Objective To investigate the effective regimen to treat the hepatitis C virus (HCV) recurrence after orthotopic liver transplantation (OLT). Methods The clinical data of 4 cases of HCV recurrence after OLT were retrospectively analyzed. Of the 4 cases, there were 3 cases of HCV related liver cirrhosis and 1 case of HCV related liver cirrhosis in combination with hepatocellular carcinoma. The immunosuppression regimen as FK506, MMF and corticosteroids was used after OLT. As soon as HCV recurrence was confirmed by liver biopsy during 8 to 12 weeks after OLT, pegylated interferonα-2a (PEG-IFNα-2a) and ribavirin (RIB) were used for 48 weeks. PEG-IFNα-2a was started at a dose of 180 μg per week subcutaneously and RIB at a dose of 1000 mg per day orally, respective-ly. Blood routine, liver and kidney function test, HCV-RNA and transplanted liver biopsy were per-formed when necessary and biochemical response, sustained virologic response and histological re-sponse were tested in due time. Remits All of the 4 cases except for 1 achieved sustained virologic re-sponse and the liver function was as normal as before. The histological activity index was improved significantly for both inflammatory activity and fibrosis according to liver biopsy in 0, 48, 72 week srespectively. Case 4 was given corticosteroids for consecutively 3 days when acute rejection was veri-fied by liver biopsy and the condition improved. None of them stopped treatment or withdrew from them directly. Conclusion The combination of PEG-IFNα-2a and RIB was an effective regimen to treat the HCV recurrence after OLT and the side effects could be overcame easily.

Objective Create patient-derived xenograft (PDX) model of bone and soft tissue sarcoma,and analyze the success rate of PDX model,observe the effects of chemotherapy on PDX models and its coincidence,and provide a theoretical basis for screening sensitive second and third line drugs.Methods Collected 31 cases of bone and soft tissue sarcoma from January 2015 to May 2016,which included 12 male and 19 female,with an average age of (28.5±19.9) y.The tumor tissue was obtained the day of operation,and it was cut into 2 mm3 pieces and injected into the flank of BAL B/C nude mice or SCID mice.Tumor was passaged when the diameter reached 1-2 cm and the P0 tissue was froze.If there was no obvious tumor mass grows out for 3 months,the model creation will be stopped.We inoculated the mice with patients sample with or without chemotherapy,observed the effect of chemotherapy on the success rate of PDX modeling and the success rate of modeling of different pathological types,and also observed the relationship between the success rate of PDX modeling and the prognosis of patients.For the drug sensitivity test,3 mice was used in each group,and chemotherapy was given,T/C was used to evaluate the inhibition ratio after drug treatment.Results 31 PDX models were inoculated.The total success rate is 45.2％.Pathology of the PDX models and their success rates:24 osteosarcoma models,success rate is 37％;2 leiomyosarcoma models,success rate is 100％;2 chondrosarcoma models,success rate is 50％;1 Ewing sarcoma model successed;1 fibrosarcoma model and 1 synovial sarcoma model,were not successed.Post chemotherapy model success rate is 33％ (4/12),compared with 53％(10/19) of model success rate that without chemotherapy.And there is relationship between success rate of PDX model creation and patient outcome.The faster the PDX model creation,the worse the outcome.The drug sensitivity of PDX model coincides the clinical situation.Conclusion The success rate of creating PDX model of bone and soft tissue sarcoma is around 30％-40％,and it is related to the pathology and whether got chemotherapy or not,PDX models coincide sarcomas clinical situation,and it is hopefully to use PDX model in selecting personalized drugs.

