Objective To share our experiences on integrated services in providing fetal diagnosis and postnatal treatment for congenital diaphragmatic hernia(CDH).Methods A retrospective analysis was conducted on 25 pregnancies diagnosed as CDH by both prenatal ultrasound and MRI in Maternal and Children Hospital of Guangdong Province from January 2012 to January 2014.All of the subjects received integral medical management including prenatal management (prenatal diagnosis and consultation), perinatal management (prenatal care and delivery) and neonatal treatment.Results Among the 25 CDH fetuses, 11 were mild, nine were moderate, and five were severe.One severe case, who was diagnosed at 26 gestational weeks, was aborted on demand of the mother.The other 24 cases continued their pregnancy and all delivered after 35 weeks including 13 cesarean sections (one due to twin pregnancy and 12 due to maternal demand) and 11 vaginal birth.The mean gestational age when CDH was diagnosed was (24.5 ± 3.5) weeks, and the 24 women delivered at an average of (37.5 ± 1.4) gestational weeks.The eleven mild cases accepted mask oxygenation.For those 13 moderate or severe CDH cases, all received dexamethasone to promote fetal lung maturity at 32 gestational weeks, seven were intubated before clamp the cord, and the other six did after.These 13 babies accepted high-frequency oscillation ventilation, with a median duration of 58 hours, and some of them treated with inhaled nitric oxide on requirement with a median duration of 52 hours.Except two cases died before operation, the rest 22 cases underwent neonatal surgery.One moderate case died at 48 hours after surgery due to pulmonary hypertension and respiratory failure.Another one severe case withdrew treatment at two months old.The other 20 infants recovered fully.Conclusions Integrated management including prenatal diagnosis and postnatal treatment, provides an effective and streamlined mode for diagnosis and treatment of CDH.Therefore,it might minimize potential medical risks.

Objective To explore the optimal concentration of heparin sodium solution, which to seal up intravenous indwelling needle, in patients with Ⅳ thrombocytopenia. Methods A total of 90 patients withⅣthrombocytopenia who required intravenous indwelling needle were randomly divided into three groups which namely A, B and C groups with 30 cases each. A group was sealed up the tube of intravenous indwelling needle with 1 ml heparin sodium solution of 6.25 U/ml, B group with 12.50 U/ml and C group with 25.00 U/ml. The change of the platelet count, plasma prothrombin time (PT), activated partial thromboplastin time (APTT), plasma fibrinogen (Fbg) after extubation were observed in three groups and the incidence of blocking up and retention time were compared among three groups. Results The change of the platelet count, PT, APTT, Fbg were showed no statistical significance among three groups (P>0.05). The incidence of blocking up was 66.7%(22/30) in A group , 43.3%(13/30) in B group and 16.7%(5/30) in C group. They were showed statistical significance (χ2=15.000, P < 0.01). Retention time of tube above or equal to 3 days were observed respectively 13 person (43.3%,13/30) in A group, 21 cases(70.0%, 21/30) in B group, 25 patients(83.3%, 25/30) in C group. All above were showed statistical significance (χ2=11.000, P<0.01). Conclusions Heparin sodium 25.00 U/ml sealing up the tube of intravenous indwelling needle is safe in patient with Ⅳthrombocytopenia, which will reduce the ration of blocking tube and extend the life of tube.

To explore the clinical characteristic and intervention strategies for pregnancy complicated with heart failure. The clinical data of 67 pregnant women with heart failure during January 1998 to December 2010 were collected and analyzed.The rate of heart failure in pregnancy with heart diseases was 31％ (67/216).The causes of pregnancy complicated with heart failure were peripartum cardiomyopathy ( n =33,49％ ) and hypertensive disorder complicating with pregnancy heart disease( n =28,42％ ).Heart failure in pregnancy appeared at an average of (36.0 ± 2.7 ) weeks.The average terminating time of pregnant women with heart failure was ( 36.5 ± 2.1 ) weeks.Cesarean section was the main safe choice of delivery for pregnant women with heart failure.The average weight of newborns for pregnant women with heart failure was(2517 ±541 )g.The rate of neonatal asphyxia was 22％ (11/50).Strengthening routine antenatal examination and treating pregnant complications timely can prevent and reduce the incidence of heart failure.

Objective To discuss the diagnosis and early intervention treatment of fetal congenital broncho-genic cysts based on the cases reviewed. Methods The clinical features of 7 infants presenting bronchogenic cysts diagnosed antenatally from January 2013 to May 2014 in Guangdong Women and Children's Hospital and Health In-stitute were reviewed retrospectively. Pathology,the prenatal diagnosis and treatment of bronchogenic cysts experience were summarized combined with CT after birth and surgery. Results Based on the prenatal diagnosis of fetal and postnatal CT and surgical pathology,a total of 7 cases with congenital bronchial cysts were diagnosed. Of which 4 ca-ses were suggestive of congenital cystsic adenomatoid malformation by prenatal diagnosis,and the other 3 cases had fetal bronchial cysts by prenatal diagnosis,antenatal diagnosis was accurate in 42. 9%(3 / 7 cases). CT examinations were taken in 7 cases after birth,and the cyst excision was performed on them with surgery thoracic approach;the average age at surgery was(5. 3 ± 1. 7)months. Four cases had simple bronchial cystss,2 cases with congenital cystsic adenomatoid malformation,1 case with congenital pulmonary sequestration. The accuracy of CT diagnosis was 85. 7%(6 / 7 cases). All surgical treatment was effective. Conclusions Fetal bronchial cysts is always associated with the other presence of lung congenital malformations. Prenatal diagnosis of congenital bronchial cysts is difficult. Prenatal diagnosis is difficult to exclude congenital cystsic adenomatoid malformation. To avoid symptoms like oppres-sion,infection,prenatal diagnosis combined with CT examination after birth and early treatment are necessary and reliable clinically.

