Objective To investigate re-innervation in the neovaginal mucosa of patients underwent sigmoid colon vaginoplasty in treatment of Mayer-Rokitansky-Kistner-Hauser Syndrome (MRKHS).Methods Biopsies in the upper third of the posterior neovagina were taken in 20 patients treated by sigmoid colon vaginoplasty at 1, 2 and 3 years after surgery, respectively. Protein gene product 9. 5 ( PGP 9. 5 ),vasoactive intestinal peptide (VIP) and neuropeptide Y (NPY) were detected by immunohistochemical method and compared with those in intact sigmoid colon mucosa. Results ( 1 ) Density of nerve fiber:abundant distribution of PGP 9. 5 nerve fibers were observed in the mucosal muscle layer, submucosa, and smooth muscle layer of the neovagina. The nerve fibers of VIP and NPY immunoreactivity were mainly distributed around blood vessels and in the smooth muscles. In the neovagina, the density of nerve fibers of PGP 9. 5 of 17 ± 6 were much more than VIP of 2. 9 ± 1.0 and NPY of 2. 5 ± 0. 8 significantly ( P ＜ 0. 05 ).( 2 ) Expression of PGP 9. 5 in neovagina: at 1 year after surgery, PGP 9. 5 positive expression of 14 ± 4 was significantly lower in the neovagina than 28 ± 7 in the intact sigmoid colon( P ＜ 0. 05 ). However, after 2 to 3 years, its expression displayed an upgrade tendency in the neovagina and was significantly higher at the 3 year postoperatively than that at the 1 years postoperatively ( 22 ± 7 vs. 14 ± 4, P ＜ 0. 05 ). The changes were much more obvious in submucosa. (3) The expression of VIP and NPY in neovagina: at 1 year after surgery, VIP and NPY positive nerve fibers were also decreased in the neovagina when compared with those in the intact sigmoid colon ( 2. 3 ± 0. 7 vs. 5.3 ± 1.4, P ＜ 0. 05; 2.5 ± 1. 1 vs. 5.5 ± 1.1, P ＜ 0. 05 ) . At 2 to 3 years after surgery, the positive VIP fiber showed initially decreased and subsequently increased tendency. The density of VIP of 3.7 ± 0. 7 in the neovagina at 3 years postoperatively was higher than 2. 3 ±0. 7 at 1 years postoperatively (P ＜ 0. 05 ). No significant up-regulation was observed in NPY-positive expression in the neovagina within 3 years after operation. Conclusions Distribution of sensory PGP 9. 5,VIP and NPY immunoreactive nerve fibers was similar to the pattern observed within the intact sigmoid colon wall. The number of nerve fibers in the neovagina decreased after surgery and then increased subsequently within 3 years after surgery.

[ ABSTRACT] AIM: To study the effect of adenosine A 2A receptor antagonist SCH58261 on hypoxic-ischemic brain damage ( HIBD) in a mature fetal rabbit model .METHODS:Pregnant New Zealand white rabbits at gestational day 29 were selected and were randomly divided into sham-operated group, hypoxic-ischemic group, SCH58261 0.04 mg/kg group, SCH58261 0.12 mg/kg group and DMSO group.The intrauterine rabbit HIBD model was established .All pregnant rabbits were subjected to cesarean section 24 h after the sham operation or experimental procedure to induce hypoxic-ische-mic injury in the fetus .The survival neonatal rabbits were kept in a neonatal incubator at 35℃.The general conditions of the newborn rabbits were recorded .The degree of neurobehavioral damage in the newborn rabbits was estimated by a neu -robehavioral scoring protocol .The concentration of SCH 58261 in the serum of pregnant rabbits , the serum of neonatal rab-bits and the brain tissues of neonatal rabbits was measured by mass spectrometry .The mRNA expression of Bcl-2/Bax and protein levels of p-P38 mitogen-activated protein kinase (MAPK) in the cortex, hippocampus and striatum area in the brain of the neonatal rabbits were determined by real-time PCR and Western blot .RESULTS:SCH58261 was detected in the se-rum and brain tissues of the newborn rabbits .The SCH58261 concentration was approximately 40 μg/L in the brain tissue of the newborn rabbits .The mRNA expression of Bcl-2 in the cortex , hippocampus and striatum of brain tissues in SCH58261 0.04 mg/kg group and SCH58261 0.12 mg/kg group was higher , and the mRNA expression of Bax was lower than those in HI group (P<0.05).The protein level of p-P38 MAPK in the cortex, hippocampus and striatum of brain tis-sues was reduced in SCH58261 0.04 mg/kg group and SCH58261 0.12 mg/kg group compared with HI group (P<0.05). The protein level of p-P38 MAPK in SCH58261 0.12 mg/kg group was a little lower than that in SCH 58261 0.04 mg/kg group (P<0.05).CONCLUSION: Adenosine A2A receptor antagonist SCH58261 attenuates hypoxia-ischemia induced neonatal brain injury by blocking adenosine A 2A receptor, subsequently inhibiting p-P38 MAPK phosphorylation to reduce neuronal apoptosis .

