Objective To study the therapeutic efficacy of Rex shunt in treating pediatric patients with prehepatic portal hypertension (PHPH).Methods Five children with PHPH who were admitted from October 2014 to May 2015 were reviewed.There were three boys and two girls,with age ranging from 50 to 95.5 months [(75.8 ± 1.9) months].They all suffered from recurrent upper gastrointestinal (GI) bleeding.Their red blood cell (RBC),white blood cell (WBC) and platelet (PLT) counts were decreased,but laboratory findings revealed no liver dysfunction.Ultrasound and CT scan diagnosed cavernous transformation of portal vein (CTPV) and splenomegaly.The mean splenic length was (42.8 ± 8.2) cm.Indirect portal venography revealed patent left portal vein.All patients underwent Rex shunt and were followed up for 3 ～ 7 months.Results The mean duration of operation was (566.0 ± 39.7) min.Intraoperative bleeding varied from 10 to 50 ml.The portal pressure significantly decreased after surgery from [(25.6 ± 1.5) mmHg,1 mmHg =0.133 kPa] preoperatively to (19.2 ± 3.3) mmHg postoperatively (P ＜ 0.05).Portal venography indicated patent left portal vein after the Rex shunt.The postoperative course was uneventful in the five patients with a mean hospital stay of (26 ± 9.3) days.There was no further GI bleeding.The RBC,WBC and PLT counts increased.Ultrasound indicated patent anastomotic stomas and decreased splenic size.Conclusion A Rex shunt in treating patients with PHPH is safe,feasible and efficacious.

Objective To analyze the impact of extent of mitral valve stenosis on the short and longterm outcome of percutaneous balloon mitral valvuloplasty (PBMV) in patients with mitral valve stenosis.Methods Two hundred and eighty-four patients with mitral valve stenosis were divided into two groups according to the Wilkins scoring system,and 191 cases whose score ≤8 were classified as group A,while the rest were classified as group B.All the patients were using the modified Inoue balloon method.Patients of successful PBMV were followed up at least 48 months and the efficiency was compared between two groups.Results The success rate of PBMV was 97.9％(187/191) and 92.5％(86/93) in group A and group B,there was significant difference between two groups (P ＜ 0.05).Echocardiography parameters improved significantly in both groups at 6 months after PBMV compared with those before PBMV (P＜ 0.05).Compared with those in group A,the changes of left atrial mean pressure [(14.31 ± 4.79) mm Hg (1 mm Hg =0.133 kPa) vs.(15.42 ± 5.14) mm Hg],across the valve pressure difference [(9.18 ± 4.66) mm Hg vs.(10.21 ± 4.38)mm Hg],pulmonary arterial systolic pressure [(26.21 ± 8.76) mm Hg vs.(32.04 ± 9.58) mm Hg],mitral valve orifice area [(1.01 ±0.16) cm2 vs.(1.21 ±0.18) cm2] after PBMV in group B were less (P＜0.05).Long-term follow-up (48-92 months) was completed in 273 successful cases and echocardiography parameters after PBMV improved significantly in both groups compared with those before PBMV during follow-up (P＜ 0.05).Compared with those in group A,the changes of left atrial mean pressure [(12.91 ±5.00) mm Hg vs.(15.1 7 ± 5.14) mm Hg],across the valve pressure difference [(7.26 ± 4.58) mm Hg vs.(9.63 ± 4.22) mm Hg],pulmonary arterial systolic pressure [(20.54 ± 7.68) mm Hg vs.(29.11 ± 8.53)mm Hg],mitral valve orifice area [(0.92 ±0.15) cm2 vs.(1.09 ±0.18) cm2] after PBMV in group B were less (P＜ 0.05).The incidence of mitral restenosis was also significantly higher in group B than that in group A [19.8％(17/86) vs.8.0％(15/187)],and there was significant difference (P ＜ 0.05).Conclusions The extent of mitral valve stenosis plays a key role on the outcome of PBMV in patients with mitral valve stenosis.Patients with lower echocardiography scores benefit more from PBMV than patients with higher echocardiography scores.

Infectious necrosis is one of severe local complications caused by acute pancreatitis,and the mortality rate was reported to be up to 10％ ～ 20％.Traditional open surgical debridement used to be the sole option for this disease.Nevertheless,this approach is associated with poor outcome.Currently,conservative treatment and minimally invasive procedures are more favorable.The treatment for infectious necrosis caused by acute pancreatitis can be summarized as 3D,representing delay,drain,debride.The patients usually receive initial treatment in ICU division,and surgical intervention is then delayed.Percutaneous drainage can be firstly performed in the early course of the disease,followed by necrotic tissue debridement with laparoscopic or video-assisted retroperitoneal procedures.Open surgical debridement is now rarely used,which is merely performed for certain refractory cases.The management of acute pancreatitis infected necrosis therefore is a clinical question that requires a multiple disciplinary team rather than a simply surgical disease.This paper reviewed the relevant issues.

