Objective: To observe the clinical therapeutic efficacy of treatment of prolapse of lumbar intervertebral disc with lumber vertebral traction plus Ding's Rolling Technique.Methods: 133 cases of prolapse of lumbar intervertebral disc were randomly divided into two groups. There were 68 cases in the treatment group, which were treated with lumber vertebral traction plus Tuina. There were 65 cases in the control group, which were treated with simple lumber vertebral traction. Results: There were statistic differences in the two groups (x2=6.86,P＜0.01). The therapeutic efficacy in the treatment group was better than the control group.Conclusion: The clinical therapeutic efficacy treated with lumber vertebral traction plus Ding's Rolling Technique was better than simple lumber vertebral traction in treating prolapse of lumbar intervertebral disc.

Objective To investigate the protective effects and mechanisms of NF-KB inhibitor pyrrolidine dithiocarbamate (PDTC) on infant rabbits with lung injury caused by mechanical ventilation. Methods Twenty healthy infant rabbits were randomly divided into four groups. (1) Mechanical ventilation (MV, with VT = 24 ml/kg);(2) Mechanical ventilation plus PDTC pre-treatment (MVP, VT = 24 ml/kg with PDTC 100 mg/kg injection via ear vein half an hour prior to MV) ; (3) Mechanical ventilation combined with endotoxin (EMV, 0.1 ml/kg of endotoxin dripping into trachea then on MV, VT = 24 ml/kg) ; (4) EMV plus PDTC pretreatment (EMVP, PDTC 100 mg/kg injection via ear vein followed by 0.1 mg/kg of endotoxin dripping into trachea in half an hour then on MV with VT = 24 ml/kg for 4 h continuously. MPO and the activation of NF-κB in lung tissues and the genetic expression and protein quantity of TNF-α and IL-8 in homogenate were measured. The pathological changes in lung tissues were examined. Results Pre-treatment with PDTC had significant minor pathological changes caused by MV and MV plus endotoxin, which were indicated by the fact that MPO, activation of NF-KB and the genetic expression and protein quantity of TNF-α and IL-8 were significantly suppressed. Conclusions PDTC could decrease the expression, synthesis and release of pro-inflammatory cytokines. This may be through suppressing the activation of NF-κB resulting in less infiltration with inflammatory cells and protective effects on lung injury caused by MV and MV plus endotoxin.

Objective To expore the mechanism of low-dose interfone-γ(IFN-γ) influences on differentiation of oligodendrocyte precursor cell. Methods The cerebral cortex samples were obtained from one day old SD rats to form mixed single cell suspensions. After culturing in full medium for 7 to 10 days, succession and differential velocity adherent technique were performed to acquire oligodendrocyte precursor cell and cultured in serum-free medium. IFN-γ, AG490 and Fludarabine were added during the culture of oligodendrocyte precursor cell and reverse transcription-polymerase chain reaction, Western blot and flow cytometry were performed to evaluate the expression of intracellular P27kip1 and its influence on the differentiation of oligodendrocyte precursor cell. Results (1)The expression of P27kip1 mRNA and protein was lower in IFN-γ group than in control group (t=85. 535, P<0. 05;t= 12. 481, P<0. 05), while the expression of P27kip1 mRNA and protein in IFN-γ+AG490 group and IFN-γ+Fludarabine group were both higher than those in IFN-γ group (P<0. 05). (2) The phosphorylation levels of JAK2/STAT1 in INF-γ group were higher than that in the other three groups (P<0. 05). (3) The percentage of myelin basic protein positive cells was (68. 42 ± 2. 53)% in IFN-γ group, lower than that in control group [(88.21 ± 1.97)%](t=10.682, P < 0.05). Myelin basic protein positive cells in IFN-γ + AG490 group were (57. 63 ±2. 75) %, lower than those in the IFN-γ group. The same figure in IFN-γ+Fludarabine group were (79. 53±4. 15)% , higher than those in IFN-γ group (t = 3.957, P<0.05). Conclusions Low-dose IFN-γ can regulate the expression of intracellular P27kip1 through JAK2/STAT1 signal transduction pathway and Fludarabine may participate in this process and improve the differentiation and maturation of oligodendrocyte precursor cell.

Kasabach-Merritt syndrome(KMS) is a massive haemangioma with thrombocytopenia and consumptive coagulopathy. The histopathology of KMS is thrombocytopenia and disseminated intravascular coagulation associated with massive haemangioma.A standard treatment regimen for KMS has not been established. Therapy includes surgery, embolism and medicine(steroids,α-interferon , immunosuppressant , etc).