Objective To examine the clinical effect of heat sensitive moxibustion in treating simple obesity with spleen-kidney deficiency type.Methods Ninety simple obesity patients with spleen-kidney deficiency type were randomized into a acupuncture group,a heat sensitive moxibustion group and a combination group,with 30 cases in each group.The heat sensitive moxibustion group was given moxibustion by self-made heat sensitive moxa stick.Heat sensitization acupoints were sought at patients' lumbosacral portion and hypogastrium.Two or three heat sensitization acupoints were selected each time.Patients were treated for 5 times each week,each time for 45min.In the acupuncture group,acupoints of Zhongwan (RN12),Shuifen (RN9),Qihai (RN6),Guanyuan (RN4),Mingmen (DU4),Yaoyangguan (DU3),bilateral Tianshu (ST25),Daheng (SP15),Daimai (GB26),Pishu (BL20),Weishu (21) and Shuidao (ST28) were selected.Seven to ten acupoints were selected each time.Even reinforcingreducing method was used.Needle was retained for 30min.During needle retention,manipulating the needles once every 10min.Patients were treated by 5 times each week.The combination group was given both acupuncture and heat sensitive moxibustion.The methods were the same as above.One month was a course.Each group was treated for 3 courses.Patients' body weight,waistline and height were recorded before and after treatment.Body mass index (BMI),body fat percent and waist to height ratio were calculated before and after treatment.The clinical effect was evaluated.Results After treatment,body weight,BMI,body fat percent and waist to height ratio in each group decreased (P ＜ 0.05).After treatment,body weight,BMI,body fat percent and waist to height ratio in the combination group was lower than those in the acupuncture group and the heat sensitive moxibustion group (P ＜ 0.05);while the difference between the acupuncture group and the heat sensitive moxibustion group was not significant (P ＞0.05).The total effective rate in the acupuncture group was 73.3％,with 76.7％ in the heat sensitive moxibustion group,and 86.7％ in the combination group.The clinical effect in the combination group was superior to that in the acupuncture group and in the heat sensitive moxibustion group.Conclusion Heat sensitive moxibustion therapy might be effective in treating simple obesity with spleen-kidney deficiency type.Moreover,the clinical effect seemed better if combined with acupuncture.

