A retrospective analysis was made of 56 children with a definite diagnosis of pulmonary edema,in whom x-ray films were taken before and after treatment.Four patients had been in Tibet for five months to 6 years.In 50 patients,pulmonary edema occurred 6~72 hours after they flied into Tibet.Two of them died during treatment because of delayed treatment and critical conditions.All 56 patients were of Han nationality,aged 5 months to 12 years.Childhood acute pulmonary edema accountes for 69% of all high altitude pulmonary edema cases.Childhood pulmonary edema had an acute onset,and it ran a fulminating course.chest films usually showed disseminating alveolar changes,and the diagnosis may be misleading.X-ray physicians should get familiar with the diagnosis to avoid a delayed diagnosis and treatment.

Objective To observe the impact of multidrug resistance-related protein (MRP) 3 gene silenced by small interfering RNA (siRNA) on the drug resistance of primary liver cancer cells. Methods The drug resistance cell lines HepG2/Adriamycin(ADM) were developed by exposing parental cells to stepwise increasing concentrations of ADM and then MRP3-siRNAs were transfected in HepG2/ADM cells with lipofectamine 2000 liposomes. Three groups were assigned:HepG2 cell group (control group), HepG2/ADM cell group (resistance group) and MRP3-siRNA transfected HepG2/ADM cell group (interference group). The MRP3 mRNA contents of 3 groups were measured by real-time fluorescent quantitative polymerase chain reaction (PCR). The expression of MRP3 protein was detected by Western blot. The 50%inhibitory concentrations (IC50) of ADM, lfuorouracil (5-FU), vincristine, oxaliplatin were determined by methyl thiazolyl tetrazolium (MTT) and the drug resistance indexes (RI) were calculated. The experimental data of 3 groups were compared by one-way analysis of variance, while pairwise comparisons were conducted using LSD-t or t test. Results The mean of MRP3 mRNA content in resistance group (5.16±0.31) was signiifcantly higher than those in control group (3.08±0.27) and interference group (2.85±0.23) (LSD-t=8.765, 10.363;P<0.05). The MRP3 protein content in resistance group (21 063±274) was signiifcantly higher than those in control group (14 476±217) and interference group (6 660±153) (LSD-t=21.836, 79.578;P<0.05). The RI of ADM, 5-FU,vincristine, oxaliplatin in resistance group were 14.40±0.31, 26.68±0.22, 28.70±0.49, 20.23±0.54, and were 3.55±0.16, 9.60±0.27, 2.11±0.17, 3.15±0.13 respectively in interference group. The RI in interference group were signiifcantly lower than those in resistance group (t=53.873, 84.933, 88.811, 53.258; P<0.05). Conclusions MRP3 gene of liver cancer cells silenced by siRNA can improve the cells' sensitivity to chemotherapy drugs and reverse its chemotherapy drug resistance.

ObjectiveTo compare the safety of cavitron ultrasonic surgical aspirator (CUSA) combined with high-frequency electrotome versus harmonic scalpel in hepatectomy.MethodsClinical data of 102 patients undergoing hepatectomy using CUSA combined with high-frequency electrotome or harmonic scalpel in Sun Yat-sen Memorial Hospital of Sun Yat-sen University between January 2011 and January 2014 were retrospectively studied. The patients were divided into the hepatectomy using CUSA combined with high-frequency electrotome group (the CUSA group,n=53) and the hepatectomy using harmonic scalpel group (the harmonic scalpel group,n=49). In the CUSA group, 32 were males and 21 were females with the average age of (48±11) years old. In the harmonic scalpel group, 31 were males and 18 were females withthe average age of (49±13) years old. The informed consents of all patients were obtained and the local ethical committee approval had been received. Porta hepatis was occluded by selective porta hepatis exclusion during hepatectomy. The interval of selective portal hepatis exclusion, intraoperative blood loss and postoperative complications of the two groups were observed. The observation indexes of the two groups were compared usingttest or Chi-square test.ResultsThe interval of selective portal hepatis exclusion of the CUSA group was (13±2) min, which was signiifcantly shorter than (23±3) min of the harmonic scalpel group (t=-19.946, P<0.05). The intraoperative blood loss of the CUSA group was (293±53) ml, which was signiifcantly less than (468±54) ml of harmonic scalpel group (t=-16.510,P<0.05). The incidence of biliary leakage of the CUSA group was 4% (2/53), which was signiifcantly lower than 16% (8/49) of the harmonic scalpel group (χ2=4.537, P<0.05).ConclusionsCompared with harmonic scalpel, CUSA combined high-frequency electrotome in hepatectomy has the advantages of less intraoperative blood loss, shorter interval of selective portal hepatis exclusion and lower incidence of biliary leakage. Thus, the safety of hepatectomy is enhanced signiifcantly.

