Clinical experience summary of surgical treatment abdominal gastrointestinal foreign body in children / 国际外科学杂志

Objective:To summarize the clinical experience of surgical treatment abdominal gastrointestinal foreign body in children, thus to provide a theoretical basis for clinical decision-making.Methods:The clinical data, including age distribution, clinical manifestations, surgical treatment strategy and prognosis, from 60 children with abdominal gastrointestinal foreign body treated by operation in Children's hospital of Hu′nan Province from January 2015 to June 2020, were retrospectively analyzed. Among the 60 children, 38 males and 22 females, with a median age of 2.9 years. Observation data included the type and location of foreign bodies in the digestive tract, clinical manifestations and surgical methods, operation time, intraoperative blood loss, postoperative hospital stay. The following-up time was 6 months to 2 years by telephone or clinic. The short/long-term complications was observed.Results:Children under 3 years old accounted for 56.7%. Types of foreign bodies included magnetic foreign bodies, sharp objects[paper clips, nails, screws, fish bone and others, etc], crystal ball, jujube pit, gastric hair stone, batteries and badminton holder. The foreign bodies were mainly located in stomach and small intestine. Abdominal pain and vomiting were the most common symptoms. The patients of foreign body with long residence time had peritonitis such as fever and abdominal pain, among 21 cases were combined with gastrointestinal perforation. There were varieties kind of operaion methods, including gastrointestinal incision and foreign bodies removal( n=22), appendectomy and foreign bodies removal( n=7), repair of gastrointestinal perforation( n=6), intestinal resection and anastomosis( n=17), intestinal resection plus enterostomy( n=5)but whose fistula was closed after 3 months, lateral wall of rectum repair( n=3). Fifty-two patients underwent common open abdomen operation, 8 patients underwent laparoscopic operation. The operating time was(93.5±19.3) min. Intraoperative blood loss was(20.2±4.3) mL. The postoperative hospitalization was 13(5, 19) d. The postoperative complications occurred in 3 patients who were nonoperative treatment recovery. Conclusions:Magnetic foreign body, sharp foreign body, crystal ball, jujube nucleus and corrosive foreign body are the main causes of digestive tract obstruction and perforation in children. Individualized operation plan should be selected as soon as possible according to the number of foreign bodies, retention position and whether or not digestive tract perforation.

Application of magnetic resonance imaging in the diagnosis of soft tissue sarcoma / 中国医师进修杂志

Objective To evaluate the diagnostic value of magnetic resonance imaging (MRI) in the diagnosis of soft tissue sarcoma. Methods Seventy-four soft tissue tumors patients having underwent plain and enhanced MRI scans were selected. A retrospective case-control study was conducted to compare the demographic and MRI characteristics between 32 cases of soft tissue sarcoma and 42 cases of benign soft tissue tumor. The examined MRI characteristics included lesion location, morphology, size, signal uniformity, intratumoral sign, sign outside the tumor and intensity pattern, et al. The MRI characteristics were compared between 2 groups. Results The 32 patients with soft tissue sarcoma included 7 cases with lipoblastoma, 5 cases with pleomorphic undifferentiated sarcoma, 5 cases with fibrosarcoma, 5 cases with synovial sarcoma 5 cases, 4 cases with dermatofibrosarcoma protuberant, 2 cases with low-grade fibromyxoid sarcoma, 2 cases with alveolar soft part sarcoma, 1 case with leiomyosarcoma, and 1 case with histiocytic sarcoma. The 42 patients with benign soft tissue tumor included 15 cases with neurilemmoma, 9 cases with angioma, 8 cases with neurofibroma, 6 cases with lipoma, and 4 cases with angiolipoma. After controlling for the potential confounding effects of sex and age, whether there was high signal on T2WI and whether the tumor boundary was clear can help for distinguishing soft tissue sarcoma and benign tumor. The occurrence of high signal on T2WI was a risk factor for soft tissue sarcomas ( OR=25.05, 95% CI 4.04 to 155.28), and tumors whose boundaries were less clear ( OR=18.84, 95% CI 2.98 to 118.99) and unclear ( OR=26.59, 95% CI 3.79 to 186.71) were more likely to be soft tissue sarcomas compared to those with clear boundaries. Conclusions The MRI characteristics of soft tissue sarcomas can be used for accurate diagnosis of the tumors before treatment.

