Comparison of effects of different lung recruitment maneuvers in infants undergoing laparoscopic surgery / 中华麻醉学杂志

Objective:To compare the effects of different lung recruitment maneuvers in infants undergoing laparoscopic surgery.Methods:A total of 70 pediatric patients of either sex, aged 1-6 yr, weighing 10-24 kg, of American Society of Anesthesiologists physical status Ⅰ or Ⅱ, scheduled for elective laparoscopic surgery from September 2020 to June 2021 with expected operation time≤2 h, were divided into 2 groups ( n=35 each) by a random number table method: recruitment maneuver using incremental positive end-expiratory pressure (PEEP) group (PV group) and recruitment maneuver using controlled lung expansion group (RM group). The children underwent pressure-controlled ventilation after tracheal intubation, and lung recruitment was performed at 20 min after pneumoperitoneum, immediately after pneumoperitoneum, and at the end of operation and before tracheal extubation.In PV group, PEEP was gradually increased, the upper limit of airway pressure was 35 mmHg, PEEP was increased by 5 cmH 2O, ventilation was performed for 30 s, then PEEP was increased to 15 cmH 2O, ventilation was continued for 30 s, then the parameters were adjusted to the original ones, and ventilation was continued until the next lung recruitment.In RM group, manual ventilation mode was used, the pressure valve was adjusted to 30 cmH 2O, the pressure was increased to the maximum by rapid oxygenation, the breathing cuff was manually squeezed until the airway pressure achieved 30-35 mmHg, and 30 s later ventilation was performed with the original ventilation parameters, lasting for 30 s until the next lung recruitment.Peak airway pressure and mean airway pressure were recorded at 5 min after tracheal intubation (T 1), 20 min after pneumoperitoneum (T 2), immediately after pneumoperitoneum (T 3) and before extubation after surgery (T 4), and dynamic lung compliance was calculated.Blood gas analysis was performed at T 2 and T 4, and arterial partial pressure of oxygen and arterial partial pressure of carbon dioxide were recorded, oxygenation index, alveolar-arterial oxygen partial pressure difference and respiratory index were calculated.Lung ultrasonography scores were assessed before tracheal extubation (T 0) and at T 4 and 20 min after entering the postanesthesia care unit (T 5). The time of tracheal extubation and length of postoperative hospital stay were recorded.Hypoxemia in postanesthesia care unit and occurrence of pulmonary complications within 3 days after operation were recorded. Results:Compared with RM group, peak airway pressure and mean airway pressure were significantly decreased at T 2, 3, dynamic lung compliance was increased at T 2-4, arterial partial pressure of oxygen and oxygenation index were decreased , arterial partial pressure of carbon dioxide, alveolar-arterial oxygen partial pressure difference and respiratory index were increased at T 2 and T 4, lung ultrasonography scores were decreased at T 4 and T 5, and the incidence of postoperative hypoxemia was increased, and tracheal extubation time was prolonged in RM group ( P<0.05). Conclusions:Lung recruitment maneuver using incremental PEEP provides better efficacy than that using controlled lung expansion in infants undergoing laparoscopic surgery.

Application of optical coherence tomography in the diagnosis of congenital pseudarthrosis of tibia / 中华实用儿科临床杂志

Objective:To explore the feasibility of the application of optical coherence tomography (OCT) in the diagnosis of congenital pseudarthrosis of tibia (CPT) in children.Methods:Ten children with neurofibromatosis type Ⅰ (NF1) and CPT were treated in the Third Affiliated Hospital of Zhengzhou University from January 2016 to December 2019, and enrolled as the experimental group.The bone tissue samples were collected and subjected to OCT scanning after intraoperative observation and evaluation, and were contrasted with conventional histological examination.During the same period, the bone tissues of 5 non-NF1 and non-CPT induced-labor fetuses were collected as the control group for the above examination, and the bone tissue examination results of the experimental group and the control group were compared as well.Results:Compared with the bone tissues of the control group, that of the experimental group displayed thickening trabecular bone, part of trabecular bone fusion, disordered arrangement, proliferation and fatification of interstitial fibrous tissue.OCT scan can directly show the nerves and blood vessels in the bone tissue, scattered in adipose tissue.OCT scan showed that the bone tissues of the control group were neatly arranged, with dense and regular shadows.The bone tissues of the experimental group could be observed with strong refraction, loose arrangement, and disordered bone fractures, fibrous ossification, scattered nerves, blood vessels, and increased vacuolar fat cells.Conclusions:OCT can quickly and clearly scan the freshly isolated tissues and directly display the internal structure of the tissues.It is highly compatible with routine pathological examinations and can be an effective supplement to the pathological diagnosis of children with CPT and retain samples for subsequent genetic studies.

