Paediatric ventriculoperitoneal shunt failures: 12-year experience from a Singapore children's hospital.

PURPOSE: Cerebrospinal fluid (CSF) shunt failures in children are devastating. The primary aims of this study are to, firstly, review our institutional series of ventriculoperitoneal shunt (VPS) insertions and identify factors associated with shunt failure. METHODS: This is a single-institution, retrospective study conducted over a 12-year period. All patients under 18 years old with VPS inserted were included. Variables of interest such as patient characteristics, hydrocephalus aetiology, shunt implant details, and outcomes were subjected to statistical analyses. RESULTS: A total of 214 VPS patients were selected for this study. The mean age at VPS insertion was 6 months with a mean follow-up duration of 44 months. The most common type of hydrocephalus was obstructive (n = 142, 66.4%), and the most frequent aetiology was tumour-related (n = 66, 30.8%). The 30-day shunt failure rate was 9.3%: 9 infections (4.2%), 7 occlusions (3.3%), and 4 others (1.9%). After multivariable analysis, only recent central nervous system (CNS) infection prior to VPS insertion remained significant (OR 15.4 (1.3-175), p = 0.028). CONCLUSION: This is the first, large-scale local study focused on the shunt failure in Singaporean children. Significant findings in our study demonstrate that recently treated CNS infection is a factor associated with 30-day shunt failure while the values of CSF constituents were not contributory.

[Role of PRKCD and ASK1 in U937 cell differentiation].

OBJECTIVE: To investigate the expression of ASK1 and PRKCD in the process of monocyte differentiation, and explore their role in functional changes of hypersplenism spleen macrophages (Mφ) in portal hypertension (PH). METHODS: U937 cells were stimulated to differentiate into monocyte/macrophage-like cells by cultivation in PMA and the mRNA expressions of ASK1 and PRKCD were detected by q-PCR and the changes of protein expression were identified by western blot analysis. The secretion of phagocytose related cytokines such as IL-10 and TNF-α were tested by ELISA, and the function of the macrophage-like cells were studied by chicken red blood cell phagocytose test. RESULTS: The expressions of PRKCD and ASK1 mRNA were gradually decreased along with the cell differentiation, while the secretion of TNF-α was increased, IL-10 secretion reached a maximum at 24 h after PAM stimulation, and then gradually fell. The expression of ASK1 and p-ASK1 were rapidly increased compared with the non-stimulated U937 cells, while the expression of PRKCD and p-PRKCD were sightly declined. The phagocytose test show that U937 cells induced with PMA were able to swallow the chicken red blood cell. CONCLUSION: Up-regulated protein expression of ASK1 and p-ASK1 and down-regulated protein expression of PRKCD and p-PRKCD in the process of PMA induced monocyte differentiation, are consist with the expression changes of splenic macrophage phagocytosis in hypersplenism, which leads to increased activity of Mφ.

[Ultrasonic atomization of Shaduolika and dexamethasone for pain relief in patients with foliate papillitis].

PURPOSE: To evaluate the effect of ultrasonic atomization of Shaduolika (a traditional Chinese herb), dexamethasone for pain relief in patients with foliate papillitis. METHODS: 84 patients with foliate papillitis were divided into two groups randomly with the single-blind method. Patients in the experimental group were treated with ultrasonic atomization of Shaduolika and dexamethasone, while patients in the control group were treated by taking Niuhuangjiedu tablets (mixed traditional Chinese medicine). All the patients were observed for five days. Pain relief degree by VAS and the response to the interventions between the experimental and the control group were recorded and compared. The data was analyzed with Ridit test, Chi-square test and Student's t test using SAS6.12 software package, respectively. RESULTS: Pain scores between the experimental and the control group prior to treatment had no significant difference (U=0.1859<1.96, P>0.05), while significant difference existed in pain relief after treatment (U=5.773, P<0.01). The effect of ultrasonic atomization of Shaduolika and dexamethasone for pain relief was significantly better than the control group (U=5.233,P<0.01). CONCLUSIONS: For patients with foliate papillitis, ultrasonic atomization of Shaduolika and dexamethasone is a safe and effective method.