0 05) HR in group A was faster than that in group B at T 3 (P

Objective To investigate the clinical efficacy of laparoscopic Soave's surgery for the treatment of congenital Hirschsprung's disease in infants (age ＜ 2 months).Methods The clinical data of 368 infants with congenital Hirschsprung's disease who received laparoscopic Soave's surgery at the Children's Hospital of Xuzhou City from June 2005 to June 2012 were retrospectively analyzed.Three Trocars with diameter of 0.5 cm were used.The colic ligament was freed and the mesentery was ligated laparoscopically,then the rectal mucosa was stripped for 5-7 cm in length,and was pulled out through the rectal muscle sheath.Patients were followed up via out-patient examination at postoperative month 1,3,6,12 to learn the frequency of defecation,constipation and anal stenosis.The follow-up was ended in June of 2013.Results Two patients were converted to open surgery,and the remaining 366 patients received laparoscopic surgery successfully,with no incidence of wound infection.The operation time,volume of blood loss and duration of hospital stay were (100 ±20)minutes,(5.4 ± 1.5) mL and (7.3 ± 1.5) days,respectively.The average time for antibiotics usage was (3.5 ± 1.6) days and the time for infusion was (3.8 ± 1.4) days.All the infants were followed up,and the mean time for postoperative follow-up was 4.5 years (range,1.0-8.0 years).Eleven patients were complicated with Hirschsprung's disease associated enteritis,7 patients with constipation,5 with anal stenosis,4 with fecal pollution.The condition of the infants was improved after conservative treatment.Conclusion Laparoscopic Soave's surgery is suitable for the treatment of congenital Hirschsprung's diseases in infants aged under 2 months,it has the advantages of small trauma,quick recovery,better cosmetic effects and few complications.

Objective To compare the efficacies of 4 risk models (THRIVE[Totaled Health Risks in Vascular Events],MSS[Multicenter Stroke Survey],HIAT[Houston Intra-Arterial Therapy],and GRASPS[Glucose at presentation,Race,Age,Sex,Systolic blood pressure,Severity of stroke at presentation]) in predicting intracranial hemorrhage and poor outcomes in acute anterior circulation ischemic stroke after mechanical thrombectomy.Methods From May 2013 to March 2016,153 consecutive patients with acute anterior circulation vascular occlusion conducted mechanical thrombectomy within 6 hours after onset and admitted to the Departments of Neurology,Jinling Hospital,Nanjing University School of Medicine and Zhongshan Hospital,Xiamen University were enrolled prospectively.Logistic regression analysis and the area under the receiver operating characteristic (ROC) curve (AUC) were used to investigate the efficacies of 4 risk models (the THRIVE,MSS,HIAT,and GRASPS scores) for predicting intracerebral hemorrhage (including any intracranial hemorrhage events and symptomatic intracranial hemorrhage) and poor outcomes (including 90 d all-cause death and modified Rankin Scale[mRS] score≥3) in acute anterior circulation ischemic stroke after mechanical thrombectomy.Results The MSS score (AUC 0.639,95%CI 0.548-0.730,P=0.004) and GRASPS score (AUC 0.616,95%CI 0.525-0.706,P=0.017) could predict any intracranial hemorrhage events,but the predictive accuracy was low.They had the predictive value for death within 90 d after mechanical thrombectomy,and the GRASPS score (AUC 0.783,95%CI 0.706-0.860,P<0.001) had the moderate predictive accuracy,and the AUC of the other 3 models was all<0.7,the predictive accuracy was low.The models could predict the poor prognosis at 90 d (90 d mRS≥3).The AUCs of both the GRASPS score and THRIVE score were >0.7.The AUC of GRASPS score was the largest (AUC 0.782,95%CI 0.708-0.885,P<0.01).Both had moderate predictive accuracy.Conclusion The GRASPS score had a better clinical predictive value for all-cause death and poor prognosis within 90 d after mechanical thrombectomy.The THRIVE score had a better clinical predictive value for poor prognosis at 90 d.The 4 models predictive value for intracranial hemorrhage events after mechanical thrombectomy should be further examined.