A preliminary study on the ultrasonic evaluation of deformity changes during the treatment of congenital clubfoot in infants / 中华超声影像学杂志

Objective:To evaluate the deformity changes in the treatment of congenital clubfoot in infants by ultrasound, and to explore its clinical application value.Methods:Seventeen infants with congenital clubfoot treated in the Department of Pediatric Orthopaedics of the Third Affiliated Hospital of Zhengzhou University from March 2020 to June 2021 and 27 normal infants in the same period were selected. The distance between medial malleolus and scaphoids (MM-N distance) of all feet was measured by ultrasound. The distance from the tangent line of the lateral edge of calcaneus to the midpoint of the lateral edge of the chondroid bone (C-C distance), medial soft tissue thickness and tibial calcaneal angle were measured by ultrasound. The data before, after treatment and during follow-up were statistically analyzed.Results:A total of 88 feet of 44 infants were evaluated. The mean number of cast was 4.7±1.1, the follow-up time was (96.9±59.3)days. The MM-N distance, C-C distance and posterior tibial calcaneal angle in the clubfoot group were improved after treatment and at the last follow-up, and the differences were statistically significant (all P<0.01). During the treatment, 1 case had false correction, and 2 cases recurred in the last follow-up. Conclusions:Ultrasound can clearly display the medial, dorsal, lateral and posterior articular structures of normal and clubfoot, and can observe the deformity changes of clubfoot during the correction process, which can provide guidance for the clinical treatment of clubfoot.

Correlation between characteristics of multimodal ultrasound and postoperative pathological remission and expression of BCL-2 in breast cancer patients with neoadjuvant chemotherapy / 中华内分泌外科杂志

Objective:To explore the characteristics of multimodal ultrasound before neoadjuvant chemotherapy (NAC) and the degree of postoperative pathological remission and B-cell lymphoma-2 (BCL-2) .Methods:From Jan. 2018 to Dec. 2020, female breast cancer patients who underwent breast-conserving or total mastectomy surgery at Shaanxi Hospital of traditional Chinese Medicine were selected as the research objects. Routine ultrasound, automatic breast full-volume imaging, and contrast-enhanced ultrasound were performed before chemotherapy. The postoperative pathological remission was evaluated according to Miller and Payne’s modified pathological response grading standard. The expression of BCL-2 in breast cancer tissue was detected by immunohistochemistry. Univariate analysis was performed on the characteristics of MHR, NMHR and bcl-2 with different expression status. Then, binary Logistic regression was used to analyze the significant variables in univariate analysis.Results:Among 186 patients, 84 patients (45.2%) were in MHR group and 102 patients (54.8%) in NMHR group after NAC surgery. The maximum diameter of mass in NMRH group was > 4 cm. The proportion of CM, irregular shape of mass, microcalcification, high enhancement of CEUS and perfusion defect (62.7%, 62.7%, 70.6%, 62.7%, 66.7%) was significantly higher than that of MRH group (38.1%, 40.5%, 39.3%, 41.7%, 31.0%, P<0.05) . The proportion of irregular shape, microcalcification, Alder blood flow grade 2-3, hyperenhancement and peripheral radiation enhancement in low bcl-2 expression patients (65.1%, 69.8%, 65.1%, 71.7%, 72.6%, respectively) was significantly higher than that in high Bcl-2 expression patients (36.2%, 38.7%, 27.5%, 28.7%, 38.8% respectively) (all P<0.05) . Multivariate Logistic analysis showed that irregular masses, with microcalcifications, and high CEUS performance were independent risk factors for NMHR (all P<0.05) ; irregular masses, with microcalcifications, and CEUS manifestations of peripheral radial enhancement were independent risk factors for low expression of BCL-2 (all P<0.05) . Conclusion:Multimodal ultrasound features can be used to predict the degree of pathological remission and the expression of BCL-2 in breast cancer patients with NAC, which helps to select treatment options and predict the prognosis of patients.

