Objective To investigate the effective regimen to treat the hepatitis C virus (HCV) recurrence after orthotopic liver transplantation (OLT). Methods The clinical data of 4 cases of HCV recurrence after OLT were retrospectively analyzed. Of the 4 cases, there were 3 cases of HCV related liver cirrhosis and 1 case of HCV related liver cirrhosis in combination with hepatocellular carcinoma. The immunosuppression regimen as FK506, MMF and corticosteroids was used after OLT. As soon as HCV recurrence was confirmed by liver biopsy during 8 to 12 weeks after OLT, pegylated interferonα-2a (PEG-IFNα-2a) and ribavirin (RIB) were used for 48 weeks. PEG-IFNα-2a was started at a dose of 180 μg per week subcutaneously and RIB at a dose of 1000 mg per day orally, respective-ly. Blood routine, liver and kidney function test, HCV-RNA and transplanted liver biopsy were per-formed when necessary and biochemical response, sustained virologic response and histological re-sponse were tested in due time. Remits All of the 4 cases except for 1 achieved sustained virologic re-sponse and the liver function was as normal as before. The histological activity index was improved significantly for both inflammatory activity and fibrosis according to liver biopsy in 0, 48, 72 week srespectively. Case 4 was given corticosteroids for consecutively 3 days when acute rejection was veri-fied by liver biopsy and the condition improved. None of them stopped treatment or withdrew from them directly. Conclusion The combination of PEG-IFNα-2a and RIB was an effective regimen to treat the HCV recurrence after OLT and the side effects could be overcame easily.

Objective Create patient-derived xenograft (PDX) model of bone and soft tissue sarcoma,and analyze the success rate of PDX model,observe the effects of chemotherapy on PDX models and its coincidence,and provide a theoretical basis for screening sensitive second and third line drugs.Methods Collected 31 cases of bone and soft tissue sarcoma from January 2015 to May 2016,which included 12 male and 19 female,with an average age of (28.5±19.9) y.The tumor tissue was obtained the day of operation,and it was cut into 2 mm3 pieces and injected into the flank of BAL B/C nude mice or SCID mice.Tumor was passaged when the diameter reached 1-2 cm and the P0 tissue was froze.If there was no obvious tumor mass grows out for 3 months,the model creation will be stopped.We inoculated the mice with patients sample with or without chemotherapy,observed the effect of chemotherapy on the success rate of PDX modeling and the success rate of modeling of different pathological types,and also observed the relationship between the success rate of PDX modeling and the prognosis of patients.For the drug sensitivity test,3 mice was used in each group,and chemotherapy was given,T/C was used to evaluate the inhibition ratio after drug treatment.Results 31 PDX models were inoculated.The total success rate is 45.2％.Pathology of the PDX models and their success rates:24 osteosarcoma models,success rate is 37％;2 leiomyosarcoma models,success rate is 100％;2 chondrosarcoma models,success rate is 50％;1 Ewing sarcoma model successed;1 fibrosarcoma model and 1 synovial sarcoma model,were not successed.Post chemotherapy model success rate is 33％ (4/12),compared with 53％(10/19) of model success rate that without chemotherapy.And there is relationship between success rate of PDX model creation and patient outcome.The faster the PDX model creation,the worse the outcome.The drug sensitivity of PDX model coincides the clinical situation.Conclusion The success rate of creating PDX model of bone and soft tissue sarcoma is around 30％-40％,and it is related to the pathology and whether got chemotherapy or not,PDX models coincide sarcomas clinical situation,and it is hopefully to use PDX model in selecting personalized drugs.

