1.A multicenter prospective study on early identification of refractory Mycoplasma pneumoniae pneumonia in children
Dan XU ; Ailian ZHANG ; Jishan ZHENG ; Mingwei YE ; Fan LI ; Gencai QIAN ; Hongbo SHI ; Xiaohong JIN ; Lieping HUANG ; Jiangang MEI ; Guohua MEI ; Zhen XU ; Hong FU ; Jianjun LIN ; Hongzhou YE ; Yan ZHENG ; Lingling HUA ; Min YANG ; Jiangmin TONG ; Lingling CHEN ; Yuanyuan ZHANG ; Dehua YANG ; Yunlian ZHOU ; Huiwen LI ; Yinle LAN ; Yulan XU ; Jinyan FENG ; Xing CHEN ; Min GONG ; Zhimin CHEN ; Yingshuo WANG
Chinese Journal of Pediatrics 2024;62(4):317-322
Objective:To explore potential predictors of refractory Mycoplasma pneumoniae pneumonia (RMPP) in early stage. Methods:The prospective multicenter study was conducted in Zhejiang, China from May 1 st, 2019 to January 31 st, 2020. A total of 1 428 patients with fever >48 hours to <120 hours were studied. Their clinical data and oral pharyngeal swab samples were collected; Mycoplasma pneumoniae DNA in pharyngeal swab specimens was detected. Patients with positive Mycoplasma pneumoniae DNA results underwent a series of tests, including chest X-ray, complete blood count, C-reactive protein, lactate dehydrogenase (LDH), and procalcitonin. According to the occurrence of RMPP, the patients were divided into two groups, RMPP group and general Mycoplasma pneumoniae pneumonia (GMPP) group. Measurement data between the 2 groups were compared using Mann-Whitney U test. Logistic regression analyses were used to examine the associations between clinical data and RMPP. Receiver operating characteristic (ROC) curves were used to analyse the power of the markers for predicting RMPP. Results:A total of 1 428 patients finished the study, with 801 boys and 627 girls, aged 4.3 (2.7, 6.3) years. Mycoplasma pneumoniae DNA was positive in 534 cases (37.4%), of whom 446 cases (83.5%) were diagnosed with Mycoplasma pneumoniae pneumonia, including 251 boys and 195 girls, aged 5.2 (3.3, 6.9) years. Macrolides-resistant variation was positive in 410 cases (91.9%). Fifty-five cases were with RMPP, 391 cases with GMPP. The peak body temperature before the first visit and LDH levels in RMPP patients were higher than that in GMPP patients (39.6 (39.1, 40.0) vs. 39.2 (38.9, 39.7) ℃, 333 (279, 392) vs. 311 (259, 359) U/L, both P<0.05). Logistic regression showed the prediction probability π=exp (-29.7+0.667×Peak body temperature (℃)+0.004×LDH (U/L))/(1+exp (-29.7+0.667×Peak body temperature (℃)+0.004 × LDH (U/L))), the cut-off value to predict RMPP was 0.12, with a consensus of probability forecast of 0.89, sensitivity of 0.89, and specificity of 0.67; and the area under ROC curve was 0.682 (95% CI 0.593-0.771, P<0.01). Conclusion:In MPP patients with fever over 48 to <120 hours, a prediction probability π of RMPP can be calculated based on the peak body temperature and LDH level before the first visit, which can facilitate early identification of RMPP.