Malignant epithelial tumors of the ovary:differential diagnosis with CT and MRImaging / 实用放射学杂志

Objective To investigate the value of CT and MRI in the differential diagnosis of various subtypes malignant epithelial tumors of the ovary,to improve the understanding of imaging manifestations of ovarian cancer.Methods Fifty four cases with malignant epithelial tumors of the ovary confirmed by clinical operation and pathology were included in this study and preoperative imaging examinations were analyzed retrospectively.Results Thirty four cases were diagnosed as ovary cystadenoma,including 26 cases of serous cystadenoma (48%),8 cases of mucous cystadenoma (14%),10 cases of endometrioid adenocarcinoma (19%)and 10 cases of clear-cell carcinoma (19%).All the tumors appeared as unilocular or multilocular cystic-solid masses,however some differences existed among tumors in calcification in masses,size of solid nodules,locular appearance,with or without associated massive ascites, and adjacent structures involvement .Calcification occurred in 5 cases of cystadenocarcinoma,and no calcification was found in endometrioid adenocarcinoma or clear-cell carcinoma.The proportion of solid component in clear-cell carcinoma was lower,usually presenting as intralumimal nodular protuberance.Endometrioid adenocarcinoma was often associated with endometrial hyperplasia or endometrial carcinoma and was the most prone to peripheral invasion and adhesion.Conclusion The different subtypes of ovary malignant epithelium-derived tumor have different characteristics of multilocular,the size of cyst wall nodule or solid nodule and the calcification.Compare and analysis of these characteristics help us to make a more accurate preoperative diagnosis.

CT findings of primary abdominal dedifferentiated liposarcoma:a comparative analysis with pathology / 实用放射学杂志

Objective To investigate the CT findings of primary abdominal dedifferentiated liposarcoma(DDL),and to improve the diagnostic accuracy.Methods CT images of 23 cases with primary abdominal DDL confirmed by pathologically were analyzed retrospectively,and the CT findings were compared with pathological results.Results The masses in 20 cases out of 23 cases were located in retroperitoneal region,2 in abdominal cavity and 1 in the pelvic extraperitoneal space.The mean diameter of the masses was 26.5 cm.CT showed the fatty and non-fatty regions in the masses.In 2 1 cases,the non-fatty region was manifested as a single mass and was located at the edge or on the surface of fatty region.In 2 cases,the non-fatty region was manifested as multiple well-defined masses and was located within the fatty region.In 2 1 cases,the fatty region showed misty density with strip and reticular septa.In 2 other cases,the fatty region showed slightly low density,mingled with some fat tissue density,which showed no enhancement with mild enhanced internal septa.In 20 cases,the non-fatty region showed soft tissue density,with mild to moderate heterogeneous enhancement.In 3 other cases,the density of non-fatty region varied between liquid and soft tissue with patchy enhancement on delayed phase.In addition,stippled calcification was found in 4 cases.Conclusion The primary abdominal DDL has relatively specific CT findings,which different dedifferentiated components pro-duce different CT characterizes.Finding well-differentiated fat components around non-fatty mass may help to improve the accuracy of diagnosis and reduce the misdiagnosis.

Changes in the expression of three markers in T lymphocytes of peripheral blood and immunoregulatory mechanisms of burned mice with sepsis at early stage / 中华烧伤杂志

