Objective To review the experience of surgical treatment of congenital esophageal atresia. Methods From 1987 to 2001, 32 patients with congenital esophageal atresia were treated surgically, 13 patients using the traditional method, 17 using the new method and 2 using esophago gastric reconstruction. Results There was no postoperative mortality in all patients. There was one anastomosis leak and 4 anastomosis stricture. No anastomosis leak and one esophageal stricture in the patients recieved new method. Conclusion The new surgical method for congenital esophageal atresia can effectively prevent postoperative anastomosis leak and stricture. One stage esophago gastric reconstruction can be used in type I and type II esophageal atresia and instead of two stage operation.

Objective To explore the expression of p130Cas and c-erbB-2 in human breast carcinoma and the relationship between p130Cas and c-erbB-2 levels with clinical and pathological characteristics. Methods Immunohistochemistry SP staining was applied to detect the expression of p130Cas and c-erbB-2 in tumor tissues from 53 cases of human primary breast carcinoma,10 cases of breast fibroadenoma and in 10 cases of normal breast tissues. Results Breast carcinoma tissues showed higher levels of p130Cas and c-erbB-2 than normal and fibroadenoma tissues(both P＜0.01).The expression of p130Cas was related with age, menopausal status, ER, PR status and histological grades, but not related with tumor size, lymph node status and pathological stages. The expression of c-erbB-2 was related with ER status, histological grades and lymph node status, but not related with age, menopausal status, PR status, tumor size and pathological stages. There were no significant correlations between p130Cas and c-erbB-2. Conclusion p130Cas and c-erbB-2 have relations with the malignant transformation and differentiation of breast carcinoma.c-erbB-2 is associated with metastasis of breast carcinoma.p130Cas and c-erbB-2 can be served as useful indicators in the prognosis of breast carcinoma.

ObjectiveTo explore the expression of p130Cas and paxillin in breast carcinoma and investigate the relationships of p130Cas and paxillin levels with clinical and pathological characteristics.MethodsReverse transcriptase polymerase chain reaction (RT-PCR) was applied to detect the expression of p130Cas and paxillin in tumor tissues from 30 cases of primary breast carcinoma,15 cases of normal breast tissues and 10 cases of breast fibroadenoma.ResultsThe levels of p130Cas and paxillin were 0.444 ± 0.088,0.493 ± 0.073,0.739 ± 0.092,0.755 ± 0.137 in normal breast tissues and breast fibroadenoma tissues.The levels of p130Cas and paxillin were 0.914 ±0.186,0.303 ±0.043 in breast carcinoma tissues.Breast carcinoma tissues showed higher levels of p130Cas and lower levels of paxillin than normal breast tissues and breast fibroadenoma tissues(P ＜ 0.01 ).The expression of p130Cas was related with age (r =0.599,P =0.000 ),menopausal status (t =5.602,P =0.000 ),estrogen receptor ( ER ),progesterone receptor ( PR ) status (t =5.768,P =0.000; t =4.151,P =0.000 ) and histological grades (r =-0.668,P =0.000 ),but not related with tumor size (F =0.717,P =0.497 ),lymph node status (F =1.230,P =0.308 ) and pathological stages(r =0.283,P =0.137).The expression of paxillin was related with rumor size (F=4.114,P =0.028 ),pathological stages( r =-0.520,P =0.003),and lymph node status(F=12.418,P=0.000 ),but not related with age(r =0.294,P=0.115),menopausal status(t =-0.403,P =0.690),ER,PR status(t =0.749,P =0.460;t =0.006,P =0.995) and histological grades (r =-0.173,P =0.362).Conclusions p130Cas and paxillin have relations with the malignant transformation,invasion and metastasis of breast carcinoma.Measurement of p130Cas and paxillin may provide useful prognostic information for patients with primary or metastatic breast carcinoma.