2.Consistency study of FRACTURE sequence and CT in evaluating bone changes of knee and ankle
Nan WANG ; Qingwei SONG ; Ailian LIU ; Lihua CHEN ; Haonan ZHANG ; Mingli GAO ; Jiazheng WANG ; Liangjie LIN ; Qingping GU
Chinese Journal of Radiology 2023;57(3):294-299
Objective:To explore the consistency of MRI fast field echo resembling a CT using restricted echo-spacing (FRACTURE) and CT in the evaluation of knee and ankle bone changes.Methods:From November 2020 to November 2021, seventeen patients who underwent CT and MRI FRACTURE examinations of knee joint or ankle joint in the First Affiliated Hospital of Dalian Medical University were retrospectively collected, including 14 patients with knee joint examinations and 3 patients with ankle joint examinations. According to the number of joint components, 80 components were included, including 14 for femur and patella, 17 for tibia and fibula, and 3 for talus, scaphoid, medial cuneiform, medial cuneiform, lateral cuneiform and calcaneus, respectively. The fracture, hyperosteogeny, and bone destruction of the joint bones were evaluated by two observers using CT and FRACTURE images, respectively. Kappa test was used to analyze the consistency of CT and FRACTURE images between observers in the evaluation of joint bone lesions.Results:The Kappa values (95%CI) of the consistency evaluation of fracture, hyperosteogeny, and bone destruction by CT and FRACTURE images were 0.925 (0.823-1.027), 0.905 (0.799-1.011) and 0.895(0.752-1.038) respectively for observer 1, and were 0.963 (0.892-1.034), 0.933 (0.843-1.023) and 0.886 (0.731-1.041) respectively for observer 2. The Kappa values (95%CI) of the consistency evaluation of fracture, hyperosteogeny, and bone destruction by observers 1 and 2 via CT images were 1.000 (1.000-1.000), 0.937(0.851-1.023) and 0.945 (0.839-1.051) respectively, and that by FRACTURE images were 0.962 (0.888-1.036), 0.966 (0.899-1.033) and 0.836 (0.656-1.016) respectively.Conclusion:For the evaluation of fracture, hyperosteogeny, and bone destruction of knee joint and ankle joint, MRI FRACTURE sequence is highly consistent with CT.
3.Application of echo-planar imaging correction in diffusion weighted imaging and diffusion tensor imaging of cervical spinal cord
Na LIU ; Liangjie LIN ; Haonan ZHANG ; Yanwei MIAO ; Ailian LIU ; Qingwei SONG
Chinese Journal of Radiology 2023;57(6):679-683
Objective:To explore the value of echo-planar imaging correction (EPIC) for improving image quality of diffusion weighted imaging (DWI) and diffusion tensor imaging (DTI) of cervical cord.Methods:A total of 33 subjects (20 males, 13 females) were scanned on a 3.0 T MR scanner from January to March 2022, and the sequences included T 1WI, DWI and DTI (with and without corrections). Two observers delineated the regions of interest (ROIs) on the fused images of DWI and DTI with T 1WI before and after correction, and measured the average diffusion coefficient (ADC), fractional anisotropy (FA), and offset distance of ROIs between images with and without corrections. The subjective scores of image quality were also evaluated. The ICC or Kappa was used to test the consistency of the quantitative measurement and subjective scores by the two observers. The average values by the two observers would be used for subsequent analysis. The independent pair t-test and Wilcoxon test were used for comparison of objective measurements and Mann-Whitney U test was used for subjective image assessments between images with and without corrections. Results:The measurement data and the subjective scores of the two observers were in good agreement (ICC 0.912-0.999, Kappa 0.778-0.816). The independent sample t-test showed the subjective scores were significantly different for the DWI and DTI images between before and after geometry and/or ADC corrections. The ADC values of C6, the offset distances measured by DWI before and after correction of C4, C5, and C6 and subjective scores were significantly different ( P<0.05); The FA values of C1 and C3, ADC values of C1 and C3, offset distance of C4, C5 and C6 measured by DTI before and after correction and subjective scores were statistically significant ( P<0.001). Conclusion:EPI geometry correction and ADC value correction can significantly reduce geometric distortion, increase image quality, and thus improve the diagnosis accuracy of essential diseases.