<p><b>OBJECTIVE</b>To study the expression levels of annexin A1 (ANXA1), GATA-3, and T-bet in T lymphocytes of peripheral blood in burned mice with sepsis at early stage, and to analyze their immune regulatory mechanisms.</p><p><b>METHODS</b>Seven-hundred and eighty male mice of clean grade were divided into sham injury group (n=60, sham injured on the back by immersing in 37 ℃ warm water for 10 s), burn group (n=240, inflicted with 20% TBSA deep partial- thickness burn on the back by immersing in 100 ℃ hot water for 10 s), sepsis group (n=240, intraperitoneally injected with 6 mg/kg lipopolysaccharide), and burn+ sepsis group (n=240) according to the random number table. Mice of burn+ sepsis group were treated as that in burn group at first, and then they were treated as that in sepsis group. (1) Immediately after injury, six mice in sham injury group were selected to collect lymphocyte suspension of peripheral blood (1 tube each mouse) according to the random number table. According to the random number table, 6 mice of each of the other three groups were respectively selected at post injury hour (PIH) 12, 24, 48, and 72 for the collection of lymphocyte suspension from peripheral blood (1 tube each mouse). Each tube of cell suspension was equally divided into two parts. Fluorescein isothiocyanate (FITC)-labeled human anti-mouse CD4 monoclonal antibody and phycoerythrin (PE)-labeled human anti-mouse interferon-γ monoclonal antibody were added to one part of cell suspension to mark helper T lymphocyte 1 (Th1). FITC-labeled human anti-mouse CD4 monoclonal antibody and PE-labeled human anti-mouse interleukin-4 (IL-4) monoclonal antibody were added to the other part of cell suspension to mark Th2. The percentages of Th1 and Th2 were determined with flow cytometer, and the ratio of Th1 to Th2 was calculated. (2) According to the random number table, 18 mice in sham injury group were selected immediately after injury for the collection of lymphocyte suspension of peripheral blood (1 tube each mouse), and 18 mice of each of the other 3 groups were respectively selected at PIH 12, 24, 48, and 72 to collect the lymphocyte suspension of peripheral blood (1 tube each mouse). The mRNA expression levels of ANXA1, GATA-3, and T-bet were determined by real-time fluorescent quantitative reverse transcription-PCR. (3) Immediately after injury, 36 mice in sham injury group were selected to collect lymphocyte suspension of peripheral blood (1 tube each mouse) according to the random number table, and then 36 tubes of cell suspension were divided into 6 batches (6 tubes each batch). Each one of 6 kinds of antibody combinations: antibodies for labeling Th1 and Th2 in combination with PE-anthocyanin 7 labeled human anti-mouse ANXA1 monoclonal antibody, PE-anthocyanin 7 labeled human anti-mouse GATA-3 monoclonal antibody, and PE-anthocyanin 7 labeled human anti-mouse T-bet monoclonal antibody was added to 1 tube of cell suspension at each batch. According to the random number table, 36 mice of each of the other 3 groups were respectively selected at PIH 12, 24, 48, and 72 for the collection of lymphocyte suspension of peripheral blood (1 tube each mouse), and then 36 tubes of cell suspension at each time point were divided into 6 batches for marking with 3 kinds of surface markers of Th1 and Th2 (6 tubes each batch). Each one of above-mentioned 6 kinds of antibodies was added to 1 tube of cell suspension at each time point for each batch. The percentages of ANXA1, GATA-3, and T-bet positive cells in Th1 and Th2 were determined with flow cytometer. Data were processed with one-way analysis of variance, analysis of variance of factorial design, and SNK test. The relationship between the percentages of ANXA1 positive cell and the percentages of GATA-3 positive cell in Th1 and Th2, and mRNA expression level of ANXA1 and mRNA expression level of GATA-3 in lymphocytes were assessed by linear correlation analysis.</p><p><b>RESULTS</b>(1) Compared with those in sham injury group immediately after injury, the percentages of Th1 and Th2 and the ratio of Th1 to Th2 of mice in burn group were significantly decreased from PIH 24 on, with P values below 0.05; the percentages of Th1 and Th2 and the ratios of Th1 to Th2 of mice in sepsis group and burn+ sepsis group were significantly decreased from PIH 12 on, with P values below 0.05. (2) Compared with those in sham injury group immediately after injury, the mRNA expression levels of ANXA1 and GATA-3 in lymphocyte of mice in burn group were significantly decreased from PIH 24 on, with P values below 0.05; the mRNA expression level of T-bet was significantly decreased at PIH 24 but significantly increased at PIH 48 and 72, with P values below 0.05. Compared with those in sham injury group immediately after injury, the mRNA expression levels of ANXA1 and GATA-3 in lymphocytes of mice in sepsis group were significantly decreased from PIH 12 on, and the mRNA expression level of T-bet was increased significantly from PIH 12 on, with P values below 0.05; the mRNA expression levels of ANXA1, GATA-3, and T-bet in lymphocytes of mice in burn+ sepsis group were significantly decreased from PIH 12 on, with P values below 0.05, reaching the nadir at PIH 72 (0.50±0.04, 0.45±0.03, 0.21±0.05, respectively). (3) A significant positive correlation was observed between ANXA1 mRNA expression level and GATA-3 mRNA expression level in lymphocytes of peripheral blood (r=0.862, P<0.05). (4) Compared with those in sham injury group immediately after injury, the percentages of ANXA1 and GATA-3 positive cellsin Th1 and Th2 of mice in burn group were significantly lowered from PIH 24 on, and the percentage of T-bet positive cells was significantly decreased at PIH 24, but it was increased from PIH 48 on, with P values below 0.05. The percentages of ANXA1 and GATA-3 positive cells in Th1 and Th2 of mice in sepsis group were continuously decreased from PIH 12 on, which were lower at most time points than those in sham injury group immediately after injury, with P values below 0.05. The percentages of T-bet positive cells in Th1 and Th2 of mice in sepsis group were significantly increased since PIH 12 as compared with those in sham injury group immediately after injury, with P values below 0.05. The percentages of ANXA1, GATA-3, and T-bet positive cells in Th1 and Th2 of mice in burn+ sepsis group were continuously lowered from PIH 12, with significantly statistical differences at most time points as compared with those in sham injury group immediately after injury, with P values below 0.05. (5) The percentages of GATA-3 positive cells in Th1 and Th2 were significantly positively correlated with those of ANXA1 (with r values respectively 0.747 and 0.787, P values below 0.05).</p><p><b>CONCLUSIONS</b>The expression levels of ANXA1, GATA-3, and T-bet were continuously lowered in burned mice with sepsis, and it may play an important role in Th1/Th2 balance switching to Th2 bias and immunosuppressive process.</p>

