Objective To evaluate the effect of mechanical dilation on cardia achalasia under an endoscope.Methods A total of 62 patients with cardia achalasia were treated with mechanical dilation by using a self-designed dilator under a gastroscope.Of the cases,one had experienced a failure of heller surgery,and four had received ballon dilation before the gastroscopy.Results Among the cases,2 were convered to open thoracic surgery becaues of rupture of the esophagus,1 patient could not tolerate the operation,1 received a second dilation because of unsatisfied outcome of the first attempt.In the other 58 patients,the surgery was completed in the first attempt.The mean dilation time was 3.5 minutes(ranged from 2 to 5 minutes).Slight mucosal hemorrhage was observed during the operation,while no continuous bleeding occurred.Cold liquid diet was given to the patients 2 hours after the dilation,and then semiliquid diet was prescribed in 6 hours,after that the patients began to take normal diet gradually.The patients were followed up for 2 to 11 years with a mean of 7.5.All of them were cured without recurrence.Conclusions Endoscopic mechanical dilation is microinvasive,safe,and effective for cardia achalasia.It is worth being widely used because of a low cost and reliable long-term outcomes.

Child ; Gene Rearrangement, T-Lymphocyte ; Humans ; Neoplasm, Residual ; diagnosis ; Polymerase Chain Reaction ; methods ; Precursor Cell Lymphoblastic Leukemia-Lymphoma ; diagnosis ; Receptors, Antigen, T-Cell ; genetics

Adolescent ; Child ; Child, Preschool ; Female ; Homeodomain Proteins ; genetics ; Humans ; Infant ; Male ; Oncogene Proteins, Fusion ; genetics ; Precursor Cell Lymphoblastic Leukemia-Lymphoma ; genetics

Objective To analyze the second time blood screening results of ALT deferred donors,and to evaluate the importance of alanine aminotransferase(ALT) testing on the improvement of blood safety.Methods The ALT testing results of 565 360 blood donors from Feb.2006 to Jan.2008 of Shanghai Blood Center were studied retrospectively.The screening results and donation intervals of such donors who delayed their donation just because of their former unqualified ALT level were also analyzed.Results A total of 32 042 donors(5.67%) failed in ALT testing among 565 360 donors.And 3 395 ALT deferred donors participated the second time blood donation,among which 2 205(64.95%) passed the blood screening tests,while the other 1 190(35.05%) failed.Among the 1 190 unqualified blood donors,1 151(33.90%)failed again in ALT testing,and 11(0.32%) in Syphilis,12(0.35%) in HBsAg,7(0.21%) in anti-HCV and 1 in anit-HIV(0.03%).Meanwhile,donors failed both in ALT testing combined with HBsAg,anti-HCV,and anit-HIV sero-converted were 1(0.03%),2(0.06%) and 1(0.03%),respectively.And 72.64% of ALT deferred donors participated the second time blood donation within 6 months.The average donation intervals of donors with qualified ALT level but sero-converted were 140 days(from 24 to 267 days),and those with both unqualified ALT level and sero-converted were 158 days(from 91 to 220 days).Conclusion Before the new methods such as NAT were applied to blood donation screening system,ALT test could prevent the window-period failure of ELISA screening so as to improve the blood safety.

ObjectiveTo investigate advantage and disadvantage of different rehabilitation therapies used for cerebral palsy (CP) children complicated with epilepsy (EP).Methods140 CP children complicated with EP screened from 1402 CP cases, were analyzed for CP and EP types, MRI or CT, brain stem auditory evoked potentials (BAEP). All cases were treated with anti-epilepsy drugs (AEDs). Different rehabilitation therapies, including electrotherapeutic modalities, acupuncture, point injection, cerebroprotein hydrolysate injection, manual therapy, functional training, Chinese herb braising therapy, and cattle encephalon glycoside and ignotin injection were assessed.ResultsIn all 140 cases, a majority of EP types were myoclonic seizure and west syndrome, CP type was spasticity. Abnormality showed in MRI or CT (98%) and BAEP (90%). AEDs were effective for all 140 cases. Electrotherapeutic modalities, acupuncture, point injection, and cerebroprotein hydrolysate injection could make EP severely, but manual therapy, functional training, Chinese herb braising therapy, cattle encephalon glycoside and ignotin injection had no adverse effects on EP cases.ConclusionThe principles of rehabilitation treatment for the CP children complicated with EP are taking AEDs early and in a long term, avoiding electrotherapeutic modalities, acupuncture, point injection, and cerebroprotein hydrolysate injection, using manual therapy, functional training, Chinese herb braising therapy, and cattle encephalon glycoside and ignotin injection.

