Objective To explore the suitable protocols of thoracotomy inhalation program for newborns, which will help to promote respiratory tract secretion drainage and to prevent the postoperative pulmonary complications.Methods This was a double-blind,randomized clinical trial.From January 2011 to October 2013 ,a total of 60 neonatal cases received thoracotomy were recruited,which included 45 cases of congenital esophageal atresia, and 15 cases of congenital diaphragmatic hernia.All cases were randomly allocated into treatment group and control group.Treatment group received mucosolvan 7.5 mg and saline 2 ml oxygen driven inhalation and the control group was given dexamethasone 1 mg, α-chymotrypsin 1 000 U plus saline 10 ml ultrasonic atomizing inhalation.The postoperative incidence of blood oxygen falling when receiving atomizing inhalation and numbers of sputum suction were compared between two groups.Results Compared with control group, the incidences of drop of blood oxygen were significantly deceased [the first day:(0.40 ± 0.35) times vs.(1.53 ± 1.04) times;the second day: (4.32 ± 0.40) times vs.(1.10 ± 1.06) times;the third day: (0.51 ± 0.39) times vs.(1.20 ± 1.09) times;P ＜ 0.05], and the numbers of artificial sputum suction significantly deceased within 3 days after operation [the first day: (7.37 ± 4.92) times vs.(13.24 ± 5.81)times;the second day: (6.34 ± 3.84) times vs.(11.27 ± 4.64) times;the third day: (6.01 ± 2.23) times vs.(10.20 ± 4.53) times;P ＜ 0.05].No adverse reactions were found during treatment.The incidence of blood oxygen falling and the numbers of artificial sputum suction showed no significant differences between two groups on day 4 and day 5 after operation(P ＞ 0.05).Conclusion It is important to have mucosolvan inhalation program for improving condition of respiration and respiratory secretions drainage for newborns with thoracotomy mucosolvan oxygen driven inhalation is worthy being used widely.

Objective To explore the short to long term surgical outcomes and treatment experiences of esophageal atresia（EA）.Methods The clinical data of EA inpatients in our hospital from 2006 to 2009 were reviewed retrospectively.The birth weight,main associated anomalies,details of management,complications and outcomes were discussed.Main risk factors were evaluated with major prognostic classification systems.Results Totally 48 consecutive infants with EA were identified from 2006 to 2009,male 33（69%）,female 15（31%）.Mean birth weight was 2 668 g（range 1 700 g to 3 800 g）.All received primary operation.Complications included pneumonia,anastomotic leakage（16%）,tracheoesophageal fistula,incision sepsis（11%）,delayed tracheoesophageal fistula（7%）,stricture（10%）,and gastroesophageal reflux（GER）（67%）.Mortality was 12.5%,mainly due to severe pneumonia and complex cardiac anomalies.Conclusion Most patients with esophageal atresia could be cured after primary operation with excellent outcomes.The main factors for mortality were complex cardiac anomalies,aspiration and pneumonia.The main mid-term complications were GER and stricture.

Objective To retrospectively evaluate different methods (laboratory tests,liver / gallbladder ultrasound and magnetic resonance cholangiopancreatography)in differentiating biliary atresia from infant hepatitis syndrome.Methods Seventy infants with cholestatic jaundice,50 cases of biliary atresia and 20 cases of infant hepatitis syndrome were studied prospectively from January 2010 to December 2012.All cases underwent abdominal ultrasound and magnetic resonance cholangiopancreatography.The accuracy,sensitivity,specificity and predictive values of these various methods were compared.Also the laboratory parameters were statistically analyzed and compared between groups.Results Patients with BA had significantly higher GGT values at presentation [(743.5 ± 564) IU/L] compared with infants with IHS [(198.8 ± 197.8) IU/L],showing statistically significant difference (P ＜ 0.05).The sensitivity,specificity,and accuracy of the ultrasound in diagnosis of BA were 84.0％ 、100.0％ 、88.6％ respectively(P ＜ 0.05).The values for magnetic resonance cholangiopancreatography were 82.0％ 、80.0％ 、81.4％ (P ＜ 0.05).Conclusion Currently,the method of ultrasound is more reliable than MRCP for differentiating biliary atresia from infant hepatitis syndrome.

Objective To study the protein expression profiles in stegnotic and normal segment of Hirschspning disease (HD) and find the differentially expressed proteins. Methods Immobilized pH gradient two-dimensional polyacrylamide gel electrophoresis (2-DE) was used to isolate the proteins from stegnotic and normal segment of HD. After the samples were treated with silver staining,ImageMaster 2D Platinum analysis software was used to analyze the differentially expressed proteins. Results Repeatable 2-DE profiles were obtained. The mean matching rates of the stegnotic and normal mucosa were 78.1% and 86.7%,respectively. Totally, 103 spots of differentially expressed proteins were screened out between the stegnotic and the normal segment of HD. Conclusion Good reproduuibility and resolution could be obtained in the tissues of HD by applying immobilized pH gradient two-dimensional polyacrylamide gel electrophoresis.Screened differentially expressed proteins may provide the candidates of the markers for early detection of HD.

