Objective:To establish a classification system for the repair band in the subchondral bone origination point in MRI for traumatic osteonecrosis of the femoral head (ONFH) and preliminarily explore the correlation between this classification and the progression of femoral head collapse.Methods:A retrospective analysis was conducted on 73 cases of traumatic ON-FH treated at the Quanzhou Orthopedic-traumatological hospital from January 2000 to December 2019. Among them, there were 46 males and 27 females with an average age of 34.9±8.3 years (range 19-55 years). Clinical and radiological data such as age, gender, side, fracture classification, reduction quality, JIC classification, and bone repair band (BRB) classification were recorded. The progression of traumatic ONFH was assessed using the ARCO staging system, with stages IIIA and IIIB defined as mild collapse and progressive collapse, respectively. The BRB classification was established based on MRI findings, and the inter- and intra-observer consistency of the BRB classification was analyzed using Kappa test. The correlation between the BRB classification and progressive femoral head collapse was analyzed using the Kaplan-Meier survival curve and binary variable Cox regression analysis.Results:According to the BRB classification, 73 cases were divided into type 1 with superficial lesion in 38.4%, type 2 with uncertain lesion in 21.9%, and type 3 with extensive lesion in 39.7%. The inter-observer consistency Kappa value for the BRB classification was 0.798, and the intra-observer consistency Kappa value was 0.896, indicating a high level of consistency. A follow-up of 73 cases (54.8±34.9 months, range 24-165 months) showed a significant correlation between the BRB classification and ARCO staging at the last follow-up (χ 2=37.556, P<0.001), with progression to stages IIIA and IIIB as follows: type 1 had 3 and 1 cases, type 2 had 4 and 1 cases, and type 3 had 14 and 12 cases, respectively. Using the occurrence of progressive collapse (stage IIIB) as the endpoint, the risk of progression to stage IIIB for type 2 was not statistically different from type 1 [ HR=1.766, 95% CI (0.465, 6.702), P=0.403]; the risk of progression to stage IIIB for type 3 was significantly higher than for type 1 [ HR=15.126, 95% CI (4.708, 48.592), P<0.001]. Conclusion:The BRB classification is closely related to the progression of traumatic ONFH and is an independent risk factor for predicting the occurrence of progressive collapse; this classification is helpful for early diagnosis and predicting the progression of collapse and treatment plan decision-making.

Objective:To explore the therapeutic characteristics of population with gout achieving treat-to-target (T2T) indicators through real-world research and evaluate their safety.Methods:A total of 3 287 patients diagnosed with gout by rheumatologists in 21 first-class tertiary hospitals in 10 provinces, municipalities, and autonomous regions in China from January 2015 to December 2021 were included in this polycentric cross-sectional study. The database included patients′ general information, disease characteristics, and clinical application of traditional Chinese and Western medicine treatment measures. SPSS and Excel software were used for data analysis. Frequency analysis, cluster analysis, and factor analysis were used to summarize the characteristics and rules of treatment measures for patients with gout who achieved the target after treatment. The occurrence of adverse events (AE) was recorded during treatment.Results:After treatment, 691 visits (7%) achieved the serum urate (SUA) target, and the most frequent use of urate-lowering therapy (ULT) was febuxostat, followed by benzbromarone. The most common treatment options were following: GroupⅠ: traditional Chinese medicine (TCM) decoction-TCM external treatment-physical exercise-proprietary Chinese medicine; GroupⅡ: ferulic acid-nonsteroidal anti-inflammatory drugs (NSAIDs); Group Ⅲ: allopurinol-sodium bicarbonate-benzbromarone; Group Ⅳ: glucocorticoid-colchicine; Group Ⅴ: febuxostat. A total of 5 898 visits (60%) chieved manifestations of joint pain VAS scores target, and the most frequently used drug to control joint symptoms was NSAIDs. The frequency of use of drugs to control joint symptoms were 2 118 times (usage rate reached 35.9%), while the frequency of ULT were 2 504 times (usage rate reached 42.5%), which was higher than the joint symptom control drug. The most common treatment options were following: Group Ⅰ: proprietary Chinese medicine-TCM decoction-TCM external treatment-physical exercise; Group Ⅱ: NSAIDs-colchicine hormones; Group Ⅲ: allopurinol, Group Ⅳ: benzbromarone; Group Ⅴ: febuxostat. A total of 59 adverse events occurred during treatment.Conclusion:The proportions of gout patients who reach target serum urate level & good control of joint symptoms are both very low, and ULT and anti-inflammatory prescription patterns are very different from international guidelines, so it is necessary to strengthen the standardized management of gout patients. At the same time, life intervention measures account for a certain proportion of the treatment plans for the T2T population, and further exploration is needed.