ObjectiveTo investigate the difference in the outcomes in patients with acute anterior circulation stroke having achieved the Thrombolysis in Cerebral Infarction (TICI) 2b and TICI 3 recanalization after mechanical thrombectomy.MethodsThe patients with acute anterior circulation stroke having achieved successful recanalization after mechanical thrombectomy were enrolled retrospectively.They were divided into TICI 2b (almost complete recanalization) group and TICI 3 (complete recanalization) group.The good outcome was defined as the modified Rankin Scale score 0-2 at 3 months after onset.ResultsA total of 83 patients were enrolled in the study, including 38 patients (45.8%) with TICI 2b and 45 (54.2%) with TICI 3;49 (59.0%) had good outcome, and 34 (40.9%) had poor outcome.The good outcome rate in the TICI 3 group was significantly higher than that in the TICI 2b group (68.9% vs.47.4%;χ2=3.946, P=0.047).After adjusting for age, hypertension, diabetes, baseline systolic blood pressure, triglyceride, intravenous thrombolysis, and ASITN/SIR collateral grades, TICI 3 was an independent predictor for good outcome at 3 months after onset (odds ratio [OR] 3.759, 95% confidence interval [CI] 1.098-12.871;P=0.035), while the higher baseline National Institutes of Health Stroke Scale score (OR 0.820, 95% CI 0.715-0.941;P=0.005) and higher fasting glucose (OR 0.610, 95% CI 0.410-0.906;P=0.014) were the independent predictors for poor outcome at 3 months after onset.ConclusionsThere are difference in the outcomes in patients with successful recanalization in anterior circulation stroke treated with mechanical thrombectomy.The outcome is substantially better in TICI 3 than TICI 2b patients.

Objective To systematically evaluate the efficacy and adverse effects of duloxetine in the treatment of domestic depression patients,and compare with those who were treated with SSRIs drugs in the same period to explore the difference between them to guide the clinical medication.Methods A search was conducted in CBMdisc,Wanfang database,CNKI,VIP,Pubmed.The double-blind randomized controlled trials on duloxetine for depression in China were collected.The quality of the included trials was assessed according to the Cochrane Handbook 5.0,and the systematic analysis was conducted by using RevMan 5.3 soft ware.Results Seven double-blind randomized controlled trials (two of duloxetine versus fluoxetine,five of duloxetine versus paroxetine) involving 1 193 patients were included.The results of rmeta-analysis showed that:①After 6-8 weeks of treatment,there were no significant differences in the effective rate (RR =1.02,95％CI=0.78-1.32,Z=0.12,P=0.90),and the final cure rate (RR=0.95,95％CI=0.75-1.19,Z=0.47,P=0.64) between the duloxetine and fluoxetine/paroxetine groups.②Adverse reactions:the incidence rate was not significantly different between duloxetine and fluoxetine/paroxetine groups (RR =1.03,95％ CI =0.86-1.23,Z=0.32,P=0.75).Conclusion After 6-8 weeks of treatment,there are no significant differences in the effective rate and the final cure rate between duloxetine and fluoxetine/paroxetine.There is no significantly difference in common adverse reactions.

Bovine interferon-gamma (BoIFN-gamma) gene was amplified by reverse transcription polymerase chain reaction (RT-PCR) from total RNA of bovine spleen lymphocytes stimulated with ConA. The products of RT-PCR were cloned into pVAX1 vector, positive recombinant clone was identified by restriction enzyme digestion and sequencing. The recombinant plasmid pVAX1-BolFN-gamma was transfected into COS-7 cells mediated by lipofectine, indirect immunofluorescent assay analysis confirmed that rBoIFN-gamma was expressed in COS-7 cells. BoIFN-gamma gene (without signal peptide) was cloned into pET-30a(+) and pGEX-6p-1 vector, and transformed into the Escherichia coli cells. After optimizing the induction condition, SDS-PAGE analysis showed that the expression products were all found in soluble form and had a molecular weight of 23 kDa and 43 kDa respectively. BoLFN-gamma precursor gene (with signal peptide) was cloned into transfer vector pFastBac 1, and transformated into DH10Bac E. coli cells. By site-specific transposition, BoIFN-gamma gene was integrated into shuttle vector Bacmid, and transfected into the Sf9 insect cells mediated by lipofectine to produce recombinant baculovirus. Indirect immunofluorescent assay analysis confirmed that rBac-BoLFN-gamma was expressed successfully in Baculovirus vector system. The antiviral activities of rHis-BoIFN-gamma, rGST-BoIFN-gamma and rBac-BoIFN-gamma were up to 8.389 x10(7) U/mg, 6.554 x10(5) U/mg and 4.096 x 10(4) U/mL respectively, which were analyzed in MDBK/VSV system. A sandwich ELISA was established using monoclonal antibodies 3E6 and 5G4, which can detect BoIFN-gamma in quantity and provide a useful method for the clinical practice and research of BolFN-gamma.
Animals ; Antiviral Agents ; pharmacology ; Baculoviridae ; genetics ; metabolism ; COS Cells ; Cattle ; Cercopithecus aethiops ; Escherichia coli ; genetics ; metabolism ; Genetic Vectors ; genetics ; Interferon-gamma ; biosynthesis ; genetics ; pharmacology ; Recombinant Proteins ; biosynthesis ; genetics ; pharmacology ; Transfection