Objective To analysis the correlation factors which influence the prognosis and relationship of molecular subtypes on young patients.Methods Clinical data of 108 cases young breast cancer patients (≤ 35 years old) who were treat in the Third Affiliated Hospital of Zhengzhou University from January 2007 to October 2014 were retrospective analyzed.According to immunohistochemistry such as estrogen receptor (ER),progesterone receptor(PR),human epidermal growth factor receptor-2 (Her-2/neu),Ki-67 index,patients were divided into molecular subtypes and follow up.Results LuminalA subtype,LuminalB subtype,human epidermal growth factor receptor-2 overexpression subtype and basal-like accounted for 22％ (24/108),33％ (36/108),20％ (21/108) and 25％ (27/108) respectively,and there's 5-year disease-free survival rate were74.1％,62.8％,.56.8％,58.5％ respectively.Kaplan-Meier method was used to draw the disease-free survival curves through.There was no significant difference in the 5-year disease-free survival rate of each subtype (x2 =0.318,0.802,0.876,0.277,0.239,0.074,P＞0.05).Univariate analysis of prognostic factors of Log-rank showed that there were significant differences between recurrence with tumor size,age,lymph node metastasis and surgical methods in young patients with breast cancer(x2 =9.612,12.099,51.345,5.928,P＞0.05),while no significant difference with adjuvant chemotherapy,radiotherapy,endocrine therapy and molecular typing(x2 =2.381,1.958,0.027,2.612,P＞0.05).Multivariate Cox proportional hazards regression model analysis showed that tumor size (RR =5.487,95％ CI 1.519-19.822,P =0.009) and lymph node metastasis (RR =5.655,95％ CI 2.939 -10.884,P＜0.001) were independent risk factors for disease recurrence.Conclusion Tumor size and lymph node metastasis are important factors of prognosis on young patients.Young patients need the screening and therapy in the early time.

Objective To analyze the genetic characterization of VP1 region of Coxsackie virus A10(CVA10)isolated from clinical specimens of hand, foot and mouth disease(HFMD) patients in Shandong Province. Methods Clinical specimens were collected from some of HFMD patients from 2008 to 2009. The virus was isolated by cell culture. Total RNA was extracted, and the VP1 genes of the isolates were amplified by reverse transcription-polymerase chain reaction (RT-PCR) and sequenced. The genotypes were identified by molecular typing method and bioinformatics analysis.Homologous comparison and phylogenetic analysis of representative CVA10 strains were performed.Homologous comparison between the Shandong isolates and strains obtained from GenBank were performed and phylogenetic analysis of some representative CVA10 strains were performed. Results Three hundred and thirty viruses strains were isolated from 760 clinical specimens collected from HFMD patients, and 17 of them were identified as CVA10. The homologies of nucleotide and amino acid of the 17 CVA10 strains were 82.3%-100.0% and 94.2%-100.0%, respectively. Compared with the prototype strain of CVA10 (Kowalik/USA/2003), the homologies of nucleotide and amino acid were 75.6%-76.8% and 90.2%-93.2%, respectively. Interestingly, Shandong CVA10 strains were clustered into two distinct subgroups in the phylogenetic tree. Conclusions CVA10 is one of the causative agents of HFMD. Two independently circulating subgroups of CVA10 exist in Shandong province.

To analyze the genetic characteristics of a polio-I highly variant vaccine recombinant virus in Shandong Province (China) in 2011 and to identify isolates from healthy contacts, two stool specimens from one patient with acute flaccid paralysis (AFP) and 40 stool specimens from his contacts were collected for virus isolation. The complete genome of poliovirus and VP1 coding region of the non-polio enterovirus were sequenced. Homologous comparison and phylogenetic analyses based on VP1 sequences were undertaken among coxsackievirus (CV) B1, CV-B3 isolates, and those in GenBank. One poliovirus (P1/11186), CV-A4 and CV-A8 were isolated from the AFP patient; one CV-A2, Echovirus 3 (E-3), E-12 and E-14, ten CV-B1, and five CV-B3 strains were isolated from his contacts. These results led us to believe that there may be a human enterovirus epidemic in this area, and that surveillance must be enhanced. P1/11186 was a type-1 vaccine-related poliovirus; it combined with type-2 and type-3 polioviruses in 2A and 3A regions, respectively. There were 25 nucleotide mutations with 9 amino-acid alterations in the entire genome. There were 8 nucleotide mutations with 5 amino-acid alterations in the VP1 region compared with the corresponding Sabin strains. Homology analyses suggested that the ten CV-B1 isolates had 97.0%-100% nucleotide and 98.9%-100% amino-acid identities with each other, as well as 92.6%-100% nucleotide and 99.2%-100% amino-acid identities among the five CV-B3 isolates. Phylogenetic analyses on the complete sequences of VP1 among CV-B1 and CV-B3 isolates showed that Shandong strains, together with strains from other provinces in China, had a close relationship and belonged to the same group.
Base Sequence ; Capsid Proteins ; genetics ; immunology ; Child, Preschool ; China ; Humans ; Male ; Molecular Sequence Data ; Phylogeny ; Poliomyelitis ; etiology ; prevention & control ; virology ; Poliovirus ; classification ; genetics ; immunology ; isolation & purification ; Poliovirus Vaccines ; adverse effects ; genetics ; immunology