Objective To establish an appropriate preterm hypoxic-ischemic brain injury animal model. Methods A total of 32 pregnant New Zealand white rabbits at gestational day 25 were selected. The uterine blood supply in pregnant rabbits was blocked for 30, 35, 37, 40 minutes respectively, while in the control group it was not blocked. Then the pregnant rabbits were subjected to cesarean section 24 hours (at embryonic day 26, A group) or 5 days (at embryonic day 30, B group) after the experimental procedure. The general conditions of the newborn rabbits were recorded. The degree of neurobehavioral impairment in newborn rabbits was evaluated. The histological changes of brain tissue were observed. Results In A group, all newborn rabbits survived with ischemia for 30 minutes, while the stillbirth rates increased from 31.0% to 100% with ischemia from 35 to 40 minutes. In survived nowborn rabbits, the brain water content and the number of apoptotic brain cells were increased with prolonged ischemia. All these differences were statistically significant (all P<0.05). In B group, the stillbirth rates increased to 50.0% and 65.7% respectively with ischemia for 35 or 37 minutes. The birth weight of survived newborn rabbits were significantly lower than that in the control group. The neurobehavioral test scores were significantly lower in ischemic groups than that in the control group. All these differences were statistically significant (all P<0.05). The pathological examination of brain tissue found that the white matter damage in B group was more obvious than that in A group. Conclusions Continuous blockage of uterine blood supply in pregnant rabbits at gestational day 25 causes stillbirth, neurobehavioral damages and white matter injury as well as fetal rabbit intrauterine growth restriction, which can be used for the preparation of preterm hypoxic-ischemic brain injury animal model.

Objective To evaluate the effectiveness of occlusive wrapping with plastic film in the delivery room to prevent heat loss and reduce the occurrence of hypothermia on admission to the Neonatal Intensive Care Unit (NICU) in very low birth weight infants.Methods A total of 209 very low birth weight infants (birth weight＜1 500 g and gestational age＜33 weeks),born in the Second Hospital of Wenzhou Medical University (Yuying Children's Hospital) and admitted to the NICU immediately after birth from June 1,2009 to December 1,2010,were randomized to the wrap group or non-wrap group.Infants randomized to the wrap group were dried and then wrapped with polyethylene film up to their necks immediately after delivery.They were then covered with warmed blankets and transported to the NICU by the neonatal team.The non-wrap group received routine care in the delivery room following the guidelines of the Neonatal Resuscitation Program.The t test and Chi-square test were used for statistical analysis.Results The mean rectal temperature on admission to the NICU was significantly higher in infants of wrap group compared with those of non-wrap group [(36.1 ± 0.8) ℃ vs (35.5 ± 1.0) ℃,t=4.707,P＜0.01],and the incidence of hypothermia was 41.0％ (43/105) in the wrap group which was lower than that in the non-wrap group (66.3％,69/104) (x2=13.547,P＜0.01).In infants ＜29 weeks of gestation,the mean rectal temperature on admission to the NICU was higher in the wrap group than in the non-wrap group [(36.1 ± 0.8) ℃ vs (35.4 ± 1.1) ℃,t=3.051,P＜0.01].In infants ≥ 29 weeks of gestation,the mean rectal temperature on admission to the NICU was higher in the wrap group than in the non wrap group [(36.0±0.9) ℃ vs (35.5±0.9) ℃,t=3.698,P＜0.01].The arterial blood gas base excess in the wrap group and non-wrap group was-(2.9±2.7) mmol/L and-(5.0±4.2) mmol/L,respectively (t=4.473,P＜0.01).The rate of endotracheal intubation was 20.0％ (21/105) in the wrap group and 27.9％ (29/104) in the non-wrap group,(x2=1.785,P=0.182).The duration of hospitalization was (49.2± 10.7) d in the wrap group and (45.8±9.1) d in the non-wrap group,and the difference was not statistically significant (t=1.152,P=0.251).Conclusions Wrapping very low birth weight infants with plastic film in the delivery room can reduce the occurrence of hypothermia.

