Objective To evaluate the efficacy and safety of interventional occlsu ion operait no by analyizn g thes urgical data of 23 csa es of infants with patent ductusa rteriosus complicated with middle and severe pulmo an ry arterial hypertension.Methods Teh 23 cases of infants wiht patne t ductus arteriosus com-plicated with middlea nd severe pulmonary arterial hypertensionw ere collected in the hospital from January 2011 to December2014 .These infatn s rce eived transcateh ter occlusion with intravenuo s anesthesia after the preoperative examination.The operation procse s included:right ventriculography and pulmonary atr ery pressure tested,then lateral angiogar phy of descending aorta was performed to observe the type and size of patent ud ctus atr eriosus and measure ascending aorta,descending aortic pressure,and recorded the pressure re-spectively.1 ml blood sample of ascending aorta,pulmonary artery and inef rior vena vein respectively was used for gas analysis.All these data was used to calculate pulmonary vascular resistance.After tried to plug-ging effectiveyl we can release the occluder.In the postoperative 24 h,1 month,3 months,the infants should be measured with Doppler echocardiography,chest X ray and electrocardiogram examination.Results The clinical symptoms disappeared and the short-term follow-up was not associated with the complications of interventional therapy.Th e comparison of the pressure changes before and after the operation were performed as following, aortic per ssure decreased [ preoperation ( 68.3 ±17.5 )/( 21.4 ±3.7 ) mmHg, postoperation (52.4 ±8.7)/(15.6 ±3.5) mmHg,1 mmHg=0.133 kPa],ascending aorta pressure increased(preoperation (83.5 ±5.9)/(51.3 ±3.6) mmHg,postoperation(88.2 ±5.1)/(52.4 ±2.7) mmHg),and descending aorta pressure increased ( preoperation ( 81.4 ±3.3 )/( 48.2 ±2.7 ) mmHg, postoperation ( 86.5 ±4.7 )/(51.5 ±3.2) mmHg), the differences were statistically significant before and after surgery ( t =5.455/3.945 ,P<0.01;t=-2.696/-1.193 , P<0.05; t=-4.167/-3.745 , P<0.01 ) .Conclusion Under conditions of mastering the appropriate operation time and strengthening the management of the perioperative management,transcatheter measurement is safe and effective for infants with patent ductus arteriosus compli-cated with middle and severe pulmonary arterial hypertension.

Animals ; Aortic Valve ; surgery ; Aortic Valve Stenosis ; congenital ; therapy ; Balloon Valvuloplasty ; methods ; Cardiac Surgical Procedures ; adverse effects ; methods ; Catheterization ; adverse effects ; methods ; Female ; Fetal Diseases ; therapy ; Fetal Heart ; surgery ; Heart Defects, Congenital ; therapy ; Humans ; Postoperative Complications ; epidemiology ; Pregnancy ; Pregnancy Trimester, Second ; Ultrasonography, Interventional ; methods

Objective:To compare the therapeutic effects by different longitude margins of the gross tumor volume (GTV) based on elec-tive nodal irradiation (ENI) and to investigate the optimization of clinical tumor volume (CTV) in the radical chemoradiotherapy of esophageal squamous cell carcinoma (ESCC). Methods:ESCC patients treated with chemoradiotherapy for the first time in the First Af-filiated Hospital of Xiamen University from May 2009 to November 2012 were retrospectively studied. All patients were treated with ENI for radical radiotherapy, and the patients were divided into two groups:CTV1 group (with longitudinal external expansion length of less than 3 cm) and CTV2 group (with longitudinal external expansion length of more than 3 cm). The survival time and occurrence of side effects in patients were compared. Results:Among the 142 cases of patients, 82 and 61 cases were classified under CTV1 and CTV2, respectively. No significant difference in the overall survival (OS) and local recurrence-free survival (LRFS) rates was observed af-ter 1, 3, and 5 years of treatment between the two groups. The occurrence of side effects, such as bone marrow suppression, radiation pneumonitis, radiation esophagitis, and esophageal fistula, was less than 5%in both groups, and the data show that the side effect oc-currence in CTV1 was significantly lower. Conclusion:In the radical chemoradiotherapy of esophageal cancer using ENI, the OS rate of patients with a delineated CTV according to a 3 cm GTV longitudinal external expansion length is not lower than that of patients with a delineated CTV according to a GTV longitudinal external expansion length of more than 3 cm. The results provide a reference for the optimization of CTV in the radical chemoradiotherapy of ESCC.