OBJECTIVE:To analyze the characteristics and rules of pediatric adverse drug reaction (ADR) in our hospital, and provide reference for clinical safe drug use. METHODS:Retrospective study was adopted to statistically analyze the ADR re-ports in our hospital from Mar. 2012 to Jun. 2016. RESULTS:In the 176 ADR reports,102 were male(57.95%)and 74 were fe-male (42.05%);children younger than 6 years old had the highest incidence of ADR (81.26%);intravenous administration in-duced 153 cases(86.93%),the top one was antibiotics,which involving 20 antibiotics,totally 106 cases(60.23%);skin and its appendages damage were the main manifestations, totally 127 cases (50.60%). CONCLUSIONS:Pediatric ADR monitoring should be strengthened,dinical rational drug use should be promoted by cooperation in many ways to reduce and prevent the incid-erle of pediatric ADR.

Objective To explore the value of diffusion-weighted imaging (DWI) on evaluation and prediction of therapeutic outcome in concurrent chemoradiotherapy for cervical squamous carcinoma.Methods 26 cases of cervical squamous carcinoma were examined by MRI before and one month after concurrent chemoradiotherapy.The patients were divided according to tumor response evaluated by Response Evaluation Criteria in Solid Tumors (RECIST).Apparent diffusion coefficient (ADC) values and the receiver operating characteristic (ROC) curve analysis were carried out before and one month after treatment.Results 26 cases had higher mean ADC one month after the concurrent chemoradiotherapy than that before treatment[(1.542±0.189) × 10-3 mm2/s vs (0.898±0.096) × 10-3 mm2/s,P ＜ 0.05].After the treatment,there were 17cases of complete remission (CR) and 9 cases of partial remission (PR).ADC value in PR group was higher than that in CR group [(0.960±0.115) × 10-3 mm2/s vs (0.864±0.067) × 10-3 mm2/s,P ＜ 0.05].ROC curve showed that with 0.927 × 10-3 mm2/s of ADC as threshold to determine the tumor remission,the sensitivity and specificity were 66.7 ％ and 76.5 ％,respectively,and the area under the ROC curve was 0.752 (P ＜ 0.05).At one month after treatment,the tumor volume was decreased in different degrees in CR group and PR group,and the differences of ADC had statistical significance between the two groups [(1.603±0.183) × 10-3 mm2/s vs(1.427±0.146) × 10-3 mm2/s,P＜ 0.05].ROC curve showed that with 1.444 × 10-3 mm2/s of ADC as a threshold for diagnosing tumor residual,the sensitivity and specificity were 76.5 ％ and 55.6 ％ respectively,and the area under the ROC curve was 0.765 (P ＜ 0.05).Conclusions DWI as a useful supplement,can help to precisely evaluate the tumor response after the concurrent chemoradiotherapy and monitor the effects of the treatment.Besides,the ADC before chemoradiotherapy has the predictive value on short-term prognosis in cervical squamous cell carcinoma.

In recent years,postoperative mortality rate of pancreatic resection has dropped below 5％,while the complication rate still remains as high as 30％ ～ 50％.Postoperative pancreatic fistula and abdominal abscess are two serious complications after pancreatic resection,with the incidence of 10％ ～28％.Deep understanding of the physiological functions of the pancreas together with the research and development of new medications has improved the prognosis of patients with pancreatic fistula.This article gave a brief overview on the progress in this regard.

Aim To observe the expressions of KLF4 in the myocardium of diabetic mice and their changes under Tongxinluo capsule intervention. Methods For-ty KK/Upj-Ay mice were randomly divided into diabet-ic model group(n=10)and diabetic model with Tongx-inluo(TXL low,middle,high) groups(n =10,respec-tively). C57BL/6 mice were selected as control group ( n=10 ) . At the end of the 3 th month the mice were sacrificed and were weighed. The fasting blood-glucose (FBG),glycosylated hemoglobin(HbA1c),triglyceride ( TG) ,total cholesterol ( TC ) and insulin ( FINS ) were measured to calculate HOMA-IR. Radioimmunoassay was used to measure serum TNF-αand IL-6 . The path-ological changes in the myocardium of mice were ob-served by HE staining. KLF4 mRNA was examined by Real-time PCR, while KLF4 and NF-κB protein were measured by Western blot. Results Compared to the control group,FBG,HbA1c,TG,TC,FINS,HOMA-IR,
TNF-α and IL-6 in model group were markedly in-creased;the expressions of myocardial KLF4 were markedly decreased and the expression of nuclear NF-κB protein were markedly increased ( P < 0. 01 ) . Tongxinluo capsule could significantly reduce myocar-dial pathological damage, FINS, TG, TC, TNF-α, IL-6 level and the expression of nuclear NF-κB protein and up-regulate the expression of KLF4 ( P <0. 05 ) , but had no effect on FBG and HbA1c(P>0. 05). Conclu-sions KLF4 may be involved in the development of myocardial injury during diabetes. Tongxinluo capsule can ameliorate the myocardial damage and improve the function of diabetic myocardium by up-regulating the expression of KLF4 and inhibiting the activation of NF-κB inflammatory signal pathway.