BACKGROUND:Retinoic acid signaling pathways is very important in the formation pf nervous system, specialization of neurons and outgrowth of axons. The recent studies show that, retinoic acid plays an important role in the process of axonal regeneration, but few research reports its exact molecular mechanism.
OBJECTIVE:To analyze and summarize the mechanism underlying retinoic acid signaling pathways in the process of axonal regeneration.
METHODS:A computer-based online research was conducted among the VIP, CNKI, PubMed, BioMed Centeral, Springer, The Free Medical Journals, EBSCO and Foreign Journals Integration System between January 2000 and December 2013, with the key words of“retinoic acid, the central nervous system, nerve damage, axon regeneration, and mechanism”in Chinese and English. A total of 43 studies addressing the molecular mechanism of retinoic acid in axonal regeneration were screened. According to the supplementary documents, another five references were added. Repetitive research and atypical reports were excluded.
RESULTS AND CONCLUSION:Fol owing acute central nervous system injury, axonal regeneration and functional recovery are extremely limited. For proper functionality fol owing injury, axons must regrow, reinnervate their targets, and remyelinate their axons. When the central nervous system injuries occur, retinoic acid signaling pathways express transcription factor retinoic acid receptorβ2 to induce axonal regeneration fol owing injury;in dorsal root ganglion neurons, cAMP levels are greatly increased by lentiviral retinoic acid receptorβ2 expression and contribute to neurite outgrowth. More recently, retinoic acid-retinoic acid receptorβ2 pathways directly transcriptional y repress a member of the inhibitory Nogo receptor complex, Lingo-1, under an axonal growth inhibitory environment in vitro as wel as fol owing spinal cord injury in vivo. Through these molecular mechanisms, retinoic acid signaling pathways play its important role in the process of axonal regeneration.

Background and purpose: With the application of laparoscopy in the liver surgery increasingly widely used, the safety and feasibility of laparoscopic liver resection is gaining recognition gradually. This study aimed to explore the laparoscopic liver resection for the tumor and the feasibility of open liver tumor resection and clinical curative effect. Methods: We retrospectively analysed the clinical data from 37 cases of laparoscopic hepatectomy and 74 patients with open liver resection from Mar. 2015 to Mar. 2016. Measurement data by covariance analysis were obtained, and comparison between groups were made using independent sample with Wilcoxon rank test and statistical value of Z. We collected data including operation time, intra-operative blood loss, post-operative recovery time of gastrointestinal tract, surgical drainage tube after extubation time, length of hospital stay, postoperative complications, hospitalization expenses and other clinical data. Laparoscopic group had 20 males and 17 female aged 18 to 76 (median age 55). Open group had 42 males and 32 females aged 26 to 74 (median age 54). The hepatectomy included ultrasonic knife + unipolar electric coagulation, combined with laparoscopic incision suture. Surgery procedures included 13 cases of local excision in laparoscopic group and 24 cases of liver segment or lobe anatomical resection. Open group had 33 cases of local excision and 41 cases of liver segment or lobe anatomical resection. Results: The average duration of laparoscopic hepatectomy was 149 min (40-204 min). The average duration of open hepatectomy was 142 min (45-190 min). The average intra-operative blood loss was 220 mL (30-570 mL) in laparoscopic group and 360 mL (90-970 mL) in open group. The average length of hospital stay was 4.9 d (3-6 d) in laparoscopic group and 6.8 d (5-9 d) in open group. Gastrointestinal average recovery time was 1.1 days in laparoscopic group and 2.3 days in open group. The average hospitalization expenses were 38760 yuan in laparoscopic group and 39145 yuan in open group. Conclusion:Laparoscopic hepatectomy is a safe, effective and minimally invasive surgery, can be safely used in local, liver segment and half liver resection, worthy of promotion.

OBJECTIVETo retrospective analysis the complications after treatment of metacarpal and phalangeal fractures with internal fixation, and propose measures to prevent or reduce surgical complications.

METHODSFrom July 2007 to October 2009, 342 patients with metacarpal and phalangeal fractures were treated with internal fixation,including 203 males and 139 females with an average age of 30.4 years old ranging from 18 to 56 years. There were 217 right hands and 125 left hands, 38 cases of the first metacarpal fracture, 47 cases of the second metacarpal fracture, 52 cases of the third metacarpal fracture, 40 cases of the forth metacarpal fracture, 39 cases of the fifth metacarpal fracture, 43 cases of the proximal phalangeal fractures, 52 cases of the middle phalangeal fractures, and 48 case of the distal phalangeal fractures. The fractures were fixed with K-wires in 129 patients, mini plates in 153 cases, screws in 48 cases, wires in 12 cases.