OBJECTIVETo explore the relationship of Ghrelin gene polymorphism with the occurrence of human anorectal malformations (ARMs) and Hirschsprung disease(HSCR).

METHODSPCR and DNA sequencing were used to detect the single nucleotide polymorphism (SNPs) of 3 loci (rs139684563, rs149447194, rs186599567) genotype of Ghrelin gene in 100 children with ARMs, 100 children with HSCR, and 100 healthy children (normal group). Genovariation and gene mutation were analyzed with case-control method.

RESULTSThree loci SNPs were in accordance with Hardy-Weinberg genetic equilibrium. No significant differences were found in rs139684563 allele and genotype frequencies between the cases and the normal groups (P>0.05). The allele and genotype frequencies of rs149447194 and rs186599567 were significantly different between cases and normal group (P<0.05). DNA sequencing results showed that wild-type homozygous deletion (176th and 191th base A deletion, respectively) were found in rs149447194 and rs186599567of ARMs and HSCR children, and single base substitution was detected in rs149447194 of ARMs children (194th codon nucleotide CCT to CTC).

CONCLUSIONSThe rs149447194 and the rs186599567 polymorphism changes may be associated with the pathogenesis of ARMs and HSCR.

Alleles ; Base Sequence ; Gene Frequency ; Genotype ; Ghrelin ; Hirschsprung Disease ; Humans ; Mutation ; Polymerase Chain Reaction ; Polymorphism, Single Nucleotide ; Rectal Diseases ; Sequence Analysis, DNA

Objective To investigate the fetal management of prenatally diagnosed fetal mediastinal masses and the initial experience of neonatal thoracoscopic minimally invasive treatment. Methods We per-formed a retrospective study from November 2015 to November 2016 of all newborns affected by mediastinal masses and treated by thoracoscopic surgery. This group of cases were found with mediastinal masses by pre-natal ultrasound. The earliest detection of abnormal time was 16 to 31 weeks of pregnancy,with an average of 25 weeks. In the fetal period,the patients were treated with multidisciplinary consultation and individual man-agement. Prenatal examinations helped us except for chromosomal abnormalities and other organ abnormali-ties. After birth,the patients underwent CT and MRI examination. The diameter of the tumor was 1. 7 to 5. 7 cm,with an average of 3. 2 cm. The operative age was 4 to 29 days,with an average of 12. 4 days. This group of newborns were performed thoracoscopic mass resection and confirmed by intraoperative pathological exam-ination. Results After individualized precise prenatal management,all children were born successfully and confirmed that prenatal diagnosis was accurate. All mediastinal masses were completely excised in the neo-natal period. Five mediastinal masses were completely excised. One posterior mediastinum immature teratoma was converted to open thoracotomy. The mean operative duration was 112 min(100 to 150 min). There was no operative complication with a minimal amount of blood loss. With a smooth recovery,the hospital stay was 11-17 days. Pathological results included:1 esophageal duplication,2 bronchogenic cysts,1 lymphangioma, 1 cystic teratoma of anterior mediastinum,1 immature teratoma of posterior mediastinum. During a mean fol-low-up period of 8-14 months,neither complication nor recurrence occurred. Conclusion These are the pre-conditions for early treatment of neonatal patients with mediastinal masses,including definite prenatal diagno-sis,multidisciplinary consultation system and individualized and accurate fetal management. Throcoscopic ex-cision of mediastinal masses is both feasible and safe in neonates. Proper preoperative case selection may pre-vent a conversion into thoracotomy due to huge solid mass.

Objective: To summarize the technical experience of extracorporeal membrane oxygenation(ECMO)catheterization in children. Methods: Data of patients that received ECMO treatment in the pediatric intensive care unit between October 2016 and October 2018 were analyzed retrospectively.The age, weight, diagnosis, complications and the final outcomes of the patients, as well as the working mode, catheterization mode and duration of ECMO were collected. Results: A total of 15 children were treated with ECMO, including 5 males and 10 females.The median age(range) was 4.9 (1.0-11.0)years and the median weight(range) was 21.5(8.5-49.0)kg.There were 5 cases of fulminant myocarditis, 7 cases of severe pneumonia, 3 cases of septic shock, 8 cases of venous-arterial bypass(VA mode), and 7 cases of venous-venous bypass(VV mode). All the 15 patients underwent percutaneous catheterization.Two patients that experienced difficulty in percutaneous catheterization turned to open catheterization.None abandoned ECMO due to the difficulty in catheterization.The position and depth of the catheter, and the flow rate required no further adjustment.The mean ECMO duration was 96.8(1-366)h.Weaning was successful in 8 cases(53%). One case was transferred and 8 cases were dismissed, and the survival rate was 60%.There were 2 cases of bleeding at the site of catheter entrance, one treated with local compression and the other with suture.There was 1 case of femoral artery thrombosis that was relieved by percutaneous femoral artery angiography and intracavitary formation.Another case developed carotid artery thrombosis and had been undergoing antithrombotic therapy and following-up.One case had nerve injury in the left lower extremity that was relieved by oral vitamin Bs and low frequency electrical stimulation. Conclusion Catheterization is the basis of ECMO execution.Catheterization method should be individualized.Percutaneous catheterization is the choice of thumb due to its safety and simplicity.In case of failure, or during the extra-cardiac compression, the surgical method should be taken quickly, and the catheter should be placed in an open or partly-open manner.Proficient catheterization technique ensures the smooth application of ECMO in children.