Objective: Understanding mental health status of students with learning disabilities in Beijing to provide a basis for mental health promotion of students with learning disabilities. Methods: By means of random cluster sampling, 5 787 enrolled students in grade one and grade two of 11 public junior middle schools in Beijing were selected as the survey subjects. A self designed questionnaire was used to investigate the students’ learning disabilities and mental health status through anonymous self filling. Results: About 11.6% students self reported learning disabilities. The proportions of students with learning difficulty in mathematical reasoning and calculation were higher, 44.1% and 40.7% respectively. The reported rate of mental health problems was 38.3%. The top four of the 10 symptoms were obsessive compulsive symptoms, learning pressure, emotional instability and anxiety(2.19±0.77)(2.17±0.99)(2.09±0.90)(2.07±1.08). Compared with students without learning disabilities, students with self reported learning disabilities had poorer mental health status(OR=1.47), and learning disabilities were related to most factors of mental health. Different types of learning disabilities were associated with different mental health factors. Conclusion Mental health problems of students with learning disabilities are higher than that of students without learning disabilities. It is necessary to strengthen the mental health support for students with learning disabilities and improve their mental health.

Objective:To investigate the efficacy and safety of oral sirolimus in the treatment of refractory vascular anomalies.Methods:From February 2017 to February 2018, 20 cases of vascular deformity with no obvious improvements after multiple therapies in our hospital were included. Among them, 5 have Kaposiform hemangioendothelioma (KHE) with Kasabach-Merritt phenomenon (KMP), 10 have lymphatic malformation, 3 have venous malformation and 2 have lymphatic venous malformation. A single course of oral sirolimus lasted for 3 months. Initial dose was 0.8 mg/m 2 once, oral administration twice per day, and subsequent dose was adjusted to maintain the concentration of blood drug at 10-15 ng/ml. Before and after taking sirolimus, the general information, tumor changes and the adverse reactions were gathered. Efficacy was evaluated at the end of the treatment course. Effective: tumor volume reduced by more than 50% and or platelets stabilized in the normal range. Partly effective: tumor volume reduced by 25%-50%. No effect: tumor volume reduced by less than 25% or no significant change. Results:All the patients were treated with sirolimus orally for 1-3 courses, among which 11 were effective, 6 were partially effective, and 3 were ineffective. They were followed up for more than 3 months after the end of the whole course and no tumor enlargement was observed. All the 5 cases with KHE and KMP had significantly reduced tumor size and the platelets were stable in the normal range, but 2 of them suffered from severe pneumonia, one of them eventually perished. Two of the remaining children had elevated liver enzymes and high fever. The lesions of 10 patients with lymphatic malformations were reduced, and 4 of them had mild liver dysfunction. Two with lymphatic venous malformations had shrunk in different degree, and 3 with venous malformations had no effect. Three of them showed significant relief of pain symptoms, and their pain score was significantly lower than that before oral administration (8.7±1.2 vs 1.3±1.2, P=0.001). Except for 1 case with venous malformation had oral ulcer. No obvious adverse reaction were observed in the remaining 11 patients. Conclusions:Oral sirolimus may be effective and safe in the treatment of refractory vascular anomalies, but it should be treated with caution in little infants.