Objective To evaluate the role of AMP-activated protein kinase (AMPK)-dependent autophagic signaling pathway in ketamine-induced reduction of diabetic neuropathic pain (DNP) in rats.Methods Sixty male Wistar rats,aged 3 months,weighing 200-250 g,were equally randomized into 5 groups using a random number table:control group (C group),normal saline group (NS group),ketamine group (K group),ketamine + Compound C group (KC group),and ketamine + 3-methyladenine (3-MA) group (KM group).DNP model was established by intraperitoneal injection of streptozocin (STZ)65 mg/kg in anesthetized rats.Four weeks later,the equal volume of normal saline,ketamine 10 mg/kg,ketamine 10 mg/kg + Compound C1 mg/kg,and ketamine + 3-MA 2 μl were injected intraperitoneally once a day for 7 consecutive days in NS,K,KC and KM groups,respectively.The mechanical paw withdrawal threshold (MWT) was measured on 8th day.The rats were then sacrificed,and the lunbar segment (L1-5) of the spinal cord was removed for determination of the expression of AMPKαt,Beclin-1,microtubule-associated protein 1 light chain (LC) 3B (by Western blot) and dendritic spine density in the dorsal root ganglia.Results Compared with group C,the MWT,expression of AMPKα,Beclin-1,and LC3B,and dendritic spine density were significantly decreased in group NS (P＜0.05).Compared with group NS,the MWT,expression of AMPKαt,Beclin-1,and LC3B,and dendritic spine density were significantly increased in group K (P＜0.05).Compared with group K,the MWT,expression of AMPKα,Beclin-1,and LC3B,and dendritic spine density were significantly decreased in KC and KM groups (P＜0.05).Conclusion Activation of AMPK-dependent autophagic pathway is involved in ketamine-induced reduction of DNP in rats.

Objective To establish a standardized and feasible family health assessment index system based on the family practice system in Shanghai urban communities.Methods On the basis of literature review and special topic discussion, a preliminary index system framework was developed and an expert consultation questionnaire was compiled.Twenty one experts of general practice, medical specialties, health administration and public health management were invited and two rounds of improved Delphi expert consultation were conducted.The results of statistical analysis were summarized and the evaluation index system was established.Results The evaluation index system included 5 first-level indicators, 17 second-level indicators and 63 third-level indicators.The weight coefficients of first-level indicators in basic information, family structure, family function, family resources and health status of the family members were 0.199 6, 0.197 5, 0.201 7, 0.185 0, 0.216 2, respectively.In the two rounds of consultation, the positive coefficient of experts was both 100%, the degree of expert authority was 0.867 and 0.880, and the coordination coefficient was 0.294 and 0.415, respectively (P<0.05).The operational coordination coefficients were 0.320 and 0.402 (P<0.05), respectively.Conclusion The family health assessment index system constructed by the Delphi expert consultation method can provide reference for family doctors to carry out family health assessment in urban communities.

Fetal atrioventricular block (AVB) is a type of fetal bradyarrhythmias. The reported incidence of fetal complete atrioventricular block (CAVB) and mortality of perinatal fetuses and neonates are signiifcantly higher in pregnancies of anti-SSA/Ro-positive mothers than that of anti-SSA/Ro-negative mothers. The auto-antibodies in maternal serum that can be transported into fetal circulation through placenta may damage fetal cardiac conductive system and eventually result in fetal AVB. There are evidences that early diagnosis and proper treatment can improve the prognosis and survival rate of affected fetuses. In this article, the pathogenesis, risk factors, prenatal diagnosis, treatment and prognosis of fetal immune mediated AVB is reviewed.

Objective To perform a mechanical test of fresh cadaver specimens and compare the biomechanical properties of the novel minimal invasion dynamic hip plate (MIDHP) and the dynamic condylar screw (DCS) in treatment of subtrochanteric fractures of the femur.Methods All specimens were firstly used to simulate models of Seinsheimer type ⅡA subtrochanteric fractures of the femur,which were later divided into DCS group and MIDHP group.Based on experimental requirements,the femoral head and distal femur were embedded using seff-freezing type dental base acrylic resin powder.Torsion strength test was given in the first place,succeeded by compression strength test.Finally,destructive test was made to record the limit load.All experimental data were analyzed statistically.Results Torsion strength test showed that specimens of both groups were basically stable as the reverse was within 3°.Torque for specimens in DCS and MIDHP groups was (3.16 ± 0.13) N · m and (3.31 ± 0.27) N · m respectively as the reverse was 1.5°.Both torque and torsion stiffness had no statistical significance between the two groups,and the anti-rotation features of the two internal fixations were similar.Compression strength test showed that compression stiffness of specimens in DCS group was (532.27 ±61.02) N/mm and (581.98 ±77.56) N/mm in MIDHP group at a load of 800 N,with evidently higher compression displacement and stiffness in MIDHP group (P ＜ 0.05).Destructive test showed the maximum load of specimens in DCS and MIDHP groups was (2 994.38 ±244.81) N and (3 322.13 ± 141.21) N respectively,far higher in MIDHP group (P ＜ 0.01).Conclusions MIDHP is characterized by reasonable design,strong anti-rotation property and anti-compression property over DCS.In comparison with DCS,MIDHP has biomechanical advantage in treatment of femoral subtrochanteric fractures,for it can be performed minimally invasive and is worthy of further application.