OBJECTIVE: To investigate the safety of the controllable ileostomy with pipe in view of histology. METHODS: Twenty-eight Beagle dogs undergoing controllable ileostomy with pipe were studied. The special fistula tube with balloon was placed into the hole locating at the cecal root opposing the mesenteric side, and fixed by double knot compression method. RESULTS: The fistula tube was removed 14 days after surgery, then the safety of the procedure was preliminarily evaluated by gastrointestinal radiography and anatomical observation. The small intestine tissue at the compression suture was used as the experimental segment, and the small intestine tissue at the proximal non-compression suture was used as the control segment. The histological staining and the immunohistochemical staining of S-100 protein, c-kit protein and α-smooth muscle actin(α-SMA) protein between two segment were compared, while quantitative comparison of myenteric plexus, intestinal Cajal cell(ICC) and smooth muscle cells in intestinal wall was carried out. After removal of fistula tube at 14 days postoperative, the dogs were normal in feeding and defecation. The digestive tract radiography showed that the intestine was patent without obvious stenosis and obstruction. The dogs were dissected 21 days after operation. The abdominal sinus ostium was well healed and the internal sinus was well formed. Under gross inspection, blood supply, morphology and motor function of experimental intestine segment were similar from the proximal and distal segments of control intestine. S-100 immunohistochemical staining showed that the morphology and distribution of S-100 protein positive cells and "blank area" cells in the experimental and control segments were consistent. Myenteric plexus counting showed that the experimental segment was 3.62±1.82/field and the control segment was 3.27±1.62/field, whose difference was not statistically significant(t=1.30, P=0.20). Immunohistochemical staining of c-kit showed that the distribution of c-kit positive cells in both segments was consistent. Counting of the number of ICCs in myenteric plexus revealed that experimental segment was 2.96±2.57/plexus, and control segment was 2.49±1.80/plexus without significant difference(t=1.81, P=0.07). Immunohistochemical staining of α-SMA showed that the morphology and distribution of smooth muscle cells in whole intestinal wall(muscle layer, longitudinal muscle, ring muscle) in experimental and control segments were consistent. The average absorbance(A) value of α-SMA staining in ring muscle layer was detected and quantified. The experimental segment was 0.15±0.03 and control segment was 0.14±0.04 without significant difference(t=1.16, P=0.25). CONCLUSION The technique of controllable ileostomy with pipe is safe in view of histology, which may replace the traditional protective ileostomy.
Animals ; Dogs ; Ileostomy ; methods ; standards ; Intestine, Small ; surgery ; Models, Animal ; Proto-Oncogene Proteins c-kit ; metabolism ; Treatment Outcome

Enzalutamide (ENZ) is a second-generation androgen receptor (AR) antagonist used for the treatment of castration-resistant prostate cancer (CRPC) and reportedly prolongs survival time within a year of starting therapy. However, CRPC patients can develop ENZ resistance (ENZR), mainly driven by abnormal reactivation of AR signaling, involving increased expression of the full-length AR (ARfl) or dominantly active androgen receptor splice variant 7 (ARv7) and ARfl/ARv7 heterodimers. There is currently no efficient treatment for ENZR in CRPC. Herein, a small molecule LLU-206 was rationally designed based on the ENZ structure and exhibited potent inhibition of both ARfl and constitutively active ARv7 to inhibit PCa proliferation and suppress ENZR in CRPC. Mechanically, LLU-206 promoted ARfl/ARv7 protein degradation and decreased ARfl/ARv7 heterodimers through mouse double minute 2-mediated ubiquitination. Finally, LLU-206 exhibited favorable pharmacokinetic properties with poor permeability across the blood-brain barrier, leading to a lower prevalence of adverse effects, including seizure and neurotoxicity, than ENZ-based therapies. In a nutshell, our findings demonstrated that LLU-206 could effectively inhibit ARfl/ARv7-driven CRPC by dual-targeting of ARfl/ARv7 heterodimers and protein degradation, providing new insights for the design of new-generation AR inhibitors to overcome ARfl/ARv7-driven CRPC.