Objective To investigate the left ventricular (LV) torsion parameters of type B WolffParkinson-White syndrome (B-WPW) and to explore alternation of the left ventricular motion pattern in patients with B-WPW.Methods Thirty-eight patients with B-WPW were studied.And 40 volunteers were selected as control.Two-dimensional speckle tracking imaging (2D-STI) was used to acquire left ventricular torsion parameters,including peak value and time to peak value of LV twist,LV apex rotation,and LV base rotation.Apical-basal rotation delay (RDA-B) was calculated.Biplane Simpson method was used to measure LV end-diastolic volume (LVEDV),end-systolic volume (LVESV) and ejection fraction (LVEF).All above parameters were measured in patients with B-WPW before (B-WPW-B group) and after (B-WPW-A group) radiofrequency catheter ablation and in control group.The QRS width of lead Ⅱ was recorded,and the relationships between all above parameters with the RDA-B or QRS width were analyzed.Results Compared with the contrd group,in patients with B-WPW,the peak value of LV apex rotation (RotA),LV base rotation (RotB) and LV twist (TwistLV) were lower(LV base was more obvious than LV apex)(P ＜0.05),the time to RotB (TTPB) was shorter (P =0.004),RDAB was longer(P =0.002),the left ventricular enlarged and the QRS prolonged (P =0.000).After radiofrequency catheter ablation,the left ventricular torsion parameters in patients with B-WPW recovered significantly(P ＜0.05),but still lower than those in the control group(P ＜0.05).Conclusions The left ventricular motion pattern of patients with B-WPW alters,including the changes of peak value and time to peak value in LV apex rotation,LV base rotation and LV twist,as well as LV myocardium dyssynchrony.The motion pattern of LV in patients with B-WPW is improved in acute stage after radiofrequency catheter ablation but not yet recover totally.

OBJECTIVETo observe the effectiveness and safety of external applying Compound Tripterygium wilfordii Hook F. (TwHF) in relieving joint pain in rheumatoid arthritis (RA) patients.

METHODSIn this double-blinded, randomized multicenter trial, a total of 174 moderately active RA patients were enrolled and randomly assigned to the treatment group (treated with Compound TwHF, 87 cases) and the placebo control group (87 cases). Compound TwHF or placebo was externally applied in painful joints, 20 g each time, once per day for 8 weeks. Self-reported joint pain relief was taken as a primary effective indicator. Visual analogue scale for pain (VAS), disease activity score of 28 joints (DAS28), VAS for general health (GH) were evaluated before treatment, at week 4 and after treatment. Erythrocyte sedimentation rate (ESR) and hypersensitive C reactive protein (hs-CRP) were tested before and after treatment. Menstrual changes in females were observed during treatment. Skin irritation occurred during the recording process was assessed using skin irritation strength. Intention to treat (ITT) was statistically analyzed.

RESULTSThe joint pain relief rate in the treatment group was 90.8% (79/87 cases), higher than that in the placebo control group (69.0%, 60/87 cases; P = 0.001). VAS pain score, DAS28, VAS for GH score were significantly improved in the two groups at week 4 of treatment and after treatment, as compared with before treatment (P < 0.01). ESR and hs-CRP levels significantly decreased in the treatment group after treatment (P < 0.05, P < 0.01). No difference was found in post-treatment VAS pain score, DAS28, VAS for GH score, ESR, or hs-CRP between the two groups (P > 0.05). Eight adverse events occurred in the treatment group (5 skin allergy, 1 intolerance of medical odor, and 2 mild liver injury), while 3 adverse events occurred in the placebo control group (2 skin allergy, 1 mild liver injury). There was no statistical difference in adverse event between the two groups (P > 0.05). No menstrual change occurred in the treatment group.

CONCLUSIONExternal applying Compound TwHF was an effective and safe way to relieve-joint pain of RA patients, which could be taken as an adjuvant therapy.

Arthralgia ; drug therapy ; Arthritis, Rheumatoid ; drug therapy ; Blood Sedimentation ; C-Reactive Protein ; Drug Therapy, Combination ; Drugs, Chinese Herbal ; pharmacology ; therapeutic use ; Female ; Humans ; Phytotherapy ; Treatment Outcome ; Tripterygium

AIMTo search for more bioactive compounds from the roots of Aconitum coreanum (Lèvl.) Rapaics.

