BACKGROUND:Umbilical cord blood transplantation can ameliorate hepatic and immunologic function,repair hepatic injury,and promote hepatic regeneration,however,the differentiation mechanism and biological characteristics remain poorly understood,and the long-term efficiency need to be explored.OBJECTIVE:To investigate the long-term therapeutic efficacy of infusing umbilical cord blood and blood plasma in treating chronic severe hepatitis B patients.METHODS:Totally 50 chronic severe hepatitis B patients received treatment at the Second Xiangya Hospital,Central South University from January 2003 to January 2004 were randomly divided into the treatment and control groups,with 25 cases in each group.All patient were accepted an ordinary synthetic treatment,and the differences between age,pathogenetic condition,medication had no significance.The umbilical cord blood was obtained from healthy full-term spontaneous delivery parturient,centrifugated,remained karyotes and cord plasma,and used within 24 hours.Patients in the treatment group were received umbilical cord blood infusion,200 mL once,1 2 times per week,totally,each patients infused 4-8 times(mean 5 times);those in the control group were infused with adult fresh blood plasma.The changes of hemogram and hepatic function were measured.RESULTS AND CONCLUSION:All the patients were followed-up for 1 year.The hemogram and hepatic function indexes were similar in the 2 groups before treatment(P ＞ 0.05).The hemogram index had no obviously difference at 1 year after treatment (P ＞ 0.05),but the alanine aminotransferase and total bilirubin levels were decreased in the treatment compared with the control group(P ＜ 0.05),but the albumin was significantly increased(P ＜ 0.05).Compared with before treatment,the platelet level had no significant changes at 1 year after treatment,but the alanine aminotransferase and total bilirubin levels were deeply decreased(P＜ 0.05),albumin was significantly increased(P ＜ 0.05);the platelet and albumin levels were dramatically decreased in the control group(P ＜ 0.05).It suggested that umbilical cord blood infusion can improve the hepatic function and hemogram;therefore,it can be served as supplementary therapeutic measure for severe hepatitis.

Defecography was performed in 110 patients without any anorectal symptoms which included 57 male and 53 female with an average age of 43. 15. Normal defecography was found in 82 cases and abnormal one in 28. The normal features of defecography in 82 patients were as follows;1.There was an increase of anorectal angle during defecation. The increase was 21. 27 degrees measured-with precise axis method and 36. 72 degrees with approximate axis method.2. Reduction or obliteration of the impression of the puborectal muscle.3. There was a shortening of the anal canal by 1. 20 cm and a widening of the caliber of the anal canal to an average of 2. 23 cm.4. The resistance of the pelvic floor was good and the decending of the perineum was smaller than 3 cm during straining. The rectovaginal septum of female subjects was not deformed during straining.5. The barium paste in the distal rectum was largely or totally evacuated with an average e-vacuation rate of 90. 55%.

ObjectiveTo evaluate the mid-term clinical effect of nano-hydroxyapatite and polyamide 66 (n-HA/PA66) intervertebral fusion cage in treatment of thoracolumbar burst fractures.Methods A total of 87 patients with thoracolumbar burst fractures were managed by thoracolumbar body resection combined with n-HA/PA66 intervertebral fusion cage from December 2007 to September 2008.The clinical effect, safety and radiographic outcomes were evaluated.Results No nerve damage was deteriorated in all the patients.The neural function was improved for 1-2 grade except for four patients at Frankel grade A.The patients were followed up for mean 21.3 months (17-24 months).The kyphosis was (14.4 ± 12.6)° preoperatively, (3.7 ± 8.7) ° immediately after surgery and (4.0 ± 8.3)° at final follow-up.The distance between the upper and lower vertebral bodies was (96.9 ± 17.2) mm preoperatively, (109.5 ± 17.1) mm immediately after surgery and (108.3 ± 16.4) mm at final follow-up.No cage replacement, internal fixation breakage or neurologic impairment were observed during follow-up period.There were 58 patients with grade E fusion, 22 with grade D fusion and 7 with grade C fusion.ConclusionsAnterior decompression combined with n-HA/PA66 intervertebral fusion cage is an effective method for treatment of thoracolumbar burst fracture.The kyphosis is rectified and the intervertebral distance is corrected, with a high rate of fusion.