Objective To evaluate the characteristics of the testicular torsion patients with the first symptom of acute abdominal pain.Methods From October 1998 to May 2014, 8 adolescent or boys with testicular torsion presenting acute abdominal pain instead of scrotal pain as their primary symptom were retrospectively reviewed.The average age was 12 (3-16) years.An acute abdominal pain presented firstly in all cases, which accompanied by nausea and vomiting in 4 cases, groin pain in 2 cases, fever in 1 case. In genital examination, the scrotum skin was red and swollen, while the testis was in transverse position and tenderness.The testicular and homolateral abdominal pain got worse when we pulled the involved testis. Doppler ultrasound examination revealed that the blood supply of the involved testis decreased or disappeared.Results In the 8 cases, 5 cases were not examined their testicles or scrotum during the first evaluation, which were found the testicular necrosis during the following exploratory surgery, and orchidectomy was performed. In the other 3 cases, external genital were examined during the first evaluation, and the scrotal and testicular abnormalities were detected.Doppler ultrasonography showed abnormality in testicular blood supply.Testicular torsion was proved during the emergent operation, and the 3 testes were salvaged.The mean duration time from symptom onset to operation was 4 h in the salvaged group, while the average time was 28 h in the orchiectomy group.The mean follow-up time was 18 ( 10-36) months.In the 3 cases whose testis was saved, 1 affected testis was atrophied, and the blood supply of the other two was good.No severe complications occurred in the other 5 cases.Conclusions Testicular torsion should be considered in adolescents and boys with acute lower abdominal pain.The routine external genital examination should be performed when a boy or adolescent complains of abdominal pain.

Objective To explore the clinical efficacy of azithromycin in the different course treatment of children with mycoplasma pneumonia.Methods 1 20 children with mycoplasma pneumonia were divided into two groups according to the treatment plan.Adding different treatment course azithromycin treatment based on conventional treatment,treatment group 1 (42cases)for a single course of 3 days,the treatment group 2 (78cases)single course more than 3d,treatment group 2 including group 2 -A (22cases)and group 2 -B (41 cases)and group 2 -C (1 5cases),the single course of treatment,respectively,5d,7d,8d.Patients'body temperature returned to normal time, and the disappearing time of cough,lung rale and the time in the hospital were observed.Results The fever and lung rale disappearing time of the treatment 2 group were lower than those of treatment 1 group,while there were no signifi-cant differences[(2.99 ±2.84)d vs.(3.24 ±3.03)d,(6.57 ±4.33)d vs.(6.84 ±4.67)d,t =0.449 3,0.31 6 9, all P >0.05 ].The hospitalization time and cough time of treatment 2 group were lower than those of treatment 1 group,the differences were statistically significant[(8.32 ±4.1 6)d vs.(1 0.21 ±5.1 6)d,(9.52 ±3.67)d vs. (1 3.33 ±6.77)d,t =2.1 78 7,4.004 4,all P <0.05].The fever disappearing time of the A,B and C groups had no statistical differences(all P >0.05),while the cough time,lung rale disappearing time and hospitalization time of B group were obviously lower than A and C group,the differences were statistically significant(all P <0.05),there were no statistically significant differences between treatment A group and treatment C group(all P >0.05).Conclusion Azithromycin in the different course treatment of children with mycoplasma pneumonia has no obvious difference for fever disappearing time.However,for the clinical symptoms such as cough and lung rale selecting 7 days as a course of treatment is the best.

PurposeTo analyze fluorodeoxyglucose (FDG) PET/CT images in patients with probable sporadic Creutzfeldt-Jakob disease (sCJD) and the affected encephalic regions by statistical parameter mapping (SPM) so that image information can be provided for early clinical diagnosis.Materials and MethodsSeven patients with probable sCJD diagnosed according to the WHO criteria and 2009 clinical diagnosis criteria and 7 controls at the matched age were enrolled in the study. Both groups underwent FDG PET/CT scan and the images were analyzed visually and by SPM.ResultsThe visual analysis showed that the patients with probable sCJD had a hypometabolism in the wide pallium and basal ganglia region and that a portion of patients mainly had a lateral decrease. The SPM analysis exhibited that patients in sCJD group had a pattern of hypometabolism that affected bilateral parietal, frontal, occipital cortices and head of caudate (P<0.05) and indicated that the patients with lateral hypometabolism existed crossed cerebella diaschisis (P<0.05).ConclusionFDG PET/CT image features of sCJD patients present a hypometabolism in the wide pallium and basal ganglia region, which may be helpful in the diagnosis of sCJD in certain clinical situations.