Clinical analysis of the double-wing flap for treatment of toe syndactyly / 中华外科杂志

Objective@#To explore the clinical effect of double-wing flap for the treatment of toe syndactyly.@*Methods@#Retrospective analysis of 47 patients (60 syndactyly toes) who underwent double-wing flap to reconstruct toe web space in orthopedics department of the Third Affiliated Hospital of Zhengzhou University from February 2010 to October 2017.There were 21 males and 26 females, with an average age of 18.9 months (range: 10-48 months). All patients were treated with zigzag incisions to separate the toe syndactylys without skin grafts.The condition of wound healing and appearance of toes were observed.@*Results@#The average follow-up time was 62.3 months (range: 6 to 80 months). There were no complications such as hematoma, infection, flap necrosis and no flexion contracture and obvious scar hyperplasia in all the 47 cases, 4 of the 60 webs developed web creep.All webs had good appearance with 45 degrees inclination from the dorsal to the metatarsal side and had good flexion and abduction function.@*Conclusions@#The double-wing flap is a simple and safe operation for toe syndactyly which has a good clinical effect.

The use of a double-wing flap without skin graft for congenital syndactyly / 中华整形外科杂志

Objective@#To introduce a new surgical technique for the correction of congenital syndactyly without skin grafts.@*Methods@#The technique consists of a dorsal double-wing flap created from the dorsal skin of the metacarpophalangeal joint to cover the newly released web space and zigzag incisions in the fingers, thus avoiding the use of skin grafts in this area.@*Results@#From May 2010 to October 2016, 35 web spaces in 24 patients were treated using this technique. There were no complications such as haematoma, infection or flap necrosis. The average follow-up time was 54 months (range, 6 months to 60 months). One of the 35 webs developed web creep. No patients developed flexion contractures. All webs had good appearance with 45 degrees inclination from dorsal to palmar. All fingers had no obvious scar, and the flexion and abduction function were good.@*Conclusions@#The technique is simple, rapid, safe and easily performed and does not require the use of skin grafts.

One-stage posterior approach surgical treatment for congenital scoliosis caused by lumbosacral spine deformity in children / 中华实用儿科临床杂志