To summarize the experience about the preoperative and postoperative nursing of 11 cases with neurogenic bladder treated by sacral neuromodulation. The main nursing interventions of this procedure involved accurate recording of voiding diaries and postvoid residual, effective psychological nursing and health education of related disease information, standard videourodynamic examination. 11 patients acquired more or less benefit after the screening test and were discharged successfully, among them 2 cases had the permanent implantation of the stimulation device.

AIM: To summarize clinical characteristics and pathogenesis of iridocorneal endothelial syndrome ( ICE ) and investigate the treatment and prognosis.
METHODS:The clinical data of 12 cases (12 eyes) who received treatment in southwest hospital during Jun. 2007 to Feb. 2015 were analyzed retrospectively. The essential progressive atrophy of iris included 7 eyes, Chandler syndrome included 3 eyes, Congan - Reese syndrome included 2 eyes.
RESULTS: A total of 8 eyes were carried out once or multiple filtration surgery; 4 eyes were treated with glaucoma valve implantation. Postoperative follow- up time ranged from 15mo to 5y with the average of 30mo. Three months to 16mo after the surgery, the intraocular pressure of 4 patients were elevated again. Postoperative intraocular pressure was poorly controlled.
CONCLUSION:ICE syndrome is a group of clinically rare and serious eye disease. The excessive proliferation of ICE cells causes the existence of the corneal endothelial cells adhesion to the chamber angle and iris surface, which cause iris atrophy, secondary glaucoma, corneal endothelial decompensation. Currently, glaucoma filtration surgery and glaucoma valve implantation can only control intraocular pressure for several months, but the long-term prognosis is poor.

Objective To analyze and evaluate the efficay of split liver transplantation in children.Method From September 2006 to December 2014,210 children were treated with liver transplantation in Tianjin First Central Hospital.The clinical data were retrospectively analyzed and the difference in postoperative survival was compared between the groups.The 210 childrens were categorized into living donor liver transplantation group (183 cases) and split liver transplantation group (27 cases) based on their operation styles.In living group,all donors to recipients were immediate relatives within three generations.In split group,all donors were men,and livers were obtained from no heartbeat donors.Postoperatively,tacrolimus combined a duplex of prednisolone served as immunosuppression scheme.The survival and incidence of complications were observed.Result There was significant difference in the sex ratio between two groups (P＜0.05).The donor liver cold ischemia time was significantly longer in split group than in living group (P＜0.05).The 1-month,6-month,1-year and 2-year overall survival rate in 210 recipients was 99.5％,98.1％,96.2％ and 94.2％ respectively.The median follow-up time in living group and split group was 15.2months and 26.1 months,respectively.The 1-mont,6-month,1-year and 2-year survival rate was 99.5％,96.7％,92.6％ and 74.1 ％ in living group,and 97.8％,96.2％,77.8％ and 74.0％ in split group,respectively (P＜0.05).During the follow-up period,8 cases died (29.6％) in split group (5deaths due to infection and sepsis,and 3 deaths due to multiple organ failure),and 10 cases died (5.5％) in living group (6 deaths due to infection and sepsis,and 4 deaths due to multiple organ failure).Conclusion In the case of strict selection of donors,split liver transplantation can obtain good effect,but the incidence of complications is higher than living donor liver transplantation.Especially,the biliary complications should be prevented and managed actively.

