With the development of tertiary treatment system,the higher quality of inter-hospital transport is the most critical factor for the prognosis of the critically ill pediatric patients,especially for pediatric patients whose condition is deteriorating rapidly.Improving the quality,creating the guideline,and establishing the network platform of inter-hospital will provide complete guarantee for inter-hospital transport of critically ill pediatric patients.With the development of information technology,the purpose of this study was to analyze the function of the network platform of inter-hospital transport in Hunan Children′s Hospital.

Objective To study the efficacy of double inverted Y-shaped airway covered stent for patients with thoracostomach-right main bronchus fistula.Methods Fifteen cases with thoracostomach-right main bronchus fistula were investigated retrospectively.All patients had accepted esophageal resection and thoracostomach esophagus anastomosis,as well as radiation therapy after surgery due to esophageal cancer. All fistulas located close to the opening of right upper lobe bronchus.According to the normal tracheobronchial diameter and length of patients,two inverted Y-shaped airway covered stents were designed individually.Stenting was performed under X-ray,and the situation of fistula and clinical symptoms improvement were investigated.Results The double inverted Y-shaped airway covered stents were implanted and fistulas were closed successfully.All patients could take normal diet,and the supine cough symptoms disappeared, without complications such as airway bleeding and pneumothorax after stenting.Conclusion The stenting of double inverted Y-shaped airway covered stent may be an effective,feasible and safe treatment for thoracostomach-right main bronchus fistula.

The oral colon-specific drug delivery system (OCDDS) has gained more attention from investigators in recent years since it can increase local drug concentration and reduce dosage and side effects.The type of colonspecific drug delivery system consists of enzyme dependent,pH dependent,time dependent,pressure dependent system and CODEDSTM.The development of many new materials and technology is very important for the preparation of new type of precise positioning colon-specific preparation.This article summarizes the advances in excipients and technique for oral colon-specific drug delivery system in recent years.It may provide a reference and a basis for the researchers concerned.

BACKGROUNDTo investigate the efficacy of combined hyperfractionated radiation therapy (HFX RT) plus accelerated HFX RT and concomitant chemotherapy (CHT) in stage IIIA or IIIB non-small-cell lung cancer (NSCLC) compared with HFX RT alone.

METHODSFrom August 1998 to December 2001, 56 patients with NSCLC were randomized into the following groups: HFX RT alone group (group I, n=28), HFX RT with 1.2 Gy twice daily to a total dose of 45.6 Gy, followed by accelerated HFX RT with 1.6 Gy twice daily, the total planned radiation dose was 68.0 Gy in tumour; HFX RT/CHT concomitant group (group II, n=28), same RT with CHT consisting of 20 mg/m² of cisplatin (DDP) on days 1 to 3 and 50 mg/m² of etoposide (VP 16) on days 1 to 3, repeated every two weeks during the RT course.

RESULTSThe overall response rate was 78.6% in group II, including 10 patients with complete response and 12 with partial response; 39.3% in group I, including 11 patients with partial response. Group II had a higher overall response rate compared to Group I (P=0.003). The median survival time was 16 months for group II, 13 months for group I. There was a significant difference in the median survival time between two groups (P= 0.000 3 ). Group II (57.1%) had a lower distant metastasis rate compared with group I (85.7%) (P= 0.018 ). Patients in group II showed a higher incidence of acute and/or late high-grade toxicity (hematologic toxicity, esophagitis, late lung toxicity) compared with group I patients, but no significant difference was observed between the two groups.

CONCLUSIONSThe HFX RT plus accelerated HFX RT and concomitant PDD/VP-16 CHT is tolerable and substantially increases the response rate and prolongs survival in IIIA/IIIB NSCLC patients.

0.05) but a statistically significant negative correlation was noted between serum cholesterol and zinc (r= -0.9986, P

Objective To evaluate percutaneous intratumoral injection of chemotherapeutic agents lipiodol emulsion (CALE) for the treatment of primary liver cancer. Methods This study included 57 patients of hepatocellular carcinoma (n=49) and intrahepatic cholangiocarcinoma (n=8).53 were male and 4 were female,with a mean age of 48.02 years(range,19～70 years).In all,ninety CALE injections were assigned to 90 target areas within the lesions.Before the procedures,transcathetcr arterial chemoembolization (n=55) or infusion (n=2) was carried out in these patients.By arteriography,low blood supply of target areas was showed or it was concluded that superselective catheterization of supply arteries of lesions could not accomplished.Percutaneous intratumoral CALE injection was carried out under fluoroscopy or CT guidance.Therapeutic effect,side effect and complications were assessed based on clinical manifestation,laboratory examination and fluoroscopy or CT one week after procedure.Follow-up was carried out after 1,3,6 months and 1 year,and once every six months thereafter.Local recurrences were treated according to patients'will.Results 90 sessions of percutaneous injection were successfully performed on 57 patients,with 100% technique success rate.The volume of CALE iniected per session ranged 3.0-7.0 ml(mean,6.0 ml) in target size less than 3 cm,12.0-20 ml(mean,15 ml)in target size of 3-5 cm and 24-40 ml in target larger than 5 cm.Serum AFP was positive in 43 patients and decreased to normal in 14 patients(28%).54 lesions(60%)were with well distribution of the lipiodol-chemotherapy mixture on CT 1 month after procedure.Follow-up ranged from 2 months to six years(mean,16 months).The median survival time was 400 d.The cumulative survival rates at 200 d,600d was 85%and 30%,respectively.Complications included fever (n=22,24.4%),nausea and vomit(n=11,12.2%),and pain at the puncture site (n=17,18.9%).Conclusions Percutaneous intratumor CALE injection is safe and effective for the treatment of primary liver cancer.

