Analysis of IQSEC2 gene variant in a child with X-linked mental retardation / 中华医学遗传学杂志

OBJECTIVE@#To analyze the clinical phenotype and genetic variants of a child with X-linked mental retardation caused by IQSEC2 gene mutation, and provide reference for the diagnosis of the disease.@*METHODS@#The child was subjected to next generation sequencing (NGS), and the diagnosis was made by taking consideration of her clinical characteristics.@*RESULTS@#The child has presented with global developmental delay, particularly in fine motor skill and language development, in addition with intellectual disability. Genetic testing revealed that she has harbored a heterozygous c.1861dup variant of the IQSEC2 gene, which was not detected in either parent.@*CONCLUSION@#The de novo c.186ldup variant of the IQSEC2 gene probably underlay the X-linked mental retardation in this child. Above finding has, expanded the spectrum of IQSEC2 gene mutations and provide a basis for the diagnosis of similar cases.

Minimally invasive treatment of clavicular midshaft fracture with bridge-combined internal fixation system / 中华创伤骨科杂志

Objective:To investigate the clinical effects of minimally invasive treatment of clavicular midshaft fracture with bridge-combined internal fixation system.Methods:A retrospective analysis was conducted of the 54 patients with clavicular midshaft fracture who had been admitted to Department of Trauma Orthopedics, The First Affiliated Hospital to Dali University from September 2016 to January 2018.They were assigned into 2 groups according to different treatment methods. In the observation group of 27 patients who were subjected to minimally invasive treatment with bridge-combined internal fixation system, there were 14 males and 13 females with an age of (41.8±14.8) years, and 10 cases of type 6-A1 and 17cases of type 6-C1 by the AO classification.In the control group of 27 patients who were subjected to traditional open reduction and internal plate fixation, there were 15 males and 12 females with an age of (39.6±14.1) years, and 11 cases of type 6-A1 and 16 cases of type 6-C1 by the AO classification.The 2 groups were compared in terms of operation time, incision length, intraoperative blood loss, fracture healing time, shoulder functional recovery and incidence of postoperative complications.Results:There was no significant difference between the 2 groups in their preoperative general data, showing comparability ( P>0.05). The 54 patients were followed up for an average of 13 months (from 9 to 25 months).The observation group had an incision length of (4.34±0.65)cm, significantly shorter than that [(10.64±2.14) cm] in the control group, an intraoperative blood loss of (20.9±6.2)mL, significantly less than that [(40.7±13.5) mL] in the control group, and a fracture healing time of (4.5±0.9) months, significantly shorter than that [(5.7±1.0) months] in the control group (all P<0.05). According to the Neer scoring for shoulder function at the last follow-up, the observation group had 22 excellent, 4 good and one fair cases, giving an excellent and good rate of 96.3% (26/27) while the control group had 21 excellent, 4 good, one fair and one poor cases, giving an excellent and good rate of 92.6% (25/27). There was no significant difference in operation time or functional results between the 2 groups ( P>0.05).One case of nonunion and plate breakage was observed in the control group. Conclusion:In the treatment of clavicular midshaft fracture, compared with traditional open reduction and plate fixation, the bridge-combined internal fixation system may lead to less surgical trauma, a smaller incision and faster fracture healing.

Analysis of the medium-term curative effect of transjugular intrahepatic portosystemic shunt through jugular vein with covered Viatorr stent / 中华肝脏病杂志

Objective@#To investigate the medium-term curative effect of transjugular intrahepatic portosystemic shunt (TIPS) through jugular vein with covered Viatorr stent.@*Methods@#Data of 105 consecutive patients with covered Viatorr stent of our hospital was retrospectively analyzed. Follow-up was performed after surgery, and color Doppler was reviewed to evaluate the efficacy of TIPS.@*Results@#Transjugular intrahepatic shunt was successfully established in all patients. The pressure gradients of portal vein before and after operation were 22.33 ± 6.4 mmHg and 9.78 ± 4.9 mmHg, respectively,P< 0.01, and the difference was statistically significant. The follow-up period ranged from 12.7 to 15.6 months, with an average of 13.09 ± 1.4 month. Total bilirubin and coagulation time increased after operation, but there was no significant difference in total bilirubin and coagulation time at 1, 3, 6 and 12 months after operation. The patency rate of shunt was 100%, 99.05%, 99.05% and 99.05% at 1, 3, 6 and 12 months after operation. The incidence of hepatic encephalopathy was 34.2%, 29.5%, 19.1% and 14.3% respectively. The recurrence rate of symptoms was 0%.@*Conclusion@#Patients with cirrhotic portal hypertension who underwent TIPS with covered Viatorr stent had a lower rate of restenosis, improved liver function, and a lower incidence of severe hepatic encephalopathy. However, the long-term efficacy needs further observation.

