For treatment of pediatric inguinal hernia, we fabricated a device, i.e. so called "filling type pediatric hernia sac", which treats the problem from the abdominal cavity, through the abdominal and is a self-adaptive closer, using synthetic material. The device includes filling rack, self-adaptive umbrella support bar, bottom piece, outside pulling line and device fixing lines. The filling rack is composed of 2 concentric circles of 3.0 cm diameter with peripherally fixed together and can be pulled into the shapes of a ball or an olive. The supporting bar is structured of 3 pieces with 0.5 cm wide, 4.0 cm long, cross-fixed on top of the filling rack. The bottom piece is in a circular structure with a diameter of 3.0 cm, and it is connected to the filling rack bottom. Adjust positioning stay outside the fixed on the top of the device are connected at one end, and the other end free through filling the top frame connected with the bottom slice of central fixation. By using this device, we treated 37 pediatric inguinal hernia cases with 38 side-inguinal hernia successfully. The mean duration of post-operation follow-ups was 14.6±5.89 months, without hernia recurrence, obvious scar and hard sections of inguinal region. This device could provide a convenient, safe and effective plugging technology for children's pediatric hernia.
ObjectiveTo investigate the distribution and drug resistance of the pathogens isolated from hospitalized pediatric patients with respiratory tract infections, and to provide guidance for empiric therapy. MethodsRespiratory tract specimens from hospitalized pediatric patients with respiratory tract infections from 2011 to 2015 were collected, and the strains were identified and the drug susceptibility was tested. ResultsA total of 1995 strains of pathogens, 1281 (64.21%) from boys and 714 (35.79%) from girls, were isolated from 6236 specimens and the detection rate was 31.99%. The mean age of the hospitalized pediatric patients was (1.22±2.05) years (ranged from 1 day to 14 years). 1393 (69.82%) pediatric patients were younger than 1 year. Staphylococcus aureus, Escherichia coli, Klebsiella pneumoniae, Candida albicans and Acinetobacter baumannii ranked the top five species, accounting for 29.82%, 15.09%, 13.18%, 12.73% and 5.91%, respectively. 1995 strains included gram-negative bacteria (50.93%), gram-positive bacteria (35.29%), and fungi (13.78%). The resistance rate of Staphylococcus aureus to oxacillin was 31.76%, but it was 100% sensitive to vancomycin and linezolid. The resistant rate of gram-negative bacteria to imipenem was ranged from 1.52% to 5.93%. The resistant rate of gram-negative bacteria to ceftazidime, cefepime, piperacillin tazobactam and tobramycin was less than 30.00%. ConclusionsThe infants whose age are younger than 1 year comprise the majority of the hospitalized pediatric patients with respiratory tract infections. The proportion of male is more than that of female. Staphylococcus aureus and enterobacteriaceae were the main isolated pathogens. There is difference in drug resistance between different pathogens, so antibiotics should be chosen according to the results of drug sensitivity testing.
Finite element (FE) model of thorax with high biofidelity is one of the most important methods to investigate thoracic injury mechanism because of the absence of pediatric cadaver experiments. Based on the validated thorax finite element model, the FE models with equivalent muscles and real geometric muscles were developed respectively, and the effect of muscle biofidelity on thoracic injury was analyzed with reconstructing pediatric cadaver thorax impact experiments. The simulation results showed that the thoracic impact force, the maximum displacement and the maximum von-Mises stress of FE models with equivalent muscles were slightly greater than those from FE models with real geometric muscles, and the maximum principal strains of heart and lung were a little lower. And the correlation coefficient between cadaver corridor and FE model with real muscles was also greater than that between cadaver corridor and FE model with equivalent muscles. As a conclusion, the FE models with real geometric muscles can accurately reflect the biomechanical response of thorax during the impact.
