Anatomic study and clinical application of thinned posterior tibial artery perforator flap / 中华整形外科杂志

<p><b>OBJECTIVE</b>To explore the feasibility and therapeutic effect of thinned posterior tibial artery free perforator flap for the reconstruction of soft tissue defects at dorsum of hands.</p><p><b>METHODS</b>Six fresh adult lower limbs specimens were injected with red latex via arterial cannula and dissected. The number, distribution, branches, and outer diameter of posterior tibia artery perforators were observed. Based on the anatomic study, the perforator flaps were designed to reconstruct soft tissue defects at dorsum of hands and wrists. The redundant fat on the flaps was removed, but preserving the nutrient vascular system. 11 flaps were used with the size ranging from 2 cm x 5 cm to 10 cm x 14 cm.</p><p><b>RESULTS</b>43 skin perforators of posterior tibial artery were observed in six lower limbs, 29 perforators with the outer diameter is greater than 0.5 mm when they threading over the deep fascia plane, on average every 4.8 bundles of sides. The mean outside diameter of perforating artery is (1.8 +/- 0.5) mm, and the length is (44 +/- 15) mm. 6 perforators were founded both in the second and fifth zone which could be used for anastomosis for its better diameters. All flaps survived completely without any complication at donor sites. 7 cases were followed up for 3-12 months. Both satisfactory functional and cosmetic results were achieved with a soft and thinned appearance.</p><p><b>CONCLUSIONS</b>The thinned posterior tibial artery free perforator flap has a reliable blood supply and good appearance. It is very suitable for the reconstruction of small or medium-sized defects at the dorsum of hands and wrists.</p>

A follow-up of the survival and medical factors responsible for the termination of treatment in very or extremely low birth weight infants / 中国当代儿科杂志

<p><b>OBJECTIVE</b>To study the outcomes of very or extremely low birth weight (VLBW/ELBW) infants born between 2000 and 2008 in a single NICU and the medical factors associated with the termination of treatment in some infants.</p><p><b>METHODS</b>In this case control study, the clinical data of 148 VLBW/ELBW infants were retrospectively studied and the surviving infants were followed up. Both univariate analysis and multivariate logistic regression analysis were used to investigate the medical factors associated with terminating treatment in infants.</p><p><b>RESULTS</b>Twenty infants (13.5%) failed to respond to the therapy and died in the hospital. Three infants (2.0%) died after discharge. Nineteen infants (12.8%) did not receive treatment due to decision of the guardian and died. Thirty infants (20.3%) were not followed up after discharge. Seventy-six infants (51.4%) survived, including 47 healthy infants, 2 cases of congenital diseases and 27 cases with poor prognosis. Multivariate logistic regression analysis showed there were 2 significant factors associated with terminating treatment: neonatal respiratory distress syndrome (P=0.030, OR=11.396, 95%CI 1.-102.701) and hospitalization periods (the year 2004-2006) (P=0.039, OR=9.869, 95%CI 1.118-87.140).</p><p><b>CONCLUSIONS</b>The survival status of VLBW and ELBW infants needs to be improved. It is important to decrease the incidence of neonatal respiratory distress syndrome for decreasing the proportion of terminating treatment in the infants.</p>

Factors related to the outcome of patients with chronic severe hepatitis B and effectiveness of antivirus therapy / 中华实验和临床病毒学杂志

<p><b>OBJECTIVE</b>To investigate the factors related to the outcome of patients with chronic severe hepatitis B and effectiveness of antivirus therapy.</p><p><b>METHODS</b>The effects of the factors including age, prothrombin activity (PTA), serum HBeAg, Anti-HBe, HBV-DNA load, with or without complication, antivirus therapy and so on, on outcome of 330 patients with chronic severe hepatitis B were analyzed in this retrospective study.</p><p><b>RESULTS</b>The mortality of patients with chronic severe hepatitis B was significantly higher among patients at higher age, with lower PTA, and with more complications. The mortality of patients with HBV-DNA more than 1x10(5) copies/ml (52.3 percent) was higher than that of patients whose HBV-DNA was less than 1x10(5) copies/ml (32.9 percent). There was no correlation between serum HBeAg or anti-HBe and the mortality. The mortality of patients with HBV-DNA higher than 1x10(5) copies/ml (30.38 percent) who were treated with lamivudine in 2005 was lower than that of patients whose HBV-DNA was less than 1x10(5) copies/ml (54.64 percent) who were not treated with any antiviral therapy in 2001.</p><p><b>CONCLUSION</b>The higher serum virus load is the key factors of the mortality in addition to the other factors such as older age, lower PTA, more complication in the patients with chronic severe hepatitis B. The usage of antivirus therapy may be associated with lower mortality.</p>