Endovascular repair or medication for the management of uncomplicated type B aortic dissection / 介入放射学杂志

Objective To compare the curative effect of thoracic endovascular repair (TEVAR) plus medication with that of pure medication in treating uncomplicated type B aortic dissection,and to discuss the treatment strategy for uncomplicated type B aortic dissection.Methods The clinical data of 118 patients with definitely confirmed uncomplicated type B aortic dissection,who were admitted to authors' hospital during the period from 2004 to 2015,were retrospectively analyzed.Among the 118 patients,57 patients received TEVAR plus medication (TEVAR group) and 61 patients were treated with pure medication (drug group).The complications and mortality within one month and during follow-up period in both groups were calculated respectively,and Kaplan-Meier survival curves were used to compare the survival rate between the two groups.Results The incidences of complications and morbidity during hospitalization and within one month after treatment in TEVAR group were 5.2％ and 0％ respectively,which in the drug group were 0％ and 0％ respectively.The patients were followed up for 1-110 months,with a mean of (43.3±36.7) months.The incidence of main complications and the mortality in TEVAR group were 7.0％ and 5.3％ respectively,which in the drug group were 6.6％ and 8.1％ respectively.The one-,2-,4-and 7-year cumulative survival rates in TEVAR group were 100％,97.1％,93.5％ and 78.0％ respectively,which in the drug group were 98.4％,96.4％,90.8％ and 72.7％ respectively,the differences between the two groups were not statistically significant (~=0.019,P=0.890).Conclusion For the treatment of uncomplicated type B aortic dissection,TEVAR plus medication is superior to pure drug therapy in reducing expansion rate of false cavity,but TEVAR carries some procedure-related complications,besides,TEVAR can not improve the survival rate.(J Intervent Radiol,2017,26:266-269)

Endovascular aortic repair for Stanford type B aortic dissection: learning curve analysis / 介入放射学杂志

Objective To analyze the learning curve of an experienced interventional radiologist engaged in thoracic endovascular aortic repair (TEVAR) for Stanford type B aortic dissection.Methods The clinical data of 70 patients with Stanford type B aortic dissection,who received TEVAR that was carried out by the same group of interventional physicians over the past 10 years,were retrospectively analyzed.According to the sequence of operation date,the patients were equally divided into group A,B,C,D and E with 14 patients in each group.The operation time,procedure-related complications,postoperative hospitalization days were compared among the 5 groups,and the curative effects at different stages were evaluated.Results No statistically significant differences in the age,sex,classification,concurrent hypertension,concurrent diabetes,active smoking,maximum diameter of false lumen,viscera artery supplied by the false lumen,etc.existed between each other among the 5 groups (P＞0.05).The operation time of group A and group B was (3.29±0.61) hours and (2.87±0.37) respectively (P＜0.05),while the operation time of group C,group D and group E was (1.80±0.62) hours (1.74±0.34) hours and (1.52±0.39) hours respectively (P＞0.05).The operation time of group A and group B was significantly longer than that of group C,D,and E (P＜0.001).The difference in the occurrence of complications was not statistically significant between each other among the 5 groups (P＞0.05).The hospitalization time was gradually shortened from group A to group E,although the difference was not statistically significant (P＞0.05).The surgeries of 28 patients in group A and group B were completed within 2 years and 6.2 years respectively,with an operation frequency being 3.3 patients per year and 7 patients per year respectively;while the surgeries of 42 patients in group C,group D and group E were completed within 2.2 years,1.2 years and 0.5 years respectively,with an operation frequency being 6.4 patients per year,11.7 patients per year and 17.5 patients per year respectively.Conclusion The learning curve of performing TEVAR for type B aortic dissection is approximately 28 cases;after completing 28 TEVAR procedures for type B aortic dissection at the yearly frequency of 4.6 cases by one interventional radiologist,the operation time becomes significantly shortened,and the surgical skills of theinterventional physician team can been significantly improved.