Objective: To estimate the immune memory at 12 years after hepatitis B vaccination and its risk factors among adults. Methods: The study was conducted in 20 villages of Qudi town in Jiyang county, Shandong province, China in 2003. Hepatitis B surface antigen (HBsAg), antibody against HBsAg (anti-HBs) and antibody against hepatitis B core antigen (anti-HBc) were tested for all healthy residents aged 15-40 years in these villages. Those who had no history of hepatitis B vaccination and were negative for all three indicators were divided into two groups randomly. Hepatitis B vaccine (HepB) was administrated to them on 0-6 month schedule or 0-1-6 month schedule respectively. Blood samples were obtained at one month after the last dose for each receipt and were quantitatively detected for anti-HBs. Finally a total of 629 participants completed HepB vaccination and anti-HBs testing, including 288 of two-dose group and 341 of three-dose group respectively. In 2015, an additional dose of HepB (challenge dose) was administrated to those who were negative for anti-HBs at follow-up (anti-HBs <10 mIU/ml) to evaluate the immune memory. A total of 93 blood samples, including 50 of two-dose group and 43 of three-dose group respectively, were drawn at 14 days after the challenge dose and anti-HBs was quantitatively detected. The anti-HBs geometric mean concentrations (GMCs) after the challenge dose were compared between the two groups. Multivariate linear regression model was built to find the independent risk factors associated with immune memory response (anti-HBs GMC after the challenge dose). Results: The challenge dose of HepB and post-challenge anti-HBs detection were completed among 93 participants. Totally 92 (98.92%, 92/93) participants were found holding immune memory (anti-HBs after the challenge dose was ≥10 mIU/ml). The immune memory positive rates were 100% (50/50) and 97.67% (42/43) in the two-dose group and three-dose group respectively and the corresponding anti-HBs GMC after challenge dose were 2 684.30 (95%CI: 1 721.71-4 185.08) mIU/ml and 3 527.48 (95%CI: 2 145.15-5 800.58) mIU/ml (P=0.410). The anti-HBs GMC after the challenge dose were 1 908.33 (95%CI: 1 190.01-3 060.27) mIU/ml, 4 004.20 (95%CI: 2 257.90-7 101.12) mIU/ml and 8 682.16 (95%CI: 5 813.94-12 965.36) mIU/ml among the participants whose anti-HBs titer was<4, 4-6 and 7-9 mIU/ml at follow-up, respectively (P=0.002). There was no correlation between immune schedule and anti-HBs GMC after the challenge dose; β (95%CI) was -0.07 (-0.34-0.20), P=0.601. Conclusion The immune memory after primary hepatitis B vaccination lasted for at least 12 years among adults. The immune memory response was independently associated with ant-HBs titer at follow-up, but might be similar between 0-6 month schedule and 0-1-6 month schedule.

Aortic Valve Insufficiency ; Heart Valve Prosthesis ; Heart Valve Prosthesis Implantation ; Humans ; Transcatheter Aortic Valve Replacement

OBJECTIVETo evaluate the value of preoperative assessment on transcatheter aortic valve implantation (TAVI) procedure with high-pitch dual-source computed tomography angiography (CTA).

METHODSSeventeen consecutive patients with severe symptomatic aortic stenosis underwent TAVI in our department from December 2012 to December 2013 were examined by 128-slice prospective ECG-triggered high-pitch spiral CTA and the clinical data were analyzed. Aortic annulus, sinus of Valsalva, sinotubular junction, ascending aorta and native leaflet to coronary ostium length were measured. Peripheral vascular access was evaluated. Then the patients were assessed on the suitability for TAVI procedure and prosthetic valve sizes.