Objective To investigate the clinical application of anti-β2 glyeoprotein Ⅰ antibodies (IgG, IgM, IgA)in systemic lupus erythematosus(SLE). Methods The anti-β2-GP Ⅰ antibodies and anti-cardiolipin antibodies(ACL) level were measured by ELISA in 100 SLE patients, 39 other rheumatoid arthri-tis patients and 30 healthy control people. Their clinical application was analyzed in SLE diagnose and thera-py. Results The level of anti-β2-GP Ⅰ (IgG, IgM, IgA)were significantly higher in SLE than that in healthy (P < 0. 01 ). Sensitivity, specificity, positive predictive value and negative predictive value were 17.2%, 95.7%, 85.0% and 44. 6%, respectively. There was a significant and positive correlation be-tween anti-β2-GP Ⅰ antibodies and ACL antibodies ( IgG, IgM, IgA) (r = 0.418, 0. 624, 0.518, 0. 583, P <0.01). In multivariate analysis the factors(anti-β2-GP Ⅰ antibodies, ACL antibodies, dsDAN, u1-RNP, Sm, SSA, SSB, Jo-1, Scl-70, P-protein, PT, APTT) associated with SLE disease activity index(SLEDAI) were anti-β2-GP Ⅰ (IgG) and dsDNA. Conclusion anti-β2-GP Ⅰ antibody has high specificity and positive predict value, also is associated with SLE's thrombosis. It has some values in the clinical application.

Objective To analyze the safety and effect of non-invasive pressure support ventilation in 32 patients by using a helmet and to give the appropriate way of patients who need non-invasive ventilation ( NIV) support after congenital heart disease surgery. Methods Patients over one year old after congential heart disease surgery were admitted in our Department of Cardiovascular Thoracic Surgery from July 2015 to December 2015. Patients who get clinically improved within one hour were divided into the early improved group( Group-E) ,otherwise they were classified to non-early improved group( Group-NE) . The general infor-mation,diagnosis, indication of NIV, ICU and hospital stay, complications, and mortality were collected. Results Thirty-two patients were engaged in this study,including 18 patients(56. 25%) in Group-E and 14 patients(43. 75%) in Group-NE. Patients who got improved in the first hour might have a higher incidence of avoiding reintubation[83. 33%(15/18) vs. 42. 86%(6/14),P=0. 02]. The heart rate,respiratory rate, pH,PaO2/FiO2 and lactate were improved in Group-E compared with Group-NE after the first hour by using helmet. At the end of NIV,the oxygenation showed no difference but the PaCO2 was lower in Group-E. In Group-E,the values showed a trend of improvement,while the values in Group-NE showed not only no statis-tical significance in different time points but also seemed to have a tendency of hypercapnia and reduced com-fort behavior scale in the end of NIV. There were 6 cases in Group-E and 10 cases in Group-NE developed ventilation associated pneumonia with the incidence of 33. 33%(6/18) and 71. 43%(10/14),respectively, which was significant difference (χ2 =4. 571,P =0. 03). The total duration of mechanical ventilation of Group-E was shorter than that of Group-NE [ ( 136. 72 ± 151. 49 ) h vs. ( 252. 79 ± 155. 33 ) h, P <0. 05 ] . Conclusion NIV through a helmet in children could be well tolerated and avoid re-intubation. Patients who get improved earlier may have more clinical advantages,such as less time of mechanical ventilation and lower incidence of postoperative complications. Early improvement can be considered as a valuable indicator wheth-er the patient needs to use NIV continuously.

Objective To investigate the riskf actors associated with sepsis following surgery of con-genital heart disease in children, for early-recognizing and diagnosing, improving prognosis and decreasing mortality.Methods Retrospective study wa s employed,52 patients of sepsis and 104 patients of non-sepsis with similar age,sex,na d the same diseases were enrolled during Jan 2012 to Apr 2015 in cardiac intensive care unit.Variables such as age,sex,preoperative infection,delayed sternum closure,diaphragmatic paralysis, exploraot ry chest,cardiopulmonaryb ypass time, placed invasive catheter were included in the research fac-tors.The Logistic regression model was set up,OR and 95%CI were calculta ed.Results In sepsis group,the more shock and dysfunction organs,longre hospital stays,longer ICU stays and higher mortality were found compared to the non-sepsis group[25.32%vs.6.73%,3.5 ±1.1 vs.1.1 ±0.7,(35.1 ±11.2)d vs.(11.3 ±3.1)d,(21.3 ±7.1)d vs.(7.1 ±2.3)d,19.23%vs.4.81%,P<0.05].In the Logistic regres ion mod-e l,variables significantly associated with sepsisw ere preoperative infection,deal yed sternal closure,explorato-ry chest,and placed more invais ve duct,diahp ragmatic paralysis(P<0.05).OR value (95%CI) were 10.53 (1.73,64.2),26.66(2.69,263.83),19.47(1.87,203.02),4.99(1.36,18.31),8.32 (0.12,16.46 ), respectively.Conclusion Preoperative infection,delayed sternal closure,exploratory chest,placed more inva-sive duct,diaphragmatic paralysis are the risk factors of sepsis.Children with sepsis had poor clinical outcome compared to those without sepsis.