Significance of anti-nucleosome antibody, anti-C1q antibody and anti-double stranded DNA antibody in diagnosis of lupus nephritis / 吉林大学学报(医学版)

Objective:To investigate the clinical and laboratory characteristics of lupus nephritis(LN) patients by detecting the anti-nucleosome antibodies, anti-C1q antibodies and anti-double stranded antibodies(anti-ds DNA), and to clarify the risk factors of LN in the patients with systemic lupus erythematosus(SLE),and the significance of three kinds of antibodies in diagnosis of LN.Methods:A total of 120 SLE patients were selected and divided into LN group(n=60) and non-LN group(n=60).The ANAS data of 120 patients were retrospectively analyzed,the levels of anti-C1q antibodies were measured.The clinical symptoms and laboratory data of the patients with positive anti-dsDNA,-nucleosome and-C1q antibodies (3-pos group)and negative three kinds of antibodies(non 3-pos group) were analyzed in LN group.Results:The positive rate of anti-C1q antibody of the patients in LN group (40.00%) was higher than that in non-LN group (21.67%) (χ2=4.728, P=0.03).The positive rate of anti-dsDNA antibody in LN group was 66.67%, and it was 46.67% in non-LN group;the positive rates of the patients had significant difference between two groups (χ2=4.887, P=0.027).The positive rate of anti-nucleosome antibody in LN group was 58.33%, and it was 40.00% in non-LN group;the positive rates of the patients had significant difference between two groups (χ2=4.034, P=0.045).The positive rates of U1-snRNP, SmD1 and other antibodies Jo-1, SSA/Ro60kD, SSA/Ro52kD, SSB, ScL-70, CENP-B,and P0 had no significant differences between two groups(P>0.05).The levels of C3 and C4 and hemoglobinin of the patients in 3-pos group were higher than those innon 3-pos group (P0.05).The clinical symptoms were not statistically significant in 3-pos and non 3-pos groups (P>0.05).Conclusion:The anti-nucleosome, anti-C1q and anti-dsDNA antibodies are the risk factors of SLE complicated with LN;the positive antibodies can improve the diagnostic rate of LN.The 3-pos patients have more severe damage in complements and blood system with higher renal disease activities.

"Application of ""sandwich"" technique according to area calculation in endovascular repair of aortoiliac diseases" / 中国介入影像与治疗学

Objective To investigate the clinical applications of sandwich technique according to area calculation in endovascular aneurysm repair of patients with aorta and iliac artery lesions.Methods Six patients with aortoiliac artery disease confirmed by CT were treated using sandwich technique according to area calculation.The diameter of the main stent and two branches stents were chosen according to the area calculation.Technical success rate,patency of the stent graft and complications were observed.Results Technical success rate was 100％ (6/6),and no complications occurred in all the 6 patients.The clinical symptoms were significantly improved.Gutter endoleak was found in 1 patient 2 months after the procedure,and was managed by coil embolization successfully.No endoleak occurred in other patients during follow-up of 6-31 months.Conclusion For patients with special anatomy of aorta and iliac artery lesions,the application of area calculation in the sandwich technique provides a feasible approach in choosing the matching size of the main body stent and two side branches stents.

Clinical value of anti-cyclic citrullinated peptides antibody in diagnosis, treatment and prognosis of rheumatoid arthritis / 中国免疫学杂志

Objective:To investigate the diagnostic values of anti-cyclic citrullinated peptides antibody ( anti-CCP ) and rheumatoid factor( RF) in rheumatoid arthritis( RA) ,and analyse the clinical relevance of prognosis,drug reaction and bone destruction between anti-CCP and RA.Methods: Serum anti-CCP was detected by enzyme-linked immunosorbent assay ( ELISA ) , and RF was detected by immune rate nephelometry.Results:The sensitivity and specificity of anti-CCP in RA were 83.0%and 96.7%,while the sensitivity and specificity of RF in RA were 76.0%and 70.0%.When joint detect anti-CCP and RF,with anti-CCP or RF positive as a positive determination,with anti-CCP and RF negative as a negative judgment,the combined sensitivity was 87.0%,higher than that of detection alone.The combined specificity was 98.3%, higher than that of single detection.There were big different concentrations of anti-CCP among RA patients before treatment, three months after treatment and six months after treatment.There were significant differences between bone erosion and non-bone erosion in RA patients.And the more serious joint damage,the higher the concentrations of anti-CCP.As for treatment,anti-CCP concentrations declined.Conclusion:Combined detection of anti-CCP and RF can significantly improve the diagnosis and differential diagnosis of RA.The concentration of anti-CCP can change with effective treatment,then dynamic monitoring can be used as study drug efficacy.At the same time,the level of anti-CCP in patients with RA can reflect the degree of bone erosion,and serious bone destruction who was poor treatment effect.