Analysis of clinical characteristics of 187 patients with Marjolin's ulcers / 中华烧伤杂志

<p><b>OBJECTIVE</b>To analyze the etiology and clinical characteristics of Marjolin's ulcer, and to explore its prevention and treatment.</p><p><b>METHODS</b>Medical records of 187 patients with Marjolin's ulcers admitted to the Department of Burns and Reconstructive Surgery of Xiangya Hospital of Central South University from January 1998 to May 2015 were retrospectively analyzed, including gender, age of onset of initial injury or primary disease, age of onset of Marjolin's ulcer, initial injury or primary disease, length of latency, lengths of pre- and post-ulceration periods, lesion site, lesion type, lesion area, local scar tension, histopathological type, degree of carcinoma cell differentiation, bone invasion and lymphadenopathy, treatment, and prognosis. The relationships between the age of onset of initial injury or primary disease and the length of latency, and the length of pre-ulceration period and the length of post-ulceration period were assessed by Spearman correlation analysis. The recurrence rates were processed with Fisher's exact test.</p><p><b>RESULTS</b>(1) Among the patients, the ratio of male to female was nearly 1.6:1.0. The age of onset of initial injury or primary disease was 0.17-78.00 (17±18) years, and the age of onset of Marjolin's ulcers was 18-84 (49±14) years. (2) The most common initial injury among the patients was flame burn. The length of latency was 0.25-74.00 (32±16) years, and the lengths of pre- and post-ulceration periods were 0-73.00 (26±19) years and 0.08-59.00 (6±11) years respectively. The common lesion sites were the lower limbs and head and face. The rodent ulcer was the most common lesion type, and the lesion area was 1-625 (69±110) cm(2). There were obviously negative correlations between the age of onset of initial injury or primary disease and the length of latency, as well as the length of pre-ulceration period and the length of post-ulceration period (with r values respectively -0.71 and -0.50, P values below 0.01). The pathological scars of strong tension around lesions were seen in 176 cases. (3) The major histopathological type was squamous cell carcinoma, with high cell differentiation in most cases. (4) Bone invasion of carcinoma cells was observed in 59 cases. Lymph node enlargement was observed in 100 cases, and lymph node metastasis was observed in 18 cases. (5) Twenty patients did not receive any surgery, while 167 patients were treated by surgery with lesion extended resection as the main method. According to the condition of wound after the lesion extended resection, the wounds were mainly repaired by skin grafting and transplantation of local skin flap. The majority of wounds in 139 patients who underwent lesion extended resection were repaired in one surgery. Twenty-eight patients out of 104 followed-up cases had recurrence after surgery, mainly seen on head and face, upper limb, lower limb, and buttock, and there was no significant difference among them (P>0.05). The recurrence time of most patients was longer than 6 months after cure.</p><p><b>CONCLUSIONS</b>Patients with Marjolin's ulcers in younger age of onset of initial injury or primary disease tend to have longer latency, during which the shorter the pre-ulceration period is, the longer the post-ulceration period will be. Marjolin's ulcers are prone to occur in scar sites with large tension. Early treatment of high tension scar and scar ulcer is important in prevention, and surgery is the optimal treatment for Marjolin's ulcers. Regular follow-up should be carried out owning to recurrence rate in certain degree after surgery.</p>