Objective To investigate the clinical efficacy and indication of surgical treatment of L5S1 tuberculosis us?ing a medial edge of rectus abdominal muscle and retroperitoneal approach. Methods From Jan. 2010 to Nov. 2014, totally 18 cases of L5S1 tuberculosis were surgically cured by debridement, fusion and internal fixation via a medial edge of rectus ab?dominal muscle and retroperitoneal approach. There were 10 males and 8 females, with an average age of 35.6±10.1 years (21 to 55). The mean course of disease was 5.3±2.2 months. The primary destruction lesions were located at L5S1, and one patient of whom L4 was also involved, three cases S2 involved, and one S3 involved. Abscess pre sacrum was noticed in all cases. Six patients were combined with abscess in vertebral canal. Neural deficiency was detected in 3 patients, all grading as Frankel D. Dubousset's lumbosacral angle was 104°-126°, mean 114.6°±6.0°. Formal anti?tuberculosis medicine treatment was given for at least 2-3 weeks. All patients were treated using a medial edge of rectus abdominal muscle and retroperitoneal approach. Af?ter debridement, a tri?cortical iliac bone was used for structural inter?vertebrae fusion. The iliac bone was fixed to the sacrum by one cortical screw. Operation time, volume of blood loss, and surgery complications, including wound infection, looseness and shift of internal fixation, sinus occurrence, vascular injury, retrograde ejaculation in male patients were evaluated. The X?ray and 3D CT of lumbosacral spine, together with ESR and CRP were used to evaluate the control of tuberculosis during fol?low?up. The Dubousset's lumbosacral angle, visual analogue score, and the Frankel grade were compared between preoperative and postoperative. The bone graft fusion were also observed. Results The operation time was 147±16 min in average. The mean blood lose was 275 ± 77 ml. No vascular or neurological injury was noticed. There was also no retrograde ejaculation happened in this group. All patients were followed up from 18 to 28 months. Dubousset's lumbosacral angle was 122.4°±3.8° post?operatively and 121.4°±3.7° at the final follow?up. There was a significant difference between the lumbosacral angles pre and post operation, whereas no statistical difference between the post operation and the final follow?up. Bone fusion was noticed in all cases. All pa? tients have intact neurological function at the final follow?up. No screw breakage or graft bone migration occurred. VAS was 5.6± 1.09 pre?operation and 0.83±0.71 at the 3rd month's follow?up, and there was a significant difference between them. Conclusion Surgical treatment of L5S1 tuberculosis by debridement, fusion and internal fixation via a medial edge of rectus abdominal muscle and retroperitoneal approach is an effective method in terms of minimal trauma, low rate of modality, good ability in restore and maintenance of lumbosacral junction alignment and high fusion rate.

Objective To study the risk factors of prolonged postoperative recovery after the total cavopulmonary connection(TCPC) in the current era.Methods Data on all patients admitted to the cardiac intensive care unit (CICU) after a TCPC between January 2013 and March 2014 were retrospectively analyzed.We excluded all patients who died and required TCPC takedown.The study cohort was further divided into a prolonged recovery group that included patients with 75％ ile for duration of mechanical ventilation or pleural drainage,and a standard recovery group which included all other patients.A multivariable logistic regression model was used to compare demographic,anatomic,and physiological variables between the prolonged and standard recovery groups.Then,the cohort was separated into a high volume resuscitation group and a low volume resuscitation based on the 75％ ile for volume resuscitation(ml/kg) administered on the first three days after the TCPC.Results Totally 118 TCPC operations were performed.Of the study population (n =118),the median age was 3.8 years (3.1 to 4.8 years) and median weight was 14.8 kg(13.3 to 17.1 kg).The most common diagnosis was double outlet of right ventricle (n =47,39.8％).The extracardiac conduit fenestrated TCPC was the most common surgery(n =79,66.9％).Within the study population,43 (39.8％) patients met criteria for prolonged recovery.Univariate risk factors for prolonged recovery included higher preoperative mPAP(P =0.022),atrioventricular valve regurgitation (P =0.000),longer total bypass time (P =0.044),higher postoperative central venous pressure (P =0.000),AST (P =0.001),ALT (P =0.010),NT-proBNP (P =0.000),SaO2 (P =0.012),I n-otropic score (P =0.001),higher incidence of arrhythmia (P =0.000),low cardiac output syndrome (P =0.000),need for peritoneal dialysis (P =0.000),and requirement for greater volume resuscitation during the 72 postoperative hours(75％ for the entire group,P =0.000).In a multivariable Logistic model,need for greater volume resuscitation (OR 10.860,95 ％ CI 2.681,43.987) and the higher postoperative central venous pressure (OR 1.446,95 ％ C I 1.113,1.879) were the only two independent risk factors for prolonged outcome after the TCPC.Conclusion The need for high volume expansion and higher central venous pressure were the risk factors of mediate prolonged recovery.