Objective:To investigate the safety and efficacy of sirolimus through the change in platelet counts during the sirolimus therapy on Kasaback-Merritt phenomenon(KMP).Methods:Four patients were treated in Nanjing Children Hospital between Jaunary 2017 and June 2019 were enrolled in the study, including two males and two females. Their age was ranged from two days to three months. They all presented with huge mass located in neck or retroperitoneal and thrombocytopenia, hypofibrinogenemia. Their coagulation could not be improved by surgery or palate transfusion or steroids. They were all diagnosed as Kaposiform hemangioendothelioma(KHE) with KMP according to the biopsy, coagulation index and CT. Sirolimus were administered with 0.1 mg -1·kg -1·d -1 or 0.8 mg/m 2, twice daily. Subsequent dose was adjusted to maintain the trough level between 10-15 ng/ml.Steroids were weaned gradually. Blood accounts were measured following the sirolimus administration. Results:All the four patients got improvement in platelet counts. Three patients went through a significant decreasing of palate counts after adding sirolimus for about 1-4 days. Two lesions prompted improvement with smaller size, lighter color and softer texture without complete regression. Two patients had elevated liver enzymes and/or interstitial pneumonia. One recovered while the other died of severe pneumonia with dyspnea. All the palate counts of survived patients remained in normal level in the following one year.Conclusions:Sirolimus is an effective method in treating KMP and stabilizing platelet counts. However, it can not cure hemangioendothelioma.

Objective:To investigate the efficacy and safety of oral sirolimus in the treatment of refractory vascular anomalies.Methods:From February 2017 to February 2018, 20 cases of vascular deformity with no obvious improvements after multiple therapies in our hospital were included. Among them, 5 have Kaposiform hemangioendothelioma (KHE) with Kasabach-Merritt phenomenon (KMP), 10 have lymphatic malformation, 3 have venous malformation and 2 have lymphatic venous malformation. A single course of oral sirolimus lasted for 3 months. Initial dose was 0.8 mg/m 2 once, oral administration twice per day, and subsequent dose was adjusted to maintain the concentration of blood drug at 10-15 ng/ml. Before and after taking sirolimus, the general information, tumor changes and the adverse reactions were gathered. Efficacy was evaluated at the end of the treatment course. Effective: tumor volume reduced by more than 50% and or platelets stabilized in the normal range. Partly effective: tumor volume reduced by 25%-50%. No effect: tumor volume reduced by less than 25% or no significant change. Results:All the patients were treated with sirolimus orally for 1-3 courses, among which 11 were effective, 6 were partially effective, and 3 were ineffective. They were followed up for more than 3 months after the end of the whole course and no tumor enlargement was observed. All the 5 cases with KHE and KMP had significantly reduced tumor size and the platelets were stable in the normal range, but 2 of them suffered from severe pneumonia, one of them eventually perished. Two of the remaining children had elevated liver enzymes and high fever. The lesions of 10 patients with lymphatic malformations were reduced, and 4 of them had mild liver dysfunction. Two with lymphatic venous malformations had shrunk in different degree, and 3 with venous malformations had no effect. Three of them showed significant relief of pain symptoms, and their pain score was significantly lower than that before oral administration (8.7±1.2 vs 1.3±1.2, P=0.001). Except for 1 case with venous malformation had oral ulcer. No obvious adverse reaction were observed in the remaining 11 patients. Conclusions:Oral sirolimus may be effective and safe in the treatment of refractory vascular anomalies, but it should be treated with caution in little infants.

Objective:To investigate the safety and efficacy of sirolimus through the change in platelet counts during the sirolimus therapy on Kasaback-Merritt phenomenon(KMP).Methods:Four patients were treated in Nanjing Children Hospital between Jaunary 2017 and June 2019 were enrolled in the study, including two males and two females. Their age was ranged from two days to three months. They all presented with huge mass located in neck or retroperitoneal and thrombocytopenia, hypofibrinogenemia. Their coagulation could not be improved by surgery or palate transfusion or steroids. They were all diagnosed as Kaposiform hemangioendothelioma(KHE) with KMP according to the biopsy, coagulation index and CT. Sirolimus were administered with 0.1 mg -1·kg -1·d -1 or 0.8 mg/m 2, twice daily. Subsequent dose was adjusted to maintain the trough level between 10-15 ng/ml.Steroids were weaned gradually. Blood accounts were measured following the sirolimus administration. Results:All the four patients got improvement in platelet counts. Three patients went through a significant decreasing of palate counts after adding sirolimus for about 1-4 days. Two lesions prompted improvement with smaller size, lighter color and softer texture without complete regression. Two patients had elevated liver enzymes and/or interstitial pneumonia. One recovered while the other died of severe pneumonia with dyspnea. All the palate counts of survived patients remained in normal level in the following one year.Conclusions:Sirolimus is an effective method in treating KMP and stabilizing platelet counts. However, it can not cure hemangioendothelioma.