Transjugular liver biopsy：initial experience in 12 cases / 介入放射学杂志

Objective To evaluate the feasibility and safety of transjugular liver biopsy (TJLB) by using LABS 100 liver access and biopsy set (Cook Inc, bloomington, IN, USA). Methods During the period from June 2014 to Sep. 2014, a total of twelve patients received TJLB at authors’ hospital. The clinical data were retrospectively analyzed, and the indications, number of puncturing times, technical success rate, complications, sufficient amount of specimen, etc. were summarized. Results Technical success of TJLB was achieved in all patients, and no procedure- related complications occurred. The mean number of puncturing was 2.8 times, and sufficient amount of specimen for histological examination was obtained in all cases. Conclusion This preliminary result indicates that transjugular liver biopsy with the use of LABS 100 liver access and biopsy set is clinically safe and feasible.

Effect of non finasteride on elderly male patients with chronic heart failure combined with benign prostatic hyperplasia / 中国基层医药

Objective To investigate clinical efficacy of finasteride on chronic heart failure(CHF)compli-cated with benign prostatic hyperplasia(BPH)in elderly patients.Methods 100 cases of elderly patients with CHF complicated with BPH were chosen,according to the number table method,they were divided into the observation group and control group,50 cases in each group,all patients were treated according to their cardiac function to regulate anti -CHF therapy.The patients in the observation group were added with finasteride treatment,the control group pla-cebo treated patients,the measurement indexes were compared between the two groups after treatment,including pros-tate volume,N terminal pro brain natriuretic peptide concentration,creatinine,international prostate symptom score and symptom score,need operation treatment intervention,incidence acute urinary retention rate.Results After treat-ment,the prostate volume,N terminal pro brain natriuretic peptide concentration,creatinine,international prostate symptom score of symptom scores of the observation group were (23.86 ±10.27)mL,(352.63 ±72.55 )g/L, (84.0 ±11.6)mol/L,(9.3 ±4.9),those in the control group were (39.11 ±12.53)mL,(483.46 ±76.47)g/L, (99.0 ±12.8)mol/L,(13.9 ±5.6).The difference was statistically significant(t =9.47,17.56,12.33,8.48,all P <0.05);the observation group need operation treatment intervention was 16.0%,obviously less than 52.0% in the control group,there was significant difference between two groups(χ2 =21.85,P <0.05);acute urinary retention in patients with the observation group the incidence rate of 14.0%,significantly lower than 38.0% in the control group, there was significant difference between two groups(χ2 =12.83,P <0.05).Conclusion Patients with CHF compli-cated with BPH aged at the same time standard anti heart failure treatment using finasteride,significantly reduce the prostate volume,reduce the measurement indexes,and significantly reduce the rate of operation intervention patients, safe and reliable,which is worthy of clinical application.

The preventive transhepatic interventional therapy for primary liver cancer after surgical resection:comparison study between TACE and TAI / 介入放射学杂志

