Objective To evaluate the characteristics, classification, treatment methods, and cl inical outcomes of the spoke heel injuries in children. Methods From June 2001 to June 2008, 289 children with bicycle or motorcycle spoke heel injuries were treated, including 179 males and 110 females aged 2-12 years old (average 3.9 years old). There were 179 cases of skin contusion and laceration (type I), 83 cases of skin and soft tissue defect with Achilles tendon exposure (type II), and 27 cases of wide skin and soft tissue defect with the Achilles tendon defect and rupture (type III). The defect size of the skin or the soft tissues ranged from 3 cm × 2 cm to 11 cm × 7 cm in type II and type III injury. The time between injury and hospital admission was 1-53 days (average 14.5 days). Child patients with type I injury were managed with dressing or suturing after debridement. For the child patients with type II injury, the wound was repaired with the regional fascia flap in 53 cases, the reverse sural neurocutaneous vascular flap in 19 cases, the reverse saphenous neurocutaneous vascular flap in 9 cases, and the lateral supramalleolar flap in 2 cases. For the child patients with type III injury, 6 cases underwent primary repair of the Achilles tendon followed by the transposition of the reverse sural neurocutaneous vascular flap, 3 cases received primary repair of the wound with the reverse sural neurocutaneous vascular flap and secondary reconstruction of the Achilles tendon with the upturned fascia strip or the ipsilateral il iotibial tract transplant, and 18 cases underwent primary repair of the wound and the Achilles tendon with the sl iding bi-pedicled gastrocnemius musculocutaneous flap. The flap size ranged from 4 cm × 2 cm to 30 cm × 12 cm. All the donor sites were closed bypartial suture and spl it-thickness skins graft. The lower l imbs were immobil ized with plaster spl ints after operation. Results All the flaps survived except for 1 case of type II suffering from distal flap venous crisis 3 days after operation and 6 cases of type III suffering from distal flap necrosis 3-5 days after operation. All those flaps survived after symptomatic treatment. All the skin grafts at the donor site survived uneventfully. All the wounds healed by first intention. All child patients were followed up for 15-820 days (average 42 days). Child patients with type I and type II injury had a full recovery of ankle functions. While 25 cases of type III injury had ankle dorsal extension degree loss (10-30°) and unilateral plantar flexion strength decrease 3 months after operationwithout influence on walking, and 2 cases recovered well. Conclusion Spoke heel injury in children has special mec hanisms of injury, and the choice of proper treatment method should be based on the types of injury.
Extrinsic allergic alveolitis is a general term for type Ⅲ or Ⅳ allergic pneumonia caused by repeated inhalation of various antigenic organic dusts and low molecular weight chemicals in susceptible people. The lesions involve alveolar, pulmonary interstitial, and airway. The main clinical manifestations are cough, expectoration, and dyspnea. Clinically, extrinsic allergic alveolitis is classified into acute, subacute, and chronic forms. Extrinsic allergic alveolitis has a great impact on the pulmonary function of patients. Timely treatment will improve clinical symptoms and inhibit the development of disease. The current treatment plan is mainly avoiding exposure to antigen, glucocorticoid therapy, immunosuppressive therapy, anti-fibrotic therapy, and lung transplantation.
At present, coronavirus disease 2019 has become the most serious public health emergency in the world. The disease is still spreading around the world. The disease progresses rapidly and is highly contagious, causing great harm to the public health security of the world. Based on the research evidence published at home and abroad, this article systematically summarizes the biological structure of severe acute respiratory syndrome coronavirus 2, and the pathogenesis, transmission routes and susceptible populations, clinical features and treatment methods of coronavirus disease 2019. It aims to help medical workers understand coronavirus disease 2019 in order to better diagnose and treat the disease, and provide references for future research.