Clinical characteristics and prognostic factors of neonatal gastric perforation / 中华围产医学杂志

Objective:To investigate the clinical characteristics and experience in the diagnosis and treatment of neonatal gastric perforation, and the factors influencing prognosis.Methods:This was a retrospective analysis involving 49 neonatal gastric perforation cases who underwent surgical treatment in the Neonatal Surgery Department of Shanxi Children's Hospital from January 2008 to December 2017. Their clinical data, including manifestations, auxiliary examinations, operations, and prognosis, were analyzed. According to the prognosis, these patients were divided into two groups, survival group, and fatality group. Independent sample t-test or continuity correction Chi-square (or Fisher's exact) test was used for statistical analysis. Results:(1) Of the 49 cases, 29 (59.2%) were boys, and 20 (40.8%) were girls. There were 30 (61.2%) premature and 19 (38.8%) full-term babies. Their birth weight ranged between 1 010 and 5 000 g with an average of (2 450±700) g. Low birth weight infants accounted for 59.2% (29/49). There were 11 cases (22.4%) having perinatal adverse events, 17 (34.7%) complicated by septic shock before the operation, and six (12.2%) with digestive tract malformation. Two cases (4.1%) underwent resuscitation due to postnatal asphyxia; two (4.1%) received mechanical ventilation due to respiratory distress syndrome; 12 (24.5%) received indwelling were indwelled gastric tube or gastric lavage. (2) The average onset time of neonatal gastric perforation in the 49 cases was (3.8±2.0) d after birth, and 47(95.9%) of them presented initial symptoms within one week, including 36 within four days. Twenty-five cases (51.0%) were operated within 12 h after the onset. (3) The common first symptoms include abdominal distention [69.4% (34/49)] and abdominal distension complicated with vomiting (24.5%, 12/49). Thirty-nine cases (79.6%) showed a large amount of free gas under the diaphragm, compressed and down-moving liver, and decreased or disappeared stomach bubble in the preoperative abdominal radiograph. (4) All cases received emergency laparotomy and primary gastric wall repair after admission. During the operation, 27 (55.1%) of all the cases had perforation at the greater curvature, five (10.2%) at the lesser curvature, 14 (28.6%) at the anterior wall, and three (6.1%) at the posterior wall. Perforation larger than 3 cm in diameter was found in 33 cases (67.3%). Three cases (6.1%) had postoperative wound infection; two (4.1%) developed anastomotic leakage; one was complicated by pneumohydrothorax 48 h after the operation due to esophageal duplication and perforation, which was confirmed by a second operation. (5) Of the 49 cases, 35 (71.4%) were due to congenital gastric wall muscular defect, four (8.2%) were caused by iatrogenic injury, and 10 (20.4%) were spontaneous perforation. (6) Among all cases, 36 (73.5%) survived, while eight (16.3%) died, and five (10.2%) withdraw treatment after the operation. After excluding the five cases giving up treatment after the operation, the proportion of patients who underwent operation within 12 h after onset or had the perforation <3 cm in diameter was higher in the survival group than in the fatality group [61.1% (22/36) vs. 1/8, χ2=4.404, P<0.05; 41.7% (15/36) vs. 0/8, P<0.05], and the incidence of septic shock before the operation was lower [22.2% (8/36) vs. 6/8, χ2=6.147, P<0.05]. Conclusions:Neonatal gastric perforation shows a high mortality rate, and its underlying pathologic etiology is congenital gastric wall muscle defect. Abrupt abdominal distension is the main clinical manifestation. Early operation is critical to improving neonatal prognosis.