Comparative study of CT and pathological findings in Brunner’s gland adenoma / 实用放射学杂志

Objective To investigate the imaging findings and key diagnostic points of Brunner’s gland adenoma on CT.Methods The CT imaging findings and pathological features of 9 cases of Brunner’s gland adenoma confirmed by pathology were retrospec-tively analyzed,including the lesions number,site,size,shape,margin,density and the enhancement pattern.Results Of the 9 ca-ses,1 case located in the antrum and 8 cases in the duodenaum [6 cases in the duodenal bulb (75%)and 2 in the papillary (25%)]. Of the 6 cases of duodenal lesions,3 were found at the anterior wall and 3 at the posterior wall.Except 1 case which complicated with enteritis and had an obscure margin,the other 8 cases were clear margined ,and were round or nodular in shape.The maximum size of tumors ranged 1 5-68 mm in diameters (mean 35.0 mm ± 1 6.2 mm).The density of tumors was homogeneous on CT scan without necrosis or hemorrhage.In the arterial phase after administration of contrast agent,the lesions were similar to the adjacent intestinal wall enhancement,and mucosal annular enhancement (halo sign)showed in 6 cases,and the dot-shape non-enhancement area within the lesion (black star sign)showed in 5 cases,and the thickening or tortuous enhanced blood vessel showed in 6 cases.In the venous phase,9 cases were progressive enhancement,and the “black star sign”or “the black line sign”showed more clearly in 5 cases.In the pathology,the lesions were polypoid-like,solid or cystic.Under the microscope,the hyperplasic Brunner’s glands were covered with normal duodenal mucosa and separated by bundles of smooth muscle cells with dilated duct,cyst,and adipose cells,1 case with atypical hyperplasia of the glandular epithelium and 1 case with ectopic pancreas.Conclusion There are some spe-cific CT imaging features in Brunner’s gland adenoma,which is of important clinical value in accurate preoperative diagnostic.

Clinical analysis of intermittent and continuous nasal positive airway pressure treatment on recurrent apnea in preterm children / 中国医师进修杂志

Objective To compare nasal intermittent positive pressure ventilation （NIPPV） with nasal continuous positive airway pressure (NCPAP) treatment of primary apenea of premature (AOP) effect,and provide a scientific basis for the AOP treatment.Methods Seventy-six cases of children with AOP were randomly divided into NIPPV group (40 cases) and NCPAP group (36 cases).Comparison of two groups changes of blood gas,curative effect,after treatment for invasive mechanical ventilation ratio,ventilation time,and so on.Results Blood gas analysis of two groups before treatment had no significant difference (P ＞ 0.05),1,12 h after treatment of blood gas analysis was statistically significant (P ＜ 0.05).The cure rate,effective rate and inefficiency in NIPPV group were significantly better than those in NCPAP group [82.5％ (33/40)vs.61.1％ (22/36),92.5％ (37/40) vs.80.6％ (29/36),7.5％ (3/40) vs.19.4％ (7/36)].Assisted ventilation time was significantly shorter in NCPAP group[(39.45 ± 6.99) h vs.(69.39 ± 20.51) h].The difference was statistically significant (P ＜ 0.05).Two groups of intraventricular hemorrhage,bronchial pulmonary hypoplasia,neonatal necrotizing enterocolitis incidence rate had no significant difference (P ＞0.05).In NIPPV group the incidence rate of premature infant retina disease and cererbral white matter softening around the ventricle was significantly lower than that in NCPAP group [2.5％ (1/40) vs.13.9％(5/36),2.5％(1/40) vs.11.1％(4/36)].The difference was statistically significant (P ＜ 0.05).Conclusion NIPPV in the treatment of recurrent apnea in premature infants curative effect and prognosis is better than NCPAP.

