ObjectiveTo evaluate the effectiveness of elbow arthrography through lateral approach in the treatment of elbow fractures in infants.MethodsThe clinical data of 24 infants with elbow fractures admitted between May 2016 and May 2018 were retrospectively analyzed. There were 14 boys and 10 girls with an average age of 1.8 years (range, 2 months to 3 years). The time from injury to admission ranged from 1 hour to 7 days, with an average of 6.7 hours. The preoperative carrying angle was (30.8±4.5)° (range, 24°-41°), and the elbow range of motion was (128.5±4.5)° (range, 125°-134°). Elbow arthrography through lateral approach was used in all cases, including 10 cases of humeral lateral condylar fracture, 6 cases of distal humeral epiphysis fracture, 3 cases of fresh Monteggia fracture, and 5 cases of radial neck fracture. According to fracture types, open reduction with Kirschner wire fixation, closed reduction with plaster cast fixation, or closed reduction with percutaneous Kirschner wire fixation were used.ResultsNone of the children had adverse reactions such as drug allergy. All patients were follow-up 14-38 months, with an average of 19.6 months. The skin irritation around the needle tail occurred in 2 cases after operation, and the symptoms disappeared after the Kirschner wire was pulled out. The anteroposterior and lateral X-ray films of elbow joint showed that the fractures healed well and no mulunion at the fracture site or premature epiphysis closure was observed. At last follow-up, the carrying angle was (5.2±1.9)° (range, 2°-8°) and the elbow range of motion was (137.1±4.7)° (range, 133°-141°), which were significantly improved when compared with those before operation (t=22.670, P=0.000; t=11.910, P=0.000). According to Flynn clinical function evaluation standard of elbow joint, 22 cases were excellent, 1 case was good, and 1 case was fair. The excellent and good rate was 95.8%.ConclusionElbow arthrography through lateral approach can clearly judge the cartilage damage of the elbow joint surface in infants, and minimize the occurrence of misdiagnosis and missed diagnosis, and can guide the choice of treatment.
We applied resting-state functional magnetic resonance imaging (rfMRI) combined with graph theory to analyze 90 regions of the infantile small world neural network of the whole brain. We tried to get the following two points clear:① whether the parameters of the node property of the infantile small world neural network are correlated with the level of infantile intelligence development; ② whether the parameters of the infantile small world neural network are correlated with the children's baseline parameters, i.e., the demographic parameters such as gender, age, parents' education level, etc. Twelve cases of healthy infants were included in the investigation (9 males and 3 females with the average age of 33.42±8.42 months.) We then evaluated the level of infantile intelligence of all the cases and graded by Gesell Development Scale Test. We used a Siemens 3.0T Trio imaging system to perform resting-state (rs) EPI scans, and collected the BOLD functional Magnetic Resonance Imaging (fMRI) data. We performed the data processing with Statistical Parametric Mapping 5(SPM5) based on Matlab environment. Furthermore, we got the attributes of the whole brain small world and node attributes of 90 encephalic regions of templates of Anatomatic Automatic Labeling (ALL). At last, we carried out correlation study between the above-mentioned attitudes, intelligence scale parameters and demographic data. The results showed that many node attributes of small world neural network were closely correlated with intelligence scale parameters. Betweeness was mainly centered in thalamus, superior frontal gyrus, and occipital lobe (negative correlation). The r value of superior occipital gyrus associated with the individual and social intelligent scale was -0.729 (P=0.007); degree was mainly centered in amygdaloid nucleus, superior frontal gyrus, and inferior parietal gyrus (positive correlation). The r value of inferior parietal gyrus associated with the gross motor intelligent scale was 0.725 (P=0.008); efficiency was mainly centered in inferior frontal gyrus, inferior parietal gyrus, and insular lobe (positive correlation). The r value of inferior parietal gyrus associated with the language intelligent scale was 0.738 (P=0.006); Anoda cluster coefficient (anodalCp) was centered in frontal lobe, inferior parietal gyrus, and paracentral lobule (positive correlation); Node shortest path length (nlp) was centered in frontal lobe, inferior parietal gyrus, and insular lobe. The distribution of the encephalic regions in the left and right brain was different. However, no statistical significance was found between the correlation of monolithic attributes of small world and intelligence scale. The encephalic regions, in which node attributes of small world were related to other demographic indices, were mainly centered in temporal lobe, cuneus, cingulated gyrus, angular gyrus, and paracentral lobule areas. Most of them belong to the default mode network (DMN). The node attributes of small world neural network are widely related to infantile intelligence level, moreover the distribution is characteristic in different encephalic regions. The distribution of dominant encephalic is in accordance the related functions. The existing correlations reflect the ever changing small world nervous network during infantile development.