An experimental study of Zn/Ca/P-containing coatings on titanium implant surface modified by plasma electrolytic oxidation / 中华口腔医学杂志

Objective@#To explore the osteogenic activity of Zn/Ca/P-containing coatings on titanium implant surface modified by plasma electrolytic oxidation (PEO).@*Methods@#Three groups implants including Zn/Ca/P-containing surface treated by PEO in experimental groups and Ca/P-containing and TiO2 sandblasted surface in control group were randomly inserted in the bilateral mandibular of rabbits. Mechanical testing and implant-bone interface observation were performed at 4, 6, 8, 10 and 12 weeks after implantion.@*Results@#Zn/Ca/P-containing coating presented a microporous structure. The push-out value indicated the statistical differences among the three groups at each observed time point (P<0.05), and implant-bone bonding power reached a maximum value at 12 weeks, those in the Zn/Ca/P-containing group [(1.57±0.26) MPa] was higher than those in the group with sandblasted surface [(0.83±0.24) MPa] (P<0.05). Histological examination and implant-bone interface observation using field scaning electron microscope (FSEM) showed that the new bone of implant-bone interface increased with healing time and the result from Zn/Ca/P-containing group was superior to that from the control groups at each observed time point.@*Conclusions@#Zn/Ca/P-containing coatings by PEO can accelerate bone formation and remodeling, and enhance bone-implant bonding force.

Laparoscopic Malone antegrade continence enema / 中华普通外科杂志

Objective To evaluate laparoscopic appendicostomy in Malone antegrade continence enema (MACE).Methods 25 children with fecal incontinence undergoing MACE were divided into by laparoscopic technique (14 cases) and by laparotomy (11 patients).Results The operation time [(38.3 ±2.5) min vs.(60.5 ±3.6) min,t =13.7,P =0.00] was shorter in the laparoscopy group.All patients were followed up for 6 months to 3 years.No intestinal obstruction,fecal leakage in stoma and anal fecal incontinence or soiling happened.In laparoscopy group,the stomal stricture developed in 1 patient.The mucosa prolapse developed in 2 patients.In the laparotomy group,the stomal stricture developed in 2 patients.The mucosa prolapse in 1 patient.The symptom severity scoring for constipation and fecal incontinence after operation decreased in the laparoscopy group (12.1 ± 1.4 vs.33.7 ± 1.5,t =28.4,P =0.00),laparotomy group (12.5 ± 1.6 vs.33.3 ± 1.7,t =25.36,P =0.00).While the irrigation volume [(607±151) mlvs.(594±161) ml,t=0.17,P=0.87],MACE scoring (22.1 ±1.4vs.22.0±1.7,t =0.18,P =0.86) and symptom severity scoring for constipation and fecal incontinence (12.1 ± 1.4 vs.12.5 ± 1.6,t =0.46,P =0.65) were not statistically different.Conclusions The laparoscopic technique can make the MACE easier to operate and less traumatic.

An optimized method for embedding undecalcified mouse tibias in plastic blocks / 南方医科大学学报

OBJECTIVE@#To optimize the method for embedding multiple undecalcified mouse tibias in plastic blocks, improve the efficiency and stability of plastic embedding and reduce the detachment rate of plastic slides.@*METHODS@#Thirty undecalcified tibias from 15 B6 mice were used for plastic embedding after calcein labeling, fixation, dehydration and infiltration. The tibias were embedded in cylindrical plastic blocks with a diameter of 4 mm. For each bone, the 1/4 proximal tibia was cut off, and the remaining 3/4 was used for re-embedding. Five bones were embedded in a single block with each bone standing closely on the surface of a flat plate. The samples were randomized into control and experimental groups in all the processes of embedding, sectioning and staining. In the 3 groups with modified embedment, flowing CO was added into the embedding solution, embedding solution was applied to the section surface, and the slides were heated at 95 ℃ for 15 min. The polymerization time, slide detachment rate, bone formation and osteoblast parameters were analyzed.@*RESULTS@#We prepared 6 plastic blocks, each containing 5 tibias, whose cross sections were on the same plane. The blocks were completely polymerized and suitable for sectioning. Flowing CO into the embedding solution reduced the polymerization time and increased the rate of complete polymerization. Application of the embedding solution on the section surface significantly reduced the detachment rate of the sections ( < 0.05) without affecting bone formation analysis ( > 0.05). Heating the slides significantly lowered the detachment rate of the sections ( < 0.05) without affecting osteoblast analysis ( > 0.05).@*CONCLUSIONS@#The optimized method allows effective embedding of multiple undecalcified mice tibias in the same block and can be an ideal method for histological analysis of undecalcified bones.