Objective: To evaluate the clinical effect of multiple osteotomies combined with distraction osteogenesis in the treatment of non-syndromic scaphocephaly infants and young children. Methods: Clinical records of 8 non-syndromic scaphocephaly patients, during January 2017 to October 2018, from the Department of Burn and Plastic Surgery, Children′s Hospital of Nanjing Medical University, were retrospectively analyzed. There were 3 males and 5 females, aged from 3 to 28 months, with an average of 13 months. Among them, 4 cases were typical scaphocephaly, 2 cases were anterior scaphocephaly and 2 cases were posterior scaphocephaly. According to the subtypes of scaphocephaly, different osteotomy methods and distraction directions were designed. The cranial vault was osteotomized by piezosurgery osteotomy in a multiple way. The dura did not separate from cranial flap. The internal distractors were installed subsequently. After a mean latency period of 5 days, the devices were activated at a rate of 0.4-0.6 mm/d. Distractor was extended twice a day. After 10-15 days activation period and 6 months consolidation, all the distractors were removed. Three-dimensional CT scans were performed before and after operation to measure the anteroposterior and bitemporal diameters, so as to calculate the cranial index. Results: Follow-up ranged from 6 to 14 months (average, 10 months). The average anteroposterior length of 8 children was(158.2±12.9) mm before operation, and (145.5±14.2) mm after operation, which was shortened(12.6±3.4) mm. Bitemporal diameters was(99.6±8.6) mm preoperatively and(113.9±7.5) mm postoperatively, which was widened (14.2±2.8) mm. Preoperative and postoperative cranial index was 63.2 and 78.3, respectively. The scaphocephalic head shape was significantly improved in all patients. There was no serious complications such as skull necrosis or intracranial infection. Conclusions Different types of multiple osteotomy combined with distraction osteogenesis are useful to correct various scaphocephaly of infants and children, by improving skull shape and cranial index.

Objective: To investigate the treatment of nasal deformity in patients with unicoronal craniosynostosis. Methods: In patients over 6 months old, the nasal bones were wedge-removed without fixation. The management of all patients with unicoronal craniosynostosis was distraction osteogenesis of pedicled unilateral frontal bone flap. Results: Postoperative extended distance of the frontal bone was 28—41 mm (mean, 35.4 mm). After extension, three-dimensional reconstruction of cranial CT was carried out, which showed that CVAI was 0.8—1.2 (mean, 0.98), tending to normal. After discharge, dynamic cranial braces were put on for 1 year. Postoperatively, the children were followed up for 8—36 months (mean, 28 months). The shape and nasal deformity of all children were improved compared with those before surgery. Conclusions Nasal wedge resection should be used to correct nasal deformity in children over 6 months with unicoronal craniosynostosis.

Objective: To discuss the application of plane-shaped flaps for reconstruction of the web space in polysyndactyly of the fifth toe fused with the fourth toe. Methods: A total of 62 cases (81 feet) with polysyndactyly of the fifth toe fused with the fourth toe were involved in the study, 53 of which were incomplete and 9 were complete fusion of the fourth and fifth toe. The fifth toe showed various degrees of fibular clinodactyly and minor deformities. Excision of polydactyly and then using arthroplasty or osteotomy correction deviation was for fibular clinodactyly. All plane-shaped flaps were used for reconstruction of the web space deeply, and the lateral sides of toes were closed with flaps and the distal soft tissues of polydactyly were used lengthening the reconstructed fifth toe. Brachydactylias were improved, and nail folds were reconstructed. Thus, the appearances reached the normal level. Results: All the webs were reconstructed primarily without skingraft. After 12 months of follow-up, these reconstructed web space were satisfied with good appearances of width, depth and gradient. The fibular clinodactyly was completely corrected, and brachydactylias were corrected in various degrees. Nail folds reached the normal ones. Conclusions Plane-shaped flap in polysyndactyly of the fifth toe fused with the fourth toe for reconstruction of the web space is satisfactory. The reconstructed webs not only achieves good appearance, but also avoids skin grafts. It is one of the best choices of the polysyndactyly treatment.