Premature, low birth weight, small for gestational age and childhood cerebral palsy / 中华儿科杂志

<p><b>OBJECTIVE</b>To investigate the relationship between perinatal risk factors such as premature, low birth weight, small for gestational age and childhood cerebral palsy (CP).</p><p><b>METHODS</b>A cross sectional survey was carried out among 305,263 children aged 1 - 6 years old in seven cities of Jiangsu Province, China from May to July 1997. The perinatal risk factors were analysed.</p><p><b>RESULTS</b>Four hundred and eighty-four cases of CP were found among this population. The prevalence of CP for children aged 1 - 6 years old was 1.59 per thousand. The prevalence of CP were strongly correlated to prematurity (RR = 25.16), low birth weight (RR = 19.63), and also highly correlated to small for gestational age (RR = 4.34). For smaller groups divided by small for gestational age (SGA), appropriate for gestational age (AGA), large for gestational age (LGA) and then by gestational age, prematurity was found to be at high risk in SGA (RR = 9.29), AGA (RR = 28.34) and LGA (RR = 21.41) groups. For groups divided by gestational age and then by SGA, AGA and LGA, SGA was found to have significantly high risk in premature (RR = 1.45), mature (RR = 4.41) and postmature (RR = 3.19) groups. Nine groups were divided by the gestational age along with SGA, AGA and LGA, rates of CP were found to be significantly higher in most groups than in the term AGA group. Compared with the rate of CP in the term AGA group, the RR were calculated and showed as followings (from higher to lower), premature SGA (RR = 40.99), premature AGA (RR = 28.34), premature LGA (RR = 21.08), postmature SGA (RR = 8.39), mature SGA (RR = 4.41) and postmature AGA (RR = 2.63).</p><p><b>CONCLUSION</b>Prematurity and small for gestational age are both independent risk factors for cerebral palsy. Postmaturity and large for gestational age are not risk factors.</p>

Expression of caspase-3 mRNA in the hippocampus of seven-day-old hypoxic-ischemic rats and the mechanism of neural protection with magnesium sulfate / 中华儿科杂志

<p><b>OBJECTIVE</b>There was consanguineous relationship between caspase-3 and early damage after hypoxia and ischemia. Caspase-3 plays a key role in the process of apoptosis in neuron. Magnesium sulfate could protect neuron from injuries, but the mechanism was not clear. The study was to investigate the expression of caspase-3 mRNA in the hippocampus of seven-day-old hypoxic-ischemic rats and the possible mechanism of neural protection with magnesium sulfate.</p><p><b>METHODS</b>The model of seven-day-old hypoxia-ischemia rats was established. The rats were divided randomly into 6 groups as follows: (1) normal control (n = 4); (2) sham surgery control (n = 4); (3) hypoxia-ischemia (n = 4); (4) sodium chloride injection with hypoxia-ischemia (n = 4); (5) magnesium sulfate pre-injection with hypoxia-ischemia (n = 4); (6)magnesium sulfate post-injection with hypoxia-ischemia (n = 4). The therapy groups received a bolus injection of 500 mg/kg magnesium sulfate intraperitoneally 0.5 hour before or after hypoxia-ischemia. Semi-quantitative RT-PCR was used to measure caspase-3 mRNA expression in the hippocampus 24 hours after hypoxia-ischemia.</p><p><b>RESULTS</b>The expression of caspase-3 mRNA was significantly increased in the hippocampus of the hypoxia-ischemia pups (1.88 +/- 0.36 vs 0.97 +/- 0.46, P < 0.05). The expression of caspase-3 mRNA in rats with magnesium sulfate pre-injection and post-injection decreased significantly (1.54 +/- 0.49, 1.65 +/- 0.48 vs 1.88 +/- 0.36, P < 0.05).</p><p><b>CONCLUSION</b>Caspase-3 was activated in the hippocampus of the seven-day-old rats 24 hours after hypoxia-ischemia. The suppression of the expression of caspase-3 mRNA in the hippocampus was probably related to the protective effect of magnesium sulfate on the brain injury of hypoxia-ischemia.</p>