Evaluation of implant-bone contact interface on active zinc coated implants / 国际生物医学工程杂志

Objective To evaluate the implant-bone interfaces on implants with active Zn coating in a rabbit model.Methods Pure titanium cylinder implants,fabricated by machining,were prepared by surface microarc oxidation (MAO).The MAO-Zn/Ca/P coated (experimental group) and the MAO-Ca/P coated (control group)implants were randomly placed in the rabbit mandible.The samples were harvested at 4 and 12 weeks postoperatively,histological analysis on the implant-bone interfaces of the two implants was performed,and the bone coverage was compared.Results The coatings of MAO presented micro-porous structure with dense and uniform features,in which size of micro-porous increased with zinc element.The histological examination of implant-bone contact interfaces showed that the bone tissues attached on the coatings increased with time.Further,the adhered bone tissue in the experimental group was thicker and denser and had a larger amount compared to that in the control group at 4 and 12 weeks postoperatively.The bone coverage in the experimental group (70.8％±13.6％) at 12 weeks postoperatively was significantly higher than that in the control group (55.9％±13.8％) (P＜0.05).The results of bone interface element showed that the apatite layer was precipitated at 12 weeks.Conclusion The addition of active zinc element can improve the biological activity of the coating,enhance the osteogenesis ability of the coating,and accelerate the osseointegration of implant-bone interfaces.

RBP-J is required for M2 macrophage polarization in response to chitin and mediates expression of a subset of M2 genes

Development of alternatively activated (M2) macrophage phenotypes is a complex process that is coordinately regulated by a plethora of pathways and factors. Here, we report that RBP-J, a DNA-binding protein that integrates signals from multiple pathways including the Notch pathway, is critically involved in polarization of M2 macrophages. Mice deficient in RBP-J in the myeloid compartment exhibited impaired M2 phenotypes in vivo in a chitin-induced model of M2 polarization. Consistent with the in vivo findings, M2 polarization was partially compromised in vitro in Rbpj-deficient macrophages as demonstrated by reduced expression of a subset of M2 effector molecules including arginase 1. Functionally, myeloid Rbpj deficiency impaired M2 effector functions including recruitment of eosinophils and suppression of T cell proliferation. Collectively, we have identified RBP-J as an essential regulator of differentiation and function of alternatively activated macrophages.

The study of distinguishing solid solitary pulmonary nodule with diffusion weighted imaging / 实用放射学杂志

Objective To evaluate the value of diffusion weighted imaging (DWI)in distinguishing the solid solitary pulmonary nodule (SPN).Methods 42 patients with SPN (malignant in 25 and benign in 1 7)who were confirmed by operation,biopsy or follow up after treatment underwent routine chest T1 WI,T2 WI and DWI.The b values were chosen as 300,500,800 and 1 000 s/mm2 ,and the corresponding apparent diffusion coefficient (ADC)values and the signal intensity (SI)were respectively measured.Results The ADC values and SI of benign and malignant SPNs were gradually reduced with increasing b value.The ADC value between benign and malignant SPNs was statistically significant with b value of 500 s/mm2 (P 500 =0.03 <0.05 ),meanwhile the SI was statistically significant with b values from 300 to 1000 s/mm2 (P 300 <0.001,P 500 =0.03 <0.05,P 800 =0.01 <0.05, P 1 000 =0.02<0.05).Conclusion Both SI and ADC value of DWI play important role in distinguishing benign and malignant SPNs, and the diagnostic efficiency of SI is superior to ADC value.