Objective:To analyze the disaster vulnerability of hospitals in Macao Special Administrative Region to assess the disaster risk objectively, so as to provide reference for Macao hospitals to formulate their emergency plans and improve their emergency response and handling capacity.Methods:From December 2021 to February 2022, 118 medical staff were selected for a questionnaire survey using the method of departmental stratified random sampling from three general hospitals in Macao. At the same time, 7 full-time medical staff and 2 experts in the field of health care were selected for expert consultation. The main content of the questionnaire was the hospital disaster risk assessment based on the Kaiser model, and three-round expert consultation method was used to determine the model indicators. The risk value of each indicator was calculated to analyze the hospital disaster vulnerability.Results:107 valid questionnaires were collected. The top five events in the hospital disaster risk value were typhoon(52.42%), large-scale public health events/epidemic outbreaks(47.55%), strong thunderstorm convective weather(38.68%), extreme temperature(37.31%) and information system failure(33.75%). As ranked by the total risk value, the categories of hospital disasters were natural disasters(35.69%), information security(29.49%), medical technology accidents(29.36%), equipment technology accidents(26.25%), dangerous goods injuries(25.13%) and personnel injuries(19.98%).Conclusions:Macao hospitals are exposed to the highest total risk value in natural disasters, followed by information security. In addition, the risk value of large-scale public health events and epidemic outbreaks of personal injury is also so high as to deserve attention. Macao hospitals should formulate effective emergency response plans according to the risk values of various disasters and the actual situation of each medical department, so as to minimize the losses caused by disasters to both hospitals and patients.

OBJECTIVETo investigate a new bowel management program for children patients with fecal incontinence.

METHODSClinical data of 19 children with fecal incontinence undergoing bowel management program in our center between January 2012 and January 2013 were retrospectively analyzed. The main outcome measure was clinical efficacy of this program.

RESULTSFifteen out of 19 cases were genuine fecal incontinence and required continuous treatment by enema. The other 4 cases were false fecal incontinence. After treatment with this program, stool dirty and constipation were improved in genuine incontinence. Two cases of false continence could control defecation independently by oral administration of antispasmodic drug. Two cases of false continence were cured and did not need medical interference.

CONCLUSIONSBowel management program is an effective treatment for pediatric patients with fecal incontinence. The key of success is maintenance of perianal hygiene for 24 hours by continual adjustment of the elements and volumes of enemas.

Child ; Constipation ; Enema ; Fecal Incontinence ; therapy ; Humans ; Intestines ; physiopathology ; Retrospective Studies

OBJECTIVETo summarize the experience of minimally invasive treatment in 520 patients with intracranial aneurysms on a retrospective study.

METHODSThe measures used in the treatment of 520 patients were reviewed in terms of timing of surgery, induced-hypotensive anesthesia, brain protection combined with temporal occlusion of the feeding artery, external drainage of CSF, dynamic monitoring of intracranial pressure, blood flow velocity, serum osmolality and CT scanning, anti-vasospasm therapy as well as selected interventional endovascular embolization of aneurysms.

RESULTSOf the 520 patients, 485 were treated with either direct clipping or endovascular embolization and 35 patients were treated non-surgically. In 449 patients undergoing direct clipping and 36 undergoing endovascular embolization, intraoperative rupture of aneurysm occurred in 27 (6.0%) and 0%, respectively. Death occurred in 13 (2.6%), hemiplegia in 8 (1.6%), and vegetative state in 2 (0.4%). The operative mortality of direct clipping was 3.8% in 210 patients before 1990 and 1.8% in 275 patients after 1990 (36 patients undergoing endovascular embolization, the operative mortality was 0%).

CONCLUSIONThe outcome of patients with intacranial aneurysms can be markedly improved and the operative mortality can be lowered by minimally invasive treatment.

Adult ; Aneurysm, Ruptured ; mortality ; therapy ; Embolization, Therapeutic ; Female ; Follow-Up Studies ; Humans ; Intracranial Aneurysm ; mortality ; surgery ; Intraoperative Complications ; mortality ; Male ; Microsurgery ; Middle Aged ; Minimally Invasive Surgical Procedures ; Retrospective Studies ; Survival Rate ; Treatment Outcome

To report the short-term clinical outcome of three cases of distal tibial osteosarcoma treated with a novel 3D-printed ankle fusion prosthesis for limb preservation. The patients were admitted to the Department of Bone Tumor, Shanghai General Hospital from January 2020 to June 2021, with one male and two female cases, aged 18, 12, and 14 years, respectively, all diagnosed with distal tibial osteosarcoma (Ennecking stage IIb). A new self-designed ankle fusion prosthesis was used to perform osteosarcoma resection and prosthetic reconstruction of the distal tibia. The operation time, blood loss, postoperative American Orthopedic Foot and Ankle Society Score (AOFAS) and ankle range of motion were recorded. All the 3 patients successfully completed the operation and were followed up for 22 months, 18 months and 12 months, respectively. The operation time was 140 min, 110 min and 200 min, and the blood loss was 200 ml, 200 ml and 350 ml, respectively. At the last follow-up, the AOFAS were 86, 90 and 95 points, and the range of motion of ankle flexion and extension were 30°, 15° and 30°. There was no local recurrence or lung metastasis at the last follow-up. The novel 3D-printed ankle fusion prosthesis in the distal tibia is safe and effective for the reconstruction of bone defects after resection of osteosarcoma in the distal tibia, and the early postoperative function is satisfactory.