METHODSHigh speed countercurrent chromatography was successfully applied to the separation of alkaloids from Aconitum coreanum. The structures were elucidated by their physicochemical properties and spectroscopic analysis.

RESULTSTwo-phase solvent system composed of CHCl3-CH3OH-0.2 mol x L(-1) HCl (10:3:3, volume ratio) was used in this experiment, eight alkaloids were obtained from the roots of Aconitum coreanum, which were identified as: 2alpha-propionyl-11alpha,13beta-diacetyl-14-hydroxyhetisine (I), Guanfu base P (II), Guanfu base G (III), Guanfu base F (IV), Guanfu base Z (V), Guanfu base O (VI), Guanfu base A (VII), Guanfu base B (VIII).

CONCLUSIONCompound I is a new alkaloid, named Guanfu base R.

Aconitum ; chemistry ; Countercurrent Distribution ; Heterocyclic Compounds, 4 or More Rings ; chemistry ; isolation & purification ; Molecular Conformation ; Molecular Structure ; Plant Roots ; chemistry ; Plants, Medicinal ; chemistry

Objective To investigate the effects of Panax Notoginseng saponins (PNS) on protein expression of Klotho in rats with renal ischemia reperfusion injury; To discuss its protective mechanism for model rats. Methods Experimental rats were randomly divided into sham-operation group, model group, positive medicine group, PNS high-, medium- and low-dosage groups. Each administration group was given relevant medicine for gavage, once a day. Renal ischemia reperfusion injury model was established. Rats were sacrificed by taking blood from abdominal aorta after 4 hours of modeling. Serum levels of blood urea nitrogen (BUN), creatinine (SCr), malondialdehyde (MDA) content in kidney tissue, superoxide dismutase (SOD) activity and glutathione peroxidase (GSH-Px) activity were measured. HE staining was used to observe the morphological changes of renal tissue. The protein expressions of Klotho and NF-κB p65 were measured by immunohistochemical method. Results Compared with the sham-operation group, the levels of BUN and SCr in the model group increased significantly (P<0.05); protein expression of Klotho in renal tissue decreased and the protein expression of NF-κB p65 increased (P<0.05). Compared with the model group, the expression of Klotho increased but protein expression of NF-κB p65 decreased in each administration group (P<0.05); Compared with the positive medicine group, the expression of Klotho in PNS high-dosage group increased but protein expression of NF-κB p65 decreased (P<0.05). The protein expression of NF-κB p65 was negatively related to protein expression of Klotho (r=-0.895, P<0.05). Conclusion PNS can inhibit oxidative stress and anti-inflammatory effects through upregulating protein expression of Klotho, and reduce the protein expression of NF-κB p65, and thus exerts renal protective effects.

7,8-Dihydro-7,8-dihydroxybenzo(a)pyrene 9,10-oxide ; toxicity ; Carcinogens ; toxicity ; Cell Line, Tumor ; DNA Damage ; drug effects ; Dose-Response Relationship, Drug ; HSP70 Heat-Shock Proteins ; biosynthesis ; Humans

OBJECTIVETo explore the transmission routes, genotypes/subtypes distribution and genetic character of HCV in HIV/HCV co-infected and HCV mono-infected individuals in Guangdong Province.

METHODSReverse transcription (RT) nested PCR was performed to amplify the HCV NS5B gene region from 95 HIV/HCV co-infected and 99 HCV mono-infected individuals lived in Guangdong province. The PCR products were then sequenced for HCV subtyping. Genetic analysis was done by MEGA4 software.

RESULTS(1) HIV/HCV co-infected individuals infected HCV mostly through injection drug use (IDU, 78.9%), the HCV subtypes were identified as 6a (53.7%), 3a (17.9%), 1b (15.8%), 3b (11.6%) and 1a (1.0%) respectively, the genetic distance within subtype 1b was longer than those within other subtypes, the predominant HCV subtype in HIV/HCV co-infected individuals infected through IDU was 6a (60.0%). (2) HCV mono-infected individuals infected HCV mostly through blood or blood products transfusions (80.8%), the HCV subtypes were identified as 1b (67.7%), 6a (17.2%), 3a (6.1%), 2a (5.0%), 3b (2.0%), 4a (1.0%) and 5a (1.0%) respectively, the genetic distance within subtype 1b was also longer than those within other subtypes, the predominant HCV subtype in HCV mono-infected individuals infected through blood or blood products transfusions was 1b (76.2%).

CONCLUSIONThe diversity of HCV subtypes in HIV/HCV co-infected and HCV mono-infected individuals in Guangdong Province was high, both the major transmission route and HCV subtype between HIV/HCV co-infected individuals and HCV mono-infected individuals were different.

Adolescent ; Adult ; Aged ; Asian Continental Ancestry Group ; China ; epidemiology ; Coinfection ; virology ; Female ; Genotype ; HIV ; HIV Infections ; epidemiology ; virology ; Hepacivirus ; classification ; genetics ; Hepatitis C ; epidemiology ; virology ; Humans ; Male ; Middle Aged ; Phylogeny ; Young Adult