Objectives To explore the influence of standardized treatment and technical flow improvement on the diagnosis and treatment of congenital diaphragmatic hernia (CDH) after prenatal diagnosis. Methods The clinical data of neonates diagnosed with CDH who were hospitalized in neonatal intensive care unit from January 2005 to August 2016 was analyzed retrospectively. Based on the start time of standardized treatment implementation, 93 cases of CDH hospitalized from January 2010 to August 2016 were divided into the intervention group while 15 cases of CDH hospitalized from January 2005 to December 2009 were divided into the control group. The survival rate and complications of clinical outcomes between two groups were compared. Results There was no significant difference in sex, gestational age, birth weight, Apgar score, and CDH position between two groups (P >0.05). The total survival rate was 81.7％ in the intervention group and 53.3％ in the control group, and there was statistical difference (P<0.05). The difference of mechanical ventilation mode and pneumothorax rate between two groups also had statistical difference (P >0.05). The median operation time in the control group was 4.5 h and the intervention group was 49.5 h. The postoperative survival rate was 61.5％ in the control group and 90.5％ in the intervention group, and the differences between two groups were significant (P >0.05). The first blood gas analysis of deaths cases in both groups showed that there were significant differences in pH and PCO2 values (P >0.05). Conclusions Optimization of the clinical management during perioperative period can improve the survival rate of CDH and reduce complications. However, the dead cases in the intervention group had more severe pulmonary hypoplasia.

Objective To evaluate the efficacy and safety of oral erythromycin in the prevention and treatment of feeding intolerance in preterm infants. Methods The Cochrane Library,PubMed,EMBASE,CBMdise,VIP,WartFang and CNKl were searched up to the year of 2008.Randomized controlled trials (RCT) of erythmmycin for feeding intolerance in preterm infants were included.According to the dosage (low-dose,3-15 mg/kg and high dose,>15 mg/kg)and gestational age(≤32 weeks vs>32 weeks),all infants were divided into several subgroups.Meta-analysis was performed with the Cochrane Collaboration's software RevMan. Results Nine RCrs involving 542 premature infants were included.(1)In preventive studies,low-dose erythromycin could significantly decrease the duration of total parenteral nutrition compared with the high-dose erythmmycin (WMD=-2.99,95%CI:-3.99--1.98).(2)Intreatment studies,highdose erythromycin could significantly decrease the duration of total parenteral nutrition (WMD=-7.06.95%CI:-7.91--6.20,P<0.01)and hospital stay (WMD=-8.10,95%CI:-14.02--2.18,P=0.007)compared with the placebo when gestational age≤32 weeks. Erythromydn could decrease the incidence of iaundice(RR=0.36,95%CI:0.21-0.63,P=0.0003)which might be the effect of bigh-dose erytromycin. Conclusions Compared with placebo,oral erythromycin of different dosage might help to achieve full enteral feeding,shorten the duration of parenteral nutrition and hospital stay,and reduce the associated cholestasis jaundice of preterm infants with different gestational age respectively.

Objective To investigate the expression of placental growth factor (PlGF) protein and mRNA in lungs of neonatal rats exposed to 85%hyperoxia, and to establish the relationship between PlGF and bronchopulmonary dysplasia (BPD). Methods Forty-eight Sprague–Dawley neonatal rats were randomly exposed to air (control group)(n=24) and 85% hyperoxia (hyperoxia group)(n=24)within 12 h after birth. The rats were sacrificed at 3, 5 and 7 days after exposure (eight at each time) and their lungs were sampled. PlGF protein and mRNA expression in the lungs were determined by Western blot and real-time polymerase chain reaction (PCR) at 3, 5 and 7 days. Left lung tissue was used for morphological and histological observation with hematoxylin and eosin staining. Terminal air spaces and the secondary septa were counted manually under microscope. T-test was applied for statistics. Results Compared with the control group, morphological and histological analysis in the hyperoxia group revealed inflammatory cell infiltration, simplified alveolar structure, less alveolar, alveolar cavity expansion and thickened alveolar septum. Morphometric measurements showed that terminal air spaces and secondary septa were significantly fewer in the hyperoxia rats than those in the control group at 5 and 7 days (terminal air spaces:23.6±8.2 vs 33.1±6.2 and 28.5±9.2 vs 38.4±10.1, t=1.91, 2.53, all P<0.05;secondary septa:56.0±12.2 vs 78.3±8.2 and 75.4±12.2 vs 126.1±10.2, t=2.14, 2.72, all P<0.05). Real-time PCR showed that expression of PlGF mRNA increased significantly on day 3, 5 and 7 in the hyperoxia group compared with the control group (1.16±0.17, 1.34±0.15 and 1.65±0.19 vs 0.65±0.21, 0.47±0.11 and 0.46±0.17, respectively, t=1.93, 2.55, 2.79, all P<0.05). Western blot also showed that expression of PlGF protein on day 3, 5 and 7 in the hyperoxia group increased compared with the control group, but only being significant on day 3 (0.24±0.17 vs 0.09±0.01, t=2.44, P<0.05). Conclusions Hyperoxia (85%) exposure could increase PlGF protein and mRNA expression in the lungs of neonatal rats, likely contributing to pathogenesis of BPD, and might lead to pulmonary vascular developmental disorders in BPD.