To analyse the relationship between tumor necrosis factor (TNF)-α and interleukin-6 with hyperuricemia in ethnic Uygur,Kazak,and Han in Xinjiang province.1 200 cases of Uygur,Han,and Kazak populations were randomly enrolled.Serum uric acid,triglyceride,total cholesterol,high density lipoprotein-cholesterol,low density lipoprotein-cholesterol,fasting plasma glucose,body weigh and height,waist circumference,and hip circumference were measured.Waist-to-hip ratio and body mass index were calculated,and TNF-α,interleukin-6 were determined.The differences between uric acid and inflammatory factors were statistically significant; The differences in TNF-α was statistically significant between high uric acid group and control group in Uygur and Han,and the differences in interleukin-6 was statistically significant between high uric acid group and control group in Uygur,Kazak,and Han(P＜0.01).TNF-α and interleukin-6 were positively correlated with serum uric acid in Uygur,but in Kazak only interleukin-6 was negatively correlated with serum uric acid,in Han only interleukin-6 was positively correlated with serum uric acid(P ＜ 0.01).Hyperuricemia was associated with inflammatory factors,TNF-α,interleukin-6,but there were ethnic differences among Uygur,Kazak,and Han,thus it may provide people of new ideas for prevention and treatment of hyperuricemia and other related metabolic disorders.

Objective To investigate radiological characteristics of the posterior tibial plateau fracture and operative treatments for the fracture.Methods Thirty-one cases of posterior tibial plateau fracture treated between February 2009 and February 2014 were enrolled.There were 19 men and 12 women aged 24-72 years (mean,42.5 years).Injury arose from traffic accidents (13 cases),falls from a height (9 cases),fall on the ground (5 cases),and crash (4 cases).Type Ⅴ in 15 cases and type Ⅵ in 15 cases were classified by the Schatzker classification.Meanwhile,all fractures were identified as three-column pattern.According to the X-ray and CT manifestations of fracture displacement,the cases with minor displacement were grouped as Group A (22 cases) and the cases with major displacement group as Group B (9 cases).Depending on the radiographic characteristics of fracture size and angle off fracture line,anterior approach for reduction and fixation was performed in Group A and combined anterolateral and posteromedial approaches in Group B.Radiographic and functional outcomes were evaluated using the Rasmussen score.Results All cases underwent one-stage surgery uneventfully.Operation time was 80-120 minutes (mean,98 minutes) in group A and was 110-165 minutes (mean,110 minutes) in Group B.Mean total operation time was 105 minutes.Period of follow-up was 6-48 months (mean,21.5 months).Rasmussen radiographic results showed total excellent to good rate of 84％ with 86％ in Group A and 78％ in Group B respectively.Rasmussen functional results showed total excellent to good rate of 87％ with 91％ in Group A and 78％ in Group B respectively.Conclusions Anterior approach or anterolateral approach combined with posteromedial approach for reduction and internal fixation is developed according the radiographic findings and degree of fracture displacement.Clinical outcome is good and associated intraarticular soft tissue injury can be managed concurrently.

Objective To study the subject domain knowledge of clinical education of pediatrics in our country with multivariate statistical analysis and social network study,research on the domain subject distribution and knowledge cluster,and then built visualized knowledge-mapping,so as to predict and guide the developmental trend in this field.Methods We searched the CNKI with MESH keywords (pediatrics OR children OR infants) AND clinical education OR bedside education OR interview of clinics in March,2013.679 articles were enrolled in and then imported into Bicomb.After core keywords had been identified by Bicomb,a word text matrix and co-occmrence matrix of words to articles were built.Systemic clustering of the co-occmrence matrix was finished by SPSS 20.0,leading the strategic plot to be built.Then draw visualized network in Ucinet 6.0.Results Totally 679 articles about pediatrics education were included.The number of core keywords was 66,and the lowest frequency of core keywords was 5.With multivariate statistical analysis and social network study,the visualized domain knowledge-mapping was successfully built,and it directly reflected the structure of subject knowledge-mapping of pediatric clinical education in our country,and then key clusters were formed,in which the clusters of participation model of clinical education and applications of clinical education had been well developed,and had been the dominant subject in pediatric clinical education.Whereas the unbalanced developed cluster of Exploration in refommtion of clinical education was now in rapid development with the introduction of new technology and innovative teaching model.At the same time,the nursing clinical education cluster has been separate cluster,but needed further and enhanced research.Conclusion The well developed subjects of participation model of clinical education applications of clinical education stood in the center of the subject do main knowledge-mapping,and with several clusters following.And the study of refomation of clinical education makes a great contribution to the progress of the subject.The nursing teaching needed balanced development.