Most children with Hirschsprung's disease (HD) have a satisfactory outcome after a pull-through operation.However,a small group of patients develop severe postoperative complications,and a reoperation may be necessary.The most common and serious complications after definitive surgery are as follows:anastomotic stricture,a twist of the pull-through segment,retained aganglionosis,HD-associated enterocolitis,anastomotic leak,and fistulae.Using a well-defined treatment algorithm based on the clinical status as well as precise diagnostic workup can end the long suffering of patients with postoperative complications.Pull-through surgery can be safely performed with favorable outcomes after thorough history-taking,meticulous clinical examination,a thoughtful planning,adherence to basic surgical principles and under skillful hands.

Objective To explore the application value of laparoscopic surgery in type 2 diabetes patients with acute cholecystitis.Methods 50 type 2 diabetic patients with acute cholecystitis were chosen as the research objects,the patients were divided into the observation group and control group according to the method of treatment, 25 cases in each group.Strict control of blood glucose levels in patients before operation,the observation group treated by laparoscopy,the control group were treated with conventional open surgery.Recorded the operation time and hemor-rhage,postoperative abdominal drainage,anal exhaust time,patient ambulation time and hospitalization time and other indicators.The patients were followed up to record the postoperative infection,occurrence of complications such as postoperative inflammation.Results There was no statistically significant differences between the two groups in oper-ation time(t =1.02,P >0.05).In the observation group,the intraoperative blood loss was (41.2 ±8.3)mL,postop-erative drainage volume was (107.5 ±16.4)mL,which were significantly lower than those in the control group,and the anal exhaust time was (1.7 ±0.3)d,total hospitalization time was (7.1 ±1.7)d,which were significantly shorter than those of the control group,the differences were statistically significant(t =3.43,3.78,3.43,4.21,all P <0.05).The observation group the complications included wound infection 1 cases,the complication rate was 4.0%, while in the control group,the complications included bile leakage,reflux esophagitis,incision infection,fat liquefac-tion,pulmonary infection and incisional hernia,the overall complication rate was 24.0%,there was statistically signifi-cant difference in the complication rate between the two groups(χ2 =4.54,P <0.05).Conclusion The laparoscopic surgery in the treatment of type 2 diabetic patients with acute cholecystitis has exact effect,and the patients recovery time is short,the complication rate is low.

Aspartyl-(asparaginyl) β-hydroxylase (AAH) is a type 2 transmembrane protein and a member of the α-ketoglutarate-dependent dioxygenase family of proteins.AAH catalyzes hydroxylation of specific aspartyl and asparaginyl residues in epidermal growth factor-like domains of proteins.Overexpression of AAH is found in many types of cancer tissues,however,AAH expression is found only in normal placenta and paranephros tissues.AAH can translocate to cell membrane from endoplasmic reticulum membrane when it is overexpressed in cancer cell,which hydroxylate proteins such as Notch,Jagged,and cellular adhesion molecules that regulate cell migration and invasion.AAH is a potential biomarker for cancer diagnosis.

Objective To investigate the clinical efficacy of pantoprazole combined with domperidone in the treatment of chronic superficial gastritis.Methods 50 patients with chronic superficial gastritis were selected,and they were randomly divided into single drug treatment group and two drugs treatment group by the random number table method,25 cases in each group.The single drug treatment group was treated with domperidone,the two drugs treatment group was given pantoprazole combined with domperidone treatment.After 3 weeks of treatment,the total effective rate,disappearing time of abdominal pain,postprandial fullness belching disappeared time,the disappearance time of patients before meals;and after treatment,fullness,belching,abdominal pain score difference;psychological function of patients before and after treatment,differences in physical function indicators of the quality of life were compared between the two groups.Results The total effective rate of the two drugs treatment group was higher than that of the single drug treatment group (96.00％ vs.76.00％,x2 =4.153,P ＜ 0.05).The disappearance time of abdominal pain,postprandial fullness disappeared time,belching disappeared time of the two drugs treatment group were shorter than those of the single drug treatment group(t =8.201,9.155,10.762,all P ＜ 0.05).Before.treatment,the postprandial fullness,belching,abdominal pain points between the two groups had no statistically significant differences(all P ＞ 0.05).After treatment,the postprandial fullness,belching,abdominal pain of the two drugs treatment group decreased more significant (t =5.255,4.923,6.245,all P ＜ 0.05).Before treatment,the psychological function,physical function and quality of life index between the two groups showed no statistically significant differences (all P ＞ 0.05).After treatment,the psychological function,physical function and quality of life index of the two drugs treatment group increased more greatly (t =5.242,4.153,4.733,4.255,4.562,4.715,all P ＜ 0.05).Conclusion The clinical efficacy of pantoprazole combined with domperidone in the treatment of chronic superficial gastritis is effective,it can effectively improve the patients’ clinical symptoms and quality of life,shorten the treatment time,it is worthy of promoting.