Objective To explore risk factors related to acute kidney injury (AKI) in children who underwent corrective surgery for tetralogy of Fallot (TOF). Methods We retrospectively analyzed the clinical data of 726 children with corrective procedures for TOF aged less than 3 years in our hospital from March 1st 2010 to March 1st 2013. Children with AKI were picked using Acute Kidney Injury Network criteria. Demographic and perioperative variables of the remaining patients were reviewed. Univariate analysis was performed to compare the AKI group (240 patients) with the non-AKI group (486 patients). Multivariable analysis was carried out to identify significant determinants of AKI. Results A total of 240 children were with AKI. The result of univariate analysis showed that there was a statistical difference in age, Nakata index, McGoon ratio, left ventricular end-diastolic volume index (LVEDVI), transannular right ventricular outflow tract (RVOT) patch, or fresh frozen plasma (FFP) in prime solution between the AKI group and the non-AKI group. Multivariable logistic regression showed that in older children (OR=1.425, 95% CI 1.071 to 1.983, P=0.011) with more transfusion of FFP in the priming solution (OR=1.486, 95% CI 1.325 to 2.674, P<0.001) led to higher morbidity of mild AKI. In addition, there was an increase in morbidity related to AKI when children had less Nakata index (OR=0.282, 95% CI 0.092 to 0.869, P=0.013). Conclusion Postoperative AKI increases in older children group. Infusion of more FFP in priming solution increases morbidity of AKI. The less Nakata index is significantly associated with severe AKI.
The pediatric cadaver impact experiments were reconstructed using the validated finite element(FE) models of the 3-year-old and 6-year-old children. The effect of parameters, such as hammer size, material parameters and thorax anatomical structure characteristics, on the impact mechanical responses of 3-year-old and 6-year-old pediatric thorax was discussed by designing reasonable finite element simulation experiments. The research results showed that the variation of thorax contact peak force for 3-year-old group was far larger than that of 6-year-old group when the child was impacted by hammers with different size, which meant that 3-year-old child was more sensitive to hammer size. The mechanical properties of thoracic organs had little influence on the thorax injury because of the small difference between 3-year-old and 6-year-old child in this research. During the impact, rib deformation led to different impact location and deformation of internal organs because the 3-year-old and 6-year-old children had different geometrical anatomical structures, such as different size of internal organs. Therefore, the injury of internal organs in the two groups was obviously different. It is of great significance to develop children finite element models with high biofidelity according to its real anatomical structures.
ObjectiveTo summarizes the clinical characteristics of chronic appendicitis in children and discusses the diagnostic methods and the clinical application value of laparoscopic surgery.MethodsThe clinical data and treatment process of 68 children with chronic appendicitis admitted to the First Affiliated Hospital of Anhui Medical University from January 2015 to January 2020 were retrospectively analyzed, and their clinical characteristics and treatment experience were summarized and analyzed.ResultsAccording to different medical histories and symptoms, 68 cases were divided into 3 groups, with 15 patients in the typical symptom group, 28 patients in the appendix abscess group, and 25 patients in the asymptomatic group. All the 25 children in the asymptomatic group underwent barium enema examination, among which 68.0% (17/25) had filling defect in the appendix cavity, 16.0% (4/25) had no obvious appendix visualization, and 68.0% (17/25) had residual barium in the appendix cavity after 72 hours. The incidence of children in the 3 groups was concentrated at school age, but there was no significant difference in the proportion of children in different age groups between the three groups (P>0.05). All cases underwent laparoscopic exploration, 66 cases successfully completed laparoscopic appendectomy, 2 cases transferred to laparotomy, and all recovered satisfactorily. There was no statistically significant difference in the incidence of postoperative complications between the 3 groups (P>0.05).ConclusionsThe clinical manifestations of chronic appendicitis in children are diverse and difficult to diagnose. Barium enema examination (including re-examination after 72 hours) in children with atypical symptoms can help confirm the diagnosis. Chronic appendicitis in children is more common in school-age children, and laparoscopic exploration+appendectomy are the preferred treatment.