Objective To evaluate the diagnostic value of MRI-measured fetal percent predicted lung volume (PPLV) for the prognosis of left congenital diaphragmatic hernia (CDH) in fetus. Methods Clinical data of 32 children who were admitted to Women and Children's Medical Center of Guangzhou from September 2012 to December 2017 for prenatally diagnosed left CDH were retrospectively analyzed. These children were divided into two groups, the survival group (n=24) and the death group (n=8), according to the postoperative outcomes at 30 days after CDH repair. Moreover, they were also divided into non-pulmonary hypertension (non-PH) group (n=20) and PH group (n=12), based on whether they suffered from PH or not. Clinical data such as gestational age, birth weight, Apgar score and PPLV values in different groups were compared with t- or Fisher's exact test. The receiver operating characteristic (ROC) curve of the MRI-measured fetal PPLV values of the 32 children was plotted. Results (1) Comparing with the death group, fetal PPLV was significantly higher [(39.5±2.5)% vs (20.4±2.1)%, t=4.27], the gestations on initial diagnosis of CDH was later [(31.6±4.2) vs (25.4±4.6) gestational weeks, t=3.40], Apgar score of the neonates at 5 min was higher (8.7±1.5 vs 5.7±3.8, t=3.26), and fewer cases of PH were reported in the survival group [16.7% (4/24) and 8/8], all P<0.01. The area under the ROC curve of PPLV values for mortality prediction was 0.930 (95%CI: 0.843-1.016, P<0.01). When the PPLV value was 28.55%, its sensitivity and specificity for death prediction in children with left CDH were 100% and 79%, respectively. (2) Comparing with the PH group, fetal PPLV was significantly higher [(41.7±2.6)% vs (23.0±2.0)%, t=4.98], the gestations on initial diagnosis of CDH was later [(32.3±3.4) vs (26.3±5.2) gestational weeks, t=3.81], neonatal Apgar score at 5 min was higher (8.6±1.4 vs 6.8±2.5, t=2.62) and death rate was lower [0(0/20) vs 8/12] in the non-PH group (all P<0.01). The area under the ROC curve of the PPLV values for predicting PH was 0.902 1 (95%CI : 0.800-1.004, P＜0.01). When the PPLV value was 33.67%, its sensitivity and specificity for PH prediction was 100% and 75%, respectively. Conclusions Prenatal MRI measurement of PPLV can be used to predict death or as a warning sign of PH in children with left CDH, which may provide evidence for prenatal evaluation and rational clinical decision-making.

Objective To summarize the experience of cannulation for extracorporeal membrane oxygenation (ECMO) in infants less than 5 kg. Methods Eleven infants with ECMO support who weighed less than 5 kg were admitted to critical care medicine of Guangzhou Women and Children's Medical Center from June 2016 to June 2018 were enrolled. Retrospective analysis of support type, configuration, site of cannula and complication of ECMO was performed. Results The 11 infants consisted of 9 males and 2 females. The weight on ECMO of 1.96-4.60 kg, with an average of (3.14±0.65) kg; age 0.1-30.0 days, with a median of 5.6 (1.5, 8.3) days. Four cases were given ECMO because of congenital diaphragmatic hernia with severe pulmonary hypertension and other 7 cases were cannulated due to complication of congenital cardiac surgery. All infants were received veno-arterial (V-A) ECMO. In 4 cases, the cannulas were placed in the right internal jugular vein for drainage (8-10 French catheter with 6.0-7.5 cm depth) and the right carotid artery for infusion (6-8 French catheter with 2.5-3.5 cm depth); the average time of cannulation in right carotid and jugular vessels was (73±20) minutes (range 55-100 minutes). In other 7 cases, the cannulas were inserted into the right atrium (12-14 French catheter with 2.8-3.0 cm depth) for draining blood and returning it to the ascending aorta (6-8 French catheter with 1.0-2.0 cm depth); the average time of cannulation in central vessels was (64±31) minutes (range 35-110 minutes) with exclusion of 2 cases intraoperative cannulation. There were three infants with complications. One episode was shown in vascular rupture, one in catheter site hemorrhage and one in cannula malposition with later repositioning. There was no case of insertion site infection, cannula-related bloodstream infection and accident detached cannula. Conclusion Cannulation for ECMO can be performed in infants less than 5 kg with a high rate of success and a low rate of complication owing to appropriate catheter and skillful cannulation.