Appropriate classification and staging is the basis for the diagnosis and treatment of idiopathic macular hole (IMH).According to the appearance of vitreous and retina determined by optical coherence tomography,IMH can be classified as primary or secondary IMH,and IMH with or without vitreous attachment;Vitreous attachment can be further classified as vitreomacular adhesion or vitreomacular traction.According to the measured horizontal diameter,IMH can be classified as large,middle and small IMH.This new classification system and comprehensive parameters improve the traditional Ⅳ-stage theory,with a better description of the occurrence and development of IMH process.It should be used as the general principal to guide IMH classification,evaluation of surgical indications,selection of operative method,and estimation of surgical outcome.Ganglion cell damage caused by internal limiting membranes (ILM) peeling is the major concern in the IMH vitreoretinal surgery.For complicated and large IMH,inverted ILM flapping can improve the closure rate;ILM peeling and postoperative face-down posture are not necessary for IMH less than 250um in diameter.The current vitreoretinal surgery trend to treat IMH is personalized surgical treatment,following the existing evidence-based medical evidence,and based on the new classification information,ocular and systemic features of each patient.

Along with improvements in the embedding materials, continual innovation of the applied technique, and further understanding of therapeutic mechanism, the application scope of negative pressure wound therapy (NPWT) becomes broader, clinical experience in its use becomes more abundant. This issue of the journal highlights 5 papers to introduce the experience and knowledge regarding NPWT technique of the authors.
Humans ; Negative-Pressure Wound Therapy ; Wound Healing

Objective To explore the effect and safety of compression and distraction technique by external fixation without grafting in treatment of noninfectious nonunion of tubular fractures.Methods 43 patients were randomly divided into 2 groups by visiting sequence with random number,odd into the observation group,even into the control group.The observation group(22 cases) adopted the external fixation retractor pressure treatment,the control group(21 cases) was given extemal fixation combined with locking plate treatment.The efficacy of two groups was compared.Results 43 patients were followed up for 6 ～ 15 months,average 7.5 months.The bone healing time was 3 ～ 14 months,average 5.1 months.43 patients were all healed.The total effective rate of the observation group was 81.8％,which was significandy higher than 66.7％ in the control group (Z =9.654,P =0.001).There were no significant differences in adverse reactions and complications between the two groups (x2 =0.068,P =0.795).Conclusion The compression and distraction technique by external fixation in the treatment of noninfectious nonunion of tubular fractures has obvious curative effect,it can be widely used in clinical practice.

Type 1 diabetes is the main type of diabetes mellitus among children and adolescents and the incidence has steadily increased worldwide in the past 20 years,so more and more people pay attention to the pediatric type 1 diabetes.This article reviews the worldwide research progresses of epidemiology,treatment and management of type 1 diabetes.By comparing the research progresses home and abroad,we can know the gaps home and abroad better,so as to indicate potential paths for future research in China.

Sepsis-associated encephalopathy is a diffuse brain dysfunction that occurs secondary to infection.It is characterized by alteration of consciousness and cognition,seizure or focal neurological signs.Sepsis-associated encephalopathy is accompanied by abnormalities of electroencephalogram and somatosensoryevoked potentials,increased biomarkers of brain injury and,frequently,by neuroradiological abnormalities.Its diagnosis relies essentially on neurologic examination.Hepatic/uremic encephalopathy,metabolic disturbances,drug overdose,withdrawal syndrome and Wernicke's encephalopathy are the main differential diagnosis of sepsis-associated encephalopathy.Currently,treatment consists mainly of controlling sepsis.Various drugs acting on septic pathophysiology have been tested in septic animals.

Usually,invasive prenatal diagnosis of birth defects is necessary for pregnant women with advanced age .The classic technology is evaluation of fetal chromosome karyotype which is performed by cytogenetic analysis of amniotic fluid fetal exfoliated cells through amniocentesis in the second trimester .For some pregnant women who were unfit or refused to accept invasive prenatal diagnosis ,the application of new technology makes assessment of risk of fetal abnormalities more accurate .When screening is used to assess risk of fetal abnormalities , the women should be told that the screening technologies cannot substitute for invasive diagnosis testing of fetal exfoliated cells , the reason of older pregnancy and both advantages and limitations of the prenatal diagnosis and screening technologies should be considered , and the risks of invasive prenatal diagnosis and risk of missed diagnosis of abnormal fetal in selection of prenatal diagnosis strategy for pregnant women with advanced age should be compared .