Objective To explore the treatment method and clinical effect of congenital scoliosis caused by lumbosacral spine deformity in children.Methods From October 2000 to October 2015,a consecutive series of 21 congenital scoliosis due to lumbosacral spine deformity were treated in Department of Pediatric Orthopedics,the Third Affiliated Hospital of Zhengzhou University,including 12 male and 9 female,and the age was (63.1±47.3) months(3-144 months).The hemivertebrae,bone bridge,and the mixed type were found in 18 cases,2 cases,and 1 case,respectively.Hemivertebraes were on the left in 10 cases,on the right in 9 cases;involved L5 in 8 cases,S1 in 6 cases,multiple vertebrae malformation in 4 cases,wedged-shaped vertebrae involved L5 associated with contralateral bar in 1 case,unilateral unsegmented bar from L4 to S1 in 1 case,from L2 to L5 in 1 case.There were 4 cases combining with thoracic hemivertebrae,3 cases with ribs fusion and contralateral bar,16 cases(76%) with spinal cord malformations,3 cases(17%) with urinary system malformations,no congenital heart malformation.All the 21 patients were operated with one-stage posterior approach.Compared the scoliosis Cobb angle,trunk shift,operative time,blood loss volume,and complications among preoperation,post-operation and final follow-up.Results In this study,operative time was (278.9±83.1) min,blood loss volume was (355.3±249.0) mL,follow-up was (5.1±2.7) years.There were 18 cases operated with pedicle screw fixation,aged (72.9±44.1) months(16-144 months),operative time was (296.2±74.2) min,blood loss volume was(422.1±238.2) mL;the mean coronal Cobb angle of malformation area at preoperation,post operation and the final follow-up were(27.3±10.2)°,(11.0±5.9)°,(9.8±4.2)°,while the correction rate of post-operation and the final follow-up were 59.7%,64.1%.There were 3 cases operated by hemivenebra resection without pedicle screw fixation,aged 7.7 months(3-15 months),operative time was 168.3 min,blood loss volume was 103.3 mL.The mean coronal Cobb angle of malformation area at preoperation,post-operation and the final follow-up were 26.0°,13.6°,12.5°,while the correction rate of post-operation and the final follow-up were 47.7%,51.9%.The follow-up period was (5.1±2.7) years.The coronal Cobb angle of lumbosacral curve at preo-peration,post-operation and the final follow-up were (27.7±10.0)°,(11.3±5.4)°,(10.0±5.0)°,compared with preoperation,the differences of post-operation and the final follow-up were statistically significant (t=6.600,7.230,all P<0.05),with the correction rate of 59.2%,63.9%;the compensatory head side Cobb angle were(25.0±12.8)°,(11.9±8.2)°,(10.3±6.9)°,compared with preoperation,the differences of post-operation and the final follow-up were statistically significant (t=3.934,4.626,all P<0.05),with the correction rate of 52.4%,58.8%.Trunk shift was significantly improved.One case appeared fracture fixation rods breakage after 9 years,1 case appeared iliac screw breakage after 2 years but no complication such as infection,nerve injury.Conclusions The formation of obstacles and vertebral segmentation defects will lead to lumbosacral spine deformity,and scoliosis.Early one-stage posterior hemivertebra resection,breakage the bone bridge combined with pedicle screw fixation can obtain satisfactory clinical outcome.

Diagnosis and treatment of split spinal cord malformations combined with congenital spinal deformity / 中华实用儿科临床杂志

Split spinal cord malformation(SSCM) is a rare neurological abnormality that spinal cord was separated in the sagittal plane.Based on the tissue element and type of thecal shvac,SSCM is classified into Ⅰ,Ⅱ and mixed type.Congenital spinal deformity(CSD) is caused by the vertebral body formed or segmented obstacles.CSD can be divided into 3 types:Ⅰ,Ⅱ and mixed type.Both of SSCM and CSD are diagnosed depending on clinical symptoms,X rays,computed tomography (CT),magnetic resonance imaging(MRI) and other examine.Genitourinary and cardiac ultrasound should be performed at the same time.Progression of spinal deformity and nerve injury are accompanied with the growth process of children with CSD and SSCM.Early surgery can avoid further injury of nervous system,prevent spinal deformity progress and obtain good correction.Segmental tissue removal,tethered cord release and spinal deformity correction are generally consisted into an individual operative plan at present.Traditional surgical option included 2 steps:tissue removal and tethered cord release are conducted at Ⅰ phase surgery;then conducted the spinal deformity correction at Ⅱ phase.However,some reports suggested that completed the process of tissue removal,tethered cord release and spinal deformity correction at one surgery also obtain a satisfied effictiveness.The aim of this research is to review and discuss the diagnosis of the SSCM with CSD and evaluate the treatment effectiveness of Ⅰ phase surgery instead of the traditional surgical option.

Early diagnosis and treatment of congenital hemivertebra malformation / 中华实用儿科临床杂志

Hemivertebra (HV) is a congenital spinal abnormality due to a defection of formation of one side vertebral.It is divided into 3 types according to whether it fusion with adjacent vertebral : fully segmented, semi-segmented and incarcerated.HV deformity is diagnosed depending on clinical symptoms, X rays, CT and other examine.Preoperative magnetic resonance imaging of the spine, genitourinary and cardiac ultrasound should be performed at the same time.Congenital scoliosis due to HV especially fully segmented is nonresponsive to bracing,operative treatment is the mainstay of care.The 3 basic operations are fusion in situ, convex growth arrest (epiphysiodesis), and HV resection.The single posterior approach or combined anterior and posterior approach of HV resection with instrumentation is the main method now.