Objective:Limb salvage treatment for osteosarcoma in the distal tibiais challenging and the incidence of postoperative complications is high. To prove that the use of autologous bone inactivation to replant the ankle joint has a satisfactory clinical effect.Methods:This study retrospectively studied 6 cases (4 males and 2 females) of the osteosarcoma of the distal tibia from June 2018 to April 2019 in our center. The average case age was 16.8 years. All cases were first diagnosed in the center, and classic osteosarcoma was confirmed by biopsy. Before the operation, he received 4 courses of neoadjuvant chemotherapy. The tumor was resected under general anesthesia, and the tumor bone was inactivated and replanted for internal fixation and reconstruction. During the operation, the tumor segment was completely removed, and after a series of treatments, it was immersed in hypertonic saline at 65 °C for 45 min. After removal, the bone defect was filled with bone cement, and internal fixation materials such as plate screws and anchors were placed. Finally, soft tissue was rebuilt after the inactivated bone internal fixation complex (autograft-fixation composite, AFC) was replanted. Patients were treated with plaster for 3 months after surgery. Chemotherapy continued 2 weeks after surgery. Follow-up X-ray of the lower tibia were taken at 3 months, 6 months, and 12 months after the operation to evaluate the MSTS score and ankle function score (AOFAS) to evaluate the ankle function.Results:The patients were followed up for an average of 20 months. At 12 months after operation, no complications such as deep infection, mechanical failure of internal fixation, or local tumor recurrence occurred. The MSTS score averaged 26.7±2.6 points. The AOFAS average was 82.3±8.5 points. The VAS average is 2.7 points. Boneunionwasobserved in 5 cases during follow-up. All cases were satisfied with the treatment results.Conclusion:Limb salvage treatment of distal tibia osteosarcoma is more difficult. This study proves that the use of tumor bone inactivation and internal fixation to reconstruct the ankle joint can not only cure the tumor, but also has satisfactory limb function. It is an ideal strategy for limb salvage reconstruction.

Objective: To explore the relationship between one-child and low height level classification among children and adolescents, and the effects of fruits, vegetables and physical activities on this association, and to provide as cientific reference for probing into and improving the differences of their height level between one child and child with siblings. Methods: Using stratified cluster sampling method, 93 primary and secondary schools in 7 provinces and cities in China were selected for physical examination and questionnaire surveys. A total of 40 978 primary and middle school students aged 7-17 were selected. A multilevel Logistic regression model was used to analyze. Results: Univariate analysis found that being one-child was less likely to be classified as low height level(OR=0.63, 95%CI=0.58-0.67); the multilevel model also found that the probability that one-child being at low height level was still lower(OR=0.78, 95%CI=0.73-0.85), and daily vigorous-intensity physical activities ≥1 h (OR=0.92, 95%CI=0.85-0.99) and daily vegetables and fruits intake ≥5 servings (OR=0.83, 95%CI=0.75-0.92) could also reduce the probability of being at low height level. Hierarchical analysis found that when vegetables and fruits intake and physical activities time were sufficient, there was no longer a significant difference in the height level classification between one-child and child with siblings(P>0.05). Conclusion Being one-child could be a protective factor for the height level classification of children and adolescents. Adequate intake of vegetables and fruits and time of vigorous-intensity physical activities could fill the gap of height level classification between of being one-child and child with siblings. Effective behavioral intervention measures should be taken to protect the healthy growth of height among children and adolescences.