Objective To evaluate the clinical effect of hybrid operation in treating Stanford type B aortic dissection. Methods During the period from January 2011 to December 2013, hybrid operation was performed in 33 patients with complex Stanford type B aortic arch dissection. The patients included 28 males and 5 females with a average age of (50±12) years. The clinical effect and the complications, occurring in perioperative period and in 24-month follow-up period, were analyzed. Results The operation was successfully accomplished in all 33 patients, with a technical success rate of 100%. The average hospitali-zation time was 20 days. After the operation, 29 cases were followed up for 3-34 months and 4 cases were lost to follow up, the following-up rate was 87.9%. In 21 cases, the following-up time was over 12 months. Postoperative angiography showed that there was no typeⅠendoleak; complications included pulmonary infection (n=1), strokes (n=1), reversible abnormal renal function (n=6) and retrograde aortic arch dissection (n=1). No paraplegia occurred. During hospitalization time, two cases died, the mortality was 6.06%. During the following-up time, graft infection occurred in one case and continued presence of retrograde aortic arch dissection was observed in one case. Conclusion The complication occurrence after hybrid operation for Stanford type B aortic dissections is low. The hybrid technique is very safe and feasible, but several serious postoperative complications should not be ignored. The long-term effectiveness needs to be further clarified by systemic and large sample studies.

Objective·To explore the efficacy and safety of compound amino acid capsules in the treatment of malnutrition and calcium and phosphorus metabolism disorders in maintenance hemodialysis patients.Methods·In this prospective,randomized,controlled,single-center study,forty maintenance hemodialysis patients from Renji Hospital,Shanghai Jiao Tong University School of Medicine were randomly divided into two groups,the treatment group(n=21)and the control group(n=19).The treatment group was given oral compound amino acid capsules on the basis of regular hemodialysis treatment,while the control group received no special nutritional intervention.Serum albumin,prealbumin,hemoglobin,ferritin,calcium,phosphorus,1,25-(OH)2-D3 and intact parathyroid hormone levels were analyzed every 3 months,and the incidence of adverse events including death,cardio-cerebrovascular accidents and vascular access failure was recorded.The total follow-up period was 9 months.Results·Serum albumin and prealbumin in the treatment group at 6-month and 9-month were significantly higher than the baseline parameters(albumin,t=3.574,5.599,both P<0.05;prealbumin,t/Z=-2.485,2.921,both P<0.05).Albumin in the control group increased at 9-month with a lower amplification compared to the treatment group(t=3.877,P=0.001),while the difference of prealbumin showed no statistical significance during follow-up.Hemoglobin and serum ferritin in the treatment group started to increase at 3-month(hemoglobin,t=2.192;ferritin,t=2.994;both P<0.05).Phosphorus in treatment group decreased at 3-month and 9-month(t/Z=-2.743,-2.103,both P<0.05),while phosphorus in the control group remained relatively stable during the first 6 months and increased at 9-month(Z=-2.178,P=0.029).Calcium and 1,25-(OH)2-D3 in the treatment group at 3-month and 6-month were significantly higher than the baseline parameters(calcium,t=4.581,4.922,both P=0.000;1,25-(OH)2-D3 t/Z=4.504,-2.374,both P<0.05),while the increase in blood calcium in the control group was significantly smaller than that in the treatment group during the same period.1,25-(OH)2-D3 in the control group showed no significant improvement.There was no significant difference in intact parathyroid hormone level,incidence of adverse events and other laboratory examination results between the two groups.Conclusion·Compound amino acid capsules can ameliorate the nutrition status and regulate calcium and phosphorus metabolism effectively and safely in maintenance hemodialysis patients.

The construction of a countywide community for medical and health services is designed to upgrade the service capacity of primary medical and health institutions, to promote resource sharing and collaborative services, and promote the hierarchical medical system. Huzhou of Zhejiang province has launched its initiative in building a countywide community for medical services since 2018. The authors summarized its main practices in promoting the integration of the management system and optimizing operating mechanism of countywide medical and health institutions, promoting the reform of the county medical and health governance system, as well as the achievements and shortcomings, with a view to providing reference for promoting the high-quality development of the countywide medical and health service system.

Objective:To explore the isolation and culture methods of mouse parietal epithelial cells (PECs) of Bowman′s capsule, so as to provide a cell tool for further study.Methods:Mouse renal corpuscles were isolated by cell sieving combined with magnetic separation. After primary culture, identified parietal epithelial cells were induced to differentiate into podocytes. Immunofluorescence staining, real-time quantitative PCR and Western blotting were used to detect specific markers of parietal epithelial cells and podocytes.Results:Primary cultured PECs grew like paving stone and expressed Claudin-1 (PECs specific marker), CD133 (stem cell marker) and CD24 (stem cell marker), without the expression of tubular epithelial cell proteins, mesangial cell and podocyte specific proteins. Cultured to 6 generations in vitro, the PECs still expressed Claudin-1, CD133 and CD24. After incubated with differentiation medium, PECs were able to express podocyte markers WT-1 and Synaptopodin. Conclusion:The renal corpuscles are extracted by cell sieving combined with magnetic separation, and the mouse PECs successfully cultured in vitro can be induced to express podocytes′ markers.