Objective To evaluate the value of low concentration of isotonic contrast agent combined with 80 kV and adaptive statistical itera-tive reconstruction (ASiR)technique for bronchial artery with CT angiography (CTA).Methods 40 patients (18.5 kg/m2 ≤ body mass index(BMI)≤25 kg/m2 )with lung cancer were randomly divided into two groups and performed enhanced chest CT examina-tion.20 patients (low concentration group)were scanned with Visipaque 270mg I/mL,scanning protocol of (80 kV,260 mA)and other 20 patients (high concentration group)were scanned with Ultravist 370 mg I/mL,scanning protocol of (120 kV,1 50 mA). The CT value,signal noise (SD),signal-to-noise ratio (SNR),contrast-to-noise ratio (CNR)and effective dose (ED)of the two groups were compared and analyzed statistically.Differences between the two groups were determined with t test(P <0.05).Results The mean CT value of the low concentration group (31 7.33 HU±70.44 HU)was higher than that of the high concentration group (256.39 HU±37.38 HU)(P <0.05).SD,ED and dose length product (DLP)of the low concentration group (SD:7.55 ±1.51 HU;ED:1.74±0.14 mSv;DLP:124.94±9.9 mGy/cm)were lower than those of the high concentration group (SD:9.36±1.26 HU;ED:3.20±0.35 mSv;DLP:228.82±25.13 mGy/cm)(P <0.05).CNR and SNR of the low concentration group (CNR:59.71± 17.36;SNR:44.01±14.71)were higher than those of the high concentration group (CNR:37.61±6.16;SNR:27.75±4.72)(P <0.05).The subjective scores of the two groups were (3.73±0.66)and (3.81±0.59),respectively,with no statistical difference.Conclusion For the patients with normal body mass index ,it can reduce 47% radiation dose and 27% iodine dosage using low concentration of isotonic contrast agent combined with 80kV and ASiR technique for bronchial artery CTA,while maintaining similar excellent image quality.

Objective To observe the incidence of RP in NSCLC and esophageal carcinoma treated with 3DCRT and investigate the relationship between acute RP and lung function and dosimetric parameters.Methods From October 2006 to August 2008, 3DCRT plus concurrent chemotherapy of NP or LFP were applied to 64 patients with locally advanced NSCLC or esophageal carcinoma. twenty-three patients suffered form NSCLC and 41 patients from esophageal carcinoma, the prescription doses were 60 Gy/30fx and 58 -64 Gy/29 -32fx, respectively. Results For patients with esophageal carcinoma, 34% developed RP(9 grade 1,3 grade 2 and 2 grade 3). For patients with NSCLC, 96% developed RP(9 grade 1, 8 grade 2 and 5 grade 3). There was significant difference between the two groups(t =5. 55,P=0. 000). The FEV1.0/FVC and DLCO of patients with NSCLC were significantly lower than those of esophageal carcinoma, the ratio were 75.6%:82.7%(t=2.75,P=0.008)and 71.7%:81.0%(t=2.50, P=0.015),respectively. For patients whose FEV1.0, FEV1.0/FVC%, DLCO ＜80% and ≥80% before irradiation,the incidence of ≥2grade ARP were 35% vs 25% ,31% vs 26% and 35% vs 19%, respectively(x2 = 1.81,0.15,2. 13,P =0.179,0.697,0.144). While for patients whose FEV1.0 ＜ 70% and ≥70%, the incidence of severe ARP were 67% and 22% ,respectively(x2 =5.64, P =0.018). Spearman correlated analysis indicated that all the dosimetric parameters had relation with ≥ 2 grade ARP . The V20 of lung and MLD were found independently associated with RP according to multivariate analysis(x2 = 4.61,6.97, P = 0.032,0.008).Conclusions Parameters of basic lung function can predict the incidence of ≥2 grade RP to some extent,especially when the value of FEV1.0, FEV1.0/FVC%, and DLCO was lower. However, the V20 of lung and MLD may be the most valuable predictors.