Objective To compare the therapeutic efficacy of preventive transcatheter arterial chemoembolization (TACE) with that of preventive transhepatic arterial infusion (TAI) for patients with primary hepatocellular carcinoma (HCC) after hepatectomy. Methods During the period from June 2011 to June 2012 at authors’ hospital, preventive transhepatic interventional therapy was employed in 79 HCC patients within three months after hepatectomy. The followed-up endpoint was in June 2013. The clinical data were retrospectively analyzed. The patients were divided into TACE group (n=41) and TAI group (n=38). No significant differences in age, sex, preoperative liver function, Child-Pugh scores, tumor size and AFP level existed between the two groups. During interventional procedure , catheterization of proper hepatic artery was performed first, which was followed by angiography in order to clarify that there were no newly-developed tumor vessels or tumor lesions in the residual liver, then the chemotherapeutic agents were infused through the catheter. The emulsion of iodized oil with chemotherapeutic agent was used in the patients of TACE group, while only chemotherapeutic agent was adopted in the patients of TAI group. By using Chi-square test the one-year recurrence rate was determined. Kaplan-Meier estimation method was used to calculate the disease-free survival time, and t test was adopted to estimate the mean hospitalization days. The results were compared between the two groups. Results Of the 79 patients, postoperative recurrence was confirmed in 11, and the overall one-year recurrence rate was 13.9%. The one-year recurrence rate of TACE group and TAI group was 12.20% and 15.79% respectively , and no significant difference in one- year recurrence rate existed between TACE group and TAI group (χ2= 0.213, P = 0.645). The average disease-free survival time of TACE group and TAI group was (21.60 ± 1.52) months and (17.38 ± 3.01) months respectively, the difference between the two groups was of statistical significance (P = 0.038). The mean hospitalization days of TACE group and TAI group were (6.30 ± 1.84) days and (5.89 ± 2.08) days respectively, and the difference between the two groups was not statistically significant (P = 0.522). Conclusion No significant difference in one-year recurrence rate exists between the patients receiving preventive TACE and the patients receiving preventive TAI after hepatectomy for HCC. Nevertheless , preventive TACE can probably improve the disease-free survival time after hepatectomy.

Diagnostic value of anti-mutated citrullinated vimentin antibodies for rheumatoid arthritis / 中国免疫学杂志

Objective: Combined detection of anti-mutated citrullinated vimentin ( anti-MCV ) antibodies, anti-cyclic citrullinated peptide ( anti-CCP) antibodies and rheumatoid factor ( RF-IgM) levels to investigate the diagnostic value of anti-mutated citrullinated vimentin (anti-MCV) antibodies for rheumatoid arthritis(RA).Methods: A total of 359 patients with RA,128 patients with other rheumatic diseases and 90 healthy controls were involved.Enzyme linked immunosorbent assay ( ELISA) was used to detect anti-MCV and anti-CCP, and dynamic immune nephelometry was applied to detect RF-IgM .The sensitivity and specificity were obtained from the experimental data.Results:The sensitivities of anti-MCV,anti-CCP and RF-IgM were 85.1%,76.7% and 82.7%in RA respectively.The specificities were 93.2%,95.1%and 80.1%respectively.Combined detection of anti-MCV and anti-CCP,the sensitivity decreased to 70.2%; but the specificity increased to 98.7%.The sensitivity reached to 89.5% with specificity 97.6%when the union of anti-MCV and anti-CCP positivity was used as criterion.Conclusion:Anti-MCV and anti-CCP are novel makers for RA diagnosis with high sensitivity and high specificity.Combination of anti-MCV and anti-CCP is more helpful for RA diagnosis.

Long-term follow-up of the femoral artery after total percutaneous endovascular aortic repair with preclose technique using a vascular closure device / 南方医科大学学报