4.Efficacy of surgical treatment for 35 children with nail matrix nevi
Yan LIU ; Lin QIU ; Yuexian FU ; Xiaofei TIAN ; Xingang YUAN ; Jun XIAO ; Tianwu LI ; Xiaobo MAO ; Ailian MEI ; Yongqiang GUO ; Rong ZHOU
Chinese Journal of Dermatology 2022;55(5):430-433
Objective:To explore rational surgical treatment for childhood nail matrix nevi.Methods:A retrospective analysis was conducted on clinical data from 35 children with pathologically confirmed nail matrix nevi, who received surgical treatment in Children′s Hospital of Chongqing Medical University from September 2015 to March 2019. Different surgical approaches were adopted according to the site and width of lesions. For lesions with a width of ≤ 3 mm, the nail bed and nail matrix lesions were directly excised with 1-to-2-mm margins and sutured in 11 cases. For lesions with a width of > 3 mm, one of the following 3 surgical procedures was selected by the children′s parents: (1) shaving of nail bed and nail matrix lesions under a microscope at ×8 magnification (8 cases) ; (2) excision of lesions followed by full-thickness skin grafting on the periosteum of the phalanx (8 cases) ; (3) excision of lesions of the second to fifth fingers followed by transfer of skin flaps from the thenar muscle area and full-thickness skin grafting (5 cases) , or excision of lesions of the thumb followed by abdominal-wall flap transfer (3 cases) . The patients were followed up for 12 months, and clinical efficacy was evaluated.Results:During the follow-up, no recurrence occurred in the 11 cases receiving direct excision and suture, with good appearances and longitudinal linear scars on the nail. Among the 8 cases receiving shaving therapy under a microscope, 4 experienced relapse during the follow-up of 6 - 12 months, and the nail/toenail plates were rough and poor in lustrousness in the other 4 without recurrence. No recurrence was observed in the 8 cases receiving excision of the lesions and full-thickness skin grafting, of whom 1 experienced skin graft necrosis, and skin grafts survived with obvious pigmentation in the other 7 cases. Among cases receiving excision of the lesions combined with transfer of skin flaps from the thenar muscle area or abdominal-wall flap transfer, no recurrence was observed, and all transferred flaps survived; good appearances, nearly normal color and gloss of nails were obtained in the cases after transfer of skin flaps from the thenar muscle area, while the color and gloss of postoperative nails were markedly different from those of normal nails in the cases receiving abdominal-wall flap transfer.Conclusion:For nail matrix nevi with a width of ≤ 3 mm, direct excision and suture with 1-to-2-mm margins are recommended; for those with a width of > 3 mm, excision of lesions combined with full-thickness skin grafting, transfer of skin flaps from the thenar muscle area or abdominal-wall flap transfer is recommended; the shaving procedure under a microscope should be used with caution.
5.Role of CD155 in hepatocyte apoptosis and liver fibrosis induced by Echinococcus multilocularis infection in mice
Junjie SHI ; Kusuman NUERBAITI ; Ning YANG ; Xiaojuan BI ; Renyong LIN ; Ailian ZHANG
International Journal of Biomedical Engineering 2022;45(5):384-389,394
Objective:To investigate the role of CD155 in hepatocyte apoptosis and liver fibrosis in mice infected with Echinococcus multilocularis. Methods:Thirty-six female C57BL/6 mice were randomly divided into a sham surgery group and a model group, with 18 mice in each group. Mice in the model group were injected with protoscolex via the portal vein to create an animal model of E. multilocularis infection. Mice in the sham surgery group were injected with the same amount of saline. The mice were sacrificed at 1 month, 3 months, and 6 months after modeling, and liver samples were collected. Hepatic pathological changes were observed by hematoxylin-eosin staining. Liver fibrosis was detected by Sirius red staining, and expression of Caspase-3 and CD155 in hepatocytes was detected by immunohistochemical staining. The correlation between CD155 expression in hepatocytes and Caspase-3 and liver fibrosis levels were analyzed by Person. Results:There were obvious lesions in the liver of the model group accompanied by severe liver fibrosis. Compared with the sham surgery group, the expression of CD155 and Caspase-3 in mouse hepatocytes at different stages in the model group was significantly increased, and the differences were statistically significant ( P<0.05). The model group's liver fibrosis level was significantly higher at different stages than the sham surgery group, with statistical significance ( P<0.05). In addition, correlation analysis showed that expression of CD155 in hepatocytes was positively correlated with the expression of Caspase-3 ( r=0.956 8; P<0.001; 95% CI: 0.885 5-0.984 1) and that expression of CD155 in hepatocytes was positively correlated with the degree of liver fibrosis( r=0.853 9; P<0.001; 95% CI: 0.643 7-0.944 3). Conclusions:CD155 expression was significantly up-regulated in mouse hepatocytes infected with E. multilocularis at different stages, which was positively correlated with the degree of hepatocyte apoptosis and liver fibrosis, suggesting that CD155 may be involved in the process of hepatocyte apoptosis and liver fibrosis caused by E. multilocularis infection.