RESULTSMean diameter of the aortic annulus was (25.7 ± 2.0) mm, perimeter mean diameter was (26.4 ± 2.0) mm, area mean diameter was (25.4 ± 1.9) mm. Mean diameter of sinus of Valsalva was (34.0 ± 3.8) mm. Mean diameter of sinotubular junction was (30.5 ± 3.2) mm. Mean diameter of ascending aorta was (37.8 ± 2.8) mm. The length from native leaflet to left coronary ostium was (14.0 ± 2.0) mm, and the length from native leaflet to right coronary ostium was (15.9 ± 3.6) mm. Mean diameter of left iliac arteries was (7.5 ± 1.4) mm. Mean diameter of right iliac arteries was (7.4 ± 1.2) mm. Mean diameter of left femoral arteries was (7.4 ± 1.2) mm. Mean diameter of right femoral arteries was (7.3 ± 1.3) mm. One patient was considered ineligible for TAVI because of large aortic annulus diameter. Three patients died prior to TAVI. Two patients refused to undergo TAVI. Eleven patients underwent TAVI, 26# prosthetic valve was implanted in 1 patient, 29# prosthetic valve implanted in 6 patients, 31# prosthetic valve implanted in 4 patients. Prosthetic valve implantation was successful in 9 patients and only mild or trace perivalvular leakage was observed in these patients. Moderate perivalvular leakage were observed in 2 patients because of the location of implantation was too low, and perivalvular leakage was significantly reduced after re-implantation with same size prosthetic valve at a higher location.

CONCLUSIONSCTA can be used to evaluate the aortic root anatomy and vascular access, and help to choose the right size of prosthetic valve. CTA has an important practical value in preoperative screening of TAVI procedure.

Angiography ; Aorta, Thoracic ; Aortic Valve ; Aortic Valve Stenosis ; Cardiac Catheterization ; Coronary Vessels ; Femoral Artery ; Heart Valve Prosthesis Implantation ; Humans ; Prospective Studies ; Severity of Illness Index ; Sinus of Valsalva ; Tomography ; Transcatheter Aortic Valve Replacement

Objective To observe the effect of transcranial direct current stimulation (tDCS) with mirror neuronal rehabilitation training system (MNST-V1.0) in post-traumatic unconscious patients after severe craniocerebral injury. Methods A prospective, self controlled and open-label method was used. Thirty-six post-traumatic unconscious patients with severe craniocerebral injury from January 2016 to July 2017 were selected. Four cases of the patients did not complete the treatment and the last 32 cases completed the study. All patients were given routine wake-up therapy, and tDCS combined with MNST-V1.0 (20 min/time, 1 time/d, 6 times/week, a total of 8 weeks) was given at the same time. The Glasgow coma scale (GCS), JFK coma recovery scale and Four coma rating scale before treatment and 2, 4, 8 weeks after treatment were recorded. Results The scores of open reaction, language and motor response score of GCS 2, 4, 8 weeks after treatment were significantly higher than those before treatment:(1.56 ± 0.82), (2.06 ± 1.01) and (3.11 ± 1.45) scores vs. (1.00 ± 0.45) scores, (2.23 ± 1.06), (2.56 ± 1.08) and (3.02 ± 1.04) scores vs. (1.00 ± 0.61) scores, (2.79 ± 1.12), (3.22 ± 1.33) and (4.44 ± 1.07) scores vs. (1.00 ± 0.54) scores, and there were statistical differences (P ＜ 0.01 or ＜0.05). The scores of hearing, vision, movement, speech response, communication and arousal of JFK coma recovery scale 2, 4, 8 weeks after treatment were significantly higher than those before treatment, and there were statistical differences (P＜0.01). The scores of open reaction, sport reaction, brainstem response of Four coma rating scale 2, 4, 8 weeks after treatment were significantly higher than those before treatment, and there were statistical differences (P＜0.05); there was no statistical difference in respiratory score of Four coma rating scale before and after treatment (P＞0.05). Conclusions The tDCS combined with MNST-V1.0 can improve the consciousness level in post-traumatic unconscious patients with severe craniocerebral injury, and have the effect of promoting awakening.