Clinical observation of very low birth weight infants with early trace depth hydrolyzed protein formula / 国际儿科学杂志

Objective To study the effect of early trace depth hydrolyzed protein formula and infant formula milk on very low birth weight (VLBW) infants of the gastrointestinal tolerance,growth and development,and provide scientific basis for early enteral feeding VLBW.Methods 126 premature infants with birth weight lower than 1 500 g were randomly divided into observation group (63 cases) and control group (63 cases).On the basis of routine treatment,the observation group was given early trace depth hydrolyzed protein formula,the control group was given early minimal preterm formula milk.We oberserved gastrointestinal tolerance,complications and growth monitoring of two groups.Results Period to regain their birth weight,up to full enteral feeding days of age,hospitalization days,discharge rate of extrauterine growth retardation,the incidence of feeding intolerance,the incidence of neonatal necrotizing enterocolitis,feeding dyspeptic diarrhea incidence in observation group were 12.81 d,25.76 d,37.95 d,23.8％,14.3％,6.3％,3.2％.The data in control group were 16.02 d,27.75 d,45.49 d,42.9％,30.2％,19％,12.7％ respectively.There was significant difference between two groups (P ＜ 0.05).Conclusion To carry out early trace depth hydrolysis protein can reduce the risk of the incidence of complications in VLBW infant which has good promotion on the recent growth and suitable for clinical use.

Innovating the teaching model of internal medicine / 中华医学教育探索杂志

With the change of medical model and the transfer of health to communities and rural towns,the expanding enrollment of colleges and universities makes collegiate internship progrms more and more difficult Clinical College of Guilin Medical University explores the new methodology of teaching practice,constructs and practises the new molde of internal madichine teaching,Combines the coummunity internship programs with hospital internship programs.and was improved the quality of practice teaching

A clinical evaluation on accuracy of RayPex5 apex locator for measuring root canal working length / 实用口腔医学杂志

In order to evaluate the accuracy of RayPex5 apex locator in measuring root canal working length in clinical practice and to analyze the possible factor resulting in deviation, the working length of total 211 root canals were measured by handing method and electronic method respectively. The exact working length of those root canals were determined by X-ray method. The accuracy rate of electronic method and handing method was 96.21% and 78.2% respectively, with significant difference(P<0.001). The accuracy rate of front teeth group and molar group measured by electronic method was 100% and 92.5% respectively, with significant difference(P<0.05), while the apical paradentitis group and the apical non-paradentitis group, the front teeth group and the premolar group, and the premolar group and the molar group didn' t differ from each other, respectively. The study showed that the accuracy rate of electronic method was high for determining root canal working length, and Raypex 5 apex locator could define apical seat to measure root canal working length accurately.

Analysis of Leprosy Endemic and Its Control in Yunnan Province / 中华皮肤科杂志

Objective To analyze the trends of leprosy epidemic and evaluate the effects of its control in Yunnan Province. Methods The epidemiologic data were analyzed. Results There were 50 797 leprosy patients detected in Yunnan during 1954～ 1998 with a high prevalence in china.Among these patients,37 639 were cured,10 447 died,and 1 069 dropped out.There were 1 642 active patients at the end of 1998.It was in 1966 that the prevalence is highest(0.82/1 000) with 18 350 active patients and decreased to 0.04/1 000 in 1998.The incidence was 19.37/100 000 in 1957 and decreased to 0.32/100 000 in 1998.The most numerous patient (4 680) was detected with a rate of 24.45/100 000 in 1958,and the rate decreased to 1.63/100 000 in 1998.In 1960s and 1970s, a lot of leprosy villages were built and a mass survey of leprosy patients was taken.Doctors treated patients with DDS alone at that time. MDT was the first to use in Mengla in 1983 and spread during 1986～ 1989. Conclusion Several measures were taken for detecting and treating patients effectively, and the endemic and incidence decreased by a big margin as well.