Advance of conus medullaris and filum terminal / 国际外科学杂志

Tethered cord syndrome is a severe and congenital disease. Resecting the diseased ilium terminal(FT), eystis, lipoma is the main treatment for the disease, relieving the injury to the eonus medullaris. Why the FT is diseased and thickened? Is it necessary to eut internal FT or external FT? What is the injury mechanism of the low-positional or normal positional oonus medullaris? To study the component and structure of the conus medullaris and FT may give definite answers.

Study on the morphology and ultrastructure of fetus filum terminale / 国际外科学杂志

Objective The filum terminale(FT)plays an important role in the pathophysiology of tethered cord syndrome(TCS).The study on morphology and structure of fetus FF can provide reference standard for diagnosis of TCS.Methods Ten fresh human aborted fetuses had their fila measured and removed.Transversal and longitudi nal sections of the middle,and distal thirds of FF were submitted to light microscopy analysis with four different techniques.Results The bulk of the Frr is composed of 1～5μm thick spring like longitudinal bundles of colla gen separated by 5～30μm layer intervals and 1～5μm intervals in the layer,although a small quantity of eapillar ies and other elements may be present.Collagen bundles can also be found between layers and bundles.Abundant longitudinally oriented elastic fibers ale found inside or between collagen bundles.Conclusion A complex tridi mensional structure composed by ordered arrangement of spring like fibers and small quantity of capillaries should e licit considerable elastic properties to the FI".Tts alternation of structure and element maybe involved in TCS closely.

Management of split cord malformations associated with other deformities in children / 中国矫形外科杂志

[Objective]To analyze clinical features,evaluate diagnostic procedures and discuss the different forms of therapy for each case of split cord malformation(SCM).[Method]A series of 48 patients had a follow-up period of 0.5~9 years,29 males and 19 females,aged 7 days to 14 years,were evaluated retrospectively.They suffered from back midline abnormalities,neurological deficits of lower limbs and bladder dysfunction.At first they were cut filum terminale and then excised the fibrous or bony spur finally treated scoliosis.The radiologieal procedures used for the diagnosis of SCM were spinal X-ray,ultrasound,CT scan and MRI.[Result]In all of the 48 patients with tethered cord,there were 28 cases with dysplasia of lower limbs and feet,13 cases with urination and defecation dysfunction,14 cases with only dorsal-lumbar abnormalities,26 cases with scoliosis and kyphosis,14 with myelomeningocele,15 with syringomyelia and 12 with intraspinal lipomas.There were 27 cases suffering from type Ⅰ SCM,18 type Ⅱ SCM and 3 composite type SCM according to Pang.The most frequent location of the spur was at the lumbar level(38 cases),the less frequent in thoracic regions(6 cases)and exceptionally rare below S_1(2 cases),in the cervical regions(1 case),the thoralumbar(1 case).After operation,28 cases were improved,3 cases were cured and 3 cases were inefficacy.[Conclusion]The most frequent syndrome of SCM patients is lower limbs dysplasia and dorsal-lumbar abnormalities.The patients are most suffered from tethered cord and spinal deformities.To improve diagnosis of SCM,tethered cord and other deformities,the patients should be routinely evaluated by MRI and X-ray of the whole spine,sometimes could be evaluated by ultrasound and CT scan.SCM cases should be early treated by first cutting filium terminal and then excising fibrous or bony spur and hemivertebra.