Complication analysis of endorectal pull-through radical operation for Hirschsprung disease / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To summarize the complications after endorectal pull-through radical operation, Soave procedure, for Hirschsprung disease.</p><p><b>METHODS</b>Clinical data of 286 cases with Hirschsprung disease who received Soave procedure and were proved by postoperative pathology in our hospital from February 2003 to February 2010 were analyzed retrospectively. All the patients were diagnosed with barium enema and anorectal manometry. Among them, 233 cases(81.5%) were identified during neonatal period. All the patients underwent cleansing enema and anus dilation immediately after definite diagnosis. Radical operation with Soave endorectal pull-through procedure, including simple transanal endorectal pull-through in 251 cases(87.8%), transabdominal approach in 17 cases (5.9%), laparoscopy-assisted endorectal pull-through in 18 cases (6.3%). The operations were performed in 54 cases (18.9%) within 3 months of age, in 183 cases (64.1%) between 3 and 6 months, in 38 cases(13.3%) between 6 months and one year, in 10 cases (3.5%) older than 1 year. The rectosigmoid was resected in 259 cases. Subtotal colectomy was performed in 25 cases, and total colectomy in 2 cases. Postoperative regular anal dilation lasted for 6 months. A total of 286 cases (male:250, female:36) were followed up for 2 to 5 years.</p><p><b>RESULTS</b>There was wound infection in 1 case, ileus in 1 cases, anastomotic stricture in 1 case, which was cured by continuous anal dilation. Two cases had constipation and received re-operation because of refractory to conservative therapy for 6 months. Perianal erosion was found in 63 cases(22.0%) and was healed within 3 months, except 2 children undergoing total colectomy. During follow-up, enterocolitis occurred in 11 cases(3.8%), including healing in 8 cases with conservative therapy, death in 1 case, and recurrent attacks in 2 cases. Soiling occurred in 45 cases(15.7%), among them, 5 cases presented in kindergarten and primary school. Morbidities of perianal erosion, enterocolitis and soiling were higher in infants undergoing operation within 3 months as compared to those more than 3 months [90.7%(49/63) vs. 6.0%(14/63), P=0.000; 9.3%(5/54) vs. 2.6%(6/232), P=0.022; 25.9%(14/54) vs. 13.4%(31/232), P=0.022]. Morbidity of perianal erosion enterocolitis was higher in infants undergoing subtotal or total colectomy as compared to those partial colon resection[51.9%(14/27) vs. 18.9%(49/259), P=0.000; 18.5%(5/27) vs. 2.3%(6/259), P=0.000].</p><p><b>CONCLUSIONS</b>Primary transanal endorental pull-through procedure can be performed in most children with Hirschsprung disease. Postoperative short-term complications are mainly perianal erosion and long-term ones are enterocolitis and soiling. Early diagnosis, colon irrigation, avoiding premature operation and anal dilation can decrease the morbidities of enterocolitis and soiling.</p>

The imaging study on the related factors of the change of systemic circulation time for aortic dissection patients / 实用放射学杂志

Objective To explore the related imaging factors about the change of systemic circulation time for aortic dissection (AD)patients.Methods Image data of 36 patients with AD and 30 patients in control group were analyzed retrospectively,the cor-relation analysis was made between the results of imaging measurement by using CT angiography (CTA)and the threshold time of the contrast agent in the left ventricular.3 6 patients with AD were divided into 2 groups (type A 1 7 cases and type B 1 9 cases)by using Stanford type.First,the threshold time in the left ventricular of the 3 groups were analyzed comparatively;next,the correla-tions between each CTA measured parameter and the threshold time in the left ventricle were analyzed.Results Threshold time in left ventricular of group Stanford A and group Stanford B were compared with the control group respectively,the overall mean difference was statistically significant (P 0.05).There was a significant correlation between threshold time in left ventricular and the ratio of false/true lumen (r=0.676,P 0.05).Conclusion The threshold time of left ventricular for aortic dissection patients is significantly longer than the normal control group,and is significantly related with the ratio of false/true lumen.