RESULTSAll 324 patients were followed up for 3 to 15 months (averaged 8.5 months) and complications occurred in 74 patients (22.84%). The main complication was unhealthy wound healing in 24 patients (7.4%), others was adhesion of tendon in 54 patients (16.67%), malunion in 34 patients (10.49%), nonunion in 13 patients (4.01%) and shortening of metacarpal and phalangeal in 21 patients (7.41%).

CONCLUSIONThe important reasons responsible for complications are iatrogenic factors such as unsuitable implant selection, unskillful surgical technique and improper post-operative functional rehabilitation.

Adolescent ; Adult ; Female ; Finger Phalanges ; diagnostic imaging ; injuries ; physiopathology ; surgery ; Follow-Up Studies ; Fracture Fixation, Internal ; adverse effects ; Fractures, Bone ; diagnostic imaging ; physiopathology ; surgery ; Humans ; Male ; Metacarpal Bones ; diagnostic imaging ; injuries ; physiopathology ; surgery ; Middle Aged ; Postoperative Complications ; prevention & control ; Recovery of Function ; Tomography, X-Ray Computed ; Young Adult

OBJECTIVETo evaluate the short-term results of humeral head replacement for the treatment of four-part proximal humeral fractures or fracture-dislocations.

METHODSTwenty-five patients (11 male and 14 female)with four-part proximal humeral fractures or fracture-dislocations underwent humeral head replacement. The average age was 68.2 years (ranging from 56 to 77 years). All cases were followed up and evaluated the clinical results including pain, function and range of motion of shoulder with Neer scoring system.

RESULTSThe follow-up ranged from 12 to 40 months with an average time of 29.3 months. No prosthesis loosening, prosthesis dislocation, postoperative infection, nerve injury or periprosthesis fractures occurred. The results were excellent in 8 cases, good in 11 cases and fair in 6 cases. The excellent and good rate was 76% according to Neer scoring system.

CONCLUSIONReplacement of humeral head prosthesis could attain good short-term results for four-part proximal humeral fractures or fracture-dislocations. The key to improve the postoperative results is meticulous surgical techniques and appropriate correct consecutive physical therapy.

Aged ; Arthroplasty, Replacement ; methods ; Female ; Humans ; Joint Prosthesis ; Male ; Middle Aged ; Shoulder Dislocation ; surgery ; Shoulder Fractures ; surgery ; Treatment Outcome

Objective:To explore the application value of bacterial culture and antibody detection of pertussis in children.Methods:A total of 262 children diagnosed with pertussis at the Second Affiliated Hospital and Yuying Children′s Hospital of Wenzhou Medical University from January 2018 to January 2020 were collected as the research objects.Bacterial culture and serum antibody test for pertussis were performed in all cases.According to the gender, age, course of the disease, and whether the children were vaccinated with pertussis vaccine, the patients were divided into different groups and we compared the detection results of different groups.Results:The high incidence age of pertussis was less than 1 year old, mainly less than 6 months old(62.2%). The positive rate of bacterial culture was 82.4%, and the highest positive rate was found in the group of ≤6 months old (94.5%). The positive rate of bacterial culture decreased with the increase of age and course of disease, and the positive rate of children without pertussis vaccination was higher than children with pertussis vaccination( P<0.001). The positive rate of pertussis antibody test was 23.3%.The positive rate of antibody test increased with the increase of age and course of disease and the positive rate of children without pertussis vaccination was lower than children with pertussis vaccination( P<0.001). Conclusion:The high incidence age of pertussis is mainly less than 6 months old.Bacterial culture of pertussis has a good diagnostic value in the early stage of the course, and enzyme linked immunosorbent assay is more helpful in the late stage of the disease.