查看更多>>摘要：目的 探讨基于X线影像判断微小移位型肱骨外髁骨折（minimally displaced lateral humeral condylar fractures，MDLHCF）稳定性的方法及可行性。 方法 分析2013年1月至2021年8月中国医科大学附属盛京医院收治的208例MDLHCF患儿的临床及影像学资料，其中男131例，女77例，平均年龄4.5岁。患侧为左侧118例，右侧90例。根据术前磁共振成像、术中肘关节造影、保守治疗骨折愈合过程评估骨折的稳定性，分析不稳定MDLHCF的X线片特征。采用χ2检验或Fisher确切概率法进行单因素分析、多因素logistic回归分析危险因素。根据前述分析结果，请3名小儿骨科医生对其中40例肱骨外髁骨折的X线影像进行2次判定。采用Cohen'kappa系数评价结果的组内、组间一致性并计算各医生的敏感度、特异度和准确度。 结果 208例患儿中，术前磁共振成像102例，术中肘关节造影40例，保守治疗66例。根据本研究肱骨外髁骨折稳定性判断方法，稳定骨折患儿有163例，不稳定骨折45例，稳定骨折与不稳定骨折患儿除随访时间外，在性别、年龄、损伤侧别、Milch分型上差异无统计学意义。多因素logistic回归分析显示X线正位片骨折块整体外移或上移、内侧翘起，X线内斜位片骨折间隙前宽后窄或骨块前后移均提示不稳定。3名医生组内及组间检验具有中等以上的一致性（组间为0.576~0.763，组内为0.572~0.881）。 结论 基于X线片判断儿童MDLHCF的稳定性具有可行性，X线正位片显示远端骨折块整体外移或上移、内侧翘起，X线内斜位片显示骨折间隙前宽后窄或骨块前后移可提示骨折不稳定。 Objective To explore the feasibility and methods of judging the stability of minimally displaced lateral humeral condylar fracture (MDLHCF) based upon radiography. Methods From January 2013 to August 2021, retrospective analysis was conducted for 208 MDLHCF children. They were assigned into two groups of unstable fracture (n=45) and stable fracture (n=163). There were 131 boys and 77 girls with an average age of 4.5 years. And affected side was left (n=118) and right (n=90). The stability of MDLHCF was assessed by the results of magnetic resonance imaging (MRI), intraoperative elbow arthrography and conservative fracture healing. And χ2 and Fisher exact ratio tests were employed for univariate analysis and multivariate Logistic regression analysis for identifying the possible risk factors. Radiographic films of 40 MDLHCF patients were judged twice by three independent physicians. Cohen'kappa was utilized for evaluating inter/intra-observer reliabilities. Specificity, sensitivity and accuracy were calculated separately. Results Magnetic resonance imaging (MRI) (n=102), intraoperative elbow arthrography (n=40) and conservative fracture healing (n=66) were performed. No inter-group differences existed in gender, age, affected side or Milch system. Logistic multivariate analysis indicated that fragment of MDLCF moving outward, upward or its medial part curling upward in AP position and anterior fracture gap≥posterior fracture gap or fragment of LHCF moving outward or inward on internal oblique radiography all suggested suggest unstable MDLHCF. The inter/intra-observer reliabilities were at least moderate with a range of 0.576 to 0.763 and 0.572 to 0.881 respectively. Conclusions The stability of MDLHCF may be estimated based upon radiography safely and effectively. And fragment of MDLCF moving outward, upward or its medial part curling upward in AP position and medial fracture gap≥outward fracture gap or fragment of LHCF moving outward or inward on internal oblique radiography all hint at unstable MDLHCF.
查看更多>>摘要：目的 探究miR-34b-3p在神经母细胞瘤（neuroblastoma，NB）细胞增殖和凋亡过程中的调节作用。 方法 体外培养人正常背根神经节细胞和NB细胞系，搜集NB组织和邻近的正常组织。qRT-PCR检测NB组织和细胞中miR-34b-3p和FDX1的表达；CCK-8法、克隆形成实验和流式细胞术检测NB细胞的增殖和凋亡；双荧光素酶报告基因分析FDX1 mRNA 3'非翻译区（3'-untranslated region，3'-UTR）和miR-34b-3p之间的靶点关系；Western blot检测相关蛋白的表达。采用SPSS 23.0和GraphPad Prism 6.01进行Student'st-test检验。 结果 与对照组比较，miR-34b-3p在NB肿瘤组织和癌细胞系（SK-N-BE、SK-N-SH、SH-SY5Y和LAN-6）中均下调（P<0.05）。与对照组比较，miR-34b-3p过表达抑制了癌细胞SK-N-BE和SH-SY5Y的生长，并诱导凋亡增加（P<0.05）。萤光素酶报告基因证实，miR-34b-3p可以与FDX1 3'-UTR结合，抑制NB细胞中FDX1的表达。此外，FDX1过表达有效逆转了miR-34b-3p对NB细胞生长和凋亡的抑制作用。与对照组比较，miR-34b-3p稳定转染SH-SY5Y细胞抑制了异种移植瘤的生长和肿瘤重量（P<0.05）。 结论 miR-34b-3p可能通过靶向FDX1在NB中发挥肿瘤抑制作用，是一种新颖的NB诊断和治疗的生物标志物。 Objective To explore the regulatory role of miR-34b-3p in the proliferation and apoptosis of neuroblastoma (NB) cells. Methods Human normal dorsal root ganglion cell and NB cell lines were cultured in vitro, and NB tissues and adjacent normal tissues were harvested. Quantitative real-time polymerase chain reaction (qRT-PCR) was employed for detecting the expressions of miR-34b-3p and FDX1 in NB tissues and cells. The proliferation and apoptosis of NB cells were detected by CCK-8 assay, colony formation assay and flow cytometry. Target relationship between ferriredoxin 1 (FDX1) mRNA 3'untranslated region (3'-UTR) and miR-34b-3p was examined by dual-luciferase reporter gene. Western blot was utilized for detecting the expression of related proteins. And SPSS 23.0 and GraphPad Prism 6.01 were utilized for Student's t-test. Results As compared with control group, miR-34b-3p was down-regulated in NB tumor tissues and cell lines (SK-N-BE, SK-N-SH, SH-SY5Y & LAN-6)(P<0.05). An over-expression of miR-34b-3p suppressed the growth of SK-N-BE and SH-SY5Y cells and induced their apoptosis ( P<0.05). Luciferase reporter gene confirmed that miR-34b-3p conjugated with FDX1 3'-UTR and arrested the expression of FDX1 in NB cells. In addition, an over-expression of FDX1 effectively reversed the inhibitory effect of miR-34b-3p on the growth and apoptosis of NB cells. As compared with control group, stable transfection of miR-34b-3p into SH-SY5Y cells suppressed the growth and tumor weight of xenograft tumor (P<0.05). Conclusions miR-34b-3p may play a tumor suppressor role in NB through targeting FDX1. It is a novel biomarker for diagnosing and treating NB.