Objective: To evaluate the effect of dexmedetomidine on postoperative cognitive function in the patients with mild hyperbilirubinemia caused by choledocholithiasis. Methods: One hundred and twenty patients of both sexes with mild hyperbilirubinemia (serum total bilirubin levels 21-170 μmol/L) caused by choledocholithiasis, aged 51-63 yr, with body mass index of 20-28 kg/m², of American Society of Anesthesiologists physical status Ⅱ or Ⅲ, with preoperative Mini-Mental State Examination (MMSE) scores≥20, scheduled for elective cholecystectomy and choledocholithotomy, were divided into 3 groups (n=40 each) using a random number table method: control group (C group) and dexmedetomindine 0.4 μg·kg^-1·h^-1 group (D1 group) and dexmedetomindine 0.6 μg·kg^-1·h^-1 group (D2 group). After induction of anesthesia, dexmedetomidine was intravenously infused for 10 min in a loading dose of 0.5 μg/kg, followed by an infusion of 0.4 and 0.6 μg·kg^-1·h^-1 until the end of operation in D1 and D2 groups, respectively.The equal volume of normal saline was given instead in group C. with preoperative scores≥20, MMSE and Montreal Cognitive Assessment (MoCA) were used to assess the cognitive function at 1 day before operation (T₀) and 1, 3, 5 and 7 days after operation (T_1-4). The occurrence of cognitive dysfunction within 7 days after operation was recorded.Venous blood samples were collected at the time points mentioned above, and the plasma concentrations of β-amyloid (Aβ) 42 were determined by enzyme-linked immunosorbent assay. Results: Compared with group C, MoCA scores were significantly increased at T₁ in group D₁, and MMSE scores at T₁ and MoCA scores at T₁ and T₂ were significantly increased, and the plasma concentrations of Aβ42 were decreased at T_2-4 in group D2, and the incidence of cognitive dysfunction was significantly decreased in D1 and D2 groups (P<0.05). Compared with group D1, MoCA scores were significantly increased at T₁, and the plasma concentrations of Aβ42 were decreased at T_2-4 in group D2 (P<0.05). Conclusion Dexmedetomidine can improve postoperative cognitive function, and intravenous infusion at a rate of 0.6 μg·kg^-1 · h^-1 provides better efficacy for the patients with mild hyperbilirubinemia caused by choledocholithiasis.

OBJECTIVETo investigate the feasibility and safety of totally laparoscopic distal gastrectomy.

METHODSClinical data of 25 patients with distal gastric cancer undergoing totally laparoscopic distal gastrectomy between December 2011 and January 2013 were analyzed retrospectively. Only laparoscopic linear stapler was used in intracorporeal delta-shaped or Roux-en-Y anastomosis for reconstruction.

RESULTSNo patient required conversion to laparoscopy-assisted or open surgery. The mean total operative time and anastomotic time were (256±23.6) min and (35.7±8.4) min respectively in patients with delta-shaped anastomosis, and (287±11.5) min and (46.4±12.1) min in those with Roux-en-Y anastomosis. The mean blood loss was(109.6±42.3) ml, and the mean number of stapler used was 5.6. The mean time to the first flatus was (2.8±1.2) d, and mean time liquid diet to resume was (3.5±0.9) d. Postoperative complication occurred in 3 patients(12.0%).

CONCLUSIONTotally laparoscopic distal gastrectomy with intracorporeal anastomosis using laparoscopic linear stapler is safe and feasible.

