Objective To investigate the anatomical features of congenital chordee without hypospadias in children and to discuss the diagnosis and treatment.Methods From August 1984 to December 2004, 94 children with chordee withouthypospadias treated in the West China Hospital of Sichuan University were classified and analyzed for anatomical alterations. Their ages ranged from 18 months to 13 years (mean 6.9 years). Ninety-four patients were divided into four groups. With intraoperation artificial erection, the patients with penis straightened after degloving were classified as type Ⅰ patients (skin-tethering), those with peins straightened after fibrotic tissue in Buck’s fascia released as type Ⅱ patients (dysgenetic fascia), those with normal urethra and orthoplasty failed after degloving and removing fibrotic tissue as type Ⅲ patients (corporal disproportion), and those with dysgenetic urethra tethering the corpora cavernosa as type Ⅳ patients (short urethra).Results In type Ⅰ (n=31, 32.9%) patients, the ventral skin and dartos fascia were contracted while Buck’s fascia and the urethra was normal, in some (7 cases) scrotal skin extended to the ventral portion of penis (webbed penis). In type Ⅱ (n=45, 47.9%), contracture of Buck’s fascia was evident and the thickening fibrotic tissue constituted the chief obstacle to orthoplasty, though in some skin was shortened. In type Ⅲ (n=6), the dorsal and ventral sides of the corpora cavernosa were disproportionated, and the morphologically normal urethra tightly adhered to the ventral aspect of corpora cavernosa. In some cases ventral skin and fascia were contracted, but orthoplasty could notbe achieved through releasing these layers. In type Ⅳ (n=12, 12.8%), the distal urethra was paper-thin and lacking corpus spongiosum, or dense fibrotic bandswere found to be deep to the urethra. The urethra tethered the corpora cavernosaand formed a bow-to-string relation. The overlying skin and fascia were contracted in varying degrees while none had significance in straightening the penis. After operation, the length of penis increased to 6.9 cm from 5.2 cm on average and the chordee was corrected to 1.6° from 42.6° before operation on average. The patients were followed up 1 months to 15 years. The results were satisfactory.Chordee remained in 2 cases, fistula and urethral stricture occurred in 2 casesrespectively, fistula in association with urethral stricture and diverticulum in 1 case; the operation was given again and the results was satisfactory. Conclusion Patients with chordee without hypospadias may be divided into four types depending on which layer of the ventral penis constitutes thechief contribution to chordee. A systematic approach with repeated artificial erection tests is needed in determining the classification and surgical correction.
Objective To assess the efficacy and safety of Shenmai injection for children with viral myocarditis. Methods All randomized and quasi-randomized controlled trials (RCTs and quasi-RCTs) of Shenmai injection for children with viral myocarditis were searched from CBM (1981 to November 2009), CNKI (1980 to November 2009) and VIP (1989 to November 2009), The Cochrane Library (Issue 1,2010), PubMed (1966 to 2009), EMbase (1966 to 2009). Cochrane systematic reviews Handbook 5.0.1 was taken as a reference to quality evaluation of the included studies, and the Cochrane Collaboration’s RevMan 5.0 software was used for data analyses. Results A total of 15 RCTs were included. The quality of the included trials was low. The result of meta-analyses showed that: (1) The effective rate (RR 1.16, 95%CI 1.07 to 1.25) and the ECG improvement rate (RR 1.55, 95%CI 1.25 to 1.93) in Shenmai injection group were better than those in the control group. CK and CK-MB in Shenmai injection were lower than those in the control group, but the AST level was similar in the two groups. (2) The effective rate (RR 1.12, 95%CI 1.01 to 1.25) and the ECG improvement rate (RR 1.35, 95%CI 1.07 to 1.70) in Shenmai injection group were better than those in the western medicine plus routine therapy (RT) group. CK, AST and LDH in Shenmai injection group were lower than those in the western medicine plus RT group, but CK-MB was similar in the two groups. (3) The effective rate (RR 1.26, 95%CI 1.12 to 1.42) in Shenmai injection plus RT and western medicine group was better than that in RT and western medicine group. CK and LDH-1 in Shenmai injection plus RT and western medicine group were lower than those in RT and western medicine group. Adverse reactions of Shenmai injection in 4 studies included mild rash, rubicundity and chest distress. No severe adverse reactions were reported. Conclusion The evidence currently available shows that Shenmai injection may have some effect on children with viral myocarditis, including improving the effective rate, reducing myocardial enzymes and improving the ECG improvement rate. However, because of the low methodological quality of the included trials, this conclusion needs to be interpreted cautionsly, and more well-designed, high-quality RCTs need to be performed.