Objective To investigate the clinical features and gene mutation of a newborn with neonatal-onset ornithine transcarbamylase deficiency (OTCD) and report the multidisciplinary perinatal management of the mother with late-onset OTCD.Methods The clinical features,biochemical data and the treatment of a newborn boy with OTCD and his mother admitted by Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine in April,2013,were collected.The ornithine transcarbamylase (OTC) gene in the family was analyzed.Results Serum ammonium in the male newborn gradually increased to 1 020 μ mol/L at 48 h after birth.His blood amino acids level and urine organic acid level showed a pattern indicative of OTCD [blood arginine (97.43 μ mol/L,reference 1.00-25.00 μ mol/L),citrulline (27.43 μ mol/L,reference 4.00-30.00 μ mol/L),ornithine (161.66 μ mol/L,reference 10.00-120.00 μ mol/L) and methionine (70.45 μ mol/L,reference 10.00-50.00 μ mol/L); urine uracil (67.11 μ mol/mol Crea,reference 0.00-7.00 μ mol/mol Crea) and orotic acid (1 372.66 μ mol/mol Crea,reference 0.00-1.50 μ mol/mol Crea)].DNA studies revealed a c.583G ＞ A (G195R) homozygous mutation of the OTC gene.His mother was heterozygous for OTCD and developed acute hyperammonemia during pregnancy.Her blood showed a normal-leveled arginine (8.44 μ mol/L,reference 1.50-25.00 μ mol/L),a normal-leveled citrulline(8.41 μ mol/L,reference 7.00-35.00 μ mol/L),an elevated glutamate(279.15 μ mol/L,reference 45.00-200.00 μ mol/L).Her urine uracil (51.55 μ mol/mol Crea,reference 0.00-7.00 μ mol/mol Crea) and orotic acid (38.75 μ mol/mol Crea,reference 0.00-1.50 μ mol/mol) were elevated.Successful management of her prenatal and postpartum blood ammonia level was achieved after administration of pharmacologic nitrogen scavengers and protein limitation.DNA studies revealed a c.583G ＞ A (G195R) heterozygous mutation in the newborn's mother and grandmother.Conclusions General management on pregnant OTCD women is effective.Male newborn patients often have a poor prognosis.

Objective To study the effects of high concentration oxygen exposure on the Sox17 expression of vascular endothelial cells of neonatal mice lungs,and to explore the pathogenesis of blocked lung vascular development.Methods Thirty two C57B1/6J newborn mice within six hours after birth were randomly divided to hyperoxia group (n=16) and room air group (n=16).Mice of hyperoxia group were exposed to 85％ oxygen.Eight mice of either group were sacrificed at 7 and 14 days after birth respectively to observe the lung morphology and calculate radial alveolar counts (RAC),which is the number of alveoli on the straight line from the center of respiratory bronchioles to the nearest fibrous septa or the pleura.Sox 17 expression in the pulmonary vessels was detected by immunohistochemical staining.Sox17 mRNA was measured by reverse transcription polymerase chain reaction.Sox17 protein level was measured by Western blot.Two independent samples t-test was used for statistical analysis.Results Compared with day 7,the lung structures matured with more uniformed alveoli and the septas became thinner on day t4 in room air group.However,the lungs developed slowly with simplified and non-uniformed alveoli on day 14 in hyperoxia group.The Sox17 protein was positive on endothelial cells of pulmonary arteries,veins and alveolar capillarys,as well as the alveolar epithelial cells.The RAC on day 7 and day 14 in hyperoxia group were both lower than that in room air group (3.7±0.7 vs 5.0±0.8,5.3±0.6 vs 8.3±0.9,respectively,t=3.057 and 8.148,both P ＜ 0.01).Sox17 mRNA on day 7 and day 14 in hyperoxia group were both lower than that in room air group (0.62±0.10 vs 0.88±0.11,0.44±0.06vs 0.90±0.15,t=3.607 and 6.926,both P ＜ 0.01).Sox17 protein level on day 7 and day 14 in hyperoxia group were both lowered than that in room air group (0.32±0.04 vs 0.76±0.04,0.36±0.07 vs 0.96±0.06,t=3.102 and 8.421,both P ＜ 0.01).Conclusions Exposure of high concentration of oxygen may cause impairment of lung vascular development by inhibiting Sox17 expression in lungs of neonatal mice.

Summarized in the paper are the experiences of Zhejiang University and its affiliated hospitals in developing medical consortiums based on two emphases of primary ends. The authors found that a sustainable ecosystem of medical services can be built upon quality resources of the university and its hospitals if the missions, components and roadmap are clarified.