6.Anatomic characteristics and surgical management of preaxial polysyndactyly of foot accompanying varus deformity
Tianwu LI ; Ailian MEI ; Yuexian FU ; Lin QIU ; Xiaofei TIAN
Chinese Journal of Plastic Surgery 2021;37(9):987-992
Objective:To analyze and report the anatomical characteristics, surgical management and clinical outcome for preaxial polysyndactyly with varus deformity.Methods:We retrospectively reviewed our database of cases with preaxial polysyndactyly in the Department of Burn and Plastic Surgery of Children’s Hospital of Chongqing Medical University from January 2010 to January 2020. The clinical manifestations are duplicated hallux, with complete fusion of the main and auxiliary hallux, tibial hallux dysplasia, and fibular hallux with obvious varus deformity. The anatomical characteristics of this special polysyndactyly, surgical incision design, osteoarticular correction methods were analyzed, and the axial line of the big toe after the operation and its influence on the walking function were followed up.Results:A total of 10 children with preaxial polysyndactyly (12 toes) were enrolled, including 6 male and 4 female patients. Age ranged from 5 to 45 months, with an average of 19.3 months. Eight cases were unilateral, and 2 cases were bilateral. All the cases had duplicated hallux, with tibial hallux dysplasia and proximal displacement. The fibular hallux was dominant but with varus deformity to varying degrees (varus angle 25°-90°, mean 55°). During the operation, the abductor hallucis (AbdH) was found to be attached to the tibial hallux, and the metatarsophalangeal (MTP) joint of the dominant hallux was dislocated to the tibial side, with an inclination of the joint surface. Incision design: zigzag incision around extra toes were used in 3 toes with varus angle from 25° -40°, proximal pedicle flap of the extra toe was taking in 3 toes with varus angle from 45°-90°, and double Z-plasty incision was designed in 6 toes which varus angle is from 75°-90°. Correction of bone and joint: after extra toe resected, the axis of two cases with mild hallux varus was corrected by releasing the soft tissue contracture in the tibial side of the main toe and reducing the joint. The other 10 cases were obtained completely axially corrected after opening osteotomy performed at the tibial side of the metatarsal bone or phalanx, and nine of them were treated with bone graft for filling the bone defect. Wound closure: all wounds were successfully closed. Among these, 2 of the 3 toes that taking transferred proximal pedicle flap of extra toe were supplemented with skin grafts due to skin deficiency. Although the varus angle was large, the wounds of 6 toes with double Z-plasty incision were completely closed after lengthened the longitudinal skin of the tibial side of the big toe. Two cases were lost to follow-up, and the other 8 cases (10 toes) were followed up for 5-38 months (mean 13 months). Except for 1 toe with insufficient correction (hallux varus 15°) and 2 toes with overcorrection (hallux valgus 15°, 20°), the axial lines of the other big toes were normal. All cases wore shoes and walked normally.Conclusions:The anatomical characteristics of this type of preaxial polysyndactyly are the AbdH terminating in the deformed tibial toe and the medial dislocation of the associated main hallux MTP joint resulting in varus and the oblique planar of the metatarsal articulations. The deformity of hallux varus and the deficiency of tibial skin were the characteristics and the difficulties of this special type of preaxial polysyndactyly. Good axial correction can be obtained by means of opening osteotomy and intraoperative release of abductor insertion. Then the wound can be closed at one stage without skin grafting by using a double Z-plasty incision which could fully elongate the tibial side skin.