Purpose To explore the pathological features of angioimmunoblastic T-cell lymphoma(AITL)with bone marrow involvement and to improve awareness of bone marrow infiltration in AITL.Methods The tissue morphology of 32 cases of AITL with bone marrow involvement was retrospectively analyzed.Im-munohistochemistry using the EnVision method and ten-color flow cytometry were conducted to detect AITL-related immune markers.T cell clonality was analyzed through T cell receptor(TCR)gene rearrangement.Results The predominant pat-terns of tumor cell infiltration were nodular(20/32,62.5％)and interstitial or small clusters(10/32,31.3％).The nodules showed a mixture of cellular components.In some cases,the fo-ci contained a mixture of cells with characteristic"granuloma-toid"changes.The tumor cells were mainly small to medium-sized lymphocytes with inconspicuous atypia.Some cases showed plasma cell proliferation.19 cases were subject to immunohisto-chemical staining,which revealed a low count of CD4-positive T cells,with an average of 8.4％.The positive rates of T follic-ular helper cells(TFH)markers were as follows:CD10(7/14,50.0％),BCL6(6/19,31.6％),PD-1(13/19,68.4％),and CXCL13(13/19,68.4％).In most cases,tumor cells showed co-expression of PD-1 and CXCL13,but the number of positive cells was less than 1％.Flow cytometry analysis was performed in 24 cases,among which 22 cases all consistently expressed cytoplasmic CD3(cCD3),CD5,CD4,and CD2,with varying degrees of CD10 expression.In some cases,there was a lack of expression of surface CD3(sCD3)(12/22,54.5％),while there was a lack of expression of CD7(8/22,36.4％).and no abnormal T cells were found in 2 cases.TCR gene rearrangement analysis was performed in 7 cases,with 3 cases showing TCR clonality.Conclusion AITL with bone marrow involvement exhibits a lower proportion of tumor cells and less atypia,making it prone to misdiagnosis.The presence of lymphocytic foci with mixed cellular components in the bone marrow can indicate bone marrow involvement in AITL.Flow cy-tometry detection of abnormal T cells(double positive for CD4 and CD10)strongly suggests bone marrow infiltration in AITL.A comprehensive diagnosis of bone marrow involvement in AITL re-quires consideration of bone marrow biopsy,flow cytometry,and TCR gene rearrangement analysis.

Objective:To explore the feasibility of CT angiography (CTA) in investigating vascular dilatation of anterior choroidal artery (AChA) and posterior communicating artery (PComA) in patients with Moyamoya syndrome (MMS).Methods:From July 2017 to July 2018, the clinical and imaging data of MMS patients with brain CTA and DSA performed were analyzed retrospectively. According to DSA results, 71 MMS patients were divided into unilateral MMS group (20 cases, 20 hemispheres) and bilateral MMS group (51 cases, 102 hemispheres). There were 20 cases in unilateral MMS group, 10 males and 10 females, with an average age of (45±9) years; 51 cases in bilateral MMS group, 24 males and 27 females, with an average age of (44±12) years. The hemispheres were divided into dilated group and non-dilated group according to the dilatation of AChA or PComA. Kappa analysis was used to evaluate the consistency of two inspection methods to judge the expansion of AChA. The lumen diameters of PComA, P1 and P2 segments of posterior cerebral artery were measured on CTA images, and the ratio of PComA/P1 and PComA/P2 were calculated. The repeatability of CTA measures was evaluated by intra-group correlation coefficient. Independent sample t-test was used to compare CTA measurement results between PComA dilated group and non-dilated group, and ROC curve was drawn to calculate the best threshold for diagnosis of PComA expansion. The sensitivity, specificity, accuracy, positive predictive value and negative predictive value of CTA measures were calculated. Results:The sensitivity, specificity, accuracy, positive predictive value and negative predictive value of CTA diagnosis of AChA expansion inunilateral MMS were all 100.00%. The sensitivity, specificity, accuracy, positive predictive value and negative predictive value of CTA diagnosis of AChA expansionin bilateral MMS were 90.00%, 93.90%, 93.14%, 78.26% and 97.47%. Compared with DSA, there was no significant difference in the diagnostic performance of AChA expansion between single and bilateral MMS diagnosed by CTA ( P>0.05). The two methods had strong consistency (Kappa value was 1.00 and 0.79 respectively, P<0.01). A total of 46 patients (69 cerebral hemispheres) were included in the evaluation of PComA. PComA/P1 (1.09±0.41) and PComA/P2 (0.86±0.13) in the dilated group were significantly higher than those in the non-dilated group (0.71±0.21 for PComA/P1 and 0.75±0.23 for PComA/P2). The differences were statistically significant ( t=-4.59, -2.50, P<0.05). The best threshold in diagnosing PComA expansion was 0.87 (PComA/P1) and 0.76 (PComA/P2), and the sensitivity, specificity, accuracy, positive predictive value and negative predictive value were 84.62%, 83.33%, 84.06%, 86.84%, 80.65% and 79.49%, 60.00%, 71.01%, 72.09% and 69.23%, respectively. Compared with DSA, the Kappa value of CTA measures in diagnosis of PComA expansion was 0.68 (PComA/P1) and 0.40 (PComA/P2), respectively, and the difference was statistically significant ( P<0.05). Conclusions:CTA has a strong consistency with DSA in evaluating the AChA expansion in MMS. When the PComA/P1 ratio on CTA is greater than 0.87, it can be used as the diagnosis criterion for PComA expansion.