concentration was 4.10(2.48-4.60)mg/L.Univariate analysis showed that there were statistically significant differences(P＜0.05)in postmenstrual age and current weight between the patients succeeded in attaining target trough concentration and those who failed to attain the target.Baseline serum creatinine and dosing interval showed statistically significant differences(P＜0.01)between the newborns who attained the target concentration and those with higher trough concentration beyond the target.Multivariate regression analysis showed that baseline serum creatinine(OR=1.063,95％CI 1.024-1.102,P=0.001,cutoff:62 pmol/L)and dosing interval(OR=6.693,95％CI 1.604-27.920,P=0.009)were independent risk factors for excessively high vancomycin trough concentrations.Conclusions The dosing regimens as recommended in the current package insert only enable the attainment of target serum trough concentration of vancomycin in half of the premature newborns.The dosing regimen of vancomycin should be optimized by taking postmenstrual age,current weight,baseline serum creatinine and dosing interval into account.Therapeutic drug monitoring is necessary to ensure safety and effectiveness.

Objective To study the effects of Fluvastatin on the expression of intercellular adhesion molecule-1 (ICAM-1) in human umbilical vein endothelial cells (HUVECs) induced by C-reactive protein (CRP). MethodsThe HUVECs were primary cultured. HUVECs from third to sixth generations were stimulated with different concentrations CRP and at different times. Then the cells were treated with Fluvastatin in different concentration of 10-7,10-6 and 10-5mol/L. The content of ICAM-1 protein was detected with ELISA, the mRNA expression of ICAM-1 was evaluated by RT-PCR. Results In the control group, HUVECs produce ICAM-1 protein and mRNA in low concentrations. In CRP group, the content of ICAM-1 protein was increased significantly (P

Objective To study the effects of fluvastatin on the proliferation of blood vessel smooth muscle cell (SMC) and the expression of platelet derived growth factor-A(PDGF-A) in experimental atherosclerosis(As) rabbits. Methods The expression of proliferating cell nuclear antigen(PCNA) of SMC was detected by immunohistochemistry. The expression of PDGF-A protein and mRNA was determined using immunohistochemical method and RT-PCR, respectively. Results The pathological lesions of atherosclerosis in fluvastatin group was significantly milder than those in high fat diet group(P

AIM: To observe activity of scavenger receptor of macrophage derived from monocytes, the change of inflammation factor in plasma (including CRP, sICAM-1, sVCAM-1) and the influence of atorvastatin on activity of scavenger receptor in patients with coronary heart disease. METHODS: 75 patients with coronary heart disease (CHD), whose plasma lipid levels were normal, were divided into three groups: stable angina pectoris, unstable angina pectoris and acute myocardia infarction. 29 healthy persons were served as control. The level of C-reactive protein (CRP), soluble intercellular adhesion molecule-1 (sICAM-1) and soluble vascular cell adhesion molecule-1 (sVCAM-1) in plasma were determined in all subjects. Monocytes in peripheral blood were dissevered and cultured to transform into macrophage. The influence of atorvastatin on activity of scavenger receptor in macrophage was observed. RESULTS: The level of CRP, sICAM-1, sVCAM-1 and activity of scavenger receptor of macrophage in acute myocardia infarction group were higher than that in stable angina pectoris, unstable angina pectoris and control. Atorvastatin lowered the activity of scavenger receptor of macrophages derived from monocytes in patients with coronary heart disease. Activity of scavenger receptor of macrophages derived from monocytes in patients with coronary heart disease was correlated positively with CRP, sICAM-1 and sVCAM-1. CONCLUSION: Activity of scavenger receptor may be taken as index for monitoring the degree of active vulnerable atherosclerosis plaque. Atorvastatin may inhibit activity of scavenger receptor in macrophages derived from monocytes in patients with coronary heart disease.