7.Anatomic characteristics and surgical management of preaxial polysyndactyly of foot accompanying varus deformity
Tianwu LI ; Ailian MEI ; Yuexian FU ; Lin QIU ; Xiaofei TIAN
Chinese Journal of Plastic Surgery 2021;37(9):987-992
Objective:To analyze and report the anatomical characteristics, surgical management and clinical outcome for preaxial polysyndactyly with varus deformity.Methods:We retrospectively reviewed our database of cases with preaxial polysyndactyly in the Department of Burn and Plastic Surgery of Children’s Hospital of Chongqing Medical University from January 2010 to January 2020. The clinical manifestations are duplicated hallux, with complete fusion of the main and auxiliary hallux, tibial hallux dysplasia, and fibular hallux with obvious varus deformity. The anatomical characteristics of this special polysyndactyly, surgical incision design, osteoarticular correction methods were analyzed, and the axial line of the big toe after the operation and its influence on the walking function were followed up.Results:A total of 10 children with preaxial polysyndactyly (12 toes) were enrolled, including 6 male and 4 female patients. Age ranged from 5 to 45 months, with an average of 19.3 months. Eight cases were unilateral, and 2 cases were bilateral. All the cases had duplicated hallux, with tibial hallux dysplasia and proximal displacement. The fibular hallux was dominant but with varus deformity to varying degrees (varus angle 25°-90°, mean 55°). During the operation, the abductor hallucis (AbdH) was found to be attached to the tibial hallux, and the metatarsophalangeal (MTP) joint of the dominant hallux was dislocated to the tibial side, with an inclination of the joint surface. Incision design: zigzag incision around extra toes were used in 3 toes with varus angle from 25° -40°, proximal pedicle flap of the extra toe was taking in 3 toes with varus angle from 45°-90°, and double Z-plasty incision was designed in 6 toes which varus angle is from 75°-90°. Correction of bone and joint: after extra toe resected, the axis of two cases with mild hallux varus was corrected by releasing the soft tissue contracture in the tibial side of the main toe and reducing the joint. The other 10 cases were obtained completely axially corrected after opening osteotomy performed at the tibial side of the metatarsal bone or phalanx, and nine of them were treated with bone graft for filling the bone defect. Wound closure: all wounds were successfully closed. Among these, 2 of the 3 toes that taking transferred proximal pedicle flap of extra toe were supplemented with skin grafts due to skin deficiency. Although the varus angle was large, the wounds of 6 toes with double Z-plasty incision were completely closed after lengthened the longitudinal skin of the tibial side of the big toe. Two cases were lost to follow-up, and the other 8 cases (10 toes) were followed up for 5-38 months (mean 13 months). Except for 1 toe with insufficient correction (hallux varus 15°) and 2 toes with overcorrection (hallux valgus 15°, 20°), the axial lines of the other big toes were normal. All cases wore shoes and walked normally.Conclusions:The anatomical characteristics of this type of preaxial polysyndactyly are the AbdH terminating in the deformed tibial toe and the medial dislocation of the associated main hallux MTP joint resulting in varus and the oblique planar of the metatarsal articulations. The deformity of hallux varus and the deficiency of tibial skin were the characteristics and the difficulties of this special type of preaxial polysyndactyly. Good axial correction can be obtained by means of opening osteotomy and intraoperative release of abductor insertion. Then the wound can be closed at one stage without skin grafting by using a double Z-plasty incision which could fully elongate the tibial side skin.
8. Study on risk factors of postpartum hemorrhage in elderly parturients after cesarean section
Chinese Journal of Primary Medicine and Pharmacy 2019;26(18):2231-2234
Objective:
To investigate the risk factors of postpartum hemorrhage in elderly parturients after cesarean section based on logistic regression analysis and to explore nursing strategies.
Methods:
From January 2018 to March 2019, a total of 210 elderly women with cesarean section and postpartum hemorrhage in the Integrated Traditional Chinese and Western Medicine Hospital of Wenzhou were selected as the study group.And 420 elderly women who underwent cesarean section and did not have bleeding were selected as the control group, which may cause postoperative bleeding.Factors were analyzed and multivariate logistic regression analysis was performed on the factors that caused significant effects.
Results:
The incidence of pregnancy hypertension, abortion history, uterine atony, macrosomia and placenta previa in the observation group was significantly higher than that in the control group (
9. Clinical randomized controlled trial on influence of recombinant human growth hormone on the immune function of younger children with severe burn injuries
Ailian MEI ; Lin QIU ; Yue ZHANG ; Xingang YUAN ; Yan LIU ; Tianwu LI ; Xionghui DING
Chinese Journal of Burns 2019;35(10):726-732
Objective:
To preliminarily investigate the influence of recombinant human growth hormone (rhGH) on the immune function of younger children with severe burn injuries.
Methods:
A total of 30 younger children with severe burn injuries, conforming to the study criteria, were admitted to our hospital from July 2016 to July 2018. They were enrolled in the prospective, randomized, double-blinded, controlled trial and divided into group rhGH [
10. Meta-analysis on the diagnostic value of laser Doppler imaging for burn depth
Ying HUANG ; Lin QIU ; Ailian MEI ; Jiaoxun LI
Chinese Journal of Burns 2017;33(5):301-308
Objective:
To evaluate the value of laser Doppler imaging (LDI) in diagnosing deep or superficial partial-thickness burn wound with meta-analysis.
Methods:
Databases including

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