Study on the expression change of HIF-1α and VEGF in protein levels and the correlation of them in QBC939 cell line under chemical hypoxia induced by CoCl2 / 肿瘤研究与临床

Objective To examine the expression change of HIF-1α and VEGF in protein levels and the corelation of them in Q8C939 cell line under chemical hypoxia induced by CoCl2 in vitro. Methods ELISA and immunohistochemical technique were used to examine the change of VEGF and HIF-1α protein level in QBC-939 line in different concentrations (200, 150, 100, 50, 0 μmol/L) of COCl2 and different periods (6 h, 12 h, 24 h, 48 h) in hypoxia. Results CoCl2 can up-regulate the expression of HIF-1α and VEGF at least partly in a dose and time dependent pattern. ELISA demonstrated that the level of VEGF protein in different concentrations and different hypoxia periods, the result showed that the VEGF protein was in different concentration groups over contrast group (P<0.05). The VEGF protein also increased continuously with the growing of hypoxia time (P<0.05). Immunohistochemical detection of concentrations of different groups, HIF-1α, VEGF protein in the average gray compared with the control group was different(P<0.05). Different time periods of hypoxia HIF-1α, VEGF protein in the average gray, any two group comparisons have difference (P<0.05). Different concentrations, the normal control group, different time period HIF-1α and VEGF protein expression of relevance were analyzed. The correlation coefficient was 0.830, P <0.01, 0.909, P <0.01. Conclusion In QBC939 cell line of hypoxia, there is up-regulation HIF-1α and VEGF.HIF-1α regulated the expression of VEGF.

Human gingival epithelial cells cultured by a combined method of serum containing medium and serum free medium / 北京大学学报(医学版)

Objective: To search for a simple and rapid cell culture method for human gingival epithelial cells with a high success rate. Methods:Culture medium containing serum has been proved to have the ability of accelerating the early adhesion of human gingival tissue blocks, and the migration of gingival epithelial cells from the rim of the blocks. By means of this, we introduced the serum containing DMEM to the cell culture medium within the first 7-10 days, and changed with serum free cell culture medium to accelerate the mitosis, proliferation, and migration of the gingival epithelial cells, which had moved out from the tissue blocks. Using the combined method, cells were identified by the method of morphology, immunohistochemistry and analysis of the cell growth curve, as well as SEM. Compared study of the effects on the cell growth between combined method and serum containing DMEM or serum free EpiLife culture method was conducted. Results: Cells were harvested within 17-22 days. Primary culture success rate was 90.6%. Cultured cells were slabstone shaped. Immunohistochemistry analysis of keratin antibody showed a positive result. The cells had stronger ability of migration and proliferation in the serum free cell culture medium compared with that in the serum medium. Conclusion: This method can culture the gingival epithelium cells conveniently with accelerated speed.

The influence of hydroxyapatite coating on sandblasted and acid-etched surface of titanium dental implants on the biologic characteristics of marrow-origin osteoblasts / 实用口腔医学杂志

Objective:To study the effects of hydroxyapatite(HA) coating on sandblasted and acid-etched(SLA) surface of titanium dental implants(HA-SLA-Ti) on the biologic characteristics of marrow-origin osteoblasts(MOOBs).Methods:Coating of HA on the SLA surface of titanium dental implants were formed by ion beam assisted deposition (IBAD) method. MOOBs,cultured in vitro,were seeded onto the surface of HA-SLA-Ti and SLA-Ti respectively, the growth of MOOBs on the two kinds of samples were observed by scaning electron microscope.The proliferation index, alkaline phosphatase(AKP) activity, osteocalcin(BGP) content of MOOBs and mRNA relative expression level of osteopontin(opn) were examined and compared between two groups.Results: MOOBs grew well on the surface of HA-SLA-Ti; the proliferation index, AKP activity and BGP content of MOOBs were higher in HA-SLA-Ti group than those in SLA-Ti group(P