Objective To explore the feasibility of laparoscopically intracorporeal delta-shaped anastomosis in distal gastrectomy.Methods 82 consecutive patients with distal gastric cancer received laparoscopic distal gastrectomy, including intracorporeal delta-shaped anastomosis in 39 cases, and handassisted Billroth-Ⅰ anastomosis in 43 cases.The operative time, blood loss, anastomosis time were compared between the two groups.Results There were no differences between the two groups with regard to the operative time [(215 ± 24) min vs.(207 ± 13) min, t =0.406, P ＞ 0.05] and blood loss [(56 ±21)ml vs.(65 ± 26)ml, t =1.441, P ＞ 0.05], although the intracorporeal Delta-shaped anastomosis was more time-consuming than the extracorporeal Billroth-Ⅰ anastomosis [(17 ± 8) min vs.(12 ± 3) min, t =2.529, P ＜ 0.05].Conclusions Demanding expertise and some skills, totally laparoscopic distal gastrectomy with intracorporeal delta-shaped anastomosis is safe and feasible.

Objective To analyze the current status of neonatal resuscitation in medical institutions in China.Methods With the number of obstetric beds as the inclusion criteria,the survey was conducted in 163 medical institutions randomly selected in 11 provinces (including 51 tertiary hospitals,88 secondary hospitals and 24 primary hospitals) from October 1 to December 31 in 2011.The mail-questionnaire was sent to collect information about system establishment,personnel training,neonatal resuscitation equipment etc.Statistical data was analyzed by t-test,variance analysis and Chi-square test.Results The incidence of neonatal asphyxia among live birth babies was 2.15％ (3328/154 853) in tertiary hospitals,1.41％ (2829/200 731) in secondary hospitals and 1.50％ (701/46 695) in primary hospitals (x2=298.559,P＜0.01).The mortality rate during delivery was 0.41‰ (63/154 853),0.24‰ (48/200 731) and 0.60‰ (28/46 695) at the three different level hospitals,respectively (x2=16.993,P＜0.01).The mortality rate within 24 hours after delivery was 0.42‰ (65/154 853) in tertiary hospitals,0.24‰ (49/200 731) in secondary hospitals and 0.62‰ (29/46 695) in primary hospitals (x2 18.075,P＜0.01).About 86.5％ (141/163) of the included hospitals maintained routine neonatal resuscitation trainings,but only 73.0％ (119/163) applied resuscitation training equipments during the trainings.The outfit rate of basic neonatal resuscitation equipments (such as neonatal laryngoscope,radiant heater) was high in most hospitals,but the outfit rate of equipments recommended by the new guideline (such as umbilical venous catheter,T piece and oxygen saturation meter) was low.For example,the outfit rate of umbilical venous catheter was 23.5％ (12/51),10.2％ (9/88) and 4.2％ (1/24) in tertiary,secondary and primary hospitals respectively (x2 =6.992,P ＜ 0.05).47.9％ (78/163) of the hospitals had set up neonatal intensive care unit,with the proportion in tertiary,secondary and primary hospitals being 80.4％ (41/51),34.1％ (30/88) and 27.2％ (7/24),respectively (x2=31.677,P＜0.01).Most of the hospitals (80.4％,131/163) could ensure the pediatricians being presented in the delivery room for high risk women,and the proportion was 94.1％ (48/51),79.5％ (70/88) and 54.2％ (13/24) in tertiary,secondary and primary hospitals,respectively (x2 =16.591,P＜0.01).There were 88.3％ (144/163) of the hospitals had routine neonatal resuscitation case audit,with the proportion in the three different level hospitals being 94.1％ (48/51),92.0％ (81/88) and 62.5％ (15/24),respectively (x2 =18.388,P＜0.01).Conclusions Strengthen the training,equipment and system establishment in primary medical institutions is conducive to promote neonatal resuscitation.