<p><b>OBJECTIVE</b>To evaluate the long-term outcome of the femoral artery following total percutaneous endovascular aortic repair (EVAR) with preclose technique using a vascular closure device (VCD).</p><p><b>METHODS</b>From July, 2009 to July, 2012, total percutaneous EVAR was performed in 113 patients (106 males, 7 females; mean age 59.4∓13.5 years) with pre-close technique, including 60 with Stanford type B aortic dissection, 3 with thoracic aortic aneurysm, and 48 with infra-renal abdominal aortic aneurysm, and 2 with thoracic and abdominal aortic aneurysms. The Technical success and complication rates were evaluated, and the outcomes of the femoral artery were followed up with computed tomography or color Doppler ultrasound.</p><p><b>RESULTS</b>The overall technical success rate was 97.6% (161/165) with conversion to open surgery in 4 cases. The size of the sheaths used were 24Fr (n=37), 22Fr (n=29), 20Fr (n=24), 18Fr (n=25), 16Fr (n=12) and 14 Fr (n=38), and 347 VCDs were used for hemostasis of 165 femoral sites; 147 femoral sites were closed using 2 VCDs. Four access-related adverse events, including femoral arterial-venous fistula, acute femoral thrombosis, bleeding, and lower extremity ischemia, occurred in 4 (2.4%) of the 165 cases. In cases using ≤18Fr sheaths, the success rate of closure using 2 VCDs was 98.7%, as compared to 81.1% in cases using larger (≥20Fr) sheaths (P=0.0003). The success rate of the 82 anterior sites was lower than that of the 82 posterior sites (82.9% vs 95.2%, P=0.013). No lower extremity ischemia was observed, nor was femoral artery stenosis detected during the follow-up for 26∓9 months (12-50 months) in these cases.</p><p><b>CONCLUSION</b>Total percutaneous EVAR with preclose technique using VCD provides a safe and effective alternative to open femoral surgery. The sheath size can be a predictor of percutaneous access failure to require conversion to open femoral surgery or using more than 2 devices for suture. Total percutaneous endovascular aortic repair using VCD with preclose technique is safe and effective, which can be adopted as an alternative technique of surgically femoral arterial cut-down operation when the surgeon reduce the learning curve.</p>

Expression of 5-lipoxygenase in hippocampal CA1 neuronal damage following global cerebral ischemia in rats / 浙江大学学报·医学版

<p><b>OBJECTIVE</b>To determine 5-lipoxygenase (5-LOX) expression and the effect of zileuton, a selective 5-LOX inhibitor,on hippocampal neuron injury induced by global cerebral ischemia in rats.</p><p><b>METHODS</b>Global cerebral ischemia was induced by bilateral common carotid artery occlusion combined with hypotension in rats. 5-LOX expression was detected by Western blot analyses and 5-LOX localization was visualized by immunohistochemistry and double immunofluorescence methods. The 5-LOX inhibitor zileuton (10, 30, 50 mg/kg) was orally administered for 3 d after ischemia.</p><p><b>RESULTS</b>The 5-LOX expression was increased in the ischemic hippocampus on d1-7 (peaked at d3), and 5-LOX protein was primarily localized in neurons and translocated to the nuclei in the hippocampal CA1 region after ischemia. The 5-LOX inhibitor zileuton (30, 50 mg/kg) reduced ischemia-induced hippocampal neurons death 3d after ischemia.</p><p><b>CONCLUSION</b>5-LOX is involved in global cerebral ischemic damage in rats, and the 5-LOX inhibitor zileuton has a protective effect on neuronal damage in the rat hippocampus following global cerebral ischemia.</p>

Risk factors of esophageal stent dys-seal phenomenon / 中国介入影像与治疗学

Objective To evaluate the conditions and risk factors of esophageal stent dys-seal phenomenon (ESDP) .Methods Ninety-eight patients with malignant esophageal obstruction underwent metallic stent placement and 7 patients with ESDP were analyzed.The possible contributing factors,including age,gender,obstruction segment,esophagorespiratory fistula,surgical intervention,radiotherapy,the degree of upper obstruction segment expansion,stent with bellmouth,application of covered stent were investigated.All factors mentioned above were analyzed with Logistic regression analysis.Results ESDP was observed in 7 patients (7/98,7.14%) and defined as a space between the esophageal wall and the proximal part of stent without contrast agent obstruction within stent.The clinical situations of patients with ESDP included dysphagia,bucking and constantly chest pain,especially at foodintake.The results of Logistic regression analysis indicated radiotherapy (P=0.005) and the degree of upper obstruction segment expansion (P=0.017) were significantly correlated with ESDP.Conclusion ESDP is one of the complications after esophageal stent placement.It is prudent to implant esophageal stent for those patients with radiotherapy and significant upper obstruction segment expansion.