In this study, surface electromyography (sEMG) of the lower limbs of cerebral-palsy (CP) subjects in gait cycle was recorded and its parameters of gait cycle characters were analyzed to assess their clinical severity. Three algorithms, including integrated profile (IP), sample-entropy (SampEN) and smooth nonlinear energy operator (SNEO) algorithm, were applied to calculate the duration of walking sEMG segments in simulated SEMG signals. After that, the efficiency and accuracy were compared among these three algorithms. SNEO was then selected as the optimal algorithm among the three algorithms and employed for real sEMG signal processing of CP subjects. The results indicated that there was no significant difference in the accuracy of sEMG segement detection for the three algorithms. However, the computation speed of SNEO algorithm was much faster than those of the others and thus it was a suitable algorithm for detecting walking sEMG segments of CP subjects. In addition, the positive correlation was found between the clinical severity and the mean duration of walking sEMG segments in CP subjects. The results indicated that there was a significant difference in the three groups of CP subjects with different levels of severity. Our findings showed that the mean duration of walking sEMG segments could be considered as an assistant index to evaluate the clinical severity of CP subjects.
The clinical practice guideline on traditional Chinese medicine alone or combined with antibiotics for patients with acute upper respiratory infection in children was issued by China Association of Chinese Medicine in June 2017. Base on the evidence, consensus and experience, five manage groups, steering committee, consensus expert group, systematic review group, drafting group and secretary group, have promoted the project. The main work process refers to up-to-date clinical practice guideline definitions of institute of medicine and quick recommendations guide of guidelines international network and WHO. In order to provide readers with a better understanding of the guideline, the drafting process of guideline principle, main work process, and basis policy were described in detail in this paper. The guidelines’ scientific characteristics, accuracy and practicability were better exhibited in attempt to enhance its promotion and application.
【摘要】 目的 探讨小儿外科围手术期抗菌药物应用情况，为儿外科临床合理、规范使用抗菌药物提供参考。 方法 随机抽取儿外科2008年1月-2009年10月出院手术病历763份，对抗菌药物的应用情况进行分析。 结果 763份病历显示，患儿均使用了抗菌药物，应用率高达100%。抗菌药物品种应用最多的是青霉素类518例（48.05%），其次为头孢菌素类336例（31.17%），其他抗菌药物（林可霉素类、硝基咪唑类、大环内酯类等）224例（20.78%）。一联用药574例（75.00%），二联用药147例（19.00%），三联及以上用药42例（6.00%）。其中， 99例（12.98%）做过病原学检测，39例有药敏试验依据（5.11%），以G+中的葡萄球菌为主。 结论 小儿外科围手术期抗菌药物目前应用存在一定的不合理，临床应当严格按照《抗菌药物临床应用指导原则》合理、规范使用抗菌药物。【Abstract】 Objective To investigate the perioperative use of antibiotics in children’s surgery of our hospital to guide it’s reasonable and normal use. Methods A total of 763 patients who discharged from our hospital between January 2008 and October 2009 were sampled randomly for statistical analysis regarding the utilization. Results Of the 763 cases reviewed, all cases (100%) received antibiotics. In terms of the application of antibiotics, penicillins were predominantly used in 518 patients (48.05%), followed by cephalosporins in 336 patients (31.17%) and other antibiotics such as lincomycins nitroimidazoles and macrolides in 224 patients (20.78%). 574 patients (75.00%) received one antibiotic, 147 (19.00%) received two antibiotics and 42(6.00%) received at least three antibiotics concomitantly. Only 99 patients (12.98%) received etiological test and 39 patients (5.11%) received susceptibility test during antibiotic ues, most of them are G+ staphylococcus infected. Conclusion The perioperative use of antibiotics in our hospital is somewhat unreasonable, thus monitoring closely on which should be performed to promote their reasonable and normal use.
ObjectiveTo share the experience of treating special cardiac malformations by applying minimally invasive techniques.MethodsEight children with special cardiac malformations admitted to our hospital from July 2014 to September 2020 were recruited, including 3 males and 5 females, aged 0.8-1.2 (1.1±0.4) years, and weighted 7.8-11.5 (9.6±2.9) kg. There were 2 patients of huge muscular ventricular septal defect (VSD), 3 perimembranous cribriform VSD, 1 right coronary-right atrial fistula, 1 right coronary-right ventricular fistula, and 1 young, low-weight child with large aortopulmonary. All were treated with minimally invasive techniques using transesophageal echocardiography (TEE) as a guiding tool. All children received intraoperative TEE immediately to evaluate the curative effect of the surgery, and all went to outpatient clinic for reexamination of echocardiography, electrocardiogram and chest X-ray after discharge.ResultsEight children underwent minimally invasive surgery successfully without any incision infection, intracardiac infection, arrhythmia or pericardial effusion. None of the 8 children were lost to follow-up, and the results of all reexaminations were satisfactory.ConclusionThe application of minimally invasive techniques is a bold and innovative attempt for the treatment of a few special types of cardiac malformations. It has significant advantages in reducing trauma and medical costs in some suitable patients, and has certain clinical reference values.