查看更多>>摘要：胆道闭锁是一种罕见的儿童疾病，主要表现为新生儿出生后胆管闭塞、胆汁淤积以及进行性肝纤维化。Kasai肝门空肠吻合术是治疗胆道闭锁的首选术式。胆管炎是Kasai手术后最常见的并发症，其病因尚不明确，可能是由于肠道细菌逆行感染导致。有针对性的应用抗生素能有效预防胆管炎的发生，但目前对于抗生素的使用尚无明确方案，近年来人们逐渐意识到短期内使用三代头孢或碳青霉烯类抗生素或许对患儿有益。本文就近年来胆道闭锁术后预防性使用抗生素的研究进展进行相关综述。 As a rare infantile disease, biliary atresia (BA) is manifested postnatally as obstruction of bile ducts, cholestasis and progressive liver fibrosis. Kasai portoenterostomy is a preferred treatment of BA. And cholangitis is the most common complication after Kasai surgery. However, its causes remain elusive probably due to ascending infection of gut bacteria. Targeted antibiotic therapy can effectively prevent the occurrence of cholangitis. However, there is currently no consensus for dosing antibiotics. In recent years, there has been a growing awareness that short-term use of third-generation cephalosporin or carbapenems might be beneficial. This review summarized the latest researches of prophylactic use of antibiotics after Kasai portoenterostomy.
查看更多>>摘要：坏死性小肠结肠炎（necrotizing enterocolitis，NEC）是一种主要发生于早产儿的严重胃肠道疾病，病死率较高，但其发病机制尚未明确。作为固有免疫的一部分，单核/巨噬细胞在NEC的发生和发展中发挥重要作用。本文现就单核/巨噬细胞在NEC发病机制中的研究进展作一综述。 As a severe gastrointestinal disease, necrotizing enterocolitis (NEC) affects premature infants with a high mortality. However, its pathogenesis remains largely elusive. As components of innate immunity, monocytes or macrophages play an important role in the onset and development of NEC. This review summarized the latest researches of monocytes or macrophages in the pathogenesis of NEC.
查看更多>>摘要：漏斗胸与脊柱侧弯存在密切关系，而其诊断和治疗目前仍存在争议。一方面，漏斗胸人群中特发性脊柱侧弯的发生率明显高于普通人群，另一方面，漏斗胸患儿接受Nuss手术可能会继发获得性脊柱侧弯，也可能会减轻或加重所合并的特发性脊柱侧弯的严重程度。本文通过回顾漏斗胸合并特发性脊柱侧弯与漏斗胸术后获得性脊柱侧弯的相关临床经验、动物实验及生物力学研究结果，对其潜在病因、疾病关系及治疗方案进行总结，旨在启示外科医生以提高此类疾病的诊疗效果，为患儿带来最大获益。 Pectus excavatum (PE) is correlated closely with scoliosis while their diagnosis and treatment have remained controversial. On one hand, the incidence of idiopathic scoliosis is significantly higher in PE population than that in general population. On the other hand, PE children undergoing Nuss procedure are susceptible to acquired scoliosis and it may affect the severity of concomitant idiopathic scoliosis. This review summarized the relevant clinical experiences, animal experiments and biomechanical researches of PE combining with idiopathic scoliosis and acquired scoliosis secondary to Nuss procedure. Also, potential etiologies, disease relationship and treatment protocols were discussed. It was intended to assist surgeons in improving patient managements and outcomes.
查看更多>>摘要：随着Ponseti技术的广泛应用，大部分特发性马蹄内翻足可以得到满意的治疗。而复杂型马蹄内翻足很难通过经典Ponseti技术获得矫正。2006年Ponseti教授首次提出运用改良Ponseti技术治疗复杂型马蹄内翻足并获得满意效果。本文通过回顾性分析采用改良Ponseti技术治疗复杂型马蹄内翻足的相关文献，对复杂型马蹄内翻足的病因、病理解剖、诊断、初始治疗、复发、并发症及复发后的治疗等方面的进展进行综述。 With widespread applications of Ponseti method, most cases of idiopathic clubfoot may be treated satisfactorily. Complex clubfeet responds poorly classical Ponseti technique. In 2006, modified Ponseti technique was introduced for managing complex clubfoot with satisfactory outcomes. This review summarized the latest literature reports of etiology, pathoanatomy, diagnosis, initial correction, recurrence, complications and interventions.
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