Preliminary investigation of esophageal stent dys-seal syndrome / 介入放射学杂志

Objective To investigate the causes and managements of dys-seal syndrome (DSS) developed after esophageal stent placement. Methods From June 2001 to June 2008, esophageal stenting was performed in 98 consecutive patients with malignant esophageal obstruction. A total of 99 metallic stents were used. Of 98 patients. gastroesophageal anastomosis stricture was seen in 19, preoperative radiotherapy history in 26 and tracheoesophageal fistula in 34. Results DSS occurred in 7 patients, with an occurrence rate of 7.14% ,which was significant higher than that in patients with preoperative radiotherapy history and in patients showing marked dilated esophagus proximal to the obstructed site (X~2=0.017, 0.005, P=0.036, 0.013, respectively). After treatment, such as fasting, IPN or nasogastric feeding,only 1 case retumed to semi-liquid diet. Among the rest 6 cases of DSS, an additional stent was employed in one (but in vain), nasogastric feeding tube was used in 2, and removal of the stent under endoscopic guidance was carried out in 3. Conclusion DSS is one of the complications developed after esophageal stent placement, its prognosis is rather poor. Removal of the inserted stent may be the optimal treatment. The prevention of DSS includes proper pre-operation evaluation, selection of suitable stent, enhancement of perioperative nutritional support, etc.

Long-term drainage following PTCD for treatment of ischemic-type biliary lesion after liver transplantation / 中华肝胆外科杂志

Objective To evaluate the effectiveness, safety and clinical feasibility of long-term drainage following percutaneous transhepatic cholangiography and drainage (PTCD) for the treatment of ischemic-type biliary lesion (ITBL) after liver transplantation. Methods There were 11 patients with ITBL after liver transplantation. Of the 11 patients with a mean age of 42. 3, 10 were male and 1 female. All 11 cases were diagnosed by PTC or ERC (endocopic retiogiade cholangiogiaphy) before PTCD, and they responded poorly to medication or draining and stenting with ERCP. Long-term drainage following PTCD was performed, whereas adjuvant percutaneous aspiration through double guidewire technique was used for the patients with large quantities of chole mud. Results There were three types of ITBL: type Ⅰ (extrahepatic lesions, n=7), type Ⅱ (intrahepatic lesions, n= 1), and type Ⅲ (intra- and extra-hepatic alterations, n=3). PTCD was performed in all 11 patients successfully. The values of total bilirubin (TBIL) and direct reacting bilirubin (DBIL) were 206.70±54.18μmol/L, 170. 65±53. 97μmol/L and 90. 63± 13.00μmol/L, 63. 83± 13.61μmol/L before and 1 week after PTCD, respectively. The follow-up period was from 3 through 71 months (mean 20 months). During the follow-up, TBIL values ranged between 23.70 μmol/L and 241.0 μmol/L (mean 55.3±15.6 μmol/L), and DBIL values were between 8. 1 and 162.0 μmol/L (mean 32. 53±10. 21 μmol/L). Hepatic functions were good in 9 cases including 5 cases in which the drainage tube was withdrawn after long-time drainage (6～ 12 months, mean= 8.2 months) and 4 cases in which drainage continued. The other 2 cases received liver retransplantation for the grafts dyssynthesis of albumen after drainage for 3 and 8 months. Conclusion Long-term drainage following PTCD is an effective and safe approach for ITBL following liver transplantation.

Techniques and curative effects of fluoroscopy-guided foam sclerotherapy for lower extremity varicosities / 中华放射学杂志

Objective To describe the techniques of fluoroscopy-guided foam sclerotherapy for lower extremity varicosities, and evaluate the feasibility, safety and curative effects of it. Methods From October 2008 to December 2009, a total of 21 legs in 16 patients with lower extremity varicosities received radiological-guided foam sclerotherapy. They were enrolled in this study. Sodium morrhuate was foamed with by the filling-defects technique under fluoroscopy guidance. Postoperative compression was maintained for 2 weeks. Clinical effect was assessed as full success, partial success and no success. Complications were classified as minor or serious. Results The technical procedure was successful in all foam sclerotherapies for 21 legs. And, a single sclerotherapy session was adequate for all legs. The median follow-up period was 6. 0 months after treatment, ranged from 3.0 to 17.0 months. In this period, Clinical effect was assessed as full success for 17 legs (81.0%) and partial success for 4 legs ( 19.0% ). All patients presented selflimiting minor complications, including cordlike subcutaneous indurations along the treated veins (21 cases), skin hyperpigmentation in 11 legs (8 cases), local pain in 7 legs (6 cases) and superficial thrombophlebitits in one leg ( 1 case). No serious complications or systemic events occurred. Conclusion Fluoroscopy-guided foam sclerotherapy was a feasible, safe and effective treatment for lower extremity varicosities.