Zero-balanced uhrafihration; Stored blood; Priming solution; Infant; Heart surgery
Abstract:Objective To evaluate the effects of modified uhrafihration （MUF）on blood rheology in infants after open cardiac surgery. Methods According to admission number, 22 infants of body weight less than 10 kilograms with ventricular septal defect （VSD） and pulmonary hypertension （PH） were divided into control group （10 infants, the mantissa of their admission number was odd number） and experimental group （12 infants, the mantissa of their admission number was even number）. Cases in control group didn＇t undergo MUF at the end of cardiopulmonary bypass （CPB）, while cases in experimental group underwent MUF; the flow rate of MUF ranged from 10 ml/min · kg to 15 ml/min · kg. MUF lasting for 10-15 minutes. Blood samples were repeatedly collected as following time： before operation, at the end of CPB, 15 minutes after CPB or the end of MUF, 2, 24 h after operation. Blood sample of 2. 5 ml was collected from the radial artery with hepathrom test-tube. The changes of relative indexes of the blood rheology were observed by MDK-3200 completely automatic dual pathways blood rheology testing analysator at 37±1 C. Results Hemoglobin, hematocrit, red cell count, blood yielding stress, plasma viscosity, the whole blood viscosity at high shear rate, the whole blood viscosity at middle shear rate and low shear rate, the whole blood reduction viscosity at high shear rate and middle shear rate, the whole blood reduction viscosity at low shear rate and Casson viscosity in experimental group at the end of MUF were significantly higher than those in control group at 15 minutes after CPB （P〈0. 05）. There was no significant difference in red cell aggregation index and red cell deformity between two groups at each moment （P 〉 0.05 ）. Conclusion Hemoglobin, hematocrit and red cell count are significantly elevated through MUF after CPB. Whole blood viscosity in infants undergone open cardiac surgery after CPB with MUF is higher than those who didn＇t undergo MUF.
ObjectiveTo investigate the effect of artificial colloid on coagulation function in pediatric patients weighing less than 5 kg with congenital heart disease during cardiopulmonary bypass in congenital heart disease surgery by using artificial colloid instead of human serum albumin.MethodsA total of 65 pediatric patients with weight less than 5 kg who underwent congenital heart disease surgery in our hospital from September 2016 to December 2017 were included in the study. They were randomly divided into two groups: an artificial colloid group (the experimental group, n=33) and a human serum albumin combined artificial colloid group (the control group, n=32). Perioperative hemoglobin concentration (Hb), blood products and hemostatic drugs used, postoperative coagulation function index and pleural fluid volume 24 hours after surgery were monitored.ResultsThere was no significant difference in perioperative Hb and chest tube drainage between the two groups. The platelet utilization rate in the experimental group was significantly lower than that in the control group (P<0.05). No significant difference was found in the dosage of other blood products and hemostatic drugs between the two groups during the perioperative period. There was no significant difference in coagulation parameters between the two groups before and after surgery (P>0.05).ConclusionThe use of artificial colloid as colloid priming solution during cardiopulmonary bypass has no adverse effect on coagulation function in pediatric patients weighting less than 5 kg with congenital heart disease.
Corresponding author: Y I Ding -hua, E -mail: yidh@fmmu. edu. cnAbstract: Objective To investigate the optimal surgical approaches for coarctation of aorta (CoA ) associated with heart anomalies (CoA -HA ) in infants through analyzing the immediate and long-term outcome post-operation. Methods From May 1998 to November 2006, 29 patients with CoA -HA were admitted to this institute. Subclavian flap angioplasty was performed in three patients, excision of coarctation and end-to-side anastomoses in six pat ients,and end-to-end anastomoses in the remaining 20 pat ients. Their clinical data were retrospect ively reviewed and the long-term follow -up results obtained through telephone o r letters. Results Three patients died of operations, of whom one died of low cardiac output syndrome, one died of sepsis and one died of multiple organs failure. In two months’to eight years’follow -up , no later death and severe neurological complications were found. Two patients suffered from recurrent coarctation, but had no sense of symptoms and free from re-operation. In all pat ients neither systemic hypertension, nor arterial aneurysm and aortic valve regurgitation were found. Conclusions Mortality of surgical corrections is accepted fo r CoA -HA in infants. Preoperative heart dysfunction and prolonged mechanical ventilation are the high risks of operative death. Recurrent coarctation is the major later comp lication.