Objective The modified Blalock-Taussig shunt (MBTS) is considered a low-risk management option for palliation in patients with severely cyanotic heart anomalies in advanced heart centers in western countries.But the morbidity and mortality associated with MBTS remains challenge in developing countries.Methods 106 patients with severely cyanotic complex heart anomalies underwent 110 modified Blalock-Taussig shunts(B-T shunts) between October 2000 and August 2012.The mean age was (3.8 ± 1.1) months (1 day-37.2 months).The mean weight of the babies was (5.0 ± 2.1) kg (2.3 kg-12.0 k g).The cardiac anatomy was as follows:pulmonary atresia with intact ventricular septum in 25,pulmonary atresia with ventricular septum defects in 45,tricuspid atresia in 11,tetralogy of Fallot in 7,complex single ventricle physiology in 18.All patients were deeply cyanotic,and preoperative prostaglandin E1 was needed in 78 patients to ensure ductus patent and maintain oxygen saturations prior to the shunt operation.The shunts were accomplished with 3.0 mm polytetrafluoroethylene grafts in 8 patients,3.5 mm in 11,4 mm in 65,5mm in 26.Results The duration of mechanical ventilation was 4 hours-7 days,cardiac intensive care unit stay was 1-12 days,hospital stay after operation was 1-18 days.There were 3 deaths (2.6％),immediate post-operative shunt block in 1,severe hypoxidosis in 1 and heart failure in 1.Oxygen saturation increased from 68.5％ preoperatively to 79.2％ postoperatively.Four patients had shunt block,additional shunt was created respectively.There was 2 late death.Follow-up of 94 patients revealed satisfactory systemic oxygen saturation of 0.81 ± 0.10 (0.63-0.92).86 cases received further operations,including 7 in TOF radical operation,31 in Rastelli,25 in Glenn,18 in Fontan.Conclusion With an encouraging early shunt patent rate and oxygen saturation increasing,we can now adopt MBTS as an alternative in patients with severely cyanotic heart anomalies.Modified B-T shunt is a good palliation for patients with cyanoti cheart anomalies,which can increase pulmonary blood flow.Excellent surgical skills and perioperative treatment contribute to good operation results,and to low morbidity and low mortality.

Acupuncture Therapy ; Attention ; Child, Preschool ; Down Syndrome ; physiopathology ; psychology ; therapy ; Humans ; Language ; Male ; Walking

Cannabinoid Receptor Modulators ; Endocannabinoids ; Humans ; Metabolic Syndrome ; metabolism

The incidence rate of thyroid cancer is increasing very rapidly during the past years.131I treatment for DTC is an effective method.However,DTC refractory to 131I treatment or therapeutic failure is not uncommon.High level expression of nuclear factor-kappa B (NF-λB) in thyroid cancer is closely related with carcinogenesis,progression,anti-apoptosis and therapeutic resistance.NF-κB inhibitor was effective for the treatment of thyroid cancer.Combined NF-κB inhibitor with131I may improve the therapeutic efficacy.

Objective To observe the clinical efficacy of thread embedding plus Chinese medication in treating primary dysmenorrhea due to blood stagnation caused by cold accumulation. Methods Totally 136 patients with primary dysmenorrhea due to blood stagnation caused by cold accumulation were randomized into a treatment group and a control group, 68 in each group. The treatment group was intervened by thread embedding at Shiqizhui (EX-B 8) and bilateral Ciliao (BL 32) plus Chinese medication;while the control group was by Chinese medication alone. The dysmenorrhea symptom score and Visual Analogue Scale (VAS) were observed before and after intervention, and the clinical efficacies were compared. Results The total effective rate and recovery-markedly effective rate were respectively 93.8%and 78.1%in the treatment group, versus 85.2%and 50.0%in the control group, and there was a significant difference in comparing the recovery-markedly effective rate (P<0.05). After intervention, the dysmenorrhea symptom score and VAS score were significantly changed in both groups (P<0.01);there were significant differences in comparing the symptom score and VAS score between the two groups (P<0.05). The half-a-year follow-up study showed that the total effective rate and recovery-markedly effective rate were respectively 90.6%and 68.8%in the treatment group, versus 70.6%and 38.2% in the control group, and the differences were statistically significant (P<0.05, P<0.01). Conclusions Thread embedding plus Chinese medication is an effective approach in treating dysmenorrhea due to blood stagnation caused by cold accumulation, and it’s easy-to-operate and causes less pain.

Objective To investigate the value of cystatin CysC on early renal damage in patients with essential hypertensive.Methods Hundred-four patients who were diagnosed as essential hypertensive with microalbuminuria (Urinary microalbumin:20-200 mg/L) with essential hypertensive (58 males and 46 females) were enrolled and 54 healthy subjects (30 males and 24 females) were selected as controls.Serum CysC (CysC)、Crea(Cr) 、BUN、uric acid (UA) were measured and ROC curve was established based on the examination.Results There were significant difference on the level of Serum CysC[1.22(0.91,1.51 ) mg/L vs 0.73 (0.61,0.79 ) mg/L,Z=3.30,P＜0.01],BUN [6.40 ( 4.43,9.06 ) mmol/L vs 5.10 ( 4.34,5.93 ) mmol/L,Z=5.94,P＜0.01],Cr [96.3 (72.6,122.0 ) μmol/L vs 70.5 (56.2,76.0 ) μmol/L,Z=8.30,P＜0.01],UA [375.7 ( 312.3,431.8 ) μmol/L vs 328.7 ( 271,379.3 ) mmol/L,Z=3.28,P＜0.01] between essential hypertensive group and control group.According to ROC curve,the area of CysC under the ROC curve (AUC) in 104 patients was 0.87,significantly different with CR(0.78),BUN(0.66),UA(0.66) (P＜0.05 or P＜0.01 ) The Youden index of CysC was 0.69,and the corresponding sensitivity and specificity of CysC were 76％ and 93％ respectively.Conclusion The diagnostic value of serum CysC on early renal damage in patients with essential hypertensive is superior to Cr,BUN and UA,and changes of renal function can be found earlier according to the level of serum CysC,It plays a key role in the diagnosis,treatment and prognosis of the early renal damage in patients with essential hypertension.

Introduction: Prostate cancer is a heterogenous disease and the mechanisms that drive it to behave differently are not well understood. Tumour expression of the ERG oncogene occurs in the majority of patients with prostate cancer in Western studies. This is considered to be oncogenic as ERG acts as a transcription factor to regulate genes involved in tumour proliferation and invasion. In this study we investigated expression of ERG in Malaysian men with prostate cancer. Methods: Tissues were collected from 80 patients with clinically detected prostate cancer and treated with radical prostatectomy. Cases were tested for ERG by immunohistochemistry using the mouse monoclonal antibody EP111. All blocks on 48 cases were tested in order to determine the extent of heterogeneity of ERG expression within individual cases. ERG expression was analysed in relation to patient age, ethnicity and tumour stage and grade. Results: Forty-six percent of cases were ERG positive. There was no significant association between ERG and tumour grade or stage. Sixty-nine percent of Indian patients had ERG positive tumours; this was significantly higher (p=0.031) than for Chinese (40%) and Malay (44%) patients. Heterogeneity of ERG expression, in which both positive and negative clones were present, was seen in 35% of evaluated cases. Evaluation by tumour foci showed younger patients had more ERG positive tumour foci than older patients (p=0.01). Indian patients were more likely to have the majority of tumour foci with ERG staining positively, compared to either Chinese or Malay patients (P <0.01). Conclusion: In this study, tumour expression of ERG was more likely to occur in patients of Indian ethnicity.
ethnic variation

Pelvic fractures are high energy injuries involving severe trauma and potential intra pelvic bleeding. Immediate control of hemorrhage, fixation of pelvic fractures and inter department cooperation are important for their treatment. Transcatheter angiographic embolization can be used to identify bleeding sites, control hemorrhage and improve mortality and complications, and it has been proved to be a valuable technique in the diagnosis and treatment of pelvic vascular injuries. Still there is a considerable controversy on the fracture patterns, the sequence and the timing of emergency angiography and possible embolization in these patients. In this paper, we reviewed the role of angiographic embolization and we thought more attention should be paid on angiographic embolization in the control of hemorrhage.

Objective To define the indications of direct transpedicular lag screw to treat traumatic spondylolisthesis of axis (Hangmans fracure) and to evaluate the result of the technique. Methods From February 1998 to December 2000, 22 patients with acute traumatic spondylolisthesis of axis were treated. Ten of them achieved anatomic reduction by skull traction but no acceptable stability was ensured by traction alone. Among the ten patients, eight had integral and normal shaped C2 vertebral bodies (6 male, 2 female; age ranged from 18 to 42 years with an average of 28.2 years; 5, 2 and 1 patients classified as type Ⅰ, Ⅱ and Ⅱa injuries respectively according to Levine-Edwards classification and graded as D spinal injury in 2 cases and E in 6 cases according to Frankel scale) were further fixed with transpedicular lag screw. Under general anesthesia, the patients were laid in prostrate decubitus in a prepared head-neck-chest ventral plaster plate with skull traction in place to maintain reduction and lateral image intensification was applied to confirm the reduction. A posterior midline incision from C1-C3 was performed, and soft tissue was released to expose clearly the lamina, lateral mass, superior and medial aspect of the C2 pars interarticularis (isthmus plus pedicle). Points of entry for screw insertion were located at the entrance at the posterior aspect of lateral mass. The drill bit is parallel to both of the medial and superior border of C2 pars interarticularis (usually 25?-30? cephalad to the transverse plane and 30?-35? medial to the sagittal plane). The screw hole in the posterior cortex was overdrilled with a 3.5 mm drill bit for interfragmentary compression. 3.5 mm screws (25-30 mm, determined by depth gauge) were drived in after the cortex being tapped with a 3.5 mm tap. The whole procedure was done under monitoring of "C" arm fluoroscopy for safety and accuracy. Results It costs an average of 70 minutes to finish the procedure with mean blood loss of 250 ml. Hospital stay was about 18 days. A mean follow up time of 14 months (11 to 18 months) didnt confirm any early or late postoperative complications, all cases gained bony union 3 months later with complete neurological function recovery. The range of neck rotation was restored normal with no C2,3 instability or screw loosing found. Conclusion With appropriate indications, transpedicular lag screw fixation provides good reduction and stability to Hangmans fracture. This technique can only be applied to the fractures which are reductable.

Objective To explore the clinical features and operative treatment of chronic bladder entrapment and bowel herniation after traumatic symphysis pubis diastasis. Methods One patient of late pelvic posttraumatic mal-alignment as Tile C2 type, which was associated with serious symphysis separation and combination of chronic bladder entrapment and bowel herniation, was admitted to our hospital in August 2002. The X-ray, three-dimensional CT reconstruction, MRI, and the bladder cystography were performed respectively in order to confirm the conditions. With the usage of ilioinguinal approach, the symphysis pubis diastasis was exposed and restored firstly; then, the malunion site of the left iliac was corrected; finally, after the reduction and internal fixation of the pelvis, the bowel herniation was resolved and the inferior abdominal wall defect was repaired with artificial materials. During the operation, the abnormal conditions were ob-served as follow: 1) The distance of symphysis pubis separation was about 7.5 cm; 2) the full-thick of the ectus abdominis was torn longitudinally tear along the middle line, and the transversalis fascia was fibrosis and adhered to the peritoneum, which consisted of hernia capsule; 3) the small bowel had been entrapped over the bladder through the gap of rectus abdominis and the right Hesselbach triangle. Results The pa-tient was followed up of 6 months. The limb discrepancy had been corrected satisfactory with a sound frac-ture healing and a good gait recovering after operation. The urinary function has recovered with a normal ap-pearance of penis. The patient felt stronger then to relieve the bowels than he did preoperatively. The erected dysfunction did not improve postoperatively. Conclusion The combined osteotomy and rigid fixation through anterior and posterior pelvic ring in the same stage is an effective method to close the symphysis seperation, decrease the volume of pelvic cavity, construct the pelvic floor indirectly, repair the inferior ab-dominal wall defect, cure the bowel herniation, and improve the bladder entrapment.