The relationship between chronic stress during pregnancy and N-methyl-D-aspartate (NMDA) induced seizures in rat pups / 临床儿科杂志

Objective To explore the relationship between the stress during pregnancy and the NMDA-induced spasm. MethodsThe pregnant rats were divided into two groups: pregnant control group(PC group)and pregnatal stress group(PS group). The rats in PS group were forced to swim in cold water of 4℃ for five minutes. Pups of the two groups were injected NMDA 7mg/kg intraperitoneally on postnatal day 13 to induced infantile spasm-like attacks. Then the clinical behavior of pups of the two groups were observed and recorded. The ultrastructure of mitochondria was detected with scanning electron and appearance of neurons was observed with HE staining. NMDA receptor and its subuniforms (NR2A, NR2B) in hippocampus, cerebral cortex, hypothalamus and raphe nucleus of brainstem were estimated by immunohistochemistry. Results The average score of pups in PS group is higher than in PC group(7.84 ±1.01 vs 5.90 ± 1.12). There were swelling neurons and no cytonecrosis in hippocampuss of both two groups. The uhrastructure of mitochondria in hippocampuss and raphe nucleus of brainstem showed great changes in pups of PS group as membrane in mitochondria of pups in PS group. NR1, NR2A and NR2B distributed mainly on the membrane and also in cytoplasm and cellular nucleus. The NR1 expressions in hippocampus, cerebral cortex, hypothalamus and raphe nucleus in pups of PS group were elevated than those of PC group and the P value is 0.001, 0.009, 0.015, 0.001 respectively. The NR2B expressions in hippocampus, cerebral cortex hypothalamus and raphe nucleus in pups of PS group were elevated than those of PC group and the P value is 0.004, 0.002, 0.003, 0.002 separately. NR2A expressed more in hippocampus in pups of PS group than that in PC group,but there was no difference in cerebral cortex, hypothalamus and raphe nucleus between two groups and the P value is separately 0.006,0.067, 0.7, 0.5. Conclusions The mitochondria of neurons in rat pup were hurt by maternal severe stress daring pregnancy, which made the energy metabolism of neurons changed. Maternal stress can also elevate the expression of NR1, NR2A and NR2B in cerebral cortex, brainstem and hippocampus and increase the morbidity of infantile spasm-like attacks.

Evaluation of Fluency stent-grafts in transjugular intrahepatic portosystemic shunts / 中华放射学杂志

Objective To evaluate the efficacy of Fluency stent-graft (Bard Corp) in transjugular intrahcpatic portosystemic shunt (TIPS).Methods The clinical data of 21 consecutive patients treated by TIPS using Fluency stent-grafts were retrospectively reviewed.All of them were recurrent variceal bleeding secondary to portal vein hypertension,1 was bleeding secondary to primary hepatic carcinoma with port vein thrombns,and 1 was Budd-Chiari syndrome.They were followed-up after (10.1 ± 4.6) months (2.0 to 24.0 months).Stent-grafts patancy,portal vein pressure and liver function were recorded and compared.Results Twenty-five stent-grafts were successfully implanted in 21 patients,23 stent grafts were 8 mm 2 were 10 mm in diameter.The covered length of the stents varied from 6 to 8 cm.The bleeding was stopped and the portal vein pressure decreased significantly from (25.4 ± 3.5) mm Hg to (15.4 ± 2.8) mm Hg (t = 12.495,P < 0.01).During the follow-up period,The patient with primary HCC and portal vein thrombosis died 4 months after the procedure. One case had a new primary HCC during the follow-up and died 24 months after the procedure.One ease with variceal bleeding secondary to portal vein hypertension died of muhisystem organ failure.One case occluded in the hepatic vein and had another stcnt graft implanation.The other 17 cases had no stenosis after 7 to 17 months follow-up.Ultrasound showed that the stents were patent 1 week before the patients died.Three cases had transient symptoms of hepatic encephalopathy and recovered after treatment.The Child scores of the 19 patients survived more than 6 months were 6.3 ±1.4 before and 6.4 ± 1.9 after the procedure without significant difference (t = 0.645,P > 0.05).Conclusion The Fluency stent-grafts could increase the patency of the TIPS,but its efficacy on the long-term effect and hepatic encephalopathy need further investigation.