Objective To investigate the application value of hepatectomy via anterior approach in the surgery of primary liver cancer. Methods Clinical data of 138 patients with primary liver cancer undergoing hepatectomy in Sun Yat-sen Memorial Hospital and Lingnan Branch, the Third Afifliated Hospital of Sun Yat-sen University from June 2011 to June 2014 were retrospectively analyzed. There were 97 males and 41 females, aged 36 to 87 years with a median age of 52 years. The informed consents of all patients were obtained and the local ethical committee approval had been received. The patients were divided into the anterior approach hepatectomy group (anterior group, n=63) and traditional approach hepatectomy group (traditional group, n=75). Preoperative general data, intra-, post-operative parameters of two groups were compared using t test or Chi-square test. Results In the anterior group, the percentage of patients with Child-Pugh liver function grade B and C, multiple tumors and tumor diameter>10 cm was 73%(46/63), 44%(28/63) and 16%(16/63) respectively, which were signiifcantly higher compared with 37%(28/75), 17%(13/75) and 5%(4/75) in the traditional group (χ2=20.444, 12.051, 8.144;P<0.05). In the anterior group, the average intraoperative blood loss, transfusion volume of plasma and red blood cells were (428±17), (470±14) and (300±7) ml, which were signiifcantly lower compared with (517±11), (630±15) and (420±11) ml in the traditional group (t=-6.097,-2.927,-8.928;P<0.05). The rate of postoperative complications in anterior group was 10%(6/63), which was signiifcantly lower compared with 17%(13/75) in the traditional group (χ2=1.759, P<0.05). Conclusion For patients with poor liver function, multiple and large tumors, hepatectomy via anterior approach is a preferential surgical procedure rather than the traditional approach hepatectomy.

Objective To investigate the clinical value of magnetic resonance cholangiopancreatography (MRCP) in the preoperative evaluation of patients with biliary calculus. Methods Clinical data of 70 patients with biliary calculus in Sun Yat-sen Memorial Hospital and the Third Afifliated Hospital of Sun Yat-sen University from June 2012 to June 2013 were retrospectively analyzed. There were 38 males and 32 females with age ranging from 18 to 87 years old and the median age of 52 years old. The informed consents of all patients were obtained and the ethical committee approval was received. The patients underwent ultrasound examination and MRCP before operation. The surgical procedures were cholecystectomy+bile duct exploration and the intraoperative exploration result was the gold standard of diagnosis for biliary calculus and biliary tract variations. The detectable rate of biliary calculus and biliary tract variations by two methods were compared using Chi-square test and Fisher's exact probability test. Results The detectable rate of gallstones was 93%(62/67) by ultrasound and was 79%(53/67) by MRCP, where signiifcant difference was observed (χ2=4.968, P<0.05). The detectable rate of common bile duct stones was 61%(17/28) by ultrasound and was 86%(24/28) by MRCP, where signiifcant difference was observed (χ2=4.462, P<0.05). The detectable rate of the left and right hepatic duct stones was 2/5 by ultrasound and was 4/5 by MRCP, where no signiifcant difference was observed (P>0.05). The detectable rate of intrahepatic bile duct stones was 36%(4/11) by ultrasound and was 73%(8/11) by MRCP, where no signiifcant difference was observed (P>0.05). The detectable rate of biliary tract variations was 2/8 by ultrasound and was 7/8 by MRCP, where signiifcant difference was observed (P<0.05). Conclusions MRCP is superior to ultrasound examination in the detection of common bile duct stones and biliary tract variations. It can be a common practice in the preoperative evaluation of patients with biliary calculus when circumstances allow.

Objective :To explore rehabilitative effect of low—frequency (1Hz ,LF) repetitive transcranial magnetic stimulation (rTMS) combined functional electrical stimulation (FES) on lower limb spasm and motor function in pa—tients with subacute ischemic stroke (SAIS).Methods : A total of 92 SAIS patients with lower limb spasm and motor dysfunction hospitalized in our department were randomly divided into sham stimulation + FES group (sham stimu—lation group ,n＝45) and low—frequency rTMS + FES group (LF—rTMS group ,n＝47) ,both groups were continu—ously treated for three weeks .Lower limb motor function and spasm severity were assessed by Fugl—Meyer motor as—sessment (FMA) and modified Ashworth scale (MAS) respectively before and after treatment ,and motor evoked potential (MEP) was detected .Results : Compared with before treatment ,there was significant rise in FMA score , and significant reductions in MAS score and MEP in two groups after three—week treatment , P＝ 0.001 all ;com—pared with sham stimulation group ,there was significant rise in FMA score [16. 0 (13.0 ,23. 5 ) scores vs. 19. 0 (16.0 ,27.0) scores] ,and significant reductions in MAS score [1. 5 (1. 3 ,1.5) scores vs. 1. 0 (0. 5 ,1. 5) scores] and MEP [ (24.64 ± 0. 39) ms vs. (24.43 ± 0.31) ms] in LF—rTMS group after treatment , P＜0.05 or ＜ 0. 01 . Conclusion : Compared with sham stimulation + FES ,LF—rTMS + FES can more significantly improve lower limb spasm and motor function in patients with subacute ischemic stroke .