As a worldwide challenge in the field of neurosurgery, there is no effective treatment method for pediatric skull defects repair in clinic. Currently clinical used cranioplasty materials couldn’t undergo adjustment in response to skull growth and deformation. An ideal material for pediatric cranioplasty should fulfill the requirements of achieving complete closure, good osseointegration, biodegradability and conformability, sufficient cerebral protection and optimal aesthetic, and functional restoration of calvaria. Biomimetic mineralized collagen-based bone material is a kind of material that simulates the microstructural unit of natural bone on the nanometer scale. Because of its high osteogenic activity, it is widely used in repair of all kinds of bone defects. Recently, the biomimetic mineralized collagen-based bone materials have successfully been applied for cranial regeneration and repair with satisfactory results. This review mainly introduces the characteristics of the biomimetic mineralized collagen-based bone materials, the advantages for the repair of pediatric skull defects, and the related progresses.
ObjectiveTo investigate the effect of perioperative intravenous immunoglobulin (IVIG) on the reduction of blood group antibody titer and prognosis in children with ABO incompatible (ABO-I) liver transplantation.MethodsA retrospective study was conducted in 20 children undergoing ABO-I liver transplantation in Beijing Friendship Hospital Affiliated to Capital Medical University from July 2017 to March 2020. The changes of blood group antibody titer, alanine aminotransferase, and total bilirubin before and after operation, as well as survival rate were analyzed after intravenous IVIG during perioperative period.ResultsAfter ABO-I liver transplantation, the 1-year survival rate of 20 patients was 100%, and 1 case (5%) developed immune rejection. Compared with before operation, on the day of operation, IgM blood group antibody titer did not change in 4 cases (20%), increased in 1 case (5%), and decreased in 15 cases (75%); in one week after operation: 12 cases (60%) decreased, 5 cases (25%) increased, and 3 cases (15%) remained unchanged; in one month after operation: 18 cases (90%) decreased , 2 cases (10%) remained unchanged. Compared with before operation, the titer of IgG blood group antibody increased in 2 cases (10%), remained unchanged in 6 cases (30%), and decreased in 12 cases (60%); in one week after operation: 4 cases (20%) increased, 4 cases (20%) remained unchanged, and 12 cases (60%) decreased; in one month after operation: 3 cases (15%) increased, 4 cases (20%) remained unchanged, and 13 cases (65%) decreased. The levels of alanine aminotransferase and total bilirubin in 1 month after operation were lower than those on the day of operation.ConclusionThe effect of IVIG on reducing blood group antibody titer in children after ABO-I liver transplantation is not obvious, and its actual clinical effect needs to befurther confirmed.
Malnutrition is directly related to the outcomes of critically ill children. Providing ideal nutritional treatment can reduce the high catabolic state caused by the critically ill, reduce oxidative damage and regulate immune response, then improving clinical prognosis. Optimized nutritional supply for critically ill children has been transformed from auxiliary support to one of the important treatment methods. Enteral nutrition is the preferred way to provide nutrition, but parenteral nutrition is the only method of supplement and replacement when the supply of enteral nutrition is insufficient or deficient. This article reviews the timing of parenteral nutrition initiation, protein and amino acids in parenteral nutrition, the mechanism of possible adverse effects in early parenteral nutrition, and issues related to parenteral nutrition in premature infants, in order to help clinicians in pediatric intensive care unit improve the evaluation and management of parenteral nutrition use.
Interfacility transport of critically ill children is an important part of pre-hospital emergency care. The development of 5th generation mobile networks has brought revolutionary changes to emergency medicine, which can realize real-time sharing of information between hospitals and transfer ambulance units. In order to give full play to the advantages of superior medical institutions in diagnosis and treatment technology, equipment resources, and realize the safe and fast transfer of critically ill children, the technical specifications for the construction of interfacility transport of critically ill children’s ambulances with 5th generation mobile networks are specially formulated to standardize the team building, equipment and materials, transport process and quality control requirements for critically ill children’s ambulance transport, so as to reduce the fatality rate of critically ill children and improve the prognosis.