Purification, induced differentiation and identification of rat embryonic neural stem cells / 生物医学工程学杂志

The methods of purification, expanding, marking, conservation, induced differentiation and identification of neural stem cells (NSCs) in vitro were explored for further research and treatment of tethered cord syndrome in children and other neural system diseases. The cells derived from the cerebral cortex of frontal lobe in 14.5 d rat embryos were maintained in serum-free DMEM/F12 medium containing 20 ng/ml bFGF, 20 ng/ml EGF and B27 supplement. The NSCs of suspending single-cell-colon were isolated and passaged, were purified by limited dilution, and were expanded numerously with sub-colon in consecutive generations. Then, Nestin antigen expression was detected by immunohistochemistry techniques. The cells of the purified and expanded NSCs were frozen, recovered and incubated in BrdU, and the NSCs were induced to differentiate in serum or feeder layer. These revived NSCs from frozen cells could express Nestin antigen and could be induced in serum or feeder layer to differentiate into neurons and glias expressing tubulin-III and GFAP respectively. It is good and simple for purification and proliferation of NSCs numerously by the limited dilution and consecutive generations suspending single-cell-colon of NSCs from the cerebral cortex of frontal lobe in rat embryos. The NSCs could be induced on feeder layer to differentiate into neural cells numerously. BrdU can mark and trace NSCs for the research and treatment of the animal model of neural system diseases. By good command of the technlogies for the purification proliferation, and induced differentiation of NSCs in vitro, it is possible to find a new way for further research of the biologic specificity and the treatment of the disease in nervous system.

Effects of Environmental Estrogens on Apoptosis of Ovarian Cancerous PEO4 Cells / 环境与健康杂志

Objective To study the effects of dietary estrogens genistein(GS)and zearalenone(ZEA)on apoptosis in-duced by estrogen depletion in PEO4cells.Methods The monolayer ovarian cancer cell line PEO4cells were cultured in DMEM medium containing10%bovine serum.Before the addition of the testing compounds the cells were washed in phosphate-buffered saline and the medium was displaced with a phenol red-free DMEM medium containing5%dextral charcoal-stripped FBS and the cells were cultured for5days in order to exhaust the estrogen stored in the cells,and then cells were divided into5groups,including solvent control group,estrogen control group,anti-estrogen control group and2experimental groups.After treatment the apoptotic features of the cells were observed by cellular morphology,DNA fragmentation and location and height of cell hypodiploid were indicated by flow cytometry.Results The typical characteristics of apoptosis in PEO4cells were observed after estrogen deletion and then disappeared following exposure of the PEO4cells to32?10 -9 mol/L and96?10 -9 mol/L ZEA for72hrs.32?10 -6 mol/L and96?10 -6 mol/L GS could significantly aggravate apoptosis in PEO4cells.Conclusion Zearalenone is a kind of mycoestrogen that has estrogenic activity to inhibit apoptosis in PEO4cells.Genistein is a kind of phytoestrogen that has anti-estrogen activity(tamoxifen-like)to promote apoptosis in PEO4cells with the high doses range.

ISOFLAVONES INDUCED APOPTOSIS IN PROSTATE CANCER CELL PC-3 / 营养学报

Objective: To explore the mechanisms of the effect of isoflavone in reducing prostate cancer incidence throught studying the effects of isoflavone on apoptosis in PC-3 cell. Methods: Prostate cancer cell PC-3 was grown in RPMI 1640 medium supplemented with 10% bovine serum and 10 000 U/ml of penicillin/streptomycin in an incubator maintained at 5% CO 2 95% air and 100% humidity at 37 ℃. The respective test compound was added in fresh medium and the control cell received only the vehicle (MDSO). Apoptosis of PC-3 cells was analyzed by cell morphology under light microscope, agarose gel electrophoresis and flow cytometry. Results: Exposure of PC-3 cell to 50 ?mol/L GS, 75 ?mol/L DA and 75 ?mol/L GL after 72 h, the cell morphology indicated typical features commonly used to define apoptosis; agarose gel electrophoresis demonstrated laddered electrophoretic profiles of oligonucleosomal DNA fragments indicative of apoptosis, and flow cytometric analysis revealed a hyperdiploid population in the tested cells. Conclusion: Isoflavones could induce apoptosis in prostate cancer cells PC-3 and it may be the main cause of their role in cancer inhibition.