Objective:To analyze the disaster vulnerability of hospitals in Macao Special Administrative Region to assess the disaster risk objectively, so as to provide reference for Macao hospitals to formulate their emergency plans and improve their emergency response and handling capacity.Methods:From December 2021 to February 2022, 118 medical staff were selected for a questionnaire survey using the method of departmental stratified random sampling from three general hospitals in Macao. At the same time, 7 full-time medical staff and 2 experts in the field of health care were selected for expert consultation. The main content of the questionnaire was the hospital disaster risk assessment based on the Kaiser model, and three-round expert consultation method was used to determine the model indicators. The risk value of each indicator was calculated to analyze the hospital disaster vulnerability.Results:107 valid questionnaires were collected. The top five events in the hospital disaster risk value were typhoon(52.42%), large-scale public health events/epidemic outbreaks(47.55%), strong thunderstorm convective weather(38.68%), extreme temperature(37.31%) and information system failure(33.75%). As ranked by the total risk value, the categories of hospital disasters were natural disasters(35.69%), information security(29.49%), medical technology accidents(29.36%), equipment technology accidents(26.25%), dangerous goods injuries(25.13%) and personnel injuries(19.98%).Conclusions:Macao hospitals are exposed to the highest total risk value in natural disasters, followed by information security. In addition, the risk value of large-scale public health events and epidemic outbreaks of personal injury is also so high as to deserve attention. Macao hospitals should formulate effective emergency response plans according to the risk values of various disasters and the actual situation of each medical department, so as to minimize the losses caused by disasters to both hospitals and patients.

OBJECTIVETo investigate a new bowel management program for children patients with fecal incontinence.

METHODSClinical data of 19 children with fecal incontinence undergoing bowel management program in our center between January 2012 and January 2013 were retrospectively analyzed. The main outcome measure was clinical efficacy of this program.

RESULTSFifteen out of 19 cases were genuine fecal incontinence and required continuous treatment by enema. The other 4 cases were false fecal incontinence. After treatment with this program, stool dirty and constipation were improved in genuine incontinence. Two cases of false continence could control defecation independently by oral administration of antispasmodic drug. Two cases of false continence were cured and did not need medical interference.

CONCLUSIONSBowel management program is an effective treatment for pediatric patients with fecal incontinence. The key of success is maintenance of perianal hygiene for 24 hours by continual adjustment of the elements and volumes of enemas.

Child ; Constipation ; Enema ; Fecal Incontinence ; therapy ; Humans ; Intestines ; physiopathology ; Retrospective Studies

OBJECTIVETo summarize the experience of minimally invasive treatment in 520 patients with intracranial aneurysms on a retrospective study.

METHODSThe measures used in the treatment of 520 patients were reviewed in terms of timing of surgery, induced-hypotensive anesthesia, brain protection combined with temporal occlusion of the feeding artery, external drainage of CSF, dynamic monitoring of intracranial pressure, blood flow velocity, serum osmolality and CT scanning, anti-vasospasm therapy as well as selected interventional endovascular embolization of aneurysms.

RESULTSOf the 520 patients, 485 were treated with either direct clipping or endovascular embolization and 35 patients were treated non-surgically. In 449 patients undergoing direct clipping and 36 undergoing endovascular embolization, intraoperative rupture of aneurysm occurred in 27 (6.0%) and 0%, respectively. Death occurred in 13 (2.6%), hemiplegia in 8 (1.6%), and vegetative state in 2 (0.4%). The operative mortality of direct clipping was 3.8% in 210 patients before 1990 and 1.8% in 275 patients after 1990 (36 patients undergoing endovascular embolization, the operative mortality was 0%).

CONCLUSIONThe outcome of patients with intacranial aneurysms can be markedly improved and the operative mortality can be lowered by minimally invasive treatment.

Adult ; Aneurysm, Ruptured ; mortality ; therapy ; Embolization, Therapeutic ; Female ; Follow-Up Studies ; Humans ; Intracranial Aneurysm ; mortality ; surgery ; Intraoperative Complications ; mortality ; Male ; Microsurgery ; Middle Aged ; Minimally Invasive Surgical Procedures ; Retrospective Studies ; Survival Rate ; Treatment Outcome

To report the short-term clinical outcome of three cases of distal tibial osteosarcoma treated with a novel 3D-printed ankle fusion prosthesis for limb preservation. The patients were admitted to the Department of Bone Tumor, Shanghai General Hospital from January 2020 to June 2021, with one male and two female cases, aged 18, 12, and 14 years, respectively, all diagnosed with distal tibial osteosarcoma (Ennecking stage IIb). A new self-designed ankle fusion prosthesis was used to perform osteosarcoma resection and prosthetic reconstruction of the distal tibia. The operation time, blood loss, postoperative American Orthopedic Foot and Ankle Society Score (AOFAS) and ankle range of motion were recorded. All the 3 patients successfully completed the operation and were followed up for 22 months, 18 months and 12 months, respectively. The operation time was 140 min, 110 min and 200 min, and the blood loss was 200 ml, 200 ml and 350 ml, respectively. At the last follow-up, the AOFAS were 86, 90 and 95 points, and the range of motion of ankle flexion and extension were 30°, 15° and 30°. There was no local recurrence or lung metastasis at the last follow-up. The novel 3D-printed ankle fusion prosthesis in the distal tibia is safe and effective for the reconstruction of bone defects after resection of osteosarcoma in the distal tibia, and the early postoperative function is satisfactory.

Objective To summarize the experience of perioperative management for repair of congenital diaphragmatic hernia (CDH) supported by extracorporeal membrane oxygenation (ECMO). Method Retrospective review was conducted for the clinical data of CDH patients who received surgical repair on ECMO from December 2016 to June 2018 in Guangzhou Women and Children's Medical Center. Result Four fetus with prenatal diagnosis of left-side CDH were transferred to our Center and received standardized perinatal management. Moderate-severe pulmonary hypoplasia was recognized after evaluation by fetal imaging. Four cases were initiated with veno-arterial ECMO at 3, 35, 41, 11 h of life, respectively. Repair of the diaphragmatic defect was performed within two weeks after cannulation of ECMO. Furthermore, activated clotting time goals were adjusted to 180～220 s, activated partial thromboplastin time were stabilized between 50～80 s, platelets count were maintained>100×109/L and hematocrit was kept>30％before the surgery. The surgeries of four patients were completed on the 0.9th, 0.5th, 3.6th, 5.1th day of life on ECMO, respectively. The defect was repaired by parachute patch. The operative time was 85～210 min. According to CDH Staging System defect size (A to D), there were two with defects at grade C and other two at grade D. Postoperative total volume of drainage was 215～1301 ml and ECMO duration was 3.0～39.3 d. Three of them survived during neonatal period, while one died. Conclusion Repair of CDH on ECMO is feasible and help to improve neonatal survival, especially for those with moderate-severe pulmonary hypoplasia.

Objective To summarize the experience of cannulation for extracorporeal membrane oxygenation (ECMO) in infants less than 5 kg. Methods Eleven infants with ECMO support who weighed less than 5 kg were admitted to critical care medicine of Guangzhou Women and Children's Medical Center from June 2016 to June 2018 were enrolled. Retrospective analysis of support type, configuration, site of cannula and complication of ECMO was performed. Results The 11 infants consisted of 9 males and 2 females. The weight on ECMO of 1.96-4.60 kg, with an average of (3.14±0.65) kg; age 0.1-30.0 days, with a median of 5.6 (1.5, 8.3) days. Four cases were given ECMO because of congenital diaphragmatic hernia with severe pulmonary hypertension and other 7 cases were cannulated due to complication of congenital cardiac surgery. All infants were received veno-arterial (V-A) ECMO. In 4 cases, the cannulas were placed in the right internal jugular vein for drainage (8-10 French catheter with 6.0-7.5 cm depth) and the right carotid artery for infusion (6-8 French catheter with 2.5-3.5 cm depth); the average time of cannulation in right carotid and jugular vessels was (73±20) minutes (range 55-100 minutes). In other 7 cases, the cannulas were inserted into the right atrium (12-14 French catheter with 2.8-3.0 cm depth) for draining blood and returning it to the ascending aorta (6-8 French catheter with 1.0-2.0 cm depth); the average time of cannulation in central vessels was (64±31) minutes (range 35-110 minutes) with exclusion of 2 cases intraoperative cannulation. There were three infants with complications. One episode was shown in vascular rupture, one in catheter site hemorrhage and one in cannula malposition with later repositioning. There was no case of insertion site infection, cannula-related bloodstream infection and accident detached cannula. Conclusion Cannulation for ECMO can be performed in infants less than 5 kg with a high rate of success and a low rate of complication owing to appropriate catheter and skillful cannulation.

Objective To compare the prognosis of different surgical procedures and to find the relatively safe and effective treatment for severe jejunoileal atresia(sJA).Method From January 2007 to June 2018,children with sJA receiving different surgical procedures in our hospital were retrospectively reviewed.Their clinical data were analyzed,including the survival rate,complication rate,unplanned re-operation rate and postoperative nutritional status.Result A total of 130 patients were enrolled in this study.According to the different types of surgical procedures,the patients were assigned into primary anastomosis group (58 cases,44.6％),Mikulicz double barrel ileostomy group (17 cases,13.1％) and Bishop-Koop anastomosis group (55 cases,42.3％).The overall mortality rate was 6.2％ (8/130).No significant differences existed in mortality rates among the three groups (P＞0.05).The incidences of gastrointestinal complications in primary anastomosis group (70.6％,12/17) and Mikulicz group (70.6％,12/17) were both higher Bishop-Koop group (34.5％,19/55),the differences were statistically significant (P＜0.05).The unplanned re-operation rates were 34.5％ (20/58) in the primary anastomosis group and 17.6％ (3/17) in the Mikulicz group,both higher than the Bishop-Koop group (3.6％,2/55),the differences were also statistically significant (P＜0.05).Multivariate analysis showed that the risk of complications in the primary anastomosis group (OR=3.434,95％CI 1.392～8.471) and Mikulicz group (OR=5.933,95％CI 1.467～23.991) were higher than the Bishop-Koop group.The risk of unplanned re-operation in the primary anastomosis group was 12.422 times as the Bishop-Koop group (95％CI 2.535～60.877).No significant differences existed between the Mikulicz group and the Bishop-Koop group in the risk of unplanned re-operation (P＞0.05).The weight for age (Z-score) in the Bishop-Koop group (-1.4,95％CI-2.0～-0.8) at the stoma closure time was better than the Mikulicz group (-3.2,95％CI-4.4～-2.0),the difference was statistically significant (P＜0.01).Conclusion Bishop-Koop anastomosis has lower complication rate and lower unplanned re-operation rate in the treatment of sJA.The nutritional status of children who received Bishop-Koop anastomosis is better than Mikulicz double barrel ileostomy at the stoma closure time.Bishop-Koop anastomosis is relatively safe and effective for sJA patients.

Objective To investigate the prenatal imaging features of fetal congenital esophageal atresia and to further evaluate the value of MRI and ultrasound scan in the same condition.Methods This study recruited 12 singleton gravidas whose fetuses were initially suspected with congenital esophageal atresia by prenatal ultrasound scan and then confirmed by surgery and/or upper gastrointestinal angiography after birth at Guangzhou Women and Children's Medical Center from May 2011 to May 2017.Imaging features of prenatal MRI and ultrasonography of the 12 fetuses were retrospectively analyzed.Differences in imaging findings of these two methods were analyzed by Chi-square test.Results All 12 women received prenatal ultrasound examination and eight of them underwent MRI scan when fetal congenital esophageal atresia was suggested by ultrasound.Both ultrasound and MRI were capable of identifing polyhydramnios and absent or small stomach bubble (12/12 and 8/8,respectively).However,MRI was superior to ultrasound in detecting "pouch sign "/"oral filling sign" or poor filling of small intestine (7/8 vs 3/12 and 8/8 vs 0/12,x2 were 7.500 and 20.000,both P＜0.01).While,no statistical difference was shown in detecting curved tracheal between MRI and ultrasound (2/8 vs 0/12,x2=3.333,P=0.067).For Gross Ⅰ or Gross Ⅲ congenital esophageal atresia fetuses,no statistically significant difference was found in their imaging features (all P＞0.05).The total detection rates after 32 weeks of gestation of Gross Ⅰ and Gross Ⅲ cases were both 3/6.Conclusions Prenatal MRI is a vital supplement to ultrasound due to its high display rate of characterized features of congenital esophageal atresia.Thus,the combined use of ultrasound and MRI is of great importance for prenatal diagnosis of this fetal abnormality.