Objective To explore the safety and feasibility of laparoscopy in diagnosis and treatment of neonates and infants diseases.Methods Laparoscopic operations were performed in 297 neonates and infants aging from 2 hours to 6 months,from January 2001 to May 2007.The diseases of 297 cases included 80 cases of congenital hypertrophic pyloric stenosis,67 cases of obstructive jaundice,35 cases of indirect inguinal hernia,31 cases of biliary atresia,21 cases of middle or high anal atresia,21 cases of biliary hyperviscosity,7 cases of congenital diaphragmatic hernia,7 cases of jejunal atresia,6 cases of choledochal cyst,5 cases of Hirschsprung's disease,5 cases of duodenal web,3 cases of uronephrosis,2 cases of esophageal hernia,2 cases of esophageal atresia,2 cases of intestinal malrotation,1 case of intestinal obstruction,1 case of intussuception,,and 1 case of congenital muscular troticollis.Results The laparoscopic operations were completed in 294 cases,of which 67 received diagnostic cholangiography,80 received pyloromyctomy,35 received hernia sac high ligation,21 received biliary irrigation,5 received operations for membranous stenosis of duodenum,2 received Ladd operations for malrotation of intestine,1 received reduction of intussusception,1 received enterolysis,and 1 received incision of lower end of sternocleidomastoid muscle;and some complicated procedures including 31 cases of hepatic portal duct-jejunostomy,21 anoplasty,7 repair of diaphragmatic hernia,7 enterectomy and entero-anastomosis of intestinal atresia,6 hepatic duct-jejunostomy,5 radical surgery for Hirschsprung's disease(megadolicho-colon),3 pyeloplasty,2 operations for esophageal atresia,and 2 fundoplication for hiatus hernia.No massive hemorrhage,intra-or post-operative blood infusion,accidental damage or peri-operative death was reported.Three cases of biliary atresia were converted to open surgery due to oozing of blood in hepatic portal.All case were followed for 2 months-6 years,and no long-term or short-term complication was found.Conclusions Laparoscopic technique is safe and reliable in the diagnosis and treatment of diseases in neonates and infants,which is characterized by minimal invasion,quick recovery and satisfactory cosmetic effects.

Objective To compare the X-ray features between Hirschsprung alied disease (HAD)and Hirschsprung disease ( HD), and analyze the differentiations. Methods From December 2004 to December 2009, nineteen cases of HAD, aged from 30 days to 10 years (median, 14 months), received barium enema examinations in our institution. Other 19 cases with HD, also received barium enema examinations, were chosen randomly. They were aged from 42 days to 8 years ( median, 8 months). The imaging features of HAD and HD were analyzed retrospectively. The incidence rate of colon stenosis,"truncation sign" and spasm notch and R/C ratio (the longest diameter of rectum/colon) were calculated and compared between these two groups. In all these cases, diagnosis was confirmed by postoperative histopathology. The position of barium retained was also evaluated. These parameters of both groups were compared by x2 and Fisher test. Results There was statistical significance in the incidence rate of colon stenosis between HAD (9/19) and HD (18/19) (x2 = 10.364, P ＜0.01). However, there was no statistical significance in "truncation sign" and spasm notch between HAD (4/19 and 3/19, respectively)and HD ( 1/19 and 1/19, respectively) (P ＞0. 05 for both). R/C ratio was 0. 42 ±0. 15 in HAD group and 0.29±0. 12 in HD group, and there was statistical significance between them (t =2.892,P＜0.01). In HAD group, barium retained in distal sigmoid colon in 1 case (1/19), in distal descending colon in 7 cases (7/19), in distal transverse colon in 1 case (1/19), in total colon in 6 cases (6/19); However, in HD group, barium retained in distal rectum in 3 cases (3/19), in distal sigmoid colon in 13 cases ( 13/19), in distal descending colon in 3 cases (3/19). Conclusions There were some differences in the imaging features between HAD and HD though they presented similar clinic experience. HAD cases presented a lower incidence rate of colon stenosis and a higher R/C ratio than HD cases. In HAD cases, the most common site of barium retained is distal descending colon, while in HD cases, it is distal sigmoid colon.

Objective To investigate the prenatal diagnosis, perinatal management and standardized treatment protocol for neonates with duodenal obstruction. Methods A network in prenatal diagnosis, perinatal management and monitoring of congenital malformation was founded between Beijing Obstetrics and Gynecology Hospital and the Capital Institute of Pediatrics. Forty-four fetuses were prenatally diagnosed as duodenal obstructions by this network from July,2001 to September, 2010. The data of prenatal diagnosis, treatment after birth and prognosis were analyzed. Results Among 44 patients diagnosed as fetal duodenal obstruction by prenatal ultrasonography, three cases underwent induced abortion, three were in pregnancy, 14 were lost during follow-up and 24 were confirmed by surgical treatments after birth. Within 24 neonates underwent surgery, 21 showed double-bubble sign and 20 combined with polyhydroamnios in prenatal ultrasonography. Twenty-four neonates underwent upright abdominal plain film examination,22 showed double-bubble sign, 1 showed single-bubble sign and 1 showed triple-bubble sign,respectively. Nineteen neonates underwent upper gastroenterography which showed distention of stomach and duodenum, increased stomach peristalsis and an obstacle of duodenum emptying. Within 23 neonates underwent ultrasonographic studies, 10 showed distention and increased peristalsis of duodenum. Following surgical procedures were performed: diamond shape anastomosis was completed in 19 cases with annular pancreas; duodenal vertical resection, across suture and excision of the membrane was done in four cases with duodenum membranate stenosis; end-to-back anastomosis was taken in one case with duodenal separate atresia; Ladd's procedure was applied in 11 cases associated with malrotation. All patients were cured. Conclusions Standardized perinatal management and earlier intervention should be offered to newborns with duodenal obstruction to achieve better effects.

BACKGROUND:Our prior experiments have confirmed that 10 μmol/L oxytocin can induce transformation of bone marrow mesenchymal stem cels into myocardial cels. OBJECTIVE: To investigate the effects of Ginsenoside Rh2 on oxytocin-induced transformation of bone marrow mesenchymal stem cels into myocardial cels. METHODS:Rat bone marrow mesenchymal stem cels were isolated by differential adherence method. These isolated cels were randomly divided into five groups. In the blank control group, cels were routinely cultured. In the oxytocin group, cels were cultured with 10 μmol/L oxytocin for 2 consecutive weeks. In the Ginsenoside Rh2 low-, middle-, and high-dose groups, cels were treated with 0.5, 1, 2 μmol/L Ginsenoside Rh2respectively for 24 hours and then with oxytocin for additional 2 consecutive weeks. RESULTS AND CONCLUSION: Optical microscopy showed that compared to the blank control group, some cels in the oxytocin group exhibited an increased soma and some cels grew in clusters and the cel clusters enlarged with the increase in Ginsenoside Rh2 dose. Immunocytochemical staining and western blot analysis showed that cardiac Troponin T and connexin 43 protein expression in the oxytocin, Ginsenoside Rh2 low-, middle-, and high-dose groups were significantly greater than in the blank control group (P < 0.05), and cardiac Troponin T and connexin 43 protein expression in the Ginsenoside Rh2 groups was increased with the increase in Ginsenoside Rh2 dose and was significantly higher than that in the oxytocin group (P < 0.05). Confocal laser scanning microscopy showed that the relative fluorescence intensity of free calcium in the bone marrow mesenchymal stem cels in the oxytocin group was significantly increased after induction by oxytocin for 2 weeks (P < 0.05), while the relative fluorescence intensity in the Ginsenoside Rh2 groups was significantly higher than that in the Ginsenoside Rh2 groups and was positively correlated with the dose of Ginsenoside Rh2. These findings suggest that Ginsenoside Rh2 can obviously promote oxytocin-induced transformation of bone marrow mesenchymal stem cels into myocardial celsin vitro.

Objective To investigate the effect of creatine phosphate sodium on myocardial protection and calcium-sensitive receptor (CaSR) expression following high-level spinal cord injury.Methods Thirty healthy male SD rats weighing 250-300 g were assigned to sham operation,12-hour injury,24-hour injury,12-hour injury followed by a single intraperitoneal injection of creatine phosphate sodium,and 24-hour injury followed by a single intraperitoneal injection of creatine phosphate sodium according to the random number table,with 6 rats in each group.High-level spinal cord injury was induced at C7 segment by dropping a 10 g weight falling freely along the hollow glass tube from a 5 cm height.Level of blood troponin Ⅰ (cTnⅠ) was measured.Myocardial tissues were collected to study ultrastructure of myocardial cells under transmission electron microscope and CaSR expression using fluorescence quantitative PCR and Western blotting.Results cTnⅠ level was (0.031 ±0.002) U/L and (0.026 ± 0.001) U/L in 12-and 24-hour injury groups,but it was reduced to (0.023 ± 0.002) U/L and (0.018 ± 0.006) U/L at the same time point in treatment groups (P ＜ 0.05).Whereas either in injnry or treatment groups,cTnⅠ level was higher than (0.004 ± 0.002) U/L in sham operation group (P ＜ 0.05).CaSR mRNA level was (0.991 ±0.146) × 10-3 and (1.245 ±0.204) × 10-3 in 12-and 24-hour injury gronp and decreased to (0.880 ± 0.096) × 10-3 and (0.782 ± 0.138) × 10 3 at the same time point in treatment groups (P ＜ 0.05),but all were higher than (0.437 ± 0.065) × 10-3 in sham operation group (P ＜ 0.05).CaSR protein expressed in 12-and 24-hour injury group was (0.627 ±0.066) × 10 3 and (0.809 ±0.154) ×10 3 and lowered to (0.505 ±0.176) × 10-3 and (0.524 ±0.138) × 10-3 at the same time point in treatment groups,but all were higher than (0.331 ± 0.102) × 10-3 in sham operation group (P ＜ 0.05).Transmission electron microscopy demonstrated normal myocardial ultrastructure in sham operation group but impairment in injury groups,but the impairment was significantly improved in treatment groups.Conclusion Creatine phosphate sodium can decrease cTnⅠ level,attenuate the damage to myocardial ultrastructure and down-regulate CaSR after high-level spinal cord injury.

We report the intrauterine treatment of a case of fetal persistent supraventricular tachycardia complicated by heart failure. The ultrasound findings at 32 +1 weeks of gestation showed fetal tachycardia of 242 beats/min, fetal generalized edema, ascites, and visible pulsation spectrum in the intra-abdominal segment of the umbilical vein. Fetal cardiac arrhythmia persisted after maternal oral digoxin for 46 hours. In view of the continuous deterioration of the fetal condition with the persistent umbilical vein pulsation spectrum and worsening edema, fetal intramuscular injection of cedilanid under ultrasound guidance was performed, resulting in successful cardioversion. The pregnant woman gave birth to a baby girl by cesarean section due to premature rupture of membranes and oligohydramnios at 34 +6 weeks of gestation, with normal functions of heart and other organs. During a follow-up to 8 months, no obvious abnormalities were found.

Symptoms and prognosis of infants with congenital diaphragmatic hernia (CDH) are various, as all mild cases might survive while those severe ones have higher mortality. Therefore, an applicable tool that can screen out high-risk CDH children may help clinicians develop an individualized treatment plan and increase the survival rate. A growing number of international studies for CDH postnatal prediction tools, including single factor index and five score models, have been conducted in recent years, whereas few in China. We hereby summarized the advances in postnatal evaluation tools to predict the outcomes of CDH.

Background Hyperuricemia is frequently present in patients with heart failure. Many pathological conditions, such as tissue ischemia, renal function impairment, cardiac function impairment, metabolic syndrome, and inflammatory status, may impact uric acid (UA) metabolism. This study was to assess their potential relations to UA metabolism in heart failure. Methods We retrospectively assessed clinical characteristics, echocardiological, renal, metabolic and inflammatory variables selected on the basis of previous evidence of their involvement in cardiovascular diseases and UA metabolism in a large cohort of randomly selected adults with congestive heart failure (n = 553). By clustering of indices, those variables were explored using factor analysis. Results In factor analysis, serum uric acid (SUA) formed part of a principal cluster of renal functional variables which included serum creatinine (SCr) and blood urea nitrogen (BUN). Univariate correlation coefficients between variables of patients with congestive heart failure showed that the strongest correlations for SUA were with BUN (r = 0.48, P < 0.001) and SCr (r = 0.47, P < 0.001). Conclusions There was an inverse relationship between SUA levels and measures of renal function in patients with congestive heart failure. The strong correlation between SUA and SCr and BUN levels suggests that elevated SUA concentrations reflect an impairment of renal function in heart failure.

BackgroundThe relationship between lipids and coronary artery disease has been well established. However, this is not the case between lipids and heart failure. Ironically, high lipid levels are associated with better outcomes in heart failure, but the mechan-isms underlying the phenomenon are not fully understood. This study was performed to test the hypothesis that reduced intestinal lipid absorption due to venous congestion may lead to low lipid levels.MethodsWe collected data of clinical characteristics, echocardio-graph, and lipid profile in 442 unselected patients with congestive heart failure. Correlations between lipid levels[including total cho-lesterol(TCL), high-density lipoprotein cholesterol(HDL-C), low-density lipoprotein cholesterol(LDL-C), and triglycerides(TG)]and right ventricle end diastolic diameter (RVEDD), left ventricle end diastolic diameter (LVEDD), right atrium diameter (RA), left atrium diameter (LA), or left ventricle ejection fraction (LVEF) were analyzed using Pearson correlation and partial correlation. RVEDD, LVEDD, RA, and LA were indexed to the body surface area.ResultsThere was a significantly inverse correlation between TCL le-vels and RVEDD (r=-0.34,P<0.001) and RA (r=-0.36,P<0.001). Other lipids such as LDL-C, HDL-C, and TG had asimilar inverse correlation with RVEDD and RA. All these correlations remained unchanged after adjusting for age, gender, smoking status, physical activity levels, comorbidities, and medication use.ConclusionsLipid levels were inversely correlated to RVEDD in patients with congestive heart failure; however, because this was an observational study, further investigation is needed to verify our results as wellas identify a causal relationship, if any.

OBJECTIVE To investigate the effect of doxazosin(DOX) and metoprolol( MET) on vascular remodeling in rats with abdominal aorta coarctation (AAC). METHODS An animal model was established by AAC. Two weeks later, the rats were treated with DOX (10 mg.kg-1 per day) or MET (20 mg.kg-1 per day) for six weeks. Blood pressure was measured using carotid artery intubation with a MP150 polygraph. The media thickness, wall cross-sectional area and thickness / internal diameter ratio were calculated by morphometry. Vascular fibrosis was evaluated by Masson′s trichrome staining. The collagen and fibronectin expression in vascules was measured by Western blotting. RESULTS Compared with the sham group 〔(17.6±0.5)kPa〕, the mean arterial blood pressure in the model group〔(23.3±0.7)kPa〕 was significantly increased(P<0.05), but was lowered by DOX 〔(20.5±0.7)kPa〕 and MET 〔(19.0±0.4) kPa〕 (P<0.05). Moreover, HE staining showed that tunica media thickness, artery vessel area and thickness / inner diameter in the model group were increased by 39.5%, 46.4% and 27.0%(P<0.05), respectively. The tunica media thickness was decreased by 16.0% and 26.1%( P<0.05), respectively, the artery vessel area by 22.8% and 26.1%(P<0.05), respectively, and the thick-ness / inner diameter by 17.0% and 26.0%( P<0.05) when the rats were treated with DOX and MET. Masson staining showed that the collagen accumulation in vascules increased, suggesting that AAC induced fibrosis. Meanwhile, vascular fibrosis induced by AAC was also reduced by MET or DOX. Western blotting also proved that the increase of collagen and fibronectin induced by AAC could be attenuated by DOX and MET(P<0.05). CONCLUSION DOX and MET are effective in suppressing the role of norepi-nephrine in vassels, which can attenuate AAC-induced vassels remodeling